status of the measles outbreak

8/9/2019 Status of the Measles Outbreak

1/29

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


2/29


3/29

Pro)isional data as of February 20, 2015


4/29

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


5/29

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


6/29

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


7/29

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


8/29

Measles "11 ! "1#

e)orted cases ", 33, 1:9, 6## $edian 205

$ean 2


9/29

$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


10/29

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


11/29

(ncidence.million

U&S&, "1#

"

31"

13

"

3

11


12/29

$easles, %?&?, 1@@


13/29Pro)isional data as of Februar 20, 2015


14/29

%+er* Measles Case e>uires?ublic @ealth olloB!u)

1+

(os"ital

Child'are'enters

Widelyattended

gatherings!

rans"ortation

Family


15/29

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


16/29

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?


17/29

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


18/29

Infogra"hi' on tra)el and 'ases


19/29

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


20/29

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


21/29

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


22/29

22&our'e. Immuniation #'tion Coalition


23/29

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


24/29

Com)arison of "th Centur* Annual Morbidit* and


25/29

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


26/29

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


27/29

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<


28/29

///?'d'?go)Bmeasle


29/29

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

status of the measles outbreak

Documents