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Published Date: 2011-08-21 15:39:06
Subject: PRO/EDR> Measles update 2011 (28)
Archive Number: 20110821.2546

MEASLES UPDATE 2011 (28)
************************

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
------
[1] France (Mayotte)
[2] Ireland (Dublin)

Africa
-------
[3] Ethiopia (Dollo Ado)

The America
[4] USA (Minnesota)

Australasia
----------
[5] Australia (Northern Territory)
[6] Australia (New South Wales)
[7] New Zealand (Auckland)
[8] New Zealand (North Island)

******
Europe
------
[1] France (Mayotte)
Date: Thu 18 Aug 2011
Source: MayotteHebdo.com [In French, trans. & edited]
http://www.mayottehebdo.com/201108189415/risque-depidemie-de-rougeole

Risk of measles epidemic
------------------------
The Regional Agency for Health of the Indian Ocean (ARS) invites
residents to be vigilant after the detection of three indigenous cases
of measles between 5 and 14 Aug 2011. Although the disease is usually
mild in children it can lead to serious complications or death. The
only protection against measles virus infection is 2 immunisations
with measles vaccine.

No cases of measles had been reported previously in Mayotte since the
introduction of mandatory reporting in January 2009. But given the
constant risk of virus introduction into both islands vigilance must
be maintained as a consequence of the current outbreak in France,
coupled with inadequate vaccination coverage and the extreme
contagiousness of the disease. Therefore the LRA Health has
recommended the reporting (by e-mail to
<ars-oicvags-mayotte@ars.sante.fr>) of any case of illness with
symptoms of fever above 38.5 ° C, a maculopapular rash and at least
one of the following: conjunctivitis, coryza, cough, signs of Koplik
spots).

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[It is not clear what 'indigenous' means. Presumably the infection
originated through contact with metropolitan France?

Mayotte was ceded to France along with the other islands of the
Comoros group in 1843. It was the only island in the archipelago that
voted in 1974 to retain its link with France and forego independence.
In March 2009, Mayotte voted overwhelmingly to become France's 101st
department -- and fifth overseas department -- a change scheduled to
become official in 2011. A map of Mayotte can be accessed at
http://geography.about.com/library/cia/blcmayotte.htm. - Mod.CP]

******
[2] Ireland (Dublin)
Date: Fri 19 Aug 2011
Source: RTE New Ireland [edited]
< http://www.rte.ie/news/2011/0819/measles.html>

HSE warns of rapid rise in measles cases
----------------------------------------
The Health Service Executive (HSE) has reported a rapid rise in
measles cases, with most of them centred on the north side of Dublin.
It has urged parents to get their children immunised with the MMR
vaccine as measles can be a very serious and sometimes fatal illness.

There have been 135 cases of measles in Ireland so far this year, with
over 70% of the cases in the north of Dublin city. The HSE says it is
writing to GPs in the North Inner City area of Dublin to warn them of
the rise in cases. It also plans to set up special MMR vaccination
clinics in primary schools when schools re-open in September.

Cases have also been increasing across Europe where 26 000 cases have
been reported. Some have resulted in severe outcomes, with six
deaths.

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[A map of Dublin city, showing the location of the North Inner City
district, can be accessed at:
http://www.dublin.ie/neighbourhood/local-area-map.htm. - Mod.CP]

******
Africa
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[3] Ethiopia (Dollo Ado)
Date: Tue 16 Aug 2011
Source: Voice of America [edited]
http://www.voanews.com/english/news/africa/east/Alarming-Rise-of-Measles-Deaths-in-Dollo-Ado-Refugee-Complex-127879003.html

Alarming Rise of Measles Deaths in Dollo Ado Refugee Complex
------------------------------------------------------------
The United Nations refugee agency [UNHCR -- United Nations High
Commission for Refugees] reports the death rates in one of 4 refugee
camps at the Dollo Ado complex in Ethiopia have reached alarming
levels. The UNHCR says it suspects a combination of measles and
malnutrition brought on by famine is the major cause of death.

