Measles Outbreaks Continue to Spread and Claims Lives in the US and Abroad

The most recent report from the European Region of the World Health Organization (WHO) has revealed that measles outbreaks have resulted in over 14,000 infections, and the loss of 35 lives across Europe since January 2016. The majority of these deaths (31) have occurred in Romania, with the remaining deaths occurring in Italy (2), Germany (1), and Portugal (1). A 6-year-old boy in Italy was the most recent fatality from this preventable disease.

According to the European Centre for Disease Prevention and Control, a total of 15 countries have reported measles cases in 2017: Austria, Belgium, Bulgaria, the Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Slovakia, Spain, Sweden, and the United Kingdom.

The goal of complete disease eradication seems to have hit a snag with these small “pockets of low immunization coverage allow[ing] the highly contagious virus to spread among those who choose not to vaccinate, do not have equitable access to vaccines or cannot be protected through vaccination due to underlying health conditions,” according to the report.

WHO Regional Director for Europe, Zsuzsanna Jakab, MD, weighed in on the tragedy of the deaths, stating in the WHO report, “Every death or disability caused by this vaccine-preventable disease is an unacceptable tragedy. We are very concerned that although a safe, effective and affordable vaccine is available, measles remains a leading cause of death among children worldwide, and unfortunately Europe is not spared. Working closely with health authorities in all European affected countries is our priority to control the outbreaks and maintain high vaccination coverage for all sections of the population.”

To combat the outbreaks, European countries are initiating school-entry checks on vaccinations (much like the United States) and, according to the report, in Romania, officials “conducted a nationwide campaign of enhanced routine immunization activities.” In Italy, regional public health officials collaborated with representatives of the Italian Institute of Health (ISS), measles and rubella laboratory officials, as well as experts from WHO Regional Office for Europe to identify activities that are needed to help bolster disease surveillance and communication on the importance of vaccination among the community.

The threat of measles in Europe has increased to the point that the Centers for Disease Control and Prevention (CDC) recently released an advisory reminding travelers to ensure they are properly vaccinated and/or taking preventive precautions before heading to European destinations this summer. Travel health advisories have been issued for 5 European countries: France, Belgium, Germany, Italy, and Romania.

Although issues with access to vaccines account for many of the cases of measles infections in Europe, the same cannot be said for the United States, where the most common reasons for outbreaks are international travel and low immunization rates in some communities that choose not to vaccinate.

“Most measles cases in the United States are the result of international travel,” said Gary Brunette, MD, MPH, chief of CDC’s travelers’ health program in the CDC’s advisory email. “Travelers get infected while abroad and bring the disease home. This can cause outbreaks here in the United States.”

Other outbreaks occur in communities that choose not to vaccinate, as is the case in Minnesota, where, for example, the decision of members of a local Somali community to not vaccinate their children had resulted in 64 of the 79 total cases of the disease in 2017. Seventy-one of the 79 individuals were not vaccinated, and 74 of the cases were children <17 years.

According to the CDC, “Measles is one of the most contagious of all infectious diseases; approximately 9 out of 10 susceptible persons with close contact to a measles patient will develop measles. The virus spreads when an infected person coughs or sneezes. The virus can live for up to 2 hours in the air or on surfaces. People with measles usually have a rash, high fever, cough, runny nose, and red, watery eyes. Some people also get an ear infection, diarrhea, or a serious lung infection such as pneumonia. Although severe cases are rare, measles can cause swelling of the brain and death.”

Despite the potential deadly consequences of infection, many parents are still choosing not to vaccinate their children, as evidenced by a recent article from Maine’s Portland Press Herald which reported that the “number of parents opting their children out of immunizations for nonmedical reasons rose from 4% to 4.8%.” The Chairman of the Maine Immunization Coalition is quoted in the article as stating that the “numbers are extremely distressing,” and that the “lack of immunizations raises the chances of an outbreak of infectious disease,”—like measles.