Download - Status of the Measles Outbreak
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National Press Foundation
Washington, DC
February 23, 2015
National Center for Immuniation and !es"iratory Diseases
Status of Measles Outbreak
Protecting the Public with Vaccines
Anne Schuchat, MD
!#D$, %& Publi' (ealth &er)i'e
#ssistant &urgeon *eneral
Dire'tor, National Center for Immuniation and !es"iratoryDiseases
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Pro)isional data as of February 20, 2015
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0
100,000
200,000
300,000
+00,000
500,000
00,000
Year
Number of cases
1989 – 2nd Dose
Recommended
Measles Cases, United States, 196!"1#$
1963Vaccine
Licensed 1989-1991
Resurgence
1993
Vaccines for
Children
Program2000
Elimination
Declared
-201+ "ro)isional total as of De' 31st 201+
0
5,000
10,00015,000
20,000
25,000
30,000
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Measles %limination$ in theU&S&
• De'lared in 2000 and a'hie)ed due to. – (igh t/odose )a''ine 'o)erage
– (igh uality measles sur)eillan'e and res"onse
– Im"ro)ed measles 'ontrol in the World (ealth
rganiation !egion of the #meri'as
• limination does not mean 4gone fore)er
im"orted 'ases and limited s"read o''ure)ery year
- De6ned as interru"tion of 'ontinuous measles transmission forlasting 7 12 months
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Measles, United States, ""1!"1#$'(m)ortations indicated b* red bar, a+ailable since""1
-201+ "ro)isional total through De' 31st
0
100
200
300
400
500
600
700
No of Cases
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Measles %)idemiolo-* US, ""1!"11
Median 6" cases.*ear 'ran-e /0 to " (m)ortations //.*ear, ma2orit* in US
residents 3 4 cases hos)itali5ed
deaths in a))roimatel* 1,""" cases (ncidence 7 1 case.million )o)ulation
(ighest ages"e'i6' in'iden'e in infants, lo/est in adults
8accination status
58 un)a''inated 208 un9no/n )a''ination status
158 )a''inated
# outbreaks.*ear 'ran-e !1 $edian sie 'ases :33+ 'ases;
<C %& National !e"ort. to P#( on Do'umentation and )eri6'ation of measles, rubella and C!&
ination in the #meri'as
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Measles "11 ! "1#
e)orted cases ", 33, 1:9, 6## $edian 205
$ean 2
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$easles, %?&?, 2001Feb 20, 2015-Cumulati)e Number by $onth of !ash nset
- Pro)isional total 201+
- 2015 data to Feb 20, 2015
Jan Feb Mar !r Ma" J#n J#$ #% &e! 'c( No) Dec0
100
200
300
400
500
600
700 2001
2002
20
032004
2005
2006
2007
N # m
b e r o f C a s e s * C
# m # $ a ( + ) e ,
Feb 20, 2015
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Measles U&S& "1#$ 6## cases re)orted from 0 states includin-
/ outbreaks 0 im"ortations
25 from the Phili""ines and @ from India
5+ :@18; among %& residents
@=8 'ases im"ortasso'iated
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(ncidence.million
U&S&, "1#
"
31"
13
"
3
11
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$easles, %?&?, 1@@
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%+er* Measles Case e>uires?ublic @ealth olloB!u)
1+
(os"ital
Child'are'enters
Widelyattended
gatherings!
rans"ortation
Family
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easles "13
Most cases un+accinated orBith unknoBn +accinationstatus
0 im)ortations from
A5erbai2an, (ndonesia, atar,?akistan, Dubai.(ndia,Sin-a)ore.(ndonesia,Af-hanistan
Adult and child cases Measles -enot*)es / , D:
and D9 Child care center cases (E
•2 outbrea9s• #musement "ar9asso'iated 15
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Measles outbreak res)onse has a hi-heconomic burden in the U&S&
-Publi' health and health 'are 'osts eA"ended to 'ontrol the s"read of
Year
Eocation
Numberof cases'outbrea
ks
%stimated )ublic healthcost$
2011
%& 10< :1; 2?
