Evaluation of low immunization coverage among the Amish population in rural Ohio.

BACKGROUND: The Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Review included childhood immunizations among the 10 great public health achievements in the United States in the 20th century. Despite this acknowledged success, childhood immunization rates continue to be much lower in select populations. Amish communities have persistently lower immunization rates. Recent outbreaks in Amish communities include a 2014 measles outbreak in Ohio, resulting in 368 cases reported. A recent outbreak of pertussis in an Amish community in Ohio resulted in the death of a 6-week-old Amish baby. METHODS: A study was designed to determine the knowledge, beliefs, attitudes, and opinions of Amish parents relative to the immunization of Amish children. Data were collected through a questionnaire. Each potential participant was mailed a copy of a letter describing the proposed study. The questionnaire, a copy of the current immunization schedule, and a return stamped envelope were also included in the mailed packet. The study sample consisted of 84 Amish individuals who voluntarily filled out and returned questionnaires. RESULTS: The findings from the data analysis demonstrated that fear, especially concern over too many recommended immunizations and immunizations overwhelming the child's system, was the most frequent reported reasons for not having children immunized according to recommendations. CONCLUSIONS: Religious factors and access to care were not among reasons most reported. Designing an educational campaign for educating Amish parents on the risks and benefits of immunizations with focus on specific concerns may improve immunization rates.

Contact investigation of a case of active tuberculosis in the community.

BACKGROUND: Ashtabula County, Ohio, has been a low-risk county for tuberculosis (TB) based on the Centers for Disease Control and Prevention guidelines. The Ashtabula County TB clinic is provided through the Ashtabula County Health Department. Over the past 10 years, there has been an annual average of one to 2 active cases of TB seen and treated at the county TB clinic. CONTACT INVESTIGATION: In 2005, over a period of 3 months there were 6 cases of active TB identified in Ashtabula County. Contact investigation and follow-up were complicated by the fact that the suspected source case likely had active disease for more than 4 years and had some medical procedures performed at health care facilities in another county. This person was unaware of having TB and was identified through contact investigation by the county health department staff and sent for testing. The investigation was complicated further because the index case did not reveal contact with the suspected source case, although this was confirmed later through investigation. Contact investigation involved Ashtabula County and notification of other counties in Ohio. The Ohio Department of Health also was notified. DISCUSSION: Following identification of each case of active TB, contacts were identified through interviews with the clients, physicians, and health care facilities where clients were treated. Initially in Ashtabula County, 97 people were reviewed for follow-up, and 87 people were skin tested for TB. There were 7 conversions. CONCLUSION: Although the overall incidence of TB has declined in the United States, increased awareness of TB, appropriate diagnostic work-up, treatment, and control measures among health care professionals in low-incidence areas is increasingly important. Contact investigation of a case of TB requires diligence and effective communication.