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Published Date: 2011-10-23 17:49:11
Subject: PRO/EDR> Measles update 2011 (37)
Archive Number: 20111023.3160

MEASLES UPDATE 2011 (37)
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In this update:

Europe
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[1] Spain (Madrid)

The Americas
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[2] Canada (vaccine failure)
[3] Ecuador (Tungurahua)
[4,5] USA (New York City)

Oceania
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[6] New Zealand (Waiheke)
[7,8] New Zealand (Wellington)

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Europe
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[1] Spain (Madrid)
Date: Mon 17 Oct 2011
Source: El Pais [in Spanish, trans. Mod.JT, abridged, edited]
http://www.elpais.com/articulo/madrid/casos/sarampion/multiplican/ano/elpeputec/20111017elpmad_2/Tes

Measles has returned to schoolchildren as it has not done so for
years. So far this year [2011], the Community of Madrid has reported
399 cases of this infectious disease, one of the most contagious, of
which 360 have been confirmed. In the previous year [2010], 31 cases
were confirmed (out of 50 reported). This means that measles
infections have multiplied by at least 12-fold in one year, which
makes Madrid one of the communities with the largest increase. The
Spanish average shows 6 times more infections this year than in 2010,
according to the National Epidemiology Center.

The alert is not solely regional or even national. The World Health
Organization (WHO) warned last week that there are major outbreaks of
measles in Europe, America, and Africa. France is, according to WHO,
the European country with the most cases: at least 14 025 between
January and July 2011. As of 8 Oct 2011, Spain has reported 1777
confirmed infections, of which 1/6th are located in the community of
Madrid. Outbreaks have occurred mainly in gypsy populations and the
Carabanchel and Vallecas districts, which have a lower vaccination
rate.

The health authorities began taking steps in recent months to advance
the childhood immunization schedule in the case of the MMR. From 1 Jun
2011 in Madrid, the age of the 1st administered dose is no longer 15
months but 12. "This is designed to reduce virus transmission in
nursery schools," according to a statement.

The Madrid Association of Primary Care Pediatrics (AMPAP) has sent a
clear message to parents: "It is essential to vaccinate children. It
has become fashionable to avoid this, especially MMR, and that is
barbaric," said its president, Concepcion Sanchez Pina. "We are now
seeing the consequences of this fashion. It is absurd to allow
children to be infected when it is free to avoid it." So far this year
[2011], areas with more cases in outbreaks in nurseries have been
Alcobendas, Vallecas and Torrejon, in that order. Although the
increase in measles is the most striking, the spread of mumps and
whooping cough, among other diseases preventable by immunization, have
also risen.

In Spain, the National Epidemiology Center has identified over 3000
cases of mumps this year [2011], up from about 2000 last year.
Whooping cough has 1700 cases, compared to 660 in 2010. In Spain, the
2 population groups affected most are young adults with low
vaccination coverage and children under 15 months who have not yet
received the 1st dose of MMR vaccine.

In addition, Joseph Mares, a member of the Spanish Association of
Pediatrics and until recently coordinator of its vaccine advisory
committee, pointed out that people between 30 and 40 who had not
received measles vaccine are vulnerable, because mass immunization
only began in 1981 in Spain. The elderly are no at risk, because
virtually everyone had contracted the disease and were immune.

Other communities, such as Catalonia, he added, have also decided to
recommend MMR vaccination at 12 months, and where an outbreak is
already present, to advance vaccination to 6 months.

WHO recommends that vaccination coverage be equal to or greater than
95 per cent. In Madrid, according to the Ministry of Health, the
percentage of children vaccinated with a 2nd dose at between 3-6 years
was 96.7 per cent (in 2010). However, 2 doses of vaccine are required
to halt the spread of disease. According to the current immunization
schedule, children over 4 years should have received these doses.
Immunity is usually for life, according to the Spanish Association of
Vaccinology (AEV), which declares that measles is a "potentially
serious" disease because it can be complicated by otitis (in 5-9 per
cent of cases), bronchopneumonia (1-6 per cent) and encephalitis (one
case per 1000).

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The Americas
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[2] Canada (vaccine failure)
Date: Wed 19 Oct 2011
Source: The Canadian Press, online [edited]
http://www.winnipegfreepress.com/breakingnews/measles-cases-among-vaccinated-que-kids-raises-questions-about-vaccine-schedule-132215208.html

Cases of measles, once a rarity in North America, have surged in the
past few years, doctors attending a medical conference this weekend
will hear. A still smoldering outbreak in Quebec is the largest in the
Americas in over a decade.

