Worldwide Measles Spotlight: March 3, 2019

According to new reports by various governments and news publishers, the worldwide measles outbreak continues to expand during the last week of February 2019. 

In the USA, the 3 leading measles hot-spots are as follows: 

• Rockland County, NY: as of March 1st, 2019, there are 140 measles cases.
• New York City, NY: as of February 26th, there have been 121 measles cases.
• Clark County, Washington: as of March 2nd, 2019, there have been 70 measles cases. 

These three state-based totals (331) exceeds the US Centers for Disease Control and Prevention (CDC) data from February 28, 2019, which confirmed just 206 measles cases in 11 states. 

This data disparity is generally related to report timing. 

Recently, one of the USA’s leading health officials indicated a change in federal policy regarding ‘anti-vaxx’ legislation may be forthcoming. 

On February 27, 2019, Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, when testifying before the House Committee on Energy and Commerce, called ‘false information distributed through social media about the use of the Measles, Mumps, and Rubella (MMR) vaccine is a 'threat' to public health, that could only be counteracted with a sustained public education effort.’   

USA:  

Listed below are various measles updates for the week ending March 3, 2019.

• California:  The Los Angeles County Department of Public Health and the City of Pasadena Public Health Department have identified more locations for possible measles exposure. This is the same measles case previously announced. The individual visited the cities of Malibu, Santa Monica and Pasadena while infectious between December 26 to December 29. The last large outbreak of measles in California was associated with Disneyland which occurred in April 2015, when at least 131 California residents were infected with measles
• Colorado:  U.S. Representative Diana DeGette recently noted that Colorado's kindergarten MMR vaccination rate of 89 percent is among the lowest in the country. Colorado is one of 17 states that allow an exemption for personal beliefs, in addition to religious and medical exemptions. Denver Public Health has confirmed 1 adult with measles during 2019, after traveling internationally.   
• Connecticut:  The Connecticut Department of Public Health confirmed the 2nd case of measles in New Haven County. Both cases were treated at Yale-New Haven Hospital and released. The Connecticut DPH reported, "Investigators have not identified any common links between the first and second cases, although both were probably exposed to measles in early January." "The most likely scenario is that they were not vaccinated as children or may have just been vaccinated once," said the Dean of Yale School of Public Health Dr. Sten Vermund.
• Georgia:  The Georgia Department of Public Health urges healthcare providers to maintain heightened awareness for patients with measles or symptoms of measles since 3 measles cases were confirmed in the greater Atlanta area during 2019.  
• Hawaii:  The Hawaii State Department of Health confirmed 2 cases of measles on the Big Island during 2019. The DOH said they were exposed in other states to an “infected international guest,” according to a medical advisory sent by State Epidemiologist Sarah Park. “Although the visitors were advised to remain isolated and the likelihood of exposure to others is low, providers should be aware the period of infectivity while in Hawaii ranged from Jan. 4–13,” she wrote.   
• Illinois:  As of February 28, 2019, the Illinois health department confirmed 5 measles cases during 2019. Additionally, on February 22, 2019, an Illinois resident with a now confirmed diagnosis of measles was on a flight that arrived in Concourse B at Chicago Midway Airport.  The passenger was unvaccinated and infectious on that day.   
• Kentucky:  Kentucky Congressman Brett Guthrie helped lead a subcommittee hearing on the national Measles outbreak and the importance of vaccines. According to public health reports, 1 unvaccinated child has been confirmed with measles after traveling abroad. 
• Michigan:  As of March 1st, there were 4 cases of measles during 2019. In 2018 there were 19 measles cases. Overall, 3.66 percent of Michigan schoolchildren in 2017 had vaccine waivers that allowed them to skip one or all of the state-required vaccines or allowed them to deviate from the mandated immunization schedule.   
• New Hampshire: Health officials said an overseas traveler infected with measles took a bus from Boston's South Station to the Manchester Transportation Center on February 26, 2019. Anyone on Boston Express Line No. 5178, should consider themselves exposed to the virus, health officials said. 
• New Jersey:  The NJ Department of Health said on February 27, 2019, that a New Jersey resident with measles may have exposed others in Bergen County. The unidentified person visited 2 locations in Hillsdale on Feb. 18, the AFC Urgent Care at 2 Broadway between 2 and 5 p.m. and the Walgreens at 383 Washington Ave. between 3 and 5:30 p.m. Previously, the NJ Health department had declared the measles outbreak with 33 cases ‘over’. 
• New York City:  As of February 26, 2019, there have been 121 confirmed cases of measles in Brooklyn and Queens since October 2018. A single yeshiva in the Williamsburg section of Brooklyn accounted for 21 of the 31 new cases of measles during February.   
• Monroe County NY:  The Monroe County Department of Public Health has confirmed a total of 7 measles cases. 
• Rockland County NY:  As of March 1, 2019, there are 140 confirmed reported cases of measles in Rockland County.
• Westchester County NY:  Westchester County the health department was notified on March 1, 2019, that 1 Monroe College student was diagnosed with measles. The student, a resident of New York City, had traveled to the college’s New Rochelle campus. "There is a window of opportunity to get them treated," Catherine Cioffi, spokeswoman for County Executive George Latimer, said. 
• Oregon:  There are 6 confirmed measles cases in Multnomah County, Oregon as of March 1, 2019. Additionally, an individual contagious with measles visited Portland International Airport, as well as locations in Marion County during late February. This case is unrelated to the measles outbreak in Clark County, Washington and unrelated to a recent report of measles in Multnomah County.  
• Texas:  As of February 14th, 2019, the Texas DSHS reported 8 measles cases in Bell, Denton, Harris (4), Galveston, and Montgomery counties.
• Washington:  As of March 2, 2019, Clark County Public Health (CCPH) has confirmed 2 new measles cases. Since January 1st, CCPH has identified 70 confirmed cases.

