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Published Date: 2019-02-24 11:06:06
Subject: PRO/EDR> Measles update (13)
Archive Number: 20190224.6333936
MEASLES UPDATE (13)
*******************
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:
Pacific
-----
[1] Australia (New South Wales)
[2] Philippines: sitrep 05
[3] Philippines: sitrep 02
[4] Philippines: vaccine policy

Africa
---
[5] Chad
[6] Madagascar

Europe
----
[7] Poland

Americas
---
[8] USA (Washington, Clark county)
[9] Central America (Costa Rica)
[10] Opinion: Dr. M Siegel

******
[1] Australia (New South Wales)
Date: Sat 23 Feb 2019
Source: Ten Daily [abridged, edited]
https://tendaily.com.au/news/australia/a190222qux/woman-who-thought-she-was-vaccinated-against-measles-diagnosed-with-infection-20190222


A NSW woman has become the 14th person in less than 2 months to be diagnosed with measles, with health authorities urging people to be alert for symptoms of the condition. The woman, aged in her 40s and who thought she had been vaccinated as a child, became ill after returning home to Sydney from an overseas trip last week, NSW Health said in a statement on Fri [22 Feb 2019].

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

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[2] Philippines: sitrep 05
Date: Fri 22 Feb 2019
Source: NDRRMC [National Disaster Risk Reduction and Management Center] update [edited]
https://reliefweb.int/sites/reliefweb.int/files/resources/Sitrep_No_05_re_Measles_Outbreak_as_of_22_FEB2019_5PM.pdf


The Department of Health (DOH) raised the red flag for measles in other regions of Luzon, Central and Eastern Visayas on 7 Feb 2019 aside from the declaration of National Capital Region (NCR) on 6 Jan 2019.

- A total of 189 dead were reported in Regions I, III, Calabarzon, Mimaropa, V, VI, VII, VIII, X, XI, XI, ARMM, and NCR.
- A total of 11 459 cases of measles were reported in Regions I, II, III, Calabarzon, Mimaropa, V, VI, VII, VIII, IX, X, XI, XII, CARAGA, ARMM, CAR, and NCR from 1 Jan 2019 to 21 Feb 2019.
- Ages of cases ranged from under 1 month-88 years old (median: 2 years), most affected age group:1-4 years (3624 or 32%) and under 9 months (3009 or 26%); Majority (6097 or 53%) were males.
- Most of the cases were from NCR (2936 or 26%), Calabarzon (2625 or 23%), Region III (1643 or 14%), Region VI (576 or 5%) and Region X (516 or 5%).
- Majority (7306 or 64%) of the cases were not vaccinated.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[See URL above for full report with actions taken and case numbers/fatalities by region. - Mod.LK]

******
[3] Philippines: sitrep 02
Date: Wed 20 Feb 2019
Source: UNICEF-WHO [abridged, edited]
https://reliefweb.int/sites/reliefweb.int/files/resources/UNICEF%20WHO%20PHL%20SitRep2_Measles%20Outbreak_20Feb2019.pdf


Between 1 Jan and 18 Feb 2019, 9267 measles cases including 146 deaths were officially reported through the routine surveillance system from the Philippines Department of Health (DoH): a 266% increase with the same time period in 2018 (see Table 1).

Since the declaration of an outbreak in 5 regions on 11 Feb 2019, a surge in the number of measles cases is being observed (see Figure 1), caused by the rapid spread of the disease, which is highly contagious; increased awareness of parents to take their sick children to the nearest health facility, as per DoH advise; as well as improved reporting.

Even more concerning is the drastic increase in the case fatality rate (CFR) from 0.93% on 31 Dec 2018, to 2% on 7 Feb 2019.

With a median age of 2 years old, 61% of measles cases are under 5 years of age. Data from 2018 show that 10% of cases are between 6 and 15 years of age, whereas 15% are between 16 and 30 years of age. The majority of measles cases are male (53%).

As of 18 Feb 2019, 64% of all cases are not vaccinated.

Table 1: Measles Cases by Region, Philippines, 18 Feb 2018 vs 18 Feb 2019 [2018/2019/Region/Cases/Deaths/%CFR.]

