1990 – Measles Resurgence (largest loss of life since 1971) especially young children–79-108

lornajarrettblanchard January 1, 1990

–108 Hinman, et al. using “capture-recapture methodology.”[1]

— 97 Daily Reporter, Spencer, IA. “Immunizations prevent many diseases.” 4-16-1994, p. 5.

— 95 NIP[2] surveillance database; in Hinman, et al. “Acute Measles…” JID, 2004.

— 89 CDC. “Current Trends Measles – United States, 1990.” MMWR, 40/22, 6-7-1991, p. 369.

— 79 Blanchard tally of State breakouts below.

— 75 NCHS[3] multiple-cause mortality database; in Hinman, et al. “Acute Measles…” JID, 2004

— 64 CDC. Epidemiology…Prevention of Vaccine-Preventable Diseases. Ch. 12, 2012, p. 179.

— 35 Jan-May.[4]

Alaska ( ?)

— ? Outbreak. LA Times. “Measles Outbreak Plagues 23 States; Funds Run Short.” 4-14-1990.

Arizona ( ?)

— ? Navajo Reservation, Dec; preschool children.[5]

California (56)

–56 Statewide. Lan Sing, Humboldt County, CA, Health Officer.[6]

–47 Statewide, out of more than 10,000 cases in first two-thirds of the year.[7]

— ? Alameda County outbreak.[8]

— ? Bakersfield/Kern County outbreak. (noted by CDC)

— 6 Los Angeles County, by end of May, from 1,407 cases.[9]

— 2 Orange County (children).[10]

–1 Anaheim, Feb. Baby girl, 10-months.[11]

–1 Santa Ana, Jan 17. Jose Herrera, 7-months.[12]

— 5 San Bernardino County, by end of May, from 910 cases.[13]

— ? San Joaquin Valley outbreak.[14]

— ? San Diego outbreak. AP. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10.

Florida ( ?)

— ? Outbreak. LA Times. “Measles Outbreak Plagues 23 States; Funds Run Short.” 4-14-1990.

Illinois ( ?)

–? Cook County outbreak (203 cases through May).[15]

Indiana ( ?)

— 0 Adams County outbreak.[16]

— 0 Allen County, Fort Wayne. Sixth case confirmed; measles emergency declared.[17]

— ? LaGrange County. Over 30 cases reported by Jan 31.[18]

— 0 Monroe Co., Indiana Univ., Bloomington campus, early April. Six confirmed cases.[19]

Iowa (>1)

—>1 Daily Reporter, Spencer, IA. “Immunizations prevent many diseases.” 4-16-1994, p. 5.[20]

— ? 21 cases reported by March 16. AP. “Measles on rise…” Cedar Rapids Gazette, 3-16-1990, 10A.

Kansas ( 1)

— 1 Out of 316 cases by May 19. St. Marys Academy and College; boy, 13.[21]

Maine ( ?)

— ? 30 cases for the year, 26 at University of Maine.[22]

— ? 5 cases in Orono in Feb (four at Univ. of Maine, and one in public school system).[23]

Maryland ( ?)

— ? Anne Arundel County, four cases first week of May.[24]

Minnesota ( 3)

— 3 State. Hmong babies, 9-months, 11-months, 14-months; too young for vaccination.[25]

— ? St. Paul Outbreak. 117 cases Jan to April 14.[26]

Montana ( 0)

— 0 6 cases reported.[27]

Nevada ( ?)

— ? Outbreak. LA Times. “Measles Outbreak Plagues 23 States; Funds Run Short.” 4-14-1990.

New Mexico ( ?)

–~90 State cases. NMDOH. Health Status of NM. Chart “Measles, New Mexico, 1985-2013.”[28]

— 0 Alamogordo case reported, Feb.[29]

— 0 Anthony cases reported, Feb.[30]

— 0 Artesia, two cases reported, Feb.[31]

— 0 Roswell. 2 cases, late March. Roswell Daily Record, NM. “Roswell scene.” 3-28-1990, p. 10.

New York ( 9)

— 9 NYC. CDC. “Measles Outbreak – New York City, 1990-1991.” MMWR, 40/18, 5-10-1991.

Pennsylvania ( ?)

— 0 Dubois, Clearfield County, Feb. 7-8 cases confirmed.[32]

— 1 Philadelphia outbreak, starts in Oct.[33] Boy, 18-months (1^st measles death there 20 years).[34]

— 0 Titusville area school district outbreak of 40-50 cases, Feb.[35]

Texas (>7)

— 7 Dallas, by May 7. Five Dallas Co. residents (four children); two out-of-co. in Dallas hosp.[36]

–1 Jan 30. Female, 26; probably not immunized (1^st county measles death since 1979).[37]

–1 Feb 16. Girl, 15-months; hand not been immunized.[38]

–1 Feb 20. Girl, 18 months.[39]

— ? El Paso, Feb. 110 cases confirmed.[40]

— 0 Lamar, May (14 cases). Paris News, TX. “1990 Year in review.” 12-30-1990, p. 6A.

