Sonja Hutchins

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KANNAN M

Central council for research in Siddha/Siddha Central Research Institute

Maciej Banach

Medical University of Lodz, Lodz, Poland

Garumma T Feyissa

Drexel University

Laura Linnan

University of North Carolina at Chapel Hill

Susan Sawyer

University of Melbourne

Neville Golden

Stanford University

Daniel Egah

University Of Jos Nigeria

N. Kutlay

Ankara University

Anthony McCall

University of Virginia

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University of Oslo

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Papers by Sonja Hutchins

A School-Based Measles Outbreak: The Effect of a Selective Revaccination Policy and Risk Factors for Vaccine Failure

American Journal of Epidemiology, Jul 1, 1990

Persons who received measles vaccine between 12 and 14 months of age have been found to be at inc... more Persons who received measles vaccine between 12 and 14 months of age have been found to be at increased risk of measles compared with those vaccinated at greater than or equal to 15 months of age. Because of this, in 1987 the Immunization Practices Advisory Committee of the US Public Health Service recommended that, during measles outbreaks, revaccination of persons vaccinated at 12-14 months of age be considered. During a school-based outbreak in New Mexico in 1987, the authors evaluated the effect of a mandatory revaccination policy in affected schools. Before the effect of revaccination, the overall attack rate in persons vaccinated at greater than or equal to 12 months of age was 4.1 cases/1,000 students; afterward, the risk was significantly reduced by 73%, to 1.1/1,000 students. The attack rate among students targeted for revaccination declined 100%, compared with 41% among those not revaccinated. Overall, attack rates were significantly lower in schools conducting revaccination early compared with schools holding later revaccination. In a retrospective cohort study of single-dose vaccines in one school, age at vaccination was not associated with risk of disease; however, persons vaccinated greater than or equal to 10 years before the outbreak were at increased risk, independently of age at vaccination. Revaccination of persons whose most recent vaccination was between 12 and 14 months of age appeared to control transmission in this outbreak. Further studies are needed to confirm these observations and to evaluate the effect of other revaccination efforts during outbreaks.

Measles outbreaks in the United States, 1987 through 1990

The Pediatric infectious disease journal, 1996

During 1989 and 1990 reported measles cases in the United States increased 6- to 9-fold over the ... more 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. 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. 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 ou...

Measles outbreak among unvaccinated preschool-aged children: opportunities missed by health care providers to administer measles vaccine

Pediatrics, 1989

A measles outbreak in an inner-city area primarily involved preschool-aged children younger than ... more A measles outbreak in an inner-city area primarily involved preschool-aged children younger than 5 years of age. The reasons why 31 unvaccinated preschool children with measles disease had not been vaccinated were investigated. For some patients, health care providers missed opportunities to vaccinate eligible patients against measles. Of the 26 patients whose full immunization status was known, ten (38%) were vaccinated with diphtheria and tetanus toxoids and pertussis vaccine and/or oral poliovirus vaccine at a time when they could have received measles vaccine simultaneously, according to recommendations of the Immunization Practices Advisory Committee and the American Academy of Pediatrics. In addition, five of ten health care providers interviewed missed at least one opportunity to administer measles vaccine because of a minor illness that was not a contraindication to vaccination. Unvaccinated patients were more likely to receive health care in the public sector, have single m...

Periodontitis among adults aged ≥30 years - United States, 2009-2010

Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), Jan 22, 2013

Periodontal disease, or gum disease, is a chronic infection of the hard and soft tissue supportin... more Periodontal disease, or gum disease, is a chronic infection of the hard and soft tissue supporting the teeth and is a leading cause of tooth loss in older adults. Tooth loss impairs dental function and quality of life in older adults. The chronic infections associated with periodontitis can increase the risk for aspiration pneumonia in older adults and has been implicated in the pathogenesis of chronic inflammation that impairs general health. The severity of periodontal disease can be categorized as mild, moderate, or severe on the basis of multiple measurements of periodontal pocket depth, attachment loss, and gingival inflammation around teeth.

