Saturday, March 08, 2014

NYC Health Department Investigating Measles Outbreak


Photo Credit CDC

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Measles are back in the news again this week (see Thursday’s ECDC: Risk Assessment On Measles Outbreak Aboard Cruise Ship), with a CDC travel Notice issued for an outbreak in the Philippines, and reports of cluster of cases in New York City.


Our first stop, a press release from the New York City Department of Health:


Health Department Investigating Measles Outbreak in Northern Manhattan and the Bronx

Department urges all New Yorkers to make sure they are vaccinated against measles

infants should be vaccinated at 12 months of age 

March 7, 2014 – The Health Department announced today that it has identified 16 cases of measles in northern Manhattan and the Bronx. Seven adult cases and 9 pediatric cases have been identified to date. New Yorkers are urged to make sure all household members, including young children, are vaccinated. To date, there have been four hospitalizations as a result of this outbreak.

Measles is a highly contagious viral infection characterized by a generalized rash and high fever, accompanied by cough, red eyes, and runny nose, lasting five to six days. The illness typically begins with a rash on the face and then moves down the body, and may include the palms of the hands and soles of the feet.  People who contract the measles virus can spread the infection for four days before developing a rash, and for four days after the rash sets in. Measles can spread easily through the air to unprotected individuals. If you suspect you have measles, call and explain your symptoms to your doctor or medical provider BEFORE leaving to avoid exposing others to the measles virus.

The Health Department is working with New York City hospitals to prevent additional exposure to the virus in emergency departments. The Health Department is also asking pediatric-care facilities in Manhattan and the Bronx to identify and vaccinate children who have not received the MMR vaccine and to give the second dose of MMR vaccine to children at the next medical visit. Adults who are unsure of their vaccination history can be revaccinated or obtain a blood test to see if they are immune. Several adults who are included in this outbreak thought they had been vaccinated in the past, but lacked documentation.

As many as one in three people with measles develop complications. These complications from measles can be very serious and include pneumonia, miscarriage, brain inflammation, hospitalization and even death. Infants under one year of age, people who have a weakened immune system and non-immune pregnant women are at highest risk of severe illness and complications.

(Continue . . . )


Maggie Fox with NBC News has more on this story:


New York City Investigates Measles Outbreak

By Maggie Fox

New York City health officials said Friday they are investigating an outbreak of measles that’s made at least 16 people sick.

It might be part of a bigger national outbreak linked to the Philippines.

Health officials are quick to declare concern when they see someone with measles, which is one of the most contagious human diseases. Although it was once seen as a normal childhood infection, it’s easily prevented with a vaccine. And it should be, because fully a third of patients develop complications from the virus, including pneumonia, miscarriage and brain inflammation that can put patients into the hospital or even kill them.

(Continue . . .)


The outbreak in the Philippines, mentioned in Maggie’s article, is the subject of the following travel notice from the CDC.


  • Updated Measles in the Philippines Updated March 06, 2014 According to the Department of Health of the Philippines, 1,163 cases of measles and a number of measles deaths were reported in the country from January 1 through January 11, 2014. CDC recommends that travelers to the Philippines protect themselves by making sure they are properly vaccinated against measles. Clinicians should keep measles in mind when treating patients with fever and rash, especially if the patient has recently traveled internationally. Read More >>

    The measles vaccine – which was introduced in the United States in the mid-1960s - quickly reduced the incidence of the disease by more than 90%.  In the decades that followed, improved vaccination protocols were established and implemented, and in the year 2000 the United States achieved its long sought goal of  `measles elimination’.

    `Elimination’ refers to a local or regional victory over a disease, while `eradication’   indicates global success.


    Thus far, only two infectious diseases – smallpox and rinderpest – have been considered successfully eradicated, although considerable progress has been made on many others (ie. polio, yaws, Dracunculiasis).


    While the number of measles cases in the United States had dropped from nearly a million each year in the 1950s - to roughly 60 each year in the first decade of the 21st century – the virus continued to flourish elsewhere in the world, providing the opportunity for the virus to `reseed’ itself in the US.




    In 2010, we began to see an uptick in the number of `imported’ measles cases.  This from the  MMWR report  Measles — United States, 2011

    During 2011, a total of 222 measles cases (incidence rate: 0.7 per 1 million population) and 17 measles outbreaks (defined as three or more cases linked in time or place) were reported to CDC, compared with a median of 60 (range: 37–140) cases and four (range: 2–10) outbreaks reported annually during 2001–2010.

    This report updates an earlier report on measles in the United States during the first 5 months of 2011 (2). Of the 222 cases, 112 (50%) were associated with 17 outbreaks, and 200 (90%) were associated with importations from other countries, including 52 (26%) cases in U.S. residents returning from abroad and 20 (10%) cases in foreign visitors. Other cases associated with importations included 67 (34%) linked epidemiologically to importations, 39 (20%) with virologic evidence suggesting recent importation, and 22 (11%) linked to cases with virologic evidence of recent importation.

    Most patients (86%) were unvaccinated or had unknown vaccination status. The increased numbers of outbreaks and measles importations into the United States underscore the ongoing risk for measles among unvaccinated persons and the importance of vaccination against measles (3).


    Imported diseases such as measles, polio, dengue, malaria (and many others) remain an ongoing threat – even in places where they have been officially `eliminated’.  Likewise, emerging diseases, like Chikungunya, H5N1, or MERS-CoV can easily expand to new geographic regions due to enhanced global travel and trade.


    Photo Credit- CDC


    As both the CDC and the World Health Organization reminded us last month (see The Global Reach Of Infectious Disease), pathogens are excellent international travelers. A few recent blogs on other `imported’ disease threats includes:


    Chikungunya Update & CDC Webinar Online
    CDC Statement On 1st H5N1 Case In North America
    Pathogens At the Gate