Measles Outbreaks 2015

Measles in the United States

The MMR vaccine is the best way to prevent measles infections.
The MMR vaccine is the best way to prevent measles infections.. Joe Raedle/Getty Images News/Getty Images

Before the routine use of the measles vaccine (1963) and the MMR vaccine (1971), though, measles cases -- and complications from those cases -- were high. There used to be about 500,000 cases of measles and 500 measles deaths each year in the United States.

In the post-vaccine era, rates of measles, a vaccine-preventable disease, had been fairly low since the endemic spread of measles In the United States was eliminated in 2000.

Unfortunately measles cases have been on the rise recently. After hitting a record low number of cases in 2004 (just 37 cases), we seem to continue to hit new record highs for measles every few years now.

There were at least 667 confirmed cases of measles in the U.S. in 2014 - the most since 1994.

Measles Outbreaks 2015

With a large outbreak in California, 2015 got off to a very strong start.

Most concerning, more and more, cases don't seem to have an source that is easy to find, which could mean that the endemic spread of measles has returned in the United States. So instead of having to travel out of the country or be exposed to someone who got measles with a link to international travel, you could get measles just by going to a ball game, a movie theater, or to Disneyland. That makes it more important than ever to learn how to avoid measles.

Among the 189 measles cases and outbreaks in 2015 were:

  • 113 cases that were associated with a multi-state outbreak that was linked to Disneyland in California. Before it was declared over on April 17, a few unvaccinated travelers also help spread measles from this outbreak to large outbreak in Quebec, Canada. All in all, the outbreak was linked to at least 113 cases in California and an additional 169 cases in Arizona (5), Nebraska (1), Utah (3), Colorado (1), Washington (2), Oregon (1), Mexico (1), and Canada (155).
  • 13 cases, including an adult worker and 12 infants too young to be vaccinated at the KinderCare Learning Center in Illinois.
  • At least 13 cases, all intentionally unvaccinated, in a South Dakota outbreak that started with an unvaccinated adult traveling to India.
  • Five cases in Clallam County, Washington, including four who were not vaccinated, which cost at least $36,000 to contain and led to the death of an immunosuppressed woman.

In addition to these large outbreaks, 2015 also saw a number of quarantines for unvaccinated students, closing of daycare centers, and a recommendation from a California Department of Health state epidemiologist that people who are not vaccinated against measles "avoid visiting Disney" and "crowded places with a high concentration of international travelers, such as airports."

Other measles cases in 2015 include:

