Epidemiology Of Measles
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Measles Measles (probably from Middle Dutch or Middle High German ''masel(e)'', meaning "blemish, blood blister") is a highly contagious, Vaccine-preventable diseases, vaccine-preventable infectious disease caused by Measles morbillivirus, measles v ...
is extremely contagious, but surviving the infection results in lifelong immunity, so its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities which generate insufficient new hosts the disease will die out. This concept was first recognized by Bartlett in 1957, who referred to the minimum number supporting measles as the critical community size (CCS). Analysis of outbreaks in island communities suggested that the CCS for measles is c. 250,000. Due to the development of vaccination against measles, the world has seen a 99% decrease in measles related cases compared cases before the vaccine was developed.


Incidence

In 2018, the WHO estimated that there were around 353,236 cases of measles worldwide. This has since decreased as in 2020 there were 159,000 approximate cases. Death from measles was reported in approximately 0.2% of the cases in the United States from 1985 through 1992. In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%. Increased immunization has led to an estimated 78% drop in measles deaths among
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. Even in countries where vaccination has been introduced, vaccination rates may remain low due to parents choosing not to have their children vaccinated. In
Ireland Ireland (, ; ; Ulster Scots dialect, Ulster-Scots: ) is an island in the North Atlantic Ocean, in Northwestern Europe. Geopolitically, the island is divided between the Republic of Ireland (officially Names of the Irish state, named Irelan ...
, vaccination was introduced in 1985. There were 99,903 cases that year. Within two years, the number of cases had fallen to 201, but this fall was not sustained. Measles is a leading cause of vaccine-preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in the Measles Initiative: the
American Red Cross The American National Red Cross is a Nonprofit organization, nonprofit Humanitarianism, humanitarian organization that provides emergency assistance, disaster relief, and disaster preparedness education in the United States. Clara Barton founded ...
, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the WHO. Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region. In 2006–07 there were 12,132 cases in 32 European countries: 85% occurred in five countries: Germany, Italy, Romania, Switzerland and the UK. 80% occurred in children and there were 7 deaths. Five out of six WHO regions have set goals to eliminate measles, and at the 63rd World Health Assembly in May 2010, delegates agreed a global target of a 95% reduction in measles mortality by 2015 from the level seen in 2000, as well as to move towards eventual eradication. However, no specific global target date for eradication has yet been agreed to as of May 2010. On January 22, 2014, the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
and the
Pan American Health Organization The Pan American Health Organization (PAHO) is a specialized agency of the United Nations (UN) in charge of international health cooperation in the Americas. It fosters technical cooperation among member countries to fight communicable and non ...
declared and certified
Colombia Colombia, officially the Republic of Colombia, is a country primarily located in South America with Insular region of Colombia, insular regions in North America. The Colombian mainland is bordered by the Caribbean Sea to the north, Venezuel ...
free of the measles while becoming the first
Latin American Latin Americans (; ) are the citizenship, citizens of Latin American countries (or people with cultural, ancestral or national origins in Latin America). Latin American countries and their Latin American diaspora, diasporas are Metroethnicity, ...
country to abolish the infection within its borders. In 2018, The WHO tells us the global annual incidence was about 46 million. During this time, the African Region reported the most cases, about 40%, seen primarily from Nigeria, and Eastern Mediterranean regions. In these specific areas, the incidence was greatly seen in those less than one year old. Studies show that about 95% were immune by 15 years old, making it increasingly common for the incidence of measles to occur in young children. Cases reported in the first three months of 2019 were 300% higher than in the first three months of 2018, with outbreaks in every region of the world, even in countries with high overall vaccination coverage where it spread among clusters of unvaccinated people. Through the recent improvement of decreasing measles incidence and mortality rates across the world, recently there has been setbacks. Since 2000, the MCV coverage around the world has decreased and the total cases of measles has increased from 132,490 in 2016, to 869,700 in 2019. Though many countries have eliminated measles, several countries have discovered new cases in 2019. Growing concern has been generating in increase cases of measles as incidence in measles have increased in recent years due to anti-vaccination movements due to religion and politics. Measles eradication has been challenging for many countries to maintain herd immunity. Due to political unrest, economic challenges, and accessibility to healthcare and proper vaccinations achieving proper vaccination levels in developing countries has halted. Another challenge faced worldwide is vaccination hesitancy. The World Health Organization and Centers for Disease Control and Prevention have listed this is a top ten challenge to global health in reducing the incidence of measles. In April 2020, the WHO indicated that many countries had started suspending their measles vaccination programs due to the impact of the
COVID-19 pandemic The COVID-19 pandemic (also known as the coronavirus pandemic and COVID pandemic), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began with an disease outbreak, outbreak of COVID-19 in Wuhan, China, in December ...
. It is projected that 117 million children will be at risk of infection. Currently all 194 countries have started to routinely vaccinate children with the MCV vaccine, and 122 countries have included the MMR into their routine child immunization schedules.


