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Published Date: 2011-10-02 22:32:45
Subject: PRO/EDR> Measles update 2011 (34)
Archive Number: 20111002.2973

MEASLES UPDATE 2011 (34)
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In this update

Europe
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[1] UK (Kent)
[2] Switzerland (2003 - 2010)

The Americas
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[3] Ecuador (Ambato)
[4] USA (CDC India update)

Oceania
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[5] Australia (update)
[6] New Zealand (update)
[7] New Zealand (in flight transmission)
[8] New Zealand (Waikato)

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Europe
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[1] UK (Kent)
Date: Fri 30 Sep 2011
Source: BBC News [edited]
http://www.bbc.co.uk/news/uk-england-kent-15122908

The HPA [Health Protection Agency] says measles can be fatal and is
urging students to get vaccinated. Cases of measles in Kent so far
this year [2011] are more than 10 times the number of diagnoses made
in 2010, according to the Health HPA. The HPA said there had been 62
cases up to July 2011, mainly in children and young adults, compared
with 6 in 2010. It said many cases had been in clusters in
universities and schools, with many patients unvaccinated.

Students starting or returning to university are being urged to make
sure they have had the MMR vaccine. There were also 29 cases
meningococcal meningitis last year [2010], and the HPA is also
advising students to have the meningitis C vaccination before they
start term.

Dr Mathi Chandrakumar, from the Kent Health Protection Unit said:
"University bars and campuses where lots of students are in close
proximity are ideal places for bacteria and viruses to spread, which
is why we may see more outbreaks of these infections in this
environment. Measles and meningitis are infections that can both be
fatal. It is absolutely vital that all students ensure they are
completely up to date with all their vaccinations, especially the MMR
and meningitis C vaccine.

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[2] Switzerland (2003 - 2010)
Date: Fri 30 Sep 2011
Source: Eurosurveillance, Volume 16, Issue 39 [summarised & edited]
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19980

Measles in Geneva between 2003 and 2010: persistence of measles
outbreaks despite high immunisation coverage
------------------------------------
(By: Delaporte E, Jeannot E, Sudre P, Wyler Lazarevic CA, Richard JL,
Chastonay P.)

Despite high immunisation coverage, several measles outbreaks occurred
in the canton of Geneva between 2003 and 2010, with 161 reported cases
(52 in 2003, 16 in 2005 and 93 in 2007-2010). It affected mainly 10-14
year-old children in 2003 (31 percent), and adults 20 years and older
in 2005 (75 percent) and 2007-2010 (39 percent). Several cases were
imported from neighbouring cantons and countries, as confirmed by the
diversity of the genotypes identified (D8, D6, D5, D4 and G3).
Infections were mainly transmitted via family (54 percent) and school
(22 percent) in 2003, hospital (71 percent) and family (29 percent) in
2005, and family (55 percent) and school (26 percent) in 2007-2010. In
2003, 6 percent of infected patients were vaccinated, 27 percent in
2005 and 2 percent in 2007-2010, none of them with 2 doses of
measles-containing vaccine. Between 2003 and 2008, measles vaccine
coverage, particularly for the 2nd dose, increased by 23 percentage
points to 91.7 percent in the 28-month-olds, by 27 points to 92.3
percent in the 5-6 year-olds, and by 19 points to 86 percent in the
13-14 year-olds. In a cosmopolitan setting where immunisation coverage
is high but not sufficient to eradicate measles, outbreaks can be
limited by efficient surveillance and early control measures. Catch-up
vaccination needs to be reinforced among teenagers and young adults.

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******
The Americas
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[3] Ecuador (Ambato)
Date Tue: 27 Sep 2011
Source: EL Universo [in Spanish, machine translation, edited]
http://www.eluniverso.com/2011/09/27/1/1447/26-ninos-hospitalizados-brote-sarampion.html

The National Director of Epidemiology, Juan Moreira, said yesterday
[26 Sep 2011] that 26 children remained hospitalized on suspicion of
having measles. He added that this total included 8 confirmed cases
with 2 of them identified as "African genotype" [i.e. B-3 genotype;
see comment below]. "This confirms that measles was introduced from
outside the country," said Moreira, in Quito, during a press
conference about the outbreak in the parish of Quisapincha in Ambato,
where last week the death of a child with suspected pneumonia was
recorded. However, Moreira stated that measles has caused the death.

Last Friday [23 Sep 2011], Georgina de la Cruz, of Intercultural
Health, said the outbreak originated from abroad and was European in
origin having been introduced by a commercial group that was visiting
Quisapincha.

As of last Saturday [24 Sep 2011] the Ambato Teaching Hospital had 25
children with suspected measles, according to Franklin Escobar, the
Director of the Nursing Home. Another 2 infants had been admitted on
Sunday [25 Sep 2011].

A pediatrics ward had been assigned to care for children who present
with symptoms related to measles, and infants with other diseases had
been transferred to other health units, including the Social Security
Hospital in Ambato.

