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FIGURE I. Reported measles cases – United States, weeks 51-52, 1987 and weeks 01-02, 1988

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The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. Director, Centers for Disease Control

Editor James O. Mason, M.D., Dr.P.H.

Michael B. Gregg, M.D. Director, Epidemiology Program Office

Managing Editor Carl W. Tyler, Jr., M.D.

Gwendolyn A. Ingraham

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CENTERS FOR DISEASE CONTROL

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Measles United States, First 26
Weeks, 1987
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Epidemiologic Notes and Reports

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For the first 26 weeks of 1987, a provisional total of 2,637 measles cases was reported to CDC by 37 states and 5.6% of the nation's 3,138 counties.* This total is 32.7% less than the 3,921 cases reported for the same period in 1986 (1), when 42 states and 9.0% of the counties reported cases. The overall incidence rate for the first half of 1987 was 1.1 cases per 100,000 population; the rate for the first half of 1986 was 1.7/100,000.

Seven states and New York City accounted for 2,148 (81.5%) of the cases reported for the first 26 weeks of 1987: California reported 647; New York City, 414; New Mexico, 303; Texas, 200; Missouri, 178; New Hampshire, 150; Wisconsin, 139; and Illinois, 117. Incidence rates greater than 3.0/100,000 occurred in New Mexico (22.8), Montana (15.6), New Hampshire (13.2), New York City (5.1), Delaware (4.5), Vermont (4.1), and Missouri (3.6).

CDC's Division of Immunization received detailed information on 2,595 (98.4%) of the 2,637 reported cases. Of these, 2,305 (88.8%) met the standard clinical case definition for measles, and 723 (27.9%) were serologically confirmed. The usual seasonal pattern was observed - most cases occurred between March and May (weeks 9 to 19) (Figure 1).

Fifty-seven (2.2%) of the 2,595 cases were known to be imported from other countries; 30 (52.6%) of these cases occurred among U.S. citizens. An additional 74 cases (2.9%) were epidemiologically linked to imported cases within two generations. Forty-six outbreaks (five or more epidemiologically related cases) accounted for 87.6% of all cases. Five outbreaks of more than 100 cases each accounted for 59.2% of all reported cases.

As in 1986, almost 30% of cases involved children under 5 years of age (Table 1). Two hundred twenty-five (30.0%) of the 750 preschool-aged patients were less than 1 year of age; 122 (16.3%) were 12-14 months of age; 32 (4.2%), 15 months of age; and 371 (49.5%), 16 months through 4 years of age. The 15- to 19-year age group also accounted for approximately 30% of the cases and was the only age group for which the incidence rate did not decrease between 1986 and 1987. The groups aged zero to *A provisional total of 3,588 was reported for all of 1987. *Fever 38.3 °C (101 °F) or higher, if measured; generalized rash lasting 3 or more days; and at least one of the following: cough, coryza, or conjunctivitis.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / PUBLIC HEALTH SERVICE

US STS BY MAR 3 198"

Measles Continued 4 years and 15-19 years had the highest incidence rates (4.1/100,000 each); the 10- to 14-year age group had the next highest (3.0/100,000).

Complications were reported in 351 (13.5%) of the 2,595 cases. Otitis media was reported in 175 (6.7%) cases; diarrhea, in 129 (5.0%); pneumonia, in 68 (2.6%); and encephalitis, in 2 (0.1%). Two hundred and one (7.7%) of these patients were hospitalized. Four deaths were attributed to measles, for a death-to-case ratio of 1.5:1,000. All four patients were immunocompromised. Two were 4-year-olds with acquired immunodeficiency syndrome; one was a 9-year-old who had autoimmune hemolytic anemia and was receiving corticosteroid therapy; and one was a 57-yearold with chronic lymphocytic leukemia. Two cases were acquired in the hospital, and two were acquired in the community.

