Global Resurgence of Measles
N. S. Crowcroft
University of Toronto, Toronto, ON
- Compare and contrast reasons for measles outbreaks in different countries
- Summarize what this implies for future measles control
In the first 6 months of 2019, more measles cases were reported to the World Health Organization (WHO) than in any year since 2006. In the same year, WHO identified vaccine hesitancy as one of the top 10 challenges facing public health. It all seemed like a large step backwards after the declaration of measles elimination in the Americas in 2016, and strong progress made in many countries and regions. What is going on and how should we respond?
Measles outbreaks occur because immunization coverage is not high enough, and this happens for 3 main reasons that are not mutually exclusive:
1. Gaps in immunity due to weak immunization systems, exacerbated by poverty and malnutrition
2. Crisis caused by other health emergencies, political crisis or conflict
3. Vaccine hesitancy
Much recent attention has focused on the last reason. In some countries, anti-vaccination campaigning and spread of misinformation on social media has certainly damaged vaccine confidence. But digging deeper, circumstances that have enabled vaccine hesitancy to flourish illustrate how a systems-level response is needed. Other issues may need to be addressed both to promote confidence in vaccines and to prevent outbreaks. For example, genuine vaccine safety issues have sensitized some communities to anti-vaccination messages, indicating that vaccine safety systems need to be stronger.
While immunization systems strengthening has been discussed for many years, the resurgence of measles could be an opportunity to drive transformative change. Measles is the most infectious vaccine-preventable disease and requires the highest coverage to remain under control. Measles is therefore one of our best indicators of whether immunization programs are reaching every child. Looking to the future, measles could be a pathfinder to stronger immunization systems, lighting the way to better prevention of all vaccine-preventable diseases for everyone, everywhere.
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2. WHO Strategic Advisory Group of Experts. Global measles rubella update, presented to SAGE October 2019 www.who.int/immunization/sage/meetings/2019/october/kretsinger_measlesRubella_sage_october_2019.pdf.
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4. Crowcroft NS, Bolotin S. Measles outbreaks demand systems-level action locally, nationally and globally. CMAJ. 2019 Jul 15;191(28):E777-E778.
5. World Health Organization. Immunization Agenda 2030: A Global Strategy to Leave No One Behind www.who.int/immunization/immunization_agenda_2030/en/.
Measles Outbreak in New York City, 2018-2019
J. R. Zucker
New York City Department of Health and Mental Hygiene, New York, NY
Describe factors that contributed to the measles outbreak in New York City and interventions that were undertaken to end measles transmission and increase measles-mumps-rubella vaccination
An outbreak of measles in New York City began on September 30, 2018, when an unvaccinated child returned from Israel with measles. Additional measles importations, from Israel and other parts of Europe to New York City, as well as low vaccination rates, propagated transmission and led to the largest measles outbreak in the US since 1992. Of the 649 confirmed cases, 93% were among Orthodox Jewish persons and 72% occurred in Williamsburg, Brooklyn. Demographic and clinical characteristics of the case-patients, increases in vaccine uptake in the affected community, and challenges and lessons learned will be presented.
1. Patel M, Lee AD, Clemmons NS, Redd SB, Poser S, Blog D, Zucker JR, Leung J, Link-Gelles R, Pham H, Arciuolo RJ, Rausch-Phung E, Bankamp B, Rota PA, Weinbaum CM, Gastañaduy PA. National Update on Measles Cases and Outbreaks – United States, January 1 – October 1, 2019. MMWR 2019;68(40):893-896.
2. Alroy KA, Vora NM, Arciuolo RJ, Asfaw M, Isaac BM, Iwamoto M, Jean A, Benkel, DH, Blaney K, Crouch B, Geevarughese A, Graham KA, Lash M, Daskalakis D, Zucker JR, Rosen JB. Notes from the Field: Interventions to Reduce Measles Virus Exposures in Outpatient Health Care Facilities – New York City, 2018. MMWR 2019;68(36):791-792.
3. Rosen JB, Arciuolo RJ, Khawja AM, Fu J, Giancotti FR, Zucker JR. Public Health Consequences of a 2013 Measles Outbreak in New York City. JAMA Pediatrics, 2018;172(9):811-817.