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.

»» Read More

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.

»» Read More

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.

»» Read More

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.

»» Read More

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?

 

 

»» Read More

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.

»» Read More