California DPH Statement On Measles Outbreak

2014 Measles Status As of November – Credit CDC

 

# 9612

 

Fifteen years ago measles was declared eliminated in the United States – a product of  more than 35 years of successful vaccination policies.   But measles, like Whooping Cough (Pertussis), has made a comeback over the past decade, with rising rates both in the United States and around the world.

 

During the 1950s – before the introduction of the measles vaccine – the US saw roughly 4 million infections which hospitalized nearly 50,000, and contributed to the deaths of several hundred every year. 

 

Last May, in CDC Telebriefing: Worst US Measles Outbreak In 20 Years, we looked at the worst start for measles in 2 decades, and as the chart at the top of this blog shows, that trend continued throughout the year.  According to the CDC, many of the cases in the U.S. last year were  brought in from the Philippines (see the Measles in the Philippines Travelers' Health Notice).

The CDC warns:

• The majority of the people who got measles are unvaccinated.
• Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa.
• Travelers with measles continue to bring the disease into the U.S.
• Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.

 

Although 2015 has barely begun, already California is reporting a major measles outbreak linked to exposures at Disneyland earlier in the month.  Here is the latest update.

 

 

California Department of Public Health Confirms 59 Cases of Measles

Date: 1/21/2015

Number: 15-008

Contact: Anita Gore - (916) 440-7259

SACRAMENTO

Dr. Ron Chapman, director of the California Department of Public Health (CDPH) and state health officer, announced today that local public health officials have confirmed a total of 59 cases of measles in California residents since the end of December 2014. 

“If you have symptoms, and believe you may have been exposed, please contact your health care provider. Unless you have an emergency, it is best to contact your health care provider by phone to prevent spread in doctor’s offices.” said Chapman. “The best way to prevent measles and its spread is to get vaccinated.”

Of the confirmed cases, 42 have been linked to an initial exposure in December at Disneyland or Disney California Adventure Park in Anaheim, California. The confirmed cases include five Disney employees. In addition, other cases have visited Disney parks while infectious in January. CDPH recommends that any patient with a measles compatible illness who has recently visited venues where international travelers congregate, such as theme parks, airports, etc., be considered to have a plausible exposure to measles.

Measles is a highly infectious, airborne disease that typically begins with fever, cough, runny nose and red eyes, and within a few days a red rash appears, usually first on the face and then spreading downward to the rest of the body. 

Vaccination is the most important strategy to prevent measles. Two doses of measles-containing vaccine (MMR vaccine) are more than 99 percent effective in preventing measles. Measles vaccines have been available in the United States since 1963, and two doses have been recommended since 1989. If you are unsure of your vaccination status, check with your doctor to have a test to check for measles immunity or to receive vaccination.

Local health departments and CDPH continue to investigate reported cases. Several “secondary” cases in persons exposed to the initial group have been reported.  Secondary cases are common with measles. As with the first group of cases, there is a risk of additional transmission in places where the secondary cases have been while infectious. Persons can be infectious for a few days prior to developing symptoms of measles and may feel well enough to be out and about potentially exposing others. 

In addition, public health officials are continuing to contact persons exposed to measles cases to determine their vaccination history and implement strategies to prevent spread. This is an ongoing situation, and CDPH expects to receive additional reports of cases.

Measles has been eliminated in the United States since 2000. However, large measles outbreaks have occurred in many countries, particularly in Western Europe, Pakistan, Vietnam and the Philippines in recent years. Travelers to areas where measles circulates can bring measles back to the U.S., resulting in limited domestic transmission of measles. California has many international attractions and visitors come from many parts of the world. It is important for health care providers and the public to be aware that measles transmission can occur in California, and they can prevent transmission by receiving the MMR vaccine. 

The California measles patients reside in 11 local health jurisdictions (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Santa Clara and Ventura Counties and the cities of Long Beach and Pasadena). Patients range in age from seven months to 70 years. Vaccination status is documented for 34 of the 59 cases. Of these 34, 28 were unvaccinated, one had received one dose and five had received two or more doses of MMR vaccine. 

Health care providers treating patients with fever and a rash should consider measles, and ask patients about travel to international destinations and domestic venues that are popular with international visitors. People who are unvaccinated should know that there is presently a risk for acquiring measles in California.

