Factors Associated With Measles Transmission in the United States During the Postelimination Era | Infectious Diseases | JAMA Pediatrics | JAMA Network
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1.
Dabbagh  A, Patel  MK, Dumolard  L,  et al.  Progress toward regional measles elimination—worldwide, 2000-2016.  MMWR Morb Mortal Wkly Rep. 2017;66(42):1148-1153. doi:10.15585/mmwr.mm6642a6PubMedGoogle ScholarCrossref
2.
Centers for Disease Control and Prevention. Measles cases and outbreaks. https://www.cdc.gov/measles/cases-outbreaks.html. Updated October 11, 2019. Accessed March 1, 2019.
3.
Mossong  J, Hens  N, Jit  M,  et al.  Social contacts and mixing patterns relevant to the spread of infectious diseases.  PLoS Med. 2008;5(3):e74. doi:10.1371/journal.pmed.0050074PubMedGoogle Scholar
4.
Becker  AD, Birger  RB, Teillant  A, Gastanaduy  PA, Wallace  GS, Grenfell  BT.  Estimating enhanced prevaccination measles transmission hotspots in the context of cross-scale dynamics.  Proc Natl Acad Sci U S A. 2016;113(51):14595-14600. doi:10.1073/pnas.1604976113PubMedGoogle ScholarCrossref
5.
Sartorius  B, Cohen  C, Chirwa  T, Ntshoe  G, Puren  A, Hofman  K.  Identifying high-risk areas for sporadic measles outbreaks: lessons from South Africa.  Bull World Health Organ. 2013;91(3):174-183. doi:10.2471/BLT.12.110726PubMedGoogle ScholarCrossref
6.
Carazo Perez  S, De Serres  G, Bureau  A, Skowronski  DM.  Reduced antibody response to infant measles vaccination: effects based on type and timing of the first vaccine dose persist after the second dose.  Clin Infect Dis. 2017;65(7):1094-1102. doi:10.1093/cid/cix510PubMedGoogle ScholarCrossref
7.
De Serres  G, Boulianne  N, Defay  F,  et al.  Higher risk of measles when the first dose of a 2-dose schedule of measles vaccine is given at 12-14 months versus 15 months of age.  Clin Infect Dis. 2012;55(3):394-402. doi:10.1093/cid/cis439PubMedGoogle ScholarCrossref
8.
LeBaron  CW, Beeler  J, Sullivan  BJ,  et al.  Persistence of measles antibodies after 2 doses of measles vaccine in a postelimination environment.  Arch Pediatr Adolesc Med. 2007;161(3):294-301. doi:10.1001/archpedi.161.3.294PubMedGoogle ScholarCrossref
9.
Rosen  JB, Rota  JS, Hickman  CJ,  et al.  Outbreak of measles among persons with prior evidence of immunity, New York City, 2011.  Clin Infect Dis. 2014;58(9):1205-1210. doi:10.1093/cid/ciu105PubMedGoogle ScholarCrossref
10.
Centers for Disease Control and Prevention. National Notifiable Disease Surveillance System (NNDSS): measles/rubeola 2013 case definition. https://wwwn.cdc.gov/nndss/conditions/measles/case-definition/2013/. Accessed Feb 1, 2019.
11.
Gastanaduy  P, Redd  S, Clemmons  N,  et al. Chapter 7: Measles. In: Roush SW, Baldy LM, Kirkconnell Hall MA, eds. Manual for the Surveillance of Vaccine-Preventable Diseases. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html. Updated April 1, 2014. Accessed May 6, 2018.
12.
Gastañaduy  PA, Paul  P, Fiebelkorn  AP,  et al.  Assessment of the status of measles elimination in the United States, 2001-2014.  Am J Epidemiol. 2017;185(7):562-569. doi:10.1093/aje/kww168PubMedGoogle ScholarCrossref
13.
Gastañaduy  PA, Funk  S, Paul  P,  et al.  Impact of public health responses during a measles outbreak in an Amish community in Ohio: modeling the dynamics of transmission.  Am J Epidemiol. 2018;187(9):2002-2010. doi:10.1093/aje/kwy082PubMedGoogle ScholarCrossref
14.
Cori  A, Ferguson  NM, Fraser  C, Cauchemez  S.  A new framework and software to estimate time-varying reproduction numbers during epidemics.  Am J Epidemiol. 2013;178(9):1505-1512. doi:10.1093/aje/kwt133PubMedGoogle ScholarCrossref
15.