Assessing immunization coverage in private practice

Journal of the National Medical Association, 2000

To achieve national health objectives of eliminating most childhood vaccine-preventable diseases ... more To achieve national health objectives of eliminating most childhood vaccine-preventable diseases by the year 2010, all health care providers will have to improve the immunization rates of their patients. Currently, immunization rates of children 19 to 35 months of age are less than national objectives, suggesting a need for optimized immunization services. A key strategy for improving age-appropriate immunization coverage by health care providers is the assessment of immunization coverage. Because most (62%), immunization services in the United States are delivered in the private sector, a concerted effort in private practice is critical to improving immunization rates. Assessment of immunization coverage of patients enrolled in private practice serves 1) to measure the overall performance of the practice in providing the standard of care, 2) to identify strategies for improving coverage, and 3) to document the quality of health services delivered (report card). Assessment of immuni...

Value of a small control group for estimating intervention effectiveness: results from simulations of immunization effectiveness studies

Journal of comparative effectiveness research, Jan 11, 2015

To improve evidence for public health practice, the conduct of effectiveness studies by practitio... more To improve evidence for public health practice, the conduct of effectiveness studies by practitioners is needed and may be stimulated if knowledge that smaller than usual samples may provide the same reliability of intervention effect size as larger samples. We examined reliability of intervention effect using computerized simulations of 2000 hypothetical immunization effectiveness studies from an actual study population and by small (30 and 60) and larger (100 and 200) control groups compared with an intervention group of 200 participants. Across simulated studies, the mean intervention effect (14%) and effect sizes were equivalent regardless of control group size and equal to the actual study effect. These results are relevant for similarly designed and executed studies and indicate that studies with smaller control groups can generate valid and accurate evidence for effective public health practice in communities.

Studies of missed opportunities for immunization in developing and industrialized countries

Bulletin of the World Health Organization, 1993

Missed opportunities for immunization are an obstacle to raising immunization coverage among chil... more Missed opportunities for immunization are an obstacle to raising immunization coverage among children and women of childbearing age. To determine their global magnitude and reasons, studies reported up to July 1991 were reviewed. A standard measure for the prevalence of missed opportunities was calculated for each study. Seventy-nine studies were identified from 45 countries; 18 were population-based, 52 were health-service-based, and 9 were intervention trials. A median of 32% (range, 0-99%) of the children and women of childbearing age who were surveyed had missed opportunities during visits to the health services for immunization or other reasons. Missed opportunities were mainly due to failure to administer simultaneously all vaccines for which a child was eligible; false contraindications; health workers' practices, including not opening a multidose vaccine vial for a small number of persons to avoid vaccine wastage; and logistical problems. To eliminate missed opportunitie...

Value of a small control group for estimating intervention effectiveness: results from simulations of immunization effectiveness studies

Journal of Comparative Effectiveness Research, 2015

Current epidemiology of pertussis in the United States

The Tokai journal of experimental and clinical medicine, 1988

The incidence of pertussis in the United States decreased rapidly during the 20th century, with t... more The incidence of pertussis in the United States decreased rapidly during the 20th century, with the most impressive decreases resulting from the widespread use of DTP vaccine since the late 1940's. As a result of immunization laws, vaccine coverage levels against pertussis at school entry have been greater than 95% since 1980. National surveillance for pertussis done by the Centers for Disease Control (CDC) consists of two parts: a weekly telephone reporting system and a written case report system providing more detailed demographic, clinical, and laboratory information. In addition, data on secondary spread of pertussis among household contacts of reported cases were available on a small proportion of reported cases during 1979-1983. During the period 1980-1986, a total of 17,396 cases of pertussis was reported to CDC by weekly telephone reports. The annual incidence of reported pertussis rose during this period from 0.5 cases per 100,000 population to 1.7/100,000. Infants less...

