In the late winter of 1988, pediatricians in big cities around the country started reporting large increases in the numbers of patients they saw with diffuse red rashes and high fevers (greater than 101°F). The rash, usually extending downward from the hairline to the rest of the body, began after a two-week incubation period. The spots were often so close together that the entire involved area appeared red. Sometimes the skin in such an area peeled after a few days. The rash lasted five to six days. Many of the children also suffered from diarrhea.
The age group most affected was preschoolers. This was a change in epidemiology for this infection, as previously the disease most often struck school-age children. A vaccine had been introduced for this disease in 1963, and since the only 5,000-6,000 cases a year had been reported in the United States. 18, 193 cases were reported in 1989. In 1990 the epidemic peaked with almost 28,000 cases reported in the US. By 2002, the incidence in this country had fallen and was again in the range of 5,000-6,000 cases a year.
- What was this resurgent infection?
- What are some possible reasons for the epidemic in 1989-1991?
- What is herd immunity? Discuss it in relation to this outbreak.
- What is the schedule for vaccination for this infection in the United States?
- Are serious sequelae associated with this infection? If so, what are they?
- How do you think outbreaks such as this one can be avoided? Do you feel childhood vaccination should be regulated differently in the United States?