The four deaths due to measles during the first half of 1987 are the first reported to the Division of Immunization since 1985 (3). All four cases either initiated or were part of nosocomial outbreaks involving medical personnel. In addition, a higher proportion of cases were acquired in medical settings in 1987 than in previous years (4-6). The deaths, combined with the increased proportion of cases acquired in medical settings, highlight the role of these settings in the transmission of measles and emphasize the need for immunization requirements for medical personnel at risk of exposure (7,8). As in previous years, a large proportion of persons who acquired measles had been vaccinated. In an effort to decrease the occurrence of these cases, changes in the current immunization strategy are being discussed. In many outbreaks, persons vaccinated at 12-14 months of age have been demonstrated to be at slightly higher risk for measles than persons vaccinated at 15 or more months of age. Therefore, the Immunization Practices Advisory Committee (ACIP) recently recommended that revaccination of persons previously vaccinated at 12-14 months of age be considered during outbreaks (8,9). Most cases of measles among persons who received vaccine at 15 months of age or older appear to be the result of primary vaccine failure and not of waning immunity (10). The two major impediments to measles elimination in the United Statesunvaccinated preschoolers and vaccine failure in the school-aged populationrequire different solutions. Health-care providers should take advantage of every opportunity to vaccinate these children (11). Measles-containing vaccines should be administered to eligible children regardless of the need for other vaccines. The ACIP now recommends simultaneous administration of MMR, DTP, and OPV at 15 months of age (12), both routinely and for children behind on their immunization schedules. The number of vaccine failures among children 5-19 years of age has stimulated efforts to devise strategies to reduce the rate of primary vaccine failure. CDC is convening a group of consultants to review the current status of efforts to eliminate measles in the United States and to discuss potential modifications (13) to the current strategies. These modifications include revaccination, either routinely, as a two-dose schedule, or selectively, as part of outbreak control. References 1. Centers for Disease Control. Measles-United States, first 26 weeks, 1986. MMWR 1986;35:525-8,533. 2. Centers for Disease Control. Classification of measles cases and categorization of measles elimination programs. MMWR 1983;31:707-11. 3. Centers for Disease Control. Multiple measles outbreaks on college campuses - Ohio, Massachusetts, Illinois. MMWR 1985;34:129-30. 4. Davis RM, Orenstein WA, Frank JA, et al. Transmission of measles in medical settings: 1980 through 1984. JAMA 1986;255:1295-8. 5. Centers for Disease Control. Measles-United States, 1985. MMWR 1986;35:366-70. 6. Centers for Disease Control. Measles - United States, 1986. MMWR 1987;36:301-5. 7. Williams WW. Guideline for infection control in hospital personnel. Infect Control 1983;4(suppl):326-49. 8. Orenstein WA, Markowitz LE, Preblud SR, Hinman AR, Tomasi A, Bart KJ. Appropriate age for measles vaccination in the United States. Dev Biol Stand 1986;65:13-21. 9. Immunization Practices Advisory Committee. Measles prevention. MMWR 1987;36: 409-18,423-5. 10. Preblud SR, Markowitz LE, Orenstein WA. Update on measles vaccine effectiveness. Presented at the 21st immunization conference, New Orleans, Louisiana, June 8-11, 1987. 11. Hutchins SS, Escolan J, Markowitz LE, et al. An outbreak of measles among unvaccinated preschool-aged children. Presented at the American Public Health Association 115th annual meeting, New Orleans, Louisiana, October 18, 1987. 12. Immunization Practices Advisory Committee. New recommended schedule for active immunization of normal infants and children. MMWR 1986;35:577-9. 13. Orenstein WA, Hinman AR, Preblud SR, Markowitz LE. Additional strategies for measles elimination. Presented at the 21st immunization conference, New Orleans, Louisiana, June 8-11, 1987. Perspectives in Disease Prevention and Health Promotion Semen Banking, Organ and Tissue Transplantation, The following recommendations regarding storage and use of semen were prepared by the Food and Drug Administration and the Centers for Disease Control with the endorsement of the American Association of Tissue Banks, the American Fertility Society, and the American College of Obstetricians and Gynecologists. The Public Health Service published its initial recommendations regarding screening prospective donors of semen, organs, or tissues for the presence of antibody to human immunodeficiency virus (HIV) in 1985 (1). The role of donated semen in the transmission of HIV infection was confirmed later that year (2). In late 1986 and early 1987, transmission of acute viral hepatitis B resulting from artificial insemination with donated semen was reported (3,4). In April of 1987, an allogenic skin graft was implicated in the transmission of HIV infection (5). A month later, a cadaveric organ donor was found positive for antibody to HIV after his organs were transplanted (6). Most recently, the House of Delegates of the American Medical Association, at its Semen Banking - Continued meeting held June 21-25, 1987, adopted a recommendation that testing for antibody to HIV be performed for all donors of blood, organs, or tissues intended for transplantation and for donors of semen or ova (7). Other professional organizations, such as the American Association of Tissue Banks and the American Fertility Society, have published standards and guidelines designed to prevent or minimize the possibility of transmitting disease through artificial insemination or allotransplants (8,9). Based on current knowledge, the following recommendations are made with respect to organ and tissue transplantation and artificial insemination: Prospective donors of organs, tissues, and semen should be tested for antibody to HIV (1,6). Tests for hospitalized donors should be run on a serum sample taken prior to the donor's receipt of any blood transfusions to avoid situations in which multiple transfusions might result in an antibody loss due to hemodilution (6). Organs and tissues from prospective donors found seropositive for HIV antibody should not be used except when the transplantation of an indispensable organ is necessary to save a patient's life. Anthrax TABLE II. Notifiable diseases of low frequency, United States Botulism: Foodborne (Calif. 1) Infant (Wash. 1) Other (Calif. 1) Brucellosis Cholera Congenital rubella syndrome Congenital syphilis, ages < 1 year Diphtheria *There were no cases of internationally imported measles reported for this week. Cum. 1988 2'' 3 '22 |