Tag: measles strains

Did New York Declare Medical Martial Law over a Measles Outbreak?

You have to admire anti-vaccine folks for one thing, they are consistent.

Well, actually, no.

Admire is the wrong word…

Did New York Declare Medical Martial Law over a Measles Outbreak?

As most folks know, Rockland County Executive Ed Day made an emergency declaration banning unvaccinated kids from public places.

I guess because he was anticipating a freak-out from anti-vaccine folks, he went out of his way to say that the emergency declaration does not mean that law enforcement will be asking for vaccine records and that they are just trying to get the attention of parents, some of whom weren’t cooperating when their kids were sick.

So what was the reaction?

About as you would expect…

Medical martial law? An emergency declaration saying you will get a class B misdemeanor if your unvaccinated kid goes to the mall is the same thing as martial law? Ordinary laws have been suspended and the military is taking over?

If you listened to the press conference, the problem isn’t really that we need new laws, it is that some folks aren’t cooperating with existing ones. Again, in the middle of the longest outbreak in recent history, some parents who have kids sick with measles aren’t talking to health department officials who simply want to control and stop the outbreak.

What else is wrong with the Natural News post?

Of course, it is the stuff about shedding and “improperly weakened viral strains.”

In truth, measles outbreaks are started when unvaccinated folks travel out of the country, get measles, and bring it back to a community with a lot of other unvaccinated people. And tragically, sometimes folks who are too young to be vaccinated or who have true medical contraindications to getting vaccinated get caught up in these outbreaks.

Did they listen to the press conference? When did he say that they would be going door-to-door?

Hillary Simpson telling folks in New York to riot.

Is it actually legal to tell folks to riot and incite them to open civil disobedience?

Kate Tietje calling for open civil disobedience.

Surpriginsly, most went to straight to comments about Hitler and concentration camps.

It is offensive to compare the emergency declaration in Rockland county to putting people in concentration camps.

This is the modern anti-vaccine movement.

These are the leaders and heroes of the anti-vaccine movement.

Larry Cook on the emergency ban in Rockland County.

To be clear, rabbis in the community have been telling folks to get vaccinated and protected!

“Whoever isn’t vaccinated is a murderer” reads a rabbinic letter recently signed by leading charedi rabbis in Israel, according to Yeshiva World News. The kol koreh was distributed after a spread of Measles in the ultra-Orthodox communities in Israel and around the world. Earlier this month an unvaccinated infant died, and more than 1300 people have been infected with a preventable disease. The Gedolim who signed the Kol Koreh include: Rav Yitzchak Silberstein, Rav Shimon Ba’adani, Rav Sriel Rosenberg, Rav Moshe Shaul Klein Rav Menachem Mendel Lubin.
As Measles Spread, Leading Charedi Rabbis Come Out Strongly Against Anti-Vaxxers

I wonder what the people in these communities would think of all of this holocaust imagery that anti-vaccine folks are using to try and keep the outbreaks going?

The National Vaccine Information Center is exploiting a photo of five year old Avram Rosenthal and his two year old brother Emanuel of the Kovno ghetto in Lithuania. Both boys were later deported to the death camp at Majdanek where they were murdered. — This is a photo of five year old Avram Rosenthal and his two year old brother Emanuel of the Kovno ghetto in Lithuania. Both boys were later deported to the death camp at Majdanek where they were murdered. Why is it being used in an article about measles outbreaks?

It is very clear that this is not about religion.

“The Orthodox Union (OU) and the Rabbinical Council of America (RCA) strongly urge all parents to vaccinate their healthy children on the timetable recommended by their pediatrician.”
Statement on Vaccinations from the OU and Rabbinical Council of America

People in these communities have been misled and misinformed by anti-vaccine propaganda.

How about we make folks who push anti-vaccine misinformation wear dunce caps? — How about dunce caps on folks who push anti-vaccine misinformation?

Don’t let them make it worse.

More Measles Myths

It’s kind of sad that some folks still believe many of the measles myths that were being told in 1963.

Folks once accepted measles as inevitable because they had no choice, but that changed when we got a vaccine. — Measles was long known as a harmless killer…

Wait, measles isn’t harmless?

But what about that Brady Bunch episode!?!

More Measles Myths

What other myths about measles have you heard?

Have you heard that folks never worried about measles before we had a vaccine? That it never even made the newspaper?

There were newspaper articles warning about measles in 1959 - a measles year.

