Circulating vaccine-derived polio virus or cVDPV are outbreaks of polio that are actually caused by the polio vaccine.
Very rarely, the attenuated (weakened) virus in the oral polio vaccine can revert to a form that can cause the person who was vaccinated or their close contact to actually develop polio.
It should not be confused with VAPP or vaccine-associated paralytic polio. With VAPP, the original strain of attenuated vaccine virus reverts to a form that can cause polio, but it does spread from one person to another, so does not lead to outbreaks.
Fortunately, both VAPP and cVDPV are rare.
How rare? VAPP only occurs in about 1 in every 1.27 million children receiving their first dose of OPV.
And according to the WHO, there had only been about 24 outbreaks of cVDPV over the past 10 years. Tragically, this has resulted in at least 750 cases of paralytic polio in 21 countries.
A new outbreak of cVDPV in Syria adds to those numbers though.
After being polio free for 15 years, since 1999, Syria began having cases of wild type polio again in 2013 (35 cases) and 2014 (1 case). Those polio cases and the emergence of an outbreak of cVDPV2 (there are three strains of polio virus – this outbreak was caused by the type-2 strain) highlight the effects of years of poor immunization rates because of war.
While there are many challenges to getting kids vaccinated in Syria, up to 355 vaccination teams with 61 supervisors will be working out of five vaccine distribution centers to vaccinate 328,000 children to control the outbreak and get kids vaccinated.
Circulating Vaccine-Derived Polio Virus
Just like wild type polio, we can stop cVDPV by increasing vaccination rates and increasing access to improved sanitation facilities.
Although anti-vaccine folks routinely cry wolf about shedding, the oral polio vaccine really does shed – in the stool of people who have been recently vaccinated. You can then be exposed to the attenuated polio vaccine virus (which can help give immunity to others in the community by passive immunization) or a strain of cVDPV (which can, unfortunately, help give others, especially if they are not vaccinated, paralytic polio) if they are exposed to open sewage or can not practice proper hygiene, etc.
Can’t we just stop using the live, oral polio vaccine?
Although a serious side effect of the vaccine, the vaccine’s benefits clearly outweigh the risk of both VAPP and cVDPV while polio is endemic (lots of cases) in a region, after all, without the vaccine, hundreds of thousands of children would get polio and would be paralyzed.
In polio-free countries, the risks of VAPP and cVDPV becomes greater than the risk of polio though, and they move to the inactivated polio vaccine. That helps prevent a situation in which the polio vaccines actually causes more cases of polio than wild type polio viruses.
Eventually, all countries will move to the IPV vaccine as we move closer to polio eradication. We came one step closer to that point in April 2016 when all countries that were still using the oral polio vaccine switched from trivalent OPV (three strains) to bivalent OPV (two strains) for their routine immunization programs. This could eliminate up to 90% of cases of cVDPV (most are caused by the type-2 strain which is not in bOPV)!
What To Know About cVDPV
Circulating vaccine-derived polio virus outbreaks are a rare side effect of the oral polio vaccine.
The idea of herd immunity has been around since at least 1923 and became used to describe “the indirect protection afforded to individuals by the presence and proximity of others who are immune.”
That’s not much different from how the CDC defines herd immunity today:
A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community.
Also called community immunity, it is often misunderstood by folks in the anti-vaccine movement.
Challenging the Concept of Herd Immunity
That the idea of herd immunity is being challenged is not new.
“Along with the growth of interest in herd immunity, there has been a proliferation of views of what it means or even of whether it exists at all.”
Paul E. M. Fine Herd Immunity: History, Theory, Practice
It is mostly because we live in open communities that don’t mix randomly.
Keep in mind that the best model for herd immunity is a randomly mixing closed community – “one in which the probability of contact within any time interval is the same for every choice of two individuals in the population.”
Again, that doesn’t mean herd immunity doesn’t work.
It just means we can expect to see some outbreaks when someone in a well vaccinated community visits another community with lower vaccination levels and more disease, gets sick, and returns.
