The US Centers for Disease Control and Prevention (CDC) today said childhood immunization levels are near or above national targets, but added that the encouraging news is tempered by a spike in measles activity this year, led by outbreaks in which people refused the vaccine.
The CDC’s childhood immunization findings are from a survey that serves as a report card for the federal Vaccine for Children (VFC) program, which celebrates its 20th anniversary this year. The survey results, plus three separate reports on measles, appeared today in Morbidity and Mortality Weekly Report (MMWR).
At a media briefing today, Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said Congress passed the law implementing the VFC program in 1993 as part of a response to a severe measles outbreak from 1989 to 1991 that sickened 55,000 people and killed 123.
So far this year 159 cases of measles have been reported in the United States, the second most since the disease was eliminated from the country in 2000, she said. Nearly all the US cases have links to imported infections in those who traveled to parts of the world where measles still circulates. Schuchat said the imported measles cases this year are from 18 countries, half from the European region.
Infection clusters that have cropped up in the United States this year have affected communities where like-minded people forego vaccinations due to philosophical or religious objections, she said. Measles is one of the most contagious diseases there is, and the country needs very high levels of immunization to protect vulnerable populations, which includes babies less than 1 year old who are too young to receive the vaccine.
When measles cases are detected, containment efforts are tremendously costly, Schuchat said, adding that many people, including health practitioners, don't recall a time when measles circulated. "Please remember, these diseases are still out there, just a plane ride away," she said.
The outbreak in New York was sparked by an unvaccinated 17-year-old who got sick with measles in March while returning from the United Kingdom. The outbreak affected two Brooklyn neighborhoods and was propagated by a few extended families whose members declined measles, mumps, and rubella (MMR) vaccination.
The outbreak sickened 58 people and occurred in an Orthodox Jewish community that had high vaccination coverage, which probably prevented further spread of the disease, according to a detailed MMWR report.
In North Carolina’s outbreak, which sickened 23 people, the index case was an individual who got sick in April after spending 3 months in India. Most infections occurred in residents of a largely unvaccinated religious community in a rural part of the state, according to a separate MMWR report.
Texas has reported 21 measles cases so far this year, 17 of them in unvaccinated people, Schuchat said. Most of the cases occurred in a church community, and the index patient was an adult with unknown measles vaccination history who had traveled to Indonesia, according to an MMWR report on US outbreaks this year.
Schuchat drew a contrast between the intent of the VFC program, which was implemented to shore up missed vaccination opportunities in doctors' offices in children of families who can’t afford them, with what health officials are encountering in some groups actively rejecting childhood vaccines.
Of the VFC program, she said, "We've come a long way in 20 years, but there is still more work to do."
The survey results published today in MMWR measured coverage in toddlers ages 19 months to 35 months in 2012 and compared the findings with Healthy People 2020 goals, which set a target of 90% for childhood vaccines. The phone survey included responses pertaining to 17,000 toddlers, and providers verified most of the vaccination reports.
Coverage was near or above 90% for the childhood vaccines, with small but significant decreases from 2011 that the CDC said is probably the result of a change in survey method, which now includes a higher percentage of families contacted through cell phone sampling.
The survey found few differences among racial and ethnic groups, but researchers found that coverage still lags in those living below the poverty line for newer vaccines and those that require four doses to complete the series. It also found that vaccination coverage in youngsters varied by state.
Sustained and improved coverage is needed to maintain low levels of vaccine-preventable diseases in children and to prevent the resurgence of illnesses such as measles, the CDC report said.
Sep 13 MMWR report on childhood vaccinations
Sep 13 MMWR report on New York City measles outbreak
Sep 13 MMWR report on North Carolina measles outbreak
Sep 13 MMWR US measles report