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Major impediments to measles elimination. The modern epidemiology of an ancient disease
Abstract:
Great success has been achieved in controlling measles in the United States with a greater than 99% reduction in incidence rate from the prevaccine era. However, since 1981, the incidence rate of measles in the United States has been relatively stable at approximately 1,500 to 3,000 reported cases annually. We reviewed available information to determine the remaining impediments to elimination of measles. The potential impediments can be divided into two categories: (1) implementation of the current strategy and (2) whether the current strategy needs modification. The major reason for the failure to achieve elimination appears to be the fact that some persons for whom vaccine is indicated have not been vaccinated. While vaccine failures and importations play a role in transmission, sustained transmission in a totally vaccinated community has not been demonstrated. All chains of transmission have involved some unvaccinated persons. Measles elimination will require complete implementation of current strategies and careful monitoring of epidemiologic trends to determine whether future modifications in strategy are needed.
Insights
Achieving measles elimination in the US is hindered by unvaccinated individuals. Complete implementation of vaccination strategies and ongoing monitoring are crucial for eradicating measles.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Measles control in the US has drastically reduced incidence (>99%) since the pre-vaccine era.
- Despite success, measles incidence has remained stable (1,500-3,000 cases/year) since 1981, preventing elimination.
Purpose of the Study:
- To identify remaining obstacles to measles elimination in the United States.
- To evaluate the current measles control strategy and determine if modifications are necessary.
Main Methods:
- Review of available information on measles epidemiology and control in the US.
- Analysis of factors contributing to ongoing measles transmission.
Main Results:
- The primary impediment to measles elimination is incomplete vaccination coverage among eligible individuals.
- While vaccine failures and imported cases contribute to transmission, sustained transmission in fully vaccinated populations has not been observed.
- All identified transmission chains involve unvaccinated individuals.
Conclusions:
- Measles elimination requires full implementation of existing vaccination strategies.
- Continuous monitoring of epidemiological trends is essential to assess the need for future strategy adjustments.