Elimination of Endemic Measles, Rubella, and Congenital Rubella Syndrome From the Western Hemisphere The US Experience
Elimination of Endemic Measles, Rubella, and Congenital Rubella Syndrome From the Western Hemisphere The US Experience
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DOI：
10.1001/jamapediatrics.2013.4342
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发表时间：
2014-02-01
期刊：
影响因子：
26.1
通讯作者：
Seward, Jane F.
中科院分区：
文献类型：
--
作者：
Papania, Mark J.;Wallace, Gregory S.;Seward, Jane F.
重要性为了验证西半球地方性麻疹、风疹和先天性风疹综合征（CRS）的消除情况，泛美卫生组织要求每个成员国编写一份国家消除报告。美国记录了2000年消灭地方性麻疹和2004年消灭地方性风疹和CRS的情况。2011年12月，美国疾病控制和预防中心召集了一个外部专家小组，以审查证据并确定地方性麻疹、风疹和CRS的消除是否已经持续。目的审查美国持续消除地方性麻疹、风疹和CRS的证据。回顾2001年至2011年麻疹和2004年至2011年风疹和CRS的数据，涵盖美国常住人口和国际游客，包括疾病流行病学，病例输入状况，分子流行病学，监测充分性，和人口免疫力的估计全国疫苗接种覆盖率和血清学调查。主要结果和措施麻疹，风疹，和CRS病例的年度数量，由输入状态，爆发规模和分布，美国人口麻疹和风疹血清阳性的比例;结果自2001年以来，美国麻疹发病率一直保持在1例/100万人口以下。自2004年以来，风疹发病率一直低于每1000万人口1例，CRS发病率一直低于每500万新生儿1例。88%的麻疹病例和54%的风疹病例是国际输入的，或者在流行病学或病毒学上与输入有关。与输入无关的少数病例不足以代表地方性传播。分子流行病学表明没有地方性基因型。美国的监测系统足以发现地方性麻疹或风疹。血清阳性率和疫苗接种覆盖率的数据表明，高水平的人口免疫力麻疹和风疹。结论和相关性外部专家小组的结论是，消除地方性麻疹，风疹，CRS从美国持续到2011年。然而，国际输入仍在继续，卫生保健提供者应怀疑患有发热性皮疹疾病的患者患有麻疹或风疹，特别是当与国际旅行或国际游客有关时，并应向当地卫生部门报告疑似病例。
IMPORTANCE To verify the elimination of endemic measles, rubella, and congenital rubella syndrome (CRS) from the Western hemisphere, the Pan American Health Organization requested each member country to compile a national elimination report. The United States documented the elimination of endemic measles in 2000 and of endemic rubella and CRS in 2004. In December 2011, the Centers for Disease Control and Prevention convened an external expert panel to review the evidence and determine whether elimination of endemic measles, rubella, and CRS had been sustained.OBJECTIVE To review the evidence for sustained elimination of endemic measles, rubella, and CRS from the United States through 2011.DESIGN, SETTING, AND PARTICIPANTS Review of data for measles from 2001 to 2011 and for rubella and CRS from 2004 to 2011 covering the US resident population and international visitors, including disease epidemiology, importation status of cases, molecular epidemiology, adequacy of surveillance, and population immunity as estimated by national vaccination coverage and serologic surveys.MAIN OUTCOMES AND MEASURES Annual numbers of measles, rubella, and CRS cases, by importation status, outbreak size, and distribution; proportions of US population seropositive for measles and rubella; and measles-mumps-rubella vaccination coverage levels.RESULTS Since 2001, US reported measles incidence has remained below 1 case per 1 000 000 population. Since 2004, rubella incidence has been below 1 case per 10 000 000 population, and CRS incidence has been below 1 case per 5 000 000 births. Eighty-eight percent of measles cases and 54% of rubella cases were internationally imported or epidemiologically or virologically linked to importation. The few cases not linked to importation were insufficient to represent endemic transmission. Molecular epidemiology indicated no endemic genotypes. The US surveillance system is adequate to detect endemic measles or rubella. Seroprevalence and vaccination coverage data indicate high levels of population immunity to measles and rubella.CONCLUSIONS AND RELEVANCE The external expert panel concluded that the elimination of endemic measles, rubella, and CRS from the United States was sustained through 2011. However, international importation continues, and health care providers should suspect measles or rubella in patients with febrile rash illness, especially when associated with international travel or international visitors, and should report suspected cases to the local health department.