–? Laredo. 39 cases by Feb 14; School district sends 250 unvaccinated students home.[41]

Virginia ( 0)

— 0 86 cases during year in state.[42]

— 0 Virginia Peninsula outbreak of 12 cases primarily among unvaccinated preschoolers.[43]

Washington (>2)

— 2 Out of 266 cases. CDC. “Epidemiologic Notes…Measles – Washington, 1990.” MMWR.

— 0 But 266 cases reported by mid-July, described as an epidemic imported by unvaccinated.[44]

— 0 Yakima County outbreak (22 cases of 46 in the State in Spring).[45]

Narrative Information

CDC MMWR: “As of May 10, 1991, local and state health departments reported a provisional total of 27,672 measles cases in the United States for 1990[46] — a 52.1% increase over the 18,193 cases reported for 1989[47]…and 89 suspected measles-associated deaths. Cases were reported from 49 states and the District of Columbia. The overall incidence rate in 1990 was 11.1 cases per 100,000 population. This report summarizes epidemiologic features of measles cases reported for 1990 and compares findings with cases reported for 1989.

“In 1990, children less than 5 years of age accounted for 48.1% of measles cases, compared with 36.6% of cases in 1989… Persons greater than or equal to 20 years of age accounted for 22.5% of all reported cases in 1990, compared with 17.0% in 1989.

Estimated incidence rates were higher in 1990 than in 1989 for all age groups, except 15- to 19-year-olds. The largest increases in incidence rates were among children less than 1 year of age (137.6%) and adults greater than or equal to 25 years of age (130.0%). The highest incidence rates were among children aged less than 1 year (119.3 per 100,000) and 1–4 years (58.3 per 100,000).

“Information on race/ethnicity was available for 11,083 (40.1%) cases reported from 34 states and the District of Columbia (no race/ethnicity information was available for cases reported from the other 15 states, including California). Of these, 6192 (55.9%) occurred among non-Hispanic whites; 2472 (22.3%), non-Hispanic blacks; 2082 (18.8%), Hispanics; and 337 (3.0%), other racial or ethnic groups. Incidence rates were highest for Hispanics (29.5 cases per 100,000 population) and blacks (12.3 per 100,000) and lowest for non-Hispanic whites (5.2 per 100,000).

“Importations from other countries accounted for 377 (1.4%) cases; an additional 188 (0.7%) cases were epidemiologically linked within two generations of transmission to imported cases. Of the 377 cases, 249 (66.0%) were acquired in Mexico, and 95 (25.2%) in other Central American, South American, or Caribbean countries.

“A total of 240 outbreaks, involving from five to 7514 persons, accounted for 87.0% of the cases. Outbreaks affecting predominantly preschool-aged children involved 19,827 (71.7%) cases; school-aged persons, 2842 (10.3%) cases; and postschool-aged persons, 1376 (5.0%) cases. The largest outbreaks involved predominantly preschool-aged children and occurred in Los Angeles (7514 cases); Dallas (2331); New York City (1108); San Diego (1049); and Bakersfield/Kern County, California (1011). These outbreaks accounted for 47.0% of all cases reported for 1990.

“Vaccination status was known for 27,632 (99.9%) patients. Of these, 5100 (18.4%) were known to have been vaccinated on or after their first birthday…; approximately 71.4% of these persons were 5-19 years of age. Of the 22,532 (81.4%) persons who were unvaccinated or inadequately vaccinated (i.e., vaccinated before their first birthday), routine vaccination was indicated for 12,268 (54.4%… Almost 40% of these vaccine-eligible persons were children 16 months to 4 years of age. Measles occurred in 8,698 (31.4% of total) persons for whom routine vaccination was not indicated, of whom 7,257 (83.4%) were children less than 16 months of age. Of the 1,566 persons (5.7% of total) who were unvaccinated for other reasons, 1,424 (90.9%) were persons with religious or philosophic exemption to vaccination….

“A provisional total of 89 measles-associated deaths were reported, for a death-to-case ratio of 3.2 deaths per 1000 reported cases. Deaths were reported from 15 states. Forty-nine (55.1%) deaths occurred among children less than 5 years of age, including 15 (16.9%) children less than 12 months of age and 13 (14.6%) children 5–19 years of age. The other 27 (30.3%) deaths occurred among adults greater than or equal to 20 years of age. Eighty-one (91.0%) suspected measles-associated deaths occurred among unvaccinated persons. Reported by: Div of Immunization, Center for Prevention Svcs, CDC….

