Historical perspective of measles control in the United States Open Access

Gomez Estevez, Araceli Mariana (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/1831ck683?locale=en
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Abstract

Measles is a highly contagious disease with significant childhood mortality slated for regional elimination and eventual eradication. Maintenance and assessment of local measles elimination is challenging in face of continued importations of the disease. In the present study, we quantify measles transmissibility in the United Sates from 1985 to 2015, by estimation of the effective reproduction number (RE) (the average number of secondary cases generated by a case). Four mathematical methods to estimate RE were applied to national surveillance data to ascertain when measles elimination was achieved in the United States. Analysis shows that since 1997, RE point estimates by all methods were below the threshold value of 1; the minimum to sustain endemic transmission. Thereafter, year-to-year variability in the values of RE and an increase in transmissibility in recent years were noted with all methods. Fluctuations in RE show an inverse proportion pattern with vaccination rates, and RE values below 1 correlated with a measles incidence of 1 case per million population. Our findings suggest that elimination of endemic measles transmission was attained in 1997 in the United States, and maintained, and emphasize the primacy of high measles vaccination coverage throughout the population to limit measles transmission.

Table of Contents

Table of Contents

Table of Contents

Historical perspective of measles control in the United States 1
METHODS 4
RESULTS 6
DISCUSSION 7
ACKNOWLEDGMENTS 13
REFERENCES 14
FIGURES 20

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