Epidemiology and transmission of measles
- Jorge L Barinaga, MD, MS
Jorge L Barinaga, MD, MS
- Assistant Professor of Medicine
- Tufts University School of Medicine
- Paul R Skolnik, MD, FACP, FIDSA
Paul R Skolnik, MD, FACP, FIDSA
- Professor of Medicine
- University of Connecticut School of Medicine
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Measles is a highly contagious viral illness characterized by fever, malaise, rash, cough, coryza, and conjunctivitis . There are no known measles virus reservoirs outside of humans . The epidemiology and transmission of measles and its complications will be reviewed here. The clinical manifestations, diagnosis, prevention, and treatment are discussed separately. (See "Clinical presentation and diagnosis of measles" and "Prevention and treatment of measles".)
Measles infection — Measles occurs worldwide; control efforts have substantially altered the global distribution . Measles incidence has decreased substantially in regions where vaccination has been instituted; measles in the developing world has been attributed to low vaccination rates .
In developed countries during the prevaccine era, more than 90 percent of children acquired measles by age 15 [5-7]. Following implementation of routine childhood vaccination at age 12 to 15 months, the age of peak measles incidence during epidemics in the United States shifted to six months of age. This is approximately the time at which transplacentally acquired maternal antibodies are no longer present if the mother has vaccine-induced immunity [8-10].
Worldwide, measles is a significant cause of morbidity and mortality. Precise incidence estimates are difficult to obtain because of heterogeneous surveillance systems and probable underreporting . In 2000, measles was estimated to cause approximately 31 to 39.9 million illnesses worldwide with an estimated 733,000 to 777,000 deaths, making it the fifth most common cause of death in children under five years of age [11-13].
The World Health Assembly adopted the World Health Organization (WHO)/United Nations International Children's Emergency Fund (UNICEF) Global Immunization Vision and Strategy, which included a goal of 90 percent reduction in global measles mortality between 2000 and 2010 [14,15]. The WHO identified 47 "priority countries" to focus measles mortality reduction efforts; these nations jointly account for approximately 98 percent of measles deaths. The strategy in these nations includes the following measures: (1) measles immunization with a goal of >90 percent national coverage and >80 percent per-district coverage with two doses of vaccine; (2) surveillance activities, including case investigation and laboratory testing in all suspected cases; and (3) clinical management of measles cases, including administration of vitamin A [12,16].
- Moss WJ, Griffin DE. Measles. Lancet 2012; 379:153.
- Black FL. Measles. In: Viral infections in humans: Epidemiology and control, Evans AS, Kaslow RA (Eds), Plenum Publishing, New York 1997. p.507.
- BABBOTT FL Jr, GORDON JE. Modern measles. Am J Med Sci 1954; 228:334.
- Global measles mortality reduction and regional elimination: a status report. J Infect Dis 2003; 187(Suppl 1):S1.
- LANGMUIR AD. Medical importance of measles. Am J Dis Child 1962; 103:224.
- Markowitz LE, Katz SL. Vaccines, Plotkin SA, Mortimer EA (Eds), WB Saunders, Philadelphia 1994. p.229.
- Arya LS, Taana I, Tahiri C, et al. Spectrum of complications of measles in Afghanistan: a study of 784 cases. J Trop Med Hyg 1987; 90:117.
- Papania M, Baughman AL, Lee S, et al. Increased susceptibility to measles in infants in the United States. Pediatrics 1999; 104:e59.
- Maldonado YA, Lawrence EC, DeHovitz R, et al. Early loss of passive measles antibody in infants of mothers with vaccine-induced immunity. Pediatrics 1995; 96:447.
- Markowitz LE, Albrecht P, Rhodes P, et al. Changing levels of measles antibody titers in women and children in the United States: impact on response to vaccination. Kaiser Permanente Measles Vaccine Trial Team. Pediatrics 1996; 97:53.
- Stein CE, Birmingham M, Kurian M, et al. The global burden of measles in the year 2000--a model that uses country-specific indicators. J Infect Dis 2003; 187 Suppl 1:S8.
