Background

Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home.

Methods

We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles–mumps–rubella (MMR) vaccine (given as either MMR or measles–mumps–rubella–varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated.

Results

A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million.

Conclusions

Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.

中文翻译：

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疫苗接种不足的后果-麻疹暴发，纽约市，2018–2019年

背景

2000年在美国宣布消灭了麻疹，但仍存在因国际进口而引起暴发的风险。当一名未接种疫苗的儿童带着麻疹从以色列返回家乡时，纽约市爆发了麻疹。皮疹发作于2018年9月30日，即孩子返回家园后9天。

方法

我们通过进行访谈，审查医疗和免疫记录，识别暴露者并进行诊断测试来调查可疑的麻疹病例。麻疹－腮腺炎－风疹（MMR）疫苗（以MMR或麻疹－腮腺炎－风疹－水痘疫苗（统称为MMR疫苗））的摄入量通过全市免疫注册中心进行监测。计算了纽约市卫生和心理卫生部门的总直接费用。

结果

总共确认了649例麻疹病例，在2018年9月30日至2019年7月15日之间出现皮疹发作。大部分患者（93.4％）是东正教犹太社区的一部分，而其中473例患者（ 72.9％）居住在纽约布鲁克林的威廉斯堡地区。中位年龄为3岁；81.2％的患者年龄在18岁或以下，并且有82.8％的已知疫苗接种史的患者未接种疫苗。严重并发症包括肺炎（37例[5.7％]）和住院（49例[7.6％]）；在住院患者中，有20名（40.8％）被送往重症监护室。由于努力促进疫苗接种，威廉斯堡至少接受一剂MMR疫苗的儿童比例从79.5％增加到91岁。12至59个月大的儿童中占1％。截至2019年9月9日，卫生和心理卫生部共有559名工作人员（占该机构的7％）参与了麻疹应对工作。卫生和心理卫生部的费用为840万美元。

结论

麻疹的进口和幼儿的疫苗接种延误导致纽约市爆发麻疹。疫情应对工作占用大量资源，并造成了严重的疾病，特别是在未接种疫苗的儿童中。