CDC Telebriefing: Worst US Measles Outbreak In 20 Years

 

# 8683

 

It is never a good sign when -  by late May - the year-to-date number of measles reported in the United States already exceeds the yearly totals for any year since the turn of the 21st century. While many people think of measles as a relatively benign childhood illness, it actually produces significant morbidity and mortality with respiratory, ocular, and neurological complications - sometimes resulting in death.

 

During the 1950s – before the introduction of the measles vaccine – the US saw roughly 4 million infections which hospitalized nearly 50,000, and contributed to the deaths of several hundred every year. 

 

The chart below (source: CDC) shows the remarkable effectiveness of that vaccination campaign.  

By the year 2000, the number of locally acquired measles cases in the US was so low, the disease was considered to be effectively eliminated in the United States (see MMWR Measles — United States, 2011 Weekly April 20, 2012 / 61(15);253-257 - In 2000, the United States achieved measles elimination (defined as interruption of year-round endemic measles transmission)).

Just to define our terms: `Elimination’ refers to a local or regional victory over a disease, while `eradication’   indicates global success.

 

But between less-than-optimal vaccination rates over the past decade, and the constant importation of this highly infectious disease by unvaccinated travelers who recently visited regions of the globe that have not achieved measles control, the number of cases has begun to rise again in recent years (see NYC Health Department Investigating Measles Outbreak).

 

Dr. Anne Schuchat, in a telebriefing  from the CDC yesterday (links below), described the situation:

 

To date, 15 outbreaks have been reported.  An outbreak includes three or more related cases.  Besides the outbreak in Ohio, other large outbreaks have occurred in New York City and California, which has responded to six outbreaks in six counties.  Why are we having such a bad measles year?  There are two factors.  First, measles is coming in on airplanes from places where the disease still circulates or where large outbreaks are occurring.  Second, imported measles virus is landing in places in the U.S., where groups of unimmunized people live.  That setting gives the measles virus a welcome wagon by providing a chance for outbreaks to occur, and the larger the outbreak, the more difficult to stop.  Up to 288 cases in the U.S., 280, or 97 percent, were associated with importations from at least 18 countries.  This is a reminder that measles is still common in many parts of the world, including countries in Europe, Asia, the pacific and Africa.

 

The audio and transcript for this entire briefing has been posted at the link below:

Press Briefing Transcript

CDC Telebriefing – CDC to announce record-breaking year in reported cases of measles in the United States

Thursday, May 29, 2014 12:00 p.m. ET

• Audio recording  [MP3, 10.0 MB]

 

The CDC also published a press release to accompany this telebriefing:

 

Measles cases in the United States reach 20-year high

CDC urges vaccination as summer travel season approaches

Two hundred and eighty-eight cases of measles were reported to the Centers for Disease Control and Prevention (CDC) in the United States between Jan. 1 and May 23, 2014. This is the largest number of measles cases in the United States reported in the first five months of a year since 1994.  Nearly all of the measles cases this year have been associated with international travel by unvaccinated people.

“The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the United States and spread to others in communities where many people are not vaccinated,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunizations and Respiratory Diseases.  “Many of the clusters in the U.S. began following travel to the Philippines where a large outbreak has been occurring since October 2013.”

Of the 288 cases, 280 (97 percent) were associated with importations from at least 18 countries.  More than one in seven cases has led to hospitalization.  Ninety percent of all measles cases in the United States were in people who were not vaccinated or whose vaccination status was unknown.  Among the U.S. residents who were not vaccinated, 85 percent were religious, philosophical or personal reasons. 

The large number of measles cases this year stresses the importance of vaccination. Healthcare providers should use every patient encounter to ensure that all their patients are up to date on vaccinations; especially, before international travel.

More than ever health care providers need to be alert to the possibility of measles and be familiar with the signs and symptoms so they can detect cases early.

“Many U.S. health care providers have never seen or treated a patient with measles because of the nation’s robust vaccination efforts and our rapid response to outbreaks,” said Schuchat.

(Continue . . .)

 

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 continue to remind us (see The Global Reach Of Infectious Disease), pathogens are excellent international travelers. A few recent blogs on other `imported’ disease threats includes:

 

MMWR Early Release On MERS-CoV

Chikungunya Update & CDC Webinar Online

Minnesota: Rare Imported Case Of Lassa Fever

H5N1 In Canada: A Matter Of Import

 

NYC Health Department Investigating Measles Outbreak

 

Photo Credit CDC

# 8359

 

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

ECDC: Risk Assessment On Measles Outbreak Aboard Cruise Ship

 Remarkable effectiveness of the US Measles vaccination campaign – Source CDC

 

 

# 8353

 

Although most people think of measles as a relatively mild, `childhood disease’, statistics from the  World Health Organization show otherwise.

