Sunday, 9th of January 2011 |
Abstract below; full text is at http://jid.oxfordjournals.org/content/202/10/1520.long
Abstract
Background. Measles affected entire birth cohorts in the prevaccine era but was declared eliminated in the United States in 2000 because of a successful measles vaccination program.
Methods. We reviewed US surveillance data on confirmed measles cases reported to the Centers for Disease Control and Prevention and data on national measles-mumps-rubella (MMR) vaccination coverage during postelimination years 2001–2008.
Results. During 2001–2008, a total of 557 confirmed cases of measles (annual median no. of cases, 56) and 38 outbreaks (annual median no. of outbreaks, 4) were reported in the United States; 232 (42%) of the cases were imported from 44 countries, including European countries. Among case-patients who were US residents, the highest incidences of measles were among infants 6–11 months of age and children 12–15 months of age (3.5 and 2.6 cases/1 million person-years, respectively). From 2001 through 2008, national 1-dose MMR vaccine coverage among children 19–35 months of age ranged from 91% to 93%. From 2001 through 2008, a total of 285 US-resident case-patients (65%) were considered to have preventable measles (ie, the patients were eligible for vaccination but unvaccinated). During 2004–2008, a total of 68% of vaccine-eligible US-resident case-patients claimed exemptions for personal beliefs.
Conclusions. The United States maintained measles elimination from 2001 through 2008 because of sustained high vaccination coverage. Challenges to maintaining elimination include large outbreaks of measles in highly traveled developed countries, frequent international travel, and clusters of US residents who remain unvaccinated because of personal belief exemptions.
Measles is a highly infectious, acute viral disease that causes rash, respiratory symptoms, and fever. Severe complications, which may result in death, include pneumonia and encephalitis. In the decade before the national measles vaccine program was implemented in 1963, it was estimated that 3–4 million people in the United States acquired measles each year [1]. Of the ∼500,000 measles cases reported annually, 500 resulted in death, 48,000 resulted in hospitalization, and 1000 resulted in permanent brain damage due to measles encephalitis [1].
Achieving a high level of population immunity is the best way to prevent measles. Accordingly, 2 doses of measles-mumps-rubella (MMR) vaccine are recommended for all US children [2]. The first dose should be administered at 12–15 months of age and the second dose at 4–6 years of age. Laws in every state require age-appropriate vaccination of children enrolled in child care facilities and documentation of evidence of measles immunity at the time of entry into kindergarten or first grade [3]. As the vaccinated cohorts age, all children in kindergarten through grade 12 should be covered by the requirements [3]. For adults without evidence of measles immunity, one dose of MMR vaccine is recommended. Two doses are recommended if the adult is in a high-risk group (ie, healthcare workers, international travelers, or students at post-high school educational institutions) [2].
Because of the success of the measles vaccine program in achieving and maintaining high 1- and 2-dose MMR vaccine coverage in preschool and school-aged children and improved control of measles throughout Central and South America, measles was declared eliminated from the United States in 2000 [4] and from the World Health Organization (WHO) Region of the Americas in 2002 [5]. Elimination is defined as the absence of transmission of endemic disease (ie, no epidemiological or virological evidence that measles virus transmission is continuously occurring in a defined geographical area for ⩾12 months). However, in 2008, it was estimated that there were 20 million cases of measles worldwide and 164,000 related deaths [6]. Importation of measles virus from abroad continues to test the status of elimination in the United States. In this report, we summarize the epidemiology of measles in the United States during measles postelimination years 2001–2008.
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