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OSAC Health Security Snapshot: Measles

The following is based on open-source reporting. It is designed to give a brief snapshot of a particular outbreak. For additional information, please contact OSAC’s Global Health and Pandemic Analyst.

What is Breaking Out?

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.

Measles starts with fever, runny nose, cough, red eyes, and sore throat. It’s followed by a rash that spreads over the body. Infected people can spread measles to others from four days before through four days after the rash appears.

Particularly in malnourished children and people with reduced immunity, measles can cause serious complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). Very rarely, complications can include a fatal disease of the central nervous system.

Where is it Breaking Out?

Measles remains a common disease in many parts of the world, including areas in Europe, Asia, the Pacific, and Africa. Worldwide, 36 cases of measles per 1 million persons are reported each year; about 134,200 die.

Europe is seeing a rise in measles reporting, widely attributed to the vaccine gap phenomenon, which includes vaccine skepticism, access (supply/procurement) difficulty, and misinformation both on vaccine efficacy and on disease prevalence. The European Centre for Disease Prevention and Control (ECDC) reported in late April that “during January and February 2017, there were more than 1,500 cases of measles in 14 different European countries.” Immunization rates have dropped below the protective threshold of 95% population coverage in seven of these countries (France, Germany, Italy, Poland, Romania, Switzerland, and Ukraine), allowing the virus to spread. Some key European developments include:

  • Romania has been in the midst of a measles outbreak since February 2016, with 6,434 confirmed cases and 26 deaths.
  • Germany, too, is in the midst of an outbreak.  The country is fining parents up to US$2,800 for not vaccinating their children and is working to debunk anti-vaxxer propaganda.
  • As of mid-April, Italy had more than 1,600 reported cases in 19 of the country’s 21 regions. The ECDC reported that most cases were not infants or young children, but patients older than 15 years who were not vaccinated as children, underscoring immunization gaps since at least 2012.

There are also outbreaks occurring in Africa and Asia, where measles is endemic in dozens of countries.

Notably, in September 2016, the Pan American Health Organization (PAHO) announced that the Americas “became the first WHO region to be declared free of measles after going 14 years without an endemic case.” The declaration means that measles has not circulated in the Americas continuously for at least 12 months; however, that does not mean there are no cases, as travelers may carry the virus.

When Does it Occur?

When a population falls below the 95% threshold for vaccination coverage – called herd immunity – countries are more likely to have measles outbreaks. Global vaccine coverage has stagnated at about 78% for the past five years, so outbreaks are not unexpected. Some parts of Romania, especially in the western parts of the country, fell to 50%, while parts of Italy were as low as 70% vaccinated.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection. Similarly, geo-political conflict and forced migration can also disrupt vaccination schedules.

That said, there is little evidence that refugees or migrants from the Syrian conflict or elsewhere are the cause of the measles outbreak in Europe. Most of the refugees and migrants now arriving in Europe come from Middle Eastern countries where vaccines are widely accepted and coverage has traditionally been high...Most outbreaks of vaccine-preventable diseases (including measles) occur in the [European] Region independently of refugee and migrant population movement; however, refugees, asylum-seekers and migrants should be vaccinated without unnecessary delay according to the immunization schedule of the country in which they intend to stay for more than a week.

Who is Impacted?

Measles is a disease of humans; measles virus is not spread by any other animal species. Measles can be serious in all age groups.

Children younger than five years of age and adults older than 20 years of age are more likely to suffer from measles complications.

At high risk for measles virus are travelers who are not immune to measles, that is not vaccinated and not exposed to the virus. Not only do they put themselves at great risk, they could also put other passengers, friends/family/colleagues, and those who have not been fully vaccinated – including infants and the immunocompromised -- in danger. There are specific populations who may decide not to receive, or to postpone receiving, the MMR (measles, mumps, and rubella) vaccine.


Why Should I be Concerned?

Anyone who is not protected against measles is at risk of getting infected when they travel internationally. Certain activities, such as attending crowded events, can increase the spread of infectious disease, including measles.

Each year, unvaccinated travelers get measles and bring it to the U.S. This has sometimes led to outbreaks. The majority of measles cases brought into the United States come from U.S. residents who were traveling abroad.

For a traveler who has not been vaccinated against measles, there are guidelines for catch-up schedules that may include one or two doses and minimum intervals between them, depending on age and other indications. Should additional vaccinations be required, larger intervals may be needed. The intervals could impact the ability to travel. For example, immunity to measles starts to develop two weeks after the MMR vaccination.


How do I Respond?

No specific antiviral treatment exists for measles virus.  Most people who do not develop more serious complications will recover within 2-3 weeks.

Vaccination is the best protection against measles. Measles can be prevented with MMR vaccine, which protects against three diseases: measles, mumps, and rubella. The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective. Before going to a foreign country, make sure you and your family are immune to measles. If you are unsure about your immunity, the U.S. Centers for Disease Control and Prevention (CDC) recommends talking with your doctor and visiting Who Needs Measles Vaccine. The CDC considers people who received two doses of measles vaccine as children…protected for life, and they do not ever need a booster dose.

One of the biggest public health hurdles to stopping measles is how little adults know about the disease, especially their own susceptibility to the virus. The CDC offers various web graphics and infographics that can be posted on private sector media platforms and in physical buildings; some are also available in Spanish.

The U.S. Embassies and Consulates often include a list of medical service providers on their U.S. Citizen Services webpage, generally under “Local Resources for U.S. Citizens.” Consular Affairs messages are listed on the OSAC website under Reports/Consular Reporting and on U.S. Citizen Services webpages.


Relevant Sources