Tag: measles strains

Was the Measles Outbreak in Michigan Caused by Vaccine-Strain Measles?

Anti-vaccine folks are pushing some new misinformation about measles outbreaks.

Was the Measles Outbreak in Michigan Caused by Vaccine-Strain Measles?

What is it this time?

The Michigan measles outbreak was not caused by a vaccine strain of measles.
The Michigan measles outbreak was not caused by a vaccine strain of measles.

Vaccine-strain measles?

Causing an outbreak?!?

Since a vaccine-strain has never triggered an outbreak before, you would think these folks would be a little more skeptical about this “news.”

So what’s the real story?

“The Michigan Department of Health and Human Services (MDHHS) is reducing the statewide count of measles for 2019 to 39 following further testing of two of the cases.”

State measles cases reduced to 39 following additional testing

So there is a hint of truth to their new rumor…

“One child in Washtenaw County had been potentially exposed to measles and that child, along with an Oakland County child, had both been recently vaccinated. Their symptoms and initial test results classified them as measles cases. Per the Centers for Disease Control and Prevention (CDC) protocol, additional genotype testing was conducted and determined they were not measles cases. “

State measles cases reduced to 39 following additional testing

On further testing though, they didn’t have wild strain measles. They had a vaccine strain – because they had recently been vaccinated.

These two kids likely had a fever and rash and because they had recently been exposed to measles, it was initially assumed that they had measles. That was likely a safe bet in the middle of a large measles outbreak.

But as often seems to happen, anti-vaccine folks get confused by vaccine reactions and vaccine associated measles.

So they didn’t have measles induced by the vaccine. They had a simple vaccine reaction, with a fever and rash.

What’s the difference? All of the other symptoms of measles!

The Southeast Michigan outbreak, which included 44 cases, began in mid-March.
The Southeast Michigan outbreak, which included 44 cases, began in mid-March.

As ridiculous as it is to have to say this, the Michigan measles outbreak was not canceled. And like other outbreaks, the Michigan measles outbreak was not caused by a vaccine or shedding.

More on the Michigan Measles Outbreak

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?

Is Measles Still Eliminated in the United States?

Do you remember when measles was eliminated in the United States?

You probably should.

Remember when we eliminated measles and we used to only have about 100 cases of measles in the United States each year?
Remember when we eliminated measles and we used to only have about 100 cases of measles in the United States each year? Pensacola News Journal July 2000

It wasn’t that long ago…

When Measles Was Eliminated in the United States

After several years of declining numbers of measles outbreaks in the United States, the endemic spread of measles was declared eliminated in March 2000.

“The data indicated that, during 1997–1999, measles incidence has remained low (<0.5 cases per 1,000,000 population) and that most states and 99% of counties reported no measles cases. In addition, measles surveillance was sensitive enough to consistently detect imported cases, isolated cases, and small outbreaks. Evidence of high population immunity included coverage of >90% with the first dose of measles vaccine in children aged 19–35 months since 1996 and 98% coverage among children entering school. In 48 states and the District of Columbia, a second dose of measles vaccine is required for school entry. A national serosurvey indicated that 93% of persons aged >6 years have antibody to measles.”

Measles — United States, 1999

What did that mean?

It is easy to understand when you note that we still had 86 cases of measles in the United States that year.

So, measles wasn’t gone yet. It was just that most cases were imported from outside the country. Only imported strains of the measles virus were causing outbreaks.

“The end of endemic measles transmission in the United States has both domestic and international importance. Domestically, the absence of endemic exposure to measles means few persons in the United States will be infected and risk complications of measles. This decreased risk of exposure provides protection to groups not protected directly by vaccination: children too young for routine vaccination; the few persons who, although vaccinated, are not protected, primarily from failure to mount an adequate response to vaccine; persons for whom vaccine is contraindicated (e.g., those with immunodeficiency); and persons who choose not to be vaccinated.”