In Quisapincha and 18 surrounding communities, vaccination clinics
have been set up. These will continue until tomorrow [28 Sep 2011].
Escobar said that sometimes there is resistance to vaccination and
some children are left unprotected. "But we hope the outbreak will
peak and stabilize," he added.

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[Ambato is a city located in the central Andean valley of Ecuador. It
is the capital of the province of Tungurahua and at an elevation of
2577 meters above sea level. The following are extracts from a later
(28 Sep 2011) report in Elcomercio.com
(http://www.elcomercio.com/pais/sarampion-revela-situacion-pobreza-Quisapincha_0_562143962.html)
[in Spanish, translated by Mod.JG]:

"Quisapincha Parish is one of the most ancient indigenous villages in
Tungurahua. However, its development lay behind that of Ambato in
spite of being no more than half an hour from the aforementioned
provincial capital.

During the last decade, urban areas in Quisapincha achieved some
degree of development thanks to manufacturing sweaters and other
pieces of clothing. Also, commercial tourism was significantly
increased when the Ambato-Pinilo-Ambatillo-Quisapincha road was
asphalted and the Parque Provincial de la Familia was built.

The recent measles outbreak is causing much concern in Quisapincha.
There has been plenty of suffering, and the poor availability of basic
services did not improve at all for affected people, in spite of
having received help from Hospital Docente Ambato (Ambato Teaching
Hospital). Every morning since last Thursday in the pediatrics ward of
the aforementioned hospital, relatives of 29 children and 2 adults
infected by African measles must overcome many obstacles. At 6 am,
nurses request them to pick up pieces of carton, mattresses, and
blankets they had used for staying overnight. At 7.00 am, small
containers with food are brought by personnel from the hospital. Now
it is breakfast time for both patients and their relatives. Every
healthcare worker is protected with gowns, gloves and masks. But this
is not the case for patients' relatives.

Dr. Juan Martin Moreira, Regional Health Authority, stated that 26
cases of measles were reported in September 2011. Eight of them were
confirmed in the lab, and 2 were identified as B3 genotype (the strain
circulating in Africa). These cases were recorded in Atahualpa and
Quisapincha parishes, belonging to Ambato territory in Tungurahua.
Both communities are 10- and 30-minutes driving time from Ambato
center.

Cases were found thanks to the alert state decreed in the country,
after last April [2011], when the Panamerican Health Organization
(PAHO) and the World Health Organization (WHO) declared an
epidemiological alert for the Americas because of the increase in the
number of imported cases of measles," said Dr. Moreira."

Ambato can be located in the HealthMap/ProMED-mail interactive map at:
http://healthmap.org/r/1h_n. - Mod.CP]

******
[4] USA (CDC - India update)
Date: Fri 30 Sep 2011
Source: dalje.com, a UPI report [edited]
http://dalje.com/en-lifestyle/worldwide-measles-deaths-declining/385647

An estimated 164 000 children died worldwide from measles in 2008,
down from 733 000 in 2000, U.S. health officials report. The report,
published in the Centers for Disease Control and Prevention (CDC)
Morbidity and Mortality Weekly Report, said about 77 percent of the
deaths in 2008 occurred in Southeast Asia, with the majority of those
deaths occurring in India.

"Reduction in measles deaths in India is essential to achieve the
global goal of 95 percent reduction in measles deaths by 2015 compared
to the number of deaths in 2000," the report said. "Providing 2 doses
of measles vaccine to all children is an important step to reduce
measles deaths, and until recently, India was the only country to
provide only one dose of measles vaccine. In 2010, the government of
India took a significant step forward in reducing measles deaths by
initiating introduction of a 2nd dose of measles vaccine."

The introduction of a 2nd dose of measles vaccine is being implemented
in phases across Indian states, and significant progress in reducing
measles deaths in India could be expected in the future if the union
and state governments of India completely implement strategies to
reduce measles deaths, officials said.

--
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[This statement describes encouraging progress in measles vaccination
coverage in India but sadly ignores the resurgence in 2011 of the
disease in Europe, where measles has been largely controlled, and
eliminated in North America. - Mod.CP]

*****
Oceania
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[5] Australia (update)
Date: Mon 26 Sep 2011
Source: Medical Observer [edited]
http://www.medicalobserver.com.au/news/measles-cases-double-in-past-year

Australia has experienced almost double the number of measles cases
this year [2011] compared to last year, hampering plans to eliminate
the disease. Dr Robert Menzies, deputy director (surveillance) at the
National Centre for Immunisation Research and Surveillance, Sydney,
said the outbreaks were due to poor vaccination coverage among young
adults, a cohort with a high rate of overseas travel and pockets of
low coverage in some communities.

Between January and September this year [2011], 136 measles cases were
notified in Australia, compared to 70 cases in 2010. Some 61 percent
of cases (82 individuals) were unvaccinated, including 9 children aged
younger than 12 months.

"Lots of countries overseas have [outbreaks], and it is setting back
our plans to eliminate measles," Dr Menzies said. "We're aiming to
eliminate it in the western Pacific by next year [2012], but those
plans are not going to come to fruition."