The other myths they push are just as easily disproven…

the recent measles outbreaks aren’t being caused by a vaccine strain of measles
there is no third dose of MMR for measles prevention, although it is sometimes given during a mumps outbreak
measles outbreaks aren’t being caused by refugees or immigrants
declining immunization rates in specific areas and clusters of the country are causing the recent measles outbreaks
measles outbreaks aren’t being caused by vaccinated kids during shedding season and no, shedding season isn’t a real thing!
high dose vitamin A isn’t a cure for measles
the recent outbreaks weren’t made up by the media to cause panic
the MMR vaccine works very well, at least when you get vaccinated
the recent measles outbreaks aren’t being caused by a wild strain of measles that isn’t covered by the MMR vaccine

Which of these myths do you believe?

Which ones are keeping you from vaccinating and protecting your kids?

About Those Vaccine Strains in Measles Outbreaks…

A lot happens to control and contain a measles outbreak these days.

For one thing, you have to confirm that everyone with measles symptoms actually has measles. If you miss anyone, because measles is so contagious, then they could expose other people and the outbreak will keep getting bigger.

How do they confirm who has measles and who doesn’t?

While you could just make a clinical diagnosis, simply relying on the person’s history and pattern of symptoms, typically everyone just gets tested.

About Those Vaccine Strains in Measles Outbreaks…

What kind of testing?

“Laboratory confirmation is essential for all sporadic measles cases and all outbreaks. Detection of measles-specific IgM antibody and measles RNA by real-time polymerase chain reaction (RT-PCR) are the most common methods for confirming measles infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have measles at first contact with them. Urine samples may also contain virus, and when feasible to do so, collecting both respiratory and urine samples can increase the likelihood of detecting measles virus.”
Measles For Healthcare Professionals

It depends, but often a throat swab or a throat swab and urine are collected for PCR testing, especially if it has been 7 or fewer days since the patient came down with their rash.

If it has been longer than 7 days, then testing using urine and blood specimens can be performed.

“Molecular analysis can also be conducted to determine the genotype of the measles virus. Genotyping is used to map the transmission pathways of measles viruses. The genetic data can help to link or unlink cases and can suggest a source for imported cases. Genotyping is the only way to distinguish between wild-type measles virus infection and a rash caused by a recent measles vaccination.”
Measles For Healthcare Professionals

Because many people get vaccinated during an outbreak and a rash and fever is a side effect of the MMR vaccine, testing becomes very important in those who were recently vaccinated.

Statistics from the 2015 Disneyland measles outbreak... — Statistics from the 2015 Disneyland measles outbreak. Anti-vaccine folks, this slide doesn’t mean what you think it means.

After getting vaccinated, testing helps confirm that someone has vaccine strain measles and not wild type, a vaccine reaction, and don’t actually have measles.

“Here, we describe a real-time reverse transcription-PCR (RT-PCR) method that detects the vaccine genotype (MeVA RT-quantitative PCR [RT-qPCR]) and that can provide rapid discrimination between wild-type-virus infections and vaccine reactions.”
Roy et al on Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR

An no, the vaccine reaction is not that they developed measles! They developed a rash and/or fever, a common side effect of the MMR vaccine.

“During outbreaks, measles vaccine is administered to help control the outbreak, and in these situations, vaccine reactions may be mistakenly classified as measles cases.”
CDC on Genetic Analysis of Measles Viruses

So the reports that you might have seen that 31 people in the California measles outbreak had a vaccine strain of measles aren’t true. There were at least 31 people who were recently vaccinated during the outbreak and had a rash and/or fever, and they tested positive for the vaccine strain, proving that they weren’t actually part of the outbreak. None of them actually had measles though.

Has anyone ever gotten the measles after being vaccinated?

“Vaccine‐associated measles is a possible, but extremely rare event.”
Sood et al on Vaccine‐associated measles in an immunocompetent child

Yes, there are a few case reports.

Very rare case reports.

Who's to blame for low immunization rates and continuing outbreaks? — Who’s to blame for low immunization rates and continuing outbreaks?

We know who’s responsible for the rise in measles outbreaks and no, it ain’t folks who have recently been vaccinated. Vaccines are safe and necessary.

Get vaccinated. Stop the outbreaks.

Is a Vaccine Strain Causing The Latest Measles Outbreak?

What’s the first question anti-vaccine folks start asking whenever we see a large outbreak of measles?

No, it’s not how can I get my kids vaccinated and protected so that they don’t get measles…

It is whether or not it a vaccine strain of measles started the outbreak.

Where do folks get all of this stuff about genotypes and vaccine strains? I wonder…

Dr. Bob had no facts, but still posted that a vaccine strain of measles could have killed a woman who got caught up in the last measles outbreak in Washington.

Yup.

The usual suspects.

Is a Vaccine Strain Causing The Latest Measles Outbreak?

