In the pre-vaccine era, measles was ubiquitous. In the UK, there were 160,000 to 800,000 cases reported every year, with peaks every 2 years. In the US, epidemics also occurred about every 2 to 5 years; 200,000 to 400,000 cases were reported yearly but, in fact, nearly every child in each birth cohort of about 4 million was affected. Highest attack rates occurred in children aged 5 to 9 years, with no difference noted in incidence between males and females. Measles vaccine was introduced in the 1960s, leading to a more than 99% reduction in the number of reported measles cases. Two doses of the measles vaccine are recommended to ensure immunity. In Finland the 2-dose MMR vaccination has been in use since 1982, with high coverage consistently achieved. Indigenous measles has been eliminated since 1994. Since 1994, most measles infections in the US were imported or linked to imported cases. In 2000, measles was declared no longer endemic in the US.
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