Outbreaks

As measles contagion is high, it can spread rapidly through the population. The incubation period for measles is 10–12 days, and is characterized by seasonal epidemics, and spreads quickly against non-vaccinated persons. Measles is quite uncommon in populations of highly vaccinated areas, yet when it does occur, it is more commonly seen in adults. The development of the measles vaccine has been vital in reducing outbreaks. Without a measles vaccine, measles epidemics could happen every 2 to 5 years and last up to 3 to 4 months at a time. Commonly outbreaks in one country spread to others and this can be traced by close examination of the virus DNA. As of 2020 measles is widespread and there have been over the last decade many outbreaks in areas that were formerly declared measles free. See below for individual countries by continent. Some examples of measles spreading between countries are: * As of May 2011, over 17,000 cases of measles had so far been reported from France between January 2008 and April 2011, including 2 deaths in 2010 and 6 deaths in 2011. Over 7,500 of these cases fell in the first three months of 2011, and Spain, Turkey, Macedonia, and Belgium have been among the other European countries reporting further smaller outbreaks. The French outbreak has been specifically linked to a further outbreak in Quebec in 2011, where 327 cases have been reported between January and June 1, 2011, and the European outbreaks in general have also been implicated in further small outbreaks in the US, where 40 separate importations from the European region had been reported between January 1 and May 20. * In 2014 many unvaccinated US citizens visiting the Philippines, and other countries, contracted measles, resulting in 288 cases being recorded in the United States in the first five months of 2014, a twenty-year high. In Vietnam, in the measles epidemic in the beginning of 2014, as of April 19 there were 8,500 measles cases and 114 fatalities, and as of May 30 there were 21,639 measles cases and 142 fatalities. * The increase of measles in January and February 2022 sparked concern due to the COVID-19 pandemic and the displacement of millions due to conflict crises. This includes Ukraine, Ethiopia, Somalia, and Afghanistan as this disrupts the routine immunization schedule and the primary focus is the safety of citizens.


European reservoir

It has proven difficult to vaccinate a sufficient number of children in Europe to eradicate the disease, because of opposition on philosophical or religious grounds, or fears of side-effects, or because some minority groups are hard to reach, or simply because parents forget to have their children vaccinated. Vaccination is not mandatory in some countries in Europe, in contrast to the United States and many Latin American countries, where children must be vaccinated before they enter school.


Africa


Congo

In January 2020, the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
announced that the death toll from the measles outbreak in the
Democratic Republic of the Congo The Democratic Republic of the Congo (DRC), also known as the DR Congo, Congo-Kinshasa, or simply the Congo (the last ambiguously also referring to the neighbouring Republic of the Congo), is a country in Central Africa. By land area, it is t ...
had reached 6,000, triple that of
Ebola Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a viral hemorrhagic fever in humans and other primates, caused by ebolaviruses. Symptoms typically start anywhere between two days and three weeks after in ...
. 310,000 cases have been reported since 2019. US $27.6 million has been spent, but $40 million more is needed.


Madagascar

In 2019, 1,200 had died of measles in an outbreak in
Madagascar Madagascar, officially the Republic of Madagascar, is an island country that includes the island of Madagascar and numerous smaller peripheral islands. Lying off the southeastern coast of Africa, it is the world's List of islands by area, f ...
.