Measles cases have surged in parts of Canada and the United States
this year [2011], with cases among unvaccinated children and teens
driving the high numbers, public health officials from both countries
will tell a major infectious diseases conference this weekend. But an
unusual observation from a large outbreak in Quebec may raise some
alarm among those who attend the conference, the annual meeting of the
Infectious Diseases Society of America.

An investigation into an outbreak in a high school in a town that was
heavily hit by the virus found that about half of the cases were in
teens who had received the recommended 2 doses of vaccine in
childhood, in other words, teens whom authorities would have expected
to have been protected from the measles virus. It's generally assumed
that the measles vaccine, when given in a 2-dose schedule in early
childhood, should protect against measles infection about 99 per cent
of the time. So the discovery that 52 of the 98 teens who caught
measles were fully vaccinated came as a shock to the researchers who
conducted the investigation.

"That's the real question. How could that have happened?" said Dr
Gaston De Serres, an infectious diseases expert with Quebec's public
health agency and one of the authors of the study. In an interview
before the start of the conference, De Serres would not name the
highly affected town or the high school in it. But he suggested the
discovery that as many of the cases were fully vaccinated as
unvaccinated raises a serious question about whether the timing of the
delivery of the 1st dose of measles vaccine is undermining the
efficacy of the prevention program.

It is recommended that the 1st dose of measles vaccine be administered
at 12 months of age, with the 2nd coming at either 18 months or some
time before a child starts school. Quebec uses the 12-month and
18-month schedule. The vaccine can't be given earlier, because of a
phenomenon that helps babies survive infancy. Children are born
without a fully developed immune system; it starts to build as babies
become exposed to a variety of disease threats over their 1st few
years. In pregnancy and after birth, through breastfeeding, babies
acquire antibodies from their mothers that tide them over until they
can make their own. But that means if they are given the measles
vaccine -- which is made from weakened live viruses -- too early,
their mothers' antibodies will kill the vaccine viruses, preventing
protection from being induced. It has been thought that 12 months were
appropriately late for vaccination to begin, and it may still be. De
Serres insisted other studies will have to confirm his group's
findings before anyone starts advocating delaying the 1st dose of
measles vaccine.

"This is the 1st outbreak where an investigation has shown this effect
in 2-dose recipients," he said. But the study did note that teens in
the school who got their 1st dose of measles vaccine at 15 months of
age were more than 3 times less likely to get measles in the outbreak
than teens who got their 1st shot at 12 months. If other groups
confirm what the Quebec investigation found, it could mean there is a
lot more susceptibility to measles in the vaccinated population than
is currently being assumed, De Serres admitted.

"There may be more vulnerability than we know and were planning for,"
he said. "The problem is: if you have a population where the disease
does not enter often, you may have a pool of susceptibles that is
growing up, year after year, and you will be unaware of that
vulnerability." Changing vaccine schedules is not something that is
done lightly, especially at a time when little children are getting an
increasing number of vaccinations.

There's another factor one would have to consider when debating the
question, noted Dr Allison McGeer, an infectious diseases expert at
Toronto's Mount Sinai Hospital. Many measles cases seen in Canada are
in the children of new Canadians who have travelled to their homelands
to show off their new babies. Some of those families are travelling to
places where measles viruses are still circulating. "If you knew that
a child was going to stay in Canada ... a 15-month 1st dose
(schedule), based on this experience, certainly sounds like a sensible
thing to do," McGeer said. "But measles is one of those diseases where
when immigrant parents take their children home to see the
grandparents, it frequently happens before or just about the age of
one year. ... If you shift the 1st dose to older, some of those kids
will come back with measles."

After the Boston meeting, De Serres will be travelling to Atlanta to
brief the US Advisory Committee on Immunization Practices [ACIP] of
his group's findings. ACIP set vaccine policy for the US. Meanwhile,
measles experts at the US Centers for Disease Controland Prevention
have been watching the Quebec outbreak -- the largest in the Americas
in a decade -- with interest. "France we've been thinking of as a
cautionary tale," said Dr Greg Wallace, team lead in the division of
viral diseases for domestic measles, mumps, rubella and polio control.
France has had an enormous measles outbreak this year [2011], one
which ignited outbreaks in other parts of Western Europe as well. "But
certainly Canada's more of a cautionary tale because their system is
much more similar to us in terms of coverage levels overall."

Huong McLean, one of Wallace's colleagues, will update the conference
on measles activity in the US, where 214 cases have been reported this
year [2011]. A typical year would see around 50 cases, but Wallace
noted the US has had more imported cases this year than in recent
years, probably because of the high numbers of cases in Western
Europe. Most of the US cases could have been avoided if the adults or
children involved had been vaccinated, McLean said.