 

Key facts

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2012, there were 122 000 measles deaths globally – about 330 deaths every day or 14 deaths every hour.
• Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2012 worldwide.
• In 2012, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.
• Since 2000, more than 1 billion children in high risk countries were vaccinated against the disease through mass vaccination campaigns ― about 145 million of them in 2012.

 

Earlier this year the WHO announced that Measles deaths reach record lows , attributing these gains to `a result of global routine measles immunization coverage holding steady at 84%¹ and 145 countries having introduced a routine second dose of measles vaccine to ensure immunity and prevent outbreaks.’

 

While good news, the WHO also warned that these gains were fragile, with five of six WHO regions still experiencing large outbreaks, and that far too many people remain at risk due to lack of immunization.

 

Indeed, in 2011 we saw a number of large outbreaks (see WHO: Measles Outbreaks In The Americas, Europe & Africa) and in the fall of that year the ECDC declared Measles Eradication as their `theme’ For 2012.

 

Late last week it emerged that crewmembers aboard the Costa Pacifica cruise ship had come down with measles while in the Italian port of Civitavecchia. Being highly infectious (at least, among an unvaccinated population), and with an incubation period of 10 to 14 days, obviously this outbreak warrants serious scrutiny.

 

Today the ECDC released a Rapid Risk Assessment: Measles on a cruise ship, Mediterranean Sea (excerpts below), which assesses the risks of further spread, and discusses mitigation options.  The bottom line, from their assessment, reads:

 

The Costa Pacifica regularly sails on seven-day cruises in the western Mediterranean. The apparent high attack rate among the crew suggests a low vaccine coverage in this group. Measles is highly contagious. Given the relatively long incubation period and the contagiousness prior to disease symptoms, it is likely that new cases will appear among the crew, and further transmission may take place.

 

From the 5-page document we get the following narrative.

 

EVENT BACKGROUND

On the evening of 27 February 2014, Italy reported that on board the Costa Pacifica – a cruise ship which had arrived from Palma de Mallorca, Spain, earlier that day and docked in the port of Civitavecchia, Italy – around forty crew members showed symptoms of exanthematous disease suspected to be measles. This was based on laboratory confirmation (PCR on urine samples) and the fact that the ship’s medical staff reported on 26 February 2014 that one crew member, a 27-year-old female, had a respiratory illness and a skin rash when she disembarked at Genoa on 22 February. 

The medical staff at the Rome–Fiumicino Office of USMAF (Uffici di Sanità Marittima, Aerea e di Frontiera: Maritime, Air and Frontier Health Office under the Italian Ministry of Health), which is also responsible for Civitavecchia, and experts on infectious diseases from the National Institute of Infectious Diseases (INMI) in Rome performed a thorough examination of the medical situation on board upon the ship’s arrival.

 
On 28 February, Italy reported that nine persons were hospitalised at the National Institute of Infectious Diseases (INMI) in Rome, with symptoms suggestive of measles. Initial laboratory tests confirmed the diagnosis of measles in seven people (IgM antibodies). Two cases of probable measles infection in crew  members were identified when the ship arrived in Savona on 1 March 2014. They and four close contacts were transferred to a resort in Orbetello, Italy, for isolation.

The ship arrived in Marseille on 2 March 2014 where no clinical cases of measles or fever were reported among the passengers and crew on board.

On 3 March, the Costa Pacifica docked in the port of Barcelona, Spain. After an inspection by the Port Health Officers, who had assessed the sanitary situation on board the vessel, the Ship Sanitation Certificate was  ‘negative’, i.e. no cases were detected on board the vessel.

 

On 5 March 2014, the ship called at Palma de Mallorca, Spain; the ship’s authorities detected no new cases. 

According to the information provided by the medical team on board and the medical log, no new suspected measles cases have been detected since 1 March 2014.The itinerary of the cruise ship involves the ports of Marseille, France; Barcelona, Spain; Palma de Mallorca, Spain; Civitavecchia, Italy; La Spenzia, Italy; and
Savona, Italy.

