Since late December 1988, more than 1600 cases of measles have
been
reported in the province of Quebec, Canada. Five hundred of the
cases
have occurred in metropolitan Montreal. In 199 (40%) of these
cases,
the onset of rash occurred in April (Figure 1). Detailed
information is
available for 486 (97%) of the 500 Montreal cases. Of these, 104
(21%)
occurred in preschoolers aged 0-4 years, 328 (67%) in school- aged
persons 5-19 years of age, and 54 (11%) in adults greater than or
equal
to 20 years of age. Of the adults, 42 (78%) were aged 20-29 years.
Of
school-aged patients, 191 (58%) had histories of previous
vaccinations.
From January through March, "Operation Mise a jour" (Operation
Update)
was conducted in Montreal to ensure that all primary and secondary
school students were adequately vaccinated against measles. Before
this
campaign, approximately 50,000 of the 285,000 Montreal primary and
secondary school students lacked documentation of vaccination.
During
the campaign, approximately 30,000 (60%) of these students were
vaccinated.
Reported by: RS Remis, MD, L Bedard, MScN, R Palmer, Bureau
regional
des maladies infectieuses; Les departements de sante communautaire
du
Regroupement de DSC du Montreal metropolitain; Centres locaux de
services communautaires du Montreal metropolitain, Montreal; PM
Lavigne, MD, Provincial Epidemiologist, Quebec City, Quebec;
Laboratory
Centre for Disease Control, Ottawa, Ontario, Canada. Div of
Immunization, Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: Quebec does not require measles vaccination for
school
attendance. Because of increased emphasis on childhood
immunizations
since the early 1980s, measles vaccine coverage among children 1-4
years of age is estimated to be greater than 95%. Vaccine coverage
in
schools is lower. In the Montreal area before the outbreak,
approximately 90% of primary school students and 70% of secondary
school students had proof of measles immunity. School immunization
requirements in the United States have been shown to be an
effective
means of increasing vaccine coverage among school-aged children and
of
decreasing the incidence of measles (1).
The U.S. Immunization Practices Advisory Committee (ACIP)
recommends
that all persons born after 1956 who are greater than or equal to
15
months of age have evidence of measles immunity (i.e.,
documentation of
receipt of live measles vaccine on or after the first birthday,
physician-diagnosed measles, or laboratory evidence of measles
immunity). In addition, the ACIP recommends that persons born after
1956 who travel abroad receive a one-time dose of measles vaccine,
regardless of their previous vaccination status, unless there is a
contraindication to receipt of vaccine (2). Persons born before
1957
are not considered susceptible. All persons planning to travel to
Quebec or to other areas with ongoing measles activity, including
those
within the United States, should ensure that their measles
vaccination
status is adequate.
References
Robbins KB, Brandling-Bennett D, Hinman AR. Low measles
incidence:
association with enforcement of school immunization laws. Am J
Public
Health 1981;71:270-4.
2.ACIP. Measles prevention. MMWR 1987;36:409-18,423-5.
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