Global & Disaster Medicine

Archive for the ‘Measles’ Category

NYC: The Number of Measles Cases Grows to 390

NYC Health

April 24, 2019 — The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April. Of the 390 cases, 323 (83%) have occurred in Williamsburg (ZIP codes 11205, 11206, 11211, 11249), which has been under an Emergency Order to get vaccinated with the Measles-Mumps-Rubella vaccine (MMR) since April 12. A small number of cases have occurred outside of these neighborhoods but have, to date, not resulted in sustained transmission of measles. Twelve individuals have received summonses for being non-compliant with the Emergency Order since the City began issuing summonses last week. Any person receiving the summons is entitled to a hearing, and if the hearing officer upholds the summons, a $1,000 penalty will be imposed. Failing to appear at the hearing or respond to the summons will result in a $2,000 fine.

Health Commissioner Dr. Oxiris Barbot said, “We have now identified two expectant mothers who have contracted measles. These cases are stark reminders of why New Yorkers must get vaccinated against the measles as soon as possible. When we do not get vaccinated, we put our friends, our relatives, our neighbors, our classmates and other fellow New Yorkers at risk. We urgently repeat our plea to every New Yorker, especially those in the affected areas — unless you have a medical condition that prohibits you from doing so, please get vaccinated.”

“Currently, the outbreak remains intensely focused in Williamsburg where vaccination rates must continue to improve. While we’ve seen a few cases in people out of the Orthodox Jewish community, all but one of these individuals were exposed in Williamsburg and Borough Park and none of these have resulted in sustained transmission, mainly due to the power of herd immunity afforded by the high vaccination rates outside of the Williamsburg epicenter of this outbreak,” said Deputy Commissioner Dr. Demetre Daskalakis. “There’s no reason why a healthy child or adult should not be vaccinated against measles. We need to make sure that everyone who can get vaccinated, who doesn’t know their immunity status or vaccination history, gets the vaccine to protect themselves and those around them that can’t.”

The Health Department encourages all New Yorkers to make sure they are up to date with all age-appropriate vaccinations, including the MMR vaccine.

Today the Health Department has also issued a Health Alert to healthcare providers in NYC to provide additional updated citywide outbreak-related guidance to hasten the end of measles transmission. Updated outbreak-related guidance includes:

  1. Updated guidance for adults who have not completed a two-dose series of a measles-containing vaccine, do not have immunization records or are not immune, if they reside or regularly spend time in Williamsburg or Borough Park or other areas with measles activity including New York State and international travel.
  2. Updated guidance for children includes the following recommendations:
    1. Administration of an early extra dose of MMR vaccine for children 6- 11 months old if they reside or regularly spend time in Williamsburg, Borough Park or Crown Height and areas with measles activity.
    2. For Orthodox Jewish children 6- 11 months old, living in other neighborhoods, an extra dose of MMR should be considered.
    3. Administration of the second dose of MMR vaccine for children 1-4 years old who have already gotten their first scheduled dose of MMR and who reside or regularly spend time in neighborhoods and areas with measles activity.

The Health Department has issued three prior Health Alerts to healthcare providers in the affected community and around the city. Additionally, the Health Department has specifically alerted obstetricians/gynecologists and other healthcare providers of the outbreak and recommended that pregnant women be screened for measles immunity. The Health Department also recommended that in instances where pregnant women have been exposed, woman’s measles immunity should be assessed quickly to determine if she should receive intravenous immune globulin (IVIG). In a past outbreak of measles, cases in pregnant women resulted in a baby being born with measles and a miscarriage.

Eight individuals, including the initial case, acquired measles while travelling abroad to Israel (5), the United Kingdom (2) and Ukraine (1), areas with active outbreaks, highlighting the need for MMR vaccination for individuals traveling overseas. A small number of cases have occurred outside of the Williamsburg and Borough Park neighborhoods at the core of the current outbreak. These cases have been diagnosed in residents of Midwood/Marine Park (4), Brighton Beach (2), Flushing (2), Crown Heights (1), Bensonhurst (1), Far Rockaway (1) and the Hunts Point, Longwood and Melrose section of The Bronx (1). Seven individuals who do not identify as members of the Orthodox Jewish community have been diagnosed with measles since the outbreak began in October. Of individuals who acquired measles in NYC, only one person diagnosed with measles during this outbreak, who lives in the Hunts Point, Longwood and Melrose section of The Bronx, does not report an exposure associated with the Orthodox Jewish community of Williamsburg, Borough Park, or other area with measles activity.

