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Epidemiology of measles in Taiwan: dynamics of transmission and timeliness of reporting during an epidemic in 1988–9

Published online by Cambridge University Press:  15 May 2009

M. S. Lee ,
C. C. King ,
C. J. Chen ,
S. Y. Yang  and
M. S. Ho
M. S. Lee
Affiliation:
Institute of Epidemiology, National Taiwan University, Taipei, Taiwan, Republic of China (ROC)
C. C. King*
Affiliation:
Institute of Epidemiology, National Taiwan University, Taipei, Taiwan, Republic of China (ROC)
C. J. Chen
Affiliation:
Institute of Epidemiology, National Taiwan University, Taipei, Taiwan, Republic of China (ROC)
S. Y. Yang
Affiliation:
Bureau of Communicable Diseases Control, Department of Health, Taiwan, ROC
M. S. Ho
Affiliation:
Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, ROC
*
* Author for correspondence: Dr C. C. King, Institute of Epidemiology, National Taiwan University. Rm. 1549, No. 1 Jen-Ai Road Sec. 1. Taipei, Taiwan 100, Republic of China.
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We analysed nation-wide reported measles cases during the 1988–9 epidemic and found that longer duration and wider spread were two major characteristics of the outbreak. All the 22 county/city index cases were reported with a delay of > 4 days and 64% were aged 5–14 years. This epidemic occurred mainly among 5–14-year-old school-children (59%), infants under 1 year (19%), and pre-school children (18%). The overall attack rate was 0·63 cases per 10000 population, with the highest attack rate (7·4 cases per 10000 population) occurring in infants. Among 280 confirmed cases <15 months of age, 9-month-old infants (42 cases) had a higher risk of measles and peaked at 10 months (49 cases). This epidemic started in March 1988 among 5–9-year-old children in the northern suburban area, then spread to Taipei City and neighbouring counties or cities. It continued to spread from the northern to southern and western areas during the summer vacation and New Year holidays. Multiple logistic regression analysis showed that the delay of measles reporting was strongly associated with the cases infected early in the epidemic (OR= 6·9, P < 0·001) and reported from teaching hospitals (OR = 2·6, P < 0·001). The reappearance of high attack rates among 5–9-year-old children in the 1985 and 1988–9 measles epidemics in Taiwan indicated the persistence of pockets of susceptible individuals even after mass immunization.

Type
Research Article
Information
Epidemiology & Infection , Volume 114 , Issue 2 , April 1995 , pp. 345 - 359
Copyright
Copyright © Cambridge University Press 1995

