Friday, August 24, 2018

PRO/EDR> Measles update (54): Americas

MEASLES UPDATE (54): AMERICAS
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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:
[1] USA: Contra Costa County, CA; Los Angeles County, CA; Arizona -
alert imported case
[2] PAHO/WHO Epidemiological Update 20 Aug 2018

******
[1] USA: Contra Costa County, CA; Los Angeles County, CA; Arizona -
alert imported case
Date: Wed 22 Aug 2018
Source: San Francisco Chronicle [edited]
<https://www.sfchronicle.com/bayarea/article/Measles-case-in-Contra-Costa-County-sparks-13174924.php>


A confirmed case of measles prompted Contra Costa County public health
officials on Wed [22 Aug 2018] to warn residents and visitors they may
have been exposed to the highly contagious airborne illness [see URL
above for location of possible exposure]. The infected person visited
several popular indoor venues in Contra Costa County, Los Angeles
County, and Arizona, and officials in the latter areas have issued
their own advisories.

A statement issued Monday [20 Aug 2018] by the Los Angeles County
Public Health Department warned people in Santa Monica that they might
have been exposed to an infected tourist at 6 sites between 8 and 10
Aug [2018]. Privacy laws prevent health officials from releasing
identifying information about the person who contracted measles, said
Paul Leung, communicable disease program chief for the Contra Costa
Department of Public Health.

Leung said the patient, who did not know whether he or she had been
vaccinated, has recovered and is no longer contagious. Health
officials advised anyone who may have been exposed to the patient or
develops a high fever and rash to contact their doctor immediately.
[...]

"Most people have been vaccinated and therefore are protected and not
at risk, even if they have shared the same indoor air-space with a
contagious person," said Dr. Chris Farnitano, Contra Costa County's
chief health officer. "However, residents should be aware of the
situation, because anyone who was exposed and not protected by vaccine
is at risk of developing measles."

Contra Costa County's last reported case of measles was in 2014, Leung
said, but 6 cases were reported earlier this year in Santa Clara
County.

[Byline: Michael Cabanatuan]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The CDC also posted an alert on Epi-X (Epidemic Information Exchange,
a secure web-based network that serves as an information exchange):
The California Department of Public Health and The Arizona Department
of Health Services are investigating exposures related to a
laboratory-confirmed measles case with rash onset on 10 Aug 2018.
Persons may have been exposed at multiple California and Arizona
venues between 6 and 14 Aug 2018.

This serves as a reminder that even though the USA is considered free
of measles, i.e., no endemic transmission except through introduced
cases, measles can be brought into the country by tourists and
following travel by citizens to regions where there still are a high
number of measles cases. According to the WHO, measles cases have
reached a record high in Europe this year [2018], with more cases
recorded in the first 6 months of 2018 than any other 12-month period
this decade. Therefore, parents must maintain vaccination of their
children. - Mod.LK]

******
[2] PAHO / WHO Epidemiological Update 20 Aug 2018
Date: Mon 20 Aug 2018
Source: PAHO / WHO [edited]
<https://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=1170&gid=46071&lang=en>


Between epidemiological week (EW) 1 and EW 33 of 2018, a total of 5004
confirmed measles cases, including 68 deaths, were reported in 11
countries in the Americas: Antigua and Barbuda (one case), Argentina
(8 cases), Brazil (1237 cases, including 6 deaths), Canada (19 cases),
Colombia (60 cases), Ecuador (17 cases), Guatemala (one case), Mexico
(5 cases), Peru (4 cases), the USA (107 cases), and the Bolivarian
Republic of Venezuela (3545 cases, including 62 deaths). The following
is a summary of the current outbreaks in the Americas:

Data provided for Argentina, Brazil, Colombia, Ecuador, Peru, USA,
Venezuela

Measles in indigenous communities
--------------------------
Data provided on communities in Brazil, Venezuela

