Measles and mumps outbreaks in the United States: Think globally, vaccinate locally.

Measles and mumps outbreaks in the United States have laimed numerous headlines over the past six months. The 397 easles cases in the U.S. from January 1 to June 6, 2014 have urpassed the highest annual totals since the 2000 declaration of easles elimination in the U.S. [1]. Mumps outbreaks have made heir marks across college campuses in Ohio and New York. What imilarities have there been in the recent U.S. measles and mumps utbreaks? Both have highlighted the importance of imported nfections to the U.S. among unvaccinated travelers. Both have lluminated “failure to vaccinate” cracks in MMR vaccine coverge in Western Europe and the U.S., which largely have their roots n the anti-vaccine movement and scientifically unfounded conerns about the measles-mumps-rubella (MMR) vaccine. Both have aised questions of vaccine failure. Measles is one of the most contagious viruses known in umans and has a secondary attack rate in susceptible contacts f greater than 90% [2]. Before the advent of the measles vaccine, 00,000 measles cases were reported annually in the U.S., with 500 easles-related deaths, 48,000 hospitalizations, and 4000 cases of ncephalitis leaving nearly 1000 of those patients permanently deaf r with neurologic impairment [3]. Worldwide, it is estimated the easles vaccine saved an estimated 12.7 million lives during the ears of 2000–2008 [3]. Global reductions in measles morbidity and ortality are tremendous public health achievements. Measles is argeted for elimination in five WHO regions by 2020 [4], and WHO as concluded that measles eradication is feasible and a future goal 5]. Despite these advances, large measles outbreaks in countries hat do not lack access to MMR vaccine continue to occur. The nited Kingdom declared measles endemic again in 2008 [6]. The HO European Region reported >30,000 cases of measles in 2011 nd was the source of nearly half of the measles importations to he U.S. in 2011 [7]. Of the 288 measles cases reported from January 1 to May 23, 014, 97% were associated with importations from 18 different ountries [8]. Forty of the 45 importations (89%) were from U.S. esidents returning from abroad [8]. Only five importations were dentified from foreign visitors. Forty-nine percent of the imporations were from the Philippines, with an additional 16% being ssociated with travel to the WHO Western Pacific Region, 18% to HO Southeast Asia, 9% to European, and 8% to Americas regions 8]. The majority (69%) of the 288 cases occurred in unvaccinated ndividuals or those who had unknown MMR vaccination staus (20%). But importantly, 10% of cases occurred in previously