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Published Date: 2011-07-17 21:42:35
Subject: PRO/EDR> Measles update 2011 (23)
Archive Number: 20110717.2169

MEASLES UPDATE 2011(23)
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:

Europe
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[1] ECDC statement
[2] UK (Scotland)
Africa
------
[3] Congo DR
[4] Ethiopia & Kenya
The Americas
------------
[5] USA (Michigan)
[6] USA (Pennsylvania)
[7] USA (Utah)
Australasia
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[8] Australia (South)
[9], [10] & [11] New Zealand (Auckland)

******
Europe
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[1] ECDC statement
Date: Fri 14 Jul 2011
Source: Eurosurveillance, Volume 16, Issue 28, 14 Jul 2011 [edited]
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19917

For many years, Eurosurveillance has made it a point to publish
articles on measles outbreaks and measles prevention and control in
Europe. The purpose has always been to increase awareness about this
dangerous and potentially fatal infectious disease and highlight
opportunities for preventive measures. Measles transmission has been
firmly re-established in some European Union (EU) Member States [1].
It is astonishing to see that the EU has become an exporter of measles
to the rest of the world, threatening to undermine years of efforts to
eliminate endemic transmission of the measles virus. Visitors to
Europe are now advised to immunise their infants as early as from 6
months of age [2,3] in order to protect them from a disease that can
result in complications and lead to severe sequelae such as brain
damage and death. All this happens despite the fact that measles can
be prevented through vaccination with 2 doses of a measles-containing
vaccine, optimally the measles-mumps-rubella vaccine, and that measles
can be not only eliminated (less than one notified confirmed endemic
case per million population) but also eradicated.

The conditions for eradication are favourable: humans are the only
reservoir for the measles virus; the vaccine is safe, inexpensive and
produces life-long immunity; diagnostic tests are both specific and
sensitive; all infected people develop symptoms; and there are no
chronic carriers. Eradicating measles would represent a major public
health achievement, well worth the investment it requires. For the EU,
the 1st step towards eradication of measles is effective control
within its own borders. Finally, eradication will be the result of
elimination of transmission on all continents. [However, the extreme
contagiousness of measles virus infection will make the global
eradication of measles a more challenging undertaking than the
previously achieved eradication of smallpox, a less contagious
infection - Mod.CP]

However, given the current epidemiological situation, continued
awareness and efforts are needed. Although measles transmission peaks
during the winter and early spring in Europe, the many mass-gathering
events that take place during the summer in Europe offer favourable
conditions for the spread of the virus between countries here and to
countries in other continents. Therefore, all those who plan to attend
mass gatherings in Europe, such as the World Youth Day on 16-21 Aug
2011 in Madrid, Spain, should ensure that they are protected against
measles.

The European Centre for Disease Prevention (ECDC) has taken an
initiative to step up measles surveillance in Europe. Eurosurveillance
welcomes this initiative, which comprises the European monthly measles
monitoring [4]. This online publication was launched on 13 Jul 2011
and promises to provide timely updates on measles outbreaks and
endemic transmission in Europe based on the findings of active
surveillance. This should help to raise public awareness, generate
political will and increase public health resources for fighting an
infectious disease that should long ago have been dispatched to the
annals of infectious disease control.

References

[1] Muscat M, Bang H, Wohlfahrt J, Glismann S, Molbak K; EUVAC.NET
Group. Measles in Europe: an epidemiological assessment. Lancet. 2009
Jan 31;373(9661):383-9.
[2] Centers for Disease Control and Prevention (CDC). In the News.
2011 measles update. Atlanta: CDC; 2011. [Accessed 14 Jul 2011].
Available from:
http://wwwnc.cdc.gov/travel/notices/in-the-news/measles.htm.
[3] Public Health Agency of Canada (PHAC). Measles: global update.
Travel health notice. Ottawa: PHAC; 2011. [Accessed 14 Jul 2011].
Available from:
http://www.phac-aspc.gc.ca/tmp-pmv/thn-csv/measles-rougeole-eng.php.
[4] European Centre for Disease Prevention and Control (ECDC).
European measles monthly monitoring (EMMO), June 2011. Stockholm:
ECDC; 2011. Available from:
http://ecdc.europa.eu/en/publications/Publications/2011_June_measles_montly.pdf.

