US measles cases top 700; states grapple with 9 outbreaks

After the United States set a post-elimination-era record in measles cases last week, infections continue to pile up, and with 78 cases for the past week, the country has now reached 704 total, the US Centers for Disease Control and Prevention (CDC) said today.

Thirteen outbreaks—defined as three more related cases—have now been reported in 2019 so far, and account for 94% of all cases. Nine outbreaks are currently active, up from six reported the previous week. The CDC today spelled out all the details and implications of this year's surge in cases in an early report in Morbidity and Mortality Weekly Report (MMWR) and in its weekly case update.

Cases could top 1994 total

In the two reports the CDC said the 78 new cases lift the nation's total so far this year—which isn't even half over—to 704 cases in 22 states as of Apr 26.

Officials are now eyeing 1994 and its 963 case count. That's the year the federally funded Vaccines for Children program began, which the CDC said led to very stable rates of people vaccinated against the disease. It took 6 more years for measles elimination to be declared in the United States, meaning transmission was stopped and that the disease was no longer considered endemic in the country.

The country could top 1994 totals in the coming months at the current pace. In 1993 officials recorded 312 cases, according to the CDC, but more than 2,000 infections in 1992.

The CDC said 6 of the 13 outbreaks have been linked to underimmunized close-knit communities, which make up 88% of all cases. The outbreak areas include New York City and 12 states: California, Connecticut, Georgia, Illinois, Maryland, Michigan, Missouri, New Jersey, New York, Oregon, Texas, and Washington.

California currently has three outbreaks linked to international travelers, and of the 38 confirmed cases in the state as of Apr 24, 25 reflect outbreak cases, according to the California Department of Public Health (CDPH). The outbreak locations in California are the Butte County area, Los Angeles County, and Sacramento County.

Meanwhile, an outbreak centered in New York City's Orthodox Jewish community has topped 400 cases, with 33 new cases boosting the total to 423 cases, according to the latest update from NYC Health.

Of the 704 US patients, 503 (71%) weren't vaccinated, 76 (11%) had at least one dose of measles-containing vaccine, and the vaccination status of 125 (18%) is unknown. Fully 689 (98%) of the infections involved US residents. So far, 66 of people with measles (9%) have been hospitalized, and 24 (3%) had pneumonia. No deaths or cases of encephalitis—a potentially fatal complication—have been reported.

There have been 44 cases imported from a wide range of countries, 34 of which involved US citizens. The vast majority of imported cases originated in the Philippines, Ukraine, Israel, Thailand, Vietnam, and Germany.

In its MMWR report, the CDC warned that unvaccinated US residents who travel abroad are at risk for getting sick with measles and that close-knit communities that have low vaccination rates are at risk for sustained outbreaks.

Save the Children response ramps up

In a statement today, Save the Children—a London-based nongovernmental organization—said today that its Children's Emergency Health Unit has already responded to three measles outbreaks this year—in South Sudan, Kenya, and Madagascar—more than in any previous year.

The group said its campaign in Madagascar that focused on the country's northeast Sava region faced unique challenges, including remote locations that required a 2-day trek through mountainous and forested regions with vaccines and materials transported by canoes and carried by human porters.

Though most parents were eager to have their children vaccinated, teams faced some community resistance, but local leaders took an active role in informing people about the campaign. Save the Children vaccinated more than 180,000 children in two districts in Madagascar, and the nonprofit added that the health ministry is reporting a decline in the number of new cases. So far, Madagascar has reported 118,000 measles cases, 1,700 of them fatal.

See also:

Apr 29 MMWR report

 Apr 29 CDC measles update

CDC measles Q and A

CDPH measles page

NYC Health measles page

Apr 29 Save the Children post

Apr 25 CIDRAP News story "Soaring measles cases near 700, set record"

Apr 22 CIDRAP News story "US measles total grows by 71 cases, nears record"

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