South Africa

Beginning in September 2009,
Johannesburg Johannesburg ( , , ; Zulu language, Zulu and Xhosa language, Xhosa: eGoli ) (colloquially known as Jozi, Joburg, Jo'burg or "The City of Gold") is the most populous city in South Africa. With 5,538,596 people in the City of Johannesburg alon ...
,
South Africa South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. Its Provinces of South Africa, nine provinces are bounded to the south by of coastline that stretches along the Atlantic O ...
reported about 48 cases of measles. Soon after the outbreak, the government ordered all children to be vaccinated. Vaccination programs were then initiated in all schools, and parents of young children were advised to have them vaccinated. Many people were not willing to have the vaccination done, as it was believed to be unsafe and ineffective. The Health Department assured the public that their program was indeed safe. Speculation arose as to whether or not new needles were being used. By mid-October, there were at least 940 recorded cases, and four deaths. By 2020, South Africa eliminated measles outbreaks as there was less than one case per million citizens in the population in 2015, 2016, and 2020. An outbreak started in September 2022, the strain being genotype D8 - similar to the 2022 outbreak strain in Zimbabwe. By October 2023 there were 1199 confirmed positive tests from 7054 serum samples, with most cases in the
Limpopo province Limpopo () is the northernmost province of South Africa. It is named after the Limpopo River, which forms the province's western and northern borders. The term Limpopo is derived from Rivombo (Livombo/Lebombo), a group of Tsonga settlers ...
.


Zimbabwe

In April 2022 cases were reported from the village of Makabvepi near the border with
Mozambique Mozambique, officially the Republic of Mozambique, is a country located in Southeast Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi and Zambia to the northwest, Zimbabwe to the west, and Eswatini and South Afr ...
, with child deaths from families that belonged to the Johane Marange Apostolic Church whose large Easter service and then a Passover celebration spread measles across the country. The church publicly opposed vaccination and is closely aligned with President Emmerson Mnangagwa who attended the Passover gathering. Vaccine hesitancy was amplified by churches discouraging immunization and urging members to rely on prayer and the intercession of pastors instead. , there were more than 6500 reported cases and 704 deaths.


Americas

Indigenous measles was declared to have been eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002, with only northern
Argentina Argentina, officially the Argentine Republic, is a country in the southern half of South America. It covers an area of , making it the List of South American countries by area, second-largest country in South America after Brazil, the fourt ...
and rural
Canada Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
, particularly in Ontario, Quebec, and Alberta, having minor endemic status. Outbreaks are still occurring, however, following importations of measles viruses from other world regions. In June 2006, an outbreak in
Boston Boston is the capital and most populous city in the Commonwealth (U.S. state), Commonwealth of Massachusetts in the United States. The city serves as the cultural and Financial centre, financial center of New England, a region of the Northeas ...
resulted after a resident became infected in
India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...
.


Canada

Canadian data since 1924 shows measles outbreaks occurring frequently until the large vaccination campaigns in the 1970s. The 1935 epidemic stands out during this early period, with 83,000 reported cases (770 cases per 100,000 population); the highest number of fatalities occurring in 1926, with 892. Immunization programs became widely spread during the 1970s, with an estimated 85% of the target population receiving one dose of vaccination by the end of the decade. However, the frequent recurrence of significant outbreaks (including 6,178 cases in 1991 alone) showed Canada's 1-dose strategy was lacking, even with provinces requiring immunization for school attendance. Two-dose MMR programs and catch-up campaigns were widely introduced in 1996-1997. The Canadian government defines endemic measles as a situation where a chain of transmission continues uninterrupted for 12 months.Guidelines for the Prevention and Control of Measles Outbreaks in Canada
, Canada Communicable Disease Report, Endorsed by Chief Medical Officers of Heath, 2 November 2012
By this standard, Canada has been free of endemic measles since 1998, but sporadic imported outbreaks have continued. Southern regions of the province of Quebec witnessed a measles outbreak affecting 94 persons in the Spring and summer 2007. The outbreak lasted 25 weeks, included more than one strain of the measles virus and had 12-17 generations of spread. In 2008, Canada had more than 30 confirmed cases in Ontario in 2008, with more than half reported in Toronto.North York: Measles outbreak may bring new strategy
May 2008
In 2011, Quebec experienced the largest outbreak of measles in the Americas since 2002. The outbreak began on 8 January with unvaccinated individuals acquiring the disease whilst traveling to France, a country with high measles incidence, and returning home to Quebec. Public health officials responded to the outbreak by launching a mass vaccination campaign, and on 22 December, the outbreak ended with a total of 776 cases having occurred. 615 cases (79%) had not been vaccinated, including 29 infants too young to receive the vaccine. 11% of cases required hospitalization, and complications occurred in 64 cases (8%), with pneumonia being the most common complication observed (3% of cases). No deaths were reported. A measles outbreak was declared on 8 March 2014 in regions east of
Vancouver Vancouver is a major city in Western Canada, located in the Lower Mainland region of British Columbia. As the List of cities in British Columbia, most populous city in the province, the 2021 Canadian census recorded 662,248 people in the cit ...
in the
Fraser Valley The Fraser Valley is a geographical region in southwestern British Columbia, Canada and northwestern Washington State. It starts just west of Hope in a narrow valley encompassing the Fraser River and ends at the Pacific Ocean stretching from th ...
area where vaccination rates were known to be low in school and religious groups. A total of 228 cases were confirmed. On March 24, Fraser Health Authority said the outbreak have been contained and confined to the original community. In May 2024, a child under the age of five in
Ontario Ontario is the southernmost Provinces and territories of Canada, province of Canada. Located in Central Canada, Ontario is the Population of Canada by province and territory, country's most populous province. As of the 2021 Canadian census, it ...
died of measles, the first case in the province in over a decade. The child was reportedly not vaccinated against the virus, and required hospitalization before his death.


