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Cases have been reported from nine states and outbreaks are ongoing in four: Wisconsin, Arizona, Michigan, and New York.
Of the 64 cases, 59 occurred among U.S. residents and 54 were associated with importation of measles from other countries. Most (63) case-patients were unvaccinated or had unknown vaccination status; 1 had received two doses of vaccine. Of the 59 U.S. patients,
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-- 13 were < 12 months old
Too young to be vaccinated routinely
-- 7 were 12-15 months old
Not yet vaccinated
-- 21 were 16 months to 19 years old
14 (67%) claimed vaccination exemptions due to religious or personal beliefs
7 (all < 5 years of age) were unvaccinated due to delay or missed opportunities
-- 18 were > 20 years old
14 had unknown or undocumented vaccination status
2 (who acquired measles in Europe) claimed personal belief or religious exemptions
1 had evidence of immunity through birth before 1957
1 had documentation of receiving two doses of MMR vaccine
Unvaccinated children tend to be clustered geographically and/or socially, augmenting the risk for outbreaks. Transmission has occurred in community and healthcare settings, including homes, childcare centers, schools, hospitals, emergency rooms, and physicians' offices.
The 64 patients ranged in age from 5 months to 71 years:
-- 14 were < 12 months old (13 plus one visitor to the U.S.)
-- 18 were 1-4 years old
-- 11 were 5-19 years old
-- 18 were 20-49 years old
-- 3 were = 50 years old
14 patients were hospitalized; no deaths have been reported.
Spread of measles has been controlled or limited due to
1. high vaccination coverage in the U.S.
2. excellent two-dose vaccine performance
3. rapid and effective public health responses
These cases and outbreaks serve as a reminder that measles can and still does occur in the U.S. Ongoing measles virus transmission was declared eliminated in the U.S. in 2000, but the risk of cases and outbreaks from imported disease remains.
These cases and outbreaks resulted primarily from failure to vaccinate, many because of personal or religious belief exemption. This fact highlights
-- the ongoing risk of measles in unvaccinated persons
-- the risk that unvaccinated persons transmitting measles to others, including infants too young to be vaccinated
-- the importance of maintaining high levels of vaccination
Measles is an ongoing risk to those who choose not to be vaccinated and a risk to infants and children who have not yet received vaccine.
-- The measles cases and outbreaks in 2008 result primarily from failure to vaccinate, many because of personal or religious exemption
-- Unvaccinated persons are at risk for acquiring measles themselves and also of transmitting to others, including children too young to be vaccinated.
-- Increases in the proportion of the population declining vaccination for themselves or their children might lead to large-scale outbreaks in the U.S.
-- Israel and a number of countries in Europe (e.g., Switzerland, Austria, Ireland, United Kingdom) are currently experiencing sizeable measles outbreaks affecting their general populations or among populations refusing vaccination.
-- Maintaining high vaccine coverage with MMR vaccine in the U.S. population is critical for preventing measles cases and outbreaks in this country.
-- Pe
