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Mathis AD, Raines K, Masters NB, Filardo TD, Kim G, Crooke SN, Bankamp B, Rota PA, Sugerman DE. Measles - United States, January 1, 2020-March 28, 2024. MMWR Morb Mortal Wkly Rep 2024; 73:295-300. [PMID: 38602886 PMCID: PMC11008791 DOI: 10.15585/mmwr.mm7314a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020-March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020-2023. Among the 338 reported cases, the median patient age was 3 years (range = 0-64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020-2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.
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Affiliation(s)
- Adria D. Mathis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Kelley Raines
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Nina B. Masters
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Thomas D. Filardo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Gimin Kim
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Stephen N. Crooke
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Bettina Bankamp
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Paul A. Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - David E. Sugerman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
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Tiller EC, Masters NB, Raines KL, Mathis AD, Crooke SN, Zwickl RC, French GK, Alexy ER, Koch EM, Tucker NE, Wilson EM, Krauss TS, Leasure E, Budd J, Billing LM, Dewart C, Tarter K, Dickerson K, Iyer R, Jones AN, Halabi KC, Washam MC, Sugerman DE, Roberts MW. Notes from the Field: Measles Outbreak - Central Ohio, 2022-2023. MMWR Morb Mortal Wkly Rep 2023; 72:847-849. [PMID: 37535476 PMCID: PMC10414998 DOI: 10.15585/mmwr.mm7231a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
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Masters NB, Beck AS, Mathis AD, Leung J, Raines K, Paul P, Stanley SE, Weg AL, Pieracci EG, Gearhart S, Jumabaeva M, Bankamp B, Rota PA, Sugerman DE, Gastañaduy PA. Measles virus transmission patterns and public health responses during Operation Allies Welcome: a descriptive epidemiological study. Lancet Public Health 2023; 8:e618-e628. [PMID: 37516478 PMCID: PMC10411127 DOI: 10.1016/s2468-2667(23)00130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND On Aug 29, 2021, Operation Allies Welcome (OAW) was established to support the resettlement of more than 80 000 Afghan evacuees in the USA. After identification of measles among evacuees, incoming evacuee flights were temporarily paused, and mass measles vaccination of evacuees aged 6 months or older was introduced domestically and overseas, with a 21-day quarantine period after vaccination. We aimed to evaluate patterns of measles virus transmission during this outbreak and the impact of control measures. METHODS We conducted a measles outbreak investigation among Afghan evacuees who were resettled in the USA as part of OAW. Patients with measles were defined as individuals with an acute febrile rash illness between Aug 29, 2021, and Nov 26, 2021, and either laboratory confirmation of infection or epidemiological link to a patient with measles with laboratory confirmation. We analysed the demographics and clinical characteristics of patients with measles and used epidemiological information and whole-genome sequencing to track transmission pathways. A transmission model was used to evaluate the effects of vaccination and other interventions. FINDINGS 47 people with measles (attack rate: 0·65 per 1000 evacuees) were reported in six US locations housing evacuees in four states. The median age of patients was 1 year (range 0-26); 33 (70%) were younger than 5 years. The age distribution shifted during the outbreak towards infants younger than 12 months. 20 (43%) patients with wild-type measles virus had rash onset after vaccination. No fatalities or community spread were identified, nor further importations after flight resumption. In a non-intervention scenario, transmission models estimated that a median of 5506 cases (IQR 10-5626) could have occurred. Infection clusters based on epidemiological criteria could be delineated into smaller clusters using phylogenetic analyses; however, sequences with few substitution count differences did not always indicate single lines of transmission. INTERPRETATION Implementation of control measures limited measles transmission during OAW. Our findings highlight the importance of integration between epidemiological and genetic information in discerning between individual lines of transmission in an elimination setting. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Nina B Masters
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Andrew S Beck
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adria D Mathis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelley Raines
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Prabasaj Paul
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Scott E Stanley
- Office of the Joint Staff Surgeon, The Joint Staff, Department of Defense, Washington, DC, USA
| | - Alden L Weg
- Office of the Joint Staff Surgeon, The Joint Staff, Department of Defense, Washington, DC, USA
| | - Emily G Pieracci
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Gearhart
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Madina Jumabaeva
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Bettina Bankamp
