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Published Date: 2018-08-31 20:50:34
Subject: PRO/EDR> Measles update (56): Americas, Europe
Archive Number: 20180831.6000907
MEASLES UPDATE (56): AMERICAS, EUROPE
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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:
[1] Americas
[2] Europe

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[1] Americas
Date: Wed 29 Aug 2018
Source: Precision Vaccinations [edited]
https://www.precisionvaccinations.com/travel-alert-level-1-issued-cdc-brazil-measles-outbreak


A travel alert level 1 has been issued by the CDC in response to Brazil's measles outbreak. International travelers to Brazil and the state of Amazonas, in particular, should ensure they are vaccinated against measles before departure, announced the Centers for Disease Control and Prevention (CDC). This CDC alert is in reaction to the ongoing measles outbreak throughout Brazil.

On [Mon 20 Aug 2018], the Pan American Health Organization (PAHO) reported 1237 confirmed measles cases and 6 deaths in Brazil during 2018.

In the state of Amazonas, the measles outbreak that began March 2018 is ongoing, and 910 cases have been confirmed, including 2 deaths. Only 2 municipalities in this region, Manaus and Manacapuru, have confirmed cases during 2018.

In addition to the measles vaccination alert, the CDC suggests all travelers to Brazil review their immunizations for the following vaccine-preventable diseases:
- measles, mumps & rubella (MMR) vaccine
- diphtheria, tetanus & pertussis (DPT) vaccine
- varicella (chicken pox) vaccine
- polio vaccine
- hepatitis A
- typhoid
- flu shot

[...]

[Byline: Don Ward Hackett]

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Communicated by:
ProMED-mail
<promed@promedmail.org>

[See ProMED-mail Measles update (55): Americas, PAHO 20180830.5996307 for a PAHO report on measles in the Americas. CDC issued a level 3 alert for Venezuela, meaning USA citizens should avoid visiting the country. A level 1 alert means to practice usual precautions, level 2 means to practice enhanced precautions, and level 3 means to avoid nonessential travel.

The majority of cases continue to be reported in the states of Amazonas and Roraima. In Amazonas state, all reported cases are Brazilian nationals, and over 1800 cases were reported in children less than 9 years old. Make sure you are fully vaccinated or otherwise protected against measles.

To protect themselves, travelers should get vaccinated if they are not fully immunized, and they should avoid contact with people who are sick.

Europe is also experiencing a surge in measles cases (see next post). In January 2018, CDC issued a level 1 alert for Italy in response to their high number of cases. Italy's health ministry stated that 4991 measles cases were reported during 2017, a 6-fold increase over 2016, as reported by the AP.]

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[2] Europe
Date: Fri 31 Aug 2018
Source: The Lancet [edited]
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32031-2/fulltext?dgcid=raven_jbs_etoc_email&code=lancet-site


Citation: Ed Holt. 41 000 measles cases in Europe since the beginning of 2018. The Lancet. 2018; 392: World Report | Vol 392(10149): 724. doi: https://doi.org/10.1016/S0140-6736(18)32031-2

Despite her country having the highest number of measles deaths in Europe this year, Jovana Kostic is adamant that she will not have her 2-year-old vaccinated. She was fined CSD 150 000 (EUR 1266/USD 1395) for her refusal. "I was convinced that the 1st round of vaccination weakened his immune system. He was never sick before that, and after the 1st dose, he had a fever for more than 7 days," the 24-year-old from Subotica in northern Serbia told The Lancet.

Kostic is one of a growing number of people in Serbia and across Europe who are refusing, or questioning, vaccinations against measles and other diseases. And this, say health experts, is contributing to low vaccine coverage that is driving a measles epidemic that has swept across Europe this year, claiming 37 lives -- 14 of which were in Serbia -- with more than 41 000 cases reported in the first 6 months of the year. The number of cases is an 8-year high and almost twice as much as in the whole of 2017. WHO and other global health groups have called on European countries to step up efforts to halt the spread. They have also described the outbreak as "unacceptable."

