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IJE Advance Access published online on November 18, 2005
International Journal of Epidemiology, doi:10.1093/ije/dyi222
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Published by Oxford University Press 2005
Accepted September 29, 2005

Original paper

Measles outbreak in the Republic of the Marshall Islands, 2003

Terri B. Hyde 1 *, Gustavo H. Dayan 2, Justina R. Langidrik 3, Robin Nandy 4, Russell Edwards 5, Kennar Briand 3, Mailynn Konelios 3, Mona Marin 6, Huong Q. Nguyen 2, Anthony P. Khalifah 7, Michael J. O'Leary 8, Nobia J. Williams 5, William J. Bellini 8, Daoling Bi 2, Cedric J. Brown 2, Jane F. Seward 2, and Mark J. Papania 2

1 Viral Vaccine Preventable Diseases Branch, National Immunization Program (NIP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; Respiratory and Enteric Virus Branch, National Center for Infectious Diseases, CDC, Atlanta, GA, USA
2 Viral Vaccine Preventable Diseases Branch, National Immunization Program (NIP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
3 Ministry of Health, Republic of the Marshall Islands, USA
4 Global Measles Branch, NIP, CDC, Atlanta, GA, USA; Epidemic Intelligence Service, Epidemiology Programs Office, CDC, Atlanta, GA, USA
5 Respiratory and Enteric Virus Branch, National Center for Infectious Diseases, CDC, Atlanta, GA, USA
6 Viral Vaccine Preventable Diseases Branch, National Immunization Program (NIP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; Epidemic Intelligence Service, Epidemiology Programs Office, CDC, Atlanta, GA, USA
7 Epidemic Intelligence Service, Epidemiology Programs Office, CDC, Atlanta, GA, USA
8 Office of Global Health, National Center for Infectious Disease, CDC, Guam, USA

* To whom correspondence should be addressed.
Terri B. Hyde, E-mail: thyde{at}cdc.gov


  Abstract

Background Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (≥95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000.

Methods RMI is a Pacific island nation (1999 population: 50 840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control.

Results Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged ≥15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years.

Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. ‘Islands’ of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.

Keywords: Measles; measles vaccine; MMR; vaccination campaign.
This work was presented in part at the 38th National Immunization Conference, May 11-14, 2004, Nashville, Tennessee (Workshop Session C8) and the Pediatric Academic Society Meeting, May 14-17, 2005, Washington DC (Abstract 735).
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