Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Evaluation of Measles Vaccine Effectiveness in a Community Outbreak

지역사회 유행을 통하여 평가한 홍역 예방접종의 효과

  • Park, Byung-Chan (Department of Preventive Medicine, College of Medicine, Dongguk University) ;
  • Park, Sue-Kyung (Department of Preventive Medicine, College of Medicine, Dongguk University) ;
  • Cheong, Hae-Kwan (Department of Preventive Medicine, College of Medicine, Dongguk University)
  • 박병찬 (동국대학교 의과대학 예방의학교실) ;
  • 박수경 (동국대학교 의과대학 예방의학교실) ;
  • 정해관 (동국대학교 의과대학 예방의학교실)
  • Published : 2002.03.01
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Abstract

Objective : From an analysis of a community outbreak of measles in Youngju, Gyeongbuk, in March 2000, the authors evaluated the effectiveness of the measles vaccination and its determinants to Provide an epidemiologic basis for the establishment of a vaccination policy. Methods : Information was collected regarding the vaccinations from the health records of four primary schools and through a questionnaire surrey of the parents of students in two middle and two high schools (N=4638). Measles cases were surveyed from the patient list of each school and from case reports in the public health center. The attack rate and vaccine effectiveness of measles was evaluated by school; grade; frequency, region, and institution of vaccination. Results : The attack rate cf measles, 6.3% among the total subjects, was higher in middle school students (15.8%) than in primary (2.0%, p<0.05) and high school students (8.9%, p<0.05). The attack rate of the unvaccinated group was 4.6-fold higher than the vaccinated group in primary schools (p<0.05). Vaccine effectiveness was 83.2% among lower graders of primary schools, 34.0% among higher graders of primary schools,26.1% in middle schools, and -7.0% in high schools. In multiple logistic regression analysis, grade in school (odds ratio, 0.77; 95% CI=0.67-0.87) and frequency of vaccination (odds ratio, 0.57: 95% CI=0.37-0.58) were significant predictors of the outcome. Conclusions : We concluded that the explosive outbreak of measles in this area resulted from both inadequate vaccination coverage and secondary failure of vaccination. There was no evidence of any effect of the cold chain system on the vaccine failure.

