Epidemiology and Health

Original Article

Epidemic characteristics of measles and efforts to control measles infections in Zhejiang Province, China: Rui Yan, Mengya Yang, Hanqing He, Yan Feng, Yang Zhou, Xuewen Tang, Xuan Deng, Yao Zhu, Yuxia Du, Can Chen, Cao Kexin, Shigui Yang, RIDPHE Group; Epidemiol Health. 2024;46:e2024075. Published online September 11, 2024; DOI: https://doi.org/10.4178/epih.e2024075

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Abstract

OBJECTIVES
Several countries have successfully eliminated measles, and China is making significant strides toward achieving this goal. This study focused on investigating the patterns of measles infections in Zhejiang Province, China, as well as control measures. The objective was to provide valuable insights that could contribute to the development of nationwide elimination strategies.

METHODS

We analyzed measles surveillance data from 2005 to 2022 in Zhejiang Province. We utilized a joinpoint regression model to examine trends in measles. Additionally, we employed SaTScan version 9.5 to identify spatial-temporal clusters. Finally, we used an age-period-cohort model to assess the effects of age, period, and cohort.

RESULTS

The age-standardized incidence rate (ASIR) of measles infection in Zhejiang Province from 2005 to 2022 was 5.24 per 100,000, showing a consistent and significant downward trend with an annual percentage change of -24.93% (p<0.05). After 2020, the ASIR for measles infection fell to below 0.1 per 100,000. The majority of measles cases occurred in individuals either without an immunization history or with an unknown immunization status, representing 41.06% and 41.40% of the cases from 2010 to 2022, respectively. According to data from the National Measles Surveillance System, the annual rate of discarded measles cases from 2009 to 2014, and the annual rate of discarded measles and rubella cases from 2015 to 2022, were both above 2 per 100,000, indicating the high sensitivity of the measles surveillance system.

CONCLUSIONS

The significant reduction in measles incidence from 2005 to 2022 demonstrates substantial progress in Zhejiang Province towards the elimination of measles.

Summary

Key Message
Measles incidence in Zhejiang Province has been declining since 2008, with a particularly notable decrease from 2020 to 2022. Adults remain the primary population susceptible to measles in Zhejiang Province. Therefore, it is essential to enhance prevention and control measures for measles, especially among individuals who have not received the MCV immunization. The reduced incidence of measles during the COVID-19 pandemic presents Zhejiang Province with a unique opportunity to leverage the lowest recorded measles incidence in its history and accelerate efforts in measles elimination.

Citations

Citations to this article as recorded by

Surveillance and analysis of adverse events following immunization (AEFI) with measles, mumps, and rubella (MMR) vaccine in Zhejiang Province, China, 2020–2025
Xuejiao Pan, Yaping Chen, Hanqing He, Xiaohua Qi, Lingzhi Shen, Hui Liang
Frontiers in Public Health.2026;[Epub] CrossRef
Application of the age-period-cohort model in tuberculosis
Dan Luo, Fengying Wang, Songhua Chen, Yu Zhang, Wei Wang, Qian Wu, Yuxiao Ling, Yiqing Zhou, Yang Li, Kui Liu, Bin Chen
Frontiers in Public Health.2025;[Epub] CrossRef

Perspective

Measles susceptibility of marriage migrant women in Korea: Sooyeon Kim, Sun A Kim, Hanbich Hong, Seong Ryeong Choi, Hae-Young Na, Sung Un Shin, Kyung-Hwa Park, Sook In Jung, Min-Ho Shin, Sun-Seog Kweon, Seung Ji Kang; Epidemiol Health. 2022;44:e2022031. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022031

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Abstract

International migrants could be considered a risk group susceptible to vaccine-preventable diseases. We conducted a measles seroprevalence study among 419 marriage migrant women living in Sinan-gun and Wando-gun, South Jeolla Province, located in the southwestern part of Korea. The overall seroimmunity was 92.8%. The seroimmunity varied considerably according to the country of origin and increased with age. Our current analysis could be valuable in the context of discussions concerning vaccination policies for immigrants in Korea.

