Thursday, September 6, 2018

PRO/EDR> Measles update (57): Africa, Americas, Europe, Pacific

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Mauritius (Port Louis, Black River): fatal
[2] Venezuela (Caracas)
[3] USA (Minnesota, North Dakota)
[4] Ukraine
[5] Australia (New South Wales): travel associated

[1] Mauritius (Port Louis, Black River): fatal
Date: Mon 3 Sep 2018
Source: Outbreak News Today [edited]

Mauritius health officials stating reporting sporadic measles cases in
late-March 2018 and by mid-May [2018], the measles epidemic threshold
was met.

From March through late August [2018], 808 confirmed measles cases,
including 3 deaths (case fatality ratio 0.4 percent), have been
reported in Mauritius. 2 districts, Port Louis and Black River, have
been the most affected.

The 3 reported deaths occurred among immunocompromised adults, aged
between 29 and 31 years.

The National Institute for Communicable Diseases (NICD) in South
Africa isolated the D8 genotype of the measles virus in a number of

During this outbreak, about 50 percent of the confirmed cases never
received any measles containing vaccine and an additional 29 percent
didn't know their vaccination status. 20 percent of the confirmed
cases received 1 dose of measles containing vaccine.

This outbreak comes after about a decade since the last case of
measles was detected in the country in 2009.

Communicated by:

[A measles outbreak has been ongoing in Mauritius since March 2018.
The case count has risen from 450 to over 800 since that time. 3
immunocompromised people are reported to have died from the infection.
The increase in the cases of infection over the last 6 months
indicates that there is active transmission of the disease in the
country. There is a vaccine for measles, however, outbreaks continue
to hit several African countries, causing the deaths of children. The
vaccine is part of the vaccination schedules for children in Africa
that is given at 9 months of age, with a booster at 14 months of age.
Unfortunately, in Mauritius the infection affects adults as well.

Some parents/guardians refuse to take their children for vaccination
because there is a misconception that the vaccine causes other
diseases, including autism. Other people also refuse to take their
children for this particular vaccination for religious reasons. More
needs to be done to make parents/guardians have confidence in

Most times, unvaccinated young children are at highest risk of measles
and its complications, including death. Unvaccinated pregnant women
are also at risk, as are any non-immune persons (who have not been
vaccinated or were vaccinated but did not develop immunity). There
could be several adults who may be immunodeficient who could be
infected with the measles virus.

Measles is caused by a virus of the paramyxovirus family that is
normally passed through direct contact and through the air. The virus
infects the respiratory tract, then spreads throughout the body.
Measles is a human disease and is not known to occur in animals.

In countries where there have been outbreaks of measles, health
authorities have embarked on a vaccination campaign to reach out to
those who might have missed it when they were young and even those who
might have taken it. This might be the way to go for the health
authorities in Mauritius. - Mod.YA

Mauritius, officially the Republic of Mauritius (French: République
de Maurice), is an island nation in the Indian Ocean about 2000 km
(about 1250 mi) off the southeast coast of Africa. The increase in
measles burden is very similar to other countries where vaccination
hesitancy has become strong. - Mod.LK

HealthMap/ProMED-mail map of Mauritius:

See also
Measles - Mauritius: fatal]

[2] Venezuela (Caracas)
Date: Tue 4 Sep 2018 8:45 AM VET
Source: El Pitazo [in Spanish, machine trans., edited]

Until 31 Aug 2018, pediatricians at the JM de los Ríos hospital in
Caracas had received 1074 cases with symptoms of the [measles] virus.
There was a drop in admissions of the new affected people because the
outpatient clinic has been limited by the indefinite strike that the
health sector has maintained for the past 2 months.

Six children have died from measles at the hospital, since they began
receiving the 1st cases with the disease in December 2017, after the
epidemic spread from the south and the east towards the capital region
of the country.

The majority of lethal cases were children under 2 years of age who
had not been adequately immunized against the viral infection. The
cause of the deaths was respiratory complications associated with this
highly contagious disease.