The Americas:

As of epidemiological week #2 of 2019, 5 countries reported having confirmed measles cases between December 2018 and January 2019: Brazil, Canada, Chile, Colombia, and Venezuela.

• Brazil:  Currently, 3 Brazilian states of Amazonas, Roraima e Pará, continue to report new measles cases in 2019. UNICEF trained health monitors working in migrant shelters for Venezuelan refugees. UNICEF has included the measles vaccine as part of the Municipal Seal programme that covers 1,924 municipalities. And, the CDC reaffirmed a Level 1 Travel Alert regarding Bazil’s ongoing measles outbreak for 2019. 
• Vancouver, BC, Canada:  Two new cases of measles infection have been reported to Vancouver Coastal Health. Both cases are related to the school outbreak. This brings the total of people with measles, who either live in or spent time in VCH, to 15 people, as of February 27, 2019. 
• Columbia:  There is an outbreak of measles in Colombia. The most recent measles case had rash onset in EW 2 of 2019, and the most recent cases under investigation are in the departments of La Guajira and Norte de Santander and in the districts of Barranquilla, Bogotá, and Cartagena. Travelers to Colombia should make sure they are vaccinated against measles with the MMR vaccine. Colombian officials say their system is strained by the estimated 1 million Venezuelans that have already entered the country. The CDC reaffirmed a Level 1 Travel Alert regarding an outbreak of measles in Colombia. 
• Costa Rica:  An unvaccinated male from France is suspected of measles. Costa Rica had been free of the disease for five years. The 5-year-old boy arrived on February 18, 2019. The CDC suggests various vaccines prior to visiting Costa Rica.   
• Honduras:  During September 2018, the Honduran Ministry of Health said 34% of the total population was susceptible to measles because they never received the MMR vaccine. Gavi reported Honduras population was 8.4 million. The CDC has reaffirmed its vaccine suggestions visitors to Honduras for 2019.   
• Mexico:  Jorge Alcocer Varela, Secretary of Health reported that there is no health alert for measles. But, 777,000 children in Mexico were not vaccinated. Mexico’s first National Vaccination Week of 2019 is set for the start of February. Between 1997 and 2017, only 176 cases of measles have been registered in Mexico.   
• Venezuela:  According to a CDC report published on January 30, 2019, Venezuela had contributed 68 percent of the measles cases reported in the Americas and most of the measles-related deaths (73/85), as of October 23, 2018.  The national coverage rate for the second dose of the measles vaccine was estimated at 52%. The CDC reaffirmed Venezuela’s Level 3 Travel Alert for 2019.