Summary

Korean summary
전라남도 신안군과 완도군에 거주하는 결혼이주여성 419명을 대상으로 홍역항체 양성률을 조사하였다. 전체적 항체양성률은 92.8% 로 높았으나, 나이로 나누어 분석하였을 때, 30세 미만에서는 83.1% 로 30세 이상의 95.5% 에 비해 통계적으로 유의미하게 낮았다. 출신국가에 따른 분석에서는 캄보디아 출신의 경우 30세 미만에서 항체 양성률이 40.0 % 에 불과하여, 타국가 들에 비해 통계적으로 유의미하게 낮았다.

Key Message
To prevent measles resurgence, continuous monitoring of immunity in communities, including foreign-born populations who may have different serostatus, is essential.

Citations

Citations to this article as recorded by

Features for the foreign labor migrants medical care organization
A.S. Moskvicheva
Russian Journal of Preventive Medicine.2026; 29(2): 97. CrossRef
Cardiovascular disease risk disparities between immigrants and native Koreans: a population-based study in Gwangju, Korea
Jung-Ho Yang, Yerin Choi, Ran Lee, Seong Eun Kim, Kyung-Hwa Park, Seong-Woo Choi, BongKyu Sun, Kyunghak Kim, Sun-Seog Kweon
Epidemiology and Health.2025; 47: e2025067. CrossRef
Exploring the interplay of migrant entrepreneurship, emotional intelligence and social integration of marriage migrant women in South Korea
Mandari Pabasara Wijerathna, Yong-Byoung Chae
Asian and Pacific Migration Journal.2024; 33(2): 377. CrossRef
Seroprevalence of Measles Antibodies Among Migrant Populations: A Systematic Review and Meta-Analysis
Somen K Pradhan, Ashutosh Panda, Ipsita Debata, Prem S Panda
Cureus.2024;[Epub] CrossRef
Seroprevalence of measles antibody among immigrants in Gwangju, South Korea
Ran Lee, Sarah Kim, Hyerin Na, Ji In Seo, Jang Gwon Yoon, A Ram Park, So Hyun Bae, So Yeong Park, Jun Hwi Cho, Jin Kim, Seong-Woo Choi, Sun-Seog Kweon, Bongkyu Sun, Kyunghak Kim, Kyung-Hwa Park, Seong Eun Kim
Frontiers in Public Health.2024;[Epub] CrossRef

Original Article

Incidence of varicella in children in Jeju-do, Korea, 2005-2016: age-period-cohort analysis: Jinhee Kim, Ji-Eun Kim, Jong-Myon Bae; Epidemiol Health. 2018;40:e2018054. Published online November 8, 2018; DOI: https://doi.org/10.4178/epih.e2018054

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Abstract

OBJECTIVES
Although the nationwide inoculation rate of varicella vaccine was approximately 95% in Korean children recently, the number of notified varicella cases is unexpectedly continuously increasing till now. To suggest some hypotheses regarding this discrepancy, an age-period-cohort (APC) analysis as a descriptive epidemiology study was conducted for children residing in Jeju-do, Korea.

METHODS

The raw data were obtained from the nationwide database for insurance claim of healthcare fee provided by the National Health Insurance Service, Korea. The selection criteria were children aged 2-13 years who visited any healthcare center due to varicella from 2005 to 2016 while residing in Jeju-do. After calculating the birth cohort-specific crude incidence rates by age and year, the intrinsic estimator method was used to perform the APC analysis.

RESULTS

As the annual crude incidence rates decreased with increasing age between 2005 and 2016, the age and period effects also decreased. The intrinsic estimator coefficients suggesting the cohort effect shifted from positive to negative in 2011, the starting year of free varicella vaccine program in Jeju-do.

CONCLUSIONS

The results suggested that inoculated varicella vaccines have preventive effects. However, further studies to evaluate waning immunity would be needed.

