The 1991 measles epidemic in Israel.

INTRODUCTION AND METHODS. Prior to the institution of universal childhood vaccination against measles in Israel in 1967, large outbreaks occurred in epidemic cycles at intervals of 2-4 years. The mean annual incidence in the pre-vaccination period, 1950-66, was 470/100,000 per year. With the institution of routine measles vaccination, incidence rates fell, and since 1970 measles incidence has averaged less than one-tenth the pre-vaccination incidence rate, although epidemics occurred in 1975, 1982, 1984-85, and 1991. In this report, based upon cases of measles reported to and investigated by the Ministry of Health, we present an analysis of the 1991 measles epidemic, the measures taken to contain it, and an overview of the prospects for measles control in Israel in the future. RESULTS AND CONCLUSIONS. The 1991 measles epidemic, 1036 reported cases (incidence: 20.0/100,000), began in the south of the country among underimmunized Beduin children and spread to the Jewish population in the south and then to the rest of the country. The highest incidence was in children aged 12-23 months, followed by children less than 12 months of age and children aged 2-4 years. In the main, cases occurred in persons never immunized in the past, but in 37% of cases vaccine failure seems to have occurred. Control measures included mass vaccination of children in the south and lowering the age for routine measles vaccination nationwide to 12 months. Despite very substantial gains towards measles control in Israel, elimination of the disease is not a realistic goal, mainly because the transmission potential of the disease is too high and vaccine coverage and efficacy are not high enough. Trends in measles incidence over the last four decades allow a cautious optimism that measles containment can be achieved.     

Measles in Poland in 2001

The number of notified measles cases in Poland in 2001 was 133, incidence per 100,000 inhabitants was 0.3. The low incidence has been observed for the last 3 years. Only 73 out of 133 cases were serologically confirmed, 6 other cases were epidemiologically linked to the laboratory confirmed cases. Unvaccinated cases have accounted for almost half of cases. Differences in incidence were noticed across the country and ranged from 0 cases in Opolskie and Zachodniopomorskie voivodeships to 0.7/100,000 in Ma?opolskie and 1.0/100,000 in Swietokrzyskie voivodeship. The highest incidence was observed in the children one year of age (3.7/100,000) and seven years old (2.3/100,000), however, in general, the age distribution of cases has been shifted toward older ages with 44 cases (33% of all cases) in adults. A proportion of children 13-24 months of age vaccinated with first dose of measles vaccine was 77.1%, and proportion of seven years old children vaccinated with second dose of measles vaccine was 81.7%.     

中国2012~2013年麻疹流行病学特征与消除麻疹进展

目的分析中国(未包括香港、澳门特别行政区和台湾地区,下同)2012~2013年麻疹流行病学特征和消除麻疹的策略与措施,为消除麻疹提供参考。方法对中国2012~2013年麻疹发病、麻疹监测系统(Measles Surveillance System,MSS)运转指标,以及采取的消除麻疹策略与措施进行描述流行病学分析。结果中国2012年报告麻疹发病率为0.46/10万(6183例),报告死亡8例;2013年报告麻疹发病率为2.04/10万(27 646例),报告死亡24例。2013年报告发病率、病例数、死亡数分别较2012年增加343.48%、347.13%、200.00%。2012年未出现3~5月的麻疹发病季节高峰,但2013年较为明显。2012年和2013年,青海、广东省和新疆维吾尔自治区报告发病率均居全国前5位,2012年全国有1074个县(区、市、旗,下同)、2013年有1871个县有麻疹病例报告。两年均以8月婴儿麻疹发病率最高,其后依次为8~23月龄、2~6岁、15~34岁、7~14岁、≥35岁。2012年8月龄、8~23月龄、2~6岁、7~14岁、≥15岁麻疹病例分别占24.47%、33.92%、11.95%、2.41%、27.25%,2013年分别占30.81%、29.59%、10.34%、2.29%、26.97%。两年8~23月龄麻疹病例无含麻疹成分疫苗(Measles-containing Vaccine,MCV)免疫史的均70%,2~3岁麻疹病例中约50%无MCV免疫史。2012~2013年MSS各项运转指标中,排除麻疹病例报告发病率均2/10万,疑似麻疹病例48h内完整调查率、散发疑似麻疹病例血标本采集率、血清学检测结果 7d内报告率均97%,麻疹爆发疫情病原学标本采集率80%。2012~2013年共报告了2009例麻疹病例基因型鉴定结果,H1a基因亚型所占比例均96%。结论中国消除麻疹虽然取得了明显进展,但仍存在薄弱地区、薄弱人群,经过近年易感者的积累,麻疹疫情开始反弹。需要扎实地落实既定的消除麻疹策略与措施,包括以提高适龄儿童MCV及时、全程接种率为核心,重点地区必要时开展选择性或非选择性MCV补充免疫活动,加强麻疹监测,提高MSS敏感性,做好麻疹疫情调查与处置,并关注小月龄婴儿和成人易感者在麻疹病毒传播中的作用、探讨针对性的策略与措施。     