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[Beginning in June 2011, the ECDC will publish a Monthly Measles
Surveillance Report. The summary of the current report (June 2011)
reads as follows:

- Between January and June 2011, more than 21 000 measles cases were
reported from 30 EU and EEA/EFTA countries, with France (12 699),
Spain (2261), Romania (1619), Italy (over 1500) and Germany (1193)
accounting for the majority of cases.

- Since the last update in May [2011], a new outbreak was reported
from the autonomous Province of Bolzano, Italy, with more than 600
reported cases in 2011.

- Seven of the 30 countries did not report any measles case in 2011:
Cyprus, Hungary, Iceland, Latvia, Liechtenstein, Luxembourg, and
Slovakia.

- The World Youth Day and other mass-gathering events in Europe
during the summer months increase the risk of measles transmission in
Europe and exportation of measles to other parts of the world.

The Monthly ECDC Surveillance Report also contains a tabulation of
all cases and a map showing the distribution of measles cases
identified through epidemic intelligence (2011) and the 2-dose measles
vaccine coverage (2009, CISID*) for EU and EEA/EFTA countries.

Future reports will be reproduced monthly in ProMED-mail. - Mod.CP]

******
[2] UK (Scotland)
Date: Thu 14 Jul 2011
Source: The Herald [edited]
http://www.heraldscotland.com/news/health/23-cases-of-measles-in-scotland-1.1111998

Doctors have recorded a rise in the number of people who have caught
measles this year [2011]. The 23 cases in Scotland this year so far,
compared with 10 last year, is anomalous but not concerning, according
to Health Protection Scotland (HPS), which monitors and records
infectious diseases. Rather than being a specific outbreak, it was
made up of small clusters around the country.

HPS said numbers fluctuated each year because not everyone had taken
up immunisation. Nine people aged between 20-24 have caught measles so
far this year [2011], a figure which is still relatively low.

[Byline: Brian Donnelly]

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******
Africa
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[3] Congo DR
Date: Tue 12 Jul 2011
Source: New Media Radio [abbreviated & edited]
http://www.unmultimedia.org/radio/english/2011/07/thousands-taken-ill-by-measles-and-cholera-in-dr-congo/

An outbreak of measles and cholera is sweeping across the Democratic
Republic of Congo [Congo DR] according to the World Health
Organization (WHO). The diseases have already claimed over 2500 lives.
WHO says efforts to contain the outbreaks through vaccination and
provision of hygiene kits have been hampered by lack of adequate
funding.

The measles outbreak is spreading through 7 provinces in Eastern
Congo DR. Tarik Jasarevic from WHO says [a sum of] USD 9 million is
required to undertake vaccination campaigns to contain the measles
outbreak. "The 1st 2 campaigns are planned this month [July 2011],
targeting 915 000 children in 9 provinces. The 1st campaign should
take place from 14-19 Jul 2011 in Kasai Occidental, Bas Congo,
Equateur and Provence Orientale, and the 2nd campaign on 21-25 Jul
2011 in Kasai Occidental, Kasai Oriental, Katanga, Maniema and Sud
Kivu." The vaccination campaigns will be undertaken jointly by the
World Health Organization and the UN Children's agency UNICEF.

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[A map of the provinces of Congo DR can be accessed at:
http://www.mapsofworld.com/democratic-republic-of-congo/democratic-republic-of-congo-political-map.html.
- Mod.CP]

******
[4] (Ethiopia & Kenya)
Date: Fri 15 Jul 2011
Source: Newser, via Associated Press [edited]
http://www.newser.com/article/d9og1lf81/un-reports-measles-outbreaks-deaths-among-children-in-ethiopia-kenya.html

UNICEF spokeswoman Marixie Mercado said on Friday [15 Jul 2011] that
at least 17 584 measles cases, including 114 deaths, have been
reported by Ethiopian health officials in the 1st half of the year
[2011]. Two million children in Ethiopia are at risk of contracting
measles.

World Health Organization spokesman Tarek Jasarevic says at least 462
cases of measles, including 11 deaths, have been confirmed in recent
months among Somali refugee children in the Kenyan refugee complex
known as Dadaab.