“However, within the population of a community, there may be pockets of susceptibles, either because prior epidemics have failed to spread into the group or because they have not accepted immunization.”
John P. Fox Herd Immunity
You must also consider the size of the community when thinking about herd immunity, for example, a family, school, neighborhood, or city, versus the entire state. So you can have herd immunity levels of protection at the state or city level because of high average vaccination levels, but pockets of susceptibles who live in the same neighborhood or go to the same school can mean that you don’t have herd immunity in those places, leading to outbreaks.
“Hib vaccine coverage of less than 70% in the Gambia was sufficient to eliminate Hib disease, with similar findings seen in Navajo populations.”
RA Adegbola Elimination of Hib disease from The Gambia after…
Lastly, there is not one herd immunity level for all diseases. It is a separate threshold for each and every disease, depending on how easily it spreads, how many people are already immune, how long immunity lasts, if there is a vaccine, and the effectiveness of the vaccine, etc. That means that a community can have herd immunity for Hib and polio, but not the flu, and for rubella and measles, but not pertussis.
What happened in The Gambia is a great example of herd immunity. After introducing a three dose primary Hib immunization schedule (no booster dose), rates of Hib meningitis quickly went from 200 per 100,000 to none. A few years later, there were 6 cases of Hib meningitis in mostly vaccinated children (no booster dose) and in the majority of cases, “close contacts had a history of frequent or recent travel to Senegal, a neighboring country with strong kinship links with The Gambia and where vaccination against Hib was not introduced” until the following year.
With a Hib meningitis rate of 3 per 100,000, they are still far below pre-vaccine levels of disease, and their situation doesn’t mean that herd immunity isn’t real, as you will understand once you review these myths about herd immunity.
Myths About Herd Immunity
What are some common myths about herd immunity?
that natural immunity is better than getting vaccinated. Not True.Natural immunity often comes with a price. Remember, many vaccine-preventable diseases are life-threatening, even in this age of modern medicine.
you can just hide in the herd. Not True. “Freeloaders” can gamble and hope that their intentionally unvaccinated kids won’t get a vaccine-preventable disease, but it won’t always work. There is a risk to “free-riding, in which individuals profit from the protection provided by a well-vaccinated society without contributing to herd immunity themselves.”
most adults aren’t immune because they haven’t been vaccinated or don’t get boosters, but since we aren’t seeing that many outbreaks, herd immunity itself must be a myth. Not True.Adults were either born in the pre-vaccine era and likely have natural immunity or were born in the vaccine era and are vaccinated and immune. But again, herd immunity is disease specific, so when we talk about herd immunity for measles, it doesn’t matter if they have immunity against hepatitis A or Hib. And adults get few boosters or catch-up vaccines. Also, some vaccines, like Hib and Prevnar, have indirect effects, protecting adults even though they aren’t vaccinated because vaccinated kids are less likely to become infectious.
most vaccines wear off too soon to provide long lasting protection for herd immunity to be real. Not True. While waning immunity is a problem for a few diseases, like pertussis and mumps, and you need boosters for others, like tetanus, vaccine induced immunity is typically long lasting and often life-long.
herd immunity wasn’t developed by observing immunized people, it was all about natural immunity. Not True. The first experiments about herd immunity by Topley and Wilson in 1923 involved vaccinated mice. Ok, they weren’t immunized people, but it wasn’t just about natural immunity! And much earlier, in 1840, it was noted that “smallpox would be disturbed, and sometimes arrested, by vaccination, which protected a part of the population.” That’s herd immunity he was talking about.
herd immunity is not a scientifically validated concept. Not True. It has been well studied for almost 100 years.
if herd immunity was real, diseases would be eradicated once you reached herd immunity levels. Not True. Reaching herd immunity levels simply starts a downward trend in disease incidence. A little more work has to be done at the final stages of eradication, like was done for smallpox and is being done for polio.
natural immunity causes much of the decrease in mortality from a disease in the developed world, even before a vaccine is introduced. Not True. While it is certainly true that there was a big drop in mortality in the first half of the 20th century for most conditions because of improvements in sanitation, nutrition, and medical science, it was not a consequence of natural herd immunity. And we continue to see significant levels of mortality and morbidity for many diseases in the modern era, especially for those that can’t yet be prevented by a vaccine, like RSV, West Nile Virus, and malaria, etc.
