Measles imported to the United States by children adopted from China.
In July 2013, the National Immunization Program of China was notified by the US Centers for Disease Control and Prevention that measles was detected in 3 newly adopted, special needs children with cerebral palsy (CP) from China. We report an investigation of measles transmission in China that led to infection of these children. Interviews were conducted with welfare institute staff and panel physicians; health records of the potentially exposed population were reviewed; and immunization coverage was assessed among institute residents. Five residents with CP, all unvaccinated against measles, among who were the 3 adoptees, were linked epidemiologically into 3 generations of measles transmission antecedent to the US outbreak. In a random sample of residents, first dose of measles containing vaccine (MCV1) and MCV2 coverage was 16 of 17 (94%) and 7 of 11 (64%) among children with CP, and 100% (32 of 32) and 96% (21 of 22) among children without CP. Vaccinators reported reluctance to vaccinate children with CP because the China pharmacopeia lists encephalopathy as a contraindication to vaccination. Panel physicians reported to investigators no necessity of vaccination for adoptees to the United States if US parents sign an affidavit exempting the child from vaccination. We recommend that the China pharmacopeia vaccine contraindications be reviewed and updated, the United States should reconsider allowing vaccination exemptions for internationally adopted children unless there are true medical contraindications to vaccination, and US pediatricians should counsel adopting parents to ensure that their child is up-to-date on recommended vaccinations before coming to the United States.
National Immunization Program, and.
Qiru
Q
Su
The Institute of Immunization Program, Henan provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China;
Yanyang
Y
Zhang
The Institute of Immunization Program, Henan provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China;
Yating
Y
Ma
National Immunization Program, and Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China; Taizhou prefecture Center for Disease Control and Prevention, Taizhou, Zhejiang, China; and.
Xiang
X
Zheng
The Institute of Immunization Program, Zhengzhou prefecture Center for Disease Control and Prevention, Zhengzhou, Henan, China.
Tongwu
T
Han
The Institute of Immunization Program, Zhengzhou prefecture Center for Disease Control and Prevention, Zhengzhou, Henan, China.
Feng
F
Li
National Immunization Program, and.
Lixin
L
Hao
National Immunization Program, and.
Chao
C
Ma
National Immunization Program, and.
Huaqing
H
Wang
National Immunization Program, and.
Li
L
Li
National Immunization Program, and HmLuo@vip.sina.com.
Huiming
H
Luo
D000300:Adoption; D044466:Asian People / Q000706:statistics & numerical data*; D001930:Brain Injuries / Q000453:epidemiology / Q000208:ethnology; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D002681:China / Q000208:ethnology; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control / Q000635:transmission*; D008458:Measles Vaccine / Q000008:administration & dosage; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D014481:United States
D008458:Measles Vaccine
adoption; cerebral palsy; contraindications; disease outbreaks; measles; vaccination