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Measles and Rubella: Is The End in Sight?

Summary and Comment |
January 13, 2014

Measles and Rubella: Is The End in Sight?

  1. Deborah Lehman, MD

Elimination of endemic infections in the U.S has been sustained through 2011, but unvaccinated populations remain at risk from imported cases.

  1. Deborah Lehman, MD

Elimination of endemic measles in the U.S. was documented in 2000 and elimination of endemic rubella and congenital rubella syndrome (CRS) was documented in 2004. To determine whether elimination has been sustained, the CDC convened an expert panel to review all cases of measles from 2001–2011 and cases of rubella and CRS from 2004–2011.

Cases were examined for evidence of importation and source of infection. Analysis of genotype data from a third of the isolates demonstrated varying genotypes from year to year. Of the 911 measles cases, half were associated with outbreaks, the majority was in infants aged 6 to 11 months, 65% of cases were in unvaccinated individuals, and 88% were imported or linked to an imported case. Of the 77 reported rubella cases, 60% were in adults, 88% were in unvaccinated individuals, 54% were associated with an imported virus, but in contrast to measles, only 14% resulted in transmission. Of four reported cases of CRS, three were imported. Worldwide elimination of rubella and CRS is on the horizon; the World Health Assembly has set goals for elimination of rubella and CRS in two World Health Organization regions by 2015 and measles and rubella in five regions by 2020.

Comment

Rubella is the leading cause of preventable birth defects and measles causes significant morbidity and mortality, so the continued control of these diseases in the U.S. is encouraging. Nonetheless, this report reminds us of the continued epidemic outside our borders. In 2013, 175 cases of measles already have been reported (almost 3 times the average annual number) including 9 outbreaks (see http://www.cdc.gov/media/releases/2013/t1205-measles-threat.html). Due to the highly contagious nature of these infections, vulnerable populations (those unimmunized due to age, immune status, or choice) will remain at risk until global eradication is achieved.

  • Disclosures for Deborah Lehman, MD at time of publication Nothing to disclose

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