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Absence of Reported Measles -- United States,
November 1993
For the first time since measles reporting began in 1912, no
measles cases have been reported in the United States for 3
consecutive weeks (November 7-November 27 {weeks 45-47}, 1993). In
addition, no cases have been reported with onset since September 22
that were not directly linked with importations.
Of the provisional total of 277 measles cases reported in 1993
through November 27, a total of 57 persons had onsets of illness
since July 4. Of these, 29 (51%) were imported or linked through a
continuous chain of transmission to an imported case. Twelve (21%)
cases resulted from continued transmission from measles outbreaks
that began before July 4. Fourteen (25%) cases could not be linked
to an existing outbreak, an international importation, or another
reported case and were classified as sporadic index cases. Two
cases were epidemiologically linked to these cases. Twelve of the
14 sporadic index cases were laboratory confirmed.
Reported by: State and local health depts. National Immunization
Program, CDC. Editorial Note
Editorial Note: The 3-week period without reported measles cases
reflects at least four factors: 1) major increases in measles
vaccination coverage levels among preschool-aged children; 2)
increased use of a second dose of measles vaccine among school-aged
children and young adults attending college; 3) an overall increase
in efforts to control measles throughout the Western Hemisphere;
and 4) the usual seasonally low incidence of measles during the
fall (1,2). Furthermore, the absence of any reported persons with
sporadic index cases of measles who had onset after September 22
may reflect a cessation of endemic measles transmission in the
United States during this period.
The absence of reported endemic foci of measles transmission
does not indicate that measles has been eliminated in the United
States. In the past, substantial numbers of measles cases were not
reported to public health authorities (3). Therefore, surveillance
must be intensified to permit the identification and elimination of
any remaining foci of transmission. Any case of rash illness
suspected to be measles should be reported promptly to public
health authorities to enable immediate investigation and vigorous
control measures to minimize spread of infection. For each case,
laboratory confirmation should be obtained, vaccination status
determined, and source of exposure ascertained.
Although current measles activity is at its lowest level ever
in the United States, previous periods of low activity have been
followed by resurgences (4,5). High vaccination coverage levels
among preschool- and school-aged children need to be achieved and
sustained in all communities to ensure the elimination of endemic
measles transmission.
References
CDC. Measles -- United States, first 26 weeks, 1993. MMWR
1993;42:813-6.
Pan American Health Organization. Central America: defeating
measles. EPI Newsletter 1993;XV(5):2-3.
Davis SF, Strebel PM, Atkinson WL, et al. Reporting efficiency
during a measles outbreak in New York City, 1991. Am J Public
Health 1993;83:1011-5.
CDC. Measles -- United States, 1982. MMWR 1983;32:49-51.
Atkinson WL, Orenstein WA, Krugman S. The resurgence of measles
in the United States, 1989-90. Annu Rev Med 1992;43:451-63.
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