Editorial Note…. Failure to vaccinate children at the appropriate age was the major factor contributing to the resurgence of measles in the United States in 1989–1990 (National Vaccine Advisory Committee, unpublished data, 1991). Surveys in areas experiencing measles outbreaks indicate that as few as 50% of children have been vaccinated against measles by their second birthday (5), and that black and Hispanic children are less likely to be age-appropriately vaccinated than are white children.”[48]

Background

CDC, Epidemiology…: “Measles is an acute viral infectious disease. References to measles can be found from as early as the 7th century. The disease was described by the Persian physician Rhazes in the 10th century as “more dreaded than smallpox.”

“In 1846, Peter Panum described the incubation period of measles and lifelong immunity after recovery from the disease. Enders and Peebles isolated the virus in human and monkey kidney tissue culture in 1954. The first live attenuated vaccine was licensed for use in the United States in 1963 (Edmonston B strain).

“Before a vaccine was available, infection with measles virus was nearly universal during child-hood, and more than 90% of persons were immune by age 15 years. Measles is still a common and often fatal disease in developing countries. The World Health Organization estimates there were 164,000 deaths globally from measles in 2008….

“Measles transmission is primarily person to person via large respiratory droplets. Airborne transmission via aerosolized droplet nuclei has been documented in closed areas (e.g., office examination room) for up to 2 hours after a person with measles occupied the area….

“Measles is highly communicable, with greater than 90% secondary attack rates among susceptible persons. Measles may be transmitted from 4 days before to 4 days after rash onset. Maximum communicability occurs from onset of prodrome through the first 3–4 days of rash.

“Before 1963 approximately 500,000 cases and 500 deaths were reported annually, with epidemic cycles every 2–3 years. However, the actual number of cases was estimated at 3–4 million annually. More than 50% of persons had measles by age 6, and more than 90% had measles by age 15. The highest incidence was among 5–9-year-olds, who generally accounted for more than 50% of reported cases.

“Following licensure of vaccine in 1963, the incidence of measles decreased by more than 98%, and 2-3-year epidemic cycles no longer occurred. Because of this success, a 1978 Measles Elimination Program set a goal to eliminate indigenous measles by October 1, 1982 (26,871 cases were reported in 1978). The 1982 elimination goal was not met, but in 1983, only 1,497 cases were reported (0.6 cases per 100,000 population), the lowest annual total ever reported up to that time.

“During 1980-1988, a median of 57% of reported cases were among school-aged persons (5-19 years of age), and a median of 29% were among children younger than 5 years of age. A median of 8% of cases were among infants younger than 1 year of age.

“From 1985 through 1988, 42% of cases occurred in persons who were vaccinated on or after their first birthday. During these years, 68% of cases in school-aged children (5–19 years) occurred among those who had been appropriately vaccinated. The occurrence of measles among previously vaccinated children (i.e., vaccine failure) led to the recommendation for a second dose in this age group.

“From 1989 through 1991, a dramatic increase in cases occurred. During these 3 years a total of 55,622 cases were reported (18,193 in 1989; 27,786 in 1990; 9,643 in 1991). In addition to the increased number of cases, a change occurred in their age distribution. Prior to the resurgence, school-aged children had accounted for the largest proportion of reported cases. During the resurgence, 45% of all reported cases were in children younger than 5 years of age. In 1990, 48% of patients were in this age group, the first time that the proportion of cases in children younger than 5 years of age exceeded the proportion of cases in 5–19-year-olds (35%).

“Overall incidence rates were highest for Hispanics and blacks and lowest for non-Hispanic whites. Among children younger than 5 years of age, the incidence of measles among blacks and Hispanics was four to seven times higher than among non-Hispanic whites.

“A total of 123 measles-associated deaths were reported (death-to-case ratio of 2.2 per 1,000 cases). Forty-nine percent of deaths were among children younger than 5 years of age. Ninety percent of fatal cases occurred among persons with no history of vaccination. Sixty-four deaths were reported in 1990, the largest annual number of deaths from measles since 1971.

“The most important cause of the measles resurgence of 1989-1991 was low vaccination coverage. Measles vaccine coverage was low in many cities, including some that experienced large outbreaks among preschool-aged children throughout the early to mid-1980s. Surveys in areas experiencing outbreaks among preschool-aged children indicated that as few as 50% of children had been vaccinated against measles by their second birthday, and that black and Hispanic children were less likely to be age-appropriately vaccinated than were white children.

“In addition, measles susceptibility of infants younger than 1 year of age may have increased. During the 1989-1991 measles resurgence, incidence rates for infants were more than twice as high as those in any other age group. The mothers of many infants who developed measles were young, and their measles immunity was most often due to vaccination rather than infection with wild virus. As a result, a smaller amount of antibody was transferred across the placenta to the fetus, compared with antibody transfer from mothers who had higher antibody titers resulting from wild-virus infection. The lower quantity of antibody resulted in immunity that waned more rapidly, making infants susceptible at a younger age than in the past.

“The increase in measles in 1989-1991 was not limited to the United States. Large outbreaks of measles were reported by many other countries of North and Central America, including Canada, El Salvador, Guatemala, Honduras, Jamaica, Mexico, and Nicaragua.