WHO has warned that the movement of people and poor sanitation in
overcrowded camps and towns due to drought and violence in East Africa
increase the risk of cholera, typhoid and measles epidemics.

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[A map of Africa showing the locations of Ethiopia and Kenya can be
accessed at: http://www.worldatlas.com/webimage/countrys/af.htm. -
Mod.CP]

******
The Americas
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[5] USA (Michigan)
Date: Mon 11 Jul 2011
Source: mlive.com [edited]
http://www.mlive.com/news/bay-city/index.ssf/2011/07/measles_cases_hit_15-year_high.html

Disease control experts are warning that measles cases are at a
15-year-high nationwide. According to the Centers for Disease Control
and Prevention (CDC) and the Immunization Action Coalition, over 150
measles cases have been reported in more than 25 states, including
[the] one [case] in Michigan.

Bay County Health Department officials said the single case in
Michigan was in Oakland County, and that person had recently traveled
out of state. However, Indiana has reported several cases in the
northeast area bordering Michigan.

Widespread measles was eliminated in the U.S. in 2000, but the highly
contagious disease has been making a comeback in the absence of
immunity and vaccination coverage, the CDC reported. Measles is
primarily spread by contact with an infected person through coughing
and sneezing. Symptoms typically occur 10-12 days after exposure and
include a fever followed by a rash. Measles can be transmitted 4 days
before symptoms occur to 4 days after the rash appears.

[Byline: Holly Setter]

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[Oakland County is in the south of the state and can be located in
the map of the counties of Michigan at:
http://www.digital-topo-maps.com/county-map/michigan.shtml. -
Mod.CP]

******
[6] USA (Pennsylvania)
Date: Thu 14 2011
Source: Ulitzer.com [abbreviated & edited]
http://www.ulitzer.com/node/1909223

The state Department of Health is advising the public of a possible
case of measles exposure in Morgantown, Berks County. A person who was
diagnosed with the measles may have exposed other people to the
disease on Monday 11 Jul 2011, between 1 p.m. and 5 p.m., at the Rite
Aid Drug Store, 3145 Main St., in Morgantown.

Most people in the United States are immune to measles, either
because they received the measles mumps rubella (MMR) vaccine in
childhood or because they were exposed to measles in the pre-vaccine
era. However, the following groups of individuals are at risk of
becoming infected with measles:
- Infants less than one year of age who are too young to have
received the MMR vaccine;
- Persons who were vaccinated with an inactivated vaccine, which was
used from 1963 through 1967, and have not been revaccinated;
- Persons born after 1957 who have only received one dose of MMR
vaccine;
- Those who refused vaccination; and
- Those from parts of the world where there is low vaccination
coverage or circulating measles.

If you or your children are at risk for measles and become ill with
the symptoms of this disease one to 2 weeks after possible exposure,
you should tell your health care provider that you've been exposed to
measles so that precautions can be taken to avoid exposing anyone
else. Health care providers who treat patients with suspected cases of
measles should call the Pennsylvania Department of Health at
1-877-PA-HEALTH for consultation and to arrange testing.

The Department of Health is offering immune globulin at a special
clinic to be held Sat 16 Jul 2011 from 9 a.m. to noon at the Berks
County State Health Center in the Reading State Office Building, on
625 Cherry Street, Reading, Pa., 19602. Appointments are not
necessary. For more information about measles, call 1-877-PA-HEALTH
(877-724-3258) or visit http://www.health.state.pa.us.

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[The location of Berks county can be found in the map of the counties
of Pennsylvania at:
http://www.digital-topo-maps.com/county-map/pennsylvania.shtml. -
Mod.CP]

******
[7] USA (Utah)
Date: Mon 11 Jul 2011
Source: Fox13now [edited]
http://www.fox13now.com/news/local/kstu-utah-measles-6-cases-of-measles-confirmed-in-cache-county-20110711,0,2777089.story

The Bear River Health Department has now confirmed a 6th case of
measles in Cache County. The most recent case comes nearly 6 weeks
after the 1st case of measles was confirmed in the county. While it
appears the cases may be associated with the statewide outbreak, the
health department has not identified a link at this time.

