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Measles Elimination In the Americas-Reply

Ciro A. de Quadros, MD, MPH; Jean-Marc Olivé, MD, MPH; Bradley S. Hersh, MD, MPH; Marc S. Strassburg, MPH, DrPH; Donald A. Henderson, MD, MPH; David Brandling-Bennett, MD, DTPH; George A. O. Alleyne, MD, FRCP, DSc
JAMA. 1996;275(17):1312. doi:10.1001/jama.1996.03530410025021.
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In Reply.  —We thank Mr Gay and Dr Nokes for their comments concerning our article. In their letter, they question the use of the Pan American Health Organization's operational criterion of the accumulation of 1 birth cohort of susceptible preschool-aged children for determining the proper interval between follow-up campaigns.We agree with Gay and Nokes that an epidemiologically based mathematical model could provide valuable guidance in determining the appropriate interval for follow-up campaigns and that the longer the intervals between such campaigns, the more economical and feasible such a strategy would be. As noted, however, a more conservative strategy is currently recommended that for most countries will call for a "followup" campaign every 4 to 5 years.The present strategy was adopted for 2 principal reasons. Most important is the fact that, until now, measles transmission has never been interrupted over any large contiguous area for more than a matter


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