Elimination of endemic measles rubella and congenital rubella syndrome from the Western hemisphere: the US experience.

Printable Copy

JAMA Pediatr. 2014 Feb;168(2):148-55. doi: 10.1001/jamapediatrics.2013.4342.

Elimination of endemic measles rubella and congenital rubella syndrome from the Western hemisphere: the US experience.

Papania MJ¹ Wallace GS² Rota PA¹ Icenogle JP¹ Fiebelkorn AP² Armstrong GL² Reef SE³ Redd SB² Abernathy ES¹ Barskey AE⁴ Hao L¹ McLean HQ⁵Rota JS¹ Bellini WJ¹ Seward JF⁶.

Author information

Abstract

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 1000000 population. Since 2004 rubella incidence has been below 1 case per 10000000 population and CRS incidence has been below 1 case per 5000000 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. Sero prevalence 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.