Australians born in the 1970s and '80s when only one vaccine dose was
given were of concern, as they had low coverage and were also likely
to be travellers, he said. "We do encourage people to be vaccinated if
they are going to travel overseas if they haven't already received 2
doses of measles vaccine," he said.

Despite widespread global outbreaks, experts believed it was unlikely
measles would "take off" in Australia and cause an epidemic. "Although
this year [2011] there have been more outbreaks, our modelling is
telling us that our coverage is high enough... We're at about 90
percent of kids getting 2 doses," he said.

So far this year [2011], NSW has had 71 cases, Victoria 31, Queensland
16, Western Australia 9, Northern Territory 3, South Australia 3,
Australian Capital Territory 2, and Tasmania one.

[Byline: Emma Sorensen]

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******
[6] New Zealand (update)
Date: Tue 27 Sep 2011
Source: Scoop Health [abbreviated & edited]
http://www.scoop.co.nz/stories/GE1109/S00145/update-on-measles-cases.htm

Auckland Regional Public Health Service can report that 11 new cases
of measles across the Auckland region have been confirmed since Fri 23
Sep 2011. As of this morning [27 Sep 2011], the cumulative totals
were:
- 179 people have been confirmed as having measles since 30 May
2011.
- 17 people are in quarantine.
- 2 people were in hospital over the weekend, bringing the total
number of people hospitalised since the outbreak began to 26.

Dr Richard Hoskins says, "We urge anyone showing signs of measles to
call your doctor or Healthline on 0800 611116 for more advice." If
people are unwell, they should stay away from work, school or public
places to help prevent putting other people at risk. Call your doctor
before going into their surgery so they can take measures to prevent
the disease from spreading.

For further information, see
http://www.arphs.govt.nz/notifiable/measles.asp, or phone Healthline
at 0800 611 116.

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*****
[7] NZ (in-flight transmission)
Date: Fri 30 Sep 2011
Source: The Dominion Post via stuff.co [edited]
http://www.stuff.co.nz/national/health/5710892/Measles-case-a-Vic-Uni-student

A Victoria University student has contracted measles, public health
officials have confirmed. The student, 19, who is in Wellington
Hospital in a stable condition, became infected after close contact
with an infected passenger on [an internal] flight from Auckland to
Wellington earlier this month [September 2011].

The Dominion Post understands Victoria University has emailed all
students advising them of the case. Regional Public Health confirmed
the case yesterday [29 Sep 2011], and today confirmed the person is a
student at the university.

There have been 179 confirmed cases of measles in Auckland since 30
May 2011. In the past week, 26 people have been admitted to hospital.
Measles is a highly infectious disease that can have serious
complications such as ear infection, pneumonia and brain damage. It is
potentially fatal. Early symptoms are fever, runny nose, cough, sore
red eyes and white spots on the inside of the mouth.

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******
[8] New Zealand (Waikato)
Date: Fri 30 Sep 2011
Source: stuff.oc [abbreviated & edited]
http://www.stuff.co.nz/waikato-times/news/5707742/Measles-cases-tied-to-Te-Awamutu

Waikato health authorities are bracing for more confirmed cases of
measles they say are "inevitable" due to the region's "less than
adequate" immunisation rate. Parents from a Hamilton daycare centre
were yesterday [29 Sep 2011] advised that one of the children was
being tested for measles after presenting with a rash, but Waikato DHB
medical officer of health Dr Anita Bell said it was just one of many
unconfirmed cases being investigated.

There have been 24 confirmed cases of measles in people aged between 7
and 31 in Waikato. Of those tested, Dr Bell said all were unimmunised
except for one who had received one of the 2 recommended doses. All
but 2 of the cases have links back to Te Awamutu College, where the
initial Waikato outbreak began early last month [August 2011].

A public health bulletin sent to all GPs and medical centres from Dr
Bell and Dr Felicity Dumble this month [September 2011] states that
"although several incubation times have elapsed since the last
confirmed Waikato case, it is inevitable that reintroduction will
occur, and given our community's less-than-adequate immunisation rate,
more cases must be expected," it said.

More than 100 Waikato children are being tested for measles as health
authorities take every precaution against the highly contagious
disease. "The problem is there are over 100 cases in the Waikato,
where children are presenting with rashes; but this can occur with
many different conditions like pavo [?], but it's a case of testing
everything to be absolutely certain," she said.

Dr Bell said that while "very few" of the cases tested were positive,
increased awareness and vigilance are necessary. "The good thing is we
are getting children tested immediately, and results are coming back
straight away," she said.

Population Health has also recorded 9 confirmed cases of meningococcal
disease this year [2011] resulting in 2 deaths. The deaths in April
and August 2011 were both due to the meningococcal C bacteria, though
Dr Bell said there were no plans to offer free vaccinations in the
region.

[Byline: Maryann Twentyman]

--
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[The absence of reports from Africa and Asia continues to impede
assessment of the current status of progress towards the final
elimination of measles virus infection. - Mod.CP]

See Also