Worldwide Measles Spotlight: March 10, 2019

According to various governments and news publishers, the worldwide measles outbreak continues to expand, leading to increased costs and deaths, as of March 10, 2019 reporting. 

Recently, on March 6, 2019, the U.S. Surgeon General Dr. Jerome Adams said: “We need to make it easier to get a vaccination than to get a vaccine exemption.”

Dr. Adams continued saying ‘he cannot explicitly endorse state-level laws, but he voiced support for the idea behind bills in the Oregon and Washington legislatures, which would eliminate widely-used exemptions from mandatory vaccination.’ 

Currently, the 4 leading measles hot-spots in the USA are as follows: 

• Rockland County, NY: as of March 6th, 2019, there are 144 measles cases.
• New York City, NY: as of March 5th, there have been 133 measles cases.
• Clark County, Washington: as of March 9th, 2019, there have been 70 measles cases.
• Texas: as of March 8, 2019, the Texas Department of State Health Services confirmed 11 measles cases during 2019.

These four state-based totals (358) exceeds the US Centers for Disease Control and Prevention (CDC) data from March 7, 2019, which confirmed just 228 measles cases in 12 states.

This data disparity is generally related to reporting timing.

Additionally, a new study published on March 5, 2019, clarified the average cost to provide care for a measles case during 2017. This study reported the negative economic impact was approximately $78,356 USD per patient. 

This new data is significantly higher than previous studies which found the average cost of treating a measles patient was between $4,600 and $10,376 USD.   

Listed below are various state-based measles updates for the week ending March 10, 2019.

USA: 

• California: On March 6, 2019, the Health Department reported 3 cases of measles.  The statement said a passenger who had measles was on an international flight landed at SFO in February. The person who had measles during the time of the flight was a Santa Cruz County resident. Since then, 2 additional passengers who were exposed to measles on that flight have become sick with measles: one was a San Francisco resident and the other was a Santa Clara County resident. 
• Colorado: As of February 27, 2019, 1 adult with measles during 2019, after traveling internationally.  A February 2019 report by Children’s Hospital Colorado found Colorado ranks 23rd in the nation when it comes to vaccination rates for children. During the 2017-18 school year, only 88.7 percent of kindergarteners in Colorado received the MMR vaccine.
• 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.
• Georgia: The Georgia Department of Public Health said 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.  
• Illinois: The Illinois Health department confirmed 5 measles cases during 2019. There were 5 total measles cases in 2018.
• Kentucky: One case of measles has been confirmed in a young child living in the region served by the Barren River District Health Department. The child, who was unvaccinated, recently traveled out of the country to an area where measles is endemic, the Kentucky Department for Public Health (DPH) reported on February 15, 2019.
• Michigan: As of March 1st, there were 4 cases of measles during 2019. In 2018 there were 19 measles cases in Washtenaw and Oakland counties. Terri Adams, a registered nurse and section manager for the Division of Immunization at the Michigan Department of Health and Human Services said, "In Michigan, we have seen the highest number of measles cases this past year than we have in 24 years,"
• New Hampshire: Health officials said 1 overseas traveler infected with measles took a bus from Boston's South Station to the Manchester Transportation Center on February 26, 2019. "The concerning thing about this situation is that this person traveled on public transportation during a time when they were infectious with the measles virus, meaning that they were able to transmit it to other individuals," said Dr. Benjamin Chan, the state epidemiologist.
• New Jersey: The New Jersey Department of Health (NJDOH) is warning residents about 4 confirmed measles cases in unrelated incidents during February and March 2019. A Bergen County resident developed measles after contact with a community outside New Jersey experiencing an ongoing outbreak of measles and potentially exposed individuals in Bergen County; An Essex County resident developed measles following travel from a country that is currently experiencing an ongoing outbreak of measles; and 2 Ocean County residents were confirmed to have measles and potentially exposed individuals in Ocean County between February 26 and March 5. Previously, the NJDOH had declared between October 2018 and January 2019, a total of 33 measles cases were identified, including 30 confirmed cases in Ocean County residents and 3 cases in one Passaic County, NJ.
• New York City: As of March 5, 2019, there have been 133 confirmed cases of measles in Brooklyn and Queens since October 2018.  
• Monroe County NY: The Monroe County Department of Public Health has confirmed a total of 7 measles cases during 2019.
• Rockland County NY: As of March 6, 2019, there are 144 confirmed reported cases of measles in Rockland County, NY. Statistics released by the County show that out of the 144 confirmed cases of measles, 118 of the patients say they did not have an MMR vaccine, 5 people had only one dose and 6 had two doses.
• Westchester County, NY: The Westchester County Health Department was notified on March 1st that a Monroe College student has been diagnosed with measles.  The student, who is a resident of New York City, had traveled to the College’s New Rochelle NY campus.
• Oregon: There are 6 confirmed measles cases in Multnomah County, Oregon, as of March 4, 2019.
• Texas: As of March 8, 2019, the Texas Department of State Health Services (DSHS) confirmed 11 measles cases in Texas during 2019. DSHS had 9 confirmed cases in 2018 and one in 2017.   
• Washington: As of March 9, 2019, Clark County Public Health (CCPH) has confirmed 70 measles cases during 2019.  Sixty-six of the Clark County cases were found in people 18 and younger and the vast majority were not immunized, according to the county’s public health department. And, more than 800 students considered exposed to the highly contagious disease in Clark County have been ordered to stay away from classrooms for up to 3 weeks.   

