Abstract
OBJECTIVES: Although measles has not been endemic in the U.S. since 1997 due to high vaccination coverage, recent U.S. measles outbreaks have been associated with individuals and groups who have refused vaccination for philosophical, cultural, or religious reasons. One such outbreak occurred in Indiana among a group of church members in May and June of 2005. Our objectives were to: (1) determine attitudes and beliefs of church leaders and members regarding vaccinations and the outbreak experience, (2) describe reasons for vaccine acceptance and nonacceptance, and (3) assess the feasibility of a knowledge and attitudes study in the context of a vaccine-preventable disease outbreak. METHODS: We conducted a focus group with church leaders and families and held 12 structured household interviews with church members directly and indirectly involved in the outbreaks. RESULTS: A combination of safety concerns, personal experience, and religious beliefs contributed to vaccination refusal among a subgroup of church members. While the experience with measles disease did not necessarily translate into a more positive perception of vaccines, most families that refused vaccination would accept some future vaccines under unique circumstances, such as disease presence in the community or if vaccination could be delayed until a child was older. CONCLUSIONS: Lessons learned from this outbreak experience can inform future outbreak investigations elsewhere. Maintaining open communication with parents who refuse immunizations, as well as working with their trusted social networks, can help public health professionals facilitate alternative means of disease control during a vaccine-preventable disease outbreak in the community.