Tag: travel vaccines

What Do We Know About the Rockland County Measles Outbreak?

Breaking News – there are 5 new cases in Rockland County, bringing the total in this ongoing outbreak to 135. (see below)

We know a lot about the measles outbreak in Rockland County, New York.

Nothing about what Del Bigtree and Sharyl Attkisson have been saying is right.
Nothing about what Del Bigtree and Sharyl Attkisson have been saying is right.

That makes it easy to spot anti-vaccine propaganda.

What Do We Know About the Rockland County Measles Outbreak?

What do we know?

We know that the outbreak is still growing.

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

And we know that most of the folks in the outbreak are unvaccinated.

What else do we know?

“At the end of September 2018, an international traveler arrived in Rockland County with a suspected case of the measles.”

Rockland County Measles Information

The outbreak is already the largest in New York State since the 1990s, before the endemic spread of measles was declared eliminated in the United States.

While it is unlikely to surpass the Ohio measles outbreak of 2014, which reached 384 cases, the Rockland County outbreak has already lasted longer.

In fact, this might be one of the longer outbreaks we have had in a long while.

OutbreakCasesDuration
Brooklyn outbreak 2013583/13 to 6/9
Ohio outbreak 20143843/24 to 7/23
Disneyland outbreak 201514712/28 to 4/16
Minnesota outbreak 2017793/30 to 8/25
Rockland County outbreak 2018
1359/18 – ?
Brooklyn outbreak 20187310/18 – ?

The Minnesota outbreak of 2017 lasted nearly 5 months, but that includes the 42 days that they went measles-free.

Why 42 days? That’s equal to two incubation periods and if that much time has passed since the last person was infectious, there is little danger that there is still a missed case of measles in the community.

However, since there have been recent cases in Rockland County, we would be into the 6th month, mid-March, to get to that same point now.

Why has this outbreak been so hard to control?

“8 separate index cases, all with exposures to ongoing measles outbreak in Israel.”

Measles Review for Providers

Folks keep reintroducing measles into the community!

And immunization rates in the zip codes most affected by the outbreaks were as low as 54% at the start of the outbreak.

What else do we know?

Nine schools, now in compliance, were fined because they didn’t follow the Rockland County Health Commissioners order to keep unvaccinated and undervaccinated students out of school and provide immunization records and attendance records to the Rockland County Department of Health.

“ALL schools within the Village of New Square and any school with less than an 80% MMR vaccination rate within the geographical area affected by the measles outbreak (Spring Valley, Monsey) will be required to keep un- or under-vaccinated students home until 21 days have passed since the last confirmed measles case in Rockland.”

Health Department Announces Increased School Exclusions Due to Measles Outbreak

We don’t know why they aren’t quarantining all intentionally unvaccinated kids from school until the outbreak is over…

We do know that at least six people have been hospitalized in the Rockland County measles outbreak, including one child who ended up in the pediatric intensive care unit.

And we know that vaccines are safe and necessary! Get vaccinated and stop the outbreaks.

“Children 6 months through 11 months of age get an MMR vaccine now. Getting an MMR vaccine now will help give them some protection against measles. They will still have to get a vaccine at 12-15 months of age and again at 4-6 years of age.

Children 1 through 3 years of age who have already received their first MMR vaccine should get a second MMR vaccine now, as long as 28 days have passed since the first MMR vaccine was given to them. This second MMR vaccine will count for school entry.”

In fact, in Rockland County and other areas being hit with an outbreak, kids should get an early MMR, when they are six months old. And they can get their second dose early too, as early as 4 weeks after their first dose when they turn 12 months old.

Lastly, we know that you shouldn’t believe any of the anti-vaccine misinformation that is going around that might scare you away from vaccinating and protecting your kids. That’s why we have these outbreaks…

More on the The Rockland County Measles Outbreak

Updated February 13, 2019

Where Is Measles on the Rise?

We have been hearing a lot about ongoing measles outbreaks in the United States this year.

Brooklyn. Rockland County. The Pacific Northwest.

Think 2018 was a big year for measles? It was the second highest number of cases since 1996.

How will 2019 shape up?

