Teen Carried Measles Back From Romania
Unvaccinated Kids at Teen's Church Caught Up in Indiana Outbreak
August 2, 2006 - The country's largest measles outbreak in a
decade was sparked when an unvaccinated teenager returned from a mission trip
to Romania and attended a single church gathering with other unvaccinated
Of the 34 people who became sick during the 2005 outbreak: 33 were members
of the same northwest Indiana church, 32 had not been vaccinated against
measles, and 28 were school-aged. Of the 28 school-aged children, 20 were
The parents of most of the children who got sick said they had refused
measles vaccination for their children because of fears about vaccine
Containing the Outbreak
The experience shows that outbreaks of vaccine-preventable diseases can
easily occur among relatively small numbers of unvaccinated people, says Amy A.
Parker, MSN, of the CDC.
It also illustrates the importance of maintaining high vaccination levels.
The outbreak did not spread beyond the church to the community at-large, where
measles immunization coverage approached 98% in school-aged children.
"The outbreak stayed fairly well contained within the unvaccinated
population," Parker tells WebMD. "Vaccination coverage rates are very
high in Indiana and throughout the U.S., primarily because of school policies
[requiring proof of vaccination for school entry]."
Parker and CDC colleagues published their detailed investigation of the
Indiana church outbreak in the Aug. 3 issue of The New England Journal of
Measles was officially declared eliminated from the U.S. in 2000.
But it remains a major illness in most of the rest of the world, with 30
million measles infections and 454,000 deaths from the disease each year,
according to the World Health Organization.
Teen Unaware She Had Measles
In mid-May 2005, an unvaccinated 17-year-old Indiana girl returned from a
church mission trip, where she worked in a Romanian orphanage. She unknowingly
became infected with measles during the trip, and had symptoms of the disease
when she attended a large church gathering the day after she arrived home.
Around 500 people attended the church function, and roughly 50 did not have
evidence of measles immunity.
During the six weeks in which the measles outbreak raged within the church,
33 church members -- mostly children and teens -- became ill. In all but one of
those cases, the victims had not been vaccinated against the disease.
The single measles case that did not involve a member of the church occurred
in a 34-year-old health care worker at a hospital where two church cases were
The woman had been vaccinated as a young child, but may have received only
one dose of vaccine instead of the recommended two.
Parents Cite Vaccine Safety Fears
CDC researchers interviewed church members who had declined vaccinations for
Many cited press reports suggesting a link between measles vaccine and autism as
a reason for their refusal.
"Most families with these concerns continued to decline vaccination,
even in the midst of an outbreak involving hospitalizations among their own
community members," the CDC researchers reported.
The fact that 20 of the 33 church-related illnesses occurred among
homeschooled children illustrates the importance of promoting immunization
among that group, Parker says.
Proof of measles vaccination is required for children entering school, but
West Virginia is the only state in the U.S. with a similar requirement for
In an editorial accompanying the CDC report, infectious disease specialist
E. Kim Mulholland, MD, noted that the Indiana outbreak shows the importance of
vaccinating everyone who travels to regions where measles is still an endemic
Mulholland is a professor in the infectious disease epidemiology unit of the
London School of Hygiene & Tropical Medicine.
He tells WebMD the outbreak also shows how vulnerable communities can be
when vaccination rates are lower than they should be.
"I am not convinced that parents who choose not to vaccinate their
children really understand all the risks and implications that go along with
that decision," he says.