Disparities in Life Expectancy Across US Counties Linked to County Social Factors, 2009 Community Health Status Indicators (CHSI)

Journal of Racial and Ethnic Health Disparities, 2014

Objectives In response to a National Healthy People 2020 goal to create social environments to im... more Objectives In response to a National Healthy People 2020 goal to create social environments to improve health, we examined US community health status by social factors to identify opportunities for health improvement. County-level relationships between life expectancy and known social determinants of health were assessed. Methods An ecological study of all 3,141 US counties or equivalents using 2009 Community Health Status Indicators dataset was conducted. We examined health status and social indicators across counties and correlation of average life expectancy with educational, income, and racial indicators. Results Life expectancy varied across US counties (median, 77 years; range, 67-81) and was negatively correlated with percentages of residents living below the federal poverty level (r=−0.65; P<0.05), of adults aged ≥25 years without a high school diploma (r=−0.64; P<0.05), and of African-American residents (r=−0.56; P<0.05). By contrast, life expectancy positively correlated with percentage of White-American residents (r= 0.51; P< 0.05). Correlations persisted across counties with varying poverty and educational attainment; strongest correlations found in counties with largest percentage of residents in poverty or adults with no high school diploma. Conclusions Life expectancy across US counties is moderately to strongly linked with county poverty, educational attainment, and racial composition. Counties with the longest life expectancy need further examination to identify their effective policies, resources, and investments responsible for better health.

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General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP)

MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, Jan 8, 2002

This report is a revision of General Recommendations on Immunization and updates the 1994 stateme... more This report is a revision of General Recommendations on Immunization and updates the 1994 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1994;43[No. RR-1]:1-38). The principal changes include expansion of the discussion of vaccination spacing and timing, recommendations for vaccinations administered by an incorrect route, information regarding needle-free injection technology, vaccination of children adopted from countries outside the United States, timing of live-virus vaccination and tuberculosis screening, expansion of the discussion and tables of contraindications and precautions regarding vaccinations, and addition of a directory of immunization resources. These recommendations are not comprehensive for each vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for additional details. This rep...

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Elimination of measles and of disparities in measles childhood vaccine coverage among racial and ethnic minority populations in the United States

The Journal of infectious diseases, 2004

The gap in measles vaccine coverage between white and nonwhite children was as large as 18% in 19... more The gap in measles vaccine coverage between white and nonwhite children was as large as 18% in 1970. During the measles epidemic of 1989-1991, attack rates among nonwhite children <5 years of age were 4- to 7-fold higher than rates among white children. Because of the epidemic and of the known disparity in vaccine coverage and risk of disease, a dual strategy to eliminate measles in the United States was implemented: universal interventions likely to reach the majority of children and targeted interventions more likely to reach nonwhite children. In 1992, the gap in coverage between white and nonwhite children was reduced to 6% (from 15% in 1985); the risk of disease among nonwhite children was narrowed to <or=4-fold the risk of white children. During the 1990s, further implementation of the dual strategy resulted in narrowing the gap in vaccine coverage to 2% and elimination of endemic disease in all racial and ethnic populations. This dual strategy deserves close scrutiny by...

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Epidemiology of measles in the United States in 1989 and 1990

The Pediatric Infectious Disease Journal, 1992

During 1989 and 1990 measles incidence increased sharply in the United States. We compared cases ... more During 1989 and 1990 measles incidence increased sharply in the United States. We compared cases reported during these years with those reported between 1981 and 1988. Incidence increased 462% in 1989, and incidence in 1990 (11.2/100,000) was the highest in more than a decade. Although all ages were affected the greatest increases were in children &lt; 5 years and in adults. Incidence was 7- to 10-fold higher among racial/ethnic minority preschoolers than whites, and 80% of vaccine-eligible preschool age cases were unvaccinated. Complications occurred in 9418 (20.5%) cases, most frequently in young children and adults. Large urban outbreaks affecting predominantly unvaccinated preschoolers were common; 47% of all cases reported in 1990 were associated with 5 outbreaks. Reasons for the increased incidence are not clear. Current information suggests no change in vaccination coverage among preschool age children or in vaccine efficacy. Continued surveillance and evaluation of epidemiologic and laboratory data are necessary. The most pressing need is to improve age-appropriate vaccination among preschool age children.

