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Published Date: 2019-02-20 10:20:38
Subject: PRO/EDR> Measles update (12): Americas, Asia
Archive Number: 20190220.6326123
MEASLES UPDATE (12): AMERICAS, ASIA
***********************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Americas
---
[1] USA: CDC update, multistate alert
[2] USA: (Illinois, Champaign-Urbana)
[3] USA: (Washington state, Clark county)

Asia
---
[4] Philippines
[5] Philippines
[6] India (Bihar)
[7] Taiwan: travel alert
[8] Japan

******
[1] USA: CDC update, multistate alert
Date: Sun 17 Feb 2019
Source: DG Alerts from CDC (US); State Health Agencies [edited]
https://tinyurl.com/yxfstb95


CDC update
----------
According to an update by the Centers for Disease Control and Prevention (CDC), there have been 101 individual cases of measles have been confirmed in 10 states from [1 Jan to 7 Feb 2019].

The states that have reported cases to CDC are California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, and Washington.

See figure [at URL above] showing the number of measles cases reported by year, from 2010-2019 (as of 7 Feb 2019).

So far, 5 outbreaks (defined as 3 or more cases) have been reported in 2019 in the following jurisdictions:
- New York state, Rockland county
- New York state, Monroe county
- New York City
- Washington (Clark county)
- Texas

These outbreaks are linked to travelers who brought measles back from other countries such as Israel and Ukraine, where large measles outbreaks are occurring.

New York
--------
As of 13 Feb 2019, there are 135 confirmed reported cases of measles in Rockland county.

Vaccination rates for confirmed measles cases in Rockland county:
- 81.5% have had 0 MMRs [measles, mumps, rubella vaccine]
- 3.1% have had 1 MMR
- 4.6% have had 2 MMRs
- 10.8% unknown status

Meanwhile, as of 12 Feb 2019, there have been 73 confirmed cases of measles in the Orthodox Jewish community in Brooklyn since October [2018]. The initial child with measles was unvaccinated and acquired measles on a visit to Israel, where a large outbreak of the disease is occurring. Since then, there have been additional children from Brooklyn who were unvaccinated and acquired measles while in Israel.
Children who did not travel were also infected in Brooklyn or Rockland county.

The neighborhoods that are affected include:
- Bensonhurst: 1 confirmed measles case (no new cases since November 2018)
- Borough Park: 39 confirmed measles cases (1 new case in the past week)
- Midwood/Marine Park: 1 confirmed measles case (no new cases since November 2018)
- Williamsburg: 32 confirmed measles cases (5 new case in the past week)

Washington
----------
Clark County Public Health is continuing its measles outbreak investigation and has identified 2 new confirmed cases. Since 1 Jan 2019, Public Health has identified 61 confirmed cases and currently is not investigating any suspect cases. Public Health has identified 2 new locations where people may have been exposed to measles.

Here are the details of the confirmed cases:
Age
- 1 to 10 years: 44 cases
- 11 to 18 years: 14 cases
- 19 to 29 years: 1 case
- 30 to 39 years: 2 cases
Immunization status
- Unimmunized: 54 cases
- Unverified: 5 cases
- 1 MMR vaccine: 2 cases
Hospitalization: 1 case (none currently)

Public Health is not providing any additional information about the 2 cases with 1 dose of MMR in order to protect the patients' privacy.

Texas
-----
So far, 8 measles cases have been confirmed in Texas this year [2019]. The Department of State Health Services Public Health Region for the Houston area is urging health care providers to consider measles when diagnosing patients because early identification, along with immunization, is key to preventing measles from spreading.

Texas had 9 confirmed cases in 2018 and 1 in 2017.

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

[HealthMap/ProMED-mail map of United States: http://healthmap.org/promed/p/106]

******
[2] USA: (Illinois, Champaign-Urbana)
Date: Sun 17 Feb 2019
Source: WILL radio and TV [abridged, edited]
https://will.illinois.edu/news/story/two-more-measles-cases-reported-in-champaign-urbana


The Champaign-Urbana Public Health District [CUPHD] said in a news release [Sun 17 Feb 2019] that 2 more cases of measles have been reported in the area, bringing the total number of cases to 4 so far this year [2019].

CUPHD said the 3rd case was in quarantine the entire time the disease was infectious, so they don't believe it was spread to anyone else. But they said it's possible the person with the 4th case spread it to other individuals at the times and places listed [at the source URL above].

