Consequences of Undervaccination - Measles Outbreak, New York City, 2018-2019

BACKGROUND

Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home.

METHODS

We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated.

RESULTS

A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million.

CONCLUSIONS

Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.

Knowledge and practice of mothers/care-takers towards diarrhoea and its treatment in rural communities in Ethiopia

Diarrhoeal diseases are major causes of childhood morbidity and mortality in developing countries. Knowledge and practices of mothers or other care-takers of children are important determinants of the occurrence or outcome of diarrhoeal diseases. Base-line information on these variables is also needed for developing health education programmes and for formulating national policy on home fluid therapy. This study was conducted with the objectives of assessing the knowledge and practice of mothers and other caretakers of children towards diarrhoeal diseases and the sociodemographic correlates of adequate knowledge and practice. A study was conducted in the rural North, South, East and West Shewa Administrative Regions in April, 1990. A two-stage cluster sampling proportionate to size was used to select a total of 750 mothers or other caretakers. These were interviewed by trained and supervised health workers who used a pretested questionnaire. The three major ethnic groups were Oromo, Guragie and Hadya. Of the total respondents, 79.3% were illiterate, 78.5% got their water from unprotected sources, 88.9% had no latrines, 80.4% had no access to mass media and 7.1% spent more than 2 hours to reach to the nearest health facilities. Only 2.6% and 5.7% of mothers had adequate knowledge and practice on diarrhoea or its treatment, respectively. Age and educational level of mothers or other caretakers were found to be positively associated with adequate knowledge and practice towards diarrhoea and its treatment. The study clearly indicated that health education messages have not been effectively disseminated to the rural population. It is, therefore, strongly recommended that the Diarrhoeal Diseases Control Programme strengthens its communication activities through increasing persuasion of health workers who could serve as effective means of reaching the population who have access to health services.

Patterns of breast feeding in western Ethiopia and their relationship to acute diarrhoea in infants

To determine the extent of protection from breast feeding against acute diarrhoea, a cross-sectional study was conducted in rural areas in a western region of Ethiopia, Gamo-Gofa. The standard cluster sampling technique promoted by WHO/CDD Program was used. We employed trained and supervised health workers (physicians nurses, and sanitarians) as interviewers, and a pretested questionnaire was utilized for the purpose. Among a total of 3002 children under the age of 5 years surveyed for diarrhoeal disease morbidity, mortality, and treatment rates, all those 6 months of age and less (n = 331) were taken as subjects to examine the trends of breast feeding and their association with the occurrence of acute diarrhoeal diseases. It was found that out of these 331 infants, 217 (66 per cent) were exclusively breast-fed and 114 (34 per cent) were partially breast-fed. No one in the study group was fully weaned. Out of those who were exclusively breast-fed (n = 217), 25 (12 per cent) had diarrhoea which started within the past 2 weeks of the survey. Among those partially breast-fed (n = 114), 46 (40 per cent) had diarrhoea. The difference in the occurrence of diarrhoea among exclusively and partially breast-fed infants was statistically significant (P less than 0.0001). When infants with partial breast feeding were contrasted with those on exclusive breast feeding, a relative risk of developing diarrhoea of 5.2 (95 per cent confidence interval 3.00, 9.10) was obtained. It is recommended that breast feeding which tends to diminish with urbanization be promoted as one important intervention of the control of diarrhoeal diseases.