American Journal of Epidemiology Vol. 132, No. 1: 157-168
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health
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A SCHOOL-BASED MEASLES OUTBREAK: THE EFFECT OF A SELECTIVE REVACCINATION POLICY AND RISK FACTORS FOR VACCINE FAILURE
1Division of Immunization, Center for Prevention Services, Centers for Disease Control Atlanta, GA 30333
2Dartmouth-Hitchcock Medical Center Hanover, NH
3New Mexico Health and Environment Department Santa Fe, NM
4Albuquerque Public Schools Albuquerque, NM
Reprint requests to Technical Information Services, Center for Prevention Services, Centers for Disease Control, 1600 Clifton Road NE, Atlanta, GA 30333
Persons who received measles vaccine between 12 and 14 months of age have been found to be at increased risk of measles compared with those vaccinated at 
15 months of age. Because of this, in 1987 the Immunization Practices Advisory Committee of the US Public Health Service recommended that, during measles outbreaks, revaccination of persons vaccinated at 12–14 months of age be considered. During a school-based outbreak in New Mexico in 1987, the authors evaluated the effect of a mandatory revaccination policy in affected schools. Before the effect of revaccination, the overall attack rate in persons vaccinated at 12 months of age was 4.1 cases/1,000 students; afterward, the risk was significantly reduced by 73%, to 1.1/1,000 students. The attack rate among students targeted for revaccination declined 100%, compared with 41% among those not revaccinated. Overall, attack rates were significantly lower in schools conducting revaccination early compared with schools holding later revaccination. In a retrospective cohort study of single-dose vaccinees in one school, age at vaccination was not associated with risk of disease; however, persons vaccinated 10 years before the outbreak were at increased risk, independently of age at vaccination. Revaccination of persons whose most recent vaccination was between 12 and 14 months of age appeared to control transmission in this outbreak. Further studies are needed to confirm these observations and to evaluate the effect of other revaccination efforts during outbreaks.
measles; measles vaccine; vaccination; vaccines
*Deceased.
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