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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.


  1. CDC. Increase in rubella and congenital rubella syndrome--United States, 1988-1990. MMWR 1991;40:93-9.

  2. 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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