Advice to national authorities

- Vaccinate to maintain homogeneous coverage of 95 percent with the
1st and 2nd doses of the measles, mumps, rubella (MMR) vaccine in all
municipalities;
- Vaccinate at-risk populations (without proof of vaccination or
immunity against measles and rubella), such as healthcare workers,
people working in tourism and transportation (hotels and catering,
airports, taxi drivers, and others) and international travelers;
- Maintain a reserve of measles-rubella (MR) vaccines and syringes for
control of imported cases in each country of the region;
- Strengthen epidemiological surveillance of measles to achieve timely
detection of all suspected cases of measles in public and private
healthcare facilities and ensure that samples are received by
laboratories within 5 days of being taken;
- Provide a rapid response to imported measles cases through the
activation of rapid-response teams to avoid the re-establishment of
endemic transmission. Once a rapid-response team has been activated,
continued coordination between the national and local levels must be
ensured, with permanent and fluid communication channels between all
levels (national, sub-national, and local);
- Identify migratory flows from abroad (arrival of foreign persons)
and internal flows (movements of population groups) in each country to
facilitate access to vaccination services, according to the national
scheme;
- Increase vaccination coverage and strengthen epidemiological
surveillance in border areas in order to increase population immunity
and rapidly detect/respond to suspected measles cases;
- During outbreak, establish adequate intra-hospital cases management
to avoid nosocomial transmission, with an adequate flow of patients to
isolation rooms (avoiding contact with other patients in waiting rooms
and/or hospitalization settings.

Additionally, PAHO/WHO recommends that member states advise that all
travelers aged 6 months and older who cannot show proof of vaccination
or immunity receive the measles and rubella vaccine, preferably the
triple viral vaccine (measles, mumps and rubella - MMR), at least 2
weeks before traveling to areas where measles transmission has been
documented. The recommendations of PAHO/WHO in relation to advice for
travelers are available in the 27 Oct 2017 PAHO/ WHO Epidemiological
Update on Measles (Pan American Health Organization / World Health
Organization. Epidemiological Update: Measles. 27 October 2017,
Washington, D.C.: PAHO/WHO; 2017. Available at:
<https://bit.ly/2I3gCSi>).

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

[This is a comprehensive and excellent summary of measles cases in the
Americas. See the URL for figures showing cases over time in each
region. The points under advice are critical to protect communities
against measles.

Measles in the indigenous communities in Brazil and Venezuela is
particularly distressing. The PAHO report states that between EW 11
and EW 27 of 2018, there were 126 confirmed cases reported (by
laboratory and/or epidemiological link), including 53 deaths, in the
Yanomami. That is a 42 percent mortality rate.

Excerpted from
<https://www.survivalinternational.org/tribes/yanomami>:
"The Yanomami are the largest relatively isolated tribe in South
America. They live in the rainforests and mountains of northern Brazil
and southern Venezuela. Thousands of gold miners are now working
illegally on Yanomami land, transmitting deadly diseases like malaria
..." [and other diseases, likely measles].

"Yanomami health is suffering, and critical medical care is not
reaching them, especially in Venezuela." This is a dire situation. -
Mod.LK

HealthMap/ProMED-mail maps:
Contra Costa County, California, United States:
<http://healthmap.org/promed/p/4569>
Los Angeles County, California, United States:
<http://healthmap.org/promed/p/4259>
Arizona, United States: <http://healthmap.org/promed/p/207>
Americas: <http://healthmap.org/promed/p/52913>]