“Reported cases of measles declined rapidly after the 1989–1991 resurgence. This decline was due primarily to intensive efforts to vaccinate preschool-aged children. Measles vaccination levels among 2-year-old children increased from 70% in 1990 to 91% in 1997.

“Since 1993, fewer than 500 cases have been reported annually, and fewer than 200 cases per year have been reported since 1997. A record low annual total of 37 cases was reported in 2004. Available epidemiologic and virologic data indicate that measles transmission in the United States has been interrupted. The majority of cases are now imported from other countries or linked to imported cases. Most imported cases originate in Asia and Europe and occur both among U.S. citizens traveling abroad and persons visiting the United States from other countries. An aggressive measles vaccination program by the Pan American Health Organization has resulted in record low measles incidence in Latin America and the Caribbean, and the interruption of indigenous measles transmission in the Americas. Measles elimination from the Americas was achieved in 2002 and has been sustained since then, with only imported and importation-related measles cases occurring in the region….

“In 2008 a total of 140 measles cases was reported, the largest annual total since 1996. Eighty nine percent of these cases were imported from or associated with importations from other countries, particularly countries in Europe where several outbreaks are ongoing. Persons younger than 20 years of age accounted for 76% of the cases; 91% were in persons who were unvaccinated (most because of personal or religious beliefs) or of unknown vaccination status. The increase in the number of cases of measles in 2008 was not a result of a greater number of imported measles cases. It was the result of more measles transmission after the virus was imported. The importation-associated cases occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated. Many of these children were home-schooled and not subject to school entry vaccination requirements….

“To date there is no convincing evidence that any vaccine causes autism or autism spectrum disorder. Concern has been raised about a possible relation between MMR vaccine and autism by some parents of children with autism. Symptoms of autism are often noticed by parents during the second year of life, and may follow administration of MMR by weeks or months. Two independent nongovernmental groups, the Institute of Medicine (IOM) and the American Academy of Pediatrics (AAP), have reviewed the evidence regarding a potential link between autism and MMR vaccine. Both groups independently concluded that available evidence does not support an association, and that the United States should continue its current MMR vaccination policy. Additional research on the cause of autism is needed….” (CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. Chap. 12, 2012, p. 179.)

California

Oct 14, AP: “San Jose (AP) – A shortfall of immunized children has created ‘a toddler gap’ between both rich and poor in California, according to researchers. ‘Young children, especially 7-month-old and 2-year-old children, have disturbingly low immunization levels,’ researchers wrote in this month’s issue of the Western Journal of Medicine. The state, they reported, lags behind national immunization patterns. Barely one-third of children using public clinics were adequately immunized from 1979 to 1987, and only two-thirds of the youngsters attended by private physicians met state requirements, according to findings by Dr. Michael Scheiber, of the University of California at Berkeley, and Dr. Neal Halfon, of Children’s Hospital Medical Center in Oakland.

“More than half the 550,000 children born in California every year will not be properly vaccinated by their second birthday, health officials estimate. ‘The vaccines are poison,’ said Shannon Lenz, who has nursed her three children through concurrent bouts of whooping cough. ‘I’d rather take my chances with the measles,’ said Lenz, who refuses to have her 20-month-old daughter immunized for measles, mumps, rubella and diphtheria.

“Lenz’ attitude is part of what health officials call a growing national health epidemic. Parents who distrust – or don’t know about – the country’s immunization program are contributing to rising outbreaks of major and deadly diseases. Even programs that offer free hamburgers have failed to make a dent in the immunization shortfall.

“The measles outbreak in the state is the worst in 20 years, with more than 10,000 cases and 47 deaths reported in the first two-thirds of 1990. Whooping cough is also up, with more than 400 incidents reported yearly.

“Inadequate immunization causes the outbreaks, according to state and local officials. Despite increasing medical evidence that vaccines rarely produce long-term illness or deaths, millions of parents refuse to immunize their children. ‘We’ve tried everything, and nothing has worked,’ said Dr. Loring Dales, chief of immunization for the California Department of Health Services, which spends $1.5 million a year on outreach programs.” (Associated Press, San Jose. “`Toddler gap’ of immunized children in state.” Ukiah Daily Journal, CA, 10-14-1990, p. 6.)

New York City

CDC: “In March 1990, a large measles outbreak began in New York City. Through December 1990, approximately 2500 cases and eight measles-associated deaths were reported.

Texas

May 7, AP: “Dallas (AP) – Health experts say the measles outbreak that has claimed five lives in Dallas County was a disaster waiting to happen because tens of thousands of preschool children never received immunization shots. ‘Anytime you’ve got that many children not vaccinated, the situation is right for measles, and the fuel is there to start a rather substantial outbreak,’ said Dr. William Atkinson, a medical epidemiologist with the federal Centers for Disease Control in Atlanta.

