US measles cases top 100; big outbreaks reported in Madagascar, Philippines

The US Centers for Disease Control and Prevention (CDC) said yesterday that since Jan 1 it has received reports of 101 measles cases from 10 states. Internationally, Madagascar and the Philippines are reporting steep increases in their outbreaks.

In the United States, brisk measles activity in the first month of 2019 comes on the heels of 82 imported cases confirmed in 2018, the most imported cases reported to the CDC since the disease was eliminated from the country in 2000.

Last year, the CDC recorded 17 outbreaks, including three in New York State, New York City, and New Jersey, mostly involving unvaccinated people in Orthodox Jewish communities and associated with infected travelers who were exposed in Israel.

Five outbreaks in 3 states

The activity includes five outbreaks from five jurisdictions, including two New York counties (Rockland and Monroe), New York City, Washington, and Texas. The CDC defines a measles outbreak as three or more cases, and it said the events are linked to travelers who were exposed in other countries such as Israel and Ukraine where large outbreaks are underway.

The CDC warns the disease is still common in many parts of the world, including Europe, Asia, the Pacific, and Africa, and that measles can spread easily when it reaches communities that have pockets of undervaccinated people.

Aside from the states experiencing outbreaks, others reporting cases this year include California, Colorado, Connecticut, Georgia, Illinois, New Jersey, and Oregon.

In Washington's outbreak, centered in the Vancouver area, officials in Clark County reported three more cases, raising its total to 53, according to an update today. Officials are investigating two other suspected cases. Four cases in Oregon's Multnomah County and one in Seattle-King County are linked to the outbreak in Vancouver.

All but two of the patients are children ages 18 and younger, and 47 of those infected with measles are unimmunized.

Steep rises in Madagascar, Philippines

Elsewhere, the World Health Organization (WHO) said that it is still deeply concerned about a measles outbreak in Madagascar, and though the full situation is still being assessed, the event has worsened since the first of the year.

Since September 2018 and as of Feb 5, 53,459 have been reported, 676 of them lab-confirmed. So far, 312 deaths have been reported from 106 health districts.

In the week ending Feb 3 alone, 4,079 cases were reported, and the week before, 6,971 cases were reported.

The second phase of a vaccination program launched on Feb 5, and the country has requested help from GAVI the Vaccine Alliance to assist with the cost of running the immunization campaign.

The WHO said the surge is cases is due to a loss of herd immunity due to declining immunization rates and funding is urgently needed to ensure that the vaccine campaigns reach their targets.

Meanwhile, in the Philippines, which declared a measles outbreak on Feb 6, 4,302 cases have been reported, 70 of them fatal, according to an update today from the country's Department of Health.

Post-Dengvaxia vaccine hesitancy in Philippines

The Department of Health said vaccine hesitancy is fueling the outbreak in some regions of the country and that 66% of the patients had no history of vaccination against measles.

Health officials said in a press release that a number of factors are contributing to the outbreak. "Loss of public confidence and trust in vaccines in the immunization program brought about by the Dengvaxia controversy has been documented as one of many factors that contributed to vaccine hesitancy in the country. This refers to mothers who became hesitant to have their children vaccinated with vaccines that were long proven to be effective," it said.

The Philippines was one of the first countries to begin a national dengue immunization program after Dengvaxia was approved for use, and country officials have probed the deaths of several school children to determine if their severe dengue infections were the result of vaccine use.

Last April, a WHO expert committee advised against use of the vaccine without tests to confirm prior dengue infection. Some data suggests that in kids who haven't been exposed to dengue before, the vaccine can act as a priming event and subsequently lead to more severe infections.

See also:

Feb 11 CDC measles update

Feb 12 Clark County Department of Health update

Feb 11 Philippines Department of Health press release

Apr 19, 2018, CIDRAP News story "WHO advisers halt Dengvaxia, for now"

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