Breaking News – Although there is not one, multi-state outbreak, we already have reports of measles cases and exposures in at least 131 people in 27 states, including Arkansas (1), Arizona (1), California (9), Connecticut (3), Florida (11), Illinois (3), Indiana (1), Iowa (1), Kansas (22), Louisiana (1), Maryland (1), Massachusetts (2), Michigan (3), Minnesota (3), Missouri (10), Nevada (1), New Jersey (3), New York (7), North Carolina (2),
North Dakota (1), Oklahoma (4), Oregon (5), Pennsylvania (3), South Carolina (1), Tennessee (1), Texas (10), Virginia (1), Washington (2), and Wisconsin(1), and the District of Columbia (1) in 2018. Also many reports of measles outbreaks in Europe.
We have come a long way since the development of the first measles vaccines in the early 1960s…
2018 Measles Outbreaks
We were only a few days into the new year when we had our first measles case of 2018, a new student at IU Bloomington, in Indiana. The student had traveled through Newark Liberty International Airport on their way to Indiana.
The next case occurred when a passenger on an international flight landed at Chicago’s O’Hare International Airport and left on a domestic flight to Arkansas (January 10).
In Arkansas, the person exposed at least 150 people at the University of Arkansas for Medical Sciences (UAMS) emergency department and other areas of Little Rock on January 10 and 11.
And it goes on already, with other measles cases in 2018 including:
- another case in Illinois that is unrelated to the case at O’Hare, although this one was also at the airport (on January 9) while contagious and at other places in Skokie and Evanston, outside of Chicago, Illinois.
- an unvaccinated person in Waxahachie, Texas (just south of Dallas), who may have exposed others at a movie theater on January 9.
- five more cases, all unvaccinated, in Ellis County, Texas that are linked to the original case in Waxahachie
- a graduate student at Carnegie Mellon University in Pittsburgh, Pennsylvania and exposed others on campus in late January and on several Port Authority of Allegheny County buses
- a case in Norman, Oklahoma that is related to international travel and who exposed others at Chuck E Cheese, a pediatrician’s office, and the Norman Regional HealthPlex
- a tourist from Australia exposed people at the The Metropolitan Museum of Art, Watchtower Education Center, an Urgent Care, and ER and a number of hotels around New York between February 16 and 21
- an unvaccinated student who returned from a trip to Europe and developed measles, exposing others between February 28 through March 2 in Santa Clara County, California at a school in Campbell and the Westgate Center food court.
- a traveler who arrived at Detroit Metropolitan Wayne County Airport (DTW) on March 6 and visited an urgent care center in Washtenaw County. No word yet on which airline or flight the person was on.
- at least three infants who are too young to be vaccinated in Johnson County, Kansas have measles. No word on how they were exposed yet.
- a young child arriving from Brussels to Terminal B at Newark Liberty International Airport in New Jersey on March 12, departing from Terminal C for Memphis, Tennessee
- there are at least four more cases of measles in an ongoing outbreak in and around Kansas City, bringing the total to seven cases, including six cases associated with a daycare, and multiple exposures in Olathe, Paola, Kansas City, Overland Park, and Garner, Kansas between March 2 through March 10
- The Kansas Department of Health and Environment (KDHE) now reports that ten cases have been identified in an ongoing outbreak associated with a daycare – eight Johnson County residents, one Linn County resident associated with the daycare and one Miami County resident not associated with the daycare.
- a case in St. Louis County, Missouri who exposed others on March 13 at The Magic House, St. Louis Children’s Museum and Racanelli’s New York Pizzeria in Kirkwood, and on March 14 Homewood Suites in Chesterfield.
- 3 more cases in Kansas, bringing the total to 13 cases in this ongoing outbreak, with 11 cases in Johnson County, 1 case in Linn County, and 1 case in Miami County.
- another case in the Kansas City, Missouri area, this one following international travel and with exposures on March 19 and 22 at an area restaurant and a CVS pharmacy.
- a fully vaccinated student at the University of Nevada, Reno who exposed others in Washoe County between March 27th to April 2nd on the UNR Campus and other places in Sparks and Reno, including a CVS Minute Clinic and the UNR Student Health Center.
- two more cases in the ongoing Kansas outbreak, bringing the case count to 15, which we have now learned began when an infant who was too young to be vaccinated traveled to Asia.
- a case in Tulsa, Oklahoma, linked to international travel, who exposed others from March 30th to April 3rd in multiple locations.
- five more cases in the San Francisco Bay Area of California, linked to an earlier outbreak, bringing the total to 7, including the case at the UNR Campus, which is linked to this outbreak. The outbreak began when an unvaccinated traveler returned from Europe with measles and all California cases are unvaccinated.