Consider that it isn’t even the end of January yet and we have already had more cases, 74 92, than we had in the entire years of 2002 (44 cases), 2003 (55), 2004 (37), 2005 (66), 2006 (55), 2007 (43), 2009 (71), 2010 (61), and 2012 (55).

That’s right. In just three weeks, we have had more than double the amount of cases than all of 2004!

Not surprisingly, this isn’t just happening in the United States.

Where Is Measles on the Rise?

In fact, if you understand that the endemic spread of measles was eliminated in the United States in 2000 and that outbreaks are started by folks with measles who travel in or out of the country, then it makes sense that more measles here likely means that there is more measles somewhere else.

Unfortunately, this year, that somewhere else seems to be just about everywhere.

Japan is off to the fastest start in 10 years, with 46 cases in the first two weeks of January, surpassing 2009, when they ended up with over 700 cases.
Japan is off to the fastest start in 10 years, with 46 cases in the first two weeks of January, surpassing 2009, when they ended up with over 700 cases.

Are you planning a trip to Europe anytime soon?

With so many measles cases in Europe, it shouldn't be a surprise to anyone that there are so many deaths.
With so many measles cases in Europe, it shouldn’t be a surprise to anyone that there are so many deaths.

You should know that their measles outbreaks aren’t over. There are ongoing outbreaks in Romania, France, Greece, and Italy.

“In 2018 and as of 10 January 2019, most cases in the EU were reported from Romania (5,376), France (2,902), Italy (2,427) and Greece (2,290). Thirty-five deaths were reported in 2018 from Romania (22), Italy (8), France (3) and Greece (2).

Outside EU/EFTA countries, Ukraine is experiencing the continuation of the largest outbreak, with over 54,000 cases reported in 2018, including 16 deaths, and over 2,000 cases, including one death, reported at the start of 2019. Measles cases are also reported by Algeria, Belarus, Israel, Mauritius, Serbia and the US.”

Communicable disease threats report, 6-12 January 2019, week 2

Where else are we seeing measles?

  • at least 3,150 cases in Israel and 2 deaths in 2018
  • over 17,300 in the Philippines and at least 24 deaths in 2018
  • nearly 2,000 cases in Vietnam (2018) and cases are increasing in Hanoi and Ho Chi Minh City already in 2019
  • at least 517 confirmed cases in the UK (through the 3rd quarter of 2018)
  • India remains the country with the most cases, with over 65,600 cases in 2018
  • over 19,000 cases and 39 deaths in Madagascar
  • a large outbreak in Thailand, with at least 4,327 cases
  • an ongoing outbreak in Malaysia with over 1,934 cases and 6 deaths (2018)
  • at least 30 cases in the Republic of Korea
  • outbreaks in Yemen, Nigeria, Sudan, and DR Congo
Conflict zones plus vaccine hesitancy contribute to measles outbreaks in the Philippines.
Conflict zones plus vaccine hesitancy contribute to measles outbreaks in the Philippines.

And over 16,000 confirmed measles cases, including 86 deaths, have been reported in 12 countries of the Region of the Americas: Antigua and Barbuda (1 case), Argentina (14 cases), Brazil (9,898 cases, including 13 deaths), Canada (29 cases), Chile (2 cases ), Colombia (171 cases), Ecuador (19 cases), Guatemala (1 case), Mexico (5 cases), Peru (38 cases), the United States of America (350 cases), and the Bolivarian Republic of Venezuela (5,643 cases, including 73 deaths).

Does it seem like measles is on the rise everywhere?

That’s because it basically is.

Since 2017, there has been a measles resurgence in three regions of the world and measles elimination milestones have not been met.

And as you can see, in almost all of these places where we are seeing more measles, we are seeing more people dying of measles?

That’s why it is important to get vaccinated.

There is even a recommendation to get an early MMR if you will be traveling out of the United States. Get vaccinated. Don’t bring home measles and start an outbreak.

More on the Resurgance of Measles

How Do You Get Caught up If You Have Never Been Vaccinated?

Why would someone have never gotten any vaccines and need to catch up?

