{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:58:06Z","timestamp":1768816686389,"version":"3.49.0"},"reference-count":21,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,10,1]]},"abstract":"\n Objective.<\/jats:title>\n To identify reservoirs ofHaemophilus influenzae type b (Hib) pharyngeal carriage and assess barriers to vaccination among 2 Amish communities in Pennsylvania.<\/jats:p>\n <\/jats:sec>\n \n Methods.<\/jats:title>\n We investigated recent cases, performed community surveys for Hib vaccination coverage and pharyngeal carriage, and administered a questionnaire assessing vaccination knowledge and attitudes to 298 members of 2 Amish communities (A and B) in Pennsylvania and, as a comparison group, 136 non-Amish family members who participated in state immunization clinics. From December 1999 to February 2000, 8 cases of invasive Hib disease occurred among children who were 5 years of age or younger in Pennsylvania. Six of the case-patients were from Amish communities. None of the children had been vaccinated.<\/jats:p>\n <\/jats:sec>\n \n Results.<\/jats:title>\n Among children who were 5 years of age or younger, Hib vaccine coverage was low in the 2 Amish communities: A (9 [28%] of 32) and B (3 [7%] of 41) compared with the non-Amish group (19 [95%] of 20). Hib carriage prevalence was higher in both Amish communities than in the non-Amish group (A: 3%; B: 8%; non-Amish: 0%). More households in community B had 1 or more Hib carriers than in community A (8 [28%] of 29 vs 3 [9%] of 32). Among Amish parents who did not vaccinate their children, only 25% (13 of 51) identified either religious or philosophical objections as a factor; 51% (26 of 51) reported that vaccinating was not a priority compared with other activities of daily life. Seventy-three percent (36 of 49) would vaccinate their children if vaccination were offered locally.<\/jats:p>\n <\/jats:sec>\n \n Conclusions.<\/jats:title>\n Undervaccinated communities in the United States still exist and allow circulation of Hib strains, resulting in disease among susceptible children. Identification of undervaccinated populations, such as the Amish, and targeted education and vaccination campaigns are essential to achieving elimination of Hib disease.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.108.4.e60","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:55:51Z","timestamp":1092441351000},"page":"e60-e60","source":"Crossref","is-referenced-by-count":33,"title":["Haemophilus influenzae<\/i> Type b Disease Among Amish Children in Pennsylvania: Reasons for Persistent Disease"],"prefix":"10.1542","volume":"108","author":[{"given":"Alicia M.","family":"Fry","sequence":"first","affiliation":[{"name":"From the Respiratory Diseases Branch and"},{"name":"Epidemic Intelligence Service,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Perrianne","family":"Lurie","sequence":"additional","affiliation":[{"name":"Pennsylvania Department of Health, Harrisburg, Pennsylvania."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maribeth","family":"Gidley","sequence":"additional","affiliation":[{"name":"Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; and the"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanna","family":"Schmink","sequence":"additional","affiliation":[{"name":"Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jairam","family":"Lingappa","sequence":"additional","affiliation":[{"name":"Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and"},{"name":"Epidemic Intelligence Service,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Fischer","sequence":"additional","affiliation":[{"name":"Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy E.","family":"Rosenstein","sequence":"additional","affiliation":[{"name":"Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2001,10,1]]},"reference":[{"key":"2021120819162381800_B1"},{"key":"2021120819162381800_B2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1001\/jama.1993.03500020055031","article-title":"Decline of childhoodHaemophilus influenzae type b disease in the Hib vaccine era.","volume":"269","author":"Adams","year":"1993","journal-title":"JAMA"},{"key":"2021120819162381800_B3","doi-asserted-by":"crossref","first-page":"176","DOI":"10.3201\/eid0203.960303","article-title":"Conjugate vaccines and the carriage of Haemophilus influenzae type b.","volume":"2","author":"Barbour","year":"1996","journal-title":"Emerg Infect Dis J"},{"key":"2021120819162381800_B4","doi-asserted-by":"crossref","first-page":"S132","DOI":"10.1097\/00006454-199809001-00008","article-title":"Epidemiology of Haemophilus influenzae type b disease and impact of Haemophilus influenzae type b conjugate vaccines in the United States and Canada.","volume":"17","author":"Wenger","year":"1998","journal-title":"Pediatr Infect Dis J"},{"key":"2021120819162381800_B5"},{"key":"2021120819162381800_B6"},{"key":"2021120819162381800_B7","doi-asserted-by":"crossref","first-page":"364","DOI":"10.2105\/AJPH.89.3.364","article-title":"Efficacy ofHaemophilus influenzae type b conjugate vaccines and persistence of disease in disadvantaged populations. TheHaemophilus influenzae Study Group.","volume":"89","author":"Jafari","year":"1999","journal-title":"Am J Public Health"},{"key":"2021120819162381800_B8","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1097\/00006454-199211110-00010","article-title":"Rubella among the Amish: resurgent disease in a highly susceptible community.","volume":"11","author":"Briss","year":"1992","journal-title":"Pediatr Infect Dis J"},{"key":"2021120819162381800_B9","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/infdis\/163.1.12","article-title":"Measles among the Amish: a comparative study of measles severity in primary and secondary cases in households.","volume":"163","author":"Sutter","year":"1991","journal-title":"J Infect Dis"},{"key":"2021120819162381800_B10","first-page":"436","article-title":"An epidemiologic investigation of a rubella outbreak among the Amish of Northeastern Ohio.","volume":"108","author":"Jackson","year":"1993","journal-title":"Public Health Rep"},{"key":"2021120819162381800_B11"},{"key":"2021120819162381800_B12","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1001\/jama.282.1.47","article-title":"Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risks of measles.","volume":"282","author":"Salmon","year":"1999","journal-title":"JAMA"},{"key":"2021120819162381800_B13","doi-asserted-by":"crossref","first-page":"3171","DOI":"10.1001\/jama.284.24.3171","article-title":"State mandates and childhood immunization.","volume":"284","author":"Edwards","year":"2000","journal-title":"JAMA"},{"key":"2021120819162381800_B14"},{"key":"2021120819162381800_B15","first-page":"151","article-title":"A comparison of the perceived health needs of Amish and non-Amish families in Cashton, Wisconsin.","volume":"95","author":"Dickinson","year":"1996","journal-title":"Wis Med J"},{"key":"2021120819162381800_B16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1128\/JCM.39.1.75-85.2001","article-title":"Evaluation of PFGE in epidemiological investigations of meningococcal disease outbreaks caused by Neisseria meningitidis serogroup C.","volume":"39","author":"Popovic","year":"2001","journal-title":"J Clin Microbiol"},{"key":"2021120819162381800_B17"},{"key":"2021120819162381800_B18","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1203\/00006450-197505000-00010","article-title":"Use of antiserum agar for detection ofHaemophilus influenzae type b in the pharynx.","volume":"9","author":"Michaels","year":"1975","journal-title":"Pediatr Res"},{"key":"2021120819162381800_B19"},{"key":"2021120819162381800_B20"},{"key":"2021120819162381800_B21"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/108\/4\/e60\/894922\/pe1001000ji1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/108\/4\/e60\/894922\/pe1001000ji1.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T20:00:26Z","timestamp":1638993626000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/108\/4\/e60\/67317\/Haemophilus-influenzae-Type-b-Disease-Among-Amish"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,10,1]]},"references-count":21,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2001,10,1]]},"published-print":{"date-parts":[[2001,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.108.4.e60","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[2001,10,1]]}}}