Measles susceptibility in children in Karachi, Pakistan

Measles, despite being vaccine preventable is still a major public health problem in many developing countries. We estimated the proportion of measles susceptible children in Karachi, the largest metropolitan city of Pakistan, one year after the nationwide measles supplementary immunization activity (SIA) of 2007-2008. Oral fluid specimens of 504 randomly selected children from Karachi, aged 12-59 months were collected to detect measles IgG antibodies. Measles antibodies were detected in only 55% children. The proportion of children whose families reported receiving a single or two doses of measles vaccine were 78% and 12% respectively. Only 3% of parents reported that their child received measles vaccine through the SIA. Among the reported single dose measles vaccine recipients, 58% had serologic immunity against measles while among the reported two dose measles vaccine recipients, 64% had evidence of measles immunity. Urgent strengthening of routine immunization services and high quality mass vaccination campaigns against measles are recommended to achieve measles elimination in Pakistan.     

Measles surveillance--United States, 1991.

A total of 9,643 measles cases was reported from the United States in 1991, a 65.3% decrease from the 27,786 cases reported in 1990. The overall incidence of measles was 3.9 cases per 100,000 population. The highest age-specific incidence was among children < 12 months of age (46.9/100,000) and 1-4 years of age (19.6/100,000). Incidence rates among American Indians, Hispanic, and black children < 5 years of age were 19, 6, and 4 times that for non-Hispanic white children, respectively. More than 61% of all cases were reported from seven large outbreaks, which involved predominantly unvaccinated preschool-age children in large urban areas. Although reported measles cases decreased in 1991 compared with 1989-1990, only a sustained effort to provide age-appropriate vaccination will prevent another resurgence of measles.     

African-American children are at risk of a measles outbreak in an inner-city community of Chicago, 2000

BACKGROUND: Since the measles resurgence of 1989-1991, which affected predominantly inner-city preschoolers, national vaccination rates have risen to record-high levels, but rates among inner-city, preschool-aged, African-American children lag behind national rates. The threat of measles importations from abroad exists and may be particularly important in large U.S. cities. To stop epidemic transmission, measles vaccination coverage should be at least 80%. OBJECTIVE: To determine measles vaccination rates and predictors for having received a dose of measles-containing vaccine by age 19 to 35 months among children in an inner-city community of Chicago.METHODS: We used a cross-sectional survey with probability proportional to size cluster sampling. Immunization histories from parent-held records and providers were combined to establish a complete vaccination history. RESULTS: A total of 2545 households were contacted, and 170 included a resident child aged 12 to 35 months. Of these, 97% (N=165 children) agreed to participate. Immunization history from a parent or provider was not available for 20 children. Among children aged 19 to 35 months with available immunization histories, 74% received measles vaccine (n=100); of these, 84% received the vaccine as recommended at ages 12 to 15 months. However, when including children without immunization histories, measles coverage levels among children aged 19 to 35 months were 64% (n=114). Among children with records, predictors for receipt of measles vaccine by age 19 to 35 months were possessing a hand-held immunization card (odds ratio [OR]=16.8; 95% confidence interval [CI]=4.2-67.1); utilizing a public health department provider for a usual source of care (OR=8.9; 95% CI=1.6-47.2); and being up-to-date for vaccines at 3 months of age (OR=5.0; 95% CI=1.8-14.1). CONCLUSIONS: Optimistically assuming that children without immunization histories are as well immunized as children with immunization histories, the measles vaccination rate among Englewood's children aged 19 to 35 months is too low to maintain immunity (74%). Measles coverage levels lagged behind coverage reported in a national survey in Chicago (86%) and the nation as a whole (92%). Efforts to raise and sustain coverage should be undertaken.     