The cases swell even more the measles mortality data reported, so far,
by the Pan American Health Organization (PAHO), which indicates that
Venezuela has notified, since the disease reappeared in July 2017, 115
deaths due to the virus. These include 53 indigenous people of the
Yanomami ethnic group, who live in the state of Amazonas. The Ministry
of Health has notified PAHO that only 2 measles deaths have occurred
in Caracas.

Regarding the incidence of cases, epidemiologists and infectologists
of the children's hospital agree that there was an increase in
admissions between January and June; but in the following 2 months
they have observed a decrease attributed to 2 reasons: that
consultations in the pediatric clinic have been limited by the medical
strike that began in June 2018 or that the cases decreased because the
Government began to vaccinate massively in the city. "Last week [week
of 27 Aug 2018] only 12 children with measles entered the triage of
the emergency, and that was not the rule in the previous weeks," said
a pediatrician.

The Department of Epidemiology of the JM de los Ríos hospital
reported that 1074 cases entered the pediatric department with
symptoms of measles between December 2017 and August 2018. It is not
known with certainty how many of the children who were admitted with
eruptive febrile syndrome and conjunctivitis received confirmation of
the illness by the Rafael Rangel National Institute of Hygiene,
although it was learned that until last April 2018, 159 children had
been confirmed with measles in the pediatric hospital.

From the JM de los Ríos case count, 136 patients were hospitalized in
the infectious disease area, while the rest of the children were
treated on an outpatient basis. The common cause of hospitalization
was respiratory infections.

The 1st cases of measles in Caracas began to be reported between 23
and 25 Dec 2017, 4 months after the disease reappeared in Bolívar
state. As in the JM de los Ríos, children infected with the virus
arrived at the Pediatric Elías Toro hospital, located in Catia
[Caracas], at the beginning of last January [2018], mostly from the
Sucre parish of the Libertador municipality [Caracas]. In that health
center, until the middle of June 2018, 465 cases of measles were

Currently, the Capital District is one of the entities with the
highest incidence of measles, according to the epidemiological
information of PAHO. Data from the Rafael Rangel National Institute of
Hygiene, published by the Venezuelan Society of Public Health last
May, pointed out that between December 2017 and March 2018, 235 cases
of the disease were confirmed in all the parishes of the city. At the
end of April 2018, 710 suspected cases of measles had been evaluated
in the JM de los Ríos and in the Elías Toro hospitals.

Since the epidemic reappeared in 2017, the Ministry of Health has not
divulged weekly epidemiological figures that allow knowing the
incidence of the virus and the magnitude of the spread in the national
territory. But the data sent by the ministry to PAHO detail that the
country, 1 year after the resurgence of the disease, accumulated 4272
confirmed cases of the disease, of which 3545 were diagnosed between
January and July 2018 in 23 states of the country.

The high rate of new cases that the country has sustained for more
than 12 months led to the reestablishment of the endemic transmission
of the viral infection in the territory, which meant the loss of
recognition of the country as measles-free that PAHO granted to
Venezuela in December 2016.

In view of the increase in cases, the government is executing, with
the support of PAHO, a 2nd phase of the National Vaccination Plan,
focused on protecting the population against measles and diphtheria,
which began last April 2018. The Minister of Health, Carlos Alvarado,
pointed out that in the 1st stage a national immunization coverage of
60 percent was fulfilled and aspires, in this 2nd approach of the
program, to reach 95 percent of the population, as established by
PAHO. So far, in the Healthy Child Control Service of the JM de los
Ríos are applying triple and double viral vaccines, although, say
pediatricians, the supply is not regular.

[Byline: Armando Altuve]

Communicated by:
ProMED-mail from HealthMap Alerts

[Venezuela accounts for 95 percent of measles deaths recorded in the
Americas, according to the Pan American Health Organization (PAHO) on
20 Aug 2018. Venezuela not only has the largest number of confirmed
cases of measles in the Americas, but also leads in mortality figures
for the disease, recording 115 of 121 deaths reported to the agency.

It is not clear what is meant by "triple and double viral vaccines",
but the standard dose and booster are sufficient for protection, and
it most likely refers to the MMR (measles, mumps and rubella) and MR
(measles, rubella) combined vaccines. - Mod.LK

HealthMap/ProMED-mail map of Venezuela:

[3] USA (Minnesota, North Dakota)
Date: Tue 4 Sep 2018 10:32 AM CDT
Source: Echo Press [edited]

No cases of measles have been reported in North Dakota and only 2
cases were found this year [2018] in Minnesota.