"We have the means to avoid measles cases and deaths, and the fact that this has happened in Europe is completely unacceptable," Nedret Emiroglu, director of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, told The Lancet.

Measles is one of the most infectious diseases but can be almost entirely prevented by vaccination. To eliminate the disease, vaccine coverage needs to be at 95 percent. But data from the European Centre for Disease Prevention and Control (ECDC) show that only 4 EU/European Economic Area states met that target for 2017. Experts point out that some countries, such as Ukraine, which has had the highest number of reported measles cases this year, face problems with vaccine supply, whereas in other countries, people access medical services with difficulty and cannot get the vaccines that are available. But in many countries, there is also a growing level of scepticism and even active campaigning against vaccinations.

Heidi Larson of the London School of Hygiene & Tropical Medicine and director of the Vaccine Confidence Project told The Lancet that "there has always been some historic distrust of vaccines and people not wanting to take them, but what we have seen recently is an acceleration of this and more polarisation on the issue."

"The MMR controversy from the late 1990s has not been forgotten, partly because of active support for it by groups in some parts of the continent, while there are strong anti-vaccine movements elsewhere, some of which have been picked up on by populist politicians. The vaccination issue is becoming more politically driven."

Some prominent politicians have indeed spoken out against vaccines. Marine Le Pen, the leader of France's far right National Rally party, publicly opposed mandatory vaccinations, while founder of Italy's Five Star Movement, Beppe Grillo, is a known vaccine sceptic.

Larson told The Lancet: "Populist politicians ... listen to voters' opinions, and, rather than saying outright 'yes, vaccines are bad,' they say, 'I agree with your view that they should not be mandatory, and it is your right to make your own choice.'"

In March this year [2018], Serbian health minister Zlatibor Loncar announced that criminal investigations were being launched into anti-vaccine campaigns after measles deaths. Sladjana Velkov, the most prominent anti-vaccine campaigner in the country, recently had her offices raided by Serbian police over her campaigning. A controversial figure with almost 50 000 followers on Facebook, she remains defiant and continues to speak out against vaccines.

Velkov told The Lancet: "Vaccines do not protect people from diseases; they cause diseases. There is no medical study that confirms vaccines' efficiency and safety. Companies that produce vaccines are more interested in profit than people's health."

"There are a small number of people who are very anti-vaccination, but also a lot of people who are simply questioning vaccinations," Larson explained. "People who are still being vaccinated but asking more questions about vaccinations must have those questions answered."

Tarik Derrough, senior expert for Vaccine-Preventable Diseases at the ECDC, told The Lancet, "Research has shown that frontline health workers, such as general practitioners, nurses, and school nurses, are most trusted in these cases. They are key in helping raise coverage, and they need to be given the tools and knowledge to answer people's questions. Unless there is a dramatic improvement in vaccine uptake, nothing will change."

Kostic, however, will not be changing her mind. "I have no confidence in vaccinations anymore. If the vaccinations were like the ones when I was a kid, it would be OK, but nowadays, big companies have no morals, and I do not trust them," she said.

[Byline: Ed Holt]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Measles is surging wherever vaccination coverage is low. The level of immunization needed to provide protection to the population is 95 percent. The anti-vaxxer quoted in this piece stated, "There is no medical study that confirms vaccines' efficiency and safety." This indicates that education in the schools and community centers is lacking and highly needed to reach people who have such views. The data are published and must be made public by healthcare practitioners and authoritative members of the community. - Mod.LK

HealthMap/ProMED-mail maps:
Americas: http://healthmap.org/promed/p/52913
Europe: http://healthmap.org/promed/p/6010]

See Also

Measles update (55): Americas, PAHO 20180830.5996307
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Measles update (51): Americas, Europe 20180816.5970434
Measles update (50): Americas, Europe 20180812.5961680
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