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David E Sugerman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Masters NB, Mathis AD, Leung J, Raines K, Clemmons NS, Miele K, Balajee SA, Lanzieri TM, Marin M, Christensen DL, Clarke KR, Cruz MA, Gallagher K, Gearhart S, Gertz AM, Grady-Erickson O, Habrun CA, Kim G, Kinzer MH, Miko S, Oberste MS, Petras JK, Pieracci EG, Pray IW, Rosenblum HG, Ross JM, Rothney EE, Segaloff HE, Shepersky LV, Skrobarcek KA, Stadelman AM, Sumner KM, Waltenburg MA, Weinberg M, Worrell MC, Bessette NE, Peake LR, Vogt MP, Robinson M, Westergaard RP, Griesser RH, Icenogle JP, Crooke SN, Bankamp B, Stanley SE, Friedrichs PA, Fletcher LD, Zapata IA, Wolfe HO, Gandhi PH, Charles JY, Brown CM, Cetron MS, Pesik N, Knight NW, Alvarado-Ramy F, Bell M, Talley LE, Rotz LD, Rota PA, Sugerman DE, Gastañaduy PA, Ahluwalia IB, Akinkugbe OA, Aranas A, Arons M, Atherstone C, Bampoe V, Bessler P, Bligh L, Bonner K, Bowen VB, Broadwater K, Brunette GW, Brunkard JM, Burns DA, Cantrell M, Christensen BE, Cope JR, Cory J, Crawford NE, Daigle D, Daly SM, Dejonge P, Dualeh M, Dunn KH, Eidex RB, Elgethun K, Fajardo G, Fonseca-Ford M, Franc K, Gaines J, George N, Goodson J, Green C, Grober AJ, Hailu K, Hammond DR, Harcourt BH, Hess A, Hesse E, Hirst DV, Hornsby-Myers J, Humrighouse B, Ishaq M, Ishii K, James A, Jayapaul-Philip B, Jentes ES, Johnson L, Johnston M, Jolley CD, Kacha-Ochana A, Kaur H, Keaveney M, Kelly HC, Krishnasamy V, Kumar GS, Larkin M, Layde M, LeBouf RF, Lee D, Lira RC, Lopez R, Lozier MJ, Macler A, Mainzer H, Malden D, Malenfant J, Marano N, Marsh Z, Mayer O, McDonald R, Mehta N, Menon AN, Meyer E, Miles ST, Minhaj F, Mirza S, Moller KM, Morris SB, Neu DT, Oakley LP, Ocasio DV, Osborne T, Ou AC, Peck M, Person M, Posey D, Pullia A, Qi C, Raziano AJ, Richmond-Crum M, Roohi S, Saindon JM, Sami S, Sanchez-Gonzalez L, Schweitzer R, Schwitters AM, Shamout M, Shockey CE, Shragai T, Singler KB, Sison EJ, Smith D, Smith M, Sood NJ, Sunshine BJ, Trujillo A, Vallabhaneni S, Wickson A, Yoder JS, Zambuto LR, Cozzarelli T, Rice M, Ricks M, Birchfield JS, Nambiar A, Avrakatos A, Ballard TP, Dennis E, Gambino-Shirley K, Huston AE, Jennings MG, Oldham DM, Rabener MJ, Fandre MN, Jablonka RJ, Love A, Peduzzi OL, Snow K, Greer JA, Hughes CA, Humphreys MA, Korduba AB, Neamand-Cheney KA, Pritchard NL, Smith AM, Whelpley JL, Adekoya S, Alexander V, Davis M, Falk J, Kurkjian K, McCarty E, Moss J, Myrick-West A, Patel C, Pruitt R, Saady D, Sockwell D, Touma A, Wheawill S, Woolard D, Young A, Griffin-Thomas L, Kelly S, McLeod J, Lambert MC, Danz TL, Davis T, Guenther K, Hanson E. Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021. MMWR Morb Mortal Wkly Rep 2022; 71:592-596. [PMID: 35482557 PMCID: PMC9098237 DOI: 10.15585/mmwr.mm7117a2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2).
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Mathis AD, Clemmons NS, Redd SB, Pham H, Leung J, Wharton AK, Anderson R, McNall RJ, Rausch-Phung E, Rosen JB, Blog D, Zucker JR, Bankamp B, Rota PA, Patel M, Gastañaduy PA. Maintenance of measles elimination status in the United States for 20 years despite increasing challenges. Clin Infect Dis 2021; 75:416-424. [PMID: 34849648 DOI: 10.1093/cid/ciab979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Measles elimination (interruption of endemic measles virus transmission) in the United States was declared in 2000; however, the number of cases and outbreaks have increased in recent years. We characterized the epidemiology of measles outbreaks and measles transmission patterns post-elimination to identify potential gaps in the U.S. measles control program. METHODS We analyzed national measles notification data from January 1, 2001-December 31, 2019. We defined measles infection clusters as single cases (isolated cases not linked to additional cases), 2-case clusters, or outbreaks with 3 or more linked cases. We calculated the effective reproduction number (R) to assess changes in transmissibility and reviewed molecular epidemiology data. RESULTS During 2001-2019, 3,873 measles cases, including 747 international importations, were reported in the United States; 29% of importations were associated with outbreaks. Among 871 clusters, 69% were single cases and 72% had no spread. Larger and longer clusters were reported since 2013, including seven outbreaks with >50 cases lasting >2 months, 5 of which occurred in known underimmunized, close-knit communities. No measles lineage circulated in a single transmission chain for >12 months. Higher estimates of R were noted in recent years, although R remained below the epidemic threshold of 1. CONCLUSIONS Current epidemiology continues to support the interruption of endemic measles virus transmission in the United States. However, larger and longer outbreaks in recent post-elimination years and emerging trends of increased transmission in underimmunized communities emphasize the need for targeted approaches to close existing immunity gaps and maintain measles elimination.
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Affiliation(s)
- Adria D Mathis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Nakia S Clemmons
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Susan B Redd
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Huong Pham
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Adam K Wharton
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Raydel Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Rebecca J McNall
- Division of Laboratory Systems, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Elizabeth Rausch-Phung
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, USA
| | - Jennifer B Rosen
- New York City Department of Health and Mental Hygiene, 42-09 28 th St, Long Island City, NY 11101, USA
| | - Debra Blog
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, USA
| | - Jane R Zucker
- New York City Department of Health and Mental Hygiene, 42-09 28 th St, Long Island City, NY 11101, USA.,Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Bettina Bankamp
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Manisha Patel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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