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Absence of Reported Measles -- United States, November 1993

For the first time since measles reporting began in 1912, no measles cases have been reported in the United States for 3 consecutive weeks (November 7-November 27 {weeks 45-47}, 1993). In addition, no cases have been reported with onset since September 22 that were not directly linked with importations.

Of the provisional total of 277 measles cases reported in 1993 through November 27, a total of 57 persons had onsets of illness since July 4. Of these, 29 (51%) were imported or linked through a continuous chain of transmission to an imported case. Twelve (21%) cases resulted from continued transmission from measles outbreaks that began before July 4. Fourteen (25%) cases could not be linked to an existing outbreak, an international importation, or another reported case and were classified as sporadic index cases. Two cases were epidemiologically linked to these cases. Twelve of the 14 sporadic index cases were laboratory confirmed. Reported by: State and local health depts. National Immunization Program, CDC.

Editorial Note

Editorial Note: The 3-week period without reported measles cases reflects at least four factors: 1) major increases in measles vaccination coverage levels among preschool-aged children; 2) increased use of a second dose of measles vaccine among school-aged children and young adults attending college; 3) an overall increase in efforts to control measles throughout the Western Hemisphere; and 4) the usual seasonally low incidence of measles during the fall (1,2). Furthermore, the absence of any reported persons with sporadic index cases of measles who had onset after September 22 may reflect a cessation of endemic measles transmission in the United States during this period.

The absence of reported endemic foci of measles transmission does not indicate that measles has been eliminated in the United States. In the past, substantial numbers of measles cases were not reported to public health authorities (3). Therefore, surveillance must be intensified to permit the identification and elimination of any remaining foci of transmission. Any case of rash illness suspected to be measles should be reported promptly to public health authorities to enable immediate investigation and vigorous control measures to minimize spread of infection. For each case, laboratory confirmation should be obtained, vaccination status determined, and source of exposure ascertained.

Although current measles activity is at its lowest level ever in the United States, previous periods of low activity have been followed by resurgences (4,5). High vaccination coverage levels among preschool- and school-aged children need to be achieved and sustained in all communities to ensure the elimination of endemic measles transmission.


  1. CDC. Measles -- United States, first 26 weeks, 1993. MMWR 1993;42:813-6.

  2. Pan American Health Organization. Central America: defeating measles. EPI Newsletter 1993;XV(5):2-3.

  3. Davis SF, Strebel PM, Atkinson WL, et al. Reporting efficiency during a measles outbreak in New York City, 1991. Am J Public Health 1993;83:1011-5.

  4. CDC. Measles -- United States, 1982. MMWR 1983;32:49-51.

  5. Atkinson WL, Orenstein WA, Krugman S. The resurgence of measles in the United States, 1989-90. Annu Rev Med 1992;43:451-63.

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