Update on Measles in the U.S. 2008 National Perspective Kathleen Gallagher, D.Sc, MPH NCIRD, CDC.

Slides:



Advertisements
Similar presentations
Monitoring the impact of vaccination on rubella and CRS Susan E. Reef, MD 11 th Annual Meeting The Measles and Rubella Initiative Sept. 19, 2012.
Advertisements

Global Measles and Rubella Strategic Plan
Surveillance and Response to Imported Infectious Disease
Changes to Regulation 645 under the Immunization of School Pupils Act Additional Protection for Children Attending School in Ontario Coming July 1, 2014.
Jane Seward, MBBS, MPH Acting Deputy Director, Division Viral Diseases Centers for Disease Control and Prevention FDA BPAC Meeting Bethesda, August 16.
Supporting Global Immunization – a Humanitarian Interest and a Self Interest Pediatric Grand Rounds April 4, Walter A. Orenstein MD, DSc (Hon)
Pertussis Disease Pertussis (‘whooping cough’) is a bacterial infection affecting the respiratory system, caused by the organism Bordetella pertussis.
Hepatitis B and Hepatitis B Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Center for Immunization and Respiratory Diseases.
From a research question to study objectives. Key areas Levels in fundamental or applied research Working with policymakers to understand their data needs.
Monitoring progress towards the coverage and disease incidence targets GLOBAL MEASLES AND RUBELLA MANAGEMENT MEETING March 2011 Geneva, Switzerland.
Mumps Outbreak in the Midwest: Implications for College Health Sonja Hutchins, MD, DrPH, FACPM National Center for Immunizations and Respiratory Diseases.
The Cape Verde experience with rubella outbreak & lessons from introducing rubella vaccines MoH Cape Verde ARCI meeting Dar es Salaam, Tanzania Dec 2012.
A global partnership to stop measles & rubella The Measles & Rubella Initiative: Preparing for the Next Decade Lisa Cairns, MD, MPH Sept 18, 2012 Washington,
Proceedings of the SAGE Working Group on Rubella Vaccines Susan E. Reef, MD Global Measles and Rubella Management Meeting March 15, 2011.
Asthma Prevalence in the United States National Center for Environmental Health Division of Environmental Hazards and Health Effects June 2014.
Global Places. Q1. Name the country given by the X. X France Germany Greece Italy Poland Russia Spain Sweden Switzerland Ukraine.
World Health Organization
Routine Immunization: The Missed Child Perspective Maya van den Ent, PharmD MPH Edward Hoekstra, MD, MSc David Brown, DSc, MScPH, MSc Halima Dao, MD, MSc.
Measles and Measles Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Center for Immunization and Respiratory Diseases Centers.
MEASLES VACCINATION 2015 Update Susan Reeser RN, BSN (406)
Global Immunization Performance Update through 2011.
National Immunization Program Report NVAC Washington, DC  February 3-4, 2004 Stephen L. Cochi, M.D., M.P.H. Acting Director, National Immunization Program.
Impacts of Porcine Epidemic Virus in the U.S. Swine Herd Dr. Liz Wagstrom, DVM, MS National Pork Producers Council.
Reaching the 2010 Measles Mortality Reduction Goal-can SEARO get there? Meeting of the Partners for Measles Advocacy Washington DC, September 2008.
Progress towards Sustainable Measles Mortality Reduction South-East Asia Region Jayantha Liyanage Medical Officer- EPI Immunization and Vaccine Development.
The National Program of Cancer Registries: Enhancing Cancer Incidence Data … Hannah K. Weir, PhD Division of Cancer Prevention and Control Centers for.
Emerging Infections of Concern Health and Human Resources Subpanel Governor’s Secure Commonwealth Initiative March 2015.
Pertussis Update Linda Bethel, RN, MPH Epidemiology and Immunization Services Branch.
5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees
Public Health Issues of Interest Seasonal Influenza Seasonal Norovirus Middle East Respiratory Syndrome Coronavirus Novel Influenza (A/H7N9) David H. Trump,
Immunization of Adolescents: An Update Daniel B. Fishbein, MD Health Services Research and Evaluation Branch Immunization Services Division National Immunization.