- a tourist from the United Kingdom who may have exposed others to measles in New Orleans in early April.
- another case in the Kansas City area on April 12 that is reportedly not linked to the ongoing outbreak in the JoCo area.
- two new cases in the Kansas City, Missouri area, bringing the total in that outbreak to 3, including an elementary school student who was apparently already in quarantine.
- three more cases in the Kansas City area, bringing the case count to 18, including 14 Johnson County residents, 3 Linn County residents and 1 Miami County resident.
- two cases in New York, tourists from Europe who visited the Kingdom Hall of Jehovah’s Witness in Brooklyn (April 15), the Watchtower World Headquarters in Tuxedo Park (April 16), and the Watchtower Education Center in Patterson (April 17)
- a visitor from another state with measles went to Wisconsin and exposed folks in La Crosse, Onalaska and Galesville between April 13 to 18.
- someone with measles from Missouri exposed others in Iowa on April 13 (Des Moines) and April 16 (Panera Bread)
- two infants in New Haven County, Connecticut who had traveled out of the country and may have exposed others between April 11 to 17.
- someone with measles visited Minnesota and exposed people on April 13 (Winona) and April 16 (Albert Lea)
- two more cases in Clay County, Missouri, a student at South Valley Middle School (exposed others on April 18) and a student at Liberty North High School (no exposures), bringing the total number of cases to 22 in the Kansas City area, although it is unclear how they are all related (? two outbreaks)
- a case in Santa Clara County, California that is unrelated to 5 other cases in the area
- an adult at Derynoski Elementary School in Southington, Connecticut who may have exposed others on April 26, 27, and 30. This case comes a few weeks after two infants with measles exposed others in neighboring New Haven County.
- a case in Fresno County, California who was infected in another state, exposing others at an urgent care center (April 30) and emergency room (May 2). Is this the same person who exposed folks at the Taco Bell in nearby Kern County on April 30th? And the case in San Luis Obispo County?
- three cases in Putnam County, New York who exposed others at the Watchtower Educational Center in Patterson (April 26 and 27), the Museum at the Watchtower World Headquarters in Tuxedo Park (April 27), Red Line Diner in Fishkill, a Subway restaurant (April 29) in Patterson and a grocery store (May 1) in Brewster. These cases are related to the Jehovah’s Witness exposures in mid-April, bringing the case count in that outbreak to five.
- a case in western New York, a traveler from Europe, who exposed people in Elmira and Leroy (April 30), Niagara Falls (May 1 and 2), and Dansville (May 2). Is this the same case that exposed folks in Monroe on April 29?
- exposures in Williamsport and Port Trevorton, Pennsylvania (May 2) related to a tour bus traveling from Niagara Falls, New York to Washington, D.C.
- a visitor to Pottawatomie County, Oklahoma who exposed people in Shawnee on April 27 and 28.
- a resident of Bergen County, New Jersey who exposed others in Englewood (April 24 to May 2), Newark Liberty International Airport (May 2), and Columbia (April 30)
- a unvaccinated resident of New Orleans, Louisiana who had recently traveled out of the country
- someone in Maryland who had recently traveled out of the country and exposed others to measles at Washington Dulles International Airport (May 15) and in Gaithersburg (May 17) and Rockville (May 18)
- four people in Florida, including two unvaccinated people who traveled out of the country and two people from out of state who visited Florida while contagious.
- a case related to international travel in Oklahoma City
- a case in Illinois, who exposed others at the Honeygrow restaurant in Chicago on June 12
- a case related to international travel in Wake County, North Carolina, when an unvaccinated resident exposed people at multiple places between June 8 to June 13, including the Duke University Hospital Emergency Department
- a case in Michigan related to international travel, with exposures on June 12 and 14 at the Detroit Metropolitan Wayne County Airport and in Ann Arbor
- a case in New Jersey related to international travel, with exposures on June 12 to 15 in Mount Laurel, Camben, Moorestown, and Marlton.
- an additional case in Wake County, North Carolina, where six people are still in quarantine in an outbreak that started in early June
- a case in Multnomah County, Oregon related to international travel, with exposures at an ER (Adventist Health Portland) and a child care center in Gresham, including at least 40 unvaccinated people.
- a second case in New Jersey associated with an outbreak in mid-June, with new exposures in Westmont (June 26) and Marlton (June 27).
- a second case in Oregon, reportedly already in quarantine, associated with an outbreak at a Gresham child care center that began in late June.
- a child visiting from out of the country as part of a summer program, who exposed their host family and many others in Washington, including multiple exposures in Monroe (June 20 to 21, June 24, and June 27), Everett (June 22 to 23), and Redmond (June 27).
