Consequences of Undervaccination - Measles Outbreak, New York City, 2018-2019.

Adolescent Adult Aged Child Child, Preschool Disease Outbreaks Female Health Resources / economics Hospitalization / statistics & numerical data Humans Infant Infant, Newborn Male Measles / epidemiology Measles-Mumps-Rubella Vaccine / administration & dosage Medical History Taking Middle Aged New York City / epidemiology Severity of Illness Index Vaccination / statistics & numerical data Young Adult

Journal

The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562

Informations de publication

Date de publication:
12 03 2020
Historique:
entrez: 12 3 2020
pubmed: 12 3 2020
medline: 17 3 2020
Statut: ppublish

Résumé

Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home. We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated. A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million. Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.

Sections du résumé

BACKGROUND
Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home.
METHODS
We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated.
RESULTS
A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million.
CONCLUSIONS
Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.

Identifiants

DOI: 10.1056/NEJMoa1912514 PMID: 32160662
pubmed: 32160662
doi: 10.1056/NEJMoa1912514
doi:

Substances chimiques

Measles-Mumps-Rubella Vaccine 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1009-1017

Informations de copyright

Copyright © 2020 Massachusetts Medical Society.

Auteurs

Jane R Zucker (JR)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Jennifer B Rosen (JB)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Martha Iwamoto (M)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Robert J Arciuolo (RJ)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Marisa Langdon-Embry (M)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Neil M Vora (NM)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).
ORCID: 0000-0002-4989-3108

Jennifer L Rakeman (JL)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Beth M Isaac (BM)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Antonine Jean (A)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Mekete Asfaw (M)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Simone C Hawkins (SC)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Thomas G Merrill (TG)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Maura O Kennelly (MO)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Beth Maldin Morgenthau (B)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Demetre C Daskalakis (DC)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

Oxiris Barbot (O)

From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.).

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questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Consequences of Undervaccination - Measles...
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