Effectiveness and Cost-Effectiveness of Linking the Special Supplemental Program for Women, Infants, and Children (WIC) and Immunization Activities

Journal of Public Health Policy, 1999

To raise immunization coverage among children at risk for underimmunization, we evaluated the eff... more To raise immunization coverage among children at risk for underimmunization, we evaluated the effectiveness and cost-effectiveness of immunization activities in the Special Supplemental Program for Women, Infants and Children (WIC). A controlled intervention trial was conducted in seven WIC sites in Chicago between October 1990 and March 1994. At intervention sites, staff screened children for vaccination status at every visit, referred vaccine-eligible children to either an on-site WIC nurse, on-site clinic, or off-site community provider, and issued either a 3-month supply of food vouchers to up-to-date children or a 1-month supply to children not up-to-date--a usual practice for high-risk WIC children. Our primary measure of effectiveness was the change in the baseline percentage of up-to-date children at the second birthday; cost-effectiveness was approximated for each of the three referral interventions. After one year, up-to-date vaccination coverage increased 23% above baseline for intervention groups and decreased 9% in the control group. After the second year, up-to-date vaccination further increased to 38% above baseline in intervention groups and did not change in the control group. The total cost per additional up-to-date child ranged from $30 for sites referring children off-site to $73 for sites referring children on-site to a nurse. This controlled intervention trial of screening, referral, and a voucher incentive in the WIC program demonstrated a substantial increase in immunization coverage at a low cost. Continuing to design linkages between WIC and immunization programs by building on WIC&#39;s access to at-risk populations is worth the investment.

Fatal Measles Pneumonia Without Rash in a Child with AIDS

Journal of Infectious Diseases, 1988

Page 1. 480 Concise Communications nal vaccination increases and prolongs immunoglobulin Gl antib... more

Measles Hospitalizations, United States, 1985–2002

The Journal of Infectious Diseases, 2004

Cases of measles that require hospitalization are a good marker of the burden of clinically sever... more Cases of measles that require hospitalization are a good marker of the burden of clinically severe measles in the United States. Measles hospitalizations routinely are monitored by the National Notifiable Disease Surveillance System (NNDSS). Our objectives were to describe measles hospitalizations reported to the NNDSS in 1985-2002, to use hospital discharge data from independent data sets (the National Hospital Discharge Survey [NHDS] [data available for 1985-1999] and the Health Care Investment Analysts [HCIA] hospital discharge database [data available for 1985-1996]) to provide additional estimates of total measles hospitalizations, and to compare trends in measles-associated hospitalizations. In 1985-2002, a total of 13621 patients with measles reported to the NNDSS were hospitalized (annual average, 757; range, 19-5856 patients). In 1985-1996, a total of 13472 measles hospitalizations were reported from NNDSS, compared with 28047 estimated from the NHDS and 19352 extrapolated from HCIA data. In the NNDSS, the annual total number declined after 1992 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=45 measles hospitalizations per year; this trend was closely paralleled by both the NHDS and the HCIA data. We demonstrate a decline in reported measles hospitalizations since the 1989-1991 measles resurgence, with the lowest numbers ever reported in the NNDSS. These numbers are corroborated by the very low numbers of measles hospitalizations in the NHDS and HCIA data.

Elimination of Measles and of Disparities in Measles Childhood Vaccine Coverage among Racial and Ethnic Minority Populations in the United States

The Journal of Infectious Diseases, 2004

The gap in measles vaccine coverage between white and nonwhite children was as large as 18% in 19... more The gap in measles vaccine coverage between white and nonwhite children was as large as 18% in 1970. During the measles epidemic of 1989-1991, attack rates among nonwhite children !5 years of age were 4-to 7-fold higher than rates among white children. Because of the epidemic and of the known disparity in vaccine coverage and risk of disease, a dual strategy to eliminate measles in the United States was implemented: universal interventions likely to reach the majority of children and targeted interventions more likely to reach nonwhite children. In 1992, the gap in coverage between white and nonwhite children was reduced to 6% (from 15% in 1985); the risk of disease among nonwhite children was narrowed to р4-fold the risk of white children. During the 1990s, further implementation of the dual strategy resulted in narrowing the gap in vaccine coverage to 2% and elimination of endemic disease in all racial and ethnic populations. This dual strategy deserves close scrutiny by health professionals and policy makers in devising programs to meet the Healthy People 2010 objectives for the elimination of other health disparities.