The Americas:

During 2019, ten countries in the Region of the Americas have reported confirmed measles cases: Argentina, the Bahamas, Brazil, Canada, Chile, Colombia, Costa Rica, Mexico, the United States of America, and the Bolivarian Republic of Venezuela. And, no fatal measles cases have been reported in 2019.   

• Argentina: An international traveler has been confirmed measles, as of February 5, 2019.
• Bahamas: One imported case of measles has been confirmed. The case is a 4-year-old male child with no history of vaccination who was visiting from France and arrived in the Bahamas on February 10, 2019.
• Brazil: Between EW 6 of 2018 and EW 9 of 2019, there were 10,334 confirmed measles cases reported, including 12 deaths. Since January 18, 2019, an additional 60 confirmed cases were reported. And, the CDC reaffirmed a Level 1 Travel Alert regarding Brazil’s ongoing measles outbreak for 2019.
• Vancouver, BC, Canada: As of February 27, 2019, 15 people in Ontario, Canada have been confirmed with measles. Additionally, an adult from Ontario who recently traveled across Asia has been diagnosed with measles. Niagara Region Public Health is investigating the case after it was confirmed by a laboratory on March 8, 2019. The health agency says anyone who visited Toronto Pearson International Airport on Feb. 22 between 6:20 p.m. and 9:30 p.m. may have been exposed to measles, which can pass easily from person to person.   
• Chile: Between EW 45 of 2018 and EW 8 of 2019, there were 26 confirmed measles cases, of which 8 were imported and 18 were import-related. With respect to the most recent imported case, rash onset was on 11 February 2019. The case is a 46-year-old male whose probable site of infection is Miami, Florida, United States, or Dubai, United Arab Emirates. Genotype D8 lineage was identified.
• Columbia: There is an outbreak of measles in Colombia. Between EW 10 of 2018 and EW 9 of 2019, there were 241 confirmed measles cases with no deaths reported. The cumulative incidence rate in the country is 0.22 cases per 100,000 population, and the highest incidence rates were reported from the following territorial entities: Cartagena, Barranquilla, and Bolívar. The CDC reaffirmed a Level 1 Travel Alert regarding an outbreak of measles in Colombia.
• Costa Rica: There are 3 confirmed measles cases during 2019. The CDC suggests various vaccines prior to visiting Costa Rica.   
• Honduras: The CDC has reaffirmed its vaccine suggestions for visitors to Honduras for 2019.   
• Mexico: One reported laboratory-confirmed imported measles case with a travel history to Paris, France, and to Houston, Texas, United States. Seventy-one contacts are being followed-up, all of whom are asymptomatic to date.
• Venezuela: Between 1 January and 27 February 2019, there were 283 measles cases reported, of which 40 were confirmed. The cumulative incidence rate in the country during 2017-2019 is 19.6 cases per 100,000 population, with the highest incidence rates, have been reported in Delta Amacuro, the Capital District, and the Amazonas. Previously, the CDC reported on January 30, 2019, that Venezuela had contributed 68 percent of the measles cases reported in the Americas and most of the measles-related deaths (73/85). The CDC reaffirmed Venezuela’s Level 3 Travel Alert for 2019.

The World:

During 2000 to 2017, the World Health Organization (WHO) estimates that measles vaccinations prevented 21.1 million deaths, making measles vaccine one of the best buys in public health.