Why do folks who intentionally don’t vaccinate their kids desperately want these measles outbreaks to be caused by a vaccine strain?

Because then it isn’t their fault that their kids are at risk of getting a life-threatening disease!

It’s never a vaccine strain though.

Remember the Disneyland measles outbreak. A lot of folks were talking about vaccine strains when it first started.

“…California patients were genotyped; all were measles genotype B3, which has caused a large outbreak recently in the Philippines…”
Measles Outbreak — California, Dec 2014–Feb 2015

It wasn’t a vaccine strain.

Outbreaks	Year	Genotype
Minnesota	2017	B3
Tennessee	2016	B3
California	2015	B3
Florida	2013	D8
California	2014	B3, D8
Brooklyn	2013	D8
North Carolina	2013	D8
Minnesota	2011	B3
Washington, Illinois	2008	D5, D4

For example, during 2011, 222 cases of measles and 17 outbreaks were reported in the United States, with most cases originating from just five countries (France, Italy, Romania, Spain, and Germany). Six different genotypes were identified, including B3, D4, G3, D8, H1, and D9. No vaccine strains…

And no, it doesn’t matter that the vaccine strain of measles, genotype A, differs from all of the wild strains of measles we see in the outbreaks.

“Vaccine induced immunity protects against all virus strains. Measles is considered a monotypic virus despite the genetic variations.”
Factsheet about measles

Unlike the flu, HPV, and pneumococcal bacteria, in which vaccines only protect against different serotypes, in the case of measles, the genotype simply helps us figure out where the measles case came from.

And no, the latest outbreak, wherever it is, wasn’t caused by shedding from a vaccine.

But if it isn’t the vaccine strain, then why do they that is it important to rapidly identify wild strains vs vaccine strains?

“During measles outbreaks, it is important to be able to rapidly distinguish between measles cases and vaccine reactions to avoid unnecessary outbreak response measures such as case isolation and contact investigations.”
Roy et al on Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR

That’s easy to answer.

Outbreaks typically trigger a lot of folks to get vaccinated. While that’s great, one possible problem is that some of those folks might develop a fever and/or rash after their MMR vaccine. So it is important to quickly figure out whether they are part of the outbreak and have a wild strain (maybe they were exposed before their vaccine could start to work) or are having a common, mild vaccine reaction.

But couldn’t they have vaccine-associated measles if they have a rash and fever and a vaccine strain? Theoretically, but then they would likely have true measles symptoms. And even in these rare case reports, the children didn’t spread the measles to anyone else.

So why are you waiting to know the genotype of the measles strain causing the outbreak in your area? Hopefully, it isn’t to help you decide whether or not to vaccinate and protect your kids. While it is interesting to know where the outbreak originated, you can bet that it isn’t a vaccine strain.

The Pacific Northwest Measles Outbreak of 2019

Breaking News – There are 2 new cases in Clark County (70 cases), bringing the total case count to 75 cases.

It started with a confirmed case of measles in a child in late December.

The Pacific Northwest measles outbreak on 2019 started when a child exposed others in the area in late December.

There were soon reports of more cases.

The Clark County measles outbreak quickly grew.

And more cases.

The Pacific Northwest Measles Outbreak of 2019

But the measles cases didn’t stay in Clark County.

Two of the unvaccinated kids from Clark County traveled to Hawaii while they were contagious.

As with other recent large measles outbreaks, cases soon spread to neighboring counties.

As of late January, there are now measles cases linked to this ongoing outbreak in Clark County and King County (Washington) and Multnomah County (Oregon).

The rapid growth of the outbreak led Clark County to declare a local public health emergency and Washington’ governor to declare a State of Emergency in all counties in the state of Washington.

“The measles outbreak and its effects impact the life and health of our people, as well as the economy of Washington State, and is a public disaster that affects life, health, property or the public peace.”
Governor Jay Inslee on proclaiming a State of Emergency

Why so much concern?

Are you familiar with the immunization rates in this part of the country? About the only good thing you can say about Washington’s immunization rates are that they are better than Oregon‘s…

Washington has one of the highest rates of exemptions in the United States.

That’s right.

High non-medical vaccine exemption rates and low vaccination rates. A recipe for very large outbreaks of vaccine-preventable diseases, especially measles which is so highly contagious.

Immunization rates by county in Washington.

And a recipe for disaster. These outbreaks are getting harder to control, are lasting longer, and are getting bigger and bigger.

Also remember that the last measles death in the United States, in 2015, was a woman who got caught up in a measles outbreak in Clallam County. Why didn’t that trigger folks in the area to get Vaccinated?

