An expert panel convened by the Centers for Disease Control and Prevention (CDC) has concluded that the elimination of measles, rubella and congenital rubella syndrome (CRS) from the United States was sustained through 2011, according to a report published by JAMA Pediatrics.
The United States is the most populous country to have documented the elimination of measles, rubella (generally a more mild infection) and CRS, which can cause birth defects in the children of mothers infected with rubella. Elimination does not imply zero cases because some cases will continue to occur when people are infected internationally and bring the disease to the United States, as well as due to limited local transmission. Elimination is defined as the absence of a chain of transmission that is continuous for 12 months or more, according to the study background.
Mark J. Papania, MD, MPH, of the CDC, and colleagues summarized the data and conclusions of the U.S. national report on measles, rubella and CRS elimination. The study follows up on initial verification of the elimination of measles in 2000 and of rubella in 2004.
According to researchers, reported measles incidence in the U.S. has remained below 1 case per 1 million population since 2001; rubella incidence has been below 1 case per 10 million population since 2004; and CRS incidence has been below 1 case per 5 million births. The report also indicates that 88 percent of measles cases and 54 percent of rubella cases were internationally imported or linked to importation. The results suggest the U.S. surveillance system is adequate to detect endemic measles or rubella.
The keys to ongoing success will be sustaining high levels of immunity throughout the U.S. population through vaccination, maintaining strong U.S. surveillance and public health response capacity and supporting other countries in efforts to control and eliminate measles, rubella, and CRS and, hopefully, in the future, to achieve the goal of a world without measles, rubella and CRS, the authors note.
In a related editorial, Mark Grabowsky, MD, MPH, of the Office of the Secretary Generals Special Envoy for Financing the Health Millennium Development Goals and for Malaria, New York, writes: In this issue of the journal, Papania and colleagues report that an expert panel convened by the Centers for Disease Control and Prevention has determined that the elimination of endemic measles, rubella and congenital rubella syndrome has been sustained for a decade. Along with certifications from other countries in the Americas, the entire Western hemisphere will be certified free of indigenous transmission.
The elimination of measles and rubella from the Western hemisphere is a triumph of public health with several important implications. First, imported cases of measles and rubella will still likely occur as long as there remain endemic areas in the world A second implication of the elimination of measles and rubella in the Western hemisphere is that it is a vindication of U.S. vaccination strategy, Grabowsky continues.
The greatest threat to the U.S. vaccination program may now come from parents hesitancy to vaccinate their children. Although this so-called vaccine hesitancy has not become as widespread in the United States as it appears to have become in Europe, it is increasing, Grabowsky concludes.
Reference: JAMA Pediatr. Published online Dec. 5, 2013. doi:10.1001/jamapediatrics.2013.4342.