  • A student at UC Berkeley who may have exposed others to measles on a public bus.
  • A confirmed case in Fairbanks, Alaska - their first case in 15 years, who flew in from Seattle (and is probably the King County case discussed below) and may have exposed others at an area Walmart, Home Depot, Walgreens, several supermarkets, the airport, and hospital, etc.
  • A confirmed case in King County, Washington, who may have exposed others in Seattle, including at an area McDonalds, the Baroness Hotel, a drug store, and the Sea-Tac Airport.
  • A confirmed case in Branson, Missouri, a traveler from Asia, who was contagious when visiting the ER, three local businesses, and perhaps his flight to town.
  • A confirmed case in the Washington D.C. area.
  • Another case of measles in Spokane County, Washington - an unvaccinated person that was exposed to the other case in the area.
  • An unvaccinated student from Europe in Boston, Massachusetts who also  traveled to Maine and New Hampshire.
  • Another unvaccinated child in St. Lucie County, Florida - bringing the total to five cases in central Florida in what so far looks like two separate outbreaks.
  • Another case in Indian River County, Florida - an unvaccinated child.
  • An unvaccinated adult in Spokane, Washington - the first case in the area since 1994.
  • Two unvaccinated adults in Indian River County, Florida, one of whom contracted measles while traveling out of the country.
  • An unvaccinated 6-year-old in St. Lucie County, Florida who attended Fairlawn Elementary School in Fort Pierce - leading to five unvaccinated students being kept out of school until early May.
  • The first case in Oklahoma since 1997, a case in Stillwater.
  • A case in Florida, a traveler who was contagious while attending a conference at the Gaylord Palms Resort and Convention Center and also in Maimi-Dade, Orange, and Sarasota counties.
  • A new case in Illinois, the 15th - and so far not linked to the other two outbreaks in the state.
  • A student at Princeton University in New Jersey.
  • Another case of measles in the Washington D.C. area, a case without a known source.
  • A case in a student at Elgin Community College in Kane County, Illinois.
  • A hospitalized infant in Atlanta, Georgia.
  • An unvaccinated 1 year old in Jersey City, New Jersey.
  • A traveler in King County, Washington that may have exposed others in Seattle. The unvaccinated visitor is from Brazil, where there was a large outbreak of measles last year (almost 400 cases).
  • At least one more case in Clark County, Nevada and four more possible cases in Southern and Northern Nevada, which led to the quarantine of at least 11 students at the Spanish Springs Elementary School.
  • A case in Franklin County, Pennsylvania.
  • Four cases of measles in travelers, including two international travelers, who visited Florida.
  • A case in Washington D.C.
  • A student at Bard College in Dutchess County, New York, who exposed many people while traveling on an Amtrak train to Penn Station in New York City.
  • An unvaccinated woman in New Castle County, Delaware who had recently traveled out of the country.
  • A case on the University of Minnesota Twin Cities campus in a student that had recently returned from out of the country. Although others were exposed, it is considered to be a "highly immunized" population, so hopefully the outbreak won't spread.
  • Two more cases in Arizona that are tied to the Disneyland outbreak, including a woman in Phoenix who may have exposed others up to 195 children at the Phoenix Children's East Valley Center, including a 3-year-old getting chemotherapy for leukemia.
  • An adult in Cook County, Illinois which in not linked to Disneyland.
  • A student at Valley High School in Las Vegas which led to the quarantine of 36 unvaccinated students until early February.
  • Four cases among an unvaccinated family in Kearny, Arizona that is directly linked to the Disneyland outbreak.
  • A child in Sioux Falls, South Dakota that is unrelated to 13 recent cases in the area and which has no link to travel out of the area.
  • A new case in Oakland County, Michigan that is likely linked to the Disneyland measles outbreak, meaning that the outbreak has now spread to include 7 states and 2 countries.
  • A case in Maricopa County, Arizona has been linked to the Disneyland outbreak.
  • A person in Nebraska who could have exposed others in Omaha and Blair, including at the Omaha Children's Museum.
  • A case in Lane County, Oregon that has been linked to the Disneyland measles outbreak.
  • A resident of Tarrant County in North Texas who developed measles after a trip to India.
  • Another unvaccinated person in Utah with links to the Disneyland outbreak has tested positive for measles, bringing the total in that state to 3 cases.
  • In addition to the 36 measles cases that have been associated with the Disneyland outbreak, California already has 5 additional measles cases this year with no link to Disney, including cases in Alameda, Orange, and Ventura Counties.

Measles Outbreaks - What You Need To Know

Other things to know about measles and measles outbreaks include:

  • From 2 to 5% of people do not respond to their first dose of measles vaccine, which is why a second (booster) dose is recommended. But more than 99% of people develop immunity to measles after two doses of a measles vaccine, like MMR.
  • A booster dose of MMR was not first recommended in 1989, so many adults born before 1985 may not have had two doses of MMR.
  • Measles is fatal in about 0.2% of cases.
  • Very few of the measles cases in these outbreaks are in people who are completely vaccinated. For example, in the outbreaks in Europe in 2011, when 30,000 people got measles, causing 8 deaths, 27 cases of measles encephalitis, and 1,482 cases of pneumonia, most cases were in unvaccinated (82%) or incompletely vaccinated (13%) people.
  • In addition to many developing countries where measles is still endemic,  international measles outbreaks have been reported in Europe, Japan, and the Philippines, etc., which makes it important to make sure you are fully vaccinated before traveling out of the US.
  • The measles virus is spread by respiratory droplets and can stay in an area for up to two hours after a person with measles symptoms has left.
  • People with measles are contagious from four days before they develop the measles rash.
  • Call your pediatrician if you think your child has measles (don't just show up at their office or in the ER), especially if he develops a high fever and/or rash during a local measles outbreak or after a trip out of the country.
  • It is expensive to contain a measles outbreak.

Most importantly, parents should understand that a measles vaccine (MMR) is the best way to protect your child from measles, and is especially important if there is a measles outbreak in your area or if you are traveling to an area with high rates of measles.

The rise in measles cases around the world has changed the recommendations for measles vaccination in the U.S. While children routinely get their first MMR vaccine at 12 months and a booster dose at 4 years, if they are traveling overseas, infants should get their first dose as young as six months of age. Children who are at least 12 months old should get two doses of MMR, separated by at least 28 days.

Sources:

CDC. Notifiable Diseases and Mortality Tables. MMWR. February 28, 2014 / 63(08);ND-100-ND-113.

CDC. Update: Measles --- United States, January--July 2008. MMWR. August 22, 2008 / 57(33);893-896

Manual for the Surveillance of Vaccine-Preventable Diseases (4th Edition, 2008)

The Pink Book: Epidemiology and Prevention of Vaccine Preventable Diseases. Updated 11th Edition, (May 2009)

World Health Organization. Measles Fact Sheet. December 2009. Accessed February 2011

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