Pacific Northwest Measles Outbreak of 2019
Clark County (WA)	70 cases
King County (WA)	1 case
Multonomah County (OR)	4 case
	75 cases

How many of them are vaccinated? Anti-vaccine folks are pushing hard to convince folks that everyone in the outbreaks are vaccinated. Don’t believe them!

As in most outbreaks, almost all of the people in this outbreak are unvaccinated.

How many people will get sick in the Pacific Northwest Measles Outbreak of 2019 before it ends?

You will have to make an extra appointment if you followed his immunization plan and left your kids unvaccinated and at risk during this outbreak.

Are parents going to keep listening to anti-vaccine folks who push the idea that measles isn’t that bad and make you think that it is riskier to get vaccinated?

Are they going to realize that unless they are malnourished or have a vitamin deficiency, that taking extra vitamin A that you order from someone’s online store will not reduce their risk of severe complications if their unvaccinated child gets measles?

“Please contact your pediatrician or doctor if your child is scary sick, struggling to breathe or unable to eat or very lethargic or otherwise seriously ill. Let them know you are worried they may have measles so they can arrange not to contaminate the waiting room or the whole office.”
Paul Thomas, Integrative Pediatrician

Getting vaccinated can help keep your kids from getting “scary sick” from measles…

“The above recommendations are informational only. Please consult with your doctor before implementing anything you might learn here.”
Paul Thomas, Integrative Pediatrician

The only good advice he gives.

Anti-vaccine misinformation has gotten us to the place where these outbreaks are becoming more common. Vaccinate your kids so they don’t get measles and don’t expose anyone else.

And for the anti-vaccine folks who are asking:

it isn’t going to be shedding or a vaccine strain that caused the outbreak
everyone or almost everyone in the outbreak is going to be unvaccinated
the measles vaccine does work against all the different genotypes of measles
more people don’t die from getting the MMR or any other vaccine than from the diseases they protect us against
whether the death rate of measles is 1 in 1000 or 1 in 10,000 cases, remember that just before the measles vaccine came out, in the early 1960s, nearly 500 people would die of measles each year. And it isn’t that a person dies after 1,000 or 10,000 cases. With more cases, there is just a higher chance that someone will eventually die.

And you are still worried about the MMR vaccine because anti-folks are still scaring you away from vaccinating and protecting your kids.

Vaccines are safe and necessary with few risks. There is no good reason that we should still have outbreaks like this.

News on the Latest Measles Outbreaks of 2019

Breaking News – 15 new cases in California, 1 new case in Rockland County (see below).

2019 has just started, but we already have reports of measles cases and exposures in at least 690 people in 23 states, including Arizona (1), California (38), Colorado (1), Connecticut (3), Florida (1), Georgia (3), Hawaii (2), Illinois (5), Indiana (1), Iowa (2), Kentucky (2), Massachusetts (1), Michigan (42), Mississippi (1), Missouri (1), Nevada (1), New Hampshire (1), New Jersey (13), New York (471), Oregon (11), Tennessee (1), Texas (14), and Washington (73).

And large, ongoing outbreaks in New York (Brooklyn and Rockland County) and the Pacific Northwest.

There are also many reports of measles outbreaks in Europe.

2019 Measles Outbreaks

Since there were so many ongoing measles outbreaks in 2018, it shouldn’t be surprising that we are getting off to a quick start in 2019.

Recent cases and exposures include:

someone in Oregon who exposed other people in Portland (Jan 2), The Dalles (Dec 29 and 31, 2018), and Hood River (Dec 30, 2018)
an unvaccinated toddler in Monroe County, New York who had recently traveled to Ukraine
9 new cases in Rockland County, New York (105 total)
3 new cases in the Borough Park and Williamsburg sections of Brooklyn (55 total)
3 new cases in Rockland County, New York (108 total)
a new outbreak in Clark County, Washington involving two unvaccinated children who exposed others on Jan 6 and 7 and an additional 11 suspected cases
6 new cases in Rockland County, New York (114 total)
as expected, 12 more cases in Clark County, Washington (14 total) – all children, all unvaccinated (one unverified), with multiple exposures in Vancouver, including 5 different schools, 2 churches, and 6 health care facilities
3 new cases in the Borough Park section of Brooklyn (58 total)
an adult in Denver, Colorado who became sick while traveling internationally and exposed others in Denver from Jan 10-14
2 more cases in Clark County, Washington (16 total), with 5 more suspected cases remaining and exposures in Battle Ground (Jan 8 and 14) and Vancouver (Jan 14 and 15)
2 kids from the Washington outbreak had traveled to Hawaii while contagious (January 4 to 13)
2 residents of the metro Atlanta area, with exposures between Jan 7 to 14, although there is some speculation that these cases were also travelers from the Washington outbreak

Are these cases part of the Washington outbreak?