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Geys to $aintaining $easles
limination in the %?&?• (igh 2dose $$! )a''ination 'o)erage
• (igh uality sur)eillan'e system
•
!a"id identi6'ation of and res"onse to measles'ases
• $easles is re"ortable /ithin 2+ hours "er Coun'ilof &tate and erritorial "idemiologists guidelines
• #ggressi)e outbrea9 'ontrol measures
• #''ess to reliable laboratory testing 'a"abilities
• *enoty"ing 'an gi)e 'lues to sour'e in someinstan'es
•
Information sharing tools :"iH, (#N;1<
hin9ing beyond ourborders
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Infogra"hi' on tra)el and 'ases
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MM 8accine outineecommendations$
2013 #CIP !e'ommendations at htt".BB///?'d'?go)Bmm/rB"dfBrrBrr20+?"df -#CIP, ##PBCID, ##FP, #C*, #CP, #CN$ a)ailable at htt".BB
///?'d'?go)B)a''inesBs'hedulesBh'"Badult?html
Children and adolescents /o doses at 1215 months and + years or at least 2=
days after the 6rst dose
Cat'h u" )a''ination as needed
Adults Bithout e+idence of measlesimmunit* /o doses :health'are "ersonnel, "ost high s'hool
students, tra)elers;
ne dose :others;
http://www.cdc.gov/mmwr/pdf/rr/rr6204.pdfhttp://www.cdc.gov/vaccines/schedules/hcp/adult.htmlhttp://www.cdc.gov/vaccines/schedules/hcp/adult.htmlhttp://www.cdc.gov/vaccines/schedules/hcp/adult.htmlhttp://www.cdc.gov/vaccines/schedules/hcp/adult.htmlhttp://www.cdc.gov/vaccines/schedules/hcp/adult.htmlhttp://www.cdc.gov/mmwr/pdf/rr/rr6204.pdfhttp://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf
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MM 8accine Fra+elecommendations
?ersons a-ed G1 months Bithout othere+idence of immunit* should recei+e doses$ In'ludes "ro)iding a 2nd dose to 'hildren "rior to age + yrs
In'ludes adults-- /ho ha)e only re'ei)ed one routine dose inthe "ast
Children a-ed 6!11 months should recei+e 1dose If )a''inated at age 11 months, still need 2 subseuent
doses at age 12 months
2013 #CIP !e'ommendations2nd dose of $$! )a''ine should be administered at least 2= days after the 1 st dose-- Jorn in 1@5< or later
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eem)ted from recei+in- one or more
+accines and Bith 79"4 co+era-e Bith
doses of MM +accine
Data &our'e. $$W!, 'tober 11+ s'hool year
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22&our'e. Immuniation #'tion Coalition
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Lery fe/ toddlers ha)ere'ei)ed no )a''ines at all
200= 200@ 2010 2011 2012 20130
1
"&6 "&6"&0
"&: "&:
"&08 ero dose 'hildren
@?"" HoalI714
National Immuniation &ur)ey, 1@35 month old 'hildren, %&, 200= > 2013$$W! 3:3+;K
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Com)arison of "th Centur* Annual Morbidit* and
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Com)arison of "th Centur* Annual Morbidit* andCurrent Morbidit*I 8accine!?re+entable Diseases
(istori'al Com"arisons of La''inePre)entable Disease $orbidity in the %?&?
Disease
20th Century
Annual Morbidity†2014
Reported Cases † †Percent
Decrease
Smallpox 2!00" 0 100#
Diphtheria 21!0"$ 1 % #
Measles "$0!21& '2( % #
Mumps 1'2!$44 1!1"1 #
Pertussis 200!&"2 2(!''0 ('#
Polio )paralytic* 1'!$1' 0 100#
Rubella 4&!&4" ( % #
Con+enital Rubella Syndrome 1"2 0 100#
,etanus "(0 21 '#
Haemophilus influenzae 20!000 2&- % # JM. 2007/298*18,2155-2163 CDC. MMR Jan#ar" 9 2015 63*53,/ND-733-ND-746. *MMR 2014 !ro)+s+ona$ ee 53 da(a,
Haemophilus influenzae ("!e b *+b, 5 "ears of a%e. n add+(+ona$ 12 cases of +b are es(+ma(ed (o a)e occ#rred amon% (e 226
re!or(s of + * 5 "ears of a%e, +( #nnon sero("!e.
1/9/2015
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Measles (n the ?ostelimination %ra
Measles is due to ailure to 8accinate
Measles %limination is a Hlobal ?roblem Continued threat of im"ortations
Measles occurs in the U&S&
Maintenance of elimination is challen-in- andresource intensi+e
$aintaining )a''ine 'o)erage > in'reasing )a''ine eAem"tion Intensi)e 'aseB'onta't in)estigations
(ealth'are /or9ers diagnosti' s9ills
#d)an'ed laboratory te'hniues
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JhatKs a 2ournalist to do
Co+erin- stories +s& numbers Problems /ith numbers
Peo"le in)ol)ed
• #Me'ted, isolated, in'on)enien'ed
• Institutional im"a'ts M*ths +s& facts A+oid the tra)s associated Bith Le>ual
time
SkeBin- im)ressions +s& reco-ni5in- socialnorms
2<
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///?'d'?go)Bmeasle
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AcknoBled-ements
&tate and lo'al health de"artments
CDC staM . measles e"idemiology, laboratory,health e'onomi's, 'ommuni'ations, "oli'y
ane &e/ard
*reg Walla'e #my Fiebel9orn
Paul *astanaduy
&usan !edd
Na9ia Clements
$ar9 Pa"ania &usan !eef
William Jellini
$i'helle Jas9et
eresa &mith
Natarsha hom"son
Paul !ota
ennifer !ota Ismael rtega&an'he
eanette &t Pierre
&arah Poser
essi'a #llen
$ar9 Pallans'h Garen $ason
Candi'e &/art/ood
Gristin Po"e
Nan'y $essonnier