Keywords

References

  1. 홍창의. 소아과학 제6판，대한 교과서 주식회사，서울，1997 pp. 408-10
  2. National Institute of Health. CDMR. Apr 2001; 12(4): 13-17 (Korean)
  3. 중앙역학조사반. 영주시 홍역 유행 역학조사최종보고서，2000
  4. WHO. Guidelines for Epidemic Prepare-dness and Response to Measles Outbre-aks, Geneva, Switzerland, 1999
  5. Krugman RD, Meye BC, Enterline JC, Parkman RD, Witte JJ, Meyer HM. Im-potency of livevirus vaccine as a result of improper handling in clinical practice. J Pediatr 1974; 85: 512-514 https://doi.org/10.1016/S0022-3476(74)80455-5
  6. Garenne M, Leroy O, Beau JP, Sene I. Efficacy of measles vaccine after contro-lling for exposure. Am I Epidemiol 1993; 138: 182-195
  7. Shin YK, Yoon JK, Choung JT, Tockgo Yc. Changes of measles specific IgG aft-eractive immunization of measles in Korea children. Korean J Pediatr 1996; 39(6): 788-796 (Korean)
  8. Choi SJ, Koh YJ, Sohn YM, Lee HJ, Oh SH. The effect of measles vaccination before turning 1 year-old on the measles antibody response to immunization with MMR. Korean J Pediatr 1998; 41(7):909-916 (Korean)
  9. Park SK, Kim JH, Lee JY, Na BK, Kim WJ, Cheong HK. Comparative epidem-iologic survey of measles in two primaryschools. Korean J Prev Med 2001; 34(2): 131-140 (Korean)
  10. Kenrad EN, Carolyn JW, Meil MH. Inefectious Disease Epidemiology, Aspen publishers, Inc. Gaithersburg, Maryland,2001
  11. Edees S, Pullan CR, Hull D. A random-ized single blind trial of a combined mu-mps measles rubella vaccine to evaluate serological response and reac-tion in the UK population. Public Heath 1991; 105:90-97
  12. King GE, Markowitz LE, Patriarca PA, Dales LG. Clinical efficacy of measles vaccine during the 1990 measles epide-mic. Pediatr Infect Dis J 1991; 10: 883-888 https://doi.org/10.1097/00006454-199112000-00001
  13. Garenne M, Leroy O, Beau JP, Sene I. Efficacy of measles vaccines after con-trolling for exposure. Am I Epidemiol 1993; 138: 182-195 https://doi.org/10.1093/oxfordjournals.aje.a116844
  14. National Institute of Health. CDMR Feb 2001; 12(2): 13-16 (Korean)
  15. Kim SK, Choi. JW, Son BK, Park SN, Chung CY. Epidemiology and vaccine efficacy of measles during the 1993 measles epidemic. Korean I Pediatr 1995; 38(6): 778-785 (Korean)
  16. Cutts FT, Markowitz LE: Successes and failure in measles control. J Infect Dis 1994; 170(Suppl 1):S32-41 https://doi.org/10.1093/infdis/170.Supplement_1.S32
  17. 대한소아과학회 감염위원회. 예방접종지침. 제4판 서울 : 대한 소아과학회，1997 pp.71-91
  18. Choi BY. Epidemiology of measles, mu-mps, rubella. Korean J Pediatr Infect Dis 1997; 4: 14-27 (Korean)
  19. Yi IK, Choi JW, Kim SK, Son BK, Kim JG. Epidemiologic study of measles out-break in school-aged children in East KyongGi-Do area. Korean J Pediatr 1996; 39(1): 63-71 (Korean)
  20. Wyll SA, White JJ. Measles in previo-usly vaccinated children. An epidemiolo-gical study. JAMA 1971; 216: 1306-1310 https://doi.org/10.1001/jama.216.8.1306
  21. Wassilak SCF, Orenstein WA, Strickland PL, Butler CA, Bart KJ. Continuing measles transmission in students despite a school-based outbreak control program. Am J Epidemiol 1985; 122: 208-217 https://doi.org/10.1093/oxfordjournals.aje.a114091
  22. Shasby DM, Shope TC, Downs H, Herr-man HL, Polkwski J. Epidemic measles in a highly vaccinated population. N Engl I Med 1977; 296: 585-589 https://doi.org/10.1056/NEJM197703172961102
  23. Reyes MA, Vorrero MF, Roa J, Bergon-zili G, Saravia NG. Measles vaccine fail-ure after documented seroconversion. Pediatr Infect Dis J 1987; 6: 848-851 https://doi.org/10.1097/00006454-198709000-00012
  24. CDC. Classification of measles cases and categorization of measles elimination programs. CDC MMRW Jan 07, 1983; 31(52): 707-711
  25. 전국 홍역 변역도 조사. 국립보건원， Mar2001
  26. Orenstein WA, Bernier RH, Dondero TJ, Hinman AR, MARK JS, Bart KJ, Sirotkin B. Field evaluation of vaccine efficacy. Bull WHO 1985; 63(6): 1055-1068
  27. Comstock GW. Evaluating vaccination effectiveness and vaccine efficacy by means of case-control studies. Epidemiol Rev 1994; 16(1): 77-89 https://doi.org/10.1093/oxfordjournals.epirev.a036147
  28. Smith PG, Rodrigues LC, Fine PEM. Assessment of the protective efficacy of vaccines against common diseases using case-control and cohort studies. Int J Epidemiol 1984; 13(1): 87-93 https://doi.org/10.1093/ije/13.1.87
  29. Hiton CW, Peter A, Badara S, Henrick J, John B, Francois S. Effect of subclinical infection on maintaining immunity against measles in vaccinated children in West Africa. Lancet, 1999; 353: 98-102 https://doi.org/10.1016/S0140-6736(98)02364-2