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Measles outbreak - New York City, 1990-1991.

In March 1990, a large measles outbreak began in New York City. Through December 1990, approximately 2500 cases and eight measles-associated deaths were reported. However, since January 1991, transmission has increased; through May 7, more than 2000 cases and nine deaths were reported to the New York City Department of Health (NYCDH) in 1991.

Preliminary data are available for the first 2084 cases reported in 1991. Of these patients, 1383 (66%) were <5 years of age, of whom 735 (53%) were <12 months of age. Most cases have occurred among black and Hispanic children; more than 70% of cases have been reported from the Bronx and Brooklyn. Transmission has also occurred among prisoners in the city jail system and among both patients and medical staff in some local hospitals.

To control the outbreak, NYCDH officials have recommended an additional dose of measles vaccine for 6- to 11-month-old children, have made walk-in immunization services available, are vaccinating eligible children in emergency rooms, and have mounted a citywide multimedia "stop measles" education and information campaign. in addition, New York state health officials have implemented emergency regulations that require health-care workers to demonstrate proof of measles immunity, have integrated immunization services with certification for the Special Supplemental Program for Women, Infants, and Children, and are implementing requirements for hospitals and licensed health-care facilities to offer immunization to all children served. Reported by: K Ong, MD, S Friedman, MD, A Nazitto, D Hurley, New York City Dept of Health; LF Novick, MD, GS Birkhead, MD, DL Morse, MD, State Epidemiologist, New York State Dept of Health, Div of Immunization, Center for Prevention Svcs, CDC. Editorial Note: Characteristics of the current measles outbreak in New York City are similar to recent outbreaks in other large metropolitan areas of the United States, including Chicago, Houston, and Los Angeles (1-3). These outbreaks have involved predominantly unvaccinated preschool-aged black and Hispanic children and represent the failure of current immunization strategies to achieve high vaccination coverage levels among preschool-aged children in urban areas.

Investigations in cities experiencing measles outbreaks indicate that as few as 50% of children have been vaccinated against measles by their second birthday and as few as 25% of children are up-to-date for all immunizations at age 2 years (4 ). The National Vaccine Advisory Committee (NVAC)(*) has issued recommendations to improve vaccine coverage levels among preschool-aged children (NVAC, unpublished data, 1991). These recommendations are being reviewed by federal, state, and local health agencies.

CDC is assisting the NYCDH in determining the extent of the current measles outbreak. References 1. CDC. Update: measles outbreak-Chicago, 1989. MMWR 1990;39:317-9,325-6. 2. CDC. Measles-United States, 1989 and first 20 weeks 1990. MMWR 1990;39:353-5,361-3. 3. CDC. Measies-Los Angeles County, California, 1988. MMWR 1989;38:49-52,57. 4. CDC. Measles vaccination levels among selected groups of preschool-aged children-United

States. MMWR 1991;40:36-9. (*) In 1987, the Secretary of Health and Human Services chartered the NVAC to advise and make recommendations to the director of the National Vaccine Program. Its mission is to encourage the adequate supply of safe and effective vaccines, recommend research priorities that enhance the safety and efficacy of vaccines, and develop goals and recommend initiatives for effective use of vaccines.
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Publication:Morbidity and Mortality Weekly Report
Date:May 10, 1991
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