Acute Measles Mortality in the United States, 1987–2002

International Journal of Epidemiology, 2008

Background Global deaths from measles have decreased notably in past decades, due to both increases in immunization rates and decreases in measles case fatality ratios (CFRs). While some aspects of the reduction in measles mortality can be monitored through increases in immunization coverage, estimating the level of measles deaths (in absolute terms) is problematic, particularly since incidencebased methods of estimation rely on accurate measures of measles CFRs. These ratios vary widely by geographic and epidemiologic context and even within the same community from year-to-year.

The Journal of Infectious Diseases, 2010

Background. Measles affected entire birth cohorts in the prevaccine era but was declared eliminated in the United States in 2000 because of a successful measles vaccination program. Methods. We reviewed US surveillance data on confirmed measles cases reported to the Centers for Disease Control and Prevention and data on national measles-mumps-rubella (MMR) vaccination coverage during postelimination years 2001Ϫ2008. Results. During 2001Ϫ2008, a total of 557 confirmed cases of measles (annual median no. of cases, 56) and 38 outbreaks (annual median no. of outbreaks, 4) were reported in the United States; 232 (42%) of the cases were imported from 44 countries, including European countries. Among case-patients who were US residents, the highest incidences of measles were among infants 6-11 months of age and children 12-15 months of age (3.5 and 2.6 cases/1 million person-years, respectively). From 2001 through 2008, national 1-dose MMR vaccine coverage among children 19-35 months of age ranged from 91% to 93%. From 2001 through 2008, a total of 285 USresident case-patients (65%) were considered to have preventable measles (ie, the patients were eligible for vaccination but unvaccinated). During 2004-2008, a total of 68% of vaccine-eligible US-resident case-patients claimed exemptions for personal beliefs. Conclusions. The United States maintained measles elimination from 2001 through 2008 because of sustained high vaccination coverage. Challenges to maintaining elimination include large outbreaks of measles in highly traveled developed countries, frequent international travel, and clusters of US residents who remain unvaccinated because of personal belief exemptions. Measles is a highly infectious, acute viral disease that causes rash, respiratory symptoms, and fever. Severe complications, which may result in death, include pneumonia and encephalitis. In the decade before the national measles vaccine program was implemented in

The Western journal of medicine, 1993

During 1988 through 1990, California experienced its worst measles epidemic in more than a decade, with 16,400 reported cases, 3,390 hospital admissions, and 75 deaths. More than half of the patients were younger than 5 years; the highest incidence was among infants younger than 12 months. The epidemic centered in low-income Hispanic communities in southern and central California. The major cause of the epidemic was low immunization levels among preschool-aged children and young adults. Rates of complications, admission to hospital, and death were surprisingly high. Outbreak control efforts met with indeterminate success. Problems with these efforts included insufficient funding early in the epidemic and disappointing public response to community-based immunization campaigns. The cost of medical care and outbreak control for the epidemic is conservatively estimated at $30.9 million. Unless the level of immunization in preschool-aged children is increased, this type of epidemic will ...

Research Article, 2017

Abstract: To determine the risk factors and complications in patients expired due to measles. Background: Measles is one of the vaccine-preventable diseases. Mortality and morbidity due to it has been decreased in many countries with preventive measures. However, epidemics occur off and on in some communities. Pakistan has faced an epidemic in 2012-13. Started from one province and affected others. Due to some risk factors, Pakistani children suffered from many complications. Place & Duration: Measles ward, the Children`s Hospital, Lahore form February to June 2013. Methodology: All patients who were admitted and expired in measles ward were included in the study. A Performa was filled for each patient to document the risk factors and complications in affected patients. Results: 1075 patients were admitted. 44 expired. 27 were males. Minimum age of patients who expired was 3 months and maximum was 7 years. Maximum deaths were in group 4: 27% (12/44), followed by group 2: 23% (10/44). 30 (68%) were malnourished having weight less than 5th centile. 70% of the patients died within 24 hours (31/44) because of severity of illness. 82% (36/44) patients had contacts in families or society. 86% (38/44) patients were unvaccinated and only one patient received two doses (2%). 17 patients had co-morbid conditions. These were; cystic fibrosis, dilated cardiomyopathy, complex cyanotic heart disease, Gaucher`s disease, hypothyroidism, chronic renal failure, hepatitis (3), seizures disorders, pulmonary tuberculosis, hydrocephalus, Aplastic anemia and severe nutritional anemia (3). Complications documented were; pneumonia (measles pneumonia with superadded bacterial infection) 100% (n=44), Encephalitis 47% (n=21), Enteritis 9% (n=4) and respiratory failure 4.5 % (n=2). Conclusion: Lack of vaccination is the most important risk factor for mortality, followed by malnutrition and co-morbid illness.

The Journal of Infectious Diseases, 2004

To estimate population immunity, we examined measles immunity among residents of the United States in 1999 from serological and vaccine coverage surveys. For persons aged у20 years, serological data from the third National Health and Nutrition Examination Survey (1988-1994) were used. For persons !20 years of age, immunity was estimated from results of the National Immunization Survey (1994-1998), state surveys of school entrants (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000), and vaccine coverage surveys of adolescents (1997). To estimate immunity from vaccine coverage data, 95% vaccine efficacy was used for recipients of a single dose at у12 years of age and 99% vaccine efficacy was used for those with failure of a first dose who were revaccinated. Overall, calculated population immunity was found to be 93%. Although there was not much variation in immunity by region and state, in some large urban centers immunity among preschool-aged children was as low as 86%. Overall, geographic-and age-specific estimates of a high population immunity support the epidemiological evidence that measles disease is no longer endemic in the United States.

Clinical Infectious Diseases, 2014

New England Journal of Medicine, 2006

Journal of Infectious Diseases, 2011

New England Journal of Medicine, 2012