Health officials continue to investigate all possible measles cases
and are tracking all contacts of confirmed cases in an effort to
contain the outbreak and minimize the outbreak's impact on the
community.

Officials say children and adults born after 1957 who have not been
immunized with 2 doses of MMR vaccine should see their private
physician or come to the Bear River Health Department and get
immunized. For more information, the public should call their primary
care physician or the Bear River Health Department at 792-6500.

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[The location of Cache county can be seen in the map of the state of
Utah at: http://www.onlineutah.com/counties3.shtml. - Mod.CP]

*****
Australasia
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[8] Australia (South)
Date: Fri 15 Jul 2011
Source: Courier and Mail [edited]
http://www.couriermail.com.au/news/breaking-news/measles-case-sparks-health-alert/story-e6freonf-1226095484398

South Australian health authorities have issued a public alert after
a man returned to Adelaide from overseas infected with measles. Chief
medical officer Paddy Phillips said the man was infectious when he
travelled from Dubai through Melbourne to Adelaide earlier this month
[July 2011]. He was a passenger on the Emirates flight EK 406 from
Dubai, which arrived in Melbourne on 8 Jul 2011. He then travelled on
Virgin flight DJ 213, which left Melbourne for Adelaide the same day.

"We are advising anyone who was either on these flights or in the
Adelaide or Melbourne airports on the morning of Fri 8 Jul 2011 to be
alert for any symptoms of measles over the next 2 weeks and if they
are ill to see their doctor," Professor Phillips said.

"Symptoms usually begin with fever, cough, runny nose, and sore eyes,
followed by a rash which begins on the head and then spreads down the
body." Measles is spread through the air and is highly contagious
among people who are not fully immunised. Complications can be severe.
The man is the 1st case of measles reported in South Australia in
2011. Only one case was reported in 2010.

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[A map of the states of Australia showing the location of the state
of South Australia is available at:
http://mapsof.net/australia/static-maps/gif/australia-states-rs01. -
Mod.CP]

*******
[9] New Zealand (Auckland)
Date: Mon 11 Jul 2011
Source: Auckland stuff.co.nz [edited]
http://www.stuff.co.nz/auckland/local-news/5266807/Extra-precautions-urged-after-measles-outbreak

Parents are being urged to take extra steps to stop the spread of
measles as school holidays approach. The warning comes from the
Ministry of Health, as 61 people have now been diagnosed with measles
in Auckland's largest outbreak of the disease this year [2011] with
the number expected to continue rising.

Parents should check to insure that their family's immunisations are
up-to-date, especially if they were to get on a plane, Ministry child
and youth health adviser Pat Tuohy said. "This is a good thing to do
whenever you travel, but it is especially important these school
holidays, as we have a serious measles outbreak in Auckland, and there
is a risk that could spread to other parts of New Zealand or the
Pacific," Dr Tuohy said.

He also urged Auckland parents not to send their child to school
holiday programmes, sports tournaments or other holiday activities if
they know their child is not immunised, or who is unwell or may have
been exposed to measles. "We understand it can be hard to take time
off work or change holiday plans at the last minute, but it's really
important that we do everything we can to stop measles spreading," Dr
Tuohy said. "By taking these extra steps, parents are helping to
protect children who can't be immunised because they are having cancer
treatment or have other conditions that put them at high risk of
becoming extremely sick if they do catch this disease."

Dr Tuohy said immunisation rates in New Zealand were not high enough
to prevent measles spreading. To achieve that, the ministry needed to
ensure 95 per cent of 2-year-olds were fully immunised. The current
immunisation rate was about 90 percent.

"If you can't remember whether your child is fully immunised, please
contact your family doctor before you travel. If your child has not
had the free measles, mumps and rubella (MMR) vaccine, consider
getting them immunised. About 90 to 95 percent of people are protected
from measles once they are fully immunised. If your child is not
immunised and you suspect they might have measles, please keep them at
home until they are well."