Getting caught up on your vaccines is easy.
Getting caught up on your vaccines is easy.

The usual story is that a child’s vaccines were delayed or skipped for some reason, typically over fears of anti-vaccine propaganda.

You can always get caught up though, right?

Well, not always…

Tragically, kids can get sick and catch these vaccine-preventable diseases before they have time to get vaccinated and protected. You can wait too long to get vaccinated!

How Do You Get Caught up If You Have Never Been Vaccinated?

That’s why it is important to get caught up as soon as possible.

How does that work?

The first step is figuring out which vaccines you need, considering that:

  • rotavirus vaccines are only given up to age 9-months
  • Hib and Prevnar are typically only given up to age 5-years, unless someone has specific conditions that put them at high risk for disease, although Prevnar becomes routine again at age 65-years
  • the polio vaccine is typically only given up to age 18-years
  • the meningococcal vaccines (MenACWY and MenB) are routinely given to teens and young adults through age 16 to 23-years, but older high-risk adults can also be vaccinated if necessary
  • the HPV vaccines are routinely given up to age 26-years, although they are FDA approved to be given through age 45 years
  • hepatitis A vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • hepatitis B vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • the Pneumovax (PPSV23) and shingles vaccines are given to seniors
  • if you already had a natural case of chicken pox, while you won’t need to be vaccinated, some folks might need a varicella titer to confirm that they are immune

So, depending on your age when you are starting your catch-up, there may be some vaccines that you don’t need anymore.

Still, unless you have a contraindication, you will likely at least need:

  • a yearly flu vaccine
  • 1 to 2 doses (high risk groups) of MMR
  • 2 doses of the chicken pox vaccine (Varivax)
  • 1 dose of Tdap, followed by 2 doses of Td

What’s next?

Once you have an idea of which vaccines you need, you should schedule an appointment with your health care provider and get vaccinated and protected.

A local pharmacy or health department are other places that might offer vaccines to older teens and adults.

More on Getting Caught up on Vaccines

Did a Top Cancer Scientist Suddenly Die After Getting a Yellow Fever Vaccination?

We are seeing many reports that Professor Martin Gore, an oncologist at London’s Royal Marsden Hospital for more than 35 years, died suddenly after getting a yellow fever vaccine.

Could that be true?

Could someone really die after getting a routine vaccination?

Did a Top Cancer Scientist Suddenly Die After Getting a Yellow Fever Vaccination?

Of course, it could be true.

Although vaccines are very safe, they are not 100% risk free. And tragically, they do very rarely have life-threatening side effects.

To be fair, we don’t know the full story about what happened to Prof Gore, but the media reports do say that he suffered total organ failure shortly after getting his yellow fever vaccine.

What we don’t know is how shortly after getting the vaccine or if there is any evidence for another cause for his having organ failure.

Still, although most side effects are mild, it is reported that the yellow fever vaccine, which has been available for more than 80 years, can rarely cause:

How rarely?

About 1 in 55,000 for severe allergic reactions, 1 in 125,000 for severe nervous system reactions, and 1 in 250,000 for life-threatening severe illness with organ failure.

And the risks are likely higher if you are older than age 60 years, although YEL-AND and YEL-AVD are not reported to happen with booster doses of the yellow fever vaccine.

“People aged ≥60 years may be at increased risk for serious adverse events (serious disease or, very rarely, death) following vaccination, compared with younger persons. This is particularly true if they are receiving their first yellow fever vaccination. Travelers aged ≥60 years should discuss with their healthcare provider the risks and benefits of the vaccine given their travel plans.”

Yellow Fever Frequently Asked Questions

Why would you get the yellow fever vaccine if you were older than aged 60 years and you knew there was a higher risk of severe side effects?

Yellow fever itself is a life threatening disease without a cure and a case fatality rate of up to 50%, and again, YEL-AVD is not common, occurring in about 0.4/100,000 doses.

So you would typically want to get vaccinated if you were traveling to an area where yellow fever was a risk.

“Since January 2018, 10 travel-related cases of yellow fever, including four deaths, have been reported in international travelers returning from Brazil. None of the 10 travelers had received yellow fever vaccination.”

