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Current Trends Measles -- United States, 1982

In 1982, the reported occurrence of measles reached its lowest level since national reporting of measles began in 1912. A provisional total of 1,697 cases was reported, for a record low incidence rate of 0.7 cases per 100,000 population of all ages (Figure 1). This is a 99.7% reduction from the 1950-1962 prevaccine era when an annual average of 525,730 cases was reported (315.2 cases/100,000), and a 45.7% reduction from the 3,124 cases in 1981, the previous year of record low incidence (1.4 cases/100,000). Fewer than 100 cases were reported each week during the entire year, and record low weekly numbers of cases were reported in 37 weeks. Most reporting areas reported very few or no measles cases (Figure 2). Twenty-two states reported no indigenous cases all year, including 15 states that reported no cases--indigenous or imported.* Ninety-four percent (2,944) of the nation's 3,138 counties reported no measles cases during the entire year, and only 0.7% (22) of the counties reported measles during 5 or more weeks. Those 22 counties contained 14.4% of the U.S. population.

Of the 1,697 measles cases, 119 (7.0%) were imported, with sources in 32 different countries, for an average of 2.3 international importations* per week. In addition, 498 cases within the United States were epidemiologically linked to 19 international importations. Thus, international importations and associated cases together accounted for 36.4% (617/1,697) of all measles cases reported in 1982. *See CDC. Classification of measles cases and categorization of measles elimination programs. MMWR 1983;31:707-11.

Of the 1,697 measles cases, 1,072 (63.2%) occurred in 14 separate chains of transmission, each consisting of from two to 16 generations of infection, and 625 (36.8%) occurred sporadically. Sources were identified for 11 of the 14 chains of transmission. Of these, eight were international importations, two were out-of-state importations, and one was an indigenous case in a child with a medical exemption to vaccination. Reported by Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The measles elimination program is succeeding because of public health strategies** implemented to ensure immunization of targeted populations with a safe and highly immunogenic vaccine. However, as long as measles incidence rates are 10 to 10,000 times higher outside the United States than within it, international importations will remain potential sources of measles infection (1). Although relatively few imported cases are preventable (1,2), transmission has been limited when immunity levels are high.

Because indigenous measles is extremely rare in the United States, a major challenge now exists to maintain what has been achieved (3). Measles and other vaccine-preventable diseases will return if the imperative to vaccinate children is relaxed and immunization levels are allowed to fall. Long-term success requires a sustained effort to vaccinate each new birth cohort every year, and to eliminate remaining foci of transmission. Communities that are already measles-free can best preserve that accomplishment by maintaining high immunization levels in their children and intensifying surveillance for all suspected cases of measles. **Achievement and maintenance of high immunization levels, maintenance of strong and effective surveillance, and aggressive response to the occurrence of suspected cases.

References

  1. Amler RW, Bloch AB, Orenstein WA, Bart KJ, Turner PM, Hinman AR. Imported measles in the United States. JAMA 1982;248:2129-33.

  2. Turner PM, Amler RW, Orenstein WA. Measles surveillance: United States, imported measles, first 26 weeks of 1982. EPI Newsletter, Pan-American Health Organization 1982;IV(6):4-5.

  3. Kirby CD. Measles elimination--the final push and beyond. Proceedings of the 17th Immunization Conference, May 18-19, 1982, Atlanta: 7-9.



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