International Journal of Epidemiology, Vol 28, 141-146, Copyright © 1999 by International Epidemiological Association
P Duclos, SC Redd, P Varughese and BS Hersh
BACKGROUND: Despite the implementation of mass school catch-up campaigns
for measles in Canada, an outbreak of measles occurred in early 1997 mostly
affecting the adult population. The higher incidence in Canada in adults
led us to compare immunization policies and the evolution of measles among
adults in Canada and the US. METHODS: Based on information gathered from
both national immunization programmes and surveillance systems. RESULTS:
Although the proportion of cases occurring in adults has increased
tremendously in both countries in the past decade, there was no increase in
measles incidence in these populations. The most likely factors to explain
the higher rate of measles occurring in adults in Canada are the younger
age at administration of first dose in Canada, the delay in implementation
of a second dose policy in Canada compared with the US combined with the
lack of prematriculation immunization requirements in Canadian colleges and
universities, and the higher rate of overseas travel to and from Canada.
The situation in Canada may also have been exacerbated by incomplete
efforts to control measles for many years without attempting to eliminate
the disease. CONCLUSIONS: In order to prevent measles in adults, high-risk
groups must be identified and catch-up for selected groups considered.
Vaccination of international travellers to endemic areas should be
recommended until global elimination has been achieved. Appropriate measles
control strategies in younger populations seem to be effective in
preventing measles in adults. The experience in Canada and the US suggests
that measles transmission in adults is unlikely to be a major impediment to
regional elimination or global eradication.
ARTICLES
Measles in adults in Canada and the United States: implications for measles elimination and eradication
Division of Immunization, Bureau of Infectious Diseases, Laboratory Centre for Disease Control, Ottawa, Ontario, Canada.
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