Mexico

Twenty-five cases of measles were reported in Mexico City on March 18, 2020. The outbreak began in the ''Reclusario Norte'' (Northern penitentiary) the previous week. 8,000 vaccines were applied at the penitentiary and 10,000 doses were applied at the other penitentiaries in the city. Eleven children and five adults in the nearby Gustavo A. Madero borough were among the 25 infected.


United States

300px, Measles cases in the US 1938–2019, showing the effect of vaccination Indigenous measles has been declared eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002. Though measles is considered "eliminated," outbreaks are still occurring following importations of measles viruses from other world regions. In June 2006, an outbreak in
Boston Boston is the capital and most populous city in the Commonwealth (U.S. state), Commonwealth of Massachusetts in the United States. The city serves as the cultural and Financial centre, financial center of New England, a region of the Northeas ...
resulted after a resident became infected in
India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...
, and in October 2007, a
Michigan Michigan ( ) is a peninsular U.S. state, state in the Great Lakes region, Great Lakes region of the Upper Midwest, Upper Midwestern United States. It shares water and land boundaries with Minnesota to the northwest, Wisconsin to the west, ...
girl who had been vaccinated contracted the disease overseas. In 1991 in the Philadelphia region, thousands of children were sick with measles. The center of this outbreak was traced to the Faith Tabernacle Congregation, a
Faith Healing Faith healing is the practice of prayer and gestures (such as laying on of hands) that are believed by some to elicit divine intervention in spiritual and physical healing, especially the Christian practice. Believers assert that the healin ...
church that actively discouraged parishioners from vaccinating their children. A judge issued a Court Order to forcibly treat children whose parents refused to seek medical care, and nine children were forcibly vaccinated. Nine children eventually died as a result of this outbreak. Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
, the most reported by this date since 2001, and the highest total number in six years. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status. By July 9, 2008, a total of 127 cases were reported in 15 states, making it the largest US outbreak since 1997 (when 138 cases were reported). Most of the cases were acquired outside of the United States and affected individuals who had not been vaccinated. In early 2008 there was an outbreak of measles in
San Diego, California San Diego ( , ) is a city on the Pacific coast of Southern California, adjacent to the Mexico–United States border. With a population of over 1.4 million, it is the List of United States cities by population, eighth-most populous city in t ...
. The outbreak is traced to an
unvaccinated A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an age ...
7-year-old child who went on a family trip to Europe. The
CDC The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency under the Department of Health and Human Services (HHS), and is headquartered in Atlanta, ...
refers to this as an "import-associated outbreak". The final diagnosis included 11 additional cases of measles in unvaccinated children in San Diego. All of the confirmed patients were not vaccinated because they were younger than 1, the minimum age for measles inoculation, or because their parents declined to have them vaccinated.County measles outbreak close to ending officially
, San Diego Union Tribune
The typical vaccine would be the
MMR vaccine The MMR vaccine is a vaccine against measles, mumps, and rubella (German measles), abbreviated as ''MMR''. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, w ...
. The incident drew attention to the controversy over MMR vaccination. This was
San Diego County San Diego County (), officially the County of San Diego, is a county in the southwest corner of the U.S. state of California, north to its border with Mexico. As of the 2020 census, the population was 3,298,634; it is the second-most populous ...
's first measles outbreak since 1991. In February 2008 there was an outbreak of measles in
Pima County, Arizona Pima County ( ) is a County (United States), county in the south central region of the U.S. state of Arizona, one of 15 List of counties in Arizona, counties in the state. As of the 2020 United States census, 2020 census, the population was 1 ...
. There were 13 laboratory confirmed and 4 probable measles cases, though 22 cases were previously reported. The outbreak started with a visitor from Switzerland and resulted in a public health emergency declaration by Pima County. The last confirmed Pima County case occurred in 1994, and the last outbreak occurred in 1991. By July 9, 2008, a total of 127 cases were reported in 15 states (including 22 in
Arizona Arizona is a U.S. state, state in the Southwestern United States, Southwestern region of the United States, sharing the Four Corners region of the western United States with Colorado, New Mexico, and Utah. It also borders Nevada to the nort ...
), making it the largest U.S. outbreak since 1997 (when 138 cases were reported). Most of the cases were acquired outside of the United States and affected individuals who had not been vaccinated. By July 30, 2008, the number of cases had grown to 131. Of these, about half involved children whose parents rejected vaccination. The 131 cases occurred in seven different outbreaks. There were no deaths, and 15 hospitalizations. Children who were unvaccinated or whose vaccination status was unknown accounted for 122 cases. Some of these were under the age when vaccination is recommended, but in 63 cases, the vaccinations had been refused for religious or philosophical reasons. On May 24, 2011, the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
reported that the United States has had 118 measles cases so far this year. The 118 cases were reported by 23 states and New York City between Jan 1 and May 20. Of the 118 cases, 105 (89%) were associated with cases abroad and 105 (89%) of the 118 patients had not been vaccinated. In 2013, at least 20 members of the Eagle Mountain International Church in