Measles among under-9-month-olds in rural Bangladesh: its significance for age at immunization

Any decision to modify measles immunization strategies away from the use of the conventional vaccine given to children at 9 months of age to the adoption of recently proposed vaccine strains that can be given to 4-6-month-olds will depend on the age distribution of severe cases of measles in the community. Reported are the results of an analysis of two community-based measles surveillance systems in rural Bangladesh, which found that 17% of all measles cases reported for under-5-year-olds in a nonvaccinated population involved infants aged less than 9 months. In a vaccinated population from the same area, 31% of all measles cases reported for under-5-year-olds occurred among under-9-month-olds. Using a rather restrictive definition for measles-related deaths (those occurring within 6 weeks of the onset of the rash), the proportion of measles-related deaths that occurred before 9 months of age was 13% of all such deaths that were reported.     

百色市2010年麻疹疫苗强化免疫活动分析

目的 总结分析百色市麻疹疫苗强化免疫活动的数据,为制定"消除麻疹"策略提供依据.方法 对百色市所有8月龄~14岁儿童(包括流动儿童),无论既往有无接种史或患病史,均接种1剂次麻疹疫苗.通过收集整理全市MV强化免疫报表数据和现场评估等情况,采用流行病学方法进行分析.结果 本次强化免疫摸底应种儿童数为699 354人,报告接种人数669 411人,报告接种率为95.72%;麻疹疫苗强化免疫疑似预防接种异常反应报告发生率为2.09/10万;强化免疫后全市尚无麻疹病例报告.结论 麻疹疫苗强化免疫是控制和消除麻疹的有效措施,可迅速提高人群免疫水平,控制麻疹的暴发或流行效果显著.     

贵州省2009-2010年麻疹流行病学特征分析

目的分析贵州省200920lO年麻疹流病学特征,为制定消除麻疹策略和措施提供依据。方法对贵州省2009—201O年麻疹监测系统报告资料进行描述流行病学分析。结果全省201O年麻疹报告发病率为0.22／l0万,较2009年的0．65／lO万下降66.15％,为历史最低水平。发病呈高度散发,病例仍以小年龄儿童为主,以l～7岁病例最多。2009年和2010年无免疫史或免疫史不详的病例分别占两年病例的77．55％、75．8l％。结论贵州省2008年麻疹疫苗后续强化免疫效果显著。应继续加强常规免疫,提高麻疹减毒活疫苗的及时接种率;开展查漏补种,提高流动人口的麻疹疫苗接种率。     

Mumps in Poland in 2002

In 2002, 39,978 cases of mumps were reported in Poland. The incidence (104.6 per 100,000) was higher then in 2001 (43.3), which corresponds to a periodical increase of mumps incidence occurring in Poland every 3-4 years. This year's peak is much lower than the previous ones, which can be attributed to the growing vaccine coverage. Even though the mumps vaccine was not included into the national immunization program, the coverage in the 3-year old children reached in 2002 35.5%. Approximately 3.5% of cases were hospitalized (1400) and no mumps deaths were reported. Children 5-9 years old constituted the most affected age group (incidence 965.2 per 100,000). In Poland the MMR vaccine was recommended on voluntary basis in place of measles vaccine for children in their 2nd and 7th year of age. Immunization of 2-years old children is mandatory beginning in 2004.     

