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Characteristics of Measles Cases -- United States, 1981

CDC has received detailed written information concerning investigations of 1,759 (58.0%) of the 3,032 measles cases provisionally reported in the United States in 1981. This information, submitted voluntarily by 35 states and 2 local health departments, has been reviewed to determine age, immunity status, and school and day-care-center attendance of the patients. These data have been useful in classifying measles cases by preventability, and measles patients by age and accessibility to school- and day-care-center based control measures.*

Of 1,759 persons with measles, 1,061 (60.3%) were school age, 5-19 years old (Table 1); an additional 547 measles cases (31.1%) involved preschool children. The other 151 patients (8.6%) were not in school-age or preschool groups.

Of the 1,759 measles cases, 780 (44.3%) were classified as not preventable because the patients were either too young or too old for routine vaccination, or because they had adequate evidence of immunity to measles. Of the 979 potentially preventable cases, 661 (37.6% of the total 1,759) were readily accessible to control measures, since the affected children attended schools or day-care centers. The other 318 persons (18.1%) were not readily accessible--not of school age or not known to attend a day-care center.

Of the 1,061 measles cases involving school-age children (Table 2), 638 (60.1%) were identified as potentially preventable. The remaining 423 children, although accessible, did not have preventable cases because they had adequate evidence of immunity to measles. A considerably higher percentage of preventable cases occurred in older schoolchildren.

Of the 547 measles cases among preschool-age children (Table 3), 285 (52.1%) were classified as not preventable: 219 (40.0%) children were less than 15 months old, and 66 (12.1%) had adequate evidence of immunity to measles. Of the 262 children with potentially preventable measles cases, 239 (43.7% of the total 547) were not listed as attending day-care centers and thus were not readily accessible to control measures. Therefore, only 23 (4.2%) measles cases occurring among the preschool-age children were both potentially preventable and in children readily accessible to control measures. Reported by participating state and local immunization programs; Immunization Div, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: This analysis represents the first time that information has been analyzed on a national basis to determine the potential preventability of reported measles cases and the accessibility of patients to school-based control measures. Limitations of the data must be taken into consideration in the analysis. Case reports were derived from a nonrandom sample of the total reported measles cases in 1981. Completeness of reporting varied among the reporting areas. If no immunity status or prior history of physician-diagnosed measles illness was provided, it was assumed that the person did not have adequate evidence of immunity to measles. If no day-care center was named, it was assumed that a preschool-age child did not attend a day-care center. Furthermore, incidence rates by vaccination status and day-care-center attendance cannot be determined because the denominator populations are not known. Nevertheless, the data are helpful in evaluating areas in which further emphasis in the measles elimination program should be placed.

A majority of cases occurred in the school-age population, a group that is easily accessible to control measures. The higher proportion of preventable cases in older children suggests that health authorities should continue to concentrate efforts on ensuring that junior and senior high school students have adequate evidence of immunity to measles.

Preliminary data indicate that although the actual number of cases in the preschool population decreased from 1980 to 1981, the proportion of cases occurring among preschoolers increased because of greater reductions in the number of cases among school-age children. This might have been expected since a major focus of the measles elimination effort is on school-law enforcement.

It is also expected that most preschool children who have measles are not attending organized day-care centers since many states have and enforce measles-vaccination regulations for day-care centers. Additional strategies implemented to improve immunization levels in preschool children include: postpartum maternal education programs, tracking systems for infants deemed to be at high risk of lacking vaccinations, recall systems for children who miss appointments for vaccinations, and intensive case containment activities. Additional efforts may be necessary to locate and vaccinate preschool children in those few areas of the country where substantial numbers of preschool cases are reported. *Potentially preventable case--measles illness occurring in a person at least 15 months of age and born after 1956 who lacked adequate evidence of immunity to measles. Adequate evidence of immunity--history of live measles vaccine on or after the first birthday (date of vaccination must be specified) or history of physician-diagnosed measles illness. Accessibility to control measures--enrollment in a recognized day-care center or age 5-19 years (old enough to attend school).

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