Summary

Korean summary
2011년 이후 생후 12-15개월 유아에게 수두백신 무상접종을 시행해 오고 있는 제주도에 있어서, 수두발생 신고건수가 증가하는 괴리 현상에 있어, 국민건강보험공단의 수진자료를 확보하여 연령-기간-코호트 (age-period-cohort, APC) 분석을 시행하였다. 그 결과 연령이 증가하고 연도가 최근으로 올수록 수두 발생에 대한 연령과 기간효과는 점점 감소하는 반면, 수두백신 무상접종이 시작된 2011년을 전후해서 코호트 효과는 양에서 음으로 전환하였다. 따라서 현재 접종하고 있는 수두 백신은 수두발생을 예방하는 효과가 있으며, 돌발수두 발생은 이차백신 실패로 볼 수 있다.

Citations

Citations to this article as recorded by

The comparison of seroconversion rates among different varicella vaccines administered Turkish children; MAV/06 and vOka
Zuhal Umit, Zumrut Sahbudak Bal, Aysin Zeytinoglu, Tansu Gulbahar Aydogan, Ozlem Bag, Gizem Guner Ozenen, Ferda Ozkinay, Zafer Kurugol
Human Vaccines & Immunotherapeutics.2021; 17(11): 4190. CrossRef
Recent increase in pertussis incidence in Korea: an age-period-cohort analysis
Chanhee Kim, Seonju Yi, Sung-il Cho
Epidemiology and Health.2021; 43: e2021053. CrossRef
Incidence of Scarlet Fever in Children in Jeju Province, Korea, 2002-2016: An Age-period-cohort Analysis
Jinhee Kim, Ji-Eun Kim, Jong-Myon Bae
Journal of Preventive Medicine and Public Health.2019; 52(3): 188. CrossRef

Brief Communication

A Fatal Case of Disseminated Tuberculosis Coincident with Measles-Rubella Vaccination: Hae-Kwan Cheong, Byung-Guk Yang, Young Mo Sohn, Il-Hoon Kwon, Jun Chul Kim, Hangmi Kim, Jung Ran Kim; Epidemiol Health. 2010;32:e2010002. Published online April 26, 2010; DOI: https://doi.org/10.4178/epih/e2010002

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<p>The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination. Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination. The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.</p>; Summary

Original Articles

Seroprevalence of measles and mumps antibody among preschool children in Korea, according to their vaccination history.: Jung Hwa Lee, Geun Ryang Bae, Chang Sik Park, Yoon Seok Chung, Young A Kang, Hyun Woo Han, Chun Kang; Korean J Epidemiol. 2008;30(1):34-40. Published online June 30, 2008; DOI: https://doi.org/10.4178/kje.2008.30.1.34

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Abstract

PURPOSE
To maintain measles elimination status, we evaluated the seropositivity of measles and mumps according to time interval since the first or second dose of MMR in children aged 4 to 6 years, who are starting communal life. MATERIALS AND METHOD: 2,447 children aged 4 to 6 years were enrolled at 251 public health centers over the period of March to May 2007. Subjects were verified their date of MMR vaccination and then their blood was sampled for serologic test. Measles and mumps IgG antibody was tested by ELISA at Korea CDC.

RESULTS

Vaccination coverage was 99.9% in the first dose, 64.9% in the second dose regardless of gender. Seropositivity of measles and mumps was 95.7%, 85.5% in the first dose and 98.7%, 98.1% in the second dose, respectively. The seropositivity of measles was 88.1% in 6-year-olds who did not receive the second dose of MMR. As time since receipt, seropositivity of measles tended to decrease over time and was 93.3% in vaccinees over 48 months after the first dose.

CONCLUSION

A first dose MMR at 12-15 months cannot lead to herd immunity. More public information is needed to encourage second dose vaccination before admission to day-care center or kindergarten.

