Issue
Number 413
September 22, 2003
CONTENTS OF THIS ISSUE
- CDC reports on decline in varicella incidence,
1990-2001
- CDC reports on measles epidemic in the Republic
of the Marshall Islands, July 13-September 13, 2003
- Revised: IAC updates its Prototype of
"Notification of Vaccination" Letter
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September 22, 2003
CDC REPORTS ON DECLINE IN VARICELLA INCIDENCE, 1990-2001
The Centers for Disease Control and Prevention (CDC) published "Decline in
Annual Incidence of Varicella--Selected States, 1990-2001" in the September
19 issue of the "Morbidity and Mortality Weekly Report" (MMWR). Portions of
the article are reprinted below.
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[Article's opening paragraph]
Varicella (chickenpox) is a common, highly infectious, and
vaccine-preventable disease. Before the introduction of the live attenuated
varicella vaccine in 1995, approximately 4 million cases of varicella
occurred annually in the United States, resulting in approximately 11,000
hospitalizations and 100 deaths. In 1996, the Advisory Committee on
Immunization Practices (ACIP) recommended routine vaccination of all
children at age 12-18 months, catch-up vaccination of all susceptible
children before age 13 years, and vaccination of susceptible persons with
close contact to persons at high risk for serious complications. In 1999,
ACIP updated these recommendations to include vaccination requirements for
child care and school entry and for postexposure; ACIP also strengthened
recommendations for vaccination of susceptible adults and indicated that
varicella vaccine should be considered for outbreak control. Changes in the
national annual reported incidence of varicella disease during 1972-1997
have been reported previously. This report summarizes trends in the annual
reported incidence of varicella disease in selected states during 1990-2001.
The findings underscore the continued need to improve varicella surveillance
to monitor the impact of the varicella vaccination program and assess any
changes in varicella transmission and disease. . . .
[A portion of the article's Editorial Note]
The findings in this report suggest that the steady decline in reported
varicella incidence during 1999-2001 resulted from the increased use of
varicella vaccine and not a decrease in reporting. These findings are
consistent with data from three active surveillance sites at which
individual cases are investigated (Antelope Valley, California; West
Philadelphia, Pennsylvania; and Travis County, Texas). During 1995-2000,
incidence of varicella for all age groups in these three sites declined
substantially (range: 76%-87%), corresponding with the high average
vaccination coverage of 80%.
The availability of a safe and effective varicella vaccine has reduced the
impact of the disease substantially. High vaccination coverage levels among
all age groups are necessary to ensure that persons do not reach adolescence
or adulthood without having immunity to varicella. At the start of the 2002
school year, 33 states had implemented child care or school entry
requirements for varicella (CDC, unpublished data, 2003), and five more
states implemented such requirements in September 2003.
The existing national varicella surveillance system is not adequate to
monitor the incidence of varicella disease or to assess the impact of the
vaccination program. In 2001, disease incidence was reported by 22 states
and the District of Columbia; however, only four states had adequate and
consistent reporting for the study period. The Council of State and
Territorial Epidemiologists has recommended that by 2005, states establish
or enhance varicella surveillance programs that provide individual case
reporting. . . .
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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5237a2.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5237.pdf
HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to the "Morbidity and Mortality
Weekly Report" (MMWR), visit CDC's MMWR website at:
http://www.cdc.gov/mmwr Select
"Free Subscription" from the menu at the left of the screen. Once you have
submitted the required information, weekly issues of the MMWR and all new
ACIP statements (published as MMWR's "Recommendations and Reports") will
arrive automatically by email.
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September 22, 2003
CDC REPORTS ON MEASLES EPIDEMIC IN THE REPUBLIC OF THE MARSHALL ISLANDS,
JULY 13-SEPTEMBER 13, 2003
The Centers for Disease Control and Prevention (CDC) published "Measles
Epidemic--Majuro Atoll, Republic of the Marshall Islands, July 13-September
13, 2003" in the September 19 issue of the "Morbidity and Mortality Weekly
Report" (MMWR). The article is reprinted below in its entirety, excluding
references.