 

You’ll find proposed public health warnings, and mitigation and containment advice, in this risk assessment which can be read in full at the link below:

 

Rapid Risk Assessment: Measles on a cruise ship, Mediterranean Sea

WHO: Measles Outbreaks In The Americas, Europe & Africa

 

 

# 5884

 

 

The World Health Organization today has issued a statement on their GAR (Global Alert and Response) site regarding this year’s resurgence of measles around the globe. 

 

This is a topic I’ve covered recently in:

 

ECDC: Measles Eradication `Theme’ For 2012

Alberta, Canada Issues Measles Alert

CDC Health Advisory (HAN) On Measles

Measles: Forgotten, But Not Gone

 

While many parents today think of measles as a relatively benign childhood illness, it actually causes significant morbidity and mortality - often producing respiratory, ocular, and neurological complications – and sometimes resulting in death.

 

During the 1950s – before the introduction of the measles vaccine – in the United States alone the disease infected roughly 4 million, hospitalized nearly 50,000,  and contributed to the deaths of several hundred every year.  

 

Measles was considered eliminated in the United States by the year 2000 due to the great success of the of the measles vaccine introduced in the mid-1960s.

 

 

Measles is incredibly contagious (at least among those without immunity), but is easily preventable by vaccination.

 

With an  R₀ (R-naught) of about 15 (the number of new cases in a susceptible population likely to arise from a single infection), measles is nearly 10 times more contagious than seasonal flu, and greater than 3 times more so than SARS.

 

Lower vaccine uptake, and increases in international travel, have increased opportunities for the measles virus to spread – even to areas that had previously all but eliminated it.

 

Today’s WHO statement provides information on the size and location of this year’s outbreaks.

 

Measles outbreaks: Regions of the Americas, Europe and Africa

In 2011 several large measles outbreaks have been reported from member states in the European and African regions, with several reported outbreaks in the Americas linked to Europe or Africa.

 

Europe: According to case-based and aggregated routine surveillance reporting, and outbreak reports provided to the European Regional Office, as of 20 September 2011, 40 of 53 Member States reported 26 025 confirmed measles cases from January to July 2011. The highest number of cases was reported from France with 14 025 for the first six months of the year. In addition, eleven of these cases were lethal (6 in France and one in each of Germany, Kyrgyzstan, Romania, the Former Yugoslav Republic of Macedonia and the United Kingdom). The predominant genotype currently circulating in the European Region is D4, the same endemic genotype from the United Kingdom in 2008. The most recent outbreak was reported from Israel in September, with 12 cases. Member states have responded to the outbreak by modifying the vaccination schedule, with France adopting a two-dose schedule, by offering vaccination free of charge, or by offering vaccinations in schools.

 

Africa: The Regional Office reports that as of September 2011 large measles outbreaks are occurring in the Democratic Republic of the Congo with over 103 000 cases, Nigeria (17 428 cases), Zambia (6295 cases), Ethiopia, (1408 cases) and Kenya (1995 cases). Even though deaths are not routinely reported to the Regional Office, the WHO Country Office in the Democratic Republic of the Congo reports over 1100 measles-associated deaths in the country during 2011.

 

Americas: The last case of endemic measles was reported from the region in 2002. In 2011 the Region has received reports of several outbreaks linked to importation of measles virus from other regions. The largest, in Quebec, Canada, involves 742 reported cases, 89 requiring hospitalization, but no measles-associated deaths. Other outbreaks have been reported from the United States (213 cases), Ecuador (41 cases), Brazil (18 cases), Colombia (7 cases), Mexico (3 cases), and Chile (6 cases). Most of these outbreaks are linked to importations from Europe, except for outbreaks in the United States and Chile linked to cases from Malaysia and the outbreak in Ecuador, linked to Kenya.

 

Measles is a highly infectious disease that causes complications and deaths, even in previously-healthy individuals, but is fully preventable by vaccination. Countries need to ensure that they reach 95% coverage with two doses of measles vaccine across all age groups up to 15 years of age. Otherwise the country will experience measles outbreaks with large numbers of cases, associated hospitalizations and deaths. The recent outbreaks in countries with high volumes of international travellers can lead to measles exportation to regions previously free of measles, such as the Region of the Americas or certain African countries. These exportations can lead to large outbreaks and associated deaths.

