Reemergence of measles in South Korea: implications for immunization and surveillance programs

Following the implementation of the national measles elimination program, the Republic of Korea declared in 2006 that measles had been eliminated. However in 2011, a measles outbreak was reported in Gyeongnam Province in the southeastern part of the country. We conducted active case-based surveillance and analyzed the data of cases reported in 2011 to identify the factors contributing to the reemergence of measles in this province. Of 41 confirmed measles cases reported in Korea, 32 were from within the Gyeongnam Province. Among cases identified in the outbreak, 97% had inadequate history of immunization, 28% were not immunized at the recommended ages, and 22% were infants aged 6-11 months. The outbreak involved transmission in 3 hospitals, 1 kindergarten, 1 day-care center, and 3 households. Molecular analysis of measles virus isolates from 11 cases revealed the same D9 genotype, which was the first to be discovered in Korea. In conclusion, inadequate immunization coverage, non-timely immunization, infants under 12 months of age, nosocomial transmission, and international importation may play important roles in the reemergence of measles in Korea during the attempted sustained elimination of the disease.