- Centers for Disease Control and Prevention (CDC). Global measles mortality, 2000-2008. MMWR Morb Mortal Wkly Rep 2009; 58:1321.
- Pan American Health Organization. Immunization in the Americas. http://new.paho.org/sur/index.php?option=com_content&task=view&id=91&Itemid=290 (Accessed on November 08, 2010).
- World Health Organization. Vision and Strategy 2006-2015 www.who.int/vaccines-documents/DocsPDF05/GIVS_Final_EN.pdf (Accessed on October 13, 2011).
- World Health Organization. WHO/UNICEF joint statement -- global plan for reducing measles mortality 2006-2010. http://www.who.int/immunization/documents/WHO_IVB_05.11/en/index.html (Accessed on November 03, 2010).
- WHO-recommended surveillance standard of measles. http://www.who.int/immunization_monitoring/diseases/measles_surveillance/en/index.html (Accessed on November 08, 2010).
- Simons E, Ferrari M, Fricks J, et al. Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data. Lancet 2012; 379:2173.
- Measles & Rubella Iniative http://www.measlesrubellainitiative.org/ (Accessed on April 28, 2014).
- Centers for Disease Control (CDC). Measles--United States, 1990. MMWR Morb Mortal Wkly Rep 1991; 40:369.
- Beckford AP, Kaschula RO, Stephen C. Factors associated with fatal cases of measles. A retrospective autopsy study. S Afr Med J 1985; 68:858.
- Clements CJ, Cutts FT. The epidemiology of measles: Thirty years of vaccination. In: Measles Virus, ter Meulen V, Billeter MA (Eds), Springer Verlag, Germany 1995. p.13.
- Hauspie RC, Pagezy H. Longitudinal study of growth of African babies: an analysis of seasonal variations in the average growth rate and the effects of infectious diseases on individual and average growth patterns. Acta Paediatr Scand Suppl 1989; 350:37.
- Schaumberg DA, O'Connor J, Semba RD. Risk factors for xerophthalmia in the Republic of Kiribati. Eur J Clin Nutr 1996; 50:761.
- Kagame K, Schwab L. Childhood blindness: dateline Africa. Ophthalmic Surg 1989; 20:128.
- CHRISTENSEN PE, SCHMIDT H, BANG HO, et al. An epidemic of measles in southern Greenland, 1951; measles in virgin soil. III. Measles and tuberculosis. Acta Med Scand 1953; 144:450.
- SIMPSON RE. Infectiousness of communicable diseases in the household (measles, chickenpox, and mumps). Lancet 1952; 2:549.
- Richardson M, Elliman D, Maguire H, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J 2001; 20:380.
- Asher DM, Gibbs CJ. Chronic Neurological Diseases Caused by Slow Infections. In: Viral Infections of Humans: Epidemiology and Control, Evans AS, Kaslow RA (Eds), Plenum Publishing, New York 1997. p.1027.
- Bloch AB, Orenstein WA, Ewing WM, et al. Measles outbreak in a pediatric practice: airborne transmission in an office setting. Pediatrics 1985; 75:676.
- Centers for Disease Control and Prevention (CDC). Notes from the field: Multiple cases of measles after exposure during air travel--Australia and New Zealand, January 2011. MMWR Morb Mortal Wkly Rep 2011; 60:851.
- van den Hof S, Conyn-van Spaendonck MA, van Steenbergen JE. Measles epidemic in the Netherlands, 1999-2000. J Infect Dis 2002; 186:1483.
- Waaijenborg S, Hahné SJ, Mollema L, et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis 2013; 208:10.
- Leuridan E, Hens N, Hutse V, et al. Early waning of maternal measles antibodies in era of measles elimination: longitudinal study. BMJ 2010; 340:c1626.
- Carson MM, Spady DW, Albrecht P, et al. Measles vaccination of infants in a well-vaccinated population. Pediatr Infect Dis J 1995; 14:17.
- Gindler J, Tinker S, Markowitz L, et al. Acute measles mortality in the United States, 1987-2002. J Infect Dis 2004; 189 Suppl 1:S69.
- Centers for Disease Control and Prevention (CDC). Progress toward measles elimination--region of the Americas, 2002-2003. MMWR Morb Mortal Wkly Rep 2004; 53:304.
