Breaking News – We already have reports of measles cases in at least 120 people from 16 states (California, Florida, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Utah, and Washington) in 2017, including an ongoing outbreak in Minnesota that is now up to 79 cases. Also many reports of measles outbreaks in Europe. (see below)
We have come a long way since the development of the first measles vaccines in the early 1960s…
Pre-Vaccine Era Measles Outbreaks
In the pre-vaccine era, measles was a very common childhood disease.
As it is now, it was also a deadly disease.
In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).
In 1962, there were 469,924 cases of measles in the United States and 432 deaths.
Post-Vaccine Era Measles Outbreaks
The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.
In 1970, there were only 47,351 cases and 89 deaths.
Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.
Post-Elimination Era Measles Outbreaks
Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.
We have seen more than a few records in the post-elimination era, including:
- the year with the historic low number of measles cases – 37 cases in 2004
- the year with the largest number of cases since 1994 – 667 cases in 2014
- the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014
In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.
2017 Measles Outbreaks
The first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person exposed others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.
The second case of 2017 was related to an LA county outbreak that started at the end of 2016 – a resident of Ventura County.
And it goes on already, with other measles cases in 2017 including:
- at least 120 cases (as of mid-August)
- cases in 16 states, including California, Florida, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Utah, and Washington
- an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
- one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
- four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
- a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
- an infant in Suffolk County, New York who had been overseas
- an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
- two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
- two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
- a confirmed case in Omaha, Nebraska, who exposed people on a Delta flight and multiple places in Douglas and Sarpy counties, including the Bergan Mercy Hospital Emergency Room.
- a young child in Macomb Count, Michigan who required hospitalized and has been linked to international travel
- a suspected case at William Allen White Elementary School in Lyon County, Kansas which has led to the quarantine of unvaccinated students for 3 weeks
- an unvaccinated student at Laguna Beach High in Orange County, California, which led to the quarantine of at least 6 unvaccinated students
- a staff member at Discovery Academy of Lake Alfred in Florida
- an unconfirmed case in an infant who attended the College of Staten Island Children’s Center in New York
- two children in Minnesota without a known source of infection
- another child in Minnesota – among the three Somali Minnesotans in this outbreak are two children who are just two years old – all of the cases were unvaccinated and two required hospitalization, although the common source is still not known. Vaccine hesitancy has been a problem among the Somali Minnesotans because of Wakefield‘s MMR study.
- five more unvaccinated children in Minnesota, as the outbreak grows to 8.
- a confirmed case in North Platte, Nebraska who may have exposed others at a middle school, church youth group, the Great Plains Health Emergency Room, a medical office, and a lab.
- a resident of Livingston County, Michigan who exposed others at area restaurants and St. Joseph Mercy Brighton Hospital after getting measles on a plane ride with an unvaccinated child
- another case in Minnesota, bringing the outbreak count to 9 unvaccinated children.
- three more cases in Minnesota, bringing this outbreak case count to 12, with at least 200 people in quarantine.
- four possible cases in Nebraska
- eight more cases in Minnesota, bringing this outbreak case count to 20 young children under age 5 years, and now including an infant under age 12 months.
- four more cases in Minnesota, bringing this outbreak case count to 24 young children under age 5 years and surpassing the size of the 2011 measles outbreak in the Somali community in the same area, which was also mostly among intentionally unvaccinated children.
- five more cases in Minnesota, including the first outside of Hennepin County – spreading to nearby Stearns County, bringing this outbreak case count to 29 young children under age 5 years, with only one that was vaccinated.
- three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
- more measles (2 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and now Le Sueur County), where the ongoing outbreak is up to 66 cases, almost all unvaccinated children and where there has been a call to accelerate the two dose MMR schedule for kids over age 12 months.
- a teen visiting the United States from India who developed measles and exposed others at a hotel and a hospital in Bergen County, New Jersey and in upstate New York.
- a child in Maryland who was admitted to Children’s National Medical Center in Washington, D.C.
- more measles (3 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and Le Sueur County), where the ongoing outbreak that has been confirmed to be from the wild type B3 strain is up to 68 cases, almost all unvaccinated children.
- a case in Pennsylvania who exposed others at a visitor center
- someone who visited the MIT Museum in Cambridge, Massachusetts.
- two new cases in Minnesota, ending speculation that the outbreak, now up to 70 cases, was over…
- one new case in Minnesota, raising the number of cases in this ongoing outbreak to 78 cases.
- a healthcare worker in New York who is employed by Hudson Headwaters Health Network and also works at a Warren County medical practice.
