IAC Express 2011
Issue number 938: June 23, 2011
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CDC Health Advisory: High Number of Reported Measles Cases in the U.S. in
2011--Linked to Outbreaks Abroad
AAFP, American Academy of Family Physicians; AAP,
American Academy of Pediatrics; ACIP, Advisory Committee on Immunization
Practices; AMA, American Medical Association; CDC, Centers for Disease
Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization
Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD,
National Center for Immunization and Respiratory Diseases; NIVS, National
Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD,
vaccine-preventable disease; WHO, World Health Organization.
Issue 938: June 23, 2011
Official CDC Health Advisory: High Number of Reported Measles Cases in the
U.S. in 2011--Linked to Outbreaks Abroad
On June 22, CDC issued an official CDC Health
reports increasing numbers of measles cases in the United
States in 2011. The Health Advisory is reprinted below.
Summary and Background
The United States is experiencing a high number of reported
measles cases in 2011, many of which were acquired during
international travel. From January 1 through June 17 this
year, 156 confirmed cases of measles were reported to CDC.
This is the highest reported number since 1996. Most cases
(136) were associated with importations from measles-endemic
countries or countries where large outbreaks are occurring.
The imported cases involved unvaccinated U.S. residents who
recently traveled abroad, unvaccinated visitors to the
United States, and people linked to these imported cases. To
date, 12 outbreaks (3 or more linked cases) have occurred,
accounting for 47% of the 156 cases. Of the total case-patients, 133 (85%) were unvaccinated or had undocumented
vaccination status. Of the 139 case-patients who were U.S.
residents, 86 (62%) were unvaccinated, 30 (22%) had
undocumented vaccination status, 11 (8%) had received 1 dose
of measles-mumps-rubella (MMR) vaccine, 11 (8%) had received
2 doses, and 1 (1%) had received 3 (documented) doses.
Measles was declared eliminated in the United States in 2000
due to our high 2-dose measles vaccine coverage, but it is
still endemic or large outbreaks are occurring in countries
in Europe (including France, the United Kingdom, Spain, and
Switzerland), Africa, and Asia (including India). The
increase in measles cases and outbreaks in the United States
this year underscores the ongoing risk of importations, the
need for high measles vaccine coverage, and the importance
of prompt and appropriate public health response to measles
cases and outbreaks.
Measles is a highly contagious, acute viral illness that is
transmitted by contact with an infected person through
coughing and sneezing. After an infected person leaves a
location, the virus remains contagious for up to 2 hours on
surfaces and in the air. Measles can cause severe health
complications, including pneumonia, encephalitis, and death.
Recommendations for Health Care Providers
- Ensure all patients are up to date on MMR vaccine (A) and
- For those who travel abroad, CDC recommends that all U.S.
residents older than 6 months be protected from measles
and receive MMR vaccine, if needed, prior to departure.
- Infants 6 through 11 months old should receive 1 dose
of MMR vaccine before departure. (B)
- Children 12 months of age or older should have
documentation of 2 doses of MMR vaccine (separated by
at least 28 days).
- Teenagers and adults without evidence of measles
immunity (C) should have documentation of 2
appropriately spaced doses of MMR vaccine.
- Consider measles as a diagnosis in anyone with a febrile
rash illness lasting 3 days or more, a temperature of
101 degrees F (38.3 degrees C) or higher, and clinically
compatible symptoms (cough, coryza, and/or
conjunctivitis) who has recently traveled abroad or who
has had contact with someone with a febrile rash illness.
Immunocompromised patients may not exhibit rash or may
exhibit an atypical rash. The incubation period for
measles from exposure to fever is usually about 10 days
(range, 7 to 12 days) and from exposure to rash onset is
usually 14 days (range, 7 to 21 days).
- Isolate suspect measles case-patients and immediately
report cases to local health departments to ensure a
prompt public health response.
- Obtain specimens for testing, including viral specimens
for confirmation and genotyping.
(A) Children 1 through 12 years of age may receive MMRV
vaccine for protection against measles, mumps, rubella,
and varicella; however, MMRV vaccine is currently
(B) Infants who receive a dose of MMR vaccine before their
first birthday should receive 2 more doses of MMR vaccine,
the first of which should be administered when the child is
12 through 15 months of age and the second at least 28 days
(C) One of the following is considered evidence of measles
immunity for international travelers: (1) birth before 1957,
(2) documented administration of 2 doses of live measles
virus vaccine (MMR, MMRV, or measles vaccines), (3)
laboratory (serologic) proof of immunity, or (4)
documentation of physician-diagnosed measles.
For more information:
- CDC. Measles Imported by Returning U.S. Travelers Aged
6-23 Months, 2001-2011. MMWR. 2011;60:397-400:
- CDC. Measles-United States, January-May 20, 2011. MMWR.
- CDC. Notes from the Field: Measles Outbreak--Hennepin
County, Minnesota, February-March 2011. MMWR.
- CDC's Measles (Rubeola) website:
- CDC's Measles Vaccination website:
- CDC's Travelers' Health: In the News, 2011 MeaslesUpdate:
- Medscape Today: CDC Expert Commentary: Measles: What You
Might Not Know Recognizing, diagnosing, and preventing
measles (running time: 5:20 mins):
http://www.medscape.com/viewarticle/741206 [Login, which
is required, is free]
To access the CDC Health Advisory, go to:
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