2 new cases in Rockland County, New York (116 total)

After 19 cases and an exposure at the Portland Trail Blazers game, Clark County has declared the measles outbreak to be a public health emergency.

3 more cases in Clark County, Washington (19 total), with 7 more suspected cases remaining and exposures in Camas (Jan 10- 15), Portland (Jan 11 and 14), and Vancouver (Jan 11 to 16), leading the Clark County Council Chair Eileen Quiring to declare a public health emergency.
2 new cases in Clark County, Washington (21 total), with 4 more suspected cases remaining and exposures in Vancouver (Jan 7 to 11)
4 new cases in the Borough Park and Williamsburg sections of Brooklyn (62 total)
2 new cases in Rockland County, New York (118 total)
2 new cases in Clark County, Washington (23 total), with 2 more suspected cases remaining and exposures in Vancouver (Jan 15 and 19) and Portland (Jan 15-16), including at the Portland International Airport (where did they go?)
4 new cases in Rockland County, New York (122 total)
a case in the Champaign-Urbana Public Health District in Illinois with multiple exposures (Jan 12 to 19) including the University of Illinois in Urbana and Champaign
2 new cases in Clark County, Washington (25 total), with 12 more suspected cases!
a case in King County, Washington that is linked to the outbreak in Clark County
5 new cases in Clark County, Washington (30 total), with 9 more suspected cases!
a case in Multnomah County, Oregon that is linked to the outbreak in Clark County and with exposures (Jan 20 to 23) in Gresham, Wood Village, and Troutdale

Hopefully, no kids with immune system problems were exposed to these kids with measles.

two more cases in Monroe County, New York linked to an unvaccinated toddler with exposures at Canal View Elementery School in Spencerport
1 new case in Clark County, Washington (31 total), with 8 more suspected cases!
3 new cases in Clark County, Washington (34 total), with 9 more suspected cases and exposures in Vancouver (Jan 14 to 23)
1 new case in Clark County, Washington (35 total), with 11 more suspected cases and exposures in Vancouver and Portland (Jan 14 to 23)
1 new case in Clark County, Washington (36 total), with 12 more suspected cases and exposures in Battle Ground (Jan 20)
2 new cases in the Borough Park and Williamsburg sections of Brooklyn (64 total)
an adult in New Haven, Connecticut
another case in Georgia, an unvaccinated family in the metro Atlanta area
6 new cases in Rockland County, New York (128 total)
2 new cases in Clark County, Washington (38 total), with 13 more suspected cases, and exposures in Bend, Oregon (Jan 19-20)
a 4th case in Spencerport, New York, an unvaccinated neighbor of two previous cases.
3 new cases in Clark County, Washington (41 total) with exposures at an after-school activity at Minnehaha Elementary School (Jan 17) triggering exclusion of unvaccinated students and staff, and there are also 15 more suspected cases
1 new case in Clark County, Washington (42 total)
3 new cases in Spencerport, New York (7 total), all unvaccinated.
1 new case in Clark County, Washington (43 total) and 8 more suspected cases
another case at the University of Illinois Champaign-Urbana, another unvaccinated student (2 total)
another case in Connecticut being treated at Yale New Haven Hospital
6 new cases in Clark County, Washington (47 total) and 7 more suspected cases
2 new cases in Clark County, Washington (49 total) and 9 more suspected cases
2 new cases in Rockland County, New York (130 total)
a toddler in Galveston County, Texas that is part of a cluster in the region
3 cases in Harris County, Texas, including two young children and an older woman
a 2-year-old in Montgomery County, Texas that is linked to four other cases.
a case in Bell County, Texas, the 6th in Texas, although it isn’t clear if they are all linked
3 new cases in the Borough Park and Williamsburg sections of Brooklyn (67 total)
a case in Denton County, Texas that is not linked to the 6 other cases in Texas
another case in Clark County, Washington (50 total) and 11 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (52 total)
3 new cases in Multnomah County, Oregon (4 total) that are linked to the Pacific Northwest Measles Outbreak (55 total)
another case in Clark County, Washington (51 total) and 13 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (56 total)
2 new cases in Clark County, Washington (53 total) and 7 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (58 total)
1 new case in Clark County, Washington (53 total) and 2 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (58 total) – a case that was previously confirmed turned out to be a vaccine associated rash, so case count remains the same.
6 new cases in the Borough Park and Williamsburg sections of Brooklyn (73 total)

Almost all of the measles cases in Rockland County are unvaccinated.

