Tag: elimination

When Was the Last Case of Rubella in the United States?

While we rarely hear about rubella anymore, like most other vaccine-preventable diseases, the last case of rubella in the United States was a lot more recent than you probably imagine.

Austin recently had its first case of rubella in twenty years.

Although endemic rubella and congenital rubella syndrome were declared eliminated in 2004, like measles, we still have cases each year.

When Was the Last Case of Rubella in the United States?

To be sure, rubella is far less common that it used to be.

Remember the rubella epidemics of the 1960s, when rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome?

If natural herd immunity really works, how do you explain congenital rubella syndrome in the pre-vaccine era and in countries that don't use the rubella vaccine?
If natural herd immunity really works, how do you explain congenital rubella syndrome in the pre-vaccine era and in countries that don’t use the rubella vaccine? Why doesn’t everyone get natural immunity when they are younger and rubella is milder, avoiding the chance of getting sick when they are pregnant?

How about the rubella outbreaks in the early 1990s, when rubella caused 13 deaths and 77 cases of congenital rubella syndrome?

“Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS).”

Grant et al on Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination — Worldwide, 2000–2018

One of our problems today is that most people don’t remember these epidemics and outbreaks, so they don’t understand how important it is for everyone to be vaccinated and protected.

They have no idea how fortunate they are that these diseases no longer make routine headlines.

But what happens if too many people skip or delay their vaccines?

Japan is still dealing with a large outbreak of rubella, with resulting cases of congenital rubella syndrome.

We will see more rubella and congenital rubella syndrome.

There were five cases of congenital rubella syndrome in the United States in 2017, all import related.
All five cases of congenital rubella syndrome in the United States in 2017 were import related.

While we do see some congenital rubella cases now, they are all women who were exposed to rubella outside the United States when they were pregnant.

“During 2001–2004, four CRS cases were reported to CDC; the mothers of three of the children were born outside the United States.”

Achievements in Public Health: Elimination of Rubella and Congenital Rubella Syndrome — United States, 1969–2004

Again, since the endemic spread of rubella was declared eliminated in 2004, cases since then are import related. People who aren’t immune get exposed to rubella when they are traveling to areas of the world where rubella is more common and return. Fortunately, since rubella isn’t as contagious as measles, these cases don’t usually cause big outbreaks.

So when was the last case of rubella and congenital rubella syndrome in the United States that wasn’t imported from outside the United States?

It was just before 2004.

Let’s get everyone vaccinated and protected before we see the next case.

More on Rubella and Congenital Rubella Syndrome

Measles Outbreaks in New Zealand

Just like other areas of the world, New Zealand has a problem with measles outbreaks. It shouldn’t be surprising then that they also have a problem with folks pushing anti-vax misinformation.

Where are the areas in New Zealand with 97% MMR vaccination rates?
Where are the areas in New Zealand with 97% MMR vaccination rates? Just askin…

Are they really seeing the most measles cases in the areas with the highest vaccination rates?

Measles Outbreaks in New Zealand

One thing is sure, there are a lot of measles cases in New Zealand.

“From 1 January 2019 to 10 October 2019 there have been 1742 confirmed cases of measles notified across New Zealand. 1416 of these confirmed cases are in the Auckland region.”

2019 NZ measles outbreak information

Do we know which parts of New Zealand have the most measles outbreaks?

We do!

Where are the cases in the measles outbreaks in New Zealand?
The case count is now up to 1742…

Of course, this doesn’t really tell you anything about why some districts have more cases than others…

Is it because they have more unvaccinated people or simply because they have a lot more people?

Many of the measles cases in New Zealand are in infants too young to be vaccinated and in teens and young adults.
Many of the measles cases in New Zealand are in infants too young to be vaccinated and in teens and young adults.

Wherever they live, we know that like measles outbreaks in every other part of the world, few of the folks with measles in New Zealand are known to be fully vaccinated.

And while New Zealand had eliminated home grown-cases of measles just a few years ago, it wasn’t with vaccination rates of 97%.

“For immunisation from measles, rubella and mumps two doses of the vaccine called MMR are needed. Dr McElnay said among New Zealand’s children and infants, 95 percent had had the first dose and 90 percent the full vaccine.”

NZ eliminates NZ-origin measles

Unfortunately, while they were working to get younger kids vaccinated and protected, many older kids and adults are still not vaccinated.

“However, we must remain vigilant and improve our vaccination rates because these diseases can easily spread among unimmunised people from imported cases. In New Zealand, people aged 12 to 32 years have lower vaccination rates than young children so are less likely to be protected against these diseases.”

Measles and rubella officially eliminated in New Zealand

Only about 80% of teens and young adults are fully vaccinated against measles in New Zealand!

Combined with high numbers of folks who were never vaccinated and folks who travel to other parts of the world where measles is still endemic and you have a recipe for disaster.

“While there have been no measles deaths in this outbreak, there have been five pregnant women hospitalised and two fetal losses associated with these events.”

Report investigates high hospitalisation rates for measles in Auckland region

In addition to the two unborn babies who died, there are also reports of at least three hospitalisations for encephalitis.

Two doses of the MMR vaccine is your best protection against measles.

A disaster that could easily be prevented with two doses of a vaccine that is safe, with few risks, and obviously necessary.

More on Measles in New Zealand

The Rockland County Measles Outbreak is Ending

Maybe they don’t want to jinx it or maybe no one else is paying attention, but folks should know that the Rockland County measles outbreak should be very quietly ending this week.

The last new measles case in Rockland County was on August 15.
The last new measles case in Rockland County was reported on August 15.

Wait, don’t you need to go 42 days (two incubation periods) without a new case to declare an outbreak over?

The Rockland measles outbreak will end on September 26, when 42 days have passed since the last new measles case.
The Rockland measles outbreak will end on September 25, when 42 days have passed since the last new measles case.

Yes.

But besides the 16 historical cases which were added on August 26, the last new case in Rockland County was reported on August 15.

Folks were first exposed to an unvaccinated traveler in the Rockland County measles outbreak on September 28, 2018. By mid-November, there were already 68 confirmed cases in the area.
Folks were first exposed to an unvaccinated traveler in the Rockland County measles outbreak on September 28, 2018. By mid-November, there were already 68 confirmed cases in the area.

That means that the Rockland Count outbreak, which started in September 2018, will end, if there are no new cases, on September 25, 2019.

The Rockland County Measles Outbreak is Ending

While it is exciting news that the outbreak is ending, it is even more welcome and exciting that the outbreak is ending this week!

“Outbreaks in New York City and Rockland County, New York have continued for nearly 8 months. If these outbreaks continue through summer and fall, the United States may lose its measles elimination status.”

U.S. measles cases in first five months of 2019 surpass total cases per year for past 25 years

If it had gone any longer, we would have been in danger of losing our status of having eliminated the endemic spread of measles.

Remember all of the talk about medical martial law in Rockland County?

And we would have had to continue to put up with anti-vax propaganda and misinformation that scares parents away from vaccinating and protecting their kids.

Almost all of the measles cases in Rockland County were children and almost all of them were unvaccinated.
Almost all of the measles cases in Rockland County were children and almost all of them were unvaccinated.

Instead, as the outbreak ends, we will hopefully learn some lessons, get more folks vaccinated and protected and move towards having record low numbers of measles cases once again.

Still, the Rockland County measles outbreak, with 312 cases, will end as the longest measles outbreak since the end of the endemic spread of measles in 2000.

With 654 cases, the Brooklyn outbreak, which lasted 11 months and cost over $6 million to contain, gets the record for being the largest measles outbreak in recent history.

More on the Rockland County Measles Outbreak

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