Measles outbreaks in the United States, 1987 through 1990.

BACKGROUND During 1989 and 1990 reported measles cases in the United States increased 6- to 9-fold over the annual mean of 3000 between 1985 and 1988. To evaluate recent epidemiology we summarized measles outbreaks. METHODS Confirmed measles cases reported to the National Notifiable Disease Surveillance System during 1987 through 1990 were analyzed. An outbreak was defined as > or = 5 epidemiologically linked cases. RESULTS There were 815 outbreaks, accounting for 94% of the 52,846 cases reported. Similar to 1985 and 1986, 3 patterns of measles transmission during outbreaks were identified: (1) predominantly among unvaccinated pre-school age children < 5 years of age (38% of outbreaks); (2) predominantly among vaccinated school age children 5 to 17 years of age (40%); and (3) predominantly among unvaccinated and vaccinated post-school age persons > or = 18 years of age (22%). Most outbreaks were small (median, 12 cases), but very large outbreaks occurred (maximum size, 10,670). Although school age outbreaks (58%) predominated during 1987 and 1988, preschool age (40%) and post-school age (23%) outbreaks were more important during 1989 and 1990. CONCLUSIONS Recent epidemiology suggests that to achieve elimination of measles, ACIP recommendations must be fully implemented, including (1) routine administration of the first dose of measles vaccine from 12 to 15 months of age and (2) use of a routine two-dose schedule to prevent school age and post-school age outbreaks.

[1]  S. Hadler,et al.  Measles Herd Immunity: The Association of Attack Rates With Immunization Rates in Preschool Children , 1992 .

[2]  S. Krugman,et al.  The resurgence of measles in the United States, 1989-1990. , 1992, Annual review of medicine.

[3]  M. Joffres,et al.  Reduced measles immunity in infants in a well-vaccinated population. , 1992, The Pediatric infectious disease journal.

[4]  P. Mead,et al.  A school-based measles outbreak: the effect of a selective revaccination policy and risk factors for vaccine failure. , 1990, American journal of epidemiology.

[5]  W. Orenstein,et al.  Barriers to Vaccinating Preschool Children , 2010, Journal of health care for the poor and underserved.

[6]  S. Sepe,et al.  The president's child immunization initiative--a summary of the problem and the response. , 1993, Public health reports.

[7]  E. Mast,et al.  Risk factors for measles in a previously vaccinated population and cost-effectiveness of revaccination strategies. , 1990, JAMA.

[8]  W. Williams,et al.  The impact of college prematriculation immunization requirements on risk for measles outbreaks. , 1994, JAMA.

[9]  P. Strebel,et al.  Recommended Childhood Immunization Schedule , 1995, Clinical pediatrics.

[10]  L. Markowitz,et al.  High attack rates and case fatality during a measles outbreak in groups with religious exemption to vaccination. , 1993, The Pediatric infectious disease journal.

[11]  S. Hutchins,et al.  Preschool children at high risk for measles: opportunities to vaccinate. , 1993, American journal of public health.

[12]  L. Markowitz,et al.  Pediatric emergency room visits: a risk factor for acquiring measles. , 1991, Pediatrics.

[13]  L. Markowitz,et al.  Epidemiology of measles in the United States in 1989 and 1990. , 1992, The Pediatric infectious disease journal.

[14]  Thomas W. Novotny,et al.  Measles outbreaks in religious groups exempt from immunization laws. , 1988, Public health reports.

[15]  G. Stollerman,et al.  The measles epidemic. The problems, barriers, and recommendations. The National Vaccine Advisory Committee. , 1991, JAMA.

[16]  E. Zell,et al.  Measles among the Amish: a comparative study of measles severity in primary and secondary cases in households. , 1991, The Journal of infectious diseases.

[17]  F. Black,et al.  Maternally derived measles immunity in era of vaccine-protected mothers. , 1986, The Journal of pediatrics.

[18]  P. Fine,et al.  Duration of live measles vaccine-induced immunity. , 1990, The Pediatric infectious disease journal.

[19]  F. Crosson,et al.  Need for measles revaccination in adolescents: correlation with birth date prior to 1972. , 1983, The Journal of pediatrics.

[20]  G. E. King,et al.  Clinical efficacy of measles vaccine during the 1990 measles epidemic , 1991, The Pediatric infectious disease journal.

[21]  B. Hersh,et al.  A measles outbreak at a college with a prematriculation immunization requirement. , 1991, American journal of public health.

[22]  C. E. Hawkins,et al.  Patterns of transmission in measles outbreaks in the United States, 1985-1986. , 1989, The New England journal of medicine.