“Dallas has reported more cases of measles than any other place in the country, Dr. Atkinson said. More than 2,040 cases have been reported in Dallas since the local outbreak began in December. Of the five resident who died of measles, four were children. Two out-of-county residents also have died of measles in Dallas hospitals.

“Los Angeles has reported 3,000 cases and 25 deaths since 1987, but Dallas has a higher per capita rate, Dr. Atkinson said. Dallas’ measles cases, like those nationwide, have been concentrated among preschool children who live in poverty, said Dr. Charles Haley, chief epidemiologist for Dallas County.” (Associated Press, Dallas. “Dallas measles program faulted.” Big Spring Herald, TX, 5-7-1990, p. 2-A.)

Source

Associated Press, Yakima, WA. “5 more measles cases reported in Yakima County.” Walla Walla Union-Bulletin, 4-1-1990, 5. Accessed 5-4-2016 at: http://newspaperarchive.com/us/washington/walla-walla/walla-walla-union-bulletin/1990/04-01/page-5?tag

Associated Press, Bloomington, IN. “6th measles case is confirmed at IU.” Kokomo (Ind.) Tribune. 4-15-1990, p. 11. Accessed 5-4-2016 at: http://newspaperarchive.com/us/indiana/kokomo/kokomo-tribune/1990/04-15/page-11?tag=measles+death+dead+die+kill&rtserp=tags

Associated Press, Fort Wayne, IN. “Another measles case reported.” Kokomo Tribune, IN, 3-8-1990, p. 22. Accessed 5-4-2016 at: http://newspaperarchive.com/us/indiana/kokomo/kokomo-tribune/1990/03-08/page-22?tag

Associated Press, Dallas. “Dallas measles program faulted.” Big Spring Herald, TX, 5-7-1990, p. 2-A. Accessed 5-4-2016 at: http://newspaperarchive.com/us/texas/big-spring/big-spring-herald/1990/05-07/page-2?tag

Associated Press, Laredo, TX. “Laredo officials tackle measles.” Kerrville Daily Times, TX, 2-16-1990, 3A. Accessed 5-5-2016 at: http://newspaperarchive.com/us/texas/kerrville/kerrville-daily-times/1990/02-16/page-3?tag

Associated Press, Dallas. “Measles claims 3 lives.” Herald-Zeitung, New Braunfels, TX, 2-22-1990, p. 3. Accessed 5-5-2016 at: http://newspaperarchive.com/us/texas/new-braunfels/new-braunfels-herald-zeitung/1990/02-22/page-13?tag

Associated Press, Dallas. “Measles control.” Big Spring Herald, TX, 3-8-1990, 2-A. Accessed 5-5-2016 at: http://newspaperarchive.com/us/texas/big-spring/big-spring-herald/1990/03-08/page-2?tag

Associated Press, Des Moines. “Measles on rise; immunization urged.” Cedar Rapids Gazette, IA. 3-16-1990, 10A. Accessed 5-4-2016 at: http://newspaperarchive.com/us/iowa/cedar-rapids/cedar-rapids-gazette/1990/03-16/page-19?tag

Associated Press, Los Angeles. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10. Accessed 5-4-2016 at: http://newspaperarchive.com/us/california/ukiah/ukiah-daily-journal/1990/04-01/page-10?tag

Associated Press, Topeka, KS. “Officials hope outbreak ends by fall.” Iola Register, KS, 5-19-1990, p. 2. Accessed 5-4-2016 at: http://newspaperarchive.com/us/kansas/iola/iola-register/1990/05-19/page-2?tag

Associated Press, Newport News. “Officials warn parents of red measles danger.” Bluefield Daily Telegraph, WV. 8-23-1999, A3. Accessed 5-4-2016 at: http://newspaperarchive.com/us/west-virginia/bluefield/bluefield-daily-telegraph/1990/08-31/page-5?tag

Associated Press, Indianapolis. “Second measles emergency declared.” Kokomo Tribune, IN, 1-31-1990, p. 11. Accessed 5-5-2016 at: http://newspaperarchive.com/us/indiana/kokomo/kokomo-tribune/1990/01-31/page-11?tag

Associated Press, San Jose. “`Toddler gap’ of immunized children in state.” Ukiah Daily Journal, CA, 10-14-1990, p. 6. Accessed 5-4-2016 at: http://newspaperarchive.com/us/california/ukiah/ukiah-daily-journal/1990/10-14/page-6?tag

Associated Press, Orono. “UMO immunizing against measles.” Journal Tribune, Biddeford, ME, 2-16-1990, p. 6. Accessed 5-5-2016 at: http://newspaperarchive.com/us/maine/biddeford/biddeford-journal-tribune/1990/02-16/page-6?tag