[Byline: Brian Moline]

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

[HealthMap/ProMED-mail map of Illinois, United States: http://healthmap.org/promed/p/43078]

******
[3] USA: (Washington state, Clark county)
Date: Tue 19 Feb 2019
Source: Chinook Observer [abridged, edited]
https://www.chinookobserver.com/news/state/measles-outbreak-gets-second-wind-more-clark-county-cases-likely/article_ffe92724-346f-11e9-9b2e-1bda85d7d57f.html


With only one new case last week [week of 11 Feb 2019], health authorities in Clark county were cautiously optimistic that efforts to suppress a measles outbreak were working. However, in a Fri 15 Feb 2019 interview, county Health Officer Dr Alan Melnick said the drop in cases could also be "the calm between two storms." The latter turned out to be true.

The 2nd wave
------------
On [Sat 16 Feb 2019], 6 new cases popped up. By Monday afternoon [18 Feb 2019], the county had confirmed 2 more cases and identified 4 new exposure sights. Now, numerous new cases are likely in the coming weeks.

According to Melnick, measles is "exquisitely contagious." Unvaccinated people who come into contact with it have about a 90 percent chance of getting sick. The incubation period can last up to 3 weeks. The initial symptoms can seem like a regular flu or cold, and infected people are contagious for 4 days before the distinctive head-to-toe rash shows up and 4 days after. As a result, measles sufferers often infect others before realizing they've got the virus.

"You see generations of cases. You have one cases that exposes a bunch of people. 7 to 21 days later, they get sick. They expose another generation," Melnick explained.

New exposure sites
------------------
Since the beginning of the year, there have been 62 cases in Clark county, as of 18 Feb 2019. There has been one case in King county, and a handful of cases in Oregon. There have also been outbreaks in a few other states, including more than 200 cases in insular orthodox Jewish communities in New York.

Campus contagion
----------------
In an [18 Feb 2019] email, Evergreen Schools Spokeswoman Gail Spolar said the district has made a concerted effort to get parents to vaccinate over the last few weeks. In mid-January 2019, 7.7 percent of students in the district were not protected from measles. Now, only about 3.3 percent remain unprotected. That works out to 218 susceptible students across the district's 37 campuses.

The district has excluded all unvaccinated children and staff. They could be absent for up to 21 days, Melnick said.

There are likely many other unprotected children in the area, including some who go to private schools and home schools, and those who are too young to receive the vaccine. Children outside of public school systems tend to be vaccinated at lower rates, Melnick said.

Active monitoring
-------------------
So-called "vaccine hesitancy" has created an enormous workload for local and state public authorities. When new cases are reported, health workers contact the families and try to identify anyone who might be especially vulnerable, including immunosuppressed people and pregnant women. They try to get those people immune globulin, which can be effective for up to 6 days after exposure.

The health workers conduct in-depth interviews to learn everywhere the infected people went during the contagious period. If the patients visited populous places like airports and grocery stores, authorities notify the public. The affected families are placed on active monitoring, meaning that health workers call them every day to make sure they're staying at home and find out what stage the disease is at and whether anyone else in the household has fallen sick. At one point, Clark County was actively monitoring almost 200 people.

For the last several weeks, almost half of Clark County Public Health's staff have been dedicated to measles suppression. Additionally, workers from the federal Centers for Disease Control and from other regional health departments have traveled to Clark county to help out. Many workers were pulled off of other important public health projects to focus on measles. "We're stretched pretty thin," Melnick said.

So far, the county has spent over USD 400 000. Together, the county and state Department of Health have spent about USD 1 million on efforts to suppress the disease.

Melnick said it's not uncommon for measles outbreaks to last through 2 or 3 generations of cases. That means it could be weeks or even months before the virus goes away.

"I'll start feeling extremely optimistic when we go a full incubation period without a case -- 21 days," Melnick said. "I think I'll be able to say this outbreak is over when we go 2 incubation periods."

[Byline: Natalie St John]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Also see https://www.clark.wa.gov/public-health/measles-investigation

The confirmed cases include 2 cases who traveled to Hawaii and another case who traveled to Bend, Oregon. The confirmed cases also include 2 Clark county residents who moved to Georgia. The case totals do not include confirmed cases from King county and Multnomah county, Oregon.

