Measles Cases Reach All-Time Annual High Since Elimination in US

As of April 24^th, 2019, the United States has officially documented the greatest number of measles cases in a given year since the disease was declared eliminated in 2000.

The US Centers for Disease for Control and Prevention (CDC) has reported that 704 cases of measles have been detected across 22 states so far this year. The agency attributes the high case counts primarily to a few large outbreaks that have sprung up on the West Coast in Washington State and on the East Coast in both New York City and New York state.

Outbreaks are also being monitored in New Jersey, Michigan, and Butte County, California. On Monday, April 22, the Los Angeles County Department of Public Health released a statement to announce an outbreak investigation following the confirmation of 4 measles cases, which are all linked to international travel. According to the Los Angeles Times, county public health directors made the decision to quarantine hundreds of students and professors at UCLA and Cal State LA for 24 to 48 hours following potential exposure to the contagious disease by a student who returned from international travel.

As of Monday, April 29, 2019, new outbreaks have been declared in Sacramento County along with California, Georgia, and Maryland. Additionally, officials in Clark County, Washington have announced the conclusion of the measles outbreak that documented 71 confirmed cases.

The Los Angeles County outbreak is not the only travel-associated outbreak; in fact, all of the United States outbreaks in 2019 have spurred from travelers who brought the contagious disease into the nation following travel to countries including Israel, Ukraine, and the Philippines, where measles outbreaks are ongoing. In fact, a recent report from the World Health Organization (WHO) indicates a 300% increase in measles cases worldwide, compared with the same period in 2018.

As measles spreads through pockets of unvaccinated individuals and outbreaks grow, public health officials have been struggling to curb transmission in individuals who are not vaccinated. According to the CDC, 1 of the largest barriers to controlling these outbreaks has been the spread of misinformation about the measles, mumps, rubella (MMR) vaccine. This issue has been a “significant factor” that has contributed to the outbreaks in New York, the agency says.

In order to endorse the safety of the MMR vaccine to parents in the United States, several public health agencies have issued statements in the past week.

On April 22, Peter Marks, MD, PhD, director of US Food and Drug Administration’s (FDA) Center for Biologics Evaluation and Research, issued a statement that focused not only on reinforcing the safety of the MMR vaccine, but also the dangers associated with not vaccinating.

“Measles—a respiratory disease that causes a skin rash, fever, cough, and runny nose—can be dangerous, especially for babies and young children. It is one of the most contagious diseases and can cause severe complications, including pneumonia, swelling of the brain and death. In fact, 1 to 2 children out of every 1000 who contract measles dies from complications of the disease and 1 in 4 people who get measles need to be hospitalized,” Marks wrote in the statement.

The statement also notes: “Vaccinating against measles, mumps, and rubella not only protects us and our children, it protects people who can’t be vaccinated, including children with compromised immune systems due to illness and its treatment, such as cancer.”

In a separate statement, Alex Azar, MD, secretary of the Department of Health and Human Services, also reinforced the efficacy of the vaccine, while also lamenting that the suffering of the individuals who have fallen ill with measles this year is avoidable.

“The measles vaccines are among the most extensively studied medical products we have, and their safety has been firmly established over many years in some of the largest vaccine studies ever undertaken,” Azar wrote. “With a safe and effective vaccine that protects against measles, the suffering we are seeing is avoidable…All Americans would be safer and healthier if we received measles vaccines on the recommended schedule.”

With misinformation fueling outbreaks, particularly those in New York, the CDC also recommends that parents of young children communicate with their health care providers about vaccines and that local health leaders take the time to provide accurate information to combat misinformation.

Contagion®, a New Jersey-based publication, recently invited 2 health experts from the state to partake in an Insights series on measles outbreaks and the role of public health. In the series, Glenn Fennelly, MD, MPH, professor and chair of pediatrics at Rutgers New Jersey Medical School and a pediatric infectious disease specialist, and Christina (Tina) Tan, MD, MPH, a state epidemiologist and an assistant commissioner with the New Jersey Department of Health, discussed a number of topics including epidemiology, aversion to vaccinations, and future prevention and management.

“We have to remember that 1 of the big messages that we have to get out there is that there isn’t any evidence that shows vaccines have long-term impact or adverse effects on people,” Tan said in a recent segment. “But you do run the risk of impacting your life with a vaccine-preventable disease. If you’re not vaccinated, you could have long-term sequelae related to, say, encephalitis or related to measles that will last you a lifetime.”

Both Tan and Fennelly endorsed the CDC and the American Academy of Pediatrics websites as resources that provide evidence-based strategies of how to have conversations with parents about the importance of vaccination.

“Public health wants to help providers as well because we know from a lot of research on examining attitudes toward vaccines that parents will always say having that recommendation from the providers is the No 1 source of trusted information, and that’s what influences parents to vaccinate,” Tan added.

Contagion® will continue to monitor the outbreaks and cases in the United States provide updates as they become available.

Case counts for the current outbreaks are available on the Contagion® Outbreak Monitor.