5 new cases in Rockland County, New York (135 total) and 3 suspected cases, with almost all cases being unvaccinated (81.5% are unvaccinated)
an unvaccinated child who had traveled out of the country in the Bowling Green area of Kentucky
6 new cases in Clark County, Washington (59 total) and 1 more suspected case, all linked to the Pacific Northwest Measles Outbreak (64 total)
2 new cases in Clark County, Washington (61 total), all linked to the Pacific Northwest Measles Outbreak (66 total)
2 new cases in the Champaign-Urbana Health District in Illinois, another unvaccinated student (4 total)
1 new case in Clark County, Washington (62 total), and a new exposure in Battle Ground (Feb 13), all linked to the Pacific Northwest Measles Outbreak (67 total)
3 new cases in Rockland County, New York (138 total), with almost all cases being unvaccinated (81.5% are unvaccinated)
17 new cases in the Borough Park and Williamsburg sections of Brooklyn (90 total)
1 new case in Clark County, Washington (63 total), and new exposure in Washougal (Feb 14) and Vancouver (Feb 11 and 18), all linked to the Pacific Northwest Measles Outbreak (68 total)
1 new case in Clark County, Washington (64 total), and 2 more suspected cases being investigated, all linked to the Pacific Northwest Measles Outbreak (69 total)
1 new case in Clark County, Washington (65 total), and 1 more suspected case being investigated, all linked to the Pacific Northwest Measles Outbreak (70 total)
1 new case in Rockland County, New York (139 total)
a new case in Bergen County, New Jersey, with exposures in Hillsdale (Feb 17 and 25)
30 new cases in the Borough Park and Williamsburg sections of Brooklyn, plus a case in Queens (121 total)
a case in Illinois, a resident who exposed others when their flight arrived in Concourse B at Chicago Midway Airport on Feb 22 and at Northwestern Medicine Delnor Hospital on Feb 24
3 new cases in Clark County, Washington (68 total), and 3 more suspected case being investigated, all linked to the Pacific Northwest Measles Outbreak (73 total)
1 new case in Rockland County, New York (140 total)
2 new cases in Multonmah County, Oregon that are not linked to the Pacific Northwest measles outbreak
2 new cases in Clark County, Washington (70 total) and a new exposure in Vancouver (March 1 and 2), all linked to the Pacific Northwest Measles Outbreak (75 total)
a passenger from New York City who exposed people on a Greyhound Bus as they traveled to Boston and Manchester, New Hampshire while contagious on Feb 26
3 new cases in Rockland County, New York (143 total)
12 new cases in the Williamsburg and Brighton Beach sections of Brooklyn (133 total)
a case in San Francisco, California – an adult who was exposed during an international flight
a case in San Antonio, Texas

a new case in Rockland County, New York (144 total)
another case in California related to a sick passenger on a plane
a 1-year-old in Pima County, Arizona who had traveled to Asia
an out-of-state traveler to Jefferson County, Missouri
a case in Collin County, Texas
a new case in Rockland County, New York (145 total)
25 new cases in the Borough Park, Midwood/Marine Park, and Williamsburg sections of Brooklyn (158 total)
a case in Marion County, Oregon that isn’t related to their current outbreak
1 new case in Clark County, Washington (72 total), linked to the Pacific Northwest Measles Outbreak (76 total)
a travel related case in Oakland County, Michigan with exposures in Oak Park and Southfield (March 6 to 13)
2 cases in Liberty, New York (Sullivan County) with probable ties to the outbreak in Brooklyn
2 new cases in Rockland County, New York (147 total)

There are now 147 measles cases in Rockland County.

a new case in Lakewood, New Jersey – remember that Ocean County was the site of a big outbreak last year (33 cases)… (March 9 and 14)
an internationally imported case of measles in Clark County, Nevada, with exposures at a hospital and the Treasure Island Hotel and Casino in Las Vegas (March 9 and 11)
a new case in Collin County, Texas, with exposures at a Kroger in Prosper
1 new case in Clark County, Washington (73 total), linked to the Pacific Northwest Measles Outbreak (77 total)
23 new cases in the Borough Park and Williamsburg sections of Brooklyn (181 total)
2 new cases in Rockland County, New York (149 total)
a 4th case in Ocean County, New Jersey with exposures in Lakewood (March 9 and 14)
2 new cases in Rockland County, New York (151 total)
a case in Tarrant County, Texas
another case in San Antonio, Texas (2 total)
4 more cases in Oakland County, Michigan (5 total), with 3 more cases under investigation and exposures in Oak Park, Southfield, and Berkley (March 14 to 19)
a child in Calaveras Springs, California
three new cases in Oakland County, Michigan (8 total)
two unvaccinated adults in Butte County, California and a related case in Shasta County, with exposures in Chico and Redding
10 new cases in Oakland County, Michigan (18 total), with exposures in Berkley, Oak Park, West Bloomfield, Southfield, and Royal Oak

Rockland county executive Ed Day declared a local state of emergency over the ongoing measles outbreaks in the area on March 26.