Public Health has identified suspect cases that were unimmunized when exposed to measles and received the measles-mumps-rubella (MMR) vaccine more than 72 hours after exposure. To prevent illness, one dose of MMR vaccine must be given to unimmunized people within 72 hours of exposure.

To date, the majority of lab results of confirmed cases have matched a wild strain of virus circulating in Eastern Europe. - Mod.LK]

[HealthMap/ProMED-mail map of Washington, United States: http://healthmap.org/promed/p/4647
Washington county map: https://www.mapsofworld.com/usa/states/washington/washington-county-map.html]

******
Asia
---
[4] Philippines
Date: Mon 18 Feb 2019
Source: Global News, Associated Press (AP) report [abridged, edited]
https://globalnews.ca/news/4971972/measles-outbreak-philippines/


The Philippine health secretary says 136 people, mostly children, have died of measles and 8400 others have been sickened in an outbreak blamed partly on recent vaccination fears.

Health Secretary Francisco Duque III said [Mon 18 Feb 2019] a massive immunization drive that started last week [week of 11 Feb 2019] in hard-hit Manila and 4 provincial regions may contain the outbreak by April [2019]. President Rodrigo Duterte warned in a TV message [Fri 15 Feb 2019] of fatal complications and urged children to be immunized. The outbreak began in January [2019].

Duque said a government information drive is helping restore public trust in the government's immunization program, which was marred in 2017 by an anti-dengue vaccine made by French drugmaker Sanofi, which was blamed for the deaths of at least 3 children.

The Philippines health department declared a measles outbreak in Metro Manila and Central Luzon. At least 55 deaths have been recorded since [1 Jan 2019], mostly children under the age of 4, health secretary Francisco Duque III said.

Measles outbreaks have been turning up around the globe, in parts of Europe and Africa to across North America.

The World Health Organization (WHO) has declared the anti-vaccination movement one of 2019's top 10 health threats, saying that measles cases have risen globally by 30 per cent, though not all of these cases are attributable to vaccine hesitancy.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******
[5] Philippines
Date: Sun 17 Feb 2019
Source: The Philippine Star [abridged, edited]
https://www.philstar.com/headlines/2019/02/17/1894416/duterte-urges-public-get-kids-vaccinated


President Duterte has appealed to parents to have their children vaccinated against measles following outbreaks of the disease in several parts of the country.

Data from the Department of Health (DOH) showed 70 persons, mostly children, have died in Metro Manila alone.

The DOH has so far achieved about a quarter of its measles vaccination target to combat the outbreak in Metro Manila.

Duque said they were able to vaccinate more than 100 000 recipients in the National Capital Region in the past 4 weeks.

This accounts for about 23 percent of the 450 000 target that they aim to complete in the next few months.

The DOH is prioritizing the immunization of children aged 6 -- 59 months, as well as kinder and grade school children, who account for a total of around 10 million. Some 2-million adults are also being eyed by the DOH for immunization.

Health officials said Calabarzon (Cavite, Laguna, Batangas, Rizal, and Quezon) recorded 45 deaths from measles within just 45 days.

Calabarzon is among regions hardest hit by the outbreak, with 1645 cases including 40 deaths from 1 Jan-14 Feb 2019, according to the DOH-Regional Epidemiology and Surveillance Unit (RESU).

During the same period in 2018, the region posted only 66 measles cases with 2 deaths.

The city of Antipolo in Rizal remains to have the highest number of measles cases in the region with 441, followed by Biñan in Laguna with 126 cases. The municipalities of Rodriguez and Taytay in Rizal have 105 and 95 cases, respectively. Lipa City, Batangas has 91 cases.

Calabarzon health director Eduardo Janairo is hopeful that the outbreak can be controlled sooner, before several more individuals get infected as the disease is highly contagious.

"We will be implementing key strategies on measles outbreak response including surveillance, public awareness and education, vaccination and taking care of measles patients in health care facilities," Janairo told the health officers.

He said they are targeting to vaccinate a total of 430 292 children in Calabarzon from a projected population of almost 16 million.

In Cavite, the DOH aims to immunize 113 064 children: 90 160 in Laguna, 79 839 in Batangas, 87 019 in Rizal, and 60 210 in Quezon.

The DOH is also collaborating with other government agencies and departments such as social welfare and development, and education for the vaccination of children in day care and elementary schools; Armed Forces in far-flung and conflict areas; Philippine National Police and Bureau of Fire Protection for additional logistic support and interior and local government to extend the vaccination schedule beyond regular hours.

