title: The epidemiology of measles in Tianjin, China, 2005-2014.
abstract: BACKGROUND
  Measles incidence in China has declined over the last decade and elimination is targeted by 2020. Despite increases in routine immunization services and supplementary immunization activities (SIAs), periodic outbreaks continue to occur. In this paper, we examine measles epidemiology during 2005-2014 in Tianjin, China.
  
  
  METHODS
  Measles case data were extracted from a web-based communicable disease surveillance system. We examined the socio-demographic characteristics of measles case patients, including age, sex, urbanicity, residency status, and vaccination history. Demographic characteristics of cases were compared with the general population.
  
  
  RESULTS
  From January 1, 2005 to December 31, 2014, 12,466 measles cases in Tianjin were reported. Among the cases, 7179 (57.6%) were male and 5287 (42.4%) were female. Over time, more cases occurred in adults, and for the 2711 cases in 2014, the majority were either infants <1 year (558, 20.58%) or adults ≥ 20 years (2043, 75.36%). Municipal-wide SIAs in Tianjin occurred in 2008 and 2010 with reduction in measles cases the following year for both (189 cases in 2009, and 37 cases in 2011). The number of cases rebounded to pre-SIA levels or higher within 1-3 years following each SIA: 1990 cases in 2010 and 2711 cases in 2014. Vaccination status was reported as "none" or "unknown" for 84% of all reported measles cases.
  
  
  CONCLUSIONS
  Despite the general decline in cases, measles outbreaks continue to occur. Although the SIAs reduce numbers in their immediate aftermath, case counts rebound 1-3 years after the intervention. Continued monitoring of cases through disease surveillance activities accompanied by targeted immunization activities, including to adults, can help ensure progress toward elimination.
authors.affiliation: Tianjin Centers for Disease Control and Prevention, Tianjin 300011, People's Republic of China.
authors.forename: Xiexiu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA. Electronic address: mboulton@umich.edu.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Boulton
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: JoLynn P
authors.initials: JP
authors.lastname: Montgomery
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Carlson
authors.affiliation: Tianjin Centers for Disease Control and Prevention, Tianjin 300011, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Gillespie
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Abram L
authors.initials: AL
authors.lastname: Wagner
authors.affiliation: Tianjin Centers for Disease Control and Prevention, Tianjin 300011, People's Republic of China.
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Tianjin Centers for Disease Control and Prevention, Tianjin 300011, People's Republic of China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Luo
authors.affiliation: Tianjin Centers for Disease Control and Prevention, Tianjin 300011, People's Republic of China.
authors.forename: Tian
authors.initials: T
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008457:Measles / Q000453:epidemiology*; D008875:Middle Aged; D055815:Young Adult
keywords: China; Epidemiology; Immunization; Measles