Will Europe’s deadly measles outbreak spread to the US?

By John Murphy, MDLinx
Published September 25, 2018

Key Takeaways

What has caused the massive outbreak of measles in Europe this year? And should the United States be worried?

More than 47,000 European children and adults became infected with measles between January and July 2018, according to the World Health Organization (WHO). In just 7 months, the total number of Europeans with measles far exceeded the 12-month totals reported for every prior year in this decade. This 7-month total nearly doubles the previous high record in recent years, when 23,927 cases were reported in 2017. Compare this to a low of 5,273 cases in 2016.

“This partial setback demonstrates that every person who is not immune remains vulnerable no matter where they live, and every country must keep pushing to increase coverage and close immunity gaps, even after achieving interrupted or eliminated status,” said Nedret Emiroglu, MD, PhD, director, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark.

Eight countries in WHO’s European Region—France, Georgia, Greece, Italy, the Russian Federation, Serbia, Ukraine, and the United Kingdom—have each reported more than 1,000 infections this year so far. Ukraine has been the hardest hit, with nearly 27,000 people infected—accounting for more than half of all cases in Europe.

Measles-related deaths have been reported in nearly all these countries (UK is the exception), with Romania reporting the highest number at 22. As of July 2018, 63 Europeans have died due to measles, according to the WHO.

Will it spread to the US?

In the United States, 124 cases of measles have been confirmed in 22 states and the District of Columbia as of August 11, according to the Centers for Disease Control and Prevention (CDC). Despite reports during the summer that measles cases in the US appeared high compared with that of recent years, the number of cases in 2018 has been similar to previous years and is in the expected range, the CDC reported. For comparison, 118 cases were reported in 2017.

“There is NO current multi-state measles outbreak in the United States,” the CDC website states. “Some recent media reports misinterpreted data regularly issued by CDC surveillance teams.”

The agency acknowledges that travelers from outside the US who have measles continue to bring the disease into the country. Notably, the majority of people who get measles are not vaccinated.

To prevent outbreaks, at least 95% immunization coverage with two doses of measles vaccine—which is administered as a combined measles, mumps, and rubella (MMR) shot—is needed every year in every community, the WHO advises. Nations must also make efforts to reach children, adolescents, and adults who missed routine vaccination in the past.

Although one dose is about 93% effective, the MMR vaccine is 97% effective when both doses are administered. As of 2016, 91.1% of US children age 19 to 35 months received at least one dose of the vaccine.

In Europe, immunization coverage with both doses of the vaccine increased from 88% of eligible children in 2016 to 90% in 2017, according to the WHO. However, large disparities persist at the local level, with some communities reporting more than 95% coverage and others less than 70%.

In Italy, for instance, only 85.3% of 2-year-olds were vaccinated for measles in 2015, when vaccinations were not compulsory. It wasn’t until last year that the country instituted mandatory vaccinations for children entering public school.

“We can stop this deadly disease,” said Zsuzsanna Jakab, PhD, WHO Regional Director for Europe. “But we will not succeed unless everyone plays their part: to immunize their children, themselves, their patients, their populations—and also to remind others that vaccination saves lives.”

In the United States, one of the worst measles outbreaks in recent years occurred in a Somali community in Minneapolis, MN. The community had reportedly been spurred on by anti-vaccine activists to keep their children from getting the MMR shot because of fears of autism (a link that has been discredited). By May 2017, 44 people in the community—mostly children, most of whom were not vaccinated—had measles.

“I am very concerned, especially in the midst of a measles outbreak, to have folks come into a community impacted by this disease and start talking about links between MMR and autism,” said Andrew Kiragu, MD, interim chief of pediatrics, Hennepin Medical Center, Minneapolis, in a Washington Post article. “This is a travesty.”

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