Newark, Texas Newark is a city in Tarrant and Wise counties in the U.S. state of Texas. The population was 1,096 in 2020. History According to the '' Handbook of Texas'', settlement began in the mid-1850s, referring to the community as Caddo Village becaus ...
were diagnosed with measles after a few members of the congregation traveled abroad on a mission trip and contracted the disease. The church has sponsored several vaccination drives. Senior Pastor Terri Pearsons, who had previously expressed concerns about potential links between the measles vaccine and autism, was encouraging parishioners to get vaccinated. However, she said she still has some concerns about vaccines, particularly for young children with a family history of autism, and where several immunizations are given at the same time. Professor William Schaffner, professor at the
Vanderbilt University School of Medicine Vanderbilt University School of Medicine (VUSM) is the graduate medical school of Vanderbilt University, a private research university located in Nashville, Tennessee. The School of Medicine is primarily housed within the Eskind Biomedical Libra ...
, described the pastor as "misinformed" and said that young children are among the most vulnerable to measles. In February and March 2014, 20 confirmed cases appeared in New York City. In December 2014, a measles outbreak began at
Disneyland Disneyland is a amusement park, theme park at the Disneyland Resort in Anaheim, California. It was the first theme park opened by the Walt Disney Company and the only one designed and constructed under the direct supervision of Walt Disney, ...
in Southern California. At least 173 people have become infected with measles in 21 states, as of May 2015. Health officials say 39 cases have been traced to direct exposure at the park, with 117 infections linked by primary or secondary exposure. Among the 110 California patients, 49 (45%) were unvaccinated; five (5%) had 1 dose of measles-containing vaccine, seven (6%) had 2 doses, one (1%) had 3 doses, 47 (43%) had unknown or undocumented vaccination status, and one (1%) had immunoglobulin G seropositivity documented, which indicates prior vaccination or measles infection at an undetermined time. 12 of the unvaccinated patients were infants too young to be vaccinated. Medical professionals, such as
David Gorski David Henry Gorski is an American surgical oncologist and professor of surgery at Wayne State University School of Medicine. He specializes in breast cancer surgery at the Karmanos Cancer Institute. Gorski is an outspoken skeptic and critic ...
, have criticized physicians and pediatricians in the area who do not adhere to the
CDC The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency under the Department of Health and Human Services (HHS), and is headquartered in Atlanta, ...
's recommended vaccination schedule or discourage vaccination, among them Bob Sears and Jay Gordon for reducing vaccination rates and thus weakening
herd immunity Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become i ...
, and creating a situation in which an outbreak was more likely. California passed a mandatory vaccination law in June 2015. In January 2015, it was reported that over 70 people who had visited
Disneyland Disneyland is a amusement park, theme park at the Disneyland Resort in Anaheim, California. It was the first theme park opened by the Walt Disney Company and the only one designed and constructed under the direct supervision of Walt Disney, ...
or
Disney California Adventure Disney California Adventure is a theme park at the Disneyland Resort in Anaheim, California. It is owned and operated by the Walt Disney Company through its Experiences division. The park is themed after Disney's interpretation of California ...
between Dec. 15 and Dec. 20 fell ill with measles, with 62 of them residing in
California California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...
. The total number of cases included five people who had been fully vaccinated against the disease. Between the dates of January 1 and 28, 2015, most of the 84 people who were diagnosed with measles were either infected during their visit to Disneyland or by someone who visited the theme park. In Spring 2015, the death of an immune-suppressed woman in Washington State caused by measles was diagnosed after autopsy. This was the first U.S. measles death since 2012. In spring 2017, a measles outbreak occurred in Minnesota. As of June 16, 78 cases of measles had been confirmed in the state, 71 were unvaccinated and 65 were Somali-Americans. The outbreak has been attributed to low vaccination rates among Somali-American children, which can be traced back to 2008, when Somali parents expressed concerns about disproportionately high numbers of Somali preschoolers in special education classes who were receiving services for autism spectrum disorder. Around this time,
Andrew Wakefield Andrew Jeremy Wakefield (born 3 September 1956) is a British fraudster, anti-vaccine activist, and disgraced former physician. He was struck off the medical register for "serious professional misconduct" due to his involvement in the fraudu ...
visited Minneapolis, teaming up with vaccine-skeptical groups to raise concerns about the MMR vaccine. Multiple studies have shown no connection between the
MMR vaccine The MMR vaccine is a vaccine against measles, mumps, and rubella (German measles), abbreviated as ''MMR''. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, w ...
and
autism Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing d ...
. In January 2019, Washington's Clark County Public Health officials declared a public health emergency due to a measles outbreak. As of February 28, 2019, 65 cases were identified. In March 2019, a disaster was declared by county authorities and the county health department in Rockland County, New York, over a growing measles outbreak there. Additionally there has been 259 confirmed cases of measles in Brooklyn and Queens, most of which are affecting the Orthodox Jewish community. In 2019, 1,274 reported measles cases drew concern as this was the largest reported number of cases in the United States since 1992. Cases were mostly unvaccinated individuals. In 2021, cases went down to only 49 reported cases in the United States. In 2022, cases jumped to 121 reported cases. In 2023, cases decreased to 58 reported cases, but the CDC has remarked that they have already had more cases reported in 2024 than the previous year, again citing unvaccinated individuals.


