Seroprevalence of Measles, Mumps, Rubella and Varicella Antibodies in the United States Population, 2009–2010

Measles, mumps, rubella, and varicella are acute viral diseases that are preventable by vaccination. In the United States (US), routine measles, rubella, and mumps vaccination of children was initiated in 1963, 1969, and 1977, respectively. The Advisory Committee on Immunization Practices (ACIP) recommended routine use of the combination measles, mumps and rubella (MMR) vaccine in 1977 and a 2-dose schedule at ages 12–15 months and 4–6 years in 1989 [1]. As a result of high MMR vaccination coverage (≥90% in children aged 19–35 months), incidence declined; endemic transmission of measles was declared eliminated in 2000 and documented for rubella and congenital rubella syndrome (CRS) in 2004 [2, 3]. However, import-associated cases continue to occur in the US, because measles and rubella remain endemic in other countries. Reported mumps cases also declined to an average of <300 cases annually by the early 2000s, with outbreaks occurring in limited settings [1, 4, 5]. The varicella vaccination program was implemented in 1996 as a 1-dose program. By the end of the first decade of the program, vaccination coverage reached 90% among children aged 19–35 months and incidence declined by 90% [6]. However, outbreaks continued to occur among highly vaccinated populations [7]. In 2006, ACIP recommended implementation of a routine 2-dose program, with vaccination at the same ages as MMR vaccine [6]. Further reductions in incidence and outbreaks have been reported since 2006 [8]. To sustain these achievements, high population immunity is needed. Reported antibody seroprevalence from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004 was 96%, 90%, and 91% for MMR respectively [9–11]. Varicella seroprevalence among those aged 6–19 and 20–49 years was 94% and 98%, respectively [12]. Monitoring population seroprevalence remains important to potentially identify subgroups with higher susceptibility and guide national immunization policies. We assessed seroprevalence of measles, mumps, rubella, and varicella antibodies in the US civilian noninstitutionalized population aged 6–49 years using samples from NHANES 2009–2010.