Measles outbreaks worldwide are continuing to grow at alarming rates. The United States has seen 1,172 measles cases since the beginning of 2019 (as of Aug. 1), and the most recent update from the WHO reports nearly 300,000 cases globally (as of June). Outbreak Observatory has previously covered several aspects of the global measles resurgence in our posts, including recent legislative changes in the U.S., the role of low vaccination coverage in measles outbreaks, and the measles outbreak raging alongside the DRC’s Ebola epidemic. This week’s Outbreak Thursday post seeks to serve as a brief update of the measles situation both within the US and globally, as well as a reminder of the importance of maintaining high vaccination coverage to prevent outbreaks.

Measles Worldwide

Numerous countries across the globe have seen increases in measles cases. Madagascar and Ukraine have been particularly hard hit, with 81,836 (Madagascar) and 60,985 (Ukraine) measles cases reported from December 2018 to May 2019, respectively. Low vaccination coverage is likely driving these outbreaks--for example, in Ukraine, vaccine hesitancy, vaccine shortages, and poor healthcare infrastructure are all believed to be contributing to decreases in measles vaccine coverage. In conflict-affected countries like the DRC, measles epidemics are difficult to overcome because of logistical and safety obstacles. Weak governance and violent armed groups have challenged humanitarian efforts, and the additional threat caused by the current Ebola outbreak has “[swallowed] up resources,” making it even harder to respond to other outbreaks including measles, which has so far infected over 135,000

Measles in the United States

The United States has also seen increasing case counts and growing concern that it will lose its measles elimination status. Although this year’s case counts (as of Aug. 1) are already three times the total number of measles cases reported in 2018, weekly case counts are starting to show a downward trend.

U.S. states have chosen a variety of different tactics to combat local measles outbreaks. Earlier this summer, Colorado Governor Jared Polis signed an executive order directing the state government to study the reasons behind vaccine hesitancy and educate the public about the importance of vaccination. In New York City, Spanish-speaking health officials attended local soccer games and offered players and fans the option to receive a free measles vaccine. As mentioned in our last update, New York City recently passed new legislation which prohibits religious exemptions for school vaccine requirements. New York City has only seen 6 cases of measles since July 1, 2019, a significant decrease from previous months. 

Conclusion

Although diseases such as measles are preventable, a number of factors currently contribute to continued disease spread. To stop measles outbreaks, the public health community must continue to educate communities about the threat of vaccine-preventable diseases like measles, and governments must combat the rising tide of vaccine hesitancy. Through vaccine education and health systems strengthening, countries can combat measles resurgence and get back on the road towards elimination.

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.    

This 2014 image was captured in Myanmar, by Centers for Disease Control and Prevention (CDC) Epidemiologist, Terri Hyde, M.D., M.P.H., and depicts a Myanmar mother holding her infant daughter, who was in the process of receiving her measles vaccination injection in her upper left arm from a trained nurse.

Photo courtesy of CDC/ Molly Kurnit, M.P.H.