Patterns of transmission in measles outbreaks in the United States, 1985-1986

Since the licensing of measles vaccine in 1963, the incidence of reported measles in the United States has declined to less than 2 percent of previous levels. To characterize the current epidemiology of measles in the United States, we analyzed measles outbreaks that occurred during 1985 and 1986. There were 152 outbreaks (defined as five or more cases related epidemiologically), which accounted for 88 percent of the cases reported during those two years. There were two major types of outbreaks: those in which most of the cases occurred among preschool-age children (those under 5 years of age) (26 percent) and those in which most of the cases occurred among school-age persons (those 5 to 19 years of age) (67 percent). The outbreaks among preschool-age children ranged in size from 5 to 945 cases (median, 13); a median of only 14 percent of the cases occurred in vaccinated persons, and a median of 45 percent of the cases were classified as preventable according to the current strategy. Outbreaks among school-age persons ranged in size from 5 to 363 cases (median, 25); a median of 60 percent of the cases occurred in vaccinated persons, and a median of only 27 percent of the cases were preventable. The outbreaks among preschool-age children indicate deficiencies in the implementation of the national measles-elimination strategy. However, the extent of measles transmission among highly vaccinated school-age populations suggests that additional strategies, such as selective or mass revaccination, may be necessary to prevent such outbreaks.