To stop the spread of measles in New York City, the Health Department on April 9 ordered adults and children ages 6 months and older who live, work or go to school in ZIP codes 11205, 11206, 11211 and 11249 receive a measles, mumps and rubella (MMR) vaccine within 48 hours. If non-compliant, the Health Department announced it would issue a civil summons to those in the affected ZIP codes who had not been vaccinated as of April 12.

Since the outbreak began in October, the Health Department has published ads and distributed educational materials specific to the Orthodox community in English and in Yiddish. The Department has met with rabbinical and community leaders, health care providers, and local elected officials to highlight the importance of getting vaccinated and the dangers of measles. The Health Department continues to perform extensive outreach in the community with a sixth round of robocalls that go out to about 30,000 households.


USA: From January 1 to April 19, 2019, 626 individual cases of measles have been confirmed in 22 states.

Trends in Measles Cases: 2010-2019

22 states:  Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, Tennessee, and Washington.

Measles image

Credit:  CDC

Measles has killed more than 1,200 people in Madagascar since September

NY Post

                      Locator Map for Madagascar

Measles’ comeback


“…….In 2001, the United Nations declared war on measles……[T]he U.N. began the Measles and Rubella Initiative and created Gavi, the Vaccine Alliance.

Together, they poured billions of dollars into buying vaccines and helping countries deliver it safely, which meant building refrigerated storage facilities, supplying clean needles, training vaccinators and countering other logistical obstacles common in poor countries……..

Measles declined worldwide by nearly 80 percent between 2000 and 2016, with fatalities — mostly among children younger than age 5 — plummeting to about 90,000 per year from about 550,000……

But two years ago, measles cases unexpectedly popped upward again, rising 30 percent in a single year……

The biggest factor in that increase….was poverty: Medical systems in many countries remain too weak to vaccinate enough children year after year to wall out the virus…..”

From January 1 to March 28, 2019, 387 individual cases of measles have been confirmed in 15 states; the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000.

Trends in Measles Cases, 2010-2019

The World Health Organization (WHO) Western Pacific Region: Will the measles epidemic grow out of control?


Measles outbreaks in the World Health Organization (WHO) Western Pacific Region are putting babies, children and young people at risk and threatening progress towards wiping out the disease.

The Region had historically low levels of measles cases and no major outbreaks in 2017. This landmark decline was achieved through steady efforts to vaccinate all children against measles, but last year, measles cases in the Region increased by 250%, and more than two-thirds of cases were in the Philippines. So far this year, the Philippines has reported 23 000 cases with 333 deaths — already more than all of last year. Tragically, most of the cases were among children under 5 years old.

Measles can cause debilitating complications, including encephalitis, severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss.

“In recent months, we’ve seen how swiftly and easily measles can make a comeback in communities where not enough children have been immunized,” said WHO Regional Director for the Western Pacific Takeshi Kasai.

Nine countries and areas in the Region have been verified as having eliminated measles: Australia, Brunei Darussalam, Cambodia, Hong Kong SAR (China), Japan, Macao SAR (China), New Zealand, the Republic of Korea and Singapore. Elimination means there has been no prolonged local transmission of the virus for at least three years.

But even in countries where measles has been eliminated, as long as the virus is circulating elsewhere, people who are not immunized remain at risk of infection from an imported case. This, in turn can lead to an outbreak or re-establishment of transmission.

So far this year, Australia, Cambodia, China, Hong Kong SAR (China), Japan, the Lao People’s Democratic Republic, New Zealand, the Republic of Korea, Singapore and Viet Nam have all recorded measles cases.

“The resurgence of measles around the world has resulted in increased importation of the virus to several countries in our Region,” explained Dr Kasai. “What we want to stop is large-scale outbreaks resulting from those importations.”

Threat of outbreaks continues

Everybody should be vaccinated in all countries, whether or not they have achieved elimination, according to WHO guidelines. For a community to be protected, at least 95% of children must receive two doses of measles vaccine.

“Measles spreads like wildfire,” Dr Kasai explained. “It is the most contagious human disease, and it’s very good at seeking out and spreading among even small groups of people who are not immune.”

Since 2000, more than 21 million lives have been saved worldwide through measles immunization. In 2017 in the Western Pacific Region, 97% of children received a first dose of measles vaccine (compared to 85% in 2000), and 94% got the required second dose (compared to 2% in 2000).

Need to reach unvaccinated children

Although every country in the Region has committed to eliminating measles, some populations are still missed by immunization programmes. The lack of national strategies and efforts to increase access to vaccination are part of the problem, especially in hard-to-reach areas. Misconceptions about the effectiveness or safety of vaccines can also complicate efforts to vaccinate children.

