U.S. measles cases hit 2nd-highest level since elimination in 2000

by NCN Health And Science Team Posted on April 1st, 2019

Almost 400 cases of measles (rubeola) have been confirmed in 15 states this year as the disease nears record numbers since measles was declared eliminated almost two decades ago.

The Centers for Disease Control and Prevention said 387 measles cases have been confirmed from Jan. 1 to March 28, an increase of 73 cases last week alone.

The surge has thrown a spotlight on the anti-vaccination movement. Most people who contract measles have not been vaccinated, the CDC said, and measles are extremely contagious.

“If one person has it, up to 90 percent of the people close to that person who are not immune will also become infected,” the CDC said.

The record total for one year since 2000 is 667 in 2014. There were 372 cases last year.

Globally, measles is a major concern. The World Health Organization describes the disease as a prominent cause of death among young children, despite the availability of an effective vaccine. More than 110,000 people, mostly children, died of measles worldwide in 2017. The last U.S. measles death on record was in 2015.

Most of the U.S. cases this year take place where “outbreaks” – defined as three or more localized cases – have swept parts of New York, California, Illinois, Texas and Washington state, the CDC said. The outbreaks are linked to travelers who brought measles back from countries including Israel, Ukraine and the Philippines, the CDC said.

Measles is still common in many parts of the world, including some countries in Europe, Asia, the Pacific and Africa. The CDC said vaccinations are 97 percent effective, and the agency urged vaccinations for people traveling internationally.

In New York, Rockland County officials declared a state of emergency, citing more than 150 measles cases. The county barred unvaccinated youths under 18 from public places for 30 days, although parks and outdoor areas are not included.

The ban, which will be in effect for 30 days, prompted a backlash from a small group of anti-vaccination advocates, who protested Thursday in what they dubbed on Facebook a “Rockland County – Unvaccinated Civil Disobedience.”

Common measles symptoms include fever, runny nose, cough and a rash that can spread across the entire body. A very small number of those infected can develop pneumonia, swelling of the brain or other serious symptoms. Measles can cause pregnant women to deliver prematurely.

The virus can be spread through the air or through contact with surfaces touched by those who are infected. It can live for up to two hours in areas where the infected person coughed or sneezed and on surfaces she or he touched.

Other states that reported cases to CDC are Arizona, Colorado, Connecticut, Georgia, Kentucky, Michigan, Missouri, New Hampshire, New Jersey and Oregon.

Measles

Measles is a highly contagious, serious disease caused by a virus. Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year.

Approximately 110 000 people died from measles in 2017 – mostly children under the age of 5 years, despite the availability of a safe and effective vaccine.

Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air. The virus infects the respiratory tract, then spreads throughout the body. Measles is a human disease and is not known to occur in animals.

Accelerated immunization activities have had a major impact on reducing measles deaths. During 2000– 2017, measles vaccination prevented an estimated 21.1 million deaths. Global measles deaths have decreased by 80% from an estimated 545 000 in 2000* to 110 000 in 2017.

Measles: Signs and symptoms

The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts 4 to 7 days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of 7 to 18 days).

Most measles-related deaths are caused by complications associated with the disease. Serious complications are more common in children under the age of 5, or adults over the age of 30. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.

Measles: Who is at risk?

Unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

Measles is still common in many developing countries – particularly in parts of Africa and Asia. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

Measles Transmission

Measles is one of the world’s most contagious diseases. It is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.

The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.

Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.

Measles Treatment

No specific antiviral treatment exists for measles virus.

Severe complications from measles can be avoided through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

All children diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

Measles Prevention

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 50 years. It is safe, effective and inexpensive. It costs approximately one US dollar to immunize a child against measles.

The measles vaccine is often incorporated with rubella and/or mumps vaccines. It is equally safe and effective in the single or combined form. Adding rubella to measles vaccine increases the cost only slightly, and allows for shared delivery and administration costs.

In 2017, about 85% of the world’s children received 1 dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose. In 2017, 67% of children received the second dose of the measles vaccine.

Of the estimated 20.8 million infants not vaccinated with at least one dose of measles vaccine through routine immunization in 2017, about 8.1 million were in 3 countries: India, Nigeria and Pakistan

Image: Image: A sign posted at The Vancouver Clinic in Vancouver, Wash., warns patients and visitors of a measles outbreak on Jan. 30, 2019

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NCN Health And Science Team

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