The World:  

“The root cause of the measles outbreaks … is a failure to adequately vaccinate,” says Katrina Kretsinger, the lead measles expert at WHO. “Many people in many countries remain susceptible, and large pockets of susceptible persons can lead to large outbreaks.” 

• Australia:  Australia was verified by WHO as having eliminated endemic measles in 2014.  But, 14 individuals in less than 2 months have been diagnosed with measles, as of February 22, 2019.  Australia's National Immunisation Strategy for Australia 2019 to 2024 was published during February 2019. 
• Bulgaria:  A total of 51 measles cases were announced by the chief state health inspector Dr. Angel Kunchev, as of February 27, 2019.  Bulgaria had zero cases of measles in 2014 but 165 in 2017, and 13 cases in 2018.
• Czech Republic:  During 2019, the number of measles cases has already reached close to 100 cases, with 70 of them registered in Prague. In 2018, there were 182 cases. The Czech Republic reported 73 percent vaccination rate in some areas. A court ruling by the Czech Supreme Court in 2010 established that parents cannot be in any way punished for refusing to get their child vaccinated.   
• England:  Passengers on Icelandair flight F1455 that traveled from London Heathrow to Reykjavik on Valentine's Day, have been warned they could have been exposed to measles on the aircraft. Between 1 January 2018 and 31 October 2018 there were 913 laboratory-confirmed measles cases in England The majority of measles cases have been in people who are not vaccinated. Most UK measles cases are linked to travel in Europe. Public Health England is advising people to check that they are vaccinated against measles before they travel abroad or go to large public events in the UK or elsewhere. Childhood vaccination rates in ­London are only 81.2 percent for the 1st MMR vaccination by the time they were 2 years of age, according to the most recent figures from Public Health England (PHE). The US CDC has maintained its Level 1 Travel Alert for the UK regarding measles for 2019. 
• Ethiopia:  Health officials said over 3.3 million children will receive the measles vaccine. Ethiopia launched a measles vaccine second dose (MCV2) into the routine immunization programme in the second year of life, during February 2019. The CDC suggests various vaccinations prior to visiting Ethiopia.
• France:  18 measles cases in the ARS regional were confirmed by the Auvergne-Rhone-Alpes district during February 2019. The agency said 12 other cases had been registered in the region since February 4. The ARS recorded 84 measles cases during 2018. France reported 2,269 cases during 2018. The CDC reaffirmed a Level 1 Travel Alert for France for 2019.  
• Georgia:  Since the end of 2018, the spread of measles has become intensive and that could be transformed into a full-scale epidemic, with a real risk of international dissemination. From the beginning of January 2019, 312 cases of the disease have been identified, mainly concentrated in Imereti, Samegrelo, and Kakheti.
• Greece:  As of October 2018, 3,150 measles cases were reported in all 13 Greek Regions. The majority (80.4%) of infected people were unvaccinated. The CDC reaffirmed a Level 1 Travel Alert for 2019. Travelers to Greece should make sure they are vaccinated against measles with the MMR vaccine. 
• Indonesia:  Indonesia has confirmed the number of measles cases declined by 65 percent from 11,389 in 2017 to 3,995 in 2018. But, the CDC issued a Level 1 Travel Alert for 2019, saying travelers to Indonesia should make sure they are vaccinated against measles with the MMR vaccine. 
• Israel:  The Ministry of Health notifies the general public that Afikim bus passengers in the city of Ashdod might have been exposed to measles: On 25.2.19 on bus line 14 at 13.40 from Rashbi station towards the 8th quarter; On 27.2.19 on bus line 85 at 8.45, 8th quarter, Tzhivoni Street, the Maccabi HMO on Rashbi Street; On 27.2.19 on bus line 85 at 9:40 from Rabbi Tarfon station to the 8th quarter of Ashdod. Any passenger who was born on 1957 or later, and was not vaccinated with 2 doses of the measles vaccine is advised to contact the closest health bureau in order to consider vaccination. The CDC reaffirmed a Level 1 Travel Alert for 2019, saying ‘Travelers to Israel should make sure they are vaccinated against measles with the MMR vaccine.’ 