vaccines aren’t 100% effective, so herd immunity can’t really work. Not True. Part of the equation to figure out the herd immunity threshold for a disease takes into account the effectiveness of a particular vaccine.
folks with medical exemptions for vaccines put the herd at risk just the same as those who intentionally skip vaccines. Not True. Children and adults with medical exemptions, including immune system problems, those getting treatments for cancer, and other true medical exemptions don’t have a choice about getting vaccinated.
So, like other anti-vaccine myths, none of the herd immunity myths you may have heard are true.
That makes it hard to understand why Dr. Russel Blaylock goes so far as to say “that vaccine-induced herd immunity is mostly myth can be proven quite simply.” Does he just not understand herd immunity? That is certainly a possibility, because “although herd immunity is crucial for the elimination of infectious diseases, its complexity and explicit relationship to health politics cause it to remain under-explained and under-used in vaccine advocacy. ”
He is also really big into pushing the idea that adults have no or little immunity, because when he was in medical school, he was “taught that all of the childhood vaccines lasted a lifetime,” but it has now been discovered that “most of these vaccines lost their effectiveness 2 to 10 years after being given.”
The thing is, Blaylock graduated medical school in 1971, when the only vaccines that were routinely used were smallpox (routine use ended in 1972), DPT, OPV, and MMR (it had just become available as a combined vaccine in 1971). Of these, it was long known that smallpox, diphtheria, and tetanus didn’t “last a lifetime,” and the live vaccines OPV and MMR, except for the mumps component, actually do.
Blaylock, like most anti-vaccine folks who push myths about herd immunity, is plain wrong. And like most anti-vaccine myths, using herd immunity denialism to convince parents that it is okay to skip or delay vaccines puts us all at risk for disease.
What To Know About Herd Immunity Myths
Herd immunity is not junk science or a false theory. Herd immunity is real, it works, and explains how people in a community are protected from a disease when vaccination rates are above a certain threshold.
Whenever there is a discussion about folks who intentionally choose to not vaccinate themselves or their kids, one of their arguments invariably is ‘why are you so worried if you and your kids are vaccinated?”
Here is an example:
“My argument is simple. If you are vaccinated, you should not have to fear an outbreak of any preventable disease. That’s what the vaccine is supposed to prevent, right? Therefore, why should anyone butt into someone else’s business and tell them they should vaccinate? If one and one’s dependents are vaccinated, why should they have to worry about my personal decision to not vaccinate?”
I personally don’t believe in vaccines
As most people understand, the argument is far from simple.
Who Is at Risk If You Don’t Vaccinate Your Kids?
There are many people who are at risk from those who are unvaccinated, including those who:
are too young to be vaccinated or fully vaccinated – remember, with the latest immunization schedule, kids don’t typically get their first MMR until age 12 months and their second until they are 4 to 6 years old
were vaccinated, but later developed an immune system problem and their immunity has worn off – might include children with cancer, AIDS, those receiving immunosuppressive therapy after a transplant, or a condition that requires immunosuppressive doses of steroids, etc.
These are the children and adults that can be, and should be, protected by herd immunity. At least they can be when most folks are vaccinated.
“We want to create a ‘protective cocoon’ of immunized persons surrounding patients with primary immunodeficiency diseases so that they have less chance of being exposed to a potentially serious infection like influenza.”
Medical Advisory Committee of the Immune Deficiency Foundation
So while some folks who are against vaccines try to scare others about shedding, those who take care of kids with immune system problems and their families go out of the way to get everyone around them vaccinated so their kids aren’t at risk of getting a vaccine-preventable disease!
“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”
Medical Advisory Committee of the Immune Deficiency Foundation
Tragically, not everyone has gotten the message, and we continue to see and hear about kids who are too young to be vaccinated or who couldn’t be vaccinated get exposed to those who got sick because they simply chose to not get vaccinated.