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During July 13-September 13, 2003, a total of 647 clinically diagnosed
measles cases were reported on Majuro Atoll in the Republic of the Marshall
Islands (RMI); this is the first measles outbreak reported in RMI since
1988. An additional 74 suspected measles cases are under investigation. This
report describes the clinically diagnosed measles cases and the public
health response to stop the epidemic. Of the 647 cases, 15 (2%) are
laboratory confirmed, either by serology, polymerase chain reaction, or
viral culture. The age of patients ranged from 2 weeks to 43 years (median:
12 years); 479 (74%) patients were aged less than 20 years. The overall
measles incidence on Majuro Atoll (estimated 2003 population: 25,097) is 26
cases per 1,000 population. The incidence is highest among infants aged
less than 1 year (160 per 1,000 population), followed by children aged 1-4
years.
A total of 58 persons with measles have been hospitalized; three patients
have died, including a malnourished child aged 15 months with diarrhea and
pneumonia, a woman aged 27 years with pneumonia, and a woman aged 39 years
whose immediate cause of death remains unknown. Postmortem examination was
not available for any of these patients.
To stop measles transmission, the Ministry of Health in RMI recommended
measles, mumps, and rubella vaccine (MMR) for all infants aged 6-11 months
and all persons aged 1-40 years who did not have documented proof of measles
immunity. Before the epidemic, estimated vaccine coverage with 1 dose of MMR
was less than 75% for children aged 1-13 years, according to evaluations of
computerized vaccination records and of children screened during the
vaccination campaign. As of September 13, a total of 98% of persons aged 6
months-40 years had documentation of receipt of at least 1 dose of MMR.
Campaign activities that delivered 16,913 doses included 1) vaccinating
health care and public health workers, 2) vaccinating children at nine
vaccination posts across the atoll, 3) delaying the start of the school year
until school children were vaccinated and requiring documentation of
vaccination for school entry, and 4) conducting neighborhood and
house-to-house vaccination in areas where adequate coverage was not reached.
To prevent spread from Majuro Atoll, vaccination campaigns were conducted in
other atolls and islands in RMI. The Ministry of Health suspended travel of
sea vessels and airlines from Majuro Atoll until vaccination campaigns had
been completed in other atolls and islands, and required proof of MMR
vaccination for all travelers leaving Majuro Atoll for other atolls or
islands or for international destinations. A total of 17 measles cases have
been reported from Ebeye Island in Kwajalein Atoll; 10 of these persons were
exposed in Majuro Atoll. Two other atolls have reported six cases whose
exposure was in Majuro Atoll. Measles surveillance has been enhanced in RMI,
other Pacific islands, and in the United States. Spread to other areas in
the Pacific and to the United States has been limited; five measles cases in
Hawaii, three in Guam, one in Palau, and one in California are believed to
be linked to this epidemic.
The source of importation of the measles virus to Majuro Atoll has not yet
been determined, but the H1 genotype found in this outbreak is common in
Asia, and the specific strain has been reported recently in measles cases
from Japan and China. The Advisory Committee on Immunization Practices
recommends that all international travelers be immune to measles because it
is endemic or epidemic in many parts of the world, including developed
countries. Persons aged less than 40 years who are traveling to RMI during
the next 60 days should be aware that RMI requires documentation of measles
immunity for all departing passengers on international flights. The
documentation must fulfill the same age-specific requirements used in the
vaccination campaign.
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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5237a5.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5237.pdf
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September 22, 2003
REVISED: IAC UPDATES ITS PROTOTYPE OF "NOTIFICATION OF VACCINATION" LETTER
The Immunization Action Coalition (IAC) recently revised its Prototype of
"Notification of Vaccination" Letter. A clinic, private practice, or
immunization clinic can use the letter to notify a health professional that
they have vaccinated his or her patient. Users are encouraged to modify the
prototype letter to suit their particular circumstances.
The prototype letter lists the vaccines often administered to children and
adults. IAC has updated the letter to reflect the vaccines currently
available.
To access a camera-ready (PDF) copy of the revised prototype letter, go to:
http://www.immunize.org/catg.d/p3060not.pdf
To access an HTML copy, go to:
http://www.immunize.org/catg.d/p3060not.htm |
