The End of Measles and Rubella…

JAMA Pediatrics
February 2014, Vol 168, No. 2

The Beginning of the End of Measles and Rubella
Mark Grabowsky, MD, MPH
Measles was first imported into the New World in the early 16th century by European colonists, often with devastating effects on native populations. Rubella importation followed and led to congenital rubella syndrome. It is estimated that during the following 5 centuries, more than 200 million people globally died of measles. Disease incidence fell rapidly after the availability of vaccines in the United States for measles in 1963 and rubella in 1969, and after the availability of a combined measles-rubella vaccine in 1971. As vaccination expanded into other countries of the Americas, the Pan American Health Organization established a goal to eliminate measles from the Western hemisphere by 2002 and rubella by 2010. By 2004, transmission had been interrupted in the United States. However, there has been concern that pockets of transmission persisted or that transmission could be reestablished if immunization coverage levels declined.

Elimination of Endemic Measles, Rubella, and Congenital Rubella Syndrome From the Western Hemisphere: The US Experience
Mark J. Papania, MD, MPH; Gregory S. Wallace, MD, MPH; Paul A. Rota, PhD; Joseph P. Icenogle, PhD; Amy Parker Fiebelkorn, MSN, MPH; Gregory L. Armstrong, MD; Susan E. Reef, MD; Susan B. Redd; Emily S. Abernathy, MS; Albert E. Barskey, MPH; Lijuan Hao, MD; Huong Q. McLean, PhD; Jennifer S. Rota, MPH; William J. Bellini, PhD; Jane F. Seward, MBBS
Importance  To verify the elimination of endemic measles, rubella, and congenital rubella syndrome (CRS) from the Western hemisphere, the Pan American Health Organization requested each member country to compile a national elimination report. The United States documented the elimination of endemic measles in 2000 and of endemic rubella and CRS in 2004. In December 2011, the Centers for Disease Control and Prevention convened an external expert panel to review the evidence and determine whether elimination of endemic measles, rubella, and CRS had been sustained.

Objective  To review the evidence for sustained elimination of endemic measles, rubella, and CRS from the United States through 2011.

Design, Setting, and Participants  Review of data for measles from 2001 to 2011 and for rubella and CRS from 2004 to 2011 covering the US resident population and international visitors, including disease epidemiology, importation status of cases, molecular epidemiology, adequacy of surveillance, and population immunity as estimated by national vaccination coverage and serologic surveys.

Main Outcomes and Measures  Annual numbers of measles, rubella, and CRS cases, by importation status, outbreak size, and distribution; proportions of US population seropositive for measles and rubella; and measles-mumps-rubella vaccination coverage levels.

Results  Since 2001, US reported measles incidence has remained below 1 case per 1 000 000 population. Since 2004, rubella incidence has been below 1 case per 10 000 000 population, and CRS incidence has been below 1 case per 5 000 000 births. Eighty-eight percent of measles cases and 54% of rubella cases were internationally imported or epidemiologically or virologically linked to importation. The few cases not linked to importation were insufficient to represent endemic transmission. Molecular epidemiology indicated no endemic genotypes. The US surveillance system is adequate to detect endemic measles or rubella. Seroprevalence and vaccination coverage data indicate high levels of population immunity to measles and rubella.

Conclusions and Relevance  The external expert panel concluded that the elimination of endemic measles, rubella, and CRS from the United States was sustained through 2011. However, international importation continues, and health care providers should suspect measles or rubella in patients with febrile rash illness, especially when associated with international travel or international visitors, and should report suspected cases to the local health department.