 

These outbreaks should remind travellers that they should ensure that they have had two doses of measles-containing vaccine before their trip.

ECDC: Measles Eradication `Theme’ For 2012

 

 

# 5879

 

 

Earlier this year I wrote about the rise of measles cases across much of Europe (see Measles: Forgotten, But Not Gone), with details gleaned from the WHO’s WER (Weekly Epidemiological Record). Along with it, I included a referral to an excellent 5-part series on measles by Ian York.

 

The WER report (Measles outbreaks in Europe) detailed an outbreak, which had – as of April 18th –had infected more than 6,500 people in 33 nations.

 

 

Since then, the numbers have continued to rise, with more than 28,000 cases reported across the EU as of September 1st of this year.

 

 

Yesterday at his annual hearing with the European Parliament’s Committee on the Environment, Public Health and Food Safety, the ECDC’s director called for the eradication of measles to be a major theme in 2012.

 

ECDC Director highlights measles threat to EU Parliament health committee

04 Oct 2011

ECDC

At his annual hearing with the European Parliament’s Committee on the Environment, Public Health and Food Safety, ECDC Director Marc Sprenger described the resurgence of measles in the EU as “one of the major events of this new decade”.

 

Dr Sprenger highlighted the major epidemics in some of the EU’s richer Member States, stating that fighting measles is not just about resources. “It is also about attitudes, priorities and leadership”. Dr Sprenger said “leadership in the fight against measles needs to come from Europe’s health professionals". He noted that it is crucial for paediatricians and family doctors to give balanced, evidence-based information to help parents decide on vaccinations.

• Read the speech

 

 

Over the spring and summer a significant number of measles cases were imported into the United States from this outbreak, prompting the CDC to release a HAN ADVISORY on measles in late June.

 

CDC HEALTH ADVISORY

Distributed via Health Alert Network
June 22, 2011, 16 :00 EST (04:00 PM EST)
CDCHAN-00323-11-06-22-ADV-N

High Number of Reported Measles Cases in the U.S. in 2011—Linked to Outbreaks Abroad

 

 

Measles was considered eliminated in the United States by the year 2000 due to the introduction of the measles vaccine in the mid-1960s.

 

 

Despite this success, there remain enough unvaccinated individuals to create cracks in our hard won `herd immunity’, and that can allow the virus an opportunity to spread.

 

While many parents today think of measles as a relatively benign childhood illness, it actually produced significant morbidity and mortality with respiratory, ocular, and neurological complications - sometimes resulting in death.

 

And in developing countries, the incidence – and mortality rate – of measles remains high.   These statistics from the World Health Organization:

 

Measles

Fact sheet N°286

Key facts

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2008, there were 164 000 measles deaths globally – nearly 450 deaths every day or 18 deaths every hour.
• More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
• Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide.
• In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

Alberta, Canada Issues Measles Alert

 

 

# 5779

 

 

Alberta Health Services issued a public alert yesterday after a passenger who flew from Vancouver International Airport (YVR) to Edmonton International Airport (EIA) back on August 15th was determined to have been infected with measles.

 

Media reports indicate that the patient was an  Edmontonian – believed to be unvaccinated - who had recently returned from a trip to Asia.

 

The plane carried roughly 100 passengers, and others may have been exposed at the airport terminals.  Alberta Health Services is asking anyone who may have been in on those flights to contact them immediately.

 

 

 

Confirmed measles case prompts public alert

August 23, 2011

EDMONTON – Alberta Health Services has confirmed a case of measles in the Edmonton area and is following up with individuals who may have been in close contact with the ill person. The case of measles occurred in an Albertan who recently travelled outside Canada.

 

The following groups may have been exposed to the ill person and are asked to contact Health Link Alberta as soon as possible:

• Any passengers on Air Canada flight AC244 on Monday, August 15, 2011, which departed Vancouver International Airport (YVR) at 4:30 p.m. and arrived at Edmonton International Airport (EIA) at 6:53 p.m.
• Anyone in the Edmonton International Airport Air Canada baggage claim area on Monday, August 15, 2011, from 7 p.m. until 9:30 p.m.

Measles is an extremely contagious respiratory disease caused by a virus. Measles causes fever, runny nose, cough and a rash all over the body. The rash typically begins behind the ears and on the face, spreading down to the body, and finally to the arms and legs.