Polio Eradication  Although the number of endemic countries is at an all-time low in 2002, the actual number of cases was approximately four times higher.
Edward J. Hoekstra, MD, MSc Edward J. Hoekstra, MD, MSc Senior Health Advisor Senior Health Advisor UNICEF HQ, New York UNICEF HQ, New York Peter Strebel,
Rash Decisions: The Colorado Experience with “Maybe Measles” Emily Spence Davizon, Colorado Department of Public Health and Environment.
1 1 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, March 2011 Accelerated Measles Control: Highlights and.
David Featherstone EPI / IVB WHO/HQ Measles Partners Meeting September 2008 Washington Global Measles Rubella Laboratory Network: Update.
2005 National Immunization Survey Stephen L. Cochi, M.D., M.P.H. Acting Director National Immunization Program, CDC National Press Club July 27, 2005 Department.
Thomas Clark, MD, MPH Centers for Disease Control and Prevention Immunization Program Managers Meeting November 16, 2010 Pertussis Epidemiology in the.
1 |1 | Measles pre-elimination and resurgence in the African region Balcha Masresha IVD AFRO Global Measles Management Meeting Geneva March 2011.
Tony Aragon, MS Epidemiologist Immunization Branch May 20, 2010 Vaccine Coverage.
U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics Division of Vital Statistics.
Vaccines and Related Biological Products Advisory Committee Meeting July 23, 2009 Novel influenza A (H1N1) Epidemiology Update Anthony Fiore, MD, MPH Influenza.
Invisible Threat Trailer
Vaccine-preventable disease update: The importance of immunization coverage, the threat of vaccine waivers, and measles in the mix Joel Blostein,
INFLUENZA DIVISION Update on the Epidemiology and Clinical Features of Novel H1N1 Joseph Bresee, MD Chief, Epidemiology and Prevention Branch Influenza.
Measles Mortality Reduction: the risk of resurgence Global Immunization Meeting Geneva, Switzerland 1-3 February 2010 Balcha Masresha, WHO/AFRO.
2015 Measles & Rubella Initiative Annual Partners Meeting, Human & Financial Costs of Measles and Rubella, 15 September 2015, Washington, DC Achieving.
A global partnership to stop measles & rubella 1 Measles & Rubella Initiative --Who We Are-- Stephen Cochi, MD, MPH Global Immunization Division Centers.
Surveillance Update TISWG May, 2011 Rachel Wiseman, MPH Epidemiologist Emerging and Acute Infectious Diseases May 18, 2011.
Sustaining the gains and reaching milestones on the way towards elimination of measles and rubella 15 September 2015 Dr Peter Strebel, WHO, IVB/EPI.
Current Pandemic H1N1 Updates in the Philippines Department of Health, Philippines Juan M. Lopez, MD, PGradDipPH, MPH Aldrin Q. Reyes, RN.
Prevention of Perinatal and Childhood Hepatitis B Virus Infections Background on Where We’ve Been Lisa Jacques-Carroll, MSW Immunization Services Division,
Using Surveillance Indicators for Vaccine-Preventable Diseases: National Notifiable Diseases Surveillance System Sandra W. Roush, MT, MPH National.
Characterization of a Large Mumps Outbreak Among Adolescents in Jerusalem, Israel in Communities Associated with Jewish Communities in New York.
Measles in the United States, : Eliminated but the Threat Is Not Gone
Amra Uzicanin, M.D., M.P.H. Global Immunization Division
Global Overview of Measles
Quarantine and Isolation During the Sedgwick County
Overview of National Surveillance for Vaccine-Preventable Diseases
The Role of the Immunization Registry in a Measles Outreak, New York City The Role of the Immunization Registry in a Measles Outbreak, New York City Ynolde.
23 November, 2018 Update on measles & rubella surveillance in the WHO African Region – progress and challenges Dr Richard Luce WHO/IST-Central 5th African.
Global Update on Varicella: Protecting Against an Old Enemy
Measles Epidemiology and Vaccine Policy in the U.S.
Preeta K. Kutty MD, MPH Division of Viral Disease
Overview Of Court Challenges of Vaccine Exemptions
State Ranking on Quality Dimension
Provincial Measles Immunization Catch-Up Program
The Science of Religious and Philosophical Exemptions
National Immunization Conference, Dallas, TX
National Immunization Conference
Presentation transcript:

