Troy Brown, RN
August 14, 2019
Among media reports of the death of a 44-year-old Israeli flight attendant and mother of three after contracting measles, preliminary data released by the World Health Organization (WHO) on August 12 show that the number of global cases of the disease during the first half of this year has not been this high since 2006, with annual numbers rising steadily since 2016.
Through July 31 of this year, the number of cases is almost three times the number reported at this time in 2018 — 364,808 compared with 129,239.
And the true numbers of measles cases are "considerably higher than those reported through surveillance systems because of incompleteness of reporting," WHO explains in a news release, adding that fewer than one in 10 cases is reported and that completeness of reporting varies widely by country.
In 2017, the "latest year for which WHO global measles case and death estimates are available," 6.7 million estimated cases and 110,000 estimated measles-related deaths occurred, on the basis of 173,330 reported cases, according to the report. In 2018, 353,236 cases were reported to WHO. WHO will release global and death estimates for 2018 in November 2019.
"For the current 2019 period, the WHO African Region has recorded a 900% (i.e. a 10-fold increase) increase, the European Region 120% (more than twofold increase), the Eastern Mediterranean Region 50% (1.5 fold increase), the Western Pacific Region 230% (a threefold increase); the South-East Asia Region and the Region of the Americas each saw a 15% decrease in reported cases," WHO reports.
The highest numbers of measles cases this year have occurred in the Democratic Republic of the Congo, Madagascar, and Ukraine, but nationwide emergency vaccination campaigns appear to be responsible for a marked decrease in Madagascar recently.
Major outbreaks continue in Angola, Cameroon, Chad, Kazakhstan, Nigeria, the Philippines, South Sudan, Sudan, and Thailand.
The WHO European Region has seen almost 90,000 cases of measles during the first 6 months of 2019 — more than for all of 2018 (84,462) and the highest thus far for this decade.
The United States is setting its own individual records too. According to the Centers for Disease Control and Prevention's (CDC's) preliminary numbers, 1182 cases of measles were confirmed in 30 states from January 1 to August 8, 2019.
This is an additional 10 cases from the week before and the highest number of cases reported in the United States since 1992 and since the disease was declared eliminated in 2000, according to the CDC.
Outbreaks in the United States are ongoing in El Paso, Texas; Los Angeles County, California; New York City; Rockland County, New York; and Washington State. These outbreaks are associated with unvaccinated travelers who were exposed in countries with large outbreaks.
Measles Vaccine Uptake Varies
The largest outbreaks occur in countries where there is or has been low measles vaccination rates, and, in several countries, the infection is spreading among unvaccinated or incompletely vaccinated older children, youth, and adults. Vaccination rates of 95% nationally and in communities are required to prevent the spread of measles. Only 86% and 69% of children have received their first and second measles vaccines, according to the WHO report.
Approximately 20 million children received no measles vaccine in 2018 "through their routine vaccination programmes. Furthermore, 23 countries have yet to introduce the second measles vaccine dose into their national schedule," WHO said in the report.
Extended measles outbreaks are happening even in countries with high national vaccination coverage, as a result of factors including inequities in vaccine coverage, misinformation about vaccines, and healthcare disparities among certain groups, according to WHO. Two doses of measles vaccine can almost entirely prevent measles.
WHO urges everyone to be sure they are up to date with their measles vaccinations and verify their vaccination status before travel. Children aged 6 months or older should be vaccinated against measles before travel to regions where the disease is circulating. Individuals who are unsure of their vaccination status should speak with their healthcare provider.
WHO recommends that vaccination against measles occur at least 25 days before travel.