 

About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia requiring hospitalization. For every 1,000 children who get measles, one or two will die. Individuals who have not already had measles disease and have not been immunized against measles are at highest risk for developing the disease.

(Continue . . . )

 

Earlier this year I wrote about the recent rise of measles cases across much of Europe (see Measles: Forgotten, But Not Gone), with details gleaned from the WHO’s WER (Weekly Epidemiological Record), and including a referral to an excellent 5-part series on measles by Ian York.

 

The WER report (Measles outbreaks in Europe) detailed an outbreak, which – as of April 18th – had infected more than 6,500 people in 33 nations.

 

This spring a significant number of measles cases have been imported into the United States from this outbreak, and with the summer travel season upon us, the potential for seeing more cases is great.

 

For this reason, the CDC released a HAN Advisory on measles last June.

This is an official

CDC HEALTH ADVISORY

Distributed via Health Alert Network
June 22, 2011, 16 :00 EST (04:00 PM EST)
CDCHAN-00323-11-06-22-ADV-N

High Number of Reported Measles Cases in the U.S. in 2011—Linked to Outbreaks Abroad

 

During the 1950s – before the introduction of the measles vaccine – measles infected roughly 4 million Americans, hospitalized nearly 50,000, and contributed to the deaths of several hundred every year.

 

The chart below (source: CDC) shows the remarkable effectiveness of the vaccination campaign.

 

While many parents today think of measles as a relatively benign childhood illness, it actually produced significant morbidity and mortality with respiratory, ocular, and neurological complications - sometimes resulting in death.

 

In developing countries, the incidence – and mortality rate – of measles remains high.   These statistics from the World Health Organization:

Measles

Fact sheet N°286

Key facts

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2008, there were 164 000 measles deaths globally – nearly 450 deaths every day or 18 deaths every hour.
• More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
• Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide.
• In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

CDC Health Advisory (HAN) On Measles

 

 

# 5645

 

Earlier this year I wrote about the recent rise of measles cases across much of Europe (see Measles: Forgotten, But Not Gone), with details gleaned from the WHO’s WER (Weekly Epidemiological Record), and including a referral to an excellent 5-part series on measles by Ian York.

 

The WER report (Measles outbreaks in Europe) detailed an outbreak, which had – as of April 18th –had infected more than 6,500 people in 33 nations.

 

This spring a significant number of measles cases have been imported into the United States from this outbreak, and with the summer travel season upon us, the potential for seeing more cases is great.

 

For this reason, the CDC released a HAN Advisory on measles last night.

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page.

 

There are 4 types of HAN releases.

 

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

 

This is an official

CDC HEALTH ADVISORY

Distributed via Health Alert Network
June 22, 2011, 16 :00 EST (04:00 PM EST)
CDCHAN-00323-11-06-22-ADV-N

High Number of Reported Measles Cases in the U.S. in 2011—Linked to Outbreaks Abroad

Summary and Background

The United States is experiencing a high number of reported measles cases in 2011, many of which were acquired during international travel. From January 1 through June 17 this year, 156 confirmed cases of measles were reported to CDC. This is the highest reported number since 1996. Most cases (136) were associated with importations from measles-endemic countries or countries where large outbreaks are occurring. The imported cases involved unvaccinated U.S. residents who recently traveled abroad, unvaccinated visitors to the United States, and people linked to these imported cases. To date, 12 outbreaks (3 or more linked cases) have occurred, accounting for 47% of the 156 cases. Of the total case-patients, 133 (85%) were unvaccinated or had undocumented vaccination status. Of the 139 case-patients who were U.S. residents, 86 (62%) were unvaccinated, 30 (22%) had undocumented vaccination status, 11 (8%) had received 1 dose of measles-mumps-rubella (MMR) vaccine, 11 (8%) had received 2 doses, and 1 (1%) had received 3 (documented) doses.

 

Measles was declared eliminated in the United States in 2000 due to our high 2-dose measles vaccine coverage, but it is still endemic or large outbreaks are occurring in countries in Europe (including France, the United Kingdom, Spain, and Switzerland), Africa, and Asia (including India). The increase in measles cases and outbreaks in the United States this year underscores the ongoing risk of importations, the need for high measles vaccine coverage, and the importance of prompt and appropriate public health response to measles cases and outbreaks.

