The recent federally sponsored objective of achieving immunization levels of at least 90% in US children by 19791 is predicated on the assumption that all links in the chain of immunization recordkeeping are appropriately maintained, honestly evaluated, and fully reported. I report here an epidemic that demonstrates how these records can break down at two levels of reporting: the physician's office and the school.
Report of a Case. In February 1978, the Livingston County Health Department, Howell, Mich, received a school-initiated report that an open classroom elementary school with an enrollment of 512 students had eight cases of measles. The index case, an 8-year-old second-grader, was identified. We were unable to determine the index case's initial exposure; however, the potential for exposure was high as during this time in Michigan there were numerous outbreaks of measles in different communities around the state, including a large outbreak at one of