[byline: Helen Branswell]

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******
[3] Ecuador (Tungurahua)
Date: Mon 17 Oct 2011
Source: El Tiempo [in Spanish, machine trans. edited]
http://eltiempo.com.ve/mundo/salud/brote-de-sarampion-llego-a-los-99-casos-confirmados-en-ecuador/34751

The Ecuadorian health minister said that the province of Tungurahua is
most affected by the outbreak, as it has accumulated 93 cases. [In
total], the measles outbreak has reached 99 confirmed cases, most of
whom are resident in the province of Tungurahua, in the central Andean
region, said a statement from the Health Ministry on Monday [17 Oct
2011].

In the statement, the ministry said that "during the last 24 hours, no
new reports of confirmed cases have been received. As of 16 Oct 2011,
the total number of cases is 99." He stressed that the province of
Tungurahua is most affected by the outbreak with 93 cases, most of
whom are under 5 years of age. By this weekend, a total of 1.2 million
doses of vaccine will have been delivered, and in the coming week, a
national vaccination campaign will be launched in which children will
have priority.

The index case was infected by an African genotype of measles virus in
late September 2011 and belonged to the indigenous community of Chico
Illahua, 120 km south of Quito.

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[According to the Sun 23 Oct 2011 issue of Diario HO, the total number
of cases has increased from 99 to 107
(http://www.hoy.com.ec/noticias-ecuador/casos-confirmados-de-sarampion-llegan-a-107-509291.html).

The location of Tungurahua can be found by accessing the
HealthMap/ProMED-mail interactive map via
http://healthmap.org/r/1lE1. - Mod.CP]

******
[4] USA (New York City)
Date: Thu 20 Oct 2011
Source: New York Daily News [edited]
http://www.nydailynews.com/lifestyle/health/2011/10/20/2011-10-20_unvaccinated_brooklyn_toddlers_are_infected_with_measles_virus_latest_in_years_s.html

Three Brooklyn toddlers who were not vaccinated have been diagnosed
with measles. All the children were 2 years old, but the cases do not
appear to be linked, the Health Department said on Thursday [20 Oct
2011]. The agency did not say how the youngsters contracted the virus
but warned all parents to vaccinate their children.

"Measles is highly contagious," the agency wrote in a letter to
doctors, urging them to make sure children receive their 1st dose of
the MMR vaccine by age one. The city has experienced a surge in the
number of measles cases this year [2011], counting 16 between January
and June 2011 compared to zero during the same time last year.

Half of the cases were among international travelers and weren't
linked, officials said. Some medical experts think measles is making a
comeback because some parents skip the vaccination out of unfounded
fear it could cause autism.

[byline: Kathleen Lucadamo]

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******
[5] USA (New York City)
Date: Fri 21 Oct 2011
Source: The New York Time [abbreviated & edited]
http://cityroom.blogs.nytimes.com/2011/10/21/health-department-reports-spike-in-measles-cases-in-brooklyn/

Six cases of childhood measles have been reported in Brooklyn over the
last 2 weeks, the New York City health department said Friday [21 Oct
2011], contributing to a spike in measles cases this year [2011]. The
health department usually sees 4-6 cases of measles per year in years
when there are no outbreaks, said Susan Craig, a spokeswoman for the
department. There were recent outbreaks in 2008, when there were 30
cases, and 2009, with 18 cases. Last year [2010], there were 6 cases.
So far this year, there have been 24 cases. Many of the cases this
year have been among travelers and were not linked together.

The latest outbreak took place within a close-knit Orthodox Jewish
population in Brooklyn, officials said. There have been similar
outbreaks among Orthodox Jews in the past. Some of the children had
not been vaccinated, perhaps because of a preference within the
community to delay vaccination, health officials said. At least 2 of
the cases are directly related, and it is suspected that all are
related "with unknown common exposures," Ms Craig said.

She said the health department had put out an alert to doctors because
it is the middle of a Jewish holiday season, raising the risk that
children may be exposed to measles through large gatherings and
holiday parties.

[byline: Anemona Hartocolis]

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******
Oceania
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[6] New Zealand (Waiheke)
Date: Thu 20 Oct 2011
Source: Waikato Times [abbreviated & edited]
http://www.stuff.co.nz/waikato-times/news/national-news/5824273/Measles-outbreak-hits-Waiheke-Island

The measles outbreak which has infected more than 200 Aucklanders has
now spread to Waiheke Island. A 17 year old resident on the island
recently tested positive for the disease, Dawn Rigby, manager of the
Waiheke Trust said. It is not known where the teenager contracted
measles, but because of the school holidays, his contact with others
had been limited. There were no other suspected cases on Waiheke.