Both cases were reported in young children who contracted the virus
during travels to Africa. Measles is a highly contagious and sometimes
fatal virus. [...]

The disease was considered eliminated in 2000 because high vaccination
rates led to low numbers of infections.

Last year [2017] more than 70 Minnesotans contracted measles, the
largest statewide outbreak in over 20 years. The rapid spread of the
virus was largely attributed to a lack of vaccinations among

There has not been a measles case in North Dakota since 2011.

Across the country, 124 cases of measles have been confirmed in 22
states and the District of Columbia. There have been 9 outbreaks,
which occur when 3 or more cases are linked. With 4 more months to go
before the end of the year [2018], there have already been more cases
this year than last. In 2017, 118 people contracted the measles.

[Byline: Tess Williams]

Communicated by:

[This is good news, but the CDC (Epidemic Information Exchange) on 5
Sep 2018, published a call for potential measles cases in Bismarck,
North Dakota. These cases would be related to a travel associated
case. - Mod.LK

HealthMap/ProMED-mail map of the United States:

[4] Ukraine
Date: Tue 4 Sep 2018
Source: Ukrinform [edited]

A total of 436 people have fallen ill with measles in Ukraine over the
past week, which is 18.9 percent less compared with the previous week,
the Health Ministry reports.

"Over the 35th week of 2018 [week of 27 Aug 2018], 436 people have
fallen ill with measles: 214 adults and 222 children. It is 18.9
percent less compared with the previous week," reads the report.

In particular, since the start of the year [2018], 30 363 people have
contracted measles: 12 440 adults and 17 923 children.

The largest numbers of cases of measles were recorded in Lviv region
(5913 people: 1862 adults and 4051 children), Zakarpattia region (3037
people: 537 adults and 2464 children), Ivano-Frankivsk region (2785
people: 793 adults and 1992 children), Odesa region (2382 people: 1201
adults and 1181 children), the city of Kyiv (2122 people: 1335 adults
and 787 children), and Ternopil region (1628 people: 634 adults and
994 children).

Also, according to the Health Ministry, 13 people have died of
complications from measles since the start of the year [2018]: 9
children and 4 adults.

Communicated by:
ProMED-mail from HealthMap Alerts

[HealthMap/ProMED-mail map of Ukraine:

[5] Australia (New South Wales): travel associated
Date: Wed 5 Sep 2018 3:00 PM AEST
Source: Coffs Coast Advocate [edited]

Local health authorities are again asking people to watch for symptoms
of measles with 4 cases now confirmed in the Coffs Harbour to
Woolgoolga area [New South Wales].

A further suspected case in an infant is being investigated. The cases
occurred after 2 unvaccinated school-aged children returned from an
overseas holiday with the disease and infected 2 classmates.

Of the 4 primary school-aged children, 3 are unvaccinated.

Director of North Coast Public Health Unit, Paul Corben said other
cases may emerge as measles -- which is spread in the air through
coughing or sneezing -- is highly infectious among people not fully

"I urge parents to ensure that their children are fully immunised to
protect them and others in the community against infectious diseases.
Infants under 12 months of age are particularly vulnerable to measles
as they are too young to be vaccinated," Mr Corben said.

"Despite the Coffs Harbour area having a high vaccination rate of 93
percent of 5 year olds fully vaccinated, we have taken the precaution,
under recent state legislation, of excluding 13 children from
attending school who are not vaccinated or have not received the full
course of 2 doses of measles-mumps-rubella vaccine."

Mr Corben said the Local Health District's public health unit is
contacting people known to have been in contact with these cases.

Anyone in the Coffs Harbour to Woolgoolga area who is not vaccinated
against measles should be alert to symptoms, particularly those who
were in Woolgoolga on 28 Aug 2018 or in the Coffs Harbour central
business district on 29 or 30 Aug 2018.

As the investigation is ongoing, other places and times of potential
exposure may be identified.