- someone in Franklin County, Maine (their first case in Maine in 20 years!) who traveled out of the country and caught measles, returning home and possibly exposing others at a movie theater, restaurant, farmers market, and hospital.
- A case in Butler County, Kansas. Many remember that one of the largest outbreaks of 2014 was in Kansas.
- an unvaccinated man who lives in Hennepin County, raising the number of cases in this ongoing outbreak (an outbreak that has already cost over $500,000 to contain and which many hoped would soon be over) that started in March to at least 79 cases. With the new case, the clock starts ticking again and Minnesota will have to wait to see if new cases appear over the next 3 weeks.
- passengers from 13 states on an American Airlines flight from New York to Chicago were exposed to a person with measles in early July, including a 12-week-old infant who required preventative treatment with immune globulin (IG), as she was too young to be vaccinated.
- a fully vaccinated resident of Onondaga County, New York who was exposed on a domestic flight, only developed mild symptoms, but did expose others.
- someone who exposed others at the Penn State University Hetzel Union Building Bookstore and other places in State College, Pennsylvania.
- a second case in the Wichita, Kansas area, this time in Sedgwick County, with exposures at a church, dental office, elementary school, and multiple stores over at least 3 days.
- a possible case in Sedgwick County, Kansas, a child too young to be vaccinated who may have been exposed at a church. Three other exposed infants who were too young to be vaccinated and who were considered at risk to get measles in this outbreak received immunoglobulin treatment.
- a traveler who spent time in Hampton Beach in New Hampshire, exposing others.
- the latest case – a 46-year-old male in Ohio that got the disease while traveling internationally.
How many cases will we end up with this year? It is certainly getting off to a quick start, which could mean a big year for measles, although it is certainly hard to predict what will happen.
2016 Measles Outbreaks
Starting slow, 2016 ended as a fairly average year for measles:
- 83 cases
- cases in 17 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
- a large outbreak in Arizona, 23 cases, linked to a private detention center
- a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
- an ongoing measles outbreak in Los Angeles County and Santa Barbara County that has been linked to the Los Angeles Orthodox Jewish community
- a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department
As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.
International Measles Outbreaks
The endemic spread of measles was stopped or eliminated in 2000. Since then, most of the measles outbreaks in the United States begin when someone travels out of the country, gets sick, and exposes others. Or less commonly, when an international traveler brings measles into the country.
That makes it easy to understand that large outbreaks of measles in other parts of the world could increase the risk that we have more outbreaks here. And that’s what happened in 2014 when there was an epidemic of measles in the Philippines and we ended up with the most cases since 1994, many linked to travel to and from the Philippines.
This year, the world is seeing large outbreaks of measles in:
- European Union – Austria (81 cases), Belgium (293 cases, including 2 cases of encephalitis), Bulgaria (161 cases, including one death – a 10-month old unvaccinated child), Czech Republic (130 cases, including 2 cases of encephalitis), Denmark, France (387 cases, including 2 cases of encephalitis and one death), Germany (828 cases, and a death in a 37-year-old mother of 3 children), Hungary (54 cases), Iceland (2 cases. 10-month-old unvaccinated twin siblings – the first cases in Iceland in 25 years!), Italy (3,346 cases – including three deaths), Portugal (31 cases, including one death), Slovakia, Spain (137 cases), and Sweden (19 cases). The largest outbreak is in Romania, where there have been 8,493 cases and 32 deaths in the past 13 months.
- UK – 1006 cases in 2017, including a new outbreak in Newport and Torfaen, Wales.
- Switzerland – the Swiss Sentinel Surveillance Network already reports 68 measles cases in 2017, compared to 36 in 2015 and 65 in 2016. Many of the cases are in young adults, aged 20-24 years. There has been one death, a vaccinated man being treated for leukemia.
- Australia – 60 cases so far in 2017, including an ongoing outbreak at a Waldorf school in Perth
- New Zealand – 15 cases so far in 2017
- Canada – at least 43 cases.
- Japan – 169 cases so far in 2017 (they had 41 at the end of June 2016…)
- DR Congo – over 19,000 cases with 229 deaths
- Guinea – a measles epidemic has been declared in the country, with at least 1,527 cases and 2 deaths this year
- Indonesia – island of Bali
- South Africa – 60 cases, including an outbreak in Gauteng (24 cases) that is linked to one unvaccinated family.
- Republican of South Sudan
- Somalia – over 8,000 cases
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
Updated on August 24, 2017