Tag: measles outbreaks

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
  • Chad – at 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

How Do You Know If You Have Measles Immunity?

With all of the measles cases, you might be wondering if you have immunity to measles?

Are you worried that you might get measles?

Should you get a booster dose of MMR?

Or a titer test?

How Do You Know If You Have Measles Immunity?

Fortunately, most of us can feel confident that we do have measles immunity and that we won’t get caught up in any of the ongoing outbreaks.

Why?

If you have had two doses of MMR, then you can be confident that you have measles immunity.
If you have had two doses of MMR, then you can be confident that you have measles immunity.

Because we are vaccinated and protected!

If you haven’t had two doses of MMR (or any measles containing vaccine since 1967), then understand that two doses is your best protection against measles.

Is There a Blood Test for Measles Immunity?

What about titer tests?

While there is a blood or titer test for measles immunity, it isn’t routinely used.

The one situation in which a measles titer test might be useful though, is for those born before 1957 to confirm that they really had measles.

For others considering a titer test in place of vaccination, it is typically better to just get another dose of MMR, but only if you haven’t already had two doses.

Why Was My Measles Titer Negative?

A positive measles titer does mean that you are immune, but what about a negative measles titer?

“For HCP who have 2 documented doses of MMR vaccine or other acceptable evidence of immunity to measles, serologic testing for immunity is not recommended. In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing.”

Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

If you have had two doses of MMR and have a negative measles titer, you don’t need another dose of MMR. You are likely immune, even with that negative titer.

“Most vaccinated persons who appear to lose antibody show an anamnestic immune response upon revaccination, indicating that they are probably still immune.”

Epidemiology and Prevention of Vaccine-Preventable Diseases

And since you would need a second dose if you had a negative titer after having just one shot, you might as well just get the second dose instead of checking your titer.

Do You Need a Measles Booster?

Have you had two doses of MMR?

If so, then you don’t need another dose.

The second dose isn’t technically a booster anyway. It is just for those who might not have responded to their first dose.

And two doses of MMR are about 97% effective at preventing measles.

That’s why most of the people in measles outbreaks are unvaccianted.

Neither primary nor secondary (waning immunity) vaccine failure are common with the measles vaccine.

What’s the biggest issue with the MMR? Folks who are still too scared to get their kids vaccinated and protected!

More on Measles Immunity

How Much Shedding Would a Vaccine Shed…

Are you still confused about vaccine shedding?

You should be worried about wild diseases, not shedding from vaccines.
You should be worried about wild diseases, not shedding from vaccines.

As this infographic describes, it really isn’t that complicated…

What Does Vaccine Shedding Really Mean?

To clear up some things:

  • yes, some vaccines do actually shed, but it is rarely a reason to avoid getting vaccinated and protected
  • of the vaccines that we use routinely, shedding is limited to the rotavirus vaccines, FluMist, and the chickenpox vaccines
  • some other vaccines that can shed include the oral polio vaccine and the smallpox vaccine
  • the rubella component of MMR may very rarely shed, but only in breastmilk

If vaccines do shed, why shouldn’t we be more concerned about it?

Well, for one thing, most vaccines don’t shed.

DTaP, hepatitis A, hepatitis B, Hib, flu, IPV, HPV, meningococcal, pneumococcal, and Tdap shots – none of them shed.

And then there is the fact that:

  • when a vaccine sheds, it is the weakened or attenuated vaccine strain, not the wild strain that would cause more serious disease. Putting it another way, if the vaccine strain doesn’t make the person who is getting immunized sick, then why would it get someone else sick if they got it through shedding? Of course, there is a situation in which even a vaccine strain could be dangerous, and that’s for those who are severely immunosuppressed. Still, natural disease would be bad for these kids too!
  • even with oral polio vaccines, the problem isn’t really shedding, which actually provides a type of passive immunization in areas where polio is still not well controlled. The problem is that very rarely, the attenuated virus in the oral polio vaccine can revert to a form that can cause the person who was vaccinated to actually develop polio (VAPP). Now, shedding of this strain would be a problem, but only if the other person wasn’t immune.
  • rotavirus vaccines only shed in stool. You can avoid it by washing your hands when you change your child’s diapers, which you hopefully do anyway.
  • FluMist is attenuated and cold-adapted, which means that it won’t replicate well in our warmer nasal passages and respiratory tracts.
  • you have to actually get a rash, which is rare, for the chickenpox vaccine to shed.
  • it is only kids with eczema that usually get sick if they are exposed to someone who recently had the smallpox vaccine. Since the smallpox vaccine causes skin reactions, even the attenuated vaccine strain can cause severe reactions if a child’s skin is already broken down, like with eczema.

