Outbreak of measles among Christian Science students - Missouri and Illinois, 1994

Morbidity and Mortality Weekly Report, July 1, 1994

Although Christian Science doctrine does not forbid medical care, many Christian Science parents claim religious exemption from childhood vaccination requirements. Vaccination is accepted by some members, particularly when the consequences of illness are considered less acceptable. During this outbreak, many Christian Science students accepted vaccination to attend school. However, individual decisions to be vaccinated may not be made until an outbreak is established and its potential impact becomes apparent.

During measles outbreaks in educational institutions, revaccination with MMR is recommended (4). If measles vaccine is administered within 72 hours of exposure, it may prevent or modify illness (4). The 41% postexposure vaccine failure rate in this outbreak underscores the need for a sensitive and timely measles surveillance system to identify cases promptly and to administer vaccine as early as possible. Persons vaccinated more than 72 hours postexposure may develop infection and contribute to further spread of measles.

Factors that may have contributed to limiting this outbreak include the self-imposed isolation of persons with and those susceptible to measles in the Christian Science community, high vaccination levels for one dose of measles vaccine among Missouri students and two doses among Illinois students, cooperation from private physicians in providing a second dose of measles vaccine to school-aged children both before and during the outbreak, and media coverage of the outbreak encouraging parents to obtain a second dose of measles vaccine for their children.

The findings in this report illustrate that transmission of measles can be prevented or minimized by 1) maintaining high vaccination levels in the general population, 2) conducting active surveillance in populations that do not routinely accept vaccination, and 3) initiating aggressive control efforts during an outbreak. Public health officials should emphasize in communities that do not routinely accept vaccination the importance of vaccination, active surveillance, and timely reporting of contagious diseases to the public health department.

References

(1.)CDC. Case definitions for public health surveillance. MMWR 1990;39(no. RR-13):23.

(2.)Novotny T, Jennings CE, Doran M, et al. Measles outbreaks in religious groups exempt from immunization laws. Public Health Rep 1988;103:49-54.

(3.)Rodgers DV, Gindler SS, Atkinson WL, Markowitz LE. High attack rates and case fatality during a measles outbreak with religious exemption to vaccination. Pediatr Infect Dis 1993;12:288-92.

(4.)CDC. Measles prevention: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1989;38(no. SS-9):7.