Epidemiologic Notes and Reports
Outbreaks of Rubella Among the Amish -- United States, 1991
From January 1 through April 19, 1991, at least nine
outbreaks of rubella, involving more than 400 cases, have been
reported in Amish communities in the United States. These
outbreaks have been reported from Mecosta and Montcalm counties,
Michigan; Allegany, Cattaraugus, Chautauqua, and St. Lawrence
counties, New York; Geauga, Knox, and Trumbull counties, Ohio;
and Lawrence County, Tennessee. In addition, serologically
confirmed cases of rubella have been reported from Amish
communities in six Pennsylvania counties, suggesting widespread
rubella activity among the Amish in Pennsylvania. In general,
cases have occurred among unvaccinated children and young
adults.
In 1990, three linked outbreaks causing an estimated 171
cases occurred in Amish communities in Minnesota, New York, and
Ohio. No cases of congenital rubella syndrome (CRS) associated
with these outbreaks have been reported. However, during 1990,
rubella outbreaks not involving Amish communities occurred among
unvaccinated adolescents and adults in the western United States
(1); as a result, for 1990, at least 16 confirmed or compatible
indigenous CRS cases and six additional provisional cases
occurred and have been reported to the National Congenital
Rubella Syndrome Registry.
Reported by: KR Wilcox, Jr, MD, State Epidemiologist, Michigan
Dept of Public Health. GS Birkhead, MD, G Koops, S Thompson, DL
Morse, MD, State Epidemiologist, New York State Dept of Health.
TJ Halpin, MD, State Epidemiologist, Ohio Dept of Health. DR
Tavris, MD, State Epidemiologist, Pennsylvania Dept of Health. R
Hutcheson, MD, State Epidemiologist, Tennessee Dept of Health.
Div of Immunization, Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: Because interstate and intrastate travel to
other Amish communities is common among the Amish population,
state and local health departments and clinicians should be
alerted to the risk for local outbreaks of rubella among Amish
communities. Many rubella infections cause only mild illness;
therefore, outbreaks may remain unreported unless active
surveillance for cases is conducted. In addition, active
surveillance should be conducted for cases of CRS that may
result from large outbreaks of rubella. Amish communities should
be alerted to the risk for rubella outbreaks; the consequences
of rubella infection during the first trimester of pregnancy;
and the importance of increasing vaccination levels in their
communities, especially among women of childbearing age and
children.
During the past 5 years, outbreaks of other
vaccine-preventable diseases, such as measles (2) and pertussis,
have been reported from Amish communities. Although vaccination
coverage among the Amish is low, some health departments report
that, with vigorous effort, many Amish will accept vaccination.
Health-care providers are encouraged to report rubella cases
to local and state health departments. State health departments
are requested to report rubella outbreaks and suspected cases of
CRS to the Surveillance, Investigations, and Research Branch,
Division of Immunization, Center for Prevention Services, CDC,
Mailstop E-05, 1600 Clifton Road, NE, Atlanta, GA 30333;
telephone (404) 639-1870.
References
CDC. Increase in rubella and congenital rubella
syndrome--United States, 1988-1990. MMWR 1991;40:93-9.
Sutter RW, Markowitz SE, Bennetch JM, Morris W, Zell ER,
Preblud SR. Measles among the Amish: a comparative study of
measles severity in primary and secondary cases in households. J
Infect Dis 1991;163:12-6.
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