More than 118 000 Somalis live at the Dollo Ado refugee complex in
Ethiopia. More than 78 000 of these refugees, fleeing drought and
famine, have arrived in Dollo Ado this year. U.N. refugee spokesman,
Adrian Edwards, says an assessment of mortality finds a sharp rise in
death rates in one of the four camps at Dollo Ado.

“Since the Kobe refugee camp opened in June [2011], an average of 10
children under the age of 5 have been dying each day. An outbreak of
suspected measles, combined with high rates of acute malnutrition is
thought to be the major cause of death. Across all Dollo Ado sites,
148 cases and 11 deaths due to suspected measles have been reported.
This deadly combination has historically caused similar death rates in
previous famine crises in this region,” Edwards stated. Children who
are healthy generally do not die of measles. But, for those who are
malnourished, this preventable disease can be fatal. And, so it is
proving to be for many of the acutely malnourished Somali children,
whose health has been severely weakened due to drought and famine.

Kobe houses 25 000 Somali refugees. The UNHCR and its partners on
Monday [15 Aug 2011] completed a mass vaccination campaign against
measles. All children between the ages of 6 months and 15 years were
immunized against this killer disease.

Edwards says vaccination campaigns will begin in other camps in the
coming days. “There is a need to encourage parents to return with
their children to health centers for continued treatment for
malnutrition, and to actively identify children who are sick to ensure
they receive immediate help. UNHCR is already working with refugee
leaders and outreach workers to raise awareness of measles symptoms
and hygiene promotion,” he said.

Most of the refugees arriving from Somalia are from rural areas.
UNHCR spokesman Edwards says the camps in Ethiopia may be the first
time the Somalis have ever gone to a health care facility. He says it
is crucial to make the refugees aware of the health and nutrition
programs that are available to them. He says the UNHCR, together with
the Ethiopian government and other partners, are working to improve
nutrition, water supply and sanitation in the camps. He says this can
help bring down the high mortality rate.

Measles is a highly contagious disease. The UNHCR says action to
prevent people from dying of this disease is the number one priority
facing aid agencies.

[Byline: Lisa Schlein]

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[A map showing the location of the Dollo Ado refugee complex can be
accessed at:
http://www.unhcr.org/cgi-bin/texis/vtx/page?page=49e483986. -
Mod.CP]

*****
The Americas
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[4] USA (Minnesota)
Date: Fri 19 Aug 2011
Source: Shakopee Valley News [edited]
http://www.shakopeenews.com/view/full_story/15154099/article-State-health-department-investigating-two-cases-of-measles-in-young-Dakota-County-children

State health department investigating 2 cases of measles in young
Dakota County children
----------------------------
The Minnesota Department of Health is working with Dakota County
Public Health and area health care providers in investigating two
cases of measles in young children who live in Dakota County.

A 12-month old resident of Dakota County became ill in early August
[2011] shortly after returning from Kenya where measles is currently
endemic. The child was likely infectious between 4 and 17 Aug 2011.
The child is hospitalized in critical condition. A 2nd child, a
15-month old, became ill after visiting the family of the 1st child
and is also hospitalized. Neither were vaccinated against measles.

Dakota County Public Health staff and area clinic and hospital staff
where the children were treated are notifying people who may have been
exposed and offering vaccine or immune globulin when appropriate to
decrease the chance they will develop measles. "Once again, the
occurrence of measles in Minnesota reminds us how important it is to
be vaccinated against diseases, such as measles," said Dr. Aaron
DeVries, medical director for the Infectious Disease Epidemiology,
Prevention and Control Division at MDH. "Measles is not a benign
disease, but can be very serious, even life-threatening, as this
situation demonstrates. Children can die from measles."

Vaccination is especially important for those traveling to areas of
the world where diseases such as measles are more common. "Make sure
you and your family are up to date on your immunizations before you
travel," DeVries said. Normally the 1st dose of MMR vaccine is given
to children at 12-15 months of age, but should be given to children
6-12 months of age who will be traveling internationally, particularly
to areas where measles is endemic or outbreaks are occurring.