兰山区麻疹疫苗强化免疫效果分析

目的：进一步控制兰山区的麻疹疫情。方法：1999年度对该区149 016名8月龄—14岁儿童实施了麻疹疫苗(MV)强化免疫，接种率为97．38％。随后开展了麻疹免疫监测，应用酶联免疫吸附法(EHSA)检测麻疹和风疹IgM抗体，微量血凝抑制试验检测麻疹IgG抗体。结果：强化免疫后麻疹抗体阳转率达100％，GMT从1：5．56上升到1：52．68；经过流行病学观察，强化免疫后麻疹疫情被控制，2a后发病率下降到0．75／10万，麻疹发病数与1999年相比，下降了97．53％。检测79例麻疹疑似病例血清，其中麻疹IgM阳性16例，占20．25％；风疹IgM阳性12例，占15．19％。结论：开展麻疹强化免疫对控制麻疹效果非常显著。     

Measles in Poland in 2002

In Poland 34 measles cases were registered in 2002 (0.09 per 100,000 population)--99 cases less than in the preceding year. Eleven (32%) cases occurred in unvaccinated persons, 9 (27%) in persons who had received only one dose of the vaccine and 14 (41%) in those vaccinated with two doses. The number of cases among the vaccinated population--23, including one case of vaccine associated measles--together with high vaccination coverage after 1975, indicates high effectiveness of measles vaccines used in Poland. Fifteen cases (44%) were confirmed serologically (IgM). Across the voivodeships the number of cases ranged from 0 in four voivodeships to 5 in the ?laskie voivodeship. In none of the voivodeships, however, did the incidence exceed 0.2 per 100,000. The most affected were infants (incidence 0.85 per 100,000), children in their second year of life (incidence 1.09) and children aged 5 and 6 years--incidence of 0.72 and 0.69 respectively. According to the immunization schedule these were children who should receive their first or subsequent dose of vaccine during the year 2002. Cases among children and adolescents below 15 years of age (26 cases) constituted 77% of all reported cases. Out of all reported cases 13 (38%) were hospitalized. There were no deaths due to measles in Poland in 2002.     

Mumps in 1998

In 1998 217,452 cases of mumps were reported and attack rate of 562/100,000 was two and a half times higher than in the previous year. More then four percentage (4.7) of cases were admitted to hospitals (10,147) and the percentage of hospitalised children ranged from 0.3% in Chelm voivodeship to 11.2% in Gdańsk voivodeship. Mostly affected were children in the age group 5 to 9 years old in which attack rates ranged from 3,503 to 5,815 per 100,000. Patients in this age group constituted 58% of total number of mumps. MMR vaccine is still not included into the national programme of immunization; instead monovalent measles vaccine is recommended. MMR vaccine is used on voluntary basis.     

The immunogenicity and reactogenicity of the trivalent vaccine, Trimovax, indicated for prevention of measles, mumps, and rubella, in 12-month-old children in Belarus

