Measles Update - Going Viral

Michigan Dept of Health & Human Services sent this bulletin at 06/12/2019 07:34 AM EDT
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Measles Update – Going Viral

Meghan Weinberg, PhD, MPH - Region 1 - Regional Epidemiologist - MDHHS

Until the measles, mumps, and rubella (MMR) vaccine was introduced in 1963, nearly everyone contracted measles by age 15 years [1,2]. Thanks to vaccination, the number of cases decreased to the point that measles was declared eliminated (meaning no evidence of endemic transmission) in the United States in 2000. However, measles is common in other countries and unvaccinated travelers are at risk of acquiring the virus. Once imported, a single case can spark an outbreak, particularly in communities with low MMR vaccination rates.

Measles is a highly contagious, viral illness. It typically begins with high fever (≥ 101⁰F), runny nose, cough, and red/watery eyes. Three to five days later a rash appears, usually on the face, that spreads to the trunk and lower extremities. The virus spreads to others through coughing and sneezing. Infected individuals are contagious beginning four days before rash onset through four days after. Approximately 30% of individuals develop complications, most commonly diarrhea, otitis media, and pneumonia [1]. Measles can cause serious illness requiring hospitalization. One out of every 1,000 cases will develop acute encephalitis, often resulting in permanent brain damage [2]. One or two out of every 1,000 children with measles will die from respiratory and neurologic complications. Subacute sclerosing panencephalitis (SSPE) is a neurologic degenerative disease that develops 7-10 years after measles infection. Although rare (4–11 per 100,000 measles cases, which is likely an underestimate), SSPE is usually fatal [2–4].

To date in 2019, there have been 44 confirmed measles cases in Michigan. Measles incidence started to increase in Michigan in 2018 when 19 cases were reported. Prior to this, an average of two cases were reported per year for the past decade. The majority of the 2019 cases have been linked to an outbreak that began in Oakland County in March 2019. The index case occurred in an individual who likely acquired the infection while visiting a New York City community during a measles outbreak. On June 5, Oakland County Health Division announced the end of this outbreak. Two additional cases occurred in international visitors to Michigan from Germany and Lithuania and were unrelated to the outbreak. Of the 44 cases, 38 (86%) occurred in people who were unvaccinated or lacked documented measles immunity. The median age was 29 years (range <1 – 63 years); 73% were male.

Nationally, almost 1,000 measles cases have been reported in over 25 states in 2019 to date [2]. This is the highest case count since measles was declared eliminated. At least 13 outbreaks have been reported this year, the largest of which is occurring in New York City, where over 500 cases have been confirmed since September 2018 [5]. Among the 704 cases reported nationally in January – April 2019, 631 (90%) were unvaccinated or their vaccination status was unknown [6]. The median age was 5 years, which is younger than the Michigan cases. Overall, 9% of patients were hospitalized; no deaths were reported.

Large-scale measles outbreaks are occurring globally including in Ukraine, Israel, and the Philippines. According to the World Health Organization, global measles activity in the first quarter of 2019 is 300% greater than the same period of 2018. In 2016, the WHO European Region reported 5,273 measles cases [7]. In 2018, the same region reported over 83,000 cases including 74 deaths.

As long as global measles activity remains high, there will be a risk of measles importation into Michigan. The best protection is through vaccination, which is safe and effective. Review your immunization records and speak with your healthcare provider to make sure you and your family are protected, particularly prior to international travel. Healthcare providers should ensure patients are up-to date with all recommended vaccines, including MMR, and report suspected cases to their local health department. Measles testing is available through the MDHHS Bureau of Laboratories and requires pre-approval from local health departments. For more information, visit the MDHHS measles outbreak website.

 

  1. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015. https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html
  2. CDC [Internet]. Measles, 2019. https://www.cdc.gov/measles/index.html
  3. Wendorf, K et al. Subacute Sclerosing Panencephalitis: The Devastating Measles Complication is More Common than We Think. ID Week 2016; 2016 October 26-30; New Orleans, LA. Available from: https://idsa.confex.com/idsa/2016/webprogram/Paper56915.html.
  4. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2013;62(No. 4):1-34. DOI: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
  5. New York City Department of Health [Internet]. Measles Recent Outbreak in Brooklyn and Queens, 2019. https://www1.nyc.gov/site/doh/health/health-topics/measles.page
  6. Patel M, Lee AD, Redd SB, et al. Increase in Measles Cases — United States, January 1–April 26, 2019. MMWR 2019;68:402–404. DOI: http://dx.doi.org/10.15585/mmwr.mm6817e1.
  7. WHO [Internet]. Measles – European Region. WHO Disease outbreak News May 6, 2019 https://www.who.int/csr/don/06-may-2019-measles-euro/en/