What to Know About Risks from the Unvaccinated
Intentionally unvaccinated children and adults put others at risk for vaccine-preventable diseases.
Why do some folks think that immigrants and refugees are spreading disease in the United States?
It certainly doesn’t help that Lou Dobbs once pushed the false idea that “illegal aliens” were fueling outbreaks of disease in the United States:
“The invasion of illegal aliens is threatening the health of many Americans. Highly-contagious diseases are now crossing our borders decades after those diseases had been eradicated in this country.”
Lou Dobbs Tonight
He warned, on his show in 2005, that “there are rising fears that once eradicated diseases are now returning to this country through our open borders. Those diseases are threatening the health of nearly every American as well as illegal aliens themselves.”
The once “eradicated diseases” he was talking about was leprosy. Of course though, he was wrong – leprosy has never been eradicated and it has not been increasing. Since 1985, there have been about 100 to 300 cases a year in the United States – no where near the “7,000 in the past three years” that Dobbs reported.
Immigrant Disease Spreading Propaganda Blitz
More recently, “as the taxpayer funded refugee resettlement industry launches a propaganda blitz about the so-called World Refugee Day” in 2016, Breitbart News reported that “six diseases that were recently near eradication are making a comeback in the United States.”
Of these six diseases, three – measles, mumps, and whooping cough – are vaccine-preventable and have very little to do with immigrants or refugees. Often, they have to do with unvaccinated United States citizens traveling out of the country, getting sick, and coming home to start an outbreak.
There was an outbreak of measles among a Somali community in Hennepin County, Minnesota in 2011, involving 14, mostly unvaccinated people. But they were unvaccinated because the anti-vaccine crowd (Wakefield) scared them away from being vaccinated over fears of autism, not because they were recent refugees.
Another Breitbart disease, scarlet fever, is simply the rash that you get when you have a strep infection, like strep throat. It is very common in kids and the incidence hasn’t changed over the years in the United States. For an unknown reason, the UK is seeing higher rates of scarlet fever though.
The last two Breitbart News warns about are bubonic plague and tuberculosis.
While there were 16 cases of plague in the United States in 2015, that is not unusual. The CDC reports that “in recent decades, an average of seven human plague cases have been reported each year (range: 1–17 cases per year).”
“The bacteria that cause plague, Yersinia pestis, maintain their existence in a cycle involving rodents and their fleas.”
CDC – Plague ecology in the United States
Anyway, you get bubonic plague from infected fleas and flea bites, not other sick people. You can get pneumonic plague from a sick person, but that hasn’t happened in the United States since 1924.
What about tuberculosis? That must be increasing because of new immigrants and refugees, right?
Nope. After years and years of decreasing, the number of cases and incidence rate has leveled off at its lowest level, about 9,500 cases since 2013. That’s compared to just over 14,000 cases in 2005. While that’s not to say that more work has to be done in working to eliminate tuberculosis, it is not making any kind of comeback.
Other Breitbart articles warned that “Syrian Refugees Spreading Flesh-Eating Disease, Polio, Measles, Tuberculosis, Hepatitis” and “EXCLUSIVE – Syrian Refugees Bringing Flesh-Eating Disease into U.S.?”
The “Flesh-Eating Disease” Breitbart is talking about isn’t the flesh-eating bacteria. It is a parasite that isn’t even spread from person to person. It is spread by sand fleas.
And rates of tuberculosis are actually lower in Syria than in most of Europe.
“In spite of the common perception of an association between migration and the importation of infectious diseases, there is no systematic association.”
World Health Organization
Tragically, while there have been some outbreaks of measles, polio, and other diseases in Syria, refugees are not spreading these diseases to Europe or the United States.
Of course, Breitbart isn’t the only one participating in the immigrant disease spreading propaganda blitz these days.
“Likewise, tremendous infectious disease is pouring across the border. The United States has become a dumping ground for Mexico and, in fact, for many other parts of the world.”