There has been a resurgence of measles in many parts of the world
including the United Kingdom, Europe, and Africa as vaccination rates
have declined."Minnesota communities are at risk of a similar increase
in cases if we do not maintain high measles vaccination rates," said
Kristen Ehresmann, director of the Infectious Disease Epidemiology,
Prevention and Control Division at MDH. "Contrary to misinformation
that may still be circulating, the measles vaccine is safe and
effective. Without it, the risk of disease is real."

MDH has alerted health care providers in the state, and particularly
in Dakota County, to be alert for patients with signs or symptoms of
measles. Anyone who has concerns about their health should contact
their health care provider. If additional cases were to occur as a
result of these cases, they would likely occur between now and 8 Sep
2011, health officials said. Symptoms of measles include fever, runny
nose, cough, loss of appetite, watery eyes and a rash. The rash
usually lasts 5 to 6 days and begins at the hairline, moves to the
face and upper neck, and proceeds down the body. Vomiting or diarrhea
can also accompany these symptoms. It generally takes 8 to 12 days
from exposure to the 1st symptom, which is usually fever. The measles
rash usually appears 2 to 3 days after the fever begins. Measles is
spread through the air by infectious droplets and is highly
contagious. It typically can be transmitted from 4 days before the
rash becomes visible to 4 days after the rash appears.

There is no specific treatment for measles. People with measles need
bed rest, fluids and control of fever. Patients may need treatment
specific to any complications. Complications may occur in 30 percent
of those infected and are more frequent in children under 5 years and
in adults and include pneumonia, ear infections and rarely
encephalitis. Pregnant women may experience
complications such as premature labor and stillbirth. Measles can be
especially severe in people with weakened immune systems.

[Byline: Pat Minelli]

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[A map of the counties of Minnesota, showing Dakota county in the
south east of the state, ca be accessed at:
http://geology.com/county-map/minnesota.shtml. - Mod.CP]

******
Australasia
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[5] Australia (Northern Territory)
Date: Thu 18 Aug 2011 [edited]
Source: ABC News [edited]
http://au.news.yahoo.com/a/-/business/10064599/sick-backpacker-sparks-red-centre-measles-alert/

Sick backpacker sparks red centre measles alert
-----------------------------------------------
People in Alice Springs are being warned of a higher danger of
contracting measles, after a German backpacker was diagnosed with the
disease last week. Health authorities say the illness is highly
infectious and anyone with symptoms should let their doctor know to
minimise the chance of infecting others. Dr Peter Markey of the Centre
for Disease Control says anyone affected will initially notice a
fever, cough, runny nose and sore eyes. He says a red rash develops 2
days later.

"We always take every case of measles seriously, because it is a
serious disease," he said. "We don't see much of it around these days.
It is very infectious so if people are not immune to measles and have
had even accidental contact with this case, they could come down with
measles."

The centre's Dr Teem Wing Yip says there has not been a case of
measles reported in Alice Springs since 2004.

[Byline: Tom Nightingale]

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[Alice Springs is situated in the geographic centre of Australia near
the southern border of the Northern Territory. It can be located in
the map of the Northern Territory of Australia at:
http://www.auinfo.com/Northern_Territory_map.htm. - Mod.CP]

*****
[6] Australia (New South Wales)
Date: Fri 19 Aug 2011
Source: Blacktown Sun [edited]
http://www.blacktownsun.com.au/news/local/news/general/measles-outbreak-in-blacktown-causes-alarm/2264254.aspx

Measles outbreak in Blacktown causes alarm
------------------------------------------
Doctors have warned Blacktown residents to make sure they are fully
immunised to combat an outbreak of measles. Communicable Diseases and
Immunisation Manager for the Western Sydney health district, Dr Vicky
Sheppeard said there were more measles cases this year than for the
past 8 years. She said there had been 22 measles cases reported from
2002 to 2010 in the western Sydney region and 26 this year alone in
Blacktown. "Most of these were from Mt Druitt and more than half
involved children and young adults who are at particular risk of
catching measles if they are not vaccinated," Dr Sheppeard said.

