Measles-Continued were 12-14 months of age; 18 (5.1%) were 15 months; and 173 (49.3%) were 16 months to 4 years of age. Persons 12-14 months of age accounted for 3.9% of the 1,765 cases. Of the 1,765 persons with measles, 911 (51.6%) had been vaccinated; 776 (44.0%) had been vaccinated on or after the first birthday; and 135 (7.6%) had been vaccinated before the first birthday (Table 3). A total of 854 (48.4%) persons were either unvaccinated or of unknown vaccination status. Prior physician-diagnosed measles in the absence of vaccination was reported for 21 (1.2%) persons. Of the 1,765 cases, 610 (34.6%) were classified as preventablet (1) (Table 4). The highest proportion of preventable cases occurred among persons who were not of school age. More than 70% of the cases among children 16 months to 4 years and adults 20-24 years were preventable. Although more than half of the preventable cases occurred among persons 5-19 years of age, only 29.5% of cases occurring in that age group were considered preventable. The proportion of preventable cases in this age group increased progressively with increasing age. +A case is considered preventable if measles occurs in a U.S. citizen: (1) at least 16 months of age, (2) born after 1956, (3) lacking adequate evidence of immunity to measles (documented receipt of live measles vaccine on or after the first birthday and at least 2 weeks before onset of illness, or a physiciandiagnosed measles or laboratory evidence of immunity), (4) without a medical contraindication to receiving vaccine, and (5) with no religious or philosophic exemption under state law. FIGURE 1. Reported measles cases* — United States, 1982-1984 *Shaded area represents maximum and minimum weekly values during 5-year period, 1977-1981. Source: MMWR weekly reports. TABLE 1. Geographic distribution and incidence rates of measles cases Of the 1,155 persons who had nonpreventable measles, 178 (15.4%) were too young for routine vaccination (15 months of age or under). Fifty-seven (4.9%) were born before 1957; vaccination is not ordinarily recommended for this group. Of the 920 persons 16 months to 27 years of age who acquired measles, 775 (84.2%) had been vaccinated on or after the first birthday; 18 (2.0%) had prior physician-diagnosed measles; 32 (3.5%) had international importations and were not U.S. citizens; and 41 (4.5%) had exemptions under state law. In addition, 54 (5.9%) persons-recruits at Great Lakes Naval Training Station-were considered immune because they had positive results to an indirect immunoperoxidase assay for measles antibody before their illnesses (Table 5). FIGURE 2. Reported measles cases, by week of rash onset* weeks, 1984 CASES 120 - 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 'No dates of rash onset reported for seven patients. *Rash onset in 1983. TABLE 2. Age distribution and estimated incidence rates of measles cases+ 'Cases per 100,000 population extrapolating cases with known age to total reported cases. *Provisional data. §Total cases reported to the MMWR in 1983. Total cases reported to CDC's Division of Immunization during the first 26 weeks of 1984. Measles - Continued Reported by N El-Tantawy, MD, Emory University School of Medicine, Atlanta, Georgia; Div of Immunization, Center for Prevention Svcs, CDC. Editorial Note: Although the number of reported measles cases has increased in 1984, compared with the same period in 1983, it is still far below the number in the prevaccine era (1950-1962), when an average of over 525,000 cases was reported annually. Despite the increased occurrence of measles during the first 26 weeks of 1984 over all of 1983, the geographic distribution of measles is more restricted and focal. A total of 43.9% of the persons who had measles in 1984 had been adequately vaccinated. This is within expected limits, given the high vaccine coverage in the United States (2). Since 1980, over 95% of kindergarten and first-grade students have had evidence of measles immunity. Higher coverage will be associated with higher proportions of persons who are vaccinated. Recent epidemiologic evaluations have shown a measles vaccine efficacy of 90% or higher. The increased occurrence of measles in 1984 does not appear to be due to poor vaccine efficacy. Greater emphasis needs to be placed on ensuring that persons 10-14 years old and 15-19 years old have evidence of measles immunity (3). Enactment and vigorous enforcement of regulations requiring all students in grades kindergarten through 12 to have evidence of immunity is an important means of ensuring high levels of measles immunity (2). Further efforts need to be made in preschool- and post-school-aged groups. Over 70% of the cases among young adults (20-24 years old) and preschoolers (16 months to 4 years old) TABLE 4. Age distribution and preventability of measles cases weeks, 1984* Measles - Continued were preventable. Every opportunity should be taken to vaccinate susceptible children against measles. Many colleges are considering regulations requiring evidence of measles immunity for matriculation (4). All institutions where young adults congregate should consider requiring evidence of measles immunity. References 1. CDC Classification of measles cases and categorization of measles elimination programs. MMWR 1982;31:707-11. 