Donald Trump (2015)
From politicians spreading misleading information about “tremendous infectious disease” to everyone else spamming each other with tales of immigrants spreading everything from Ebola and EV-D68 to worms, the net result is folks being scared of immigrants and refugees for no good reason.
Mychal Massie, in an Invasion USA report for WND recently wrote about a briefing given to the Arizona State Senate warning about a “Medical Ticking Time Bomb” warning that “illegals” were bringing scurvy, pernicious lice, and worms, etc. into the US.
Now unless immigrants are stealing all of our vitamin C, I don’t think that we have to worry that we will start see epidemics of scurvy any time soon.
Texas – with most of the cases in North Texas, including a large outbreak in Johnson County (72 cases) and two other outbreaks linked to four different cheerleading competitions.
At SUNY New Paltz, most of the cases were among the swim team. In addition, 20 unvaccinated students were sent home from school under quarantine until December 3.
In Arkansas, 42 workplaces, 39 schools in six school districts, six colleges and two private schools in Benton, Carroll, Conway, Faulkner, Madison, Pulaski, and Washington counties are seeing most of the cases. A quarantine is in effect, with unvaccinated children being kept out of school for 26 days from the date of exposure or for the duration of the outbreak, whichever is longer.
Many of these outbreaks occur despite many of the cases having had two doses of the MMR vaccine. A third dose is sometimes recommended during these outbreaks.
That doesn’t mean that the MMR vaccine doesn’t work. After all, just compare today’s rates of mumps, even if they are a little higher than we would like, to pre-vaccine levels…
Getting two doses of the MMR vaccine is still the best way to avoid mumps.
There is no general recommendations to get extra shots though.
Keep in mind that the MMR vaccine isn’t just for kids. Adults who didn’t have mumps when they were kids (or who were born before 1957, when most kids got mumps), should make sure they are vaccinated (at least one dose) and protected too.
Breaking News: Flu season has peaked, and is winding down. (see below)
While flu season typically peaks in February, it is very important to understand that there are few things that are typical about the flu.
Since 1982, while we have been twice as likely to see a flu activity peak in February than other winter months, we have been just as likely to get that peak in December, January, or March. That makes it important to get your flu vaccine as soon as you can.
You really never know if it is going to be an early, average, or late flu season.
While there will likely be some surprises this flu season – there always are – there are some things that you can unfortunately count on.
Among these flu facts include that:
there have been 1,482 pediatric flu deaths since the 2003-04 flu season, including 89 flu deaths last year
about 113 kids die of the flu each year – most of them unvaccinated
antiviral flu medicines, such as Tamiflu, while recommended to treat high-risk people, including kids under 2 to 5 years of age, have very modest benefits at best (they don’t do all that much, are expensive, don’t taste good, and can have side effects, etc.)
a flu vaccine is the best way to decrease your child’s chances of getting the flu
And even in a mild flu season, a lot of kids get sick with the flu.
This Year’s Flu Season
When does flu season start?
In general, flu season starts when you begin to see people around you with signs and symptoms of the flu, including fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue, etc.
To be more accurate, you can also look at reports for flu activity in your area, especially the weekly reports from the CDC.
Those flu reports can also help you determine when flu season ends.
As of late-April, the CDC is reporting that “flu activity continues to decrease in the United States.”
The CDC has also recently reported that:
this year’s flu vaccine reduces “the risk for influenza-associated medical visits by approximately half”
influenza A (H3N2) viruses, a component of this year’s flu vaccine, predominated early in this year’s flu season, which could be a sign of a severe flu season. In general, “H3N2-predominant seasons have been associated with more severe illness and higher mortality, especially in older people and young children…”
Is it a match? – “…antigenic and/or genetic characterization shows that the majority of the tested viruses remain similar to the recommended components of the 2016-2017 Northern Hemisphere vaccines.”
As often happens on the downside of a flu season peak, we are starting to see more and more influenza B each week
There are reports of a new avian influenza A(H7N9) epidemic in China. Although deadly, there is fortunately no reports of sustained human-to-human transmission of this flu virus strain that is usually associated with poultry exposure.