"The time from exposure to the disease and the onset of symptoms is
typically about 10 days but can be as long as 18 days so people should
be alert to symptoms until 17 Sep 2018," Mr Corben said.


Protecting children from potentially deadly diseases is a key priority
for the NSW Government, which has invested approximately USD 130
million in the 2018-19 Immunisation Program budget, including
Commonwealth and state vaccines.

The latest Annual Immunisation Coverage Report shows vaccination rates
in NSW are at their highest level ever, with more than 94 percent of 5
year olds vaccinated against measles.

NSW children at 1 and 5 years of age have some of the highest measles
vaccine uptake in Australia, boosted by programs including the:
- Save the Date app campaign (USD 5.5 million invested since 2013)
- Aboriginal Immunisation Health Worker program (USD 1.3 million
- New NSW Government laws that came in on 1 Jan 2018 preventing
parents who object to vaccination from enrolling their children in
preschools and early childhood centres.

Mr Corben said it was important for people to see their GP if they
have symptoms, and limit exposure to others until the GP has made a

For more information on measles, visit:

Communicated by:
ProMED-mail from HealthMap Alerts

[HealthMap/ProMED-mail map of New South Wales, Australia:

[See Also:
Measles update (56): Americas, Europe
Measles update (55): Americas, PAHO
Measles update (54): Americas
Measles update (53): Europe, WHO, worldwide
Measles update (52): Americas, Pacific
Measles update (51): Americas, Europe
Measles update (50): Americas, Europe
Measles update (49): Americas, Europe, Asia
Measles update (48): Americas, Europe
Measles update (47): Americas, Europe
Measles update (46): Americas, Asia, Indian Ocean, Europe
Measles update (45): Europe, Americas, Africa
Measles update (44): Americas, Europe, Asia
Measles update (43): Libya
Measles update (42): Somoa, MMR vaccine recall
Measles update (41): Americas, Europe, Pacific
Measles update (40): Middle East, Europe, Americas
Measles update (39): Americas, Europe, Pacific
Measles update (38): Americas, Europe, Pacific
Measles update (37): Americas, Europe, Africa, Asia
Measles update (36): Europe, South America, Africa
Measles update (35): Europe, Americas, Asia
Measles update (34): Europe, Asia, Pacific
Measles update (33): Asia, Africa, Europe, USA
Measles update (32): Europe, Pacific, Asia
Measles update (31): Asia, Africa, Europe, Americas
Measles update (30): Americas, Asia, Africa, Europe
Measles update (29): Europe, US, Pacific and Asia
Measles update (28): Europe, Asia, Pacific, USA
Measles update (27): South America, Asia, Europe, Africa, USA
Measles update (26): Europe, Pacific, Asia, USA
Measles update (25): Asia, Pacific, Africa, Middle East, Europe, USA
Measles update (24): Europe, Mexico, South America, USA, Pacific
Measles update (23): Asia, Pacific, Europe, USA, Africa
Measles update (22): USA, South America, Europe, Pacific, epi update,
Measles update (21): WHO, South America, Europe, Asia, Pacific, Africa
Measles update (20): Europe, Pacific, Americas
Measles update (19): Pacific, Americas, Europe, Asia
Measles update (18): USA, Asia, Europe, South America, WHO, PAHO
Measles update (17): Asia, Pacific, Africa, Europe
Measles update (16): Asia & Pacific, Europe, South America
Measles update (15): Europe, Asia, Pacific
Measles update (14): Europe, Asia and Pacific, USA
Measles update (13): Europe (France), USA (TX)
Measles update (12): Africa, Europe, North America, Pacific
Measles update (11): Pacific, Europe, USA
Measles update (10): Europe, Pacific, South America, USA
Measles update (09): Europe, Caribbean, Central America
Measles update (08): Asia, Central America, North America, Europe
Measles update (07): Africa, USA, Caribbean, Canada, Europe
Measles update (06): Americas, Europe, Asia/Pacific
Measles update (05): Europe, Pacific-Asia, USA
Measles update (04): Europe, USA
Measles update (03): Europe, Pacific, USA
Measles update (02): Europe, South America
Measles update (01): Asia, Europe]
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