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Measles in the United States during the postelimination era
Amy Parker Fiebelkorn1, Susan B Redd, Kathleen Gallagher
1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. AParker@cdc.gov
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.
Insights
Measles elimination in the US was maintained from 2001-2008 due to high measles-mumps-rubella (MMR) vaccination rates. However, international travel and personal belief exemptions pose challenges to continued measles prevention.
Area of Science:
- Epidemiology
- Public Health
- Immunization
Background:
- Measles was eliminated in the US in 2000 following a successful vaccination program.
- Prior to vaccination, measles affected entire birth cohorts.
Purpose of the Study:
- To review US measles surveillance data and vaccination coverage during the postelimination period (2001-2008).
- To identify challenges to maintaining measles elimination.
Main Methods:
- Reviewed confirmed measles cases reported to the CDC.
- Analyzed national measles-mumps-rubella (MMR) vaccination coverage data.
- Examined vaccination status and exemption reasons for US-resident measles cases.
Main Results:
- 557 measles cases and 38 outbreaks reported in the US (2001-2008), with 42% imported.
- Highest incidence in infants (6-11 months) and young children (12-15 months).
- 65% of US-resident cases were preventable (vaccine-eligible but unvaccinated), with 68% citing personal belief exemptions (2004-2008).
Conclusions:
- Sustained high MMR vaccination coverage maintained measles elimination from 2001-2008.
- International travel and unvaccinated clusters due to personal belief exemptions challenge ongoing elimination efforts.
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