Global & Disaster Medicine

Archive for the ‘Measles’ Category

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.

US: Measles Cases in 2019


Measles Cases in 2019

From January 1 to February 7, 2019, 101** individual cases of measles have been confirmed in 10 states.

The states that have reported cases to CDC are California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, and Washington.

Trends in Measles Cases, 2010-2019

*Cases as of December 29, 2018. Case count is preliminary and subject to change.
**Cases as of February 7, 2019. Case count is preliminary and subject to change. Data are updated weekly.

Measles Outbreaks in 2019

Five outbreaks (defined as 3 or more cases) have been reported in 2019 in the following jurisdictions:

These outbreaks are linked to travelers who brought measles back from other countries such as Israel and Ukraine, where large measles outbreaks are occurring. Make sure you are vaccinated against measles before traveling internationally.

Spread of Measles

  • The majority of people who got measles were 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.

Measles Outbreaks

In a given year, more measles cases can occur for any of the following reasons:

  • an increase in the number of travelers who get measles abroad and bring it into the U.S., and/or
  • further spread of measles in U.S. communities with pockets of unvaccinated people.

Reasons for an increase in cases some years:

  • 2018: The U.S. experienced 17 outbreaks in 2018, including three outbreaks in New York State, New York City, and New Jersey, respectively. Cases in those states occurred primarily among unvaccinated people in Orthodox Jewish communities. These outbreaks were associated with travelers who brought measles back from Israel, where a large outbreak is occurring. Eighty-two people brought measles to the U.S. from other countries in 2018. This is the greatest number of imported cases since measles was eliminated from the U.S. in 2000.
  • 2017: A 75-case outbreak was reported in Minnesota in a Somali-American community with poor vaccination coverage.
  • 2015: The United States experienced a large (147 cases), multi-state measles outbreak linked to an amusement park in California. The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious; however, no source was identified. Analysis by CDC scientists showed that the measles virus type in this outbreak (B3) was identical to the virus type that caused the large measles outbreak in the Philippines in 2014.
  • 2014: The U.S. experienced 23 measles outbreaks in 2014, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio. Many of the cases in the U.S. in 2014 were associated with cases brought in from the Philippines, which experienced a large measles outbreak.
  • 2013: The U.S. experienced 11 outbreaks in 2013, three of which had more than 20 cases, including an outbreak with 58 cases. For more information see Measles — United States, January 1-August 24, 2013.
  • 2011: In 2011, more than 30 countries in the WHO European Region reported an increase in measles, and France was experiencing a large outbreak. These led to a large number of importations (80) that year. Most of the cases that were brought to the U.S. in 2011 came from France. For more information see Measles — United States, January-May 20, 2011.
  • 2008: The increase in cases in 2008 was the result of spread in communities with groups of unvaccinated people. The U.S. experienced several outbreaks in 2008 including three large outbreaks. For more information see Update: Measles — United States, January–July 2008.

See also: The Surveillance Manual chapter on measles that describes case investigation, outbreak investigation, and outbreak control for additional information.

Measles Red Flag in the Philippines

Philippine DOH

he Department of Health (DOH) raised today the red flag for measles in other regions of Luzon, Central and Eastern Visayas aside from yesterday’s declaration in the National Capital Region.

As of 26 January 2019, validated data from CALABARZON was 575 cases with 9 deaths (CFR 2%) (2,538% an increase as compared to 21 cases of 2018), NCR was 441 with 5 deaths (CFR 1%) (1,125% increase as compared to 36 cases of 2018), Region 3 had 192 cases with 4 deaths (CFR 2%) (500% increase compared to 32 cases of 2018), Region 6 with 104 cases and 3 deaths (CFR 3%) (550% increase compared to 16 cases of 2018) and Region 7 with 71 cases with 1 death (CFR 1%) (3,450% increase compared to 2 cases of 2018).

“We are expanding the outbreak from Metro Manila to the other regions as cases have increased in the past weeks and to strengthen surveillance of new cases and alert mothers and caregivers to be more vigilant,” Health Secretary Francisco T. Duque III said.

Other regions showed the number of cases reported at 70 cases with no deaths for MIMAROPA (3,400% increase compared to 2 cases of 2018), Region 1 with 64 cases with 2 deaths (CFR 3%) (220% increase compared to 20 cases of 2018), Region 10 with 60 cases with no deaths reported (4% decrease compared to 63 cases in 2018), Region 8 with 54 cases and 1 death (2% CFR) (5,300% increase compared to 1 case of 2018), Region 12 with 43 cases with no deaths (34% decrease compared to 66 cases of 2018).  These regions should likewise step-up their response against this highly communicable disease, as well as ensure that preventive measures play a vital role in preventing the spread of the disease; these must be emphasized to mothers and the general public as a whole.

Measles is a highly contagious respiratory disease caused by a virus. It is transferred from person-to-person by sneezing, coughing, and close personal contact. Its signs and symptoms include cough, runny nose, red eyes/conjunctivitis, fever, skin rashes lasting for more than 3 days.

The disease’s complications included diarrhea, middle ear infection, pneumonia (infection of the lungs), encephalitis (swelling of the brain), malnutrition, blindness which may lead to death.

“Supportive measures like building the nutritional status of the sick person and increasing oral rehydration are important measures to increase body resistance and replace lost body fluids caused by coughing, diarrhea, and perspiration,” Duque said, adding that immunization and vitamin A supplementation of nine-month old children and unvaccinated individuals are the best defenses against measles.
The DOH is advising mothers, the public to bring their children at the first sign of fever to the nearest health facility for prompt treatment and proper case management.


Recent Posts