[See Also:
Measles update (53): Europe, WHO, worldwide
http://promedmail.org/post/20180821.5978356
Measles update (52): Americas, Pacific
http://promedmail.org/post/20180819.5975478
Measles update (51): Americas, Europe
http://promedmail.org/post/20180816.5970434
Measles update (50): Americas, Europe
http://promedmail.org/post/20180812.5961680
Measles update (49): Americas, Europe, Asia
http://promedmail.org/post/20180807.5950837
Measles update (48): Americas, Europe
http://promedmail.org/post/20180802.5943952
Measles update (47): Americas, Europe
http://promedmail.org/post/20180729.5935207
Measles update (46): Americas, Asia, Indian Ocean, Europe
http://promedmail.org/post/20180724.5924938
Measles update (45): Europe, Americas, Africa
http://promedmail.org/post/20180720.5917479
Measles update (44): Americas, Europe, Asia
http://promedmail.org/post/20180716.5908969
Measles update (43): Libya
http://promedmail.org/post/20180715.5906212
Measles update (42): Somoa, MMR vaccine recall
http://promedmail.org/post/20180712.5901735
Measles update (41): Americas, Europe, Pacific
http://promedmail.org/post/20180709.5895186
Measles update (40): Middle East, Europe, Americas
http://promedmail.org/post/20180704.5888315
Measles update (39): Americas, Europe, Pacific
http://promedmail.org/post/20180626.5876101
Measles update (38): Americas, Europe, Pacific
http://promedmail.org/post/20180624.5872709
Measles update (37): Americas, Europe, Africa, Asia
http://promedmail.org/post/20180621.5866860
Measles update (36): Europe, South America, Africa
http://promedmail.org/post/20180615.5858483
Measles update (35): Europe, Americas, Asia
http://promedmail.org/post/20180610.5848499
Measles update (34): Europe, Asia, Pacific
http://promedmail.org/post/20180606.5841052
Measles update (33): Asia, Africa, Europe, USA
http://promedmail.org/post/20180526.5820018
Measles update (32): Europe, Pacific, Asia
http://promedmail.org/post/20180524.5815287
Measles update (31): Asia, Africa, Europe, Americas
http://promedmail.org/post/20180514.5796699
Measles update (30): Americas, Asia, Africa, Europe
http://promedmail.org/post/20180510.5791951
Measles update (29): Europe, US, Pacific and Asia
http://promedmail.org/post/20180506.5787360
Measles update (28): Europe, Asia, Pacific, USA
http://promedmail.org/post/20180502.5780064
Measles update (27): South America, Asia, Europe, Africa, USA
http://promedmail.org/post/20180425.5767864
Measles update (26): Europe, Pacific, Asia, USA
http://promedmail.org/post/20180422.5761755
Measles update (25): Asia, Pacific, Africa, Middle East, Europe, USA
http://promedmail.org/post/20180419.5756685
Measles update (24): Europe, Mexico, South America, USA, Pacific
http://promedmail.org/post/20180415.5748939
Measles update (23): Asia, Pacific, Europe, USA, Africa
http://promedmail.org/post/20180413.5743280
Measles update (22): USA, South America, Europe, Pacific, epi update,
comment http://promedmail.org/post/20180409.5734358
Measles update (21): WHO, South America, Europe, Asia, Pacific, Africa
http://promedmail.org/post/20180406.5728515
Measles update (20): Europe, Pacific, Americas
http://promedmail.org/post/20180331.5720595
Measles update (19): Pacific, Americas, Europe, Asia
http://promedmail.org/post/20180324.5706015
Measles update (18): USA, Asia, Europe, South America, WHO, PAHO
http://promedmail.org/post/20180318.5694434
Measles update (17): Asia, Pacific, Africa, Europe
http://promedmail.org/post/20180314.5684766
Measles update (16): Asia & Pacific, Europe, South America
http://promedmail.org/post/20180307.5672342
Measles update (15): Europe, Asia, Pacific
http://promedmail.org/post/20180304.5663849
Measles update (14): Europe, Asia and Pacific, USA
http://promedmail.org/post/20180228.5655543
Measles update (13): Europe (France), USA (TX)
http://promedmail.org/post/20180224.5648197
Measles update (12): Africa, Europe, North America, Pacific
http://promedmail.org/post/20180218.5634900
Measles update (11): Pacific, Europe, USA
http://promedmail.org/post/20180214.5627038
Measles update (10): Europe, Pacific, South America, USA
http://promedmail.org/post/20180210.5620572
Measles update (09): Europe, Caribbean, Central America
http://promedmail.org/post/20180205.5606548
Measles update (08): Asia, Central America, North America, Europe
http://promedmail.org/post/20180201.5600423
Measles update (07): Africa, USA, Caribbean, Canada, Europe
http://promedmail.org/post/20180128.5589231
Measles update (06): Americas, Europe, Asia/Pacific
http://promedmail.org/post/20180123.5576951
Measles update (05): Europe, Pacific-Asia, USA
http://promedmail.org/post/20180118.5566770
Measles update (04): Europe, USA
http://promedmail.org/post/20180115.5561190
Measles update (03): Europe, Pacific, USA
http://promedmail.org/post/20180112.5556312
Measles update (02): Europe, South America
http://promedmail.org/post/20180109.5547446
Measles update (01): Asia, Europe
http://promedmail.org/post/20180105.5540575]
.................................................lk/rd/tw/lxl
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