Wallinga  J, Teunis  P.  Different epidemic curves for severe acute respiratory syndrome reveal similar impacts of control measures.  Am J Epidemiol. 2004;160(6):509-516. doi:10.1093/aje/kwh255PubMedGoogle ScholarCrossref
16.
Klinkenberg  D, Nishiura  H.  The correlation between infectivity and incubation period of measles, estimated from households with two cases.  J Theor Biol. 2011;284(1):52-60. doi:10.1016/j.jtbi.2011.06.015PubMedGoogle ScholarCrossref
17.
Vink  MA, Bootsma  MC, Wallinga  J.  Serial intervals of respiratory infectious diseases: a systematic review and analysis.  Am J Epidemiol. 2014;180(9):865-875. doi:10.1093/aje/kwu209PubMedGoogle ScholarCrossref
18.
Hahné  SJ, Nic Lochlainn  LM, van Burgel  ND,  et al.  Measles outbreak among previously immunized healthcare workers, the Netherlands, 2014.  J Infect Dis. 2016;214(12):1980-1986. doi:10.1093/infdis/jiw480PubMedGoogle ScholarCrossref
19.
Rota  JS, Hickman  CJ, Sowers  SB, Rota  PA, Mercader  S, Bellini  WJ.  Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission.  J Infect Dis. 2011;204(suppl 1):S559-S563. doi:10.1093/infdis/jir098PubMedGoogle ScholarCrossref
20.
Opel  DJ, Omer  SB.  Measles, mandates, and making vaccination the default option.  JAMA Pediatr. 2015;169(4):303-304. doi:10.1001/jamapediatrics.2015.0291PubMedGoogle ScholarCrossref
21.
Read  JM, Edmunds  WJ, Riley  S, Lessler  J, Cummings  DA.  Close encounters of the infectious kind: methods to measure social mixing behaviour.  Epidemiol Infect. 2012;140(12):2117-2130. doi:10.1017/S0950268812000842PubMedGoogle ScholarCrossref
22.
Lievano  FA, Papania  MJ, Helfand  RF,  et al.  Lack of evidence of measles virus shedding in people with inapparent measles virus infections.  J Infect Dis. 2004;189(suppl 1):S165-S170. doi:10.1086/377715PubMedGoogle ScholarCrossref
23.
Ackley  SF, Hacker  JK, Enanoria  WTA,  et al.  Genotype-specific measles transmissibility: a branching process analysis.  Clin Infect Dis. 2018;66(8):1270-1275. doi:10.1093/cid/cix974PubMedGoogle ScholarCrossref
24.
Gastañaduy  PA, Budd  J, Fisher  N,  et al.  A measles outbreak in an underimmunized Amish community in Ohio.  N Engl J Med. 2016;375(14):1343-1354. doi:10.1056/NEJMoa1602295PubMedGoogle ScholarCrossref
25.
Hagan  JE, Takashima  Y, Sarankhuu  A,  et al.  Risk factors for measles virus infection among adults during a large outbreak in postelimination era in Mongolia, 2015.  J Infect Dis. 2017;216(10):1187-1195. doi:10.1093/infdis/jix449PubMedGoogle ScholarCrossref
26.
Antona  D, Lévy-Bruhl  D, Baudon  C,  et al.  Measles elimination efforts and 2008-2011 outbreak, France.  Emerg Infect Dis. 2013;19(3):357-364. doi:10.3201/eid1903.121360PubMedGoogle ScholarCrossref
27.
Guerra  FM, Bolotin  S, Lim  G,  et al.  The basic reproduction number (R0) of measles: a systematic review.  Lancet Infect Dis. 2017;17(12):e420-e428. doi:10.1016/S1473-3099(17)30307-9PubMedGoogle ScholarCrossref
28.
Durrheim  DN.  Measles elimination—using outbreaks to identify and close immunity gaps.  N Engl J Med. 2016;375(14):1392-1393. doi:10.1056/NEJMe1610620PubMedGoogle ScholarCrossref
29.
Hall  V, Banerjee  E, Kenyon  C,  et al.  Measles outbreak—Minnesota April-May 2017.  MMWR Morb Mortal Wkly Rep. 2017;66(27):713-717. doi:10.15585/mmwr.mm6627a1PubMedGoogle ScholarCrossref
30.
Rosen  JB, Arciuolo  RJ, Khawja  AM, Fu  J, Giancotti  FR, Zucker  JR.  Public health consequences of a 2013 measles outbreak in New York City.  JAMA Pediatr. 2018;172(9):811-817. doi:10.1001/jamapediatrics.2018.1024PubMedGoogle ScholarCrossref
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    Original Investigation
    November 18, 2019

