This was done to prevent the spread of measles to another day care center. A meeting was held with one of the general practitioners with an anthroposophic practice. He could agree on selleck chemicals llc the necessity to vaccinate adolescent boys and girls. Mostly because of the severity of measles at an adolescent or older age but also to avoid rubella infection during pregnancy. Other healthcare professionals and some parents did prove more resilient against vaccination. For example: during the immunization campaign we noticed that some leaflets linking MMR-vaccination to autism and allergies were distributed together with our consent forms. The high percentage of parents that stated that not vaccinating their children is a personal choice is another example of resistance against vaccination.

Discussion Measles in infants The largely undiagnosed spread of measles in a day care center is one of the most important observations in this outbreak. A high attack rate in six to twelve months old infants has previously been described in other outbreaks [18,19]. In this outbreak measles infection in infants was associated with a high morbidity; the hospitalisation of eight infants during or shortly prior to the outbreak investigation was probably due to measles. Elevated IgG levels were found in the oral fluid of 11 infants. In six infants this was not accompanied with elevated IgM levels. These samples were taken during the outbreak investigation, three up to six weeks after the symptoms had subsided. IgG levels indicate either prior infection or persisting maternal antibodies.

The latter is highly unlikely for children aged six months and older. At the age of six months 99% of infants of vaccinated mothers are vulnerable. This percentage is slightly lower, 95%, for infants of naturally immune mothers [19,20]. The elevated IgG levels are thus more likely to indicate a previous measles infection. In one of the samples still available from a hospitalisation mid-February we found measles IgM. Both the IgM and the IgG confirm that measles was present in the day care center before the first notification. Measles has been quite rare in Belgium for several years and clinicians failed to diagnose it. Other, more common, diseases, such as exanthema subitum, viral rash (of unknown origin) or stomatitis, were placed higher in the differential diagnosis.

This is an important issue since health care associated spread is not uncommon. Different outbreak reports have already described how measles spreads in consultation rooms and emergency GSK-3 departments [21-24]. Anthroposophic views The European Council for Steiner Waldorf schools does not disapprove of vaccination, stating that ��families provide the proper context for such decisions�� [25]. These schools are however internationally known for their low vaccination coverage. In the United Kingdom they are categorized by the Health Protection Agency as ��unvaccinated community�� [26].