- World Health Organization. Global eradication of measles. http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_18-en.pdf (Accessed on November 08, 2010).
- World Health Organization. World Health Statistics, 2010. http://www.who.int/whosis/whostat/2010/en/index.html (Accessed on November 08, 2010).
- De Serres G, Markowski F, Toth E, et al. Largest measles epidemic in North America in a decade--Quebec, Canada, 2011: contribution of susceptibility, serendipity, and superspreading events. J Infect Dis 2013; 207:990.
- Bloch AB, Orenstein WA, Stetler HC, et al. Health impact of measles vaccination in the United States. Pediatrics 1985; 76:524.
- Centers for Disease Control and Prevention (CDC). Measles--United States, 1999. MMWR Morb Mortal Wkly Rep 2000; 49:557.
- Orenstein WA, Papania MJ, Wharton ME. Measles elimination in the United States. J Infect Dis 2004; 189 Suppl 1:S1.
- Centers for Disease Control and Prevention (CDC). Epidemiology of measles--United States, 2001-2003. MMWR Morb Mortal Wkly Rep 2004; 53:713.
- Centers for Disease Control (CDC). Measles prevention. MMWR Morb Mortal Wkly Rep 1989; 38 Suppl 9:1.
- Centers for Disease Control and Prevention (CDC). Measles - United States, 2011. MMWR Morb Mortal Wkly Rep 2012; 61:253.
- Rosen JB, Rota JS, Hickman CJ, et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis 2014; 58:1205.
- Centers for Disease Control and Prevention (CDC). Measles imported by returning U.S. travelers aged 6-23 months, 2001-2011. MMWR Morb Mortal Wkly Rep 2011; 60:397.
- Centers for Disease Control and Prevention (CDC). Measles outbreak associated with an arriving refugee - Los Angeles County, California, August-September 2011. MMWR Morb Mortal Wkly Rep 2012; 61:385.
- Centers for Disease Control and Prevention (CDC). Two measles outbreaks after importation--Utah, March-June 2011. MMWR Morb Mortal Wkly Rep 2013; 62:222.
- Zipprich J, Hacker JK, Murray EL, et al. Notes from the field: measles - California, January 1-April 18, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:362.
- Gastañaduy PA, Redd SB, Fiebelkorn AP, et al. Measles - United States, january 1-may 23, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:496.
- Centers for Disease Control and Prevention (CDC). Increased transmission and outbreaks of measles--European Region, 2011. MMWR Morb Mortal Wkly Rep 2011; 60:1605.
- Centers for Disease Control and Prevention (CDC). Progress toward measles elimination--European Region, 2005--2008. MMWR Morb Mortal Wkly Rep 2009; 58:142.
- Hahne S, te Wierik MJ, Mollema L, et al. Measles outbreak, the Netherlands, 2008. Emerg Infect Dis 2010; 16:567.
- World Health Organization. Global eradication of measles. http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_18-en.pdf (Accessed on December 16, 2011).
- Centers for Disease Control and Prevention (CDC). Measles outbreak--Netherlands, April 1999-January 2000. MMWR Morb Mortal Wkly Rep 2000; 49:299.
- Centers for Disease Control and Prevention (CDC). Progress toward measles control - African region, 2001-2008. MMWR Morb Mortal Wkly Rep 2009; 58:1036.
- Centers for Disease Control and Prevention (CDC). Progress toward the 2012 measles elimination goal--Western Pacific Region, 1990-2008. MMWR Morb Mortal Wkly Rep 2009; 58:669.
- Centers for Disease Control and Prevention (CDC). Progress toward measles elimination--Japan, 1999-2008. MMWR Morb Mortal Wkly Rep 2008; 57:1049.
- Centers for Disease Control and Prevention (CDC). Progress toward measles mortality reduction and elimination--Eastern Mediterranean Region, 1997-2007. MMWR Morb Mortal Wkly Rep 2008; 57:262.
- John TJ, Choudhury P. Accelerating measles control in India opportunity and obligation to act now. Indian Pediatr 2009; 46:939.