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Measles -- United States, First 26 Weeks, 1983

Provisional data for the first 26 weeks of 1983 (January 2-July 2) show an 11.0% increase (1,037 vs. 934) in reported measles cases in the United States, compared with the same period in 1982 (Figure 1). Transmission was limited to a few foci; 97% of the nation's 3,138 counties reported no measles cases during the 26-week period. Of the 1,037 reported cases, 784 (75.6%) occurred in 16 separate outbreaks or chains of transmission*. Eight of the 16 outbreaks occurred on college and university campuses.

The proportion of all measles cases on college campuses has increased from 1.5% (200/13,506) in 1980 to 27.2% (282/1,037) in the first 26 weeks of 1983 (Table 1). During the latter period, cases were reported from 22 campuses in 14 states. In addition, 248 secondary cases resulted from campus outbreaks; campus outbreaks and campus-associated cases together accounted for 51.1% (530/1,037) of all reported measles cases in the first 26 weeks of 1983. Extensive outbreaks lasting more than two generations occurred in Indiana, Ohio, and Texas (2,3). The outbreak that began at Indiana University ultimately accounted for 38.9% (403/1,037) of all measles cases reported in the United States in the first 26 weeks of 1983. During the Ohio outbreak, younger siblings of undergraduates visited the campus for a special event; one incubation period later, at least six siblings--all high school students--were reported to have measles. One of them caused a school-based outbreak in Summit County, Ohio, that has resulted in 49 additional cases to date.

Of the 1,037 reported cases, 51 (4.9%) were international importations, and nine (0.9%) were out-of-state importations. The international importations were reported in travelers (30 U.S. citizens and 21 foreign nationals) who arrived from 23 countries. The number of international importations (51) was not substantially different from that reported in the first 26 weeks of 1982 (64) (4). Two of the international importations occurred in college students; one was the index case for a campus outbreak in Louisiana.

Overall, campus outbreaks, campus-associated cases, and international importations accounted for 61.6% (639/1,037) of reported measles cases in the first 26 weeks of 1983, leaving 398 indigenous, non-campus-associated cases, a 37.6% reduction from the same period in 1982. Reported by RG Blankenbaker, MD, State Health Officer, G Chastain, CL Barrett, MD, State Epidemiologist, Indiana State Board of Health; CT Caraway, DVM, State Epidemiologist, Louisiana Dept of Health and Human Svcs; KM Sullivan, TJ Halpin, MD, State Epidemiologist, Ohio State Dept of Health; CE Alexander, MD, CR Webb, MD, State Epidemiologist, Texas State Dept of Health; Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Campus outbreaks, campus-associated cases, and imported cases have accounted for a greater proportion of reported measles cases in the first 26 weeks of 1983 than in previous years. Data continue to show that the impact of imported measles is limited when immunity levels are high (5,6). However, the increased morbidity on campuses is of special concern because measles is a more serious disease in adults than in schoolchildren; mortality rates from measles have been highest among adults in recent years (7).

Predictably, the most dramatic reductions in measles incidence rates have occurred among schoolchildren--a group easily targeted by school immunization laws. Provisional data indicate that 97% of children entering kindergarten and first grade in the fall of 1982 had documented immunization against measles. In contrast, immunization levels on campuses are difficult to assess because very few colleges and universities require immunization records. The susceptibility problem on campuses has two components--inadequate protection and inadequate documentation. The former allows outbreaks to occur, while the latter escalates the cost of control by necessitating expensive, rapid record reviews. In addition, many students who were previously vaccinated but who lack immunization records may have to be vaccinated unnecessarily. The Indiana University outbreak alone, excluding campus-associated outbreaks, cost over $250,000 to control.

To avoid such problems, colleges and universities should ensure that students are protected before an outbreak occurs. A permanent immunization record should be maintained in each student's academic file. Information can be updated when appropriate (e.g., for foreign travel) and will be available in the event of an outbreak. Although there is no vaccination requirement for entering the United States, it is recommended that students who anticipate foreign travel (as well as foreign students planning to study in the United States) have documentation of immunity to measles** before they travel (5). Because there is no evidence of adverse reactions following vaccination of immune individuals, combined measles-mumps-rubella (MMR) vaccine should be used whenever a person is likely to be susceptible to more than one component (8).

Indigenous measles is now extremely rare in the United States, with no cases reported in week 28. The final challenge is to break the remaining chains of transmission, particularly on college and university campuses.


  1. Amler RW, Bloch AB, Orenstein WA, et al. Measles in the United States: Chains of transmission. Proceedings of the 18th Immunization Conference, May 16-19, Atlanta: CDC (in press).

  2. CDC. Measles outbreaks on university campuses--Indiana, Ohio, Texas. MMWR 1983;32:193-5.

  3. CDC. Measles in universities--Indiana, 1983. MMWR 1983;32:113-4.

  4. CDC. Measles--United States, first 26 weeks, 1982. MMWR 1982;31:381-2.

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

  6. CDC. Measles importations--United States, 1982. MMWR 1983;32:178-9.

  7. Amler RW, Kim-Farley RF, Orenstein WA, Doster SW, Bart KJ. Measles on campus. J Am College Health Assoc 1983 (in press).

  8. Immunization Practices Advisory Committee. Measles prevention. MMWR 1982;31:217-24, 229-31.

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