"With everything in place, we are expecting cases to decrease next month," Janairo said.

[Byline: Edith Regalado]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Maps of the Philippines: https://goo.gl/vVg7ht and http://healthmap.org/promed/p/158]

******
[6] India (Bihar)
Date: Mon 18 Feb 2019 13:36 IST
Source: Hindustan Times [abridged, edited]
https://www.hindustantimes.com/patna/fresh-measles-death-takes-toll-to-8-in-west-champaran/story-q8Ppt8Gxl1mdMywWVezlrL.html


Fresh measles death takes toll to 8 in West Champaran, Bihar, India with 129 cases. The latest case was reported in a survey by the health department. 8 deaths were registered from 3 villages in the district

A survey conducted by the state health department has found yet another suspected measles death in West Champaran, taking the tally to 8 in the district in the last 10 days.

"In the course of our preliminary survey, as many as 129 suspected cases have been detected from various places so far," said Dr Kiran Shankar Jha, district Immunisation Officer. "The exact contour would only be known after the completion of the survey," said Jha.

"During the survey, unhygienic conditions have been found to be the major reason behind the spread of the disease," said Dr DN Thakur, civil surgeon (in charge), West Champaran.

The immunization coverage of the district improved from 29.14 per cent in 2015-16 to 86 per cent in 2017-18, said a health department official, quoting National Family Health Survey report. "It stands above the state average of 81 per cent," said the officer.

So far at least 1.81 crore [18.1 million] children of the 3.77 crore [37.7 million] in the age group of 9 months to less than 15 years in Bihar, have been vaccinated as part of the life-threatening measles and rubella campaign in schools and outreach sessions, which got underway on 15 Jan 2019.

[Byline: Sandeep Bhaskar]

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

[Maps of India: http://www.mapsofindia.com/maps/india/india-political-map.htm and http://healthmap.org/promed/p/64948]

******
[7] Taiwan: warns travelers to Japan of measles and rubella
Date: Sun 17 Feb 2019
Source: Outbreak News Today [abridged, edited]
http://outbreaknewstoday.com/taiwan-warns-travelers-japan-measles-german-measles-57136/


Officials with the Taiwan Centers for Disease Control (CDC) are advising (computer translated) the public to ensure they are vaccinated if traveling to Japan due to outbreaks of measles and German measles (rubella).

According to the latest data from the Japan National Institute of Infectious Diseases through 3 Feb 2019, Japan has reported 148 confirmed measles cases and 367 rubella cases.

Japan rubella outbreak grows: vaccines offered to men 39-56 [years old].

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

[HealthMap/ProMED-mail map of Taiwan: http://healthmap.org/promed/p/193]

******
[8] Japan
Date: Tue 19 Feb 2019
Source: NHK News [in Japanese, machine trans., abridged, edited]
https://www3.nhk.or.jp/news/html/20190219/k10011819801000.html?utm_int=word_contents_list-items_001&word_result


The number of measles patients has reached 167 people nationwide, the largest number in the past 10 years. The National Institute of Infectious Diseases is considering requiring vaccines for those who need it and calling for consultation beforehand when you consult a medical institution with suspected infection.

According to the National Institute of Infectious Diseases, 22 measles were reported from medical institutions nationwide in the week to 10 Feb 2019, and the number of people with measles has reached 167 in 20 prefectures.

This is the most cases in the past 10 years, and the number is increasing to more than those reported in 2008, which exceeded 10 000 and became a large epidemic.

The most affected prefectures are 49 cases in Mie prefecture, followed by 47 in Osaka, 17 in Aichi, and 11 in Tokyo. The measles strain is not confirmed to be the virus that was established in Japan at the end of 2010. It is believed the virus brought in from overseas is also high this time.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Also see: IDWR [Infectious Diseases Weekly Report] surveillance data table week 6 2019 [2-8 Feb 2019]
National Institute of Infectious Diseases, Japan
https://www.niid.go.jp/niid/en/survaillance-data-table-english.html

Notifiable Diseases, number of cases of the week, and total number of cases by prefecture. Total number of cases was updated with delayed reported and discarded cases. - Mod.LK

Maps of Japan: http://mapsof.net/uploads/static-maps/cities_of_japan_map.png and http://healthmap.org/promed/p/156]