Atkinson, William L., et al. “Measles Surveillance – United States, 1991.” MMWR (Morbidity and Mortality Weekly Report) CDC Surveillance Summaries, Vol. 41, No. SS-6, pp. 1-12. Atlanta, GA: Centers for Disease Control and Prevention, 11-20-1992. Accessed 5-5-2016 at: https://books.google.com/books?id=lnCt01e4gKcC&printsec=frontcover#v=onepage&q&f=false

Bangor Daily News. “Maine reportedly measles free despite outbreaks nationwide.” 4-25-1991. Accessed 5-5-2016 at: http://archive.bangordailynews.com/1991/04/25/maine-reportedly-measles-free-despite-outbreaks-nationwide/

Centers for Disease Control and Prevention. “Current Trends Measles – United States, 1990.” MMWR (Morbidity and Mortality Weekly Report), Vol. 40, No. 22, 6-7-1991, pp. 369-372. Accessed 5-2-2016 at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00001999.htm

Centers for Disease Control and Prevention. “Epidemiologic Notes and Reports Measles – Washington, 1990.” MMWR (Morbidity and Mortality Weekly Report), Vol. 39, No. 28, pp. 473-476. Atlanta, GA: CDC, U.S. Department of Health and Human Services, 7-20-1999. Accessed 5-5-2016 at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00001675.htm

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases (W. Atkinson, S. Wolfe, and J. Hamborsky, editors, 12^th ed.). Chapter 12: Measles. Washington, DC: Public Health Foundation, 2012. [Known as The Pink Book.] Accessed 2-3-2015 at: http://www.cdc.gov/vaccines/pubs/pinkbook/table-of-contents.html#toc

Centers for Disease Control and Prevention. “Measles Outbreak – New York City, 1990-1991.” MMWR (Morbidity and Mortality Weekly Report), Vol. 40, No. 18, 5-10-1991, pp. 305-306. Accessed 5-2-2016 at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00001980.htm

Daily Press, Hampton Roads, VA. “Fight Measles With Prevention.” 8-15-1991. Accessed 5-5-2016 at: http://articles.dailypress.com/1991-08-15/news/9108150186_1_measles-vaccine-measles-outbreaks-proper-immunization

Daily Reporter, Spencer, IA. “Immunizations prevent many diseases.” 4-16-1994, p. 5. Accessed 5-5-2016 at: https://news.google.com/newspapers?nid=1926&dat=19930416&id=FVkrAAAAIBAJ&sjid=0tkEAAAAIBAJ&pg=2752,6024531&hl=en

Gazette Telegraph, Colorado Springs, CO. “Immigrants propelled epidemic, center says.” 7-20-1990, p. 5. Accessed 5-4-2016 at: http://newspaperarchive.com/us/colorado/colorado-springs/colorado-springs-gazette-telegraph/1990/07-20/page-5?tag

Hinman, Alan R., et al. “Acute Measles Mortality in the United States, 1987-2002.” Journal of Infectious Diseases, Vol. 189 (Supplement 1), 2004, pp. S69-S77. Accessed 5-2-2016 at: http://jid.oxfordjournals.org/content/189/Supplement_1/S69.long

KRTV 3, Great Falls, MT (Zack Briggs). “No measles cases in Montana yet, officials watching neighboring states.” 2-7-2015. Accessed 5-5-2016 at: http://www.krtv.com/story/28051578/no-measles-cases-in-mt-yet-officials-watching-neighboring-states

Los Angeles Times (Ron Harris) “Measles Outbreak Plagues 23 States; Funds Run Short.” 4-14-1990. Accessed 5-5-2016 at: http://articles.latimes.com/1990-04-14/news/mn-967_1_nation-s-measles-outbreak

“Minnesota reported measles deaths 1981-2000.” Accessed 5-5-2016 at: http://www.whale.to/vaccine/measles3.html

New Mexico Department of Health. Health Status of New Mexico. Chart: “Measles, New Mexico, 1985-2013.” January 2015. Accessed 5-5-2016 at: https://nmhealth.org/data/view/general/1632/

Offit, Paul A. MD (Children’s Hospital of Philadelphia). The Philadelphia Measles Outbreak; Lessons From the Past. Accessed 5-5-2016 at: http://mchc.net/wp-content/uploads/2015/01/Philadelphia-Measles-Outbreak-Paul-Offit.pdf

Orange County Register (Susan Peterson), Santa Ana, CA. “Measles complications suspected as cause of Anaheim baby’s death.” 3-8-1990, B7. Accessed 5-5-2016 at: http://newspaperarchive.com/us/california/santa-ana/santa-ana-orange-county-register/1990/03-08/page-29?tag

Paris News, TX. “1990 Year in review.” 12-30-1990, p. 6A. Accessed 5-3-2016 at: http://newspaperarchive.com/us/texas/paris/paris-news/1990/12-30/page-8?tag

Roswell Daily Record, NM. “Measles cases reported.” 2-23-1990, p. 9. Accessed 5-5-2016 at: http://newspaperarchive.com/us/new-mexico/roswell/roswell-daily-record/1990/02-23/page-9?tag