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[A HealthMap/ProMED-mail interactive map of New Zealand can be
accessed at: http://healthmap.org/r/00c3, and a map of Auckland at:
http://www.google.co.uk/search?source=ig&hl=en&rlz=1G1GGLQ_ENGB269&=&q=map+of+new+zealand+auckland&aq=5s&aqi=g5g-s1g4&aql=&oq=Map+of+New+Zealand.
- Mod.CP]

******
[10] New Zealand (Auckland)
Date: Wed 14 Jul 2011
Source: Voxy news engine, Voxy.co.nz [abbreviated & edited]
http://www.stuff.co.nz/auckland/local-news/5284358/Measles-scare-sees-149-children-quarantined

The Auckland Regional Public Health Service [ARPHS] can confirm 64
cases of measles in the Auckland region as of this afternoon [14 Jul
2011]. Eight contacts are in quarantine (plus unimmunised contacts in
Titirangi Private Kindergarten, Avondale College, Whakaaranga School
and Auckland Academy of Dance). Five cases have now required
hospitalisation.

Most cases have occurred in West Auckland with some spread to Central
Auckland, North Shore, and Manukau. Medical Officer of Health Dr
Richard Hoskins says: "Of the 64 cases, almost all are in unimmunised
people." Several cases have unclear immunisation records, partial
immunisation, or were immunised for the 1st time several days after
exposure to an infectious case.

ARPHS records show there may be 2 people who got measles despite
having the correct number of immunisations for their age (if
immunisation was ineffective, then about 90 percent of cases would be
in immunised people). We are continuing to receive notifications of
suspect cases, indicating vigilance in primary care.

During this outbreak, ARPHS has traced more than 400 contacts (not
including those in schools and ECECs), most of the new cases are from
transmission of the virus in schools and within households. "We are
continuing to work with schools and early childhood centres to
quarantine susceptible contacts at home in case they develop measles,"
says Dr Hoskins. It is important to stress that measles is a serious
and highly infectious disease that makes people, including infants,
very sick.

"The only way to stop you catching measles is getting immunised. The
vaccination is funded for children, young people and unimmunised
adults."

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*****
[11] New Zealand (Auckland)
Date: 14 Jul 2011
Source: Eastern Courier via Auckland Stuff [abbreviated & edited]
http://www.stuff.co.nz/auckland/local-news/5284358/Measles-scare-sees-149-children-quarantined

Over 140 primary students were quarantined at school following a
measles scare, and frustrated parents abused staff when they were
called to collect their kids from the Pakuranga school.

As Auckland's measles crisis worsens -- at last count, there had been
64 cases in the latest outbreak -- Wakaaranga School moved to send
home 149 of its pupils on Monday [11 Jul 2011] who didn't have
evidence to show they had been immunised. Principal Brent Jenkin says
by the end of the day, he still had 60 children in isolation.
"Obviously, we had to keep them quarantined," he says.

Jenkin says a letter was sent home last Friday [8 Jul 2011] advising
parents who had not notified the school of their children's
immunisation status to do so immediately or keep them away on Monday
[11 Jul 2011]. The letter followed a message from the Auckland
Regional Health Service advising the school that one of their pupils
had the notifiable disease.

Jenkins says once the news got out, extra staff, including PTA
volunteers, were required to deal with the large influx of phone
calls. He said many parents took their frustrations out on the school.
Jenkin says it is not his decision to keep unimmunised children from
school. "It is one the Department of Health enforces," he says.
"Fortunately for us, it is now the school holidays. Unfortunately for
parents, a number of families are very likely to have a holiday break
with some very sick children at home."

The Farm Cove school currently has 45 children in quarantine out of a
roll of 700. The Auckland region is now in its 2nd and largest measles
outbreak for 2011. It began in mid-May 2011, and the number of people
infected continues to rise. There have been 64 confirmed cases of
measles in the Auckland region as of Wed 13 Jul 2011. Five cases have
now required hospitalisation.

[Byline: Pip Boutkrl]

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[Whereas the outbreak in Auckland continues to spread, the other
outbreak in New Zealand at Hawke's Bay, previously report in Measles
update (21), may have been contained. As of 16 Jul 2011, no new cases
of measles had been reported to the Hawke's Bay District Health Board
in the past 3 weeks. But it is still too early to declare the outbreak
over. The public health officials are concerned that there may be a
resurgence during the school holidays (see: Hawke's Bay Today, 16 Jul
2011
http://www.hawkesbaytoday.co.nz/local/news/caution-advised-over-measles/3959625/).
- Mod.CP]

See Also