Fatal Yellow Fever in Travelers to Brazil, 2018

In addition to outbreaks, yellow fever is still endemic in forty-seven countries in Africa and Central and South America, leading to 170,000 severe cases and 60,000 deaths in recent years, including some deaths in unvaccinated travelers returning from these areas. Did you read about these deaths in the paper?

Although it is not on the routine immunization schedule, if you are traveling somewhere and yellow fever is a risk, you should get a yellow fever vaccine.

Professor Gore’s death, at age 67, is a tragedy, no matter the cause.

That we are having to talk about it because anti-vaccine folks are using his death to push their idea that vaccines aren’t safe is unconscionable.

More on Yellow Fever Vaccine Deaths

Vaccine-Preventable Diseases – Year in Review 2018

Does it seem like we are moving in the wrong direction?

The eradication of smallpox shows just what vaccines can do!
The eradication of smallpox shows just what vaccines can do!

No, smallpox isn’t coming back, but many other vaccine-preventable diseases are.

Vaccine-Preventable Diseases – Year in Review 2018

With the availability of new vaccines and the expanded use of other vaccines, many of us were hopeful of the progress that was being made against vaccine-preventable diseases so far this decade.

Remember, it was just four years ago that the WHO certified India as a polio free country. And after years of declining numbers of wild polio cases, 2018 will be the first year with a higher number of cases than the previous year.

This hasn’t been a good year for measles either. The WHO Region of the Americas has lost its status as having eliminated measles!

In Bolivarian Republic of Venezuela, endemic transmission of measles has been re-established, with spread to neighbouring countries. As a result, the Region has lost its status as having eliminated measles. The Regional Technical Advisory Group, which met in July 2018, emphasized the importance of Regional action and an urgent public health response to ensure re-verification of measles elimination in Bolivarian Republic of Venezuela.

Meeting of the Strategic Advisory Group of Experts on Immunization, October 2018 – Conclusions and recommendations

After years of declining rates, global measles cases and deaths began to jump in 2017, a trend that continued in 2018.

“Outbreaks in North America and in Europe emphasize that measles can easily spread even in countries with mature health systems. Due to ongoing outbreaks, measles is again considered endemic in Germany and Russia.”

2018 Assessment Report of the Global Vaccine Action Plan

And no, this isn’t just a problem in other parts of the world.

Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

More cases in other parts of the world mean more cases in the United States because unvaccinated folks travel out of the country and bring these diseases home with them, getting others sick.

But it wasn’t just measles outbreaks, including the second largest number of cases in 22 years, that we were seeing in 2018:

  • chicken pox – although the 41 cases involving a North Carolina Waldorf school got the most attention, there were at least 6,892 cases of chicken pox last year, which continues to trend down from recent highs of over 15,000 in 2010
  • hepatitis A – clusters of outbreaks in 15 states with at least 11,166 cases, many deaths, with exposures at popular restaurants
  • mumps – from recent highs of over 6,000 cases the last few years, we were “back down” to just over 2,000 mumps cases in 2018
  • pertussis – cases were also down in 2018, with a preliminary count of about 13,439 cases last year
  • meningococcal disease – isolated outbreaks continued last year, with cases at Smith College, Colgate University, and San Diego State University

And of course, we had one of the worst flu seasons in some time last year, with 185 pediatric flu deaths.

Fortunately, there were no cases of diphtheria, neonatal tetanus, polio, or congenital rubella syndrome. At least not in the United States.

Why are some disease counts down when so many folks say the anti-vaccine movement is more active than ever?

Remember, the great majority of people vaccinate and protect their kids!

And vaccines work!

It is best to think of the anti-vaccine movement, which has always been around, as a very vocal minority that is just pushing propaganda to scare parents away from vaccinating and protecting their kids.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad these diseases are, allow themselves to be influenced by anti-vaccine propaganda, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

Also remember that many of these diseases occurred in multi-year cycles in the pre-vaccine era. When an up year hits a cluster of unvaccinated kids, we get bigger outbreaks. And then more folks get vaccinated, starting the cycle all over again. At least until we finally get the disease under better control or finally eradicated.