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Vaccination Levels Associated with Lack of Measles Transmission among Preschool‐Aged Populations in the United States, 1989–1991

The Journal of Infectious Diseases, 2004

Knowledge of the minimum level of vaccination capable of preventing measles transmission in an ag... more Knowledge of the minimum level of vaccination capable of preventing measles transmission in an age group is helpful for establishing program targets for measles elimination. In 1990, during the measles resurgence in the United States, one-half of cases occurred in children aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5 years. Although estimated population immunity among persons &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=6 years of age was 93%, immunity was lower and varied widely among preschool-aged children. To examine the association of vaccine coverage at 2 years of age and measles incidence among preschool-aged children, we analyzed ecological studies of measles incidence in Milwaukee (Wisconsin) census tracts, Dallas (Texas) ZIP code areas, and selected cities during the 1989-1991 measles resurgence. In each study area, measles incidence decreased rapidly with increasing measles vaccine coverage and became low or negligible when coverage was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=80%. Regression analysis also suggested that measles would not be transmitted when vaccine coverage was at least 79%. A minimum vaccine coverage of approximately 80% at the second birthday in census tracts, ZIP code areas, and cities in the United States may be sufficient to prevent measles transmission among preschool-aged children if population immunity is &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=93% among persons &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=6 years of age.

Persistence of Vaccine‐Induced Antibody to Measles 26–33 Years after Vaccination

The Journal of Infectious Diseases, 2004

Because measles-specific antibody titer after vaccination is lower than after natural infection, ... more Because measles-specific antibody titer after vaccination is lower than after natural infection, there is concern that vaccinated persons may gradually lose protection from measles. To examine the persistence of vaccine-induced antibody, participants of a vaccine study in 1971, with documentation of antibody 1-7 years after vaccination, were followed up in 1997-1999 to determine the presence and titer of measles antibody. Of the 56 participants (77% were 2-dose recipients), all had antibodies detected by the plaque reduction neutralization (PRN) antibody assay an average of 26-33 years after the first or second dose of measles vaccine; 92% had a PRN titer considered protective (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 : 120). Baseline hemagglutination inhibition antibody titer in 1971 strongly predicted follow-up PRN antibody titer (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Persistence of antibody in these primarily 2-dose recipients supports the current elimination strategy to achieve and sustain high population immunity with a 2-dose schedule.

Evaluation of the Measles Clinical Case Definition

The Journal of Infectious Diseases, 2004

Because measles-specific antibody titer after vaccination is lower than after natural infection, ... more Because measles-specific antibody titer after vaccination is lower than after natural infection, there is concern that vaccinated persons may gradually lose protection from measles. To examine the persistence of vaccineinduced antibody, participants of a vaccine study in 1971, with documentation of antibody 1-7 years after vaccination, were followed up in 1997-1999 to determine the presence and titer of measles antibody. Of the 56 participants (77% were 2-dose recipients), all had antibodies detected by the plaque reduction neutralization (PRN) antibody assay an average of 26-33 years after the first or second dose of measles vaccine; 92% had a PRN titer considered protective (11:120). Baseline hemagglutination inhibition antibody titer in 1971 strongly predicted follow-up PRN antibody titer ( ). Persistence of antibody in these primarily 2-dose recipients P ! .001 supports the current elimination strategy to achieve and sustain high population immunity with a 2-dose schedule.