Next year’s flu vaccine won’t be changing much, except that “The A(H1N1)pdm09 virus has been updated compared to the virus recommended for northern hemisphere 2016-2017 influenza season.”
only 3 states (down from 7), including Connecticut, New Hampshire, and New York, are still reporting widespread flu activity (the highest level)
only 8 states (down from 11), including Alaska, Arizona, Maine, Massachusetts, New Jersey, Ohio, Rhode Island, and South Carolina are still reporting regional flu activity
20 states (up from 19), California, Delaware, Florida, Iowa, Kansas, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, New Mexico, North Dakota, Oklahoma, Pennsylvania, Tennessee, Texas, Washington, West Virginia, and Wisconsin, and Puerto Rico are now reporting local flu activity
19 states (up from 13), including Alabama, Arkansas, Colorado, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Mississippi, Nebraska, Nevada, North Carolina, Oregon, South Dakota, Utah, Vermont, Virginia and Wyoming, are now reporting sporadic flu activity
there have been 89 pediatric deaths this flu season, including reports of 7 new deaths this week
Have you and your family gotten been vaccinated and protected against the flu yet?
“Anyone who has not gotten vaccinated yet this season should get vaccinated now.”
CDC Influenza Situation Update
If not, this is still a good time to get a flu vaccine.
Recent Flu Seasons
Are H3N2 predominant flu seasons really worse than others?
2003-04 flu season – 152 pediatric flu deaths (H3N2-predominant)
2004-05 flu season – 47 pediatric flu deaths
2005-06 flu season – 46 pediatric flu deaths
2006-07 flu season – 77 pediatric flu deaths
2007-08 flu season – 88 pediatric flu deaths (H3N2-predominant)
2012-13 flu season – 171 pediatric flu deaths (H3N2-predominant)
2013-14 flu season – 111 pediatric flu deaths
2014-15 flu season – 148 pediatric flu deaths (H3N2-predominant)
2015-16 flu season – 92 pediatric flu deaths
In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.”
Breaking News – We already have reports of measles cases in at least 116 people from 12 states (California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington) in 2017, including an ongoing outbreak in Minnesota that is now up to 78 cases. Also many reports of measles outbreaks in Europe. (see below)
We have come a long way since the development of the first measles vaccines in the early 1960s…
Pre-Vaccine Era Measles Outbreaks
In the pre-vaccine era, measles was a very common childhood disease.
As it is now, it was also a deadly disease.
In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).
In 1962, there were 469,924 cases of measles in the United States and 432 deaths.
Post-Vaccine Era Measles Outbreaks
The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.
In 1970, there were only 47,351 cases and 89 deaths.
Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.
Post-Elimination Era Measles Outbreaks
Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.
We have seen more than a few records in the post-elimination era, including:
the year with the historic low number of measles cases – 37 cases in 2004
the year with the largest number of cases since 1994 – 667 cases in 2014
the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014
In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.
2017 Measles Outbreaks
The first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person exposed others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.
The second case of 2017 was related to an LA county outbreak that started at the end of 2016 – a resident of Ventura County.
And it goes on already, with other measles cases in 2017 including:
at least 116 cases (as of mid-June)
cases in 12 states, including California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington
an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
a confirmed case in Omaha, Nebraska, who exposed people on a Delta flight and multiple places in Douglas and Sarpy counties, including the Bergan Mercy Hospital Emergency Room.
two children in Minnesota without a known source of infection
another child in Minnesota – among the three Somali Minnesotans in this outbreak are two children who are just two years old – all of the cases were unvaccinated and two required hospitalization, although the common source is still not known. Vaccine hesitancy has been a problem among the Somali Minnesotans because of Wakefield‘s MMR study.
five more unvaccinated children in Minnesota, as the outbreak grows to 8.
a confirmed case in North Platte, Nebraska who may have exposed others at a middle school, church youth group, the Great Plains Health Emergency Room, a medical office, and a lab.
a resident of Livingston County, Michigan who exposed others at area restaurants and St. Joseph Mercy Brighton Hospital after getting measles on a plane ride with an unvaccinated child
another case in Minnesota, bringing the outbreak count to 9 unvaccinated children.