Summary

Citations

Citations to this article as recorded by

Universal measles-mumps-rubella vaccination to new recruits and the incidence of mumps in the military
Jong Youn Moon, Jaehun Jung, Kyungmin Huh
Vaccine.2017; 35(32): 3913. CrossRef
Resurgence of Mumps in Korea
Sun Hee Park
Infection & Chemotherapy.2015; 47(1): 1. CrossRef

Incidence of complication and societal cost of measles in Korea, 2000.: Weon Young Lee, Moran Ki, Jin Kyoung Oh, Jong Koo Lee, Myung Bin Kim, Bo Youl Choi; Korean J Epidemiol. 2004;26(2):71-80.

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Abstract PDF: Abstract
OBJECTIVES
To estimate the complication rate and the societal cost of measles, a survey was conducted in Seoul, Jeonju city, and Kyonggi province in 2001.
METHODS
A telephone survey was conducted in Jeonju city (175/307) and four local areas of Kyonggi province (793/1,238) to gather information on the complications of measles. To estimate societal cost, the telephone survey was conducted for the sampled subject by complication type and the age group. The response rate was 78% (180/230). Paid bills were examined for direct cost estimation, and the time cost and the transportation expense were analyzed for indirect cost estimation.
RESULTS
The incidence of a complication of measles was 3.1% which found to be higher in younger age group. The incidence of pneumonia, otitis media, and encephalitis were 2.1%, 0.8%, and 0.2% respectively. Direct and indirect costs of in-patients without a complication were $417.00 (US $1.00 = 1,000 won) and $256.00 per case, respectively, and the out-patients who have no complication were $54.00 and $65.00, respectively. The average cost for a patient with measles without complication was $119.00 as the result. The societal cost of encephalitis was high as $6,660. Estimated total societal cost of measles ranges from $14 million to $69 million in the year 2000.
CONCLUSION
Complication rate of measles was fairly low compared to foreign countries. The lower rate could result from the difference in vaccination rate and the age distribution of the measles patients. The cost of measles without complication was not high. However, the cost for the complication and the total disease burden caused by measles shown to be high in the year 2000.; Summary

Outbreak of Measles among School Ages in Yeongju in 2000.: Hae Kwan Cheong, Geun Ryang Bae, Jin Hwa Jeong, Sue Kyung Park, Byung Chan Park, Jee Hee Kim, Joo Yeon Lee, Byung Kuk Na, Woo Joo Kim; Korean J Epidemiol. 2004;26(1):69-80.

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Abstract PDF: Abstract
BACKGROUND
The outbreak of measles from 2000 to 2001 was the biggest epidemic since measles vaccination was introduced in Korea. Outbreak of measles in Yeongju was one of the earliest milestones of the nationwide outbreak in the year 2000. The authors investigated epidemiologic characteristics of the outbreak in this area.
METHODS
The authors estimated attack rate through the investigation of all the school age cases of measles reported to local health authority between March and May, 2000. Case investigation was done to trace the source of the outbreak. One hundred seventy two cases were examined with medical examination, with interview on their clinical manifestations, and with serologic examination on the anti-measles IgM and IgG antibody.
RESULTS
Overall attack rate among the school children was 4.3%, with highest attack rate in middle school students (8.5%). The outbreak began in March in middle schools, which spread to elementary and high schools. IgG was positive in 160(93.0%) cases and IgM was positive in 94(54.6%) cases, among which 90 cases (95.7%) were also positive for IgG. IgM positive cases had higher prevalence of rash (91.5%) compared to those without IgM (70.5%). Diagnostic criteria based on the clinical manifestation and contact history showed the highest sensitivity (92.6%) compared to conventional diagnostic criteria in outbreak (40.4-44.7%) CONCLUSIONS: High proportion of susceptible children in the population due to primary or secondary vaccine failure played a key role in this outbreak. Clinical manifestation was milder than classical measles and adjustment of diagnostic criteria can be helpful in the management of outbreak.; Summary

The Epidemiologic Characteristics of Measles for Two Years in a Metropolitan City: Based on the reported measles cases since 2000.: Hyun Kyun Ki, Young Hwa Jung, Jae Keun Chung, So Yeon Ryu, Ki Soon Kim; Korean J Epidemiol. 2002;24(1):63-75.

