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Measles -- Quebec

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

  1. 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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