Response so far
Risk assessment
Surveillance and Laboratory testing
Risk communication
Case management
Immunization
Coordination
Response plans

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[See report for table and figures with case numbers by location. - Mod.LK]

******
[4] Philippines: vaccine policy
Date: Sat 23 Feb 2019
Source: Rappler [abridged, edited]
https://www.rappler.com/nation/224156-measles-cases-continues-rise-doh-proposes-no-vaccination-no-enrolment-policy


As the number of measles cases continues to rise across the country, the Department of Health (DOH) proposed a "no vaccination, no enrollment" policy in public schools.

"It was just an idea worth studying and objectively looking into its merits or the lack of it," said Health Secretary Francisco Duque III in a text message to Rappler on Sat [23 Feb 2019] when asked about the proposal.

The Department of Education (DepEd) 1st aired the DOH proposal in a statement Friday night, 22 Feb 2019.

"In view of the rising number of measles cases in the country, the Department of Education (DepEd) is studying the proposal of the Department of Health (DOH) to implement a "no vaccination, no enrollment" policy in public schools," the DepEd said.

The DepEd said, however, that it will review the proposal while considering the right of students to learn and access to quality basic education.

"As much as there is a growing need to reinvigorate the campaign for the importance of vaccination, Education Secretary Leonor Magtolis Briones emphasizes that the proposed policy must take into consideration the human rights of learners, especially their access to quality basic education," DepEd said.

DepEd said it was also looking into ways to boost parents' confidence in vaccination. The measles outbreak in parts of the country had been attributed to the vaccine scare created by the Dengvaxia controversy.

Over 830 000 children were vaccinated through the school-based dengue immunization program. Panic ensued after Dengvaxia manufacturer Sanofi Pasteur admitted in late 2017 that Dengvaxia is not guaranteed to prevent dengue among those without prior infection, and the latter may even develop more severe symptoms once infected.

In the meantime, DepEd said it was working closely with the DOH to combat the highly contagious disease. Earlier, the 2 agencies set up a joint task force focused on measles control in school.

It enumerated its measures to reverse the rising trend of measles cases:
- Develop consent and evaluation forms to identify students' vaccination status as either vaccinated, unvaccinated, or "doubtful" of vaccination
- Gather data on measles cases in schools
- Coordinate with health centers for students who were absent or whose parents did not consent to vaccination
- Follow up with students who were not vaccinated or chose to get immunized through private doctors

The DepEd was also reviewing ways to strengthen Executive Order No. 663 issued in 2007, and EO 82 issued in 2012. The 2 orders focused on ensuring basic immunization for children and addressing events considered a "national crisis."

The government is conducting a mass immunization campaign which will run until March 2019.

The DOH is targeting to vaccinate about 12 million people. Of this number, 7 million are children from kindergarten to Grade 7.

[Byline: Sofia Tomacruz]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[See "A year after Dengvaxia" from 1 Dec 2018 https://www.rappler.com/newsbreak/in-depth/217912-dengvaxia-one-year-after-outbreaks-series-part-1.

At a glance:
- The Department of Health has spent much of 2018 trying to recover from its Dengvaxia dengue vaccine controversy.
- Dengvaxia has contributed to low immunization rates with only 6 out of 10 children receiving scheduled vaccines as of November 2018.
- Accumulation of unvaccinated children has led to several measles outbreaks, with supplemental immunization activities seeing dismal results. - Mod.LK]

******
[5] Chad
Date: Fri 22 Feb 2019
Source: Relief Web [abridged, edited]
https://reliefweb.int/report/chad/chad-measles-outbreak-dg-echo-ministry-health-echo-daily-flash-22-february-2019


Chad - Measles outbreak (DG ECHO, Ministry of Health) (ECHO Daily Flash of 22 Feb 2019)
Period Jan 1-15 Feb 2019; more than 2000 cases and 11 deaths registered in 73 out of 117 districts.