Update on Measles in the U.S National Perspective Kathleen Gallagher, D.Sc, MPH NCIRD, CDC

Today’s Presentation Measles in the US in the pre- and post- elimination erasMeasles in the US in the pre- and post- elimination eras What’s going on in 2008What’s going on in 2008 Strategies to maintain eliminationStrategies to maintain elimination ChallengesChallenges

Annual Measles Disease Burden United States, 1950s 3-4 million cases3-4 million cases –~ 500,000 reported cases Severe complicationsSevere complications –4,000 encephalitis cases –150,000 respiratory complications (pneumonia) 48,000 hospitalizations48,000 hospitalizations 450 deaths450 deaths

1963 Vaccine Licensed 1 st Dose Recommendation nd Dose Recommendation 2000 Elimination Declared 1-dose preschool coverage 2-dose adolescent coverage Resurgence Reported Measles Cases United States, Measles Cases % Measles Vax Coverage Year

nd Dose Recommendation 2000 Elimination Declared Measles, United States, Reported Measles Cases Year Measles resurgence ,622 reported cases 123 reported deaths

Reported Measles Incidence United States, case/million Measles elimination declared

Measles Epidemiology, Post Elimination 63 cases reported each year ( )63 cases reported each year ( ) Cases are all related to imported cases including from developed countries – Europe, JapanCases are all related to imported cases including from developed countries – Europe, Japan Outbreaks predominantly in unprotected populationsOutbreaks predominantly in unprotected populations –2005Indiana, 34 cases in unvaccinated religious community –2006Boston,18 cases in young adults mainly one dose vaccine recipients and foreign born adults

Measles, US, 2008 Highest number of reported cases year to date (Jan-July) since 1996Highest number of reported cases year to date (Jan-July) since 1996 No increase in imported casesNo increase in imported cases Increase in spread within the U.S.Increase in spread within the U.S. –7 “outbreaks”

Measles, January – July cases from 15 states and DC131 cases from 15 states and DC 15 (11%) cases hospitalized, no deaths15 (11%) cases hospitalized, no deaths Importation status:Importation status: –17 importations 8 foreign visitors (all unvaccinated)8 foreign visitors (all unvaccinated) 9 US residents (all unvaccinated)9 US residents (all unvaccinated) –99 (76%) additional cases linked to importations or virologic evidence of importation –15 cases unknown source 123 cases in US residents123 cases in US residents –91% cases unvaccinated or unknown vaccination status

Measles Cases Reported to CDC/NCIRD January-July, 2008 (N= 131) San Diego, CA N=12 Missaukee County, MI, N=4 Pima County, AZ N=14 Los Angeles, CA N=1 Fairfax, VA N=1 Milwaukee County, WI N=6 Nassau County, NY N=1 New York City, NY N=26 Honolulu, HI N=4 Pittsburgh, PA N=1 Chicago, IL Grant County, WA N= N=19 Vernon County, WI N=1 N=1 Scott County, AR N=2 San Francisco, CA N=2, Sources: D.C. N=1 NM N=1, Unknown Baton Rouge, LA N=1, Du Page Co, I L N=31 Fulton Co, GA N=1 Cass Co, MO N=1

Reported Measles Cases, U.S *, by Importation Status *Provisional data through July 31

U.S. Residents with Measles, January 1 through July 31, 2008, by Age N = % cases < 20 years

Reasons for not receiving Measles vaccine, U.S Residents with measles who were Eligible* for Vaccination, January 1 through July 31, 2008, N=95 * Excludes infants under 12 months old, persons born before 1957, foreign visitors, and persons who are vaccinated. † Includes children 16 months to 4 years old who have not been vaccinated. § Includes persons who are age eligible for vaccination but whose vaccination status is unknown or who are unvaccinated for unknown reasons. All case-patients in this category were between 20 and 50 years old. No persons cited medical reasons for not having been vaccinated

