Tag: elimination

The Myth That Measles Never Left

Measles cases are on the rise. Where? Pretty much everywhere. But some folks are still pushing the myth that measles never left.

The highest number of measles cases in over 25 years? Don't call it a comeback?
Don’t call it a comeback? Cases in the US average 283 cases per year over the past 12 years (if you don’t skip 2019…)

It is easy to see that measles myth, like most AV myths, isn’t true.

The Myth That Measles Never Left

In the pre-vaccine era, everyone would get measles.

That translates into about 500,000 reported cases each year. Technically, it was likely closer to about 4 million cases in the United States each year, but either way, we know that lots of people got measles.

Then we got a measles vaccine and not surprisingly, cases of measles dropped. Except for a small uptick from 1989 to 1991, we were on our way to eliminating measles.

And we did, in 2000, when the endemic spread of measles was eliminated in the United States. From then on, all measles cases were imported.

In 2004, we had an historic low of just 37 measles cases in the United States!

Will we ever have fewer than 37 cases in a year?
Will we ever have fewer than 37 cases in a year?

And from 2000 to 2012, we averaged just 87 measles cases each year, which is far below the US average of 283 cases we are now seeing.

No, measles never completely left. It was not eradicated.

But it is certainly making a comeback and soaring to levels that we haven’t seen since 1992!

Just think about it… We had 37 cases of measles in 2004 and this year, we often had 37 cases in a single week!

Get vaccinated and protected so that you don’t get caught up in the next outbreak.

More on Measles Cases

Why Are Vaccinated Australians Now Catching Measles?

Measles is on the rise in Australia, like many other places. But why are vaccinated Australians now catching measles?

More vaccinated Australians are catching measles because there is more measles in Australia.
More vaccinated Australians are catching measles because there is more measles in Australia.

And has this got folks thinking it is because the disease is evolving?

Why Are Vaccinated Australians Now Catching Measles?

Well, apparently it has some folks thinking that.

Remember, Andrew Wakefield has also been talking about mutant measles.

Is that what this story in Australia was about?

No.

“In recent years, 13 Victorians have been hospitalized with measles despite having one or two vaccinations that should have made them immune. Why? Well, experts believe that because measles is so rare in Australia, we pretty much never come into contact with it, so our immune systems are starting to let their guards down and wane a little bit.”

Nathan Templeton on Measles Immunity Concerns

What is he talking about?

It’s the idea of exogenous boosting from being around natural infections. In other words, after you become immune from being vaccinated, you could get a boost in your immune protection if you are around someone with the disease.

“The exogenous boosting (EB) hypothesis posits that cell-mediated immunity is boosted for individuals reexposed to varicella-zoster virus (VZV).”

Talbird et al on Understanding the role of exogenous boosting in modeling varicella vaccination.

While this is thought to happen with chickenpox, we aren’t sure if it happens with measles.

It might, but the “problem” is that it is known that folks can have an amnestic response, so can be immune even though they have low antibody levels.

Mostly though, it is important to keep in mind that most of the people who get measles are unvaccinated, often intentionally unvaccinated.

“The key to measles elimination is increasing vaccination coverage and monitoring of measles antibody status for all ages, as well as enhancing surveillance of both domestic and overseas incidences.”

Inaida et al on Measles elimination and immunisation: national surveillance trends in Japan, 2008-2015.

So how many vaccinated Australians are getting measles?

Overall, there are 154 cases of measles in Australia so far this year.

“In Australia, the majority of measles cases are due to unvaccinated individuals becoming infected while travelling to countries in which measles is either common or there are outbreaks occurring. As measles is highly contagious, these people can then spread the disease to others, causing outbreaks, often before they are aware that they have the virus.”

Australia’s Measles Outbreaks 2019

And just as in the United States and most other countries, most of their outbreaks are started by folks who are unvaccinated.

More on Measles in Australia

When is Measles Season?

For a while, especially once we eliminated the endemic spread of measles, we weren’t thinking about measles seasons anymore.

In addition to the recent rise in measles cases, this slide shows the patterns of measles seasons in different parts of the world.
In addition to the recent rise in measles cases, this slide shows the patterns of measles seasons in different parts of the world.

Unfortunately, with ongoing outbreaks and rising cases, many people are asking again – just when is measles season?

When is Measles Season?

Traditionally, the time when measles case counts are the highest occurs:

  • during the late winter and early spring (temperate climates, like the United States)
  • after the rainy season (tropical climates)
  • when kids are in school

So just like flu season, it’s always measles season somewhere…

And in areas of the world where measles is still highly endemic, you can expect cycles of larger measles epidemics every 1 to 4 years.

Can you guess why?