• Italy:  Roberto Burioni, a medical doctor and professor at Vita-Salute San Raffaele University in Milan, proposed a “Pact for Science” that supports scientific research and tackles so-called pseudo-medicine. Italy recently reported 4,978 measles cases between February 2017 and January 2018. The CDC reaffirmed a Level 1 Travel Alert for 2019.   
• Japan:  As of February 10, 2019, 167 measles cases have been reported in 20 of Japan's 47 prefectures, the National Institute of Infectious Diseases said. The Mie Prefecture recorded the highest number of measles patients with 49, followed by Osaka with 47, Aichi with 17, and Tokyo with 11 cases. 
• Kazakhstan:  Measles has been confirmed in more than 1,600 citizens of Kazakhstan, as of February 1, 2019, with 48 children admitted to infectious diseases hospital daily. The CDC issued a Level 1 Travel Alert regarding measles on January 22, 2019.
• Madagascar:  In Madagascar, from September to February 21, 2019, 76,871 people were infected by measles and 928 died, a majority of whom were children. In February 2019, 1.4 million children were vaccinated, with another 3.9 million more to follow in March. The CDC reaffirmed a Level 1 Travel Alert for 2019.
• Philippines:  The Department of Health recorded 14,938 cases and 238 deaths from measles as of February 28, 2019. Health Department Undersecretary Eric Domingo said in a mobile phone text message, adding that “the number of cases is still rising. Most of the cases were recorded in Metro Manila, Cagayan and Mimaropa, The government will conduct a campaign in 2019 to vaccinate 9 million children against measles across 17 regions.   
• South Korea:  According to a report by the Korea Centers for Disease Control and Prevention, 38 measles cases have been confirmed during 2019.   
• Thailand:  Health officials have reported 2,758 measles cases in Thailand during 2018. The CDC suggests travelers to Thailand receive the MMR vaccine. 
• Turkey:  Turkey confirmed 510 people with measles in the first 9 months of 2018. According to the Health Ministry, 96 percent of the population was vaccinated in 2017. But, over 3.5 million refugees are in need of humanitarian aid within Turkey.   
• Ukraine:  Approximately 24,042 people were infected with measles during 2019. In February, the Ministry of Health launched an immunization drive at schools and clinics in the worst-hit Lviv region in western Ukraine. And, the CDC reaffirmed a Level 1 Travel Alert regarding measles 2019.  
• Vietnam:  Measles has been reported in 664 patients in 2019. Vietnam reported 1,963 measles patients in 2018, up 13 times against 2017, according to its Health Ministry. Ho Chi Minh City reports only 76.2% of children have been vaccinated with 2 measles vaccines, reported Dr. Nguyen Tri Dung, Director of Ho Chi Minh City Preventive Health Center. 
• Yemen:  Years of war have had a catastrophic impact on health in Yemen. Local authorities vaccinated more than 11.5 million children for measles in February 2019. The CDC suggests various vaccinations prior to visiting Yemen.

According to the CDC, measles is often brought into the USA by unvaccinated people who become infected abroad.

These international travelers then spread measles upon their return, which cause outbreaks in the USA. International travelers can request a pre-trip vaccine counseling appointment at Vax-Before-Travel.   

In the USA, there are 2 approved measles vaccines, MMR-II and ProQuad. 

The CDC Vaccine Price List provides private sector vaccine prices for general information. And, measles vaccine discounts can be found here. 

Vaccines, similar to medications, can cause side effects, says the CDC. Significant vaccine side effects should be reported to the CDC.