 

Measles is a highly contagious, acute viral illness that is transmitted by contact with an infected person through coughing and sneezing. After an infected person leaves a location, the virus remains contagious for up to 2 hours on surfaces and in the air. Measles can cause severe health complications, including pneumonia, encephalitis, and death.

Recommendations for Health Care Providers

• Ensure all patients are up to date on MMR vaccine* and other vaccines.
• For those who travel abroad, CDC recommends that all U.S. residents older than 6 months be protected from measles and receive MMR vaccine, if needed, prior to departure.
  • Infants 6 through 11 months old should receive 1 dose of MMR vaccine before departure.†
  • Children 12 months of age or older should have documentation of 2 doses of MMR vaccine (separated by at least 28 days).
  • Teenagers and adults without evidence of measles immunity** should have documentation of 2 appropriately spaced doses of MMR vaccine.

• Consider measles as a diagnosis in anyone with a febrile rash illness lasting 3 days or more, a temperature of 101ºF (38.3ºC) or higher, and clinically compatible symptoms (cough, coryza, and/or conjunctivitis) who has recently traveled abroad or who has had contact with someone with a febrile rash illness. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range, 7 to 12 days) and from exposure to rash onset is usually 14 days (range, 7 to 21 days).

• Isolate suspect measles case-patients and immediately report cases to local health departments to ensure a prompt public health response.

• Obtain specimens for testing, including viral specimens for confirmation and genotyping.

 

 

 

Measles was considered eliminated in the United States by the year 2000 due to the introduction of the measles vaccine in the mid-1960s.

 

 

Despite this success, there remain enough unvaccinated individuals to create cracks in our hard won `herd immunity’, and that allow the virus an opportunity to spread.

Measles: Forgotten, But Not Gone

 

 

# 5530

 

 

Measles, which was once almost a youth’s `rite of passage’ in the United States, has been all but eliminated in recent years after the introduction of the first measles vaccine in 1963.

 

The chart below (source: CDC) shows the remarkable effectiveness of the vaccination campaign.

 

 

While many parents today think of measles as a relatively benign childhood illness, it actually produced significant morbidity and mortality with respiratory, ocular, and neurological complications - sometimes resulting in death.

 

During the 1950s – before the introduction of the measles vaccine – in the United States the disease infected roughly 4 million, hospitalized nearly 50,000,  and contributed to the deaths of several hundred every year.  

 

Admittedly, a vast improvement over the mortality rates from earlier in the century, when the disease was far deadlier (for reasons that quite frankly, remain hard to explain – Ian York explored this fascinating mystery in Measles week, part I: Introduction ).

 

But in recent years lower uptake of the vaccine – its reputation tainted by (disproven) claims of a possible link to autism (popularized by Dr. Andrew Wakefield and promoted by various anti-vaccination groups) – and the continual importation of the disease from countries where it remains endemic - have allowed the virus to keep a toehold in developed nations.

 

In developing countries, the incidence – and mortality rate – of measles remains high.   These statistics from the World Health Organization:

 

 

Measles

Fact sheet N°286

Key facts

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2008, there were 164 000 measles deaths globally – nearly 450 deaths every day or 18 deaths every hour.
• More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
• Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide.
• In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

 

Today news on measles from several fronts. 

 

First, the WHO’s  WER (Weekly Epidemiological Record) brings us details on an ongoing measles outbreak in Europe, that has infected more than 6,500 people in 33 nations.

 

Measles outbreaks in Europe

As of 18 April 2011, 33 countries in Europe had reported  6500 measles cases. Epidemiological investigations and genotyping have confirmed transmission of measles virus among several countries in the Region and in the Americas.

<SNIP>

In all these outbreaks, except for the second out-
break in Spain and the outbreak in Turkey, the D4
genotype of measles virus has been confirmed.
The B3 genotype of measles virus was isolated
from cases in the second measles outbreak in
Spain, while the D9 genotype, originating from
and common in south-east Asia (e.g. Malaysia and
Indonesia) was confirmed to have caused the out-
break in Istanbul (Turkey) in January 2011.

(Continue . . . )

 

 

As you can see, there are a number of different strains or genotypes of measles.  New ones emerge, or are detected, every so often.  As of mid-2010, the World Health Organization (WHO) maintained reference strains representing 23 recognized genotypes.