“As higher uniform population immunity is achieved the scale of epidemics, both their duration and absolute number of cases, progressively decreases. Epidemic frequency simultaneously decreases with increasing time intervals between epidemics. Another uniform feature as elimination is approached is the loss of epidemic seasonality.”

Durrheim et al on Measles – The epidemiology of elimination

I’ll give you a hint – there is nothing different about the measles virus during those years.

Eventually though, as the number of people susceptible to measles builds up, there is the opportunity for bigger outbreaks. Of course, that doesn’t happen if most people are vaccinated and protected.

When is Measles Season in the United States?

What about in the United States in the post-vaccine era?

Visiting a place with a lot of measles, especially if you aren't vaccinated and protected, increases the risk that you will bring measles home with you and start an outbreak.
Visiting a place with a lot of measles, especially if you aren’t vaccinated and protected, increases the risk that you will bring measles home with you and start an outbreak.

We don’t really have a measles season, as all of our cases are now imported from other parts of the world.

  1. Where and when are folks traveling?
  2. Where is measles on the rise?

That’s when we will see more measles cases here.

“Source countries included Philippines (14 cases), Ukraine (8), Israel (5), Thailand (3), Vietnam (2), Germany (2), and one importation each from Algeria, France, India, Lithuania, Russia, and the United Kingdom.”

Increase in Measles Cases — United States, January 1–April 26, 2019

In the early part of 2019, we saw a lot of cases because unvaccinated travelers were returning from Philippines, Ukraine, and Israel, countries in peak measles season.

Are Europe's measles outbreaks slowing down yet?
Are Europe’s measles outbreaks slowing down yet?

As cases in those countries hopefully slow down over the summer, unfortunately, we might see a rise in other parts of the world.

Of course, there is an easy way to end our measles seasons once and for all.

Two doses of MMR is your best protection against measles.

Get vaccinated and protected, especially before traveling out of the country.

More on Measles Season?

How Many People Have Died from Measles in 2019?

As measles cases climb, some folks are interested in just one thing, how many people have died from measles this year?

A lot of people are dying from measles this year.
A lot of people are dying from measles this year.

The rest of us?

We understand that as we see more and more cases, it simply increases the chances that someone might eventually die.

How Many People Have Died from Measles in 2019?

So far, we have been very lucky that there have been no measles deaths, even as we pass 1,000 cases.

Not that 1,000 cases is some magic number where you start to see deaths.

Consider that we only had 188 cases in 2015, when we had the last measles death in the United States. That year, a woman got caught up in a small outbreak in Washington.

Where Are People Dying of Measles in 2019?

There are also many countries with rather small numbers of cases that are seeing measles deaths.

The last death in France, in April 2019, occurred after only 852 cases were reported.

In Romania, the first death of 2019, in January, came after just 133 cases.

Measles acts quickly. Do your part to protect yourself and others.

And since the outbreaks in Europe started in 2016, there have been deaths in:

  • Bulgaria – only 416 cases
  • Portugal – only 202 cases
  • Spain – only 457 cases
  • Switzerland – two deaths and only 197 cases!

Of course, there are more deaths in countries that are seeing more cases.

Again, since 2016:

CountryDeathsCases
Romania5917,850
Greece43,270
Italy139,277
France44,138
UK12,000
Germany12,000
Israel24,256 (since 2018)
Ukraine1752,034 (2019)
Serbia155,797 (since Oct 2017)
Brazil1219,036 (since 2018)
Tunisia303,141 (2019)
Malaysia62,129 (since 2017)
Thailand235,893 (since 2018)
Guinea141,359 cases (2019)

And a lot more deaths in some countries:

  • Madagascar – at least 1,233 reported deaths among 122,840 registered cases
  • Philippines – at least 389 deaths in 2019, with over 30,000 cases.
  • Venezuela – at least 134 deaths since 2017, with over 9,585 cases
  • Democratic Republic of Congo – at least 1,460 deaths this year, with over 84,000 cases
  • Nigeria – at least 89 deaths this year, with nearly 29,000 cases
  • Chadat least 191 deaths this year, with over 18,000 cases

Measles is on the rise.

Measles deaths are on the rise too. While the risk of complications of measles can be reduced with vitamin A treatment, that doesn’t eliminate them. And the benefit is mostly in those who are already vitamin A deficient. Vitamin A has a much more modest effect in developed countries, where measles deaths still occur.

What to reduce your child’s risk of dying from measles?

Get them vaccinated and protected.

Tragically, this all comes after we were making progress towards measles elimination, reaching a record low for global cases and deaths just a few years ago.

How will we respond? An even stronger effort to finally get measles under control? Or continued worsening, with more cases and more deaths?

More on How Many People Have Died from Measles in 2019