Wharton on Measles Elimination in the United States

Unfortunately, the “choose not to be vaccinated” group might be endagering our claim to have eliminated measles.

Is Measles Still Eliminated in the United States?

As we break more and more measles records this year, it would be easy to just say that the endemic spread of measles is no longer eliminated in the United States.

“Endemic measles transmission is the existence of any continuous indigenous chain of transmission of measles virus that persists for >1 year in any defined geographic area (e.g., the United States).”

Orenstein on Defining and Assessing Measles Elimination Goals

Still, when you look at the numbers, technically, measles isn’t yet spreading endemically in the United States.

Although we are seeing measles cases in 27 states, about 70% of them are in just two outbreaks in one state - New York.
Although we are seeing measles cases in 27 states, about 70% of them are in just two outbreaks in one state – New York.

We are getting close though.

The outbreaks in Rockland County and Brooklyn started in September and October 2018. If they aren’t stopped soon, will it be easier to make a case that measles is no longer eliminated in the United States?

“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

It sounds like it.

One thing to consider though, after an unvaccinated visitor introduced measles to Brooklyn from Israel back in October, measles has been reintroduced into the community at least seven other times! This includes travelers from Israel, UK, and Ukraine.

So the outbreak isn’t necessarily a “continuous indigenous chain of transmission of measles virus.”

It is multiple chains in the same community.

“There have been additional cases of measles from international travelers to Rockland, exposing more people to measles.”

2018 – 2019 Measles Outbreak in Rockland County

The same thing has happened in Rockland County after the initial importation from Israel in September.

Measles Elimination Criteria

Does that matter?

It likely should, but let’s also look at how we do with other criteria that are often used to assess the absence of the endemic spread of measles:

  • Few measles cases/low measles incidence – we will have the most cases in 2019 since 1992, but most cases are clustered in just a few big outbreaks
  • The duration of outbreaks is short – outbreaks are getting longer and harder to contain, but part of the problem is the global rise in measles and the reintroduction of measles into existing outbreaks
  • Most cases are associated with international importation – still very true
  • No endemic measles virus strain – outbreaks this year have been associated with strains that are commonly seen in Ukraine, the Philippines, and a few other areas
  • Long periods with no unknown-source cases – most cases are linked to international travel
  • High population immunity – except for pockets of susceptibles, folks who intentionally don’t vaccinate their kids or get themselves vaccinated, we do have high population immunity
  • Low levels of transmission from reported cases – in most outbreaks, that it is still true, unfortunately, there are more outbreaks this year
  • Adequate measles surveillance system – definitely true

What is the best argument that the endemic spread of measles has still been eliminated in the United States?

“A small number of cases have occurred outside of these neighborhoods but have, to date, not resulted in sustained transmission of measles.”

Measles Cases Rise to 466 Including in Two Unvaccinated Children Spending Time in Areas with Measles Activity

Even where there are big outbreaks, measles isn’t spreading outside of very specific communities of intentionally unvaccinated children and adults.

And that’s because most people are vaccinated and protected and aren’t letting measles spread endemically!

Losing Measles Elimination Status

If we did lose our status of having eliminated measles, we wouldn’t be the first.

“As of 30 June 2018, measles transmission in Venezuela has been ongoing for over one year. Therefore, endemic transmission of measles is considered to have been reestablished in Venezuela.”

Fourth ad hoc Meeting of the Technical Advisory Group (TAG) on Vaccine-preventable Diseases

Tragically, since their outbreaks began a few years ago, there have been nearly 10,000 cases and at least 78 deaths. Cases have also spread to many other countries in South America.

Venezuela isn’t the only country where we have seen the return of measles though.

In 2017, the European regional verification commission verified the reestablishment of the endemic spread of measles in the Russian Federation and in Germany.

“Countries in all six WHO regions have adopted goals for measles elimination by 2020.”