• Austria: Austria reported 25 cases in January 2019, compared with 1 case in December 2018.
• Australia: As of February 16, 2019, there have been 14 confirmed cases of measles with the Health Department warning “more cases are expected over the coming weeks”. The most recent warning came during early February when passengers on a Virgin flight from Melbourne to Perth have issued a measles caution. As part of that warning, people who visited a Hindu temple in Wangara between February 8 and 10 were also included. Australia's National Immunisation Strategy for 2019 to 2024 was published during February 2019.
• Bulgaria: 51 measles cases were reported as of February 27, 2019.  Bulgaria reported 13 cases in 2018.
• Czech Republic: During 2019, the number of measles cases has already reached close to 100 cases, with 70 cases registered in Prague. During 2018, there were a total of 182 measles cases.   
• England: During January 2019, the UK reported 43 measles cases. Public Health England is advising people to check their vaccination against measles before they travel abroad. The US CDC has maintained its Level 1 Travel Alert for the UK regarding its measles outbreak for 2019.
• Ethiopia: Measles is endemic in Ethiopia with outbreaks reported annually. 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. Measles incidence in Ethiopia is still high above 50 cases/1,000,000 population per year. The CDC suggests various vaccinations prior to visiting Ethiopia.
• France: France reported 124 measles cases in January 2019, following a reported 2,269 cases during 2018. The CDC reaffirmed a Level 1 Travel Alert for France for 2019.   
• Georgia: The country of Turkey has donated a total of 100,000 doses of the MMR vaccine to Georgia, which is currently grappling with a measles outbreak, the Health Ministry said on March 9, 2019. Since the end of 2018, the spread of measles has become intensive and that could be transformed into a full-scale epidemic, with 312 cases of the disease have been identified during 2019, mainly concentrated in Imereti, Samegrelo, and Kakheti.
• Greece: 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.
• India: On Jan. 15, 2019, the New Delhi High Court stopped the implementation of the MMR vaccination campaign, ruling vaccines cannot be forcibly administered on children without the voluntary consent of their parents.  Between 2010 and 2013, a mass measles vaccination campaign saved 41,000 to 56,000 children in India, according to a report published by eLife.
• Indonesia: 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 public of potential exposure to a measles patient at the Municipal Library, 38 Ben Gurion Blvd. Kiryat Malachi, on 5.3.19. Additionally, The Ministry of Health notified the public of exposure to a measles patient in the following dates: 6/3/2019, at Leumit Health Fund Branch Gimmel, 1 Hannah Szenes Street, and. 7/3/2019, at the Leumit Health Fund at 22 Jabotinsky Street, Kiryat Malachi. Anyone who visited these locations at the specified times is advised to contact their local health office to decide on the need for vaccinations. 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: Italy reported 165 cases in January 2019, compared with 76 in December 2018. The CDC reaffirmed a Level 1 Travel Alert for 2019.   
• Japan: As of February 17, 2019, the measles outbreak in Japan has reached 222 cases, reports the Japan National Institute of Infectious Diseases in Tokyo. And, the CDC issued a Level 1 Travel Alert for Japan on February 27, 2019, regarding the 2019 measles outbreak.
• Kazakhstan: A measles outbreak has been confirmed in Kazakhstan. The CDC issued a Level 1 Travel Alert regarding measles on January 22, 2019.
• Madagascar: At least 922 people - mostly children - have died of measles in Madagascar since October, the WHO says, despite an emergency program that has vaccinated 2.2 million of the 26 million population so far. The CDC reaffirmed a Level 1 Travel Alert for 2019.
• New Zealand: Measles outbreak in 2019 is worst 'in years' with 22 cases confirmed. Christchurch authorities admit disease is ‘circulating widely’ amid vaccine shortage.
• Philippines: Between 1 January and 18 February 2019, 9,267 measles cases including 146 deaths were officially reported to the Philippines Department of Health (DoH), which is a 266% increase with the same time period in 2018. Even more concerning is the drastic increase in the Case Fatality Rate from 0.93% on 31 December 2018, to 2% on 7 February 2019.
• Poland: 133 measles cases were confirmed in January 2019, compared with 114 in December 2018.
• Portugal: In contrast to other European countries, Portugal has achieved sustained high immunization coverage against measles. Vaccination coverage of two MMR doses in the population below 18 years of age has been at least 95% for more than two decades. Recently 37 measles cases have been confirmed in the country, mostly in adults, since November 2018, according to a Diario de Noticias report.
• South Korea: According to a report by the Korea Centers for Disease Control and Prevention, 38 measles cases have been confirmed during 2019.  Measles outbreak areas are Daegu, Gyeongsangbuk-do, Gyeongsan-si, Gyeonggi-do, Ansan city, as of January 21, 2019
• Thailand: 2,758 measles cases were confirmed in Thailand during 2018.  The provinces with the highest rates of cases include Narathiwat, Pattani, Songkhla, Yala, and Petchburi. The CDC suggests travelers to Thailand receive the MMR vaccine.
• Turkey: Turkey has donated a total of 100,000 doses of MMR vaccine to Georgia, which is currently grappling with a measles outbreak, the Health Ministry said. 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. Ukraine saw the largest year-on-year increases in measles cases in 2018, with 35,120 cases, nearly 30,000 more than in 2017.  And, the CDC reaffirmed a Level 1 Travel Alert regarding measles outbreaks in Ukraine during 2019.  
• Vietnam: Measles has been reported in 664 patients in 2019. Vietnam reported 1,963 measles patients in 2018, up 13 times compared to 2017, according to its Health Ministry. Most cases of measles are related to the inadequate vaccination of children. By the end of 2018, the Ministry of Health has conducted additional injections of measles-rubella vaccine for 4.2 million children aged 1 to 5 years in 57 provinces and cities nationwide. 
• Yemen: WHO and UNICEF concluded a nationwide measles vaccination campaign in Yemen reaching more than 11.6 million (90%) children aged 6 months–16 years across the country. 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.