Report from European Commission's Directorate-General for European Civil Protection and Humanitarian Aid Operations [link to original in report]

The Ministry of Health of Chad reported a new peak of the measles epidemics which was declared on 30 May 2018. According to latest information, between 1 Jan and 15 Feb 2019, more than 2000 cases and 11 deaths were registered in 73 out of 117 districts in the east, south and central parts of the country and in the capital N'Djamena.

The Ministry of Health reported current shortages of the vaccination doses at central level. Based on latest data, only one in 4 children aged 12-23 months is fully immunised in Chad.

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

******
[6] Madagascar
Date: Fri 22 Feb 2019
Source: WHO [abridged, edited]
https://boingboing.net/2019/02/21/madagascar-measles-epidemic-ki.html


The World Health Organization says that an epidemic of measles in Madagascar has caused more than 900 deaths.

According to WHO figures, there have been more than 68 000 cases of the disease, in which 553 deaths were confirmed and 373 suspected from measles since the outbreak began in September [2018].

Madagascar has launched a nationwide campaign to try to bring the outbreak under control, through mass vaccination campaigns and surveillance.

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

******
[7] Poland: Measles cases surge in Poland
Date: Thu 21 Feb 2019
Source: Radio Poland [abridged, edited]
http://www.thenews.pl/1/9/Artykul/407490,Measles-cases-surge-in-Poland-report


A total of 217 people were diagnosed with measles in Poland between 1 Jan and 15 Feb 2019, 8 times more than in the same period last year [2018], experts have said.

The National Health Institute reported 46 measles cases in the 1st 2 weeks of the year [2019], compared to 6 recorded in the same period in 2018.

83 infections were reported in the 2nd half of January 2019 and 88 in the 1st 2 weeks of February 2019.

According to statistics, 349 Poles came down with the condition in 2018. 46 of them had received the measles vaccine.

Twelve people were diagnosed with measles-related complications last year [2018], although there were no fatalities linked to the illness.

People aged between 30 and 39 accounted for the largest group of measles cases, standing at 26 percent.

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

******
[8] USA (Washington, Clark county)
Date: Sat 23 Feb 2019
Source: Clark County Public Health [abridged, edited]
https://www.clark.wa.gov/public-health/measles-investigation


Clark County Public Health is continuing its measles outbreak investigation and has no updates to report today [Sat 23 Feb 2019]. Since 1 Jan 2019, Public Health has identified 65 confirmed cases and is currently investigating one suspected case. Public Health has not identified any new locations where people may have been exposed to measles.

Here are the details of the [65] confirmed cases:
- Age
1 to 10 years: 47 cases
11 to 18 years: 15 cases
19 to 29 years: 1 case
30 to 39 years: 2 cases

- Immunization status: Unimmunized: 57 cases, Unverified: 6 cases, 1 MMR vaccine: 2 cases

- Hospitalization: 1 case (none currently)

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.

About 5 percent of previously unvaccinated people will develop a rash after being immunized. When administered after 72 hours, the vaccine is less likely to prevent illness, and if the person develops a rash, there is a small chance that the rash is due to the vaccine. People who experience these mild vaccine-associated rashes cannot transmit the virus to other people.

However, in these situations, it is difficult to determine whether the rash is a benign vaccine reaction or measles illness. Specimens for these suspected cases are sent to a specialized laboratory out of state to confirm measles, but it can take more than a week to get the results. In those cases, pending lab results, Public Health will treat the suspect cases as we would treat confirmed cases and release information about public locations the cases visited while potentially contagious with measles. Public Health will remove those locations if the cases are ruled out.

On 12 Feb 2019, Public Health removed one previously confirmed case after additional testing revealed the case was actually experiencing benign vaccine rash. That case -- an unimmunized child 1-10 years old -- received one dose of measles-mumps-rubella, or MMR. Public Health also removed the exposure locations associated with this case since the vaccine virus cannot be transmitted to others.

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

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

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Vaccine hesitancy is a major problem in Washington, Clark County. While officials continue to study the outbreak, one factor that made it easier for the measles to spread is the high numbers of children who have never received the MMR vaccine.

