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Factors Associated With Measles Transmission in the United States During the Postelimination Era
Paul A Gastañaduy1, Sebastian Funk2, Benjamin A Lopman3
1Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Importance:
Measles cases and outbreaks continue to occur in the United States after the introduction of measles from endemic settings.
Objective:
To discern the factors associated with measles transmission in the United States after measles had been eliminated.
Design, Setting, And Participants:
This cross-sectional study was conducted from January 1, 2001, to December 31, 2017, in the United States among US residents and international visitors with confirmed measles. A maximum likelihood algorithm that uses the observed dates of rash onset and the known distribution of the serial interval (time between symptom onset in related consecutive cases) was applied to outbreak notification data to estimate the effective reproduction number (R), or the mean number of new infections generated per case. Transmissibility was assessed by comparing R based on the characteristics of primary and secondary cases of measles.
Exposures:
Measles virus.
Main Outcomes And Measures:
Effective reproduction number (R), or the mean number of successful transmission events per case of measles (ie, the mean number of persons to whom each patient with measles spreads measles).
Results:
A total of 2218 individuals with confirmed measles cases (1025 female, 1176 male, and 17 sex not reported; median age, 15 years [range, 0-89 years]) reported from 2001 to 2017 were evaluated. Among patients who received no doses of measles vaccine, R was 0.76 (95% CI, 0.71-0.81); among patients who received 1 dose of measles vaccine, R was 0.17 (95% CI, 0.11-0.26); among patients who received 2 doses or more of measles vaccine, R was 0.27 (95% CI, 0.17-0.39); and among patients with unknown vaccination status, R was 0.52 (95% CI, 0.44-0.60). Among patients born before 1957, R was 0.35 (95% CI, 0.20-0.58), and among those born on or after 1957, R was 0.64 (95% CI, 0.61-0.68). R was higher when primary and secondary cases of measles were patients aged 5 to 17 years (0.36 [95% CI, 0.31-0.42]) compared with assortative transmission in other age groups (<1 year, 0.14 [95% CI, 0.10-0.20]; 1-4 years, 0.25 [95% CI, 0.20-0.30]; 18-29 years, 0.19 [95% CI, 0.15-0.24]; 30-49 years, 0.15 [95% CI, 0.11-0.20]; ≥50 years, 0.04 [95% CI, 0.01-0.10]).
Conclusions And Relevance:
The findings of this study support having high targets for 2-dose measles vaccine coverage, particularly among school-aged children in the United States.
Insights
Measles transmission in the US is linked to vaccination status and age. High 2-dose measles vaccine coverage is crucial, especially for school-aged children, to prevent outbreaks.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Measles outbreaks persist in the US despite elimination efforts, often linked to imported cases.
- Understanding transmission dynamics is key to maintaining measles control.
Purpose of the Study:
- To identify factors influencing measles transmission in the US post-elimination.
- To analyze the effective reproduction number (R) based on case characteristics.
Main Methods:
- Cross-sectional study of 2218 confirmed measles cases (2001-2017).
- Used a maximum likelihood algorithm on outbreak data to estimate the effective reproduction number (R).
- Assessed transmissibility by comparing R values across vaccination statuses and age groups.
Main Results:
- The effective reproduction number (R) varied significantly with measles vaccination: 0.76 (no vaccine), 0.17 (1 dose), 0.27 (≥2 doses).
- R was higher in individuals born after 1957 (0.64) compared to before (0.35).
- Measles transmission was highest among school-aged children (5-17 years) with an R of 0.36.
Conclusions:
- The study underscores the importance of high 2-dose measles vaccination coverage.
- Targeting school-aged children for vaccination is critical for preventing measles spread.
- Vaccination remains the most effective strategy for measles control in the US.
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