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Abstract PDF: Abstract
PURPOSE
There has been an epidemic of measles in Korea since 2000. Therefore, we analyze the epidemiologic haracteristics of measles in Gwangju Metropolitan City.
METHODS
We reviewed the epidemiologic investigation records and laboratory data of the measles patients reported in Gwangju Metropolitan City from January 1st 2000.
RESULTS
1) Demographic characteristics: Totally, 3,392 cases were surveyed and 3,300 cases were enrolled (3,300/3,392, 97.3%). Fifty-four percents of the patients were male (1,771/3,300) and forty-six percents of the patients were female (1,529/3,300). Average age of the patients was 8.20 years (8.20 5.56 years). Forty-seven percents of the patients were reported in the interval from November 2000 to December 2000 (1,582/3,298, 47.9%). 2) Clinical manifestations of the patients: Common symptoms of measles patients were fever (3,300/3,300, 100.0%), skin rash (3,068/3,300, 93.0%), cough (2,889/3,300, 87.5%), rhinorrhea (1,883/3,300, 57.1%), headache (1,445/3,300, 43.8%), conjunctival injection (1,182/3,300, 35.8%), and oral thrush (832/3,300, 25.2%). Among the patients, 250 patients had complications (250/3,300, 7.6%) and most of them were respiratory complications (220/250, 88.0%). 3) Vaccination: Eighty-six percent of the enrolled patients answered the question about vaccination (2,854/3,300, 86.4%); 808 patients were not taken a shot (808/2854, 28.3%), 1,762 patients received one dose (1,762/2,854, 61.7%), and 284 patients received additional dose (284/2,854, 9.9%). 4) Laboratory data: Laboratory confirmed cases were 780 patients (780/3,300, 23.6%); 603 cases were confirmed serologically, 185 cases were positive in PCR, and virus was isolated in 6 cases. Genetic sequencing of the isolated viruses was clade H1 and closely related to that of China.
CONCLUSION
Therefore, adequate surveillance and maintenance of high coverage rate of the vaccination would be the crucial factors to eradicate measles; Summary

Measles Outbreak among Institutional Infants after Hospital Infection.: Hyung Cheol Park, Eun Young Park, Sun Hee Cho, Young Jun Choi, Hyun Kyun Ki, Young Hwa Jung, Kyung Rye Moon, So Yeon Ryu, Ki Soon Kim; Korean J Epidemiol. 2001;23(1):50-58.

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Abstract PDF: Abstract
PURPOSE
S: This study was to investigate the source of infection, mode of transmission and incidence of a measles outbreak among infants living in a Gwangju welfare institution in July 2000.
METHODS
The information about 63 children was collected through the nurses interview and blood sampling and laryngopharyngeal swab were conducted to the children. In addition, an epidemiologic survey was performed to confirm the infection dissemination route.
RESULTS
Before the outbreak, two children living at the institution were admitted to a university hospital for other health problems. These children shared a room with a 5 year old diagnosed with meningitis who was later diagnosed as having measles after rashes appeared. The two children developed measles after returning to their institution and the infection spread to other children in the institution. Among 63 children observed, 14 children(22.2%) developed measles, secondary attack rate of measles due to index cases was 19.7%. And 78.6% of the patients were between 4 and 8 months old. The room where the index case lived showed an attack rate of 81.8%, which is a much higher rate compared to other rooms. The attack rate among boys(26.0%) was higher than that of girls(12.5%), but it was not statistically significant.
CONCLUSIONS
This outbreak was considered to be a nosocomial infection, where the index cases were admitted to a hospital, infected and the infection spread to children. Further studies are necessary to find out the maternal antibody levels of infants of post-vaccinated mothers and the optimal age for measles vaccination.; Summary

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