Strategies for Achieving and Maintaining Measles Elimination Maximize population immunity through vaccinationMaximize population immunity through vaccination Assure adequate surveillanceAssure adequate surveillance Respond rapidly to outbreaksRespond rapidly to outbreaks Work to improve global controlWork to improve global control

Maximize Population Immunity through Vaccination Provide scientific evidence for vaccine policy decision making and communicate policy recommendationsProvide scientific evidence for vaccine policy decision making and communicate policy recommendations Deliver recommended vaccinations on timeDeliver recommended vaccinations on time –First dose months –Second dose 4-6 years –Two dose MMR vaccine schedule for children, students, health care personnel and international travelers –At least one dose for other adults –Child care and school requirements Evaluate vaccine coverage and population immunityEvaluate vaccine coverage and population immunity –National Immunization Survey (19-35 months) –School entry assessments (≥ one dose) –Two dose coverage among school students (NHIS, adolescent NIS) –Health care personnel

Estimated MMR Vaccine Coverage among children aged months, NIS, US, MMWR

Nonmedical Exemptions for States With Religious Exemptions and With Personal Belief Exemptions Omer, Pan, Halsey et al., JAMA, 2006 Only Religious Exemptions PermittedPersonal Belief Exemptions Permitted Exemption Rate

WA State Counties’ School Entry Exemption Rates

Assure Adequate Surveillance Detect imported cases to prevent indigenous spreadDetect imported cases to prevent indigenous spread Detect small chains of transmissionDetect small chains of transmission Timely reporting and notification of casesTimely reporting and notification of cases –Polio, measles, rubella recently made “immediately” reportable by CSTE Monitor surveillance indicatorsMonitor surveillance indicators Assess completeness of reporting periodicallyAssess completeness of reporting periodically

Rapid Outbreak Response Case finding and investigationCase finding and investigation –Active surveillance –Laboratory confirmation and genotyping –Isolation of cases Contact tracingContact tracing –Identify contacts –Vaccine, IG and/or voluntary home quarantine for those without evidence immunity Assess community vaccine coverage and needs for additional community vaccination including infants monthsAssess community vaccine coverage and needs for additional community vaccination including infants months

Global Measles Achievements in measles control and eliminationAchievements in measles control and elimination However, in 2006 (estimates)However, in 2006 (estimates) –20 million cases –242,000 deaths In 2006, ~30 million U.S. residents traveled abroad and 51 million international visitors entered the U.S.In 2006, ~30 million U.S. residents traveled abroad and 51 million international visitors entered the U.S. In 2008, measles endemic in many countries, outbreaks in Europe and UK declared re- establishment of endemic disease transmissionIn 2008, measles endemic in many countries, outbreaks in Europe and UK declared re- establishment of endemic disease transmission Ongoing risk of importationsOngoing risk of importations

Measles Importations * Countries 17India 10Japan 7China 6Ukraine 4 U.K, Thailand 3 Pakistan, Mexico, Switzerland 2 Germany, Belgium, Hong Kong, Romania, Saudi Arabia, Kenya, Israel, Australia, Yemen 1 Ghana, Ethiopia, Italy, Uganda, Armenia Bangladesh, France, Indonesia, Nigeria , N = 84 * 2008, provisional data through Sept 12Countries5Italy 3Switzerland 2 Israel, Belgium, India 1 Germany, China, Pakistan, Philippines, Japan, Russia 2008, N = 20

D5 D4 Global Threat of Measles, U.S cases 17 importations 17 importations 21 virologic evidence 21 virologic evidence D4 (10), D5 (9), H1 (2) D4 (10), D5 (9), H1 (2)

Demands/Challenges in Maintaining Measles Elimination in the US Ongoing risk of importationsOngoing risk of importations Lack of familiarity with measles among the public and health care providersLack of familiarity with measles among the public and health care providers High level of investigative and public health response effort by local, state and national public health and laboratory staffHigh level of investigative and public health response effort by local, state and national public health and laboratory staff Maintaining high one and two dose vaccine coverage with increasing vaccine safety concerns in the populationMaintaining high one and two dose vaccine coverage with increasing vaccine safety concerns in the population

Thank you Kathleen Gallagher