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Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016.

ABSTRACT: BACKGROUND:We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. METHODS:Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. RESULTS:We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. CONCLUSIONS:Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.

SUBMITTER: Venkat H

PROVIDER: S-EPMC6435422 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016.

Venkat Heather H Briggs Graham G Brady Shane S Komatsu Ken K Hill Clancey C Leung Jessica J Patel Manisha M Livar Eugene E Su Chia-Ping CP Kassem Ahmed A Sowers Sun B SB Mercader Sara S Rota Paul A PA Elson Diana D Timme Evan E Robinson Susan S Fitzpatrick Kathryn K Franco Jabette J Hickman Carole C Gastañaduy Paul A PA

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20190501 12

<h4>Background</h4>We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016.<h4>Methods</h4>Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles ...[more]

PMID: 30256908

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Project description:BackgroundOn 12 October, 2016 a measles outbreak was reported in Mayuge District, eastern Uganda. We investigated the outbreak to determine its scope, identify risk factors for transmission, evaluate vaccination coverage and vaccine effectiveness, and recommend evidence-based control measures.MethodsWe defined a probable case as onset of fever (≥3 days) and generalized rash, plus ≥1 of the following: conjunctivitis, cough, and/or runny nose in a Mayuge District resident. A confirmed case was a probable case with measles-specific IgM (+) not explained by vaccination. We reviewed medical records and conducted active community case-finding. In a case-control investigation involving probable case-persons and controls matched by age and village, we evaluated risk factors for transmission for both cases and controls during the case-person's likely exposure period (i.e., 7-21 days prior to rash onset). We estimated vaccine effectiveness (VE) using the formula: VE ≈ (1-ORprotective) × 100. We calculated vaccination coverage using the percentage of controls vaccinated.ResultsWe identified 62 probable case-persons (attack rate [AR] = 4.0/10,000), including 3 confirmed. Of all age groups, children < 5 years were the most affected (AR = 14/10,000). The epidemic curve showed a propagated outbreak. Thirty-two percent (13/41) of case-persons and 13% (21/161) of control-persons visited water-collection sites (by themselves or with parents) during the case-persons' likely exposure period (ORM-H = 5.0; 95% CI = 1.5-17). Among children aged 9-59 months, the effectiveness of the single-dose measles vaccine was 75% (95% CI = 25-92); vaccination coverage was 68% (95% CI = 61-76).ConclusionsLow vaccine effectiveness, inadequate vaccination coverage and congregation at water collection points facilitated measles transmission in this outbreak. We recommended increasing measles vaccination coverage and restriction of children with signs and symptoms of measles from accessing public gatherings.

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Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016.

Publications

Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016.

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