Venezuela

In 2018, Venezuela had 5,525 cases of measles reported, which was 68% of the total cases in the Americas at the time. As of 2020, the Pan America Health Organization reported that the measles outbreak is under control, and have increased vaccination rates in over 9 million children.


Asia


Israel

Approximately 100 cases of the disease were reported in
Israel Israel, officially the State of Israel, is a country in West Asia. It Borders of Israel, shares borders with Lebanon to the north, Syria to the north-east, Jordan to the east, Egypt to the south-west, and the Mediterranean Sea to the west. Isr ...
between August 2007 and May 2008 (in sharp contrast to just some dozen cases the year before). Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage. In 2018 and 2019, Israel suffered a measles outbreak affecting 4,300 citizens.


Japan

In 2007, a large measles outbreak in
Japan Japan is an island country in East Asia. Located in the Pacific Ocean off the northeast coast of the Asia, Asian mainland, it is bordered on the west by the Sea of Japan and extends from the Sea of Okhotsk in the north to the East China Sea ...
caused a number of universities and other institutions to close in an attempt to contain the disease.


Philippines

In early 2010, there was a serious outbreak of measles in the Philippines with 742 cases, leaving four unvaccinated children dead in the capital city of
Manila Manila, officially the City of Manila, is the Capital of the Philippines, capital and second-most populous city of the Philippines after Quezon City, with a population of 1,846,513 people in 2020. Located on the eastern shore of Manila Bay on ...
. In late 2013, it was reported in the Philippines that 6,497 measles cases occurred which resulted in 23 deaths. In 2014 the Philippines experienced a large measles outbreak. According to the World Health Organization there were 57,564 suspected cases of measles, including 21,403 confirmed cases, and 110 measles deaths reported in the Philippines from January 1 through December 20, 2014. Most of the cases were among unvaccinated people. A major outbreak was declared on February 6, 2019, with 70 recorded deaths of children, this outbreak was attributed to the " Dengvaxia scare".


Europe

Despite the highest ever vaccination rate of 90% achieved in 2017 in the European region, number of measles cases tripled the next year reaching 82,596 with 72 of them resulting in death. Almost two thirds of them were registered in Ukraine, where vaccination rates dropped to 31% in 2016.


Ukraine

Ukraine has had a multiple large outbreaks