Close Call: US Can Still Officially Claim Measles Eliminated

Troy Brown, RN

October 04, 2019

After almost 20 years, the United States can still say that measles has been eliminated here, after the New York State Department of Health declared an end to that state's almost year-long measles outbreak, which threatened to topple that claim, according to the US Department of Health and Human Services (HHS).

"We are very pleased that the measles outbreak has ended in New York and that measles is still considered eliminated in the United States. This result is a credit to the cooperative work by local and state health departments, community and religious leaders, other partners, and the CDC [Centers for Disease Control and Prevention]," HHS Secretary Alex Azar, said in an HHS news release.

"But this past year's outbreak was an alarming reminder about the dangers of vaccine hesitancy and misinformation. That is why the Trump Administration will continue making it a priority to work with communities and promote vaccination as one of the easiest things you can do to keep you and your family healthy and safe," he said.

From January to September this year, the CDC confirmed 1249 measles cases in 31 states ― the highest number in the United States since 1992. Three fourths of those cases were associated with outbreaks in New York City and New York State and largely occurred among unvaccinated children in Orthodox Jewish communities.

Many cases were traced to unvaccinated travelers who were infected while traveling in other countries in early October 2018.

In the CDC report, published online today in Morbidity and Mortality Weekly Report, the authors write that 88% of this year's patients were either unvaccinated or their vaccination status was unknown; 10% of patients required hospitalization.

In the report, Manisha Patel, MD, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, and colleagues write that 86% of cases were linked to outbreaks that occurred "in underimmunized, close-knit communities, including two outbreaks in New York Orthodox Jewish communities that threatened measles elimination status in the United States."

Globally, measles outbreaks continually occur in certain countries; therefore, when unvaccinated individuals from the United States travel to those countries, they run the risk of bringing measles back home with them.

That might not be a big problem if most persons in a community are vaccinated; however, certain populations, including young infants and immunocompromised individuals, cannot receive the measles vaccination and are at risk for severe illness.

"Robust Response"

Ending the outbreak in New York took a highly coordinated effort, according to the CDC.

"Robust responses in NYC and NYS with multiple partners involved vaccination efforts, including administration of approximately 60,000 MMR [measles-mumps-rubella] vaccine doses in the affected communities; tailored communication campaigns; partnerships with religious leaders, local physicians, health centers, and advocacy groups; and use of local public health statutory authorities. These efforts ended transmission before the 12-month elimination deadline, with the most recent cases reported with rash onset on July 15, 2019, in NYC and August 19, 2019, in the rest of NYS," the authors write.

In both jurisdictions, incubation periods for measles have since passed, and no additional cases have been reported as of October 1, 2019; however, continued vigilance is important to ensure that elimination is sustained.

"Our Nation's successful public health response to this recent measles outbreak is a testament to the commitment and effectiveness of state and local health departments, and engaged communities across the country," CDC Director Robert R. Redfield, MD, said in the news release.

"CDC encourages Americans to embrace vaccination with confidence for themselves and their families. We want to emphasize that vaccines are safe. They remain the most powerful tool to preserve health and to save lives. The prevalence of measles is a global challenge, and the best way to stop this and other vaccine preventable diseases from gaining a foothold in the US is to accept vaccines," he added.

Worldwide Crisis

During the past year, measles elimination status was lost in the United Kingdom, Greece, Venezuela, and Brazil. World Health Organization data show that more measles cases were reported globally during the first 6 months of 2019 than during any year since 2006. From January 1 to July 31, 2019, 364,808 cases were reported in 182 countries ― an increase that reflects a recent global trend, as other countries work to improve and maintain vaccination rates, the HHS stated in its release.

Misinformation in some communities about the MMR vaccine's safety has played a significant role in the marked increase in measles cases in recent years, according to the HHS news release.

These communities are being deliberately targeted by some organizations, which are spreading inaccurate and misleading information. The CDC continues to urge parents to consult their family's healthcare provider to discuss the importance of vaccination and any concerns they may have. The CDC also recommends that local leaders distribute accurate, evidence-based information to correct misinformation.

Morb Mortal Wkly Rep. Published online October 4, 2019. Full text

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