Progress Toward Regional Measles Elimination — Worldwide, 2000–2017

Surprisingly, some other countries in Europe, like Belgium, France, and Italy, never eliminated measles.

What’s next?

Hopefully, instead of a new normal, the rise in cases gets us back on track to eliminating and one day eradicating measles.

More on When Measles Was Eliminated in the United States

Who Is Larry Palevsky?

Think you know all of the anti-vaccine pediatricians?

“The pediatrician who spoke on Monday night, Dr. Lawrence Palevsky, is regularly cited in pamphlets circulated in New York City that urge women not to get their children vaccinated. His views have no basis in science, experts said.”

Despite Measles Warnings, Anti-Vaccine Rally Draws Hundreds of Ultra-Orthodox Jews

Sadly, there is more than one pediatrician pandering to parent’s fears about vaccines these days.

Who Is Larry Palevsky?

Although not as well known as Sears or Thomas, who were thrown into the spotlight because they wrote anti-vaccine books and were associated with measles outbreaks in their areas, it would be hard to say what makes Palevsky different from any other anti-vaccine expert.

A holistic pediatrician, he was an “expert” for the anti-vaccination movie The Greater Good. Palevsky also often links to and quotes other notorious anti-vax “experts.”

He even appeared on the Gary Null Show – in addition to being anti-vax, Gary Null is among the alternative medicine folks who actually denies that HIV causes AIDS.

So no one should be surprised that Palevsky spoke at an anti-vaccine rally during the longest measles outbreak we have had in the United States in over 25 years. An ongoing measles outbreak that health officials are still struggling to contain.

At the rally, he talked at length about mutating viruses and falsely claimed that failed vaccines were producing a new strain of measles. Women scribbled into notepads as he spoke. Others filmed his comments, sending them to their contacts on WhatsApp. Essentially, he said, there were no studies available to show how the vaccine affects the human body.

“Is it possible that the measles-mumps-rubella vaccine that is somehow being given in this lot to communities in Williamsburg and Lakewood and Monsey, maybe in Borough Park, is it possible that these lots are bad?” he asked, referring to areas in New York and New Jersey with large ultra-Orthodox Jewish communities.

“It’s fascinating because we’re told how contagious the disease is, but somehow it’s centered in the Jewish community.”

Despite Measles Warnings, Anti-Vaccine Rally Draws Hundreds of Ultra-Orthodox Jews

It’s fascinating that a pediatrician would actually think that any of this is possible

Bad lots of vaccines?

Does Palevsky, who runs a Wellness Center, realize that only about 3-4% of the people who have gotten measles in Brooklyn and Rockland County have been fully vaccinated. Most are unvaccinated.

How does that fit into Palevsky’s theories about bad lots, mutating measles viruses, and failed vaccines?

Since Palevsky doesn’t seem to believe in the germ theory of disease, that viruses and bacteria can actually cause us to get sick, it isn’t hard to figure out. For him, of course, it would be easier to blame vaccines instead of the measles virus, I guess even vaccines that these folks have never received.

Sure. It is anything and everything except the fact that parents are intentionally not vaccinating and protecting their kids…

What’s really fascinating is that people are still listening to this kind of misinformation when they can see the consequences of what happens when they leave their community unvaccinated and unprotected.

“I believe in what’s called a starvation diet for kids when they’re sick.”

Larry Palevsky

And that they are listening to it from folks like Palevsky!

“Most of the reason that kids get sick is to move or get rid of wastes anyway.”

Larry Palevsky

But just in case they don’t get better by just removing the wastes in their body or by using supplements, essential oils or herbs and reducing their stress levels, Palevsky is very happy to refer your child to one of the homeopaths, acupuncturists, chiropractors and/or other health professionals in his office.

Palevsky wants your child to “breathe more” when they get sick…

And that’s a clue to why we continue to see outbreaks of measles.

This industry of holistic and integrative “health professionals” goes out of their way to make sure parents are too scared to vaccinate their kids.

More on Larry Palevsky