2 new cases in Rockland County, New York (153 total)
4 new cases in Oakland and Wayne counties in Michigan (22 total) with new exposures in Pontiac and Southfield
33 new cases in the Borough Park, Williamsburg, and Midwood/Marine Park sections of Brooklyn (214 total)
a new case in Santa Clara, California, with exposures in Sunnyvale, San Jose, Cupertino, Stanford, Palo Alto, Mountain View, Santa Clara, and Milpitas (March 16 to 22)
a new case in Alameda County, California with exposures in Livermore (March 23)
a new case (an out-of-state visitor) in Indianapolis, Indiana
a new case in Broward County, Florida
3 new cases in Placer County, California with exposures in Auburn (March 18)

As of March 28, the CDC is reporting 387 measles cases in 2019, the third highest number of cases in a year since 1994.

a new case in Boston, Massachusetts, with exposures in Plymouth, Waltham, Framingham, Hyannis, and Braintree (March 26 to 31)
8 new cases in Oakland and Wayne counties in Michigan (30 total)
1 new case in Rockland County (158 total)
3 new cases in Rockland County (161 total)
45 new cases in the Borough Park, Crown Heights, Williamsburg, and Flushing sections of Brooklyn (259 total)
5 new cases in Rockland County (166 total)
4 new cases in Oakland and Wayne counties in Michigan (34 total)
a new case in Dallas County, Texas that is linked to a previous case in Tarrant County
another case in Kentucky, a sibling of an unvaccinated child who developed measles last month
5 new cases in Oakland and Wayne counties in Michigan (39 total)

Williamsburg press conference on April 9.

26 new cases in the Williamsburg section of Brooklyn (285 total), as Commissioner of Health declares a public health emergency and orders unvaccinated people in the 11205, 11206, 11221 and/or 11237 zip codes to be vaccinated within 48 hours
2 new cases in Rockland County (168 total), as they discuss a plan to keep unvaccinated people at home
~~2 new cases~~ in Oakland, Washtenaw and Wayne counties in Michigan (41 39 total)
a new case in the Bronx, New York, with exposures at Montefiore Medical Center (April 9).
8 unvaccinated kids (the youngest only 6 months old) in Northern Westchester, New York and who were exposed in Brooklyn and Rockland
5 new cases in Rockland County (173 total), as they discuss a plan to keep unvaccinated people at home
7 new cases in Rockland County (180 total), as they discuss a plan to keep unvaccinated people at home
4 new cases in Rockland County (184 total), as they discuss a plan to keep unvaccinated people at home
4 new cases in California, including Santa Clara and Butte, Calaveras, Shasta, Tehama Counties
a new case in Washtenaw County, Michigan that is unrelated to the an ongoing outbreak in the area, with exposures at 18 sites, including the University of Michigan, Walgreens, CVS, Whole Foods, and DTW Airport McNamara Terminal (April 4 to 6)
a new case in New Haven County, Connecticut, linked to travel to Brooklyn
2 new cases in Rockland County (186 total), as they discuss a plan to keep unvaccinated people at home
44 new cases in the Borough Park, Midwood/Marine Park, Far Rockaway, and Williamsburg sections of Brooklyn (329 total)
4 new cases in Rockland County (190 total), as they impose new orders for the quarantine of anyone diagnosed or exposed to someone with measles
2 new cases in Oakland County and the City of Detroit, Michigan, with exposures in Oak Park, Lansing, Grand Rapids, and Ypsilanti (April 10 to 13)
a new case in Iowa, unvaccinated contact of the first case in the state
3 new cases in Rockland County (193 total)
a case in Tennessee, with exposures in Chattanooga and Clinton (April 11-12) and who traveled through Alabama (April 11)
30 new cases in the Borough Park and Williamsburg sections of Brooklyn (359 total)
20 cases in Orange County, New York, including a mother and her baby who were hospitalized

6 new cases in Rockland County (199 total)
a case in Mississippi, with exposures in Hattiesburg (April 9-10)
31 new cases in the Brighton Beach, Williamsburg, and Hunts Point, Longwood and Melrose sections of Brooklyn (390 total)
1 new case in Rockland County (200 total), as County Executive Ed Day issued a second declaration of a local State of Emergency, renewing the original declaration until 11:59 pm, Saturday, May 25, 2019.
15 new cases have been reported in California, with new cases in Los Angeles, Sacramento, Butte, and Shasta counties and quarantines at UCLA and Cal State after exposures at those schools

