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      Measles Elimination Efforts and 2008–2011 Outbreak, France

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          Abstract

          Although few measles cases were reported in France during 2006 and 2007, suggesting the country might have been close to eliminating the disease, a dramatic outbreak of >20,000 cases occurred during 2008–2011. Adolescents and young adults accounted for more than half of cases; median patient age increased from 12 to 16 years during the outbreak. The highest incidence rate was observed in children <1 year of age, reaching 135 cases/100,000 infants during the last epidemic wave. Almost 5,000 patients were hospitalized, including 1,023 for severe pneumonia and 27 for encephalitis/myelitis; 10 patients died. More than 80% of the cases during this period occurred in unvaccinated persons, reflecting heterogeneous vaccination coverage, where pockets of susceptible persons still remain. Although vaccine coverage among children improved, convincing susceptible young adults to get vaccinated remains a critical issue if the target to eliminate the disease by 2015 is to be met.

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          Most cited references14

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          Measles transmission and vaccine effectiveness during a large outbreak on a densely populated island: implications for vaccination policy.

          The Republic of the Marshall Islands (RMI) is a South Pacific nation freely associated with the United States. In 2003, the RMI experienced the largest measles outbreak within the United States or its associated areas for more than a decade, although the reported coverage of 1-dose measles-mumps-rubella (MMR) vaccine was 80%-93%. The outbreak ended only after vaccination of >35,000 persons among a population of 51,000. Of outbreak cases, 41% were reported to have been previously vaccinated. We studied measles attack rates in RMI households to assess vaccine effectiveness and patterns of disease transmission. For the household secondary attack rate study, households were selected by convenience sampling of outbreak measles cases. The primary case was defined as the first person with measles in a household. Secondary cases were household members with measles onset 7-18 days after the primary case's rash onset. Vaccine effectiveness analysis was limited to children aged 6 months to 14 years, with vaccination status verified against written records. Seventy-two households were included in the study. The median household size was 11 persons, and the median number of persons per room was 5.5. Secondary cases were more likely than primary cases to be infants (46% vs. 13%; P=.03). MMR vaccine effectiveness was 92% (95% confidence interval [CI], 67%-98%) for 1 dose and 95% (95% CI, 82%-98%) for 2 doses. Measles vaccine effectiveness was high; thus, diminished effectiveness was not the main cause of the outbreak. In communities with high population density and household crowding, very high population immunity is needed to prevent measles outbreaks and to protect infants below the age of vaccination. This may require excellent implementation of a routine 2-dose measles vaccination strategy.
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            Measles - United States, 2011.

            (2012)
            In 2000, the United States achieved measles elimination (defined as interruption of year-round endemic measles transmission). However, importations of measles into the United States continue to occur, posing risks for measles outbreaks and sustained measles transmission. During 2011, a total of 222 measles cases (incidence rate: 0.7 per 1 million population) and 17 measles outbreaks (defined as three or more cases linked in time or place) were reported to CDC, compared with a median of 60 (range: 37-140) cases and four (range: 2-10) outbreaks reported annually during 2001-2010. This report updates an earlier report on measles in the United States during the first 5 months of 2011. Of the 222 cases, 112 (50%) were associated with 17 outbreaks, and 200 (90%) were associated with importations from other countries, including 52 (26%) cases in U.S. residents returning from abroad and 20 (10%) cases in foreign visitors. Other cases associated with importations included 67 (34%) linked epidemiologically to importations, 39 (20%) with virologic evidence suggesting recent importation, and 22 (11%) linked to cases with virologic evidence of recent importation. Most patients (86%) were unvaccinated or had unknown vaccination status. The increased numbers of outbreaks and measles importations into the United States underscore the ongoing risk for measles among unvaccinated persons and the importance of vaccination against measles.
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              Spotlight on measles 2010: update on the ongoing measles outbreak in France, 2008-2010.

              Since early 2008, France has been experiencing a measles outbreak with almost 5,000 notified cases as of 30 June 2010, including three measles-related deaths. The proportion of cases 20 years or older reached 38% during the first half of 2010. This situation is the consequence of insufficient vaccine coverage (90% at age 24 months in 2007) that led to the accumulation of susceptibles over the last years. It underlines the need for additional measures targeting susceptible children and young adults.
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                Author and article information

                Journal
                Emerg Infect Dis
                Emerging Infect. Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                March 2013
                : 19
                : 3
                : 357-364
                Affiliations
                [1]Author affiliations: Institut de Veille Sanitaire, Saint-Maurice, France (D. Antona, D. Lévy-Bruhl, C. Baudon, M. Lamy, C. Maine, I. Parent du Chatelet);
                [2]National Reference Centre for Measles and Respiratory Paramyxoviridae, CHU Caen, France (F. Freymuth);
                [3]Université Claude Bernard Lyon 1, Lyon, France (D. Floret)
                Author notes
                Address for correspondence: Denise Antona, Institut de Veille Sanitaire, 12 rue du Val d’Osnes, Saint-Maurice 94415 Cedex, France; email: d.antona@ 123456invs.sante.fr
                Article
                12-1360
                10.3201/eid1903.121360
                3647670
                23618523
                48c3930b-4e66-4802-9c45-7f4b1e2ae0de
                History
                Categories
                Perspective
                Perspective

                Infectious disease & Microbiology
                measles,france,epidemiology,elimination,viruses,vaccines,immunization,children,adolescents,young adults,suggested citation for this article: antona d,lévy-bruhl d,baudon c,freymuth f,lamy m,maine c,et al. measles elimination efforts and 2008–2011 outbreak,france. emerg infect dis [internet]. 2013 mar [date cited]. http://dx.doi.org/10.3201/eid1903.121360

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