Are you still concerned about shedding?

Can a Vaccinated Person Transmit Measles Through Shedding?

To put your mind at ease, understand that you are not going to get measles from shedding.

“In this systematic review, we have determined that there have been no confirmed cases of human-to-human transmission of the measles vaccine virus.”

Greenwood et al on A systematic review of human-to-human transmission of measles vaccine virus

Well, at least not from someone who was recently vaccinated shedding a vaccine-strain of measles…

If you aren’t vaccinated and protected, you could easily get it from someone who has measles and who is shedding the wild type virus though. Measles is so contagious, you just have to be in the same room as someone with measles and you will likely get sick. In fact, you can enter a room a few hours after they have left and sill catch measles!

And in theory, if someone developed vaccine-associated measles – they got sick with a vaccine-strain of measles after getting vaccinated – then they could spread the virus to someone who wasn’t immune. That’s just because they would be contagious though, not anything specific to vaccines and shedding. Also, it is basically unheard of for this to happen.

Dectecting vaccine strain measles in urine isn't something to be concerned about because it can't lead to an infection. Measles is spread through respiratory secretions, not urine.
Dectecting vaccine strain measles in urine isn’t something to be concerned about because it can’t lead to an infection. Measles is spread through respiratory secretions, not urine.

What about all of those folks who test positive for vaccine-strain measles during an outbreak?

That’s not about shedding either.

They aren’t even people with measles. Instead, they typically have a vaccine reaction, a rash and/or fever after getting their MMR and they test positive for the vaccine strain of measles because they just got a live virus vaccine.

Is Vaccine Shedding a Threat?

Shedding isn’t the threat that anti-vaccine folks make it out to me.

Think about it. If it really was a big problem, then why don’t more intentionally unvaccinated kids with exemptions get sick when they are around kids who are vaccinated?

“Health officials should require a two-week quarantine of all children and adults who receive vaccinations. This is the minimum amount of time required to prevent transmission of infectious diseases to the rest of the population, including individuals who have been previously vaccinated.”

Sally Fallon Morell, president of the Weston A. Price Foundation

We don’t actually quarantine anyone after they are vaccinated, so why don’t more kids with immune system problems get sick via shedding?

Or just think about what happens in a typical daycare or school. All of the kids don’t get vaccinated on the same day, so if shedding was an issue, wouldn’t the kids who had gotten their vaccines first shed on the ones who weren’t yet vaccinated, getting them sick?

Of course, this doesn’t happen. Again, shedding isn’t the threat that anti-vaccine folks make it out to be.

More on Vaccine Shedding

Mapping the 2019 Measles Outbreaks

Cases of measles continue to rise, as we pass 1,000 cases in the United States.

2019 Measles Outbreaks

With a record high number of cases, there are measles cases and outbreaks in 29 states, including:

Arizona1Massachusetts2
California49Michigan44
Colorado1Mississippi1
Connecticut3Missouri1
Florida2Nevada1
Georgia3New Hampshire1
Hawaii2New Jersey13
Idaho1New York702
Illinois7Oklahoma4
Indiana1Oregon11
Iowa2Pennsylvania6
Kentucky2Tennessee3
Maine1Texas14
Maryland4Virginia1
Washington80

What’s the first thing you notice about this measles outbreaks?

Where Are the Measles Outbreaks

They aren’t spread out evenly through the United States.

A simple tilegram of the United States.
A simple tilegram of the United States.

In fact, the largest outbreaks are clustered in just a few states, including California, Michigan, New York (Rockland County and Brooklyn), and Washington (Pacific Northwest Outbreak and the Puget Sound Outbreak).

Mapping the 2019 Measles Outbreaks

What does that look like when you map it?

It looks a little strange…

A tilegram mapping the 2019 measles outbreaks in the United States.
A tilegram mapping the 2019 measles outbreaks in the United States.

And that’s because, amazingly, about 70% of cases this year are in just one state – New York!

But that doesn’t mean that you don’t have to be concerned if you don’t live in New York. After all, measles is on the rise all over the world and it is still just a plane ride away. And there are plenty of other communities with low immunization rates where folks are at risk for outbreaks.

Also consider that even without the big outbreaks, this would still rank as a big year for measles.

Bottom line?

Get vaccinated and protected and stop the outbreaks. The MMR vaccine is safe, effective, with few risks. And it is obviously necessary.

More on Mapping the 2019 Measles Outbreaks