WHO supports countries across the Region in efforts to vaccinate all children and strengthen their outbreak preparation and response. The Organization also encourages countries to address the reasons why children are not being vaccinated in some communities by combating misinformation and improving understanding of the importance and safety of vaccines.

In 2018, WHO published a Regional Strategy and Plan of Action for Measles and Rubella Elimination in the Western Pacific. The Plan assists countries in strengthening immunization programmes and developing national action plans for achieving the shared goal of measles elimination.

Europe: Measles and rubella monitoring report, March 2019


“…..Twenty-nine countries reported measles data for January 2019, with 881 cases reported by 19 countries and 10 countries reporting no cases. Germany did not report measles data for January 2019.
Overall, case numbers continued to increase compared with the previous two months. Romania, Italy, Poland and France had the highest case counts with 261, 165, 133 and 124 cases, respectively.
Notable increases were reported in Italy, Poland, France and Austria.

  • Italy reported 165 cases in January, compared with 76 in December and 58 in November.
  • Poland reported 133 cases in January, compared with 114 in December and 79 in November.
  • France reported 124 cases in January, compared with 54 in December and 61 in November.
  • Austria reported 25 cases in January, compared with one in December and four in November…..”

UNICEF: Global cases of measles are surging to alarmingly high levels, led by 10 countries accounting for more than 74% of the total increase.


Countries with ten highest increases in cases between 2017 and 2018

Ukraine 30,338
Philippines 13,192
Brazil 10,262
Yemen 6,641
Venezuela 4,916
Serbia 4,355
Madagascar 4,307
Sudan 3,496
Thailand 2,758
France 2,269

Madagascar: “…Since the outbreak began in September, the country in East Africa has seen more than 68,000 cases of the highly infectious disease…The organization says 553 people have died and an additional 373 are suspected to have died because of the measles…..”

USA Today


Measles in the Philippines: from 1 January to 9 February this year, a total of 4,302 measles cases have been reported, with 70 deaths.

Philippines DOH

measles, outbreak, vaccines, immunization

The Department of Health (DOH) today points to vaccine hesitancy as one of the reasons for the recent measles outbreak in some regions of the country.
Validated data from different regions of the country by the Epidemiology Bureau of DoH revealed that from 1 January to 9 February this year, a total of 4,302 measles cases have been reported, with 70 deaths.
Ages of cases ranged from 1 month up to 75 years old with 1 to 4 years old (34%) followed by less than 9 months old (27%) as the most affected age-groups.  Sixty-six percent of them had no history of vaccination against measles.
Of the total deaths, ages ranged from one month to 31 years old. Notably, 79% of those who died had no history of vaccination.
Regions with high reported cases are NCR (1,296 cases and 18 deaths) CALABARZON (1,086 cases and 25 deaths), Central Luzon (481 cases with 3 deaths), Western Visayas (212 cases and 4 deaths) and Northern Mindanao (189 cases and 2 deaths).
Eastern Visayas, MIMAROPA, CALABARZON, Central Visayas and Bicol are regions that have shown increasing trend as to reported cases for this week.  
Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services.
The causes of measles outbreak involved a number of factors or elements. Loss of public confidence and trust in vaccines in the immunization program brought about by the Dengvaxia controversy has been documented as one of many factors that contributed to vaccine hesitancy in the country. This refers to mothers who became hesitant to have their children vaccinated with vaccines that were long proven to be effective.
 On October 2018, the World Health Organization conducted a study in selected areas in Metro Manila to identify reasons for not bringing their children for immunization. The top reasons are the following: fear due to Dengvaxia, and the lack of time among households.
Moreover, results of the vaccine confidence project in 2015 against 2018 by London School of Hygiene and Tropical Medicine on the respondents’ views that vaccines are important decreased from 93% to 32%; safe and effective from 82% down to 21% and vaccine confidence dropped from 93 to 32% respectively.
DOH has been conducting vaccination activities against measles such as Outbreak Immunization Responses (ORI) in several regions. This was followed by a nationwide Supplemental Immunization Activity (SIA) for 6 to 59 months old which was conducted in 2 phases – in April 2018 (NCR and Mindanao) and in September 2018 (other parts of Luzon and Visayas).  Despite the efforts of health workers, the SIA campaign had achieved a coverage of 69% during Phase 1 of implementation and 29% in Phase 2.
“I appeal to the public to rebuild your trust and confidence in vaccines that were long proven to be effective, and I am quite sure that all of us sometime in our lives have been recipients of these vaccines which had protected us from various diseases,” Health Secretary Francisco T. Duque III concluded.


Recent Posts