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A School-Based Measles Outbreak: The Effect of a Selective Revaccination Policy and Risk Factors for Vaccine Failure

American Journal of Epidemiology, Jul 1, 1990

Measles outbreaks in the United States, 1987 through 1990

The Pediatric infectious disease journal, 1996

Measles outbreak among unvaccinated preschool-aged children: opportunities missed by health care providers to administer measles vaccine

Pediatrics, 1989

Periodontitis among adults aged ≥30 years - United States, 2009-2010

Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), Jan 22, 2013

Assessing immunization coverage in private practice

Journal of the National Medical Association, 2000

Value of a small control group for estimating intervention effectiveness: results from simulations of immunization effectiveness studies

Journal of comparative effectiveness research, Jan 11, 2015

Studies of missed opportunities for immunization in developing and industrialized countries

Bulletin of the World Health Organization, 1993

Value of a small control group for estimating intervention effectiveness: results from simulations of immunization effectiveness studies

Journal of Comparative Effectiveness Research, 2015

Current epidemiology of pertussis in the United States

The Tokai journal of experimental and clinical medicine, 1988

Disparities in Life Expectancy Across US Counties Linked to County Social Factors, 2009 Community Health Status Indicators (CHSI)

Journal of Racial and Ethnic Health Disparities, 2014

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General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP)

MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, Jan 8, 2002

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Elimination of measles and of disparities in measles childhood vaccine coverage among racial and ethnic minority populations in the United States

The Journal of infectious diseases, 2004

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Epidemiology of measles in the United States in 1989 and 1990

The Pediatric Infectious Disease Journal, 1992

Effectiveness and Cost-Effectiveness of Linking the Special Supplemental Program for Women, Infants, and Children (WIC) and Immunization Activities

Journal of Public Health Policy, 1999

Fatal Measles Pneumonia Without Rash in a Child with AIDS

Journal of Infectious Diseases, 1988

Page 1. 480 Concise Communications nal vaccination increases and prolongs immunoglobulin Gl antib... more

Measles Hospitalizations, United States, 1985–2002

The Journal of Infectious Diseases, 2004

Elimination of Measles and of Disparities in Measles Childhood Vaccine Coverage among Racial and Ethnic Minority Populations in the United States

The Journal of Infectious Diseases, 2004

The gap in measles vaccine coverage between white and nonwhite children was as large as 18% in 19... more The gap in measles vaccine coverage between white and nonwhite children was as large as 18% in 1970. During the measles epidemic of 1989-1991, attack rates among nonwhite children !5 years of age were 4-to 7-fold higher than rates among white children. Because of the epidemic and of the known disparity in vaccine coverage and risk of disease, a dual strategy to eliminate measles in the United States was implemented: universal interventions likely to reach the majority of children and targeted interventions more likely to reach nonwhite children. In 1992, the gap in coverage between white and nonwhite children was reduced to 6% (from 15% in 1985); the risk of disease among nonwhite children was narrowed to р4-fold the risk of white children. During the 1990s, further implementation of the dual strategy resulted in narrowing the gap in vaccine coverage to 2% and elimination of endemic disease in all racial and ethnic populations. This dual strategy deserves close scrutiny by health professionals and policy makers in devising programs to meet the Healthy People 2010 objectives for the elimination of other health disparities.

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Vaccination Levels Associated with Lack of Measles Transmission among Preschool‐Aged Populations in the United States, 1989–1991

The Journal of Infectious Diseases, 2004

Persistence of Vaccine‐Induced Antibody to Measles 26–33 Years after Vaccination

The Journal of Infectious Diseases, 2004

Evaluation of the Measles Clinical Case Definition

The Journal of Infectious Diseases, 2004

Because measles-specific antibody titer after vaccination is lower than after natural infection, ... more Because measles-specific antibody titer after vaccination is lower than after natural infection, there is concern that vaccinated persons may gradually lose protection from measles. To examine the persistence of vaccineinduced antibody, participants of a vaccine study in 1971, with documentation of antibody 1-7 years after vaccination, were followed up in 1997-1999 to determine the presence and titer of measles antibody. Of the 56 participants (77% were 2-dose recipients), all had antibodies detected by the plaque reduction neutralization (PRN) antibody assay an average of 26-33 years after the first or second dose of measles vaccine; 92% had a PRN titer considered protective (11:120). Baseline hemagglutination inhibition antibody titer in 1971 strongly predicted follow-up PRN antibody titer ( ). Persistence of antibody in these primarily 2-dose recipients P ! .001 supports the current elimination strategy to achieve and sustain high population immunity with a 2-dose schedule.

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