Want to avoid getting a vaccine-preventable disease this year?

Get vaccinated and protected and encourage everyone else to get vaccinated too.

More on Vaccine-Preventable Diseases – Year in Review 2018

News on the Latest Measles Outbreaks of 2019

Breaking News – 1 new cases in Washington (see below).

2019 has just started, but we already have reports of measles cases and exposures in at least 152 people in 9 states, including Colorado (1), Connecticut (3), Georgia (3), Hawaii (2), Kentucky (1), Illinois (4), New York (65), Oregon (5), Texas (7), and Washington (63).

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

Measles is still spreading in New York.

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?
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.
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.
Hopefully, no kids with immune system problems were exposed to these kids with measles.
Almost all of the measles cases in Rockland County are unvaccinated.

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:

Updated on February 18, 2019

Vaccines – Year in Review 2018

Another year has passed and although anti-vaccine folks keep talking about those 300 vaccines in pipeline, there were few new developments in the vaccine world in 2018.

Bob Sears got in trouble with the Medical Board of California over vaccine exemptions.
This happened in 2018.

Well, maybe that’s not entirely true.

Vaccines – Year in Review 2018

So what can we say about 2018 when it comes to vaccines?

Well, we did get some new ones!

  • approved by the FDA in late 2017, a new hepatitis B vaccine for adults, Heplisav-B, the formal recommendation for its use from the ACIP came on February 21, 2018
  • although it was both approved by the FDA and formally recommended by the ACIP in late 2017, Shingrix, the new shingles vaccine, became more widely available in 2018 – well kind of – there have been a lot of shortages due to high demand for the vaccine
  • Vaxelis, a hexavalent vaccine that combines DTaP-IPV-Hib-HepB into one shot was FDA approved on December 21, 2018, but likely won’t be available for a few more years
  • FluMist, the nasal spray flu vaccine, returned

And we lost one… Last year was the first full year that Menomune, an older meningococcal vaccine, was no longer available. It was discontinued because of low demand, as we began to use the newer vaccines, Menactra and Menveo instead.

In other immunization news:

  • a 2017 shortage of yellow fever vaccine continued into 2018
  • a shortage of monovalent pediatric hepatitis B vaccine will continue into 2019 (doesn’t affect combination vaccines with hepatitis B)
  • Gardasil 9 received an expanded recommendation – women and men between the ages of 27 and 45 years can now get vaccinated and protected with this HPV vaccine
  • the hepatitis A vaccine got a lower age recommendation – at least in special situations – “HepA vaccine be administered to infants aged 6–11 months traveling outside the United States when protection against HAV is recommended.”
  • the recommendation to use a third dose of MMR to control outbreaks of mumps was formally approved
  • the WHO updated its recommendations for use of the dengue fever vaccine (Dengvaxia) to makes sure that only dengue-seropositive persons are vaccinated, as they found an increased risk of severe dengue in seronegative people who were vaccinated
  • Of the 163 million to 168 million doses of flu vaccine that will be distributed in the United States for the 2018-2019 season, more than 80% will be thimerosal free.
  • China had an issue with substandard DTaP vaccines made by one company in one part of the country
  • India had an issue with contaminated polio vaccines made by one company in one part of the country – bivalent oral polio vaccines (two strains) still contained all three strains of polio vaccine virus
  • Measles cases and deaths spiked globally because of gaps in vaccination coverage

If you didn’t hear about any of those things in the news, you may have heard about the death of two young children in Samoa after they received an MMR vaccine. That tragedy almost certainly was caused by an error in administering/mixing the vaccines, and not because there was anything wrong with the vaccines themselves.

Need help getting educated about vaccines? Despite continued outbreaks, 2018 was a good year for vaccine advocates and vaccine education.

Several good books about vaccines were published, including:

And in case you missed it, we found out that:

Of course, for most of us, none of this is really news. We know that vaccines are safe, effective, and necessary.

And sadly, Betty Bumpers died. We can honor her legacy by continuing her work and helping to make sure that every child gets vaccinated and protected.

More on Vaccines Year in Review 2018