Dataset Information

International Importations of Measles Virus into the United States During the Postelimination Era, 2001-2016.

ABSTRACT: BACKGROUND:Although measles was declared eliminated from the United States in 2000, measles cases and outbreaks continue to occur, resulting from importations of the disease from countries where it remains endemic. METHODS:We describe the epidemiology of international importations of measles virus into the United States during the postelimination era. RESULTS:From 2001 to 2016, 553 imported measles cases were reported to the Centers for Disease Control and Prevention. A median of 28 importations occurred each year (range: 18-80). The median age of imported case-patients was 18 years (range: 3 months-75 years); 87% were unvaccinated or had an unknown vaccination status. US residents (as opposed to foreign visitors) accounted for 62% of imported measles cases. Overall, 62% of all imported case-patients reported travel to countries in the Western Pacific and European Regions of the World Health Organization during their exposure periods. The number of measles importations from specific countries was related to the incidence of measles in and the volume of travel to and from the source country. CONCLUSIONS:Our findings emphasize the importance of measles vaccination of US residents aged ?6 months before international travel according to the Advisory Committee on Immunization Practices recommendations and supporting global measles elimination efforts.

SUBMITTER: Lee AD

PROVIDER: S-EPMC6474820 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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International Importations of Measles Virus into the United States During the Postelimination Era, 2001-2016.

Lee Adria D AD Clemmons Nakia S NS Patel Manisha M Gastañaduy Paul A PA

The Journal of infectious diseases 20190401 10

<h4>Background</h4>Although measles was declared eliminated from the United States in 2000, measles cases and outbreaks continue to occur, resulting from importations of the disease from countries where it remains endemic.<h4>Methods</h4>We describe the epidemiology of international importations of measles virus into the United States during the postelimination era.<h4>Results</h4>From 2001 to 2016, 553 imported measles cases were reported to the Centers for Disease Control and Prevention. A med ...[more]

PMID: 30535027

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Project description:Measles incidence in the United States has grown dramatically, as vaccination rates are declining and transmission internationally is on the rise. Because imported cases are necessary drivers of outbreaks in non-endemic settings, predicting measles outbreaks in the US depends on predicting imported cases. To assess the predictability of imported measles cases, we performed a regression of imported measles cases in the US against an inflow variable that combines air travel data with international measles surveillance data. To understand the contribution of each data type to these predictions, we repeated the regression analysis with alternative versions of the inflow variable that replaced each data type with averaged values and with versions of the inflow variable that used modeled inputs. We assessed the performance of these regression models using correlation, coverage probability, and area under the curve statistics, including with resampling and cross-validation. Our regression model had good predictive ability with respect to the presence or absence of imported cases in a given state in a given year (area under the curve of the receiver operating characteristic curve (AUC) = 0.78) and the magnitude of imported cases (Pearson correlation = 0.84). By comparing alternative versions of the inflow variable averaging over different inputs, we found that both air travel data and international surveillance data contribute to the model's ability to predict numbers of imported cases and individually contribute to its ability to predict the presence or absence of imported cases. Predicted sources of imported measles cases varied considerably across years and US states, depending on which countries had high measles activity in a given year. Our results emphasize the importance of the relationship between global connectedness and the spread of measles. This study provides a framework for predicting and understanding imported case dynamics that could inform future studies and outbreak prevention efforts.

Project description:ImportanceMeasles cases and outbreaks continue to occur in the United States after the introduction of measles from endemic settings.ObjectiveTo discern the factors associated with measles transmission in the United States after measles had been eliminated.Design, setting, and participantsThis cross-sectional study was conducted from January 1, 2001, to December 31, 2017, in the United States among US residents and international visitors with confirmed measles. A maximum likelihood algorithm that uses the observed dates of rash onset and the known distribution of the serial interval (time between symptom onset in related consecutive cases) was applied to outbreak notification data to estimate the effective reproduction number (R), or the mean number of new infections generated per case. Transmissibility was assessed by comparing R based on the characteristics of primary and secondary cases of measles.ExposuresMeasles virus.Main outcomes and measuresEffective reproduction number (R), or the mean number of successful transmission events per case of measles (ie, the mean number of persons to whom each patient with measles spreads measles).ResultsA total of 2218 individuals with confirmed measles cases (1025 female, 1176 male, and 17 sex not reported; median age, 15 years [range, 0-89 years]) reported from 2001 to 2017 were evaluated. Among patients who received no doses of measles vaccine, R was 0.76 (95% CI, 0.71-0.81); among patients who received 1 dose of measles vaccine, R was 0.17 (95% CI, 0.11-0.26); among patients who received 2 doses or more of measles vaccine, R was 0.27 (95% CI, 0.17-0.39); and among patients with unknown vaccination status, R was 0.52 (95% CI, 0.44-0.60). Among patients born before 1957, R was 0.35 (95% CI, 0.20-0.58), and among those born on or after 1957, R was 0.64 (95% CI, 0.61-0.68). R was higher when primary and secondary cases of measles were patients aged 5 to 17 years (0.36 [95% CI, 0.31-0.42]) compared with assortative transmission in other age groups (<1 year, 0.14 [95% CI, 0.10-0.20]; 1-4 years, 0.25 [95% CI, 0.20-0.30]; 18-29 years, 0.19 [95% CI, 0.15-0.24]; 30-49 years, 0.15 [95% CI, 0.11-0.20]; ?50 years, 0.04 [95% CI, 0.01-0.10]).Conclusions and relevanceThe findings of this study support having high targets for 2-dose measles vaccine coverage, particularly among school-aged children in the United States.

Project description:BackgroundConsumer food waste in the United States represents substantial amounts of wasted nutrients, as well as needless environmental impact from wasted agricultural inputs, energy use, and greenhouse gas emissions. Efforts to reduce food waste at the consumer level are urgently needed to address the most prominent nutrition and environmental sustainability issues we now face. Importantly, individuals report that saving money is a salient motivator for reducing food waste, yet contemporary evidence on the consumer cost of wasted food is lacking. The objectives of this study are to 1) estimate the daily per capita cost of food wasted, inedible, and consumed 2) at home and away from home, and 3) by food group.MethodsThis study utilizes cross-sectional, nationally-representative data on food intake from the National Health and Nutrition Examination Survey (2001-2016), linked with nationally representative data on food waste from published literature, as well as data on food prices and food price inflation from multiple publicly-available sources. Survey-weighted procedures estimated daily per capita expenditure on food waste for 39,758 adults aged ≥20 y.ResultsTotal daily per capita food expenditure was $13.27, representing 27% wasted, 14% inedible, and 59% consumed. The greatest daily food waste expenditures were observed for meat and seafood purchased for consumption outside of the home ($0.94, 95% CI: $0.90-0.99), and fruits and vegetables purchased for consumption in the home ($0.68, $0.63-0.73).ConclusionsThe most cost-effective ways to reduce food waste at the consumer level are to focus waste reduction efforts on meat and seafood purchased for consumption outside of the home and fruits and vegetables purchased for consumption in the home. A number of strategies are available to help consumers reduce their food waste, which can increase their financial flexibility to purchase more healthy foods while simultaneously reducing environmental impact.

Dataset Information

International Importations of Measles Virus into the United States During the Postelimination Era, 2001-2016.

Publications

International Importations of Measles Virus into the United States During the Postelimination Era, 2001-2016.

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