three more cases in Minnesota, bringing this outbreak case count to 12, with at least 200 people in quarantine.
eight more cases in Minnesota, bringing this outbreak case count to 20 young children under age 5 years, and now including an infant under age 12 months.
four more cases in Minnesota, bringing this outbreak case count to 24 young children under age 5 years and surpassing the size of the 2011 measles outbreak in the Somali community in the same area, which was also mostly among intentionally unvaccinated children.
five more cases in Minnesota, including the first outside of Hennepin County – spreading to nearby Stearns County, bringing this outbreak case count to 29 young children under age 5 years, with only one that was vaccinated.
three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
more measles (2 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and now Le Sueur County), where the ongoing outbreak is up to 66 cases, almost all unvaccinated children and where there has been a call to accelerate the two dose MMR schedule for kids over age 12 months.
a child in Maryland who was admitted to Children’s National Medical Center in Washington, D.C.
more measles (3 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and Le Sueur County), where the ongoing outbreak that has been confirmed to be from the wild type B3 strain is up to 68 cases, almost all unvaccinated children.
a case in Pennsylvania who exposed others at a visitor center
someone who visited the MIT Museum in Cambridge, Massachusetts.
two new cases in Minnesota, ending speculation that the outbreak, now up to 70 cases, was over…
one new case in Minnesota, raising the number of cases in this ongoing outbreak to 78 cases.
the latest case – a healthcare worker in New York who is employed by Hudson Headwaters Health Network and also works at a Warren County medical practice.
How many cases will we end up with this year? It is certainly getting off to a quick start, which could mean a big year for measles, although it is certainly hard to predict what will happen.
2016 Measles Outbreaks
Starting slow, 2016 ended as a fairly average year for measles:
cases in 17 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
a large outbreak in Arizona, 23 cases, linked to a private detention center
a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department
As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.
International Measles Outbreaks
The endemic spread of measles was stopped or eliminated in 2000. Since then, most of the measles outbreaks in the United States begin when someone travels out of the country, gets sick, and exposes others. Or less commonly, when an international traveler brings measles into the country.
That makes it easy to understand that large outbreaks of measles in other parts of the world could increase the risk that we have more outbreaks here. And that’s what happened in 2014 when there was an epidemic of measles in the Philippines and we ended up with the most cases since 1994, many linked to travel to and from the Philippines.
This year, the world is seeing large outbreaks of measles in:
European Union – Austria (78 cases), Belgium (293 cases, including 2 cases of encephalitis), Bulgaria (130 cases, including one death – a 10-month old unvaccinated child), Czech Republic (126 cases, including 2 cases of encephalitis), Denmark, France (189 cases, including 2 cases of encephalitis), Germany (698 cases, and a death in a 37-year-old mother of 3 children), Hungary (54 cases), Iceland (2 cases. 10-month-old unvaccinated twin siblings – the first cases in Iceland in 25 years!), Italy (2,988 cases), Portugal (31 cases, including one death), Slovakia, Spain (46 cases), and Sweden (19 cases). The largest outbreak is in Romania, where there have been 6,743 cases and 30 deaths in the past 13 months.
UK – 17 cases in 2017
Switzerland – the Swiss Sentinel Surveillance Network already reports 67 measles cases in 2017, compared to 36 in 2015 and 65 in 2016. Many of the cases are in young adults, aged 20-24 years. There has been one death, a vaccinated man being treated for leukemia.
Australia – 54 cases so far in 2017
New Zealand – 11 cases so far in 2017
Canada – at least 42 cases including an active outbreak in Nova Scotia.
Japan – 164 cases so far in 2017 (they had 8 in early June 2016…)
Congo – over 14,000 cases
Guinea – a measles epidemic has been declared in the country, with at least 1,527 cases and 2 deaths this year
Indonesia – island of Bali
South Africa – 60 cases, including an outbreak in Gauteng (24 cases) that is linked to one unvaccinated family.
Republican of South Sudan
Somalia – over 8,000 cases
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.