Since the measles outbreak began in May 2011, there had been 229
confirmed cases of the disease in Auckland. Health officials were
urging anyone who had not been immunised against the disease to be
vaccinated. The Ministry of Health was working with the 3 Auckland
district health boards to ensure there was a sufficient supply of the
measles vaccine, as the disease continued to spread. Officials would
administer the measles, mumps and rubella (MMR) vaccine to anyone who
was not immunised free of charge.

The best protection against the disease is to have 2 doses of the MMR
vaccine. Doctors have also been asked by the district health boards to
contact all children between the ages of 4 and 15 who had not had 2
vaccinations.

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[Waiheke Island can be found in the HealthMap/ProMED-mail interactive
map at http://healthmap.org/r/1mmx. - Mod.CP]

******
[7] New Zealand (Wellington)
Date: Wed 19 Ot 2011
Source: The Dominion Post [edited]
http://www.stuff.co.nz/dominion-post/news/5812981/2-more-measles-cases-in-capital

Two further cases of measles in Wellington have been confirmed.
However, public health officials say neither appears to be linked to
an infected staff member at the city gelato cafe, Kaffee Eis.

The 2 latest cases, both adults, bring the total in Wellington to 4
since 28 Sep 2011. A 5th suspected case, in a child under 5, was ruled
out after testing. Medical officer of health Annette Nesdale said both
adults worked in the CBD [central business district], and contact
tracing was being done to see where they had been while infectious.
"At this stage, we haven't found any links between these 2 new cases
and the other cases. They look like they're separate introductions,
probably from people from the Auckland region."

Since May [2011], there have been about 200 cases of measles confirmed
in Auckland, after an unimmunised child caught it overseas. Dr Nesdale
said 2 of the infected people in Wellington were not immunised against
measles; one had only been partially immunised, and the final person
was not sure of their immunisation status.

[byline: Kate Newton]

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******
[8] New Zealand (Wellington)
Date: Tue 18 Oct 2011
Source: stuff.co.nz ex The Dominion Post [edited]
http://www.stuff.co.nz/dominion-post/news/5803460/More-suspected-measles-cases-in-Wellington

Public health officials are urging people to check their immunisation
status as more measles cases start appearing in Wellington. Tests are
being done to confirm 2 probable cases (a Wellington adult and a Hutt
Valley pre-schooler), following verification last week that a
hospitality worker had contracted the highly infectious disease. If
confirmed, the latest cases would take the total number in the past
month to 4.

Medical officer of health Annette Nesdale said Regional Public Health
had fielded a large number of calls from people worried they might
have been exposed to the disease. "So far, we haven't identified any
secondary cases, but people would still be in the early stages. The
1st people, if they had contact on 5 Oct 2011, would be coming out
with a rash about Wednesday [19 Oct 2011]."

Kaffee Eis customers may have been exposed to the infected man between
5-9 Oct 2011, while 2000 people had gone to Les Mills Extreme in
Taranaki St on 5-6 Oct 2011 at the same time as the infected man.
These people should contact their doctor to make sure their measles
vaccinations are up to date, Dr Nesdale said.

Neither of the 2 new cases was thought to be linked to the Kaffee Eis
case, and it was possible the infected people had contracted the
disease from visitors from Auckland, where about 200 cases of measles
have been confirmed since May 2011, Dr Nesdale said. "There are so
many cases up in Auckland now, and people travelling between Auckland
and Wellington just think that they've got a bit of a cough and red
eyes and don't know it's measles, and that's when it's most
infectious."

Anyone who was at the following locations at the specified times
should contact their doctor about their immunity status:
- Les Mills Extreme Gym on Taranaki St: Wed 5 Oct 2011, 6pm to 7pm;
Thu 6 Oct 2011, 4pm to 6pm.
- Kaffee Eis at Frank Kitts Park (the Waterfront): Wed 5 Oct 2011, 7am
to 6pm; Sat 8 Oct 2011, 9am to 6pm; Sun 9 Oct 2011, 9am to 7pm.
- Kaffee Eis in Courtenay Pl: Thu 6 Oct 2011, 7am to 4pm.
- Kaffee Eis in Cable Car Ln: Fri 7 Oct 2011, 7:30am to 9am.

[byline: Kate Newton]

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[The observation in a district of Quebec that as many measles cases
were observed among fully vaccinated individuals as among unvaccinated
individuals is at variance with general experience and raises
questions about the timing of the delivery of the 1st dose of measles
vaccine and its effects upon the efficacy of the measles prevention
program in Canada. Further analysis of this situation is awaited. -
Mod.CP]

See Also