Washington -- particularly Clark County -- has had a growing problem with declining immunizations rates. The number of kindergartners who have been immunized for measles has dropped 12 percent over the past 15 years; https://patch.com/oregon/portland/clark-county-measles-cases-now-63-three-new-exposure-sites-named. - Mod.LK]

******
[9] Central America (Costa Rica)
Date: Thu 21 Feb 2019
Source: Protect2 [abridged, edited]
https://protect2.fireeye.com/url?k=9b3e3741-c71803f5-9b3cce74-000babd9fe9f-afb2cc33b6aca68f&u=http://www.ticotimes.net/2019/02/21/costa-ricas-health-ministry-confirms-three-imported-cases-of-the-measles


Costa Rica's Health Ministry confirmed on Thu 21 Feb 2019 afternoon 3 imported cases of the measles, the country's 1st since 2014.

The affected are a 5-year-old French boy, his mother and father, according to the Health Ministry. The family has been placed in quarantine at Hospital Monseor Sanabria in Puntarenas.

The mother and child do not have the measles vaccine, according to the Health Ministry, while the father has not completed the entire vaccination series. They had arrived in Costa Rica on 18 Feb 2019.

The Health Ministry says it will investigate what contact the contagious family may have had with susceptible people.

The CDC estimates measles killed 500 people annually in the United States before a vaccine was developed in 1963.

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

******
[10] Opinion: Dr. M Siegel
Date: Fri 22 Feb 2019
Source: Fox News [abridged, edited]
https://www.foxnews.com/opinion/dr-marc-siegel-measles-outbreaks-are-far-worse-than-the-vaccine-that-can-prevent-them


Dr. Marc Siegel explains why measles can "spread like wildfire." If you're not vaccinated, there is a 90 percent chance you will contract measles if you come into contact with the disease, warns Fox News medical correspondent Dr. Marc Siegel.

Measles is a highly contagious disease which commonly causes pneumonia and, less commonly, brain swelling or even death (1 or 2 for every 1000 cases).

The measles mumps rubella vaccine is highly effective and managed to stamp out native measles in the U.S. entirely in 2000. This accomplishment was a huge triumph for the U.S. public health system.

This measles outbreak [in Clark County, Washington] has created a firestorm of response, from anti-vaccination protests against mandatory vaccines, to proposed legislation in Washington State to get rid of personal or philosophical exemptions. Such exemptions are largely responsible for less than 80 percent of the population in the area being vaccinated against measles.

Fear of a virus like measles should be worse than the fear of the vaccine to prevent it.

Dr. Scott Gottlieb, FDA commissioner, has raised the question of whether there should be a uniform policy across the country. He said to me in an exclusive statement, "We need to ask the question: When do we cross a line where some states acting in such an irresponsible fashion, and creating national and even global risks with their lax policies, requires federal health officials to pursue some uniform standards?

What we're seeing is that even if the policies on exemptions are local, the consequences of the most irresponsible state actions are national and even global. We are all paying a price for these state-level policies. If states don't reexamine these policies on their own, we need to consider what limits we can and should place on the most egregious exemptions that are contributing to outbreaks of devastating diseases. Irresponsible actions by some state officials have forced this question to be asked."

In my book "False Alarm, the Truth About the Epidemic of Fear," I point out that fear of a virus like measles should be worse than the fear of the vaccine to prevent it, a vaccine which, in this case, utilizes a neutralized virus to provoke an immune response [the virus is not neutralized as stated here, but rather is an attenuated live virus. - Mod.LK], a vaccine that generally has minimal side effects (and if there are side effects, they are due to genetic or lower socio-economic susceptibility), as some scientists claim, they are clearly far less dangerous than the risks of the disease itself.

Arthur Caplan, founding director of medical ethics at NYU Langone Health, agrees with Dr. Gottlieb and believes that the CDC and the Surgeon General must add their voices to the effort.

As a practicing internist with an eye on public health, I must insist that vaccines are the best way to protect not only the individual but also the society from emerging or, in this case, reemerging diseases.

[Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical Analyst. Twitter @drmarcsiegel.]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

See Also

Measles update (12): Americas, Asia 20190220.6326123
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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