Search

The incidence of measles virus infection has decreased to less than 2 percent of previous levels in the United States as a result of routine vaccination. Vaccination originally occurred at nine months of age, then was raised to 12 months and then to 15 months when it was observed that vaccination at a later age was more effective and that few measles cases occurred among the younger age group. It was projected that the disease would be eliminated by Oct 1982, but outbreaks are still occurring. An analysis of 152 outbreaks, each with 5 to 945 cases, indicated that outbreaks generally occur among preschool-age children under 5 years of age and school-age children between 5 and 19 years of age. Preschool-age children comprised 26 percent of the outbreaks. Fourteen percent of these children had been vaccinated, and of the remaining 86 percent, 45 percent of the cases were considered to be preventable according to current immunization standards. School-age children accounted for 67 percent of the total number of measles outbreaks, 60 percent of which occurred in vaccinated children. Twenty-seven percent of the measles cases in the 5-19 age group were considered to be preventable. The measles outbreaks in the preschool-age children reveal deficiencies in the national measles-elimination strategy. Institution of selective or universal revaccination in the school age group has been suggested even though it may be costly and difficult to accomplish, particularly in the inner city populations who may have difficulty complying with routine vaccination schedules. The benefits of such a program will eventually outway the costs in completing the elimination of measles infection.

Vaccine-preventable diseases, particularly measles and rubella, continue to have an adverse impact on health on college campuses. During 1985, 354 cases of measles (12.6% of the national total) occurred on 26 campuses in 14 states and the District of Columbia. Nearly two-thirds of college students with measles in 1985 had inadequate evidence of immunity. A total of 65 students (18.4%) required hospitalization; 3 died, accounting for all measles-related deaths in 1985. In 4 outbreaks accounting for 103 (29.1%) college cases, the index case was a student who acquired measles while traveling abroad. During 1983-1985, 7 rubella outbreaks were reported on the nation's campuses with 132 cases (6% of the national total). Three-quarters of college students with rubella had inadequate evidence of immunity. Measles and rubella can be eliminated from college campuses if college health services, clinicians, and public health officials (1) work to maintain high immunization levels, (2) improve surveillance and report suspected measles and rubella cases immediately, and (3) promptly intervene to control outbreaks. Ideally, college and university administrators, public health officials, and legislators should collectively work toward adoption and enforcement of college prematriculation immunization requirements. Maintaining accurate immunization records is also essential. In addition to measles and rubella immunization, prematriculation requirements should include mumps vaccine, tetanus-diphtheria toxoid (Td), which is needed every 10 years after primary immunization, and polio vaccine. Colleges should also educate their students at high risk for hepatitis B (such as homosexual males, health professional students, and students working in highly endemic areas). Finally, colleges should monitor the immunization needs of students traveling abroad. [ABSTRACT FROM AUTHOR]