The infectious disease expert said measles was a serious infection
that could lead to severe complications. "Measles is easily spread
when a person breathes in the measles virus that has been coughed or
sneezed into the air by an infected person, and just one person with
the infection can pass it on to many others," she said. People with
measles tend to develop fever, cough, runny nose and sore eyes. A rash
develops a few days later, starting on the face and spreading down the
body.

Dr Sheppeard said the Measles Mumps and Rubella (MMR) vaccine was safe
and effective, and provided long-lasting protection if 2 doses were
given. The MMR vaccine is given routinely at 12 months of age with the
2nd dose given from 3.5 to 4 years. Many people in their 20s, 30s and
early 40s are still vulnerable to measles because they only ever
received one MMR vaccine in childhood, the doctor warned. People in
this age group can see their GP for a free vaccine and this is
especially important for anyone planning overseas travel or planning a
pregnancy. People born during or since 1966 who do not have documented
evidence of receiving 2 doses of MMR vaccine or evidence of measles
infection are at greatest risk of catching measles.

--
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[A map of the Australian state of New South Wales, showing the
location of Blacktown just west of Sydney, can be accessed at:
http://www.ausemade.com.au/nsw/resource/map/nsw.htm. - Mod.CP]

******
[7] New Zealand (Auckland)
Date: Mon 15 Aug 2011
Source: Voxy News engine [edited]
http://www.voxy.co.nz/health/108-measles-cases-auckland/5/98261

108 measles cases in Auckland, and 2 cases of rubella
-----------------------------------------------------
The Auckland Regional Public Health Service can confirm: 108 confirmed
cases of measles in the Auckland region as of this morning Mon 15 Aug
2011]. Three contacts are in quarantine; 7 cases have required
hospitalisation during this outbreak. Most cases have occurred in West
Auckland with some spread to Central Auckland, North Shore, and
Manukau. Also there have been 2 cases of rubella notified in the
region in the last week. Medical Officer of Health, Dr Richard
Hoskins says "There has been a recent case of measles in a child who
attended Mainly Music pre-school in Cheltenham, the pre-school has
been advised to let all parents with unimmunised children know about
the case and to exclude those children from attendance.

"Last week the unimmunised students of Henderson Valley School were
also advised to be excluded, this followed one case of confirmed
measles in an unimmunised student.

"If you care for other people or young children as part of your work,
it's important that you are fully immunised to protect them and
yourself. Remember it is never too late, if you or your child are
behind with or missed out on the MMR vaccination you can catch up. If
you are unsure of you or your child's immunisation status, check with
your GP."

Medical Officer of Health, Dr Richard Hoskins says, "Auckland Regional
Public Health Service has been notified of 2 confirmed rubella cases
in the Auckland region in the past week. Rubella is a significant
disease, especially for women during the 1st 4 months of pregnancy, it
can have severe effects to the unborn child, which can include
deafness, blindness, brain damage and heart defects. The measles,
mumps & rubella (MMR) vaccine is the only protection against rubella,
we recommend all pregnant women or those who intend to become pregnant
to check their immune status."

--
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[This represents an increase of 4 cases of measles during the past 7
days, and the 1st 2 confirmed cases of rubella.

The HealthMap/ProMED-mail interactive map of New Zealand can be
accessed at: http://healthmap.org/r/00c3. - Mod.CP]

*****
[8] New Zealand (North Island)
Date: Tue 16 Aug 2011
Source: stuff.co.nz, NZPA report [edited]
http://www.stuff.co.nz/national/health/5453270/Measles-outbreak-hits-more-than-120-people

Measles outbreak hits more than 120 people
------------------------------------------
A measles outbreak which has infected more than 120 people in the
upper North Island is continuing to spread. There have now been 109
confirmed cases in Auckland, where the outbreak originated, and 19
confirmed and one suspected case in Waikato, one of which has required
hospitalisation. Cases have also been reported in Taupo and Northland.
Medical Officer of Health Dr Anita Bell said of the 20 Waikato cases,
19 had not been immunised and one had received only one of the
recommended 2 doses of the measles, mumps and rubella (MMR) vaccine.
"This is a testament to the effectiveness of the MMR vaccine in
protecting people who are fully immunised.