In the Republic of Belarus, immunization of children against measles and mumps had been carried out using monovalent preparations according to the national schedule of measles vaccination at 12 months of age and mumps vaccination at 24 months of age. A rise of rubella incidence in the last few years (i.e., for the official registration period 1980 to 1998, there was an increase from 72.2 to 607.5 cases per 100,000 population) made it necessary to implement immunization against this infection, as well. Therefore, in 1996, combined vaccination against measles, mumps, and rubella of 12-month-old children was carried out for the first time in a clinical trial that used the vaccine Trimovax [Aventis Pasteur (formerly, Pasteur Mérieux Connaught), Lyon, France]. The reactogenicity of the vaccine was investigated in 372 children. Post-vaccination reactions were noted in 5.6% of children; in 1.3% of children the reactions were classified as severe [i.e. associated with body (axillary) temperature > or = 38.6 degrees C]. For the evaluation of immunogenicity, sera from 324 children were obtained 2 to 2.5 months after inoculation, and serum antibody levels were measured by enzyme immunoassays. Among the vaccines, protective antibody titers (expressed in inverse of dilution units) were observed to measles (> or = 1:50) in 97.8%, to mumps (> or = 1:50) in 93.8%, and to rubella (> or = 1:100) in 96.0% of children. Antibodies to all three components of the vaccine were mainly present in intermediate (1:200-1:800) or high (> or = 1:1600) titers: to measles in 96.3%; to mumps in 75.8%; and to rubella in 73.5% of vaccines. The results of these trials are evidence of the good safety and immunogenicity of this MMR vaccine, which provides an alternative to the currently used measles and mumps monovaccines, with the additional benefit of providing immunity against rubella, as well.     

Mumps in Poland in 1999

In 1999, 90,214 cases of mumps were reported. Incidence of 233.4 per 100,000 was two and a half times lower than in the previous year. More then five percent (5.8%) of cases were admitted to hospitals (5,188). The percentage of hospitalised children ranged from 2.6% in ?laskie voivodeship to 9.9% in pomorskie voivodeship. Children in the 5 to 9 age group were mostly affected (incidence ranged from 1,581 to 2,295 per 100,000). Patients in this age group constituted 55% of total number of mumps cases. MMR vaccine is still not included into the national programme of immunization; instead monovalent measles vaccine is recommended and MMR vaccine is used on voluntary basis.     

Poliomyelitis trends in Pondicherry, south India, 1989-91.

STUDY OBJECTIVES: To assess the poliomyelitis trend, including study of the epidemiological features, and to correlate this with the immunisation coverage of infants. DESIGN: Three annual lameness surveys in children aged 0-60 months employing cluster sampling methods and a series of five cross sectional surveys of immunisation coverage in children aged 12-23 months of age were undertaken. SETTING: Pondicherry, India, 1988-92. SUBJECTS: More than 10,000 children in the age group of 0-60 months took part in the three annual lameness surveys and samples of 210 children aged 12-23 months were covered each year in immunisation coverage surveys. MEASUREMENTS AND MAIN RESULTS: Altogether 50 of 11,461, 24 of 10,093, and 17 of 11,218 children surveyed during 1989, 1990, and 1991 respectively had become lame as a result of poliomyelitis, giving prevalences of 4.4, 2.4, and 1.5 per 1000 children for the three surveys. The corrected prevalences of poliomyelitis were 5.9, 3.2, and 2.0 per 1000 children during 1989, 1990, and 1991 respectively. The proportion of cases aged up to 36 months fell from 48% in 1989 to 12.5% in 1990 and 6% in 1991. The age at onset was less than 1 year in most. The median age at onset was 10.7 months. About 54% of the affected children had received three doses of oral poliomyelitis vaccine (OPV) before the onset of paralysis. In 1988 immunisation coverage for the third dose of OPV was 91% and in 1992 it was 97.6%. The drop out rate for the first versus the third dose of OPV fell from 6.3 in 1988 to 1.9% in 1992. CONCLUSION: Three successive annual lameness surveys showed that poliomyelitis was declining between 1989 and 1991. Five immunisation coverage surveys conducted from 1988 to 1992 showed high initial coverage followed by an improvement in the form of almost universal coverage for OPV.     

