title: Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US experience.
abstract: OBJECTIVE
  To verify the elimination of endemic measles, rubella, and congenital rubella syndrome (CRS) from the Western hemisphere, the Pan American Health Organization requested each member country to compile a national elimination report. The United States documented the elimination of endemic measles in 2000 and of endemic rubella and CRS in 2004. In December 2011, the Centers for Disease Control and Prevention convened an external expert panel to review the evidence and determine whether elimination of endemic measles, rubella, and CRS had been sustained.
  
  
  OBJECTIVE
  To review the evidence for sustained elimination of endemic measles, rubella, and CRS from the United States through 2011.
  
  
  METHODS
  Review of data for measles from 2001 to 2011 and for rubella and CRS from 2004 to 2011 covering the US resident population and international visitors, including disease epidemiology, importation status of cases, molecular epidemiology, adequacy of surveillance, and population immunity as estimated by national vaccination coverage and serologic surveys.
  
  
  METHODS
  Annual numbers of measles, rubella, and CRS cases, by importation status, outbreak size, and distribution; proportions of US population seropositive for measles and rubella; and measles-mumps-rubella vaccination coverage levels.
  
  
  RESULTS
  Since 2001, US reported measles incidence has remained below 1 case per 1,000,000 population. Since 2004, rubella incidence has been below 1 case per 10,000,000 population, and CRS incidence has been below 1 case per 5,000,000 births. Eighty-eight percent of measles cases and 54% of rubella cases were internationally imported or epidemiologically or virologically linked to importation. The few cases not linked to importation were insufficient to represent endemic transmission. Molecular epidemiology indicated no endemic genotypes. The US surveillance system is adequate to detect endemic measles or rubella. Seroprevalence and vaccination coverage data indicate high levels of population immunity to measles and rubella.
  
  
  CONCLUSIONS
  The external expert panel concluded that the elimination of endemic measles, rubella, and CRS from the United States was sustained through 2011. However, international importation continues, and health care providers should suspect measles or rubella in patients with febrile rash illness, especially when associated with international travel or international visitors, and should report suspected cases to the local health department.
authors: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Mark J
authors: MJ
authors: Papania
authors: Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Gregory S
authors: GS
authors: Wallace
authors: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Paul A
authors: PA
authors: Rota
authors: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Joseph P
authors: JP
authors: Icenogle
authors: Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Amy Parker
authors: AP
authors: Fiebelkorn
authors: Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Gregory L
authors: GL
authors: Armstrong
authors: Global Immunization Division, Coordinating Office for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Susan E
authors: SE
authors: Reef
authors: Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Susan B
authors: SB
authors: Redd
authors: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Emily S
authors: ES
authors: Abernathy
authors: Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia4HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, National.
authors: Albert E
authors: AE
authors: Barskey
authors: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Lijuan
authors: L
authors: Hao
authors: Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia5Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
authors: Huong Q
authors: HQ
authors: McLean
authors: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Jennifer S
authors: JS
authors: Rota
authors: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: William J
authors: WJ
authors: Bellini
authors: Office of the Director, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Jane F
authors: JF
authors: Seward
mesh_terms: D019353:Endemic Diseases / Q000517:prevention & control / Q000706:statistics & numerical data*; D062665:Epidemiological Monitoring; D049674:History, 21st Century; D006801:Humans; D032541:Mass Vaccination / Q000706:statistics & numerical data; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control; D022542:Measles-Mumps-Rubella Vaccine; D012409:Rubella / Q000453:epidemiology* / Q000517:prevention & control; D012410:Rubella Syndrome, Congenital / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
chemical_list: D022542:Measles-Mumps-Rubella Vaccine