2. CDC Measles Surveillance Report No. 11, 1977-1981. September 1982. 3. ACIP. Measles prevention. MMWR 1982;31:217-24, 229-31. 4. American College Health Association. Statement of immunization policy. November 25, 1983;1-3. TABLE 5. Reasons measles cases were classified as nonpreventable first 26 weeks, 1984* Causes of nonpreventability United States, §Does not include one adequately vaccinated person who was born before 1957. UNITED STATES GOVERNMENT PRINTING OFFICE CENTERS FOR DISEASE CONTROL no. Pub with 503-A September 14, 1984 / Vol. 33 / No. 36 505 Salmonellosis from Inadequately Pasteurized Milk - Kentucky 506 Outbreaks of Respiratory Illness among Employees in Large Office Buildings Tennessee, District of Columbia 513 Diarrheal Diseases Control Program: Global Activities, 1983 515 Influenza - Southern Hemisphere, MORBIDITY AND MORTALITY WEERLY REMOR Univeralthe Tropics, 1984 Epidemiologic Notes and Reports of Michigan Public Health Library Salmonellosis from Inadequately Pasteurized Milk - Kentucky In late April 1984, three isolates of Salmonella typhimurium, all from specimens from persons associated with a convent in western Kentucky, were reported by the Kentucky Division for Laboratory Services to the Division of Epidemiology. Subsequent investigation revealed that at least 16 cases of gastroenteritis (predominantly diarrhea) were associated with the convent between March 28 and May 2. The likely vehicle was inadequately pasteurized milk. One hundred forty nuns reside at the convent; additional persons are employed as caretakers, foodhandlers, and farm workers. All meals are prepared in the convent kitchen and are available to residents and employees. In early May, 180 (90%) of 200 persons at risk filled out questionnaires on basic demographic information, recent gastrointestinal illness, and frequency of consuming milk, raw milk, chicken, turkey, pork, and eggs. Sixteen (9%) persons met the case definition of a positive stool culture for S. typhimurium or at least three loose stools per day lasting 2 or more days or any three of the following symptoms: fever, diarrhea (not meeting the criteria above), nausea and/or vomiting, or abdominal cramps; 12 additional persons (7%) who had gastrointestinal symptoms but did not meet the case definition were excluded from the statistical analysis. Ill persons had diarrhea (100%), abdominal cramps (63%), nausea (50%), fever (44%), and vomiting (13%). Diarrhea lasted 1-8 days (median 3 days), with two to 11 loose stools per day (median five). Patients were 21 years to 86 years of age (median 67 years). Fifteen (94%) were female, and 14 (88%) were convent residents. Three (19%) of the 16 consulted a physician. Of persons filling out questionnaires, 14 (15%) of 91 persons who admitted drinking pasteurized milk became ill, but only two (3%) of 75 who claimed not to have drunk milk became ill. Persons drinking pasteurized milk were approximately six times more likely to develop illness (p = 0.01). No other risk factors were identified. Fourteen (88%) of the 16 ill persons had onset on or after March 28, with three clusters of cases approximately 2 weeks apart. In late April, 24 symptomatic nuns and 18 asymptomatic foodhandlers submitted single stool-culture specimens. Five (31%) of the 16 ill persons, all nuns, had stool cultures positive for S. typhimurium; eight (50%) were negative; and three (19%) had no stool specimen submitted. A 69-year-old culture-positive ill nun was hospitalized for a Guillain-Barré-like illness 20 days after onset of gastrointestinal symptoms. A raw milk sample collected May 9 also yielded S. typhimurium. The isolate from milk and three isolates from humans had identical plasmid profiles. The remaining two human isolates were reported to be identical to each other and were probably equivalent to the other isolates. Antibiograms of all six isolates were the same. Before early March 1984, the convent had its own herd of dairy cattle and pasteurized its own milk. At that time, the convent began purchasing raw milk from a Grade-A dairy farm in U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEALTH SERVICE |