What kind of measles year will 2019 turn out to be? Unfortunately, we already have the potential for another record year…

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:

VAXOPEDIA – The Pacific Northwest Measles Outbreak of 2019
VAXOPEDIA – Is January Usually a Big Measles Month?
VAXOPEDIA – How Contagious Is Measles?
VAXOPEDIA – Why Do We Only Worry About Measles?
VAXOPEDIA – What to Do If Your Child Is Exposed to Measles
VAXOPEDIA – The Myth That Measles Isn’t Deadly
VAXOPEDIA – Can MMR Shedding Start a Measles Outbreak?
VAXOPEDIA – Who Dies with Measles?
VAXOPEDIA – Does Having Measles Protect You from Cancer?
VAXOPEDIA – A History of Measles Outbreaks in United States
VAXOPEDIA – Measles Deaths in Italy
VAXOPEDIA – Measles Deaths in the 21st Century
VAXOPEDIA – About Those Measles Outbreaks in China
VAXOPEDIA – When Was the Last Measles Death in the United States?
VAXOPEDIA – Costs of a Measles Outbreak
CDC – Measles Cases and Outbreaks
Measles – Timeline | History of Vaccines
Ask the Experts about MMR
Measles outbreak in Washington State 2019
Pacific Northwest Measles Outbreak Winter 2019
California Department of Public Health
The Number of Measles Cases Grows to 390

Updated on April 25, 2019

Can MMR Shedding Start a Measles Outbreak?

Have you ever noticed that any time that there is a new outbreak of measles, folks tend to ask the same basic questions.

How did the outbreak start?

Why weren’t they vaccinated?

Was it from shedding?

Wait, what?

Shedding??? Really?

Can MMR Shedding Start a Measles Outbreak?

It seems that the idea that the MMR vaccine sheds and can lead to measles outbreaks is one of those anti-vaccine myths that just won’t go away.

It comes back with each new measles outbreak.

The myth that MMR shedding leads to measles outbreaks is commonly spread on Facebook, like this discussion on a recent outbreak at a Kansas City daycare center.

While the oral polio vaccine is indeed associated with shedding and vaccine associated disease, that doesn’t happen with MMR. Experts don’t even recommend any restrictions for use of the MMR vaccine for household contacts of people who are immunosuppressed. And yes, your kids can even visit a cancer patient if they just had their MMR, as long as they don’t have RSV, the flu, or some other contagious disease.

What about the fact that a study once found measles virus RNA in the urine of of kids who had recently been vaccinated? Doesn’t that mean that they were shedding the vaccine virus?

No. It doesn’t.

To be considered shedding, those measles virus RNA particles in their urine would have to be contagious. Now, measles is spread by respiratory secretions. So how are measles virus RNA particles in urine going to become airborne and get someone else sick?

They don’t.

Another Facebook post about MMR and shedding. — Most measles outbreaks in daycare centers have been started by an unvaccinated child or worker who traveled out of the country.

But what about that case in Canada? Anti-vaccine folks like to bring this up when they talk about shedding. In 2013, there was a case of vaccine-associated measles. That proves that the vaccine sheds, right?

Absolutely not!

“Of note, only one case report of transmission from vaccine-associated measles has been identified.”

Murti et al. on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013

That child got measles about 5 weeks after she was vaccinated in the middle of a measles outbreak. Because she had no links to the other cases and she tested positive for vaccine-strain measles, it is thought that she had MMR vaccine-associated measles, which is extremely rare.

Shedding Light on Measles Outbreaks in Daycare

MMR shedding is not causing outbreaks of measles – or rubella and mumps, for that matter.

If shedding from the MMR, by any method, got kids sick, then why aren’t there even more cases of measles?

Daycare centers everywhere have a mix of infants and toddlers, including some who are intentionally unvaccinated, those who are too young to get their first MMR, and those who are just getting vaccinated.

When a case of measles does pop up though, it isn’t because of shedding, it is typically because someone who wasn’t vaccinated traveled out of the country, got measles, and brought it back home, exposing others.

What to Know About MMR and Shedding

Measles outbreaks are not caused by shedding from the MMR vaccine.

VAXOPEDIA

Did New York Declare Medical Martial Law over a Measles Outbreak?

Did New York Declare Medical Martial Law over a Measles Outbreak?

More on the Emergency Declaration in Rockland County