"Immunisation is the only protection from this potentially serious
disease. Immunisation protects not only the individual, but also
blocks the spread of this disease within our communities." Bell said
anyone displaying symptoms of measles, which include fever, cough,
blocked nose, sore red eyes, should immediately phone their doctor or
Healthline on 0800 611 116."

Ministry of Health immunisation manager David Wansbrough said vaccine
distribution figures showed a "significant increase" in demand for the
vaccine this year. Children needed 2 doses of the MMR vaccine to be
fully immunised - one at age 2 and the 2nd 2 years later. The National
Immunisation Register showed 90 percent of children received the 1st
dose but only 75 percent had both.

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[A Yahoo news report
(http://nz.news.yahoo.com/a/-/top-stories/10045753/measles-continues-to-spread-in-unimmunised-teenagers/)
has added the following information: "There are now 19 positive cases
of measles, 8 of which are secondary cases (came in contact with a
case), in the Waikato District Health Board area. There is one
probable case pending. These further secondary cases are linked to
Otorohanga College and Pokuru School. The probable case was identified
in Huntly with links to Auckland. One case has required
hospitalisation. There are several contacts in isolation. - Mod.CP]

[To end on a more positive not it should be recorded that on 4 Aug
2011 the WHO Measles Initiative announced it has helped vaccinate one
billion children in more than 60 developing countries since 2001,
making significant gains in the global effort to stop measles. The
child who received the history-making measles vaccination was one of
3.5 million immunized in Mozambique this May [2011]. The immunization
campaign was sponsored by the Measles Initiative’s 5 founding
partners – the American Red Cross, United Nations Foundation, U.S.
Centers for Disease Control and Prevention (CDC), UNICEF, and the
World Health Organization
(http://www.who.int/immunization/newsroom/press/measles_initiative_vaccinates_billion_4august2011/en/index.html).

However, even as the Measles Initiative’s founding partners marked
this significant achievement, they warned that governments and the
global health community should not rest or redirect their efforts and
resources elsewhere at the expense of tackling measles. Because of the
decline in deaths, measles is no longer perceived to be a threat by
many and must compete for funding with programs aimed at other
diseases. “The steady march toward a measles-free world is now
facing a setback,” said Dr Brent Burkholder, director of the CDC’s
global immunization division. “Outbreaks in Africa, a high number of
deaths in India and global funding gaps threaten the gains made in the
last 10 years and will hinder efforts to eradicate measles and achieve
MDG4.” Since 2009, widespread outbreaks affecting 30 countries in
sub-Saharan Africa, including the Democratic Republic of the Congo and
Ethiopia, have resulted in more than 320 000 new measles cases and
more than 2400 measles-related deaths. In the past year, several
European nations have faced their worst measles outbreaks in more than
10 years, with more than 30 000 estimated cases across the region. The
U.S. is also experiencing its largest measles outbreak since 1996,
with more than 150 reported cases.

“The rise in outbreaks, especially in Africa, can be attributed in
large part to the decrease in financial support to the Measles
Initiative,” said Andrea Gay, executive director of children’s
health with the United Nations Foundation. Funding decreased from a
high of USD 150 million in 2007 to USD 68 million in 2010. “Due to
inadequate funding, measles vaccination campaigns have been delayed
and the target age groups have been narrowed, resulting in outbreaks
and in less children being vaccinated overall,” she said. The WHO
estimates that waning support could result in half a million more
deaths each year and erase the Measles Initiative’s gains by 2013.
Because it costs less than US$ 1 per child to vaccinate against
measles, the real stumbling block is the lack of political commitment
in many countries.

Looking ahead to its 2nd decade, the Measles Initiative will focus on
achieving a series of interim targets toward the eventual eradication
of measles. The 1st of these milestones will be to reduce measles
mortality by 95 percent by 2015 (compared to 2000). The Measles
Initiative estimates it will need approximately USD 212 million
between 2012 and 2015 to reach the targets. - Mod.CP]

[see also:

See Also