Of the 1,805 (69.6%) patients for whom setting of transmission was reported, 960 (53.2%) acquired measles in primary or secondary schools; 122 (6.8%), in colleges

United States, first 26

FIGURE 1. Reported measles cases, by week of rash onset weeks, 1987

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TABLE 1. Reported measles cases and estimated incidence rates* of measles, by age of patients - United States, first 26 weeks, 1986 and 1987

1986*

1987 Age Group

Rate (years)

No.
(%) Rate No.

(%) Rate Change (%) 0-4 1,249 (32.0) 7.0 750 (28.9) 4.1

(-41.4) 5-9 430 (11.0) 2.6

237
(9.1) 1.4

(-46.2) 10-14 1,006 (25.8) 5.7 500 (19.3) 3.0

(-47.4) 15-19 749 (19.2) 760 (29.3) 4.1

(+ 5.1) 20-24 243 (6.2) 1.1

149
(5.7) 0.7

1-36.4) 225 224 (5.7) 0.2

199
(7.7) 0.1

1-50.0) Total 3,901 (100.0) 1.7 2,595 (100.0) 1.1

1-35.3) *Rates per 100,000 population are based on provisional data for both years. *Estimated total excludes 20 reported cases for which the age group was unknown.

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Measles Continued or universities; 386 (21.4%), at home; 114 (6.3%), in medical settings; 31 (1.7%), in day-care centers; and 192 (10.6%), in a variety of other settings including work, church, and the military.

A total of 1,274 (49.1%) patients had been vaccinated on or after their first birthdays. This group included 427 (33.5%) who were vaccinated at 12-14 months of age. There were 1,213 (46.7%) unvaccinated patients and 108 (4.2%) with histories of vaccination before their first birthdays.

Of the 2,595 cases, 704 (27.1%) were classified as preventable (2), and 1,891 (72.9%), as nonpreventable (Tables 2, 3). Between 1986 and 1987, the absolute number and proportion of preventable cases decreased for all except the over 25-year age group. The highest proportion of preventable cases occurred among persons not of school age-87.5% of cases among adults 25-29 years of age and 68.2% of cases among children 16 months through 4 years of age were preventable. Two hundred sixty-six (37.8%) of the total number of preventable cases involved children 5-19 years of age, and 17.8% of the total cases in this age group were preventable. Cases among adequately vaccinated persons constituted 67.0% of nonpreventable cases and 48.8% of total cases (Table 3). Of the 1,497 school-aged children who acquired measles, 1,119 (74.7%) had been adequately vaccinated, and 406 (27.1%) had been vaccinated at 12-14 months of age. Reported by: Div of Immunization, Center for Prevention Svcs, CDC. Editorial Note: After the record low of 1,497 measles cases in 1983, the number of measles cases increased each year through 1986. The number of cases reported for the first 26 weeks of 1987 is less than that reported during the comparable period in 1986 and reverses this trend. The incidence rates have decreased in all except the 15to 19-year age group. The increase in this group was attributable to several large outbreaks in secondary schools and colleges.

Includes two adequately vaccinated patients who were born before 1957 and five who were less than 16 months of age.

TABLE 2. Preventability of measles cases, by age of patients - United States, first 26 weeks, 1986 and 1987*

622

5-9 yrs

1986*
Preventable

Cases
Total
Age Group

Cases
No.

(%) <15 mos

0

(0.0) 16 mos-4 yrs

627

533

(85.0) 430

144

(33.5) 10-14 yrs

1,006

242

(24.1) 15-19 yrs

749

238

(31.8) 20-24 yrs

243

174

(71.6) 25-29 yrs

88

72 (81.8) 30 yrs

136

0

(0.0) Total

3,901

1,403 (36.0) *Based on provisional data for both years. *Preventability was unknown for 20 cases in 1986.

Total
Cases

379
371
237
500
760
149
104

95
2,595

1987
Preventable

Cases
No.

(%) 0

(0.0) 253

(68.2) 41

(17.3) 79

(15.8) 146

(19.2) 93

(62.4) 91

(87.5) 1

(1.1) 704

(27.1)

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