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Missed opportunities for measles-mumps-rubella (MMR) vaccination among US pediatric international travelers
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February 03 2020
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Source: JAMA Pediatr. 174(2):e194515
Details:
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Alternative Title:JAMA Pediatr
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Personal Author:
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Description:Importance:
The United States is experiencing a resurgence of measles, with more than 1000 cases in the first six months of 2019. Imported measles cases among returning international travelers are the source of most US measles outbreaks, and such importations can be reduced with pretravel measles-mumps-rubella (MMR) vaccination. Although children account for less than 10% of US international travelers, pediatric travelers account for almost half of all measles importations.
Objective:
To examine clinical practice regarding MMR vaccination of pediatric international travelers and to identify reasons for nonvaccination of those identified as MMR-eligible.
Design:
Observational study (2009–2018).
Setting:
29 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention-supported consortium of clinical sites that provide pretravel consultations.
Participants:
Pediatric travelers (≥6 months and <18 years of age) attending pretravel consultation.
Main Outcomes:
MMR vaccination among MMR-eligible pediatric travelers.
Results:
Of 14 602 pretravel consultations for pediatric international travelers, 2864 travelers (20%) were eligible to receive pretravel MMR vaccination at the time of the consultation: 365 of 398 (92%) infants (6 to <12 months), 2161 of 3623 (60%) preschool-aged travelers (1 to <6 years), and 338 of 10 581 (3%) school-aged travelers (6 to <18 years). MMR-eligible travelers were frequently not vaccinated (1682 of 2864 [59%]) including: 161 of 365 (44%) infants, 1222 of 2161 (57%) preschool-aged travelers, and 299 of 338 (88%) school-aged travelers. We observed a diversity of clinical practice at different GTEN sites. In multivariable analysis, MMR-eligible pediatric travelers were less likely to be vaccinated at the pretravel consultation if they were school-aged or evaluated at specific GTEN sites. The most common reasons for nonvaccination were provider decision not to administer MMR vaccination (37%) and guardian refusal (36%).
Conclusions and Relevance:
Although most infant and preschool-aged travelers evaluated at GTEN sites were eligible for pretravel MMR vaccination, fewer than half were vaccinated during pretravel consultation, mostly due to provider decision or guardian refusal. Strategies are needed to improve MMR vaccination among pediatric travelers that will reduce measles importations and resultant outbreaks in the United States.
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Source:
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Pubmed ID:31816033
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Pubmed Central ID:PMC6902185
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