References

REFERENCES

1.Chen, CJ, Lin, TM, Yeh, TL. Analysis of the secular trend and seasonal variation of measles mortality rate in Taiwan. Ann Acad Med 1984; 13: 136–41.Google Scholar
2.Hsu, ST. Analysis of measles epidemic and vaccine efficacy: 10 years' experience in a pediatric clinic, Changhwa. Acta Pediatr Sin 1987; 28: 342–7.Google Scholar
3.Department of Health, Taiwan, Republic of China, 1986. Health Statistics (2): Vital statistics, 1985.Google Scholar
4.Gao, JP, Malison, MD. The epidemiology of a measles outbreak on a remote offshore island near Taiwan. Int J Epidemiol 1988; 17: 894–8.Google Scholar
5.Centers for Disease Control (USA). Classification of measles cases and categorization of measles elimination programs. MMWR 1983; 31: 707–11.Google Scholar
6.Cliff, AD, Haggett, P, Ord, JK, Versey, GR. Measles epidemic cycles in Iceland. In: Spatial diffusion, an historical geography of epidemics in an island community. Cambridge: Cambridge University Press; 1981: 55–91.Google Scholar
7.En'ko, PD. On the course of epidemics of some infectious diseases. Int J Epidemiol 1989; 18: 749–55.Google Scholar
8.Yorke, JA, Nathanson, N, Pianigiani, G, Martin, J. Seasonality and the requirements for perpetuation and eradication of viruses in populations. Am J Epidemiol 1979; 109: 103–23.Google Scholar
9.Anderson, RM, May, RM. Vaccination and herd immunity to infectious diseases. Nature 1985; 318: 323–9.Google Scholar
10.Anderson, RM, May, RM. Dynamics aspects of eradication and control. In: Infectious diseases of human: dynamics and control. Oxford: Oxford University Press, 1991: 144–54.Google Scholar
11.Centers for Disease Control (USA). Measles – United States, 1989 and first 20 weeks 1990. MMWR 1990; 39: 353–63.Google Scholar
12.Varughese, PV. Measles in Canada – 1989. Canada Disease Weekly Report 1990; 16: 6.Google Scholar
13.Agocs, MM, Markowitz, LE, Straub, I, Domok, I. The 1988–1989 measles epidemic in Hungary: assessment of vaccine failure. Int J Epidemiol 1992; 21: 1007–13.Google Scholar
14.Lee, MS, King, CC, Jean, JY et al. , Seroepidemiology and evaluation of passive surveillance during 1988–1989 measles outbreak in Taiwan. Int J Epidemiol 1992; 21: 1165–74.Google Scholar
15.Yvonne, G, Paul, SG. Surveillance for measles – New Zealand, 1991. MMWR 1992; 41(SS-4): 13–17.Google Scholar
16.Hung, ML. Seroepidemiologic study of measles and rubella in Taiwan. Master thesis, Institute of Public Health, National Yang-Ming Medical College, Taiwan, ROC, 1992.Google Scholar
17.Department of Health (ROC). Vaccine coverage survey. Epidemiol Bull 1986; 2: 37–9. 53–5.Google Scholar
18.Fine, PEM, Clarkson, JA. Measles in England and Wales. I. An analysis of factors underlying seasonal patterns. Int J Epidemiol 1982; 11: 5–14.Google Scholar
19.Fine, PEM, Clarkson, JA. Measles in England and Wales. II. The impact of the measles vaccination program on the distribution of immunity in the population. Int J Epidemiol 1982; 11: 15–25.Google Scholar
20.McLean, AR, Anderson, RM. Measles in developing countries. Part II. The predicted impact of mass vaccination. Epidemiol Infect 1988; 100: 419–42.Google Scholar
21.Centers for Disease Control (USA). Measles prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1989; 38(S-9): 1–18.Google Scholar
22.Department of Health (ROC). Investigations of immunization coverage rates of infants and children in five cities or counties in Taiwan. Epidemiol Bull 1993; 9: 27–33.Google Scholar
23.Tulchinsky, TH, Ginsberg, GM, Abed, Y et al. , Measles control in developing and developed countries: the case for a two-dose policy. Bull WHO 1993; 71: 93–103Google Scholar
24.Anderson, RM, May, RM. Age-related changes in the rate of disease transmission: implications for the design of vaccination program. J Hyg 1985; 94: 365–436Google Scholar
25.Centers for Disease Control (USA). Measles and school immunization requirements – United States. MMWR 1978; 27: 303–4.Google Scholar
26.Ministry of the Interior (ROC). Demographic fact book, Taiwan-Fukien, Republic of China. 1989: 968.Google Scholar
27.Chen, CJ, Lin, TM, You, SL. Epidemiological aspects of a poliomyelitis outbreak in Taiwan, 1982. Ann Acad Med 1984; 13: 149–55.Google Scholar
28.World Health Organization. Expanded Programme on Immunization (EPI): program review (China). Wkly Epidemiol Rec 1992; 15: 109–11.Google Scholar
29.Rosenberg, ML. Shigella surveillance in the United States, 1975. J Infect Dis 1977; 136: 458–9.Google Scholar
30.Thacker, SB, Parrish, RG, Trowbridge, FL, and Surveillance Coordination Group. A method for evaluating systems of epidemiological surveillance. World Health Stat Q 1988: 41: 11–18.Google Scholar
31.Birkhead, G, Chorba, TL, Root, S, Klaucke, DN, Gibbs, NJ. Timeliness of national reporting of communicable diseases: the experience of the National Electronic Telecommunications System for Surveillance. Am J Public Health 1991; 81: 1313–15.Google Scholar
32.Katz, SL. Measles and subacute sclerosing panencephalitis. In: Joklik, WK, Willet, HP, Amos, DB, eds. Zinsser microbiology, 18th edn.new York: Appleton–Century–Crofts, 1985: 1062.Google Scholar
33.Clarkson, JM, Fine, PEM. The efficiency of measles and pertussis notification in England and Wales. Int J Epidemiol 1985; 14: 153–68.Google Scholar
34.Markowitz, LE, Preblud, SR, Orenstein, WA et al. , Patterns of transmission in measles outbreaks in the United States, 1985–1986. N Eng J Med 1989; 320: 75–81.Google Scholar
35.Cliff, AD, Hagget, P, Stroup, DF. The geographic structure of measles epidemics in the northeastern United States. A J Epidemiol 1992; 136: 592–602.Google Scholar