    Factors Associated With Measles Transmission in the United States During the Postelimination Era

    Author Affiliations
    • 1Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
    • 2Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
    • 3Rollins School of Public Health, Emory University, Atlanta, Georgia
    • 4Epidemiological Modelling Unit, Monash University, Melbourne, Victoria, Australia
    • 5Health Modelling and Analytics Team, IBM Research Australia, Melbourne, Victoria, Australia
    • 6Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
    • 7Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    JAMA Pediatr. 2020;174(1):56-62. doi:10.1001/jamapediatrics.2019.4357
    Key Points

    Question  What are the factors causing the transmission of measles in long-standing measles control programs?

    Findings  This cross-sectional study found that lack of vaccination and birth on or after 1957, as well assortative transmission by age (particularly among school-aged children), are the primary factors associated with measles transmission in the United States. Although current measles vaccines are known to be highly effective in decreasing susceptibility to measles, these analyses shed light on the degree by which vaccination also limits measles transmission.

    Meaning  The findings underscore the importance of maintaining homogenous, high, 2-dose measles vaccine coverage, especially among school-aged children, to sustain elimination of measles in the United States.

    Abstract

    Importance  Measles cases and outbreaks continue to occur in the United States after the introduction of measles from endemic settings.

    Objective  To discern the factors associated with measles transmission in the United States after measles had been eliminated.

    Design, Setting, and Participants  This cross-sectional study was conducted from January 1, 2001, to December 31, 2017, in the United States among US residents and international visitors with confirmed measles. A maximum likelihood algorithm that uses the observed dates of rash onset and the known distribution of the serial interval (time between symptom onset in related consecutive cases) was applied to outbreak notification data to estimate the effective reproduction number (R), or the mean number of new infections generated per case. Transmissibility was assessed by comparing R based on the characteristics of primary and secondary cases of measles.

    Exposures  Measles virus.

    Main Outcomes and Measures  Effective reproduction number (R), or the mean number of successful transmission events per case of measles (ie, the mean number of persons to whom each patient with measles spreads measles).

    Results  A total of 2218 individuals with confirmed measles cases (1025 female, 1176 male, and 17 sex not reported; median age, 15 years [range, 0-89 years]) reported from 2001 to 2017 were evaluated. Among patients who received no doses of measles vaccine, R was 0.76 (95% CI, 0.71-0.81); among patients who received 1 dose of measles vaccine, R was 0.17 (95% CI, 0.11-0.26); among patients who received 2 doses or more of measles vaccine, R was 0.27 (95% CI, 0.17-0.39); and among patients with unknown vaccination status, R was 0.52 (95% CI, 0.44-0.60). Among patients born before 1957, R was 0.35 (95% CI, 0.20-0.58), and among those born on or after 1957, R was 0.64 (95% CI, 0.61-0.68). R was higher when primary and secondary cases of measles were patients aged 5 to 17 years (0.36 [95% CI, 0.31-0.42]) compared with assortative transmission in other age groups (<1 year, 0.14 [95% CI, 0.10-0.20]; 1-4 years, 0.25 [95% CI, 0.20-0.30]; 18-29 years, 0.19 [95% CI, 0.15-0.24]; 30-49 years, 0.15 [95% CI, 0.11-0.20]; ≥50 years, 0.04 [95% CI, 0.01-0.10]).

    Conclusions and Relevance  The findings of this study support having high targets for 2-dose measles vaccine coverage, particularly among school-aged children in the United States.

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