Roswell Daily Record, NM. “Roswell scene.” 3-28-1990, p. 10. Accessed 5-4-2016 at: http://newspaperarchive.com/us/new-mexico/roswell/roswell-daily-record/1990/03-28/page-10?tag

Santa Ana Orange County Register, CA. “How Life Changed in 1990: Orange County.” 12-30-1990, p. J5. Accessed 5-3-2016 at: http://newspaperarchive.com/us/california/santa-ana/santa-ana-orange-county-register/1990/12-30/page-191?tag

Sing, Lan. “Immunization can prevent disease” (Letter to Editor). Times-Standard, Eureka, CA. 9-25-1991, p. 4. Accessed 5-7-2016 at: http://newspaperarchive.com/us/california/eureka/eureka-times-standard/1991/09-25/page-4?tag

Syracuse Herald-Journal, NY. “Vaccinations may prevent measles epidemic here,” 6-4-1990, B3. Accessed 5-4-2016. Accessed 5-4-2016 at: http://newspaperarchive.com/us/new-york/syracuse/syracuse-herald-journal/1990/06-04/page-16?tag

The Capital, Annapolis, MD. “Measles cases reported,” 5-5-1990, p. 8. Accessed 5-4-2016 at: http://newspaperarchive.com/us/maryland/annapolis/annapolis-capital/1990/05-05/page-8?tag

The Star, Orland Park, IL. “Fewer measles cases spotted, but officials still concerned.” 12-6-1990, p. 6. Accessed 5-3-2016 at: http://newspaperarchive.com/us/illinois/orland-park/orland-park-star/1990/12-06/page-6?tag

Titusville Herald, PA. “City, Region News of `90 Reviewed.” 12-31-1990, p. 8. Accessed 5-3-2016 at: http://newspaperarchive.com/us/pennsylvania/titusville/titusville-herald/1990/12-31/page-8?tag

Titusville Herald, PA. “Measles Confirmed at DuBois..” 3-1-1990, p. 3. Accessed 5-5-2016 at: http://newspaperarchive.com/us/pennsylvania/titusville/titusville-herald/1990/03-01/page-3?tag

WCCO-TV, Minneapolis. “MN Health Officials Worried Over Possible Measles Outbreak.” 3-31-2011. Accessed 5-5-2016 at: http://minnesota.cbslocal.com/2011/03/31/mn-health-officials-worried-over-possible-measles-outbreak/

Additional Reading:

Dales, Loring G. et al. “Measles Epidemic From Failure to Immunize.” Western Journal of Medicine, Vol. 159, No. 4, October 1993, pp. 455-464. Accessed 5-2-2016 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1022280/pdf/westjmed00074-0031.pdf

[1] Authors argue there are inefficiencies in CDC NIP and NCHS data collection which capture-recapture corrects for. See Hinman, et al. for discussion.

[2] National Immunization Program, U.S. Department of Health & Human Services. See Hinman on differences between NIP and NCHS.

[3] National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.

[4] Syracuse Herald-Journal, NY. “Vaccinations may prevent measles epidemic here,” 6-4-1990, B3.

[5] Atkinson, William L., et al. “Measles Surveillance – United States, 1991.” MMWR, 41/SS-6, 11-20-1992, p. 6.

[6] Letter to Editor by Sing, titled “Immunization can prevent disease.” Times-Standard, Eureka, CA. 9-25-1991, p. 4.

[7] AP, San Jose. “`Toddler gap’ of immunized children in state.” Ukiah Daily Journal, CA, 10-14-1990, p. 6.

[8] Associated Press, Los Angeles. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10.

[9] Associated Press, Los Angeles. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10.

[10] Orange County Register, Santa Ana, CA. “How Life Changed in 1990: Orange County.” 12-30-1990, p. J5. An earlier report noted 37 cases were confirmed in Jan, 11 in Feb, and 30 others in March, prompting Orange County epidemiologist Thomas Prendergast to state “That just indicates that measles is going full tilt in 1990 after slowing down in 1989.” Orange Co. Register. “Measles complications suspected as cause of Anaheim…” 3-8-1990, B7.

[11] Orange County Register. “Measles complications suspected as cause of Anaheim baby’s death.” 3-8-1990, B7.

[12] Orange County Register. “Measles complications suspected as cause of Anaheim baby’s death.” 3-8-1990, B7.

[13] Associated Press, Los Angeles. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10.

[14] Associated Press, Los Angeles. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10.

[15] The Star, Orland Park, IL. “Fewer measles cases spotted, but officials still concerned.” 12-6-1990, p. 6.

[16] Associated Press, Fort Wayne, IN. “Another measles case reported.” Kokomo Tribune, IN, 3-8-1990, p. 22.

[17] Associated Press, Fort Wayne, IN. “Another measles case reported.” Kokomo Tribune, IN, 3-8-1990, p. 22.