Progress towards measles elimination in Singapore

ObjectiveWe describe the epidemiological trends of measles in Singapore in relation to its progress towards measles elimination and identify gaps in fulfilling the World Health Organization Western Pacific Regional Office regional measles elimination criteria.MethodsEpidemiological data on measles maintained by the Communicable Diseases Division, Ministry of Health from 1981 to 2012 were collated and analysed. Data on measles vaccination coverage were obtained from the National Immunization Registry and School Health Services, Health Promotion Board. To assess the seroprevalence of the population, the findings of periodic seroepidemiological surveys on measles were traced and reviewed.FindingsWith the successful implementation of the National Childhood Immunization Programme using the monovalent measles vaccine, measles incidence declined from 88.5 cases per 100,000 in 1984 to 6.9 per 100,000 in 1991. Resurgences were observed in 1992, 1993 and 1997. A ‘catch-up’ vaccination programme using the trivalent measles, mumps and rubella (MMR) vaccine was conducted in 1997, followed by introduction of the two-dose vaccination schedule in January 1998. Measles incidence subsequently declined sharply to 2.9 per 100,000 in 1998. Vaccination coverage was maintained at 95% for the first dose and 92–94% for the second dose. Seroprevalence surveys showed seropositivity for measles IgG antibodies in over 95% of adults in 2004, and in 83.1% of children aged 1–17 years in 2008–2010. Sporadic cases with occasional clusters of two or more cases continued to occur among the unvaccinated population, especially children aged below 4 years. The predominant measles virus genotype has shifted from D9 to the B3 and G3 genotypes, which are endemic in neighbouring countries.ConclusionSingapore has made good progress towards the elimination of endemic measles. To further eliminate sporadic cases of measles, the national immunisation schedule has recently been amended to vaccinate children with 2 doses of MMR vaccine before 2 years of age.     

Mumps in Poland in 2003

In 2003, 87,336 cases of mumps were reported in Poland. The incidence (228,7 per 100,000) was higher then in 2002(104.6), which corresponds to a periodical increase of mumps incidence. According to the natural periodicity the peak incidence would be expected to take place in 2002. The increase of mumps incidence in 2003, still lower however then the previous peaks, can be attributed to the prolongation of the epidemics cycle usually occurring with growing vaccine coverage. Even though the mumps vaccine was not included into the national immunization program, the coverage in 3-year old children in 2003 reached 39.6%. Approximately 4.6% of cases were hospitalized (4,056) and no mumps deaths were reported. Children 5-9 year old constituted the most affected age group (incidence 2,133.1 per 100,000). In Poland the MMR vaccine was recommended on voluntary basis in place of measles vaccine for children in their 2nd and 7th year of age. Immunization of 2-years old children is mandatory beginning in 2004.     

遵义地区1992年麻疹流行因素的探讨

遵义地区自实施麻疹疫苗免疫以来，麻疹发病率大幅度下降，１９９０年发病率降至最低为０．６９／１０万。但１９９１年有所回升， １９９２年发病率高达７０．２７／１０万，疫情波及所辖１３个县（市）、 ７１．６５％的区（９１／１２７）、１９．９５％的乡（１５３／７６７）、９．５３％的村或居委会（４８８／５１２１）．＜６岁发病数占总病例数的４１．３８％，７～１４岁病例数占４３．１７％。反映出按照儿童免疫程序８月龄初种和７岁复种麻疹疫苗的工作质量未达到技术要求，造成易感者的积累，导致麻疹的流行。     

汕头市潮阳区麻疹流行病学分析

目的 掌握汕头市潮阳区麻疹发病和流行趋势,探讨控制对策.方法 对汕头市潮阳区2005-2008年麻疹监测系统报告资料进行描述流行病学分析.结果 4年全区共报告麻疹369例,年平均报告发病率为5.81/10万;病例主要集中在4～7月,占总病例数的71.54%;全区各镇各街道均有麻疹病例报告;病例主要集中在8月龄～11岁儿童,占总病例数的82.66%,其中1～2岁、3～5岁组儿童病例数最多,分别占总数的33.06%和22.22%,<8月龄婴儿和>17岁儿童病例构成逐年上升,男女性别比为1.77:1;65.5%病例无免疫史,29.24%病例免疫史不详.结论 汕头市潮阳区麻疹仍存在高发病率现象,为降低麻疹发病率,减少麻疹爆发,应进一步提高麻疹疫苗初始接种率,并尽快在全区范围内对8月龄～11岁儿童中开展初始强化免疫.