- another case in Oregon, as the Gresham childcare center measles outbreak grows to three cases, but there may not be any additional exposures as the person was unvaccinated and already in quarantine.
- an unvaccinated person in Cook County, Illinois who traveled out of the country and got measles, returning to expose others in Chicago (July 13) and Mt. Prospect (July 14)
- two residents of Michigan, one who returned from an international trip while contagious with measles, exposing others at Detroit Metropolitan Wayne County Airport (July 18)
- an international traveler to Boston, Massachusetts, who exposed people at a Tasty Burger (July 19) and at Logan Airport (July 20)
- an unvaccinated 5-year-old in Minnesota who was infected after international travel and required hospitalization during his illness
- someone in Georgetown County, South Carolina – the first case in the state since 1997.
- a case in Oregon who exposed people at multiple locations in Portland and Beaverton (July 30 to Aug 5) including at PDX Airport and on the Max Red Line.
- an unvaccinated child in Pinellas County, Florida and it is unclear where the child was exposed.
- two more cases, both unvaccinated, in Pinellas County, Florida, bringing the total number of measles cases in this outbreak to at least three, not including the person(s) who triggered the outbreak
- a tourist in Arizona who exposed other people while visiting Sedona and Kingman (Aug 6 to Aug 8)
- a tourist (is this the same tourist from Arizona?) in Santa Monica, California who exposed people to measles at multiple restaurants and hotels (Aug 8 to 10)
- a second case of measles in Portland, Oregon who exposed others at the Portland International Airport (August 17) and an area restaurant (August 18)
- a case in Massachusetts, with exposures at Logan Airport Terminal B in Boston (August 15), Lexington (August 16 and 19), and Burlington (August 20 and 21), and was apparently admitted to the Lahey Hospital & Medical Center
- an unvaccinated person who had traveled out of the country and returned with measles to Plano, Texas with exposures at Plano West Senior High School (August 14-16) and Whole Foods (August 14)
- a case in King County, Washington who got measles when traveling to Asia and exposed others at Sea-Tac Airport (August 21) and the Emergency Department at Harborview Medical Center in Seattle (August 21)
- a case in Loudoun County, Virginia with exposures in Purcellville (August 17) and Lansdowne (August 20)
- a case in Pennsylvania with exposure at the Emergency Room check-in area at Penn State Health Milton S. Hershey Medical Center (August 18)
- a suspected case of measles in a toddler in Texas who had recently traveled overseas and is being treated at Texas Children’s Hospital in Houston
- four more cases in Pinellas County, Florida, bringing the case count in this outbreak to seven, all unvaccinated
- an unvaccinated child in Hennepin County, Minnesota who had recently traveled out of the country
- a case in Dallas County, Texas who exposed others at a hotel and 5 restaurants between August 14 to 17
a case in Burleigh County, North Dakota, with exposures at three schools, a church, a supermarket, and during mass at Baptist Health Care Center, all during August 20 to 26, leading to at least 27 unvaccinated children being kept out of school– this person ended up testing negative
- someone in Dallas, Texas who flew back and forth to Harlingen, through Houston Hobby airport, on Southwest Airlines while contagious (August 21 to 22)
What kind of measles year will 2018 turn out to be?
These outbreaks are a great reminder to review the special vaccine travel requirements, including that adults who “plan to travel internationally should receive 2 doses of MMR at least 28 days apart,” that infants traveling abroad can get their first dose of MMR as early as age 6 to 11 months, with a repeat dose at age 12 months, and that “children aged who are greater than or equal to 12 months need 2 doses of MMR vaccine before traveling overseas,” even if they aren’t four to six years old yet.
For More Information On Measles Outbreaks:
- CDC – Measles Cases and Outbreaks
- Measles Timeline – History of Measles and MMR Vaccination
- Measles Deaths in the United States
- Costs of a Measles Outbreak
- CDC – Measles Outbreak — Minnesota April–May 2017
- CDC – Make Sure You’re Protected against Measles before International Travel
- Anti-Vaccine Movement Causes Worst Measles Epidemic In 20 Years
- Over Half Of Measles Cases In U.S. Outbreaks Are Often Intentionally Unvaccinated
- Anti-vax communities get measles : Outbreaks linked to denial of vaccines
- NYT – How the Anti-Vaxxers Are Winning
- ECDC – Epidemiological update: Measles – monitoring European outbreaks
- Multnomah County Clinician Alert: Measles cases 2018
- Possible measles exposure in the Kansas City, Missouri area
- Measles cases identified on both sides of the state line
Updated on September 6, 2018