The epidemiologic rationale for the failure to eradicate measles in the United States.

Conrad, Jonas; Wallace, R. B.; Witte, J J

doi:10.2105/ajph.61.11.2304

Cited by 25 publications

(4 citation statements)

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“…Over the years, the U.S. experienced several failures, but systematically incorporated the lessons learned from each failure into subsequent efforts, and finally achieved the goal in 2000 [ 17 , 18 ]. Key lessons learned from the efforts include: (1) elimination requires very high MCV vaccination coverage by age 2 years, (2) a second dose of measles vaccine is needed to achieve satisfactory levels of immunity, and (3) coverage assessment is crucial [ 17 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Measles vaccine coverage estimates in an outbreak three years after the nation-wide campaign in China: implications for measles elimination, 2013

Zheng³

et al. 2015

BMC Infect Dis

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BackgroundChina is approaching measles elimination, but indigenous measles still circulates. County L in China has reported measles-containing vaccine (MCV) coverage rates >95% since 2000. Despite high reported coverage, a large measles outbreak occurred among young children in L County. We measured MCV coverage using 5 different methods during an investigation on this outbreak and compared our estimates with reported rates.MethodsReported coverage rates are determined by aggregating clinic-based data across the county: doses administered in each clinic divided by the number of children registered in each clinic. Our methods estimated coverage for the 2010–2012 birth cohort, and were (1) administrative method: doses administered in clinics divided by the birth cohort recorded in the Statistical Year Book, (2) house-to-house convenience-sample survey of children living near cases, (3) vaccination clinic records review, (4) determination of a convenience sample of measles outbreak cases’ vaccination statuses and using the field vaccine efficacy outbreak equation to estimate population coverage, and (5) a seroprevalence survey using a convenience sample of residual blood samples from hospitals.ResultsThe measles outbreak totaled 215 cases, representing an incidence of 195.8 per million population. Our estimated MCV coverage rates were: (1) administrative method: 84.1%-87.0% for MCV1 and 80.3%-90.0% for MCV2, (2) in-house survey: 83.3% of 9–17 month children received MCV1, and 74.5% of 24–47 month children received MCV2, (3) clinic record review: 85.5% of 9–17 month children received MCV1, and 73.2% of 24–59 month children received MCV2, (4) field VE method: 83.6% of 9–47 month children received one or more MCV doses, and (5) serology: seropositive rates were <80% in the 12–17 and 18–23 month age cohorts.ConclusionsCompared with reported coverage >95%, our 5 coverage assessments all showed substantially lower coverage. China should evaluate guidelines for reporting vaccination coverage and identify feasible improvements to the assessment methods.

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Section: Discussionmentioning

confidence: 99%

Measles vaccine coverage estimates in an outbreak three years after the nation-wide campaign in China: implications for measles elimination, 2013

Zheng³

et al. 2015

BMC Infect Dis

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“…9 Clearly, 55% was not the herd immunity threshold and his feeling was Ͼ90% immunity would be needed. Estimates were that the immunity level achieved was only 72%.…”

Section: Measles Eradication-1966 -1968mentioning

confidence: 99%

The Role of Measles Elimination in Development of a National Immunization Program

Orenstein

2006

The Pediatric Infectious Disease Journal

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The U.S. Immunization Program has been one of the most successful efforts in preventive medicine. Since its beginning with passage of the Vaccination Assistance Act in 1962, polio, measles and rubella have been eliminated and many other vaccine-preventable diseases are at record or near record lows. In 1966, 3 years after licensure of the first measles vaccines, the Centers for Disease Control and Prevention began an effort to eliminate measles within the United States, an on-and-off effort that was to last more than 30 years. With measles elimination as the primary driver, fundamental components of today's immunization program were built that affected not only measles, but all of the vaccines and vaccine-preventable diseases of childhood. Some of the major contributions were the enactment and enforcement of immunization requirements for school attendance in all 50 states, enactment of an entitlement program for vaccine purchase, the Vaccines for Children Program, support for health services research to determine reasons for nonimmunization and interventions to improve coverage, development of standards for immunization practices and the measurement system for immunization coverage in all 50 states and 28 major urban areas. Key lessons have been: (1) the program must rest on a sound base of vaccine science and health services science; (2) having a limited number of measurable goals allows program focus, but consider strategies that have crosscutting impact; (3) accountability is critical to program performance at all levels-state, local and individual practice; and (4) establishing and maintaining political support is essential.

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“…The most crucial factor in the failure to achieve eradication was the failure to reach and sustain universal infant immunization with measles vaccine [6]. Measles vaccine coverage among 1-to 4-year-old children did not exceed 63% for any year, according to the US Immunization Survey (figure 3).…”

Section: Us Measles Elimination Effortsmentioning

confidence: 99%

“…Conrad et al [6] ascribed the failure to achieve eradication of measles in the United States to incomplete implementation of the strategy rather than to a faulty strategy. They surmised that the immunity threshold needed to eradicate measles was 190% and concluded, "no scientific reason has yet arisen to make us believe that eradication of measles was not possible.…”

Section: Us Measles Elimination Effortsmentioning

confidence: 99%

Evolution of Measles Elimination Strategies in the United States

Hinman

Orenstein

Papania

2004

The Journal of Infectious Diseases

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There have been 3 efforts to eliminate measles from the United States since the introduction of measles vaccine in 1963. To date, 10 major lessons have been learned from elimination efforts. First, elimination requires very high vaccination-coverage levels by age 2 years. Second, school immunization requirements ensure high coverage rates among schoolchildren. Third, a second dose of measles vaccine is needed to achieve satisfactory levels of immunity. Fourth, school immunization requirements can also ensure delivery of a second dose. Fifth, coverage assessment is crucial. Sixth, measles surveillance is critical for developing, evaluating, and refining elimination strategies. Seventh, surveillance requires laboratory backup to confirm a diagnosis. Eighth, tracking measles virus genotypes is critical to determining if an endemic strain is circulating. Ninth, once endemic transmission has been interrupted, internationally imported measles cases will continue and will cause small outbreaks. Tenth, collaborative efforts with other countries are essential to reduce imported measles cases.

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The epidemiologic rationale for the failure to eradicate measles in the United States.

Cited by 25 publications

References 1 publication

Measles vaccine coverage estimates in an outbreak three years after the nation-wide campaign in China: implications for measles elimination, 2013

Measles vaccine coverage estimates in an outbreak three years after the nation-wide campaign in China: implications for measles elimination, 2013

The Role of Measles Elimination in Development of a National Immunization Program

Evolution of Measles Elimination Strategies in the United States

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