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. 2019 Apr 19;219(10):1616-1623.
doi: 10.1093/infdis/jiy701.

International Importations of Measles Virus into the United States During the Postelimination Era, 2001-2016

Adria D Lee  1 , Nakia S Clemmons  2 , Manisha Patel  2 , Paul A Gastañaduy  2
Affiliations

International Importations of Measles Virus into the United States During the Postelimination Era, 2001-2016

Adria D Lee et al. J Infect Dis. .

Abstract

Background: Although measles was declared eliminated from the United States in 2000, measles cases and outbreaks continue to occur, resulting from importations of the disease from countries where it remains endemic.

Methods: We describe the epidemiology of international importations of measles virus into the United States during the postelimination era.

Results: From 2001 to 2016, 553 imported measles cases were reported to the Centers for Disease Control and Prevention. A median of 28 importations occurred each year (range: 18-80). The median age of imported case-patients was 18 years (range: 3 months-75 years); 87% were unvaccinated or had an unknown vaccination status. US residents (as opposed to foreign visitors) accounted for 62% of imported measles cases. Overall, 62% of all imported case-patients reported travel to countries in the Western Pacific and European Regions of the World Health Organization during their exposure periods. The number of measles importations from specific countries was related to the incidence of measles in and the volume of travel to and from the source country.

Conclusions: Our findings emphasize the importance of measles vaccination of US residents aged ≥6 months before international travel according to the Advisory Committee on Immunization Practices recommendations and supporting global measles elimination efforts.

Keywords: international importation; measles; measles elimination.

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Conflict of interest statement

Conflicts of interest

None of the authors have a conflict of interest to report.

Figures

Figure 1.
Figure 1.. Internationally imported measles cases by residence status — United States, 2001–2016.
The dark bars indicate U.S. residents and the light bars indicate foreign visitors. The dashed line indicates the proportion of all importations that were U.S. residents each year. There was an increasing trend in the proportion of importations that were U.S. residents from 2001–2016 (P <0.0001 using X2 test).
Figure 2.
Figure 2.. Geographic distribution of internationally imported measles case-patients by reporting state and county — United States, 2001–2016.
The smallest dots represent 1 importation, and the largest dot represents 33 importations (N = 541; county data were unavailable for 12 case-patients).
Figure 3.
Figure 3.. Arrival of internationally imported measles case-patients by month of rash onset — United States, 2001–2016.
The gray bars represent the number of imported case-patients reported each month and the white circles represent the proportion of all imported case-patients reported each month.
See this image and copyright information in PMC

References

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