See Also

Measles update (11) 20190217.6322038
Measles update (10) 20190214.6316885
Measles update (09): Americas, Asia, Indian Ocean, Europe, worldwide, vaccine 20190208.6305944
Measles update (08): worldwide, Americas, Asia, Pacific, Indian Ocean 20190205.6295288
Measles update (07): Americas, Africa, Europe 20190131.6288456
Measles update (06): Americas, Europe 20190125.6278243
Measles update (03): Europe, Americas, Asia, Africa, vaccine 20190112.6254875
Measles update (02): Pacific, Europe, Americas, Middle East, comment 20190108.6248575
Measles update (01): Americas, Africa, Southeast Asia 20190102.6240858
2018
----
Measles update (81): Europe, Americas, Africa 20181231.6236997
Measles update (80): Europe, Pacific, Asia, Americas, Middle East 20181228.6226574
Measles update (79): Middle East, Americas, Europe, Pacific 20181223.6221389
Measles update (78): Europe, Americas, Africa 20181220.6216069
Measles update (77): Americas, Europe, Pacific 20181213.6207900
Measles update (76): Southeast Asia, Europe, Americas 20181209.6200560
Measles update (75): S America, SE Asia, vaccine 20181206.6183455
Measles update (74): WHO, PAHO, South America, USA, Southeast Asia 20181202.6176861
Measles update (73): WHO, Europe, Pacific, Middle East, USA, South America 20181201.6174755
Measles update (72): Middle East, Africa, Southeast Asia 20181128.6168366
Measles update (71): Europe, Americas, Southeast Asia, Pacific 20181125.6163324
Measles update (70): Europe, Pacific, Americas 20181115.6146626
Measles update (69): South East Asia, Pacific, Middle East, Americas, Europe 20181112.6140598
Measles update (68): USA, South America, Middle East, Pacific 20181106.6130335
Measles update (67): Middle East, USA, Europe, South America 20181106.6128235
Measles update (66): Europe, Americas, Southeast Asia 20181102.6124542
Measles update (65): Africa, USA 20181025.6112636
Measles update (64): Americas, Canada, Europe, Africa, Asia, Pacific 20181023.6107919
Measles update (63): Americas, Europe, Africa 20181019.6101105
Measles update (62): Middle East, Europe, Pacific 20181017.6095283
Measles update (61): Middle East ex Ukraine, Europe, USA 20181015.6090960
Measles update (60): Europe, Middle East, Africa 20181004.6069532
Measles update (59): PAHO 20180923.6046073
Measles update (58): Southeast Asia, Europe, USA 20180908.6015965
Measles update (57): Africa, Americas, Europe, Pacific 20180906.6009763
Measles update (56): Americas, Europe 20180831.6000907
Measles update (55): Americas, PAHO 20180830.5996307
Measles update (54): Americas 20180824.5985569
Measles update (53): Europe, WHO, worldwide 20180821.5978356
Measles update (52): Americas, Pacific 20180819.5975478
Measles update (51): Americas, Europe 20180816.5970434
Measles update (50): Americas, Europe 20180812.5961680
Measles update (49): Americas, Europe, Asia 20180807.5950837
Measles update (48): Americas, Europe 20180802.5943952
Measles update (47): Americas, Europe 20180729.5935207
Measles update (46): Americas, Asia, Indian Ocean, Europe 20180724.5924938
Measles update (45): Europe, Americas, Africa 20180720.5917479
Measles update (44): Americas, Europe, Asia 20180716.5908969
Measles update (43): Libya 20180715.5906212
Measles update (42): Somoa, MMR vaccine recall 20180712.5901735
Measles update (41): Americas, Europe, Pacific 20180709.5895186
Measles update (40): Middle East, Europe, Americas 20180704.5888315
Measles update (39): Americas, Europe, Pacific 20180626.5876101
Measles update (38): Americas, Europe, Pacific 20180624.5872709
Measles update (37): Americas, Europe, Africa, Asia 20180621.5866860
Measles update (36): Europe, South America, Africa 20180615.5858483
Measles update (35): Europe, Americas, Asia 20180610.5848499
Measles update (34): Europe, Asia, Pacific 20180606.5841052
Measles update (33): Asia, Africa, Europe, USA 20180526.5820018
Measles update (32): Europe, Pacific, Asia 20180524.5815287
Measles update (31): Asia, Africa, Europe, Americas 20180514.5796699
Measles update (30): Americas, Asia, Africa, Europe 20180510.5791951
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