Wood D L, Brunell P A
Ahmanson Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Clin Microbiol Rev. 1995 Apr;8(2):260-7. doi: 10.1128/CMR.8.2.260.
Elimination of indigenous measles from the United States has been a public priority since 1978. To assess the progress made toward this goal, we review the epidemiology of measles from 1963 to the present. From the 1970s through early into the recent measles epidemic, the majority of measles cases were in highly vaccinated, school-age children. This was due primarily to a 1 to 5% primary measles-mumps-rubella vaccine failure rate and nonrandom mixing patterns among school-age populations. To eliminate susceptible individuals in the school-age populations, a second dose of measles vaccine is now recommended between 5 and 6 years or 11 and 12 years by both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Later in the epidemic, measles cases surged among unimmunized preschool children, especially among the poor in inner-city areas. Immunization rates have been documented to be low among preschool populations because of missed opportunities to administer vaccines at all health visits and barriers to access to immunizations. To raise immunization rates, the age for the first measles-mumps-rubella immunization was lowered to 12 to 15 months of age, federal immunization funding has increased, and new standards for immunization delivery have been developed and promulgated.
自1978年以来，在美国消除本土麻疹一直是公共卫生工作的重点。为评估在这一目标上取得的进展，我们回顾了1963年至今的麻疹流行病学情况。从20世纪70年代到近期麻疹疫情初期，大多数麻疹病例发生在疫苗接种率很高的学龄儿童中。这主要是由于麻疹-腮腺炎-风疹三联疫苗的初次接种失败率为1%至5%，以及学龄人群中存在非随机的人群混合模式。为消除学龄人群中的易感个体，免疫实践咨询委员会和美国儿科学会现均建议在5至6岁或11至12岁时接种第二剂麻疹疫苗。在疫情后期，未接种疫苗的学龄前儿童中的麻疹病例激增，尤其是市中心贫困地区的儿童。据记录，学龄前人群的免疫接种率较低，原因是在所有健康检查中都存在错过接种疫苗的机会以及获得免疫接种存在障碍。为提高免疫接种率，将首次麻疹-腮腺炎-风疹免疫接种的年龄降至12至15个月，联邦免疫接种资金增加，并且制定并颁布了新的免疫接种实施标准。