 

From Eurosurveillance this week, a report on a novel strain of (an existing genotype:G3) of measles which has spread across Europe over a 2 month period.

 

Eurosurveillance, Volume 16, Issue 17, 28 April 2011

Rapid communications

Appearance of a novel measles G3 strain in multiple European countries within a two month period, 2010

K E Brown, M N Mulders, F Freymuth, S Santibanez, M M Mosquera, S Cordey, J Beirnes, S Shulga, R Myers, D Featherstone

During late 2010, a previously unrecognised strain of measles genotype G3 virus was identified in five different European countries by the World Health Organization Measles and Rubella Laboratory Network. Apart from one, none had a travel history to south-east Asia, the usual source of G3 viruses, although epidemiological links could be established between some of the cases. This case series illustrates the value of genotyping and sequencing in tracking measles infections, and identifying otherwise unrecognised chains of transmission.

(Continue . . . )

 

And next, from the Journal of Infectious Diseases a report on the impact of an outbreak of measles in Tucson, Arizona in 2008 that affected two healthcare facilities. 

 

 

Health Care–Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact

 

J Infect Dis. (2011) jir115 first published online April 28, 2011 doi:10.1093/infdis/jir115

Sanny Y. Chen,

Shoana Anderson, Preeta K. Kutty, Francelli Lugo, Michelle McDonald, Paul A. Rota, Ismael R. Ortega-Sanchez, Ken Komatsu, Gregory L. Armstrong, Rebecca Sunenshine, and Jane F. Seward

 

You can follow the above link to read the entire article, or for the short version, you can read the press release from the IDSA.

 

Infectious Diseases Society of America

Measles outbreak underscores need for continued vigilance in health care settings

[EMBARGOED FOR APRIL 29, 2011] The U.S. measles vaccination program has been successful in eliminating endemic measles in the United States; yet this success has provided challenges that require ongoing vigilance for the rapid identification and response to measles cases in health care settings. In 2008, the largest reported health care-associated measles outbreak in the United States since 1989 occurred in Tucson, Arizona, costing approximately $800,000 in response and containment efforts. In a report published in The Journal of Infectious Diseases and available online, researchers identify preventive measures hospitals and health care facilities can implement to reduce the likelihood and decrease the economic impact of a future measles outbreak in these settings.

 

Due to a highly effective vaccine and high vaccine coverage, measles was declared eliminated in the United States in 2000; however, the potential for measles infection still exists in this country. Non-adherence to U.S. vaccination recommendations and infection among unvaccinated travelers coming into the United States continue to pose potential threats to the public and to health care personnel. In the 2008 Tucson outbreak, an unvaccinated, infected Swiss traveler visited a hospital emergency department on February 12. The traveler was admitted to the hospital the next day, but a measles diagnosis was not confirmed until February 20. This ignited an intense and lengthy public health investigation and response to persons with suspected and confirmed measles as well as contacts of those persons.

(Continue . . . )

 

And again from the Journal of Infectious diseases, an editorial comment on the above study by Stephen M. Ostroff.  

The full text of both articles is freely available.

 

EDITORIAL COMMENTARY:

Stephen M. Ostroff

Measles: Going, Going, But Not Gone

J Infect Dis. (2011) jir125 first published online April 28, 2011 doi:10.1093/infdis/jir125

 

 

While not the scourge of the early 20th century in the United States, measles remains a serious public health threat in much of the world, and is only held at bay in developed countries by relatively high vaccination rates.

 

There is a lot more to the measles story, and I highly recommend reading the entire Mystery Rays blog series on the disease by Ian York from 2010.

 

Measles week, part I: Introduction

Measles week, part II: Emerging disease

Measles week, Part III: Not the answers

Measles week, part IV: Some of the answers

Measles week, Part V: What about the vaccine?

 

 

Referral: Mystery Rays On Measles

 

 

 

# 4438

 

 

Ian York over at Mystery Rays blog has posted the second of five planned essays this week on Measles. 

 

I’ll admit after reading the first two, he’s got me hooked with this series.  I’m looking forward to the Wednesday, Thursday, and Friday  installments.

 

A referral then to the parts 1 & 2.  

 

Measles week, part I: Introduction

 

Measles week, part II: Emerging disease

 

 

I’ll undoubtedly mention the whole series in my next Roundup of Flublogia.