Documentation and Verification of Measles, …

1 United States National Report, March 28, 2012 National Center for Immunization and Respiratory Diseases Division of Viral Diseases Documentation and Verification of measles , Rubella and Congenital Rubella Syndrome Elimination in the Region of the americas CDC Report: Elimination of measles , Rubella, and CRS Acknowledgements This report was prepared by staff of the Centers for Disease Control and Prevention including Greg Armstrong, Albert Barskey, Amy Parker Fiebelkorn, Huong McLean, Susan Redd and Greg Wallace in the Epidemiology Branch, Division of Viral Diseases (DVD) and Emily Abernathy, William Bellini, Lijuan Hao, Joe Icenogle, Mark Papania, Jennifer Rota and Paul Rota in the measles , Mumps, Rubella and Herpesviruses Laboratory Branch, DVD and Mark Pallansch, Jane Seward and Jeanette St.

2 Pierre in the Office of the Director, DVD, National Center for Immunization and Respiratory Diseases (NCIRD) and Susan Reef in the Global Immunization Division, Coordinating Office for Global Health and Anne Schuchat and Melinda Wharton in the Office of the Director, NCIRD. Contact Information Centers for Disease Control and Prevention National Center for Immunization and Respiratory Disease Division of Viral Diseases 1600 Clifton Rd. Atlanta, GA 30333 MS A-24 Phone: 800-CDC -INFO (800-232-4636) E- mail inquiries to , or call DVD s main office at (404) 639-3595. March 2012 ii CDC Report: Elimination of measles , Rubella, and CRS Table of Contents I.

3 Phase 1: Initial Documentation and Verification of the Elimination of Endemic measles , Rubella, and Congenital Rubella Syndrome in the United Step 1: measles elimination Documentation and Step 2: Rubella and CRS elimination Documentation and Phase 2: Verifying and Documenting that Elimination of Endemic measles , Rubella, and Congenital Rubella Syndrome has been Sustained to the Present II. Surveillance of measles , Rubella, and Congenital Rubella Case Evaluating Potential Endemic Methods for Surveillance and Outbreak Investigation and Laboratory Surveillance Activities for measles and Rubella in the United measles laboratory surveillance Rubella laboratory surveillance III.

4 Epidemiology of Basic Importation Unknown Source Estimated Effective Reproduction Number for measles in the United measles Molecular Epidemiology of measles in the United March 2012 iii CDC Report: Elimination of measles , Rubella, and CRS IV. Epidemiology of Basic Importation Unknown Source Congenital Rubella Molecular Epidemiology of Rubella Viruses in the United V. Quality of measles , Rubella, and CRS Surveillance and Outbreak Detection of Imported Cases of measles and Detection of Isolated Cases and Short Chains of Rapid Public Health Response to measles and Rubella Cases and Laboratory Testing Volume at Monitoring Indicators for measles and Rubella VI.

5 Assessment of measles and Rubella Population measles Population Rubella Population Vaccine Coverage Vaccine VII. Sustainability of measles , Rubella, and CRS Correlation and Integration of the Evidence for Maintenance of Elimination of measles , Rubella and VIII. IX. X. External XI. March 2012 iv CDC Report: Elimination of measles , Rubella, and CRS I. Introduction The World Health Organization (WHO) Region of the americas has been a global leader in measles , rubella and congenital rubella syndrome (CRS) elimination. The Pan American Health Organization (PAHO) has coordinated the successful elimination efforts of all member countries within the Region of the americas .

6 Regional measles elimination has been sustained since 2002 and PAHO set an elimination goal for rubella and CRS by 2010. No endemic cases of rubella have been reported since 2009 and the last endemic CRS case in the americas was also reported in 2009. Three other WHO regions, the European, Eastern Mediterranean and Western Pacific regions have targeted measles for elimination by 2015 or before. Other regions are focused on measles mortality reduction strategies. The WHO European Region has a rubella elimination target of 2015 and the Eastern Mediterranean and Western Pacific regions have established congenital rubella syndrome (CRS) prevention goals. The Southeast Asian and African Regions have not established goals for rubella control or elimination.

7 As a PAHO member country, the United States is committed to the goal of eliminating endemic measles , rubella, and CRS from the Region of the americas , and to the Documentation and Verification of elimination by the end of 2011, as resolved by the 27th Pan American Sanitary Conference ( ) in 2007. As part of this regional effort, this National Report confirms the successful, sustained elimination of endemic measles from the United States since elimination was verified in 2000 and of endemic rubella and CRS since Verification of elimination in 2004. The United States has verified and documented the elimination of endemic measles and rubella in two phases. Phase 1: Initial Documentation and Verification of the Elimination of Endemic measles , Rubella and Congenital Rubella Syndrome in the United States Step 1: measles elimination Documentation and Verification In the year 2000, the verified the elimination of endemic measles within its borders.

8 In March 2000, the National Immunization Program of the Centers for Disease Control and Prevention (CDC) convened an external panel of 12 consultants to review the status of measles in the United States. The experts reviewed the strategy for elimination, which includes the following components: achieving very high coverage with 2 doses of measles -containing vaccine; sustaining adequate surveillance; responding to cases with thorough case investigation and outbreak response; and promoting measles control in other countries. The definitions of elimination, mathematical models of endemic measles transmission elimination and the population immunity required to achi eve elimination were also discussed with the panel.

9 The epidemiology of measles in the United States was presented, including the sustained extremely low incidence, the high proportion of cases that were internationally imported or import-associated, and the small and infrequent outbreaks. Also, molecular epidemiologic data were presented to the panel that showed that no endemic genotype has been detected in the United States since 1994. The quality of surveillance was reviewed in detail, including presentations by health officials from New York City, Los Angeles, and Chicago showing the various approaches to surveillance in these high-risk locations. An March 2012 page 1 of 58 CDC Report: Elimination of measles , Rubella, and CRS overall assessment showing high population immunity to measles was presented based on National Immunization Survey coverage estimates, school entry vaccine coverage surveys and national serosurvey results.

10 Finally, the progress made by other countries in the americas and the positive impact this progress had on tracking the epidemiology of measles in the United States was presented. Each of the 12 consultants in the external panel concluded that measles was not endemic in the United States. The elimination of endemic measles in the United States in 2000 was documented, along with all of the evidence presented to the external consultants, in a supplement to the Journal of Infectious The Executive Summary of the panel s opinion, along with all of the data presented and published, was provided to the Phase II external review panel and will be provided to the International Expert Committee to verify and document the sustained elimination of endemic measles from the United States.