Measles Threat Rages Elsewhere After New York City Outbreak

Marcia Frellick

September 24, 2019

WASHINGTON, DC — Although the measles outbreak in New York City was declared over on September 3, the United States could still lose its measles elimination status, said Kristen Nordlund, a spokesperson for the Centers for Disease Control and Prevention (CDC).

"A country will lose measles elimination status immediately if a chain of transmission in a given outbreak is more than 12 months," Nordlund told Medscape Medical News.

From September 2018 to August 2019, 654 cases were confirmed in New York City. If a new case is connected to the New York City outbreak on or after October 2, the country could lose the status, she explained.

Despite the recent outbreak, the largest in the United State since 1992, medical professionals often underestimate the potential severity of the disease, said Jane Zucker, MD, assistant commissioner at New York City Department of Health and Mental Hygiene, who will explain the epidemiology of measles at the upcoming IDWeek 2019.

Measles was eliminated in the United States in 2000, but the risk of having the disease today is the same as it has always been, she told Medscape Medical News.

Severity of Measles Underestimated

In the recent New York City outbreak, "we still had hospitalizations and people in the intensive care unit. We're very fortunate that nobody died, but there are other countries where that is not the case," said Zucker.

"Israel has reported three measles deaths, and in low-resource countries — such as the Democratic Republic of Congo and Madagascar — there have been much higher mortality rates," she added.

This year, measles killed 2758 people in the Democratic Republic of Congo, surpassing the year's death toll in the country for Ebola, according to Doctors Without Borders.

And as of September 19, 131 Americans have been hospitalized for measles this year, according to the CDC, 65 of whom experienced complications, including pneumonia and encephalitis.

Members of affected communities in New York City were recruited to help get the message out that the situation was serious, which was key to ending the outbreak, said Zucker.

Most of the cases were clustered in Orthodox Jewish communities with low vaccination rates, she explained. "You need trusted people to be your spokespeople," she said. "I think that's proven to be the most effective approach."

"I think we're not out of the woods yet," said Lisa Maragakis, MD, senior director of infection prevention at the Johns Hopkins School of Medicine in Baltimore.

"In the infection-prevention community and the emergency-preparedness community, we are pushing out the message that we really have to remain vigilant," she told Medscape Medical News. "It only takes a few cases to pose a large threat, especially when those individuals come to very busy settings seeking care."

What often happens, she explained, is that a parent brings a child not yet diagnosed with measles to a busy emergency department and the child sits in the waiting room spreading infection.

A person at the reception desk might be the first contact, so it is important that all levels of staff are trained to identify measles, she said, noting that "many clinicians haven't ever seen measles."

Clear signage is needed that tells people where to go to report measles-like symptoms in a hospital or office, so that others do not become infected, said Maragakis, who will talk about measles protections for staff and patients at hospitals and medical offices during the symposium.

Not all facilities have negative-pressure rooms, where patients who have or are suspected of having measles can be isolated, so a strategic plan for containment is needed, she pointed out.

Millions at Risk in Europe

"Right now, 4.5 million children and teenagers in the European Union under the age of 20 are at risk of contracting measles," said Sotirios Tsiodras, MD, PhD, professor of medicine and infectious diseases at the National and Kapodistrian University of Athens in Greece.

"Elimination is a very difficult thing for Europe to achieve," he told Medscape Medical News. One of the biggest barriers is that vaccination coverage is unequal in countries across Europe, which makes it hard to achieve 95% coverage across borders.

About 90,000 cases of measles were reported in Europe in the first 6 months of this year, more than in all of 2018, according to the World Health Organization.

Elimination "will only be achieved with relentless and simultaneous commitment from more countries," Tsiodras explained.

Nordlund, Tsiodras, Zucker, and Maragakis declared no relevant financial relationships.

IDWeek 2019.

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