[18] Associated Press, Indianapolis. “Second measles emergency declared.” Kokomo Tribune, IN, 1-31-1990, p. 11.

[19] Assoc. Press, Bloomington, IN. “6^th measles case is confirmed at IU.” Kokomo (Ind.) Tribune. 4-15-1990, p. 11.

[20] “Vaccine-preventable deaths have been reported in Iowa every year since 1981.”

[21] AP, Topeka, KS. “Officials hope outbreak ends by fall.” Iola Register, KS, 5-19-1990, p. 2.

[22] Bangor Daily News. “Maine reportedly measles free despite outbreaks nationwide.” 4-25-1991.

[23] Associated Press, Orono. “UMO immunizing against measles.” Journal Tribune, Biddeford, ME, 2-16-1990, p. 6.

[24] The Capital, Annapolis, MD. “Measles cases reported,” 5-5-1990, p. 8.

[25] “Minnesota reported measles deaths 1981-2000.” Another source notes there were more than 500 cases and that the outbreak began in the emerging Hmong community ‘Where immigrants didn’t immediately access health care or understand the value of vaccines.” (WCCO-TV, Minneapolis. “MN Health Officials Worried Over Possible Measles Outbreak.” 3-31-2011.)

[26] Los Angeles Times. “Measles Outbreak Plagues 23 States; Funds Run Short.” 4-14-1990.

[27] KRTV 3, Great Falls, MT. “No measles cases in Montana yet, officials watching neighboring states.” 2-7-2015.

[28] Notes source as Ne Mexico Dept. of Health, Infectious Disease Epidemiology Bureau.

[29] Roswell Daily Record, NM. “Measles cases reported.” 2-23-1990, p. 9.

[30] Roswell Daily Record, NM. “Measles cases reported.” 2-23-1990, p. 9.

[31] Roswell Daily Record, NM. “Measles cases reported.” 2-23-1990, p. 9.

[32] Titusville Herald, PA. “Measles Confirmed at DuBois..” 3-1-1990, p. 3.

[33] Atkinson. “Measles Surveillance – US, 1991.” MMWR CDC Surveillance Summaries, 41/SS-6, 11-20-1992, p. 6.

[34] Offit, P. A. MD (Children’s Hosp. of Philly). The Philadelphia Measles Outbreak; Lessons From…Past. Slide 7. Notes there had been 258 cases by end of month.

[35] Titusville Herald, PA. “City, Region News of `90 Reviewed.” 12-31-1990, p. 8.

[36] Associated Press, Dallas. “Dallas measles program faulted.” Big Spring Herald, TX, 5-7-1990, p. 2-A. Another source notes that as of March 5 there had been 1,013 reported cases in the county – “more than half were preschoolers and most of them hadn’t been vaccinated.” Notes the CDC was sending personnel to Dallas. (AP, Dallas. “Measles control.” Big Spring Herald, TX, 3-8-1990, 2-A.)

[37] Associated Press, Dallas. “Measles claims 3 lives.” Herald-Zeitung, New Braunfels, TX, 2-22-1990, p. 3.

[38] Associated Press, Dallas. “Measles claims 3 lives.” Herald-Zeitung, New Braunfels, TX, 2-22-1990, p. 3.

[39] Associated Press, Dallas. “Measles claims 3 lives.” Herald-Zeitung, New Braunfels, TX, 2-22-1990, p. 3.

[40] Roswell Daily Record, NM. “Measles cases reported.” 2-23-1990, p. 9.

[41] Associated Press, Laredo, TX. “Laredo officials tackle measles.” Kerrville Daily Times, TX, 2-16-1990, 3A.

[42] Daily Press, Hampton Roads, VA. “Fight Measles With Prevention.” 8-15-1991.

[43] Associated Press. “Officials warn parents of red measles danger.” Bluefield Daily Telegraph, WV. 8-23-1999, A3. One of the twelve was an adult. Writes “The original case on the Peninsula involved a child who had been overseas for a month and came back infected…”

[44] Gazette Telegraph, Colorado Springs, CO. “Immigrants propelled epidemic, center says.” 7-20-1990, p. 5.

[45] AP, Yakima, WA. “5 more measles cases reported in Yakima County.” Walla Walla Union-Bulletin, 4-1-1990, 5.

[46] An original footnote states that “As of December 31, 1990, a total of 26,520 cases had between officially reported to CDC.” An Editorial note writes: “The provisional total of 27,672 measles cases in 1990 is the largest number reported since 1977. Cases were reported from every state except North Dakota; however, 61% of all cases were reported by two states, California (12,479 cases) and Texas (4,403 cases).”

[47] CDC footnote 1: CDC. “Summary of notifiable diseases, United States, 1989.” MMWR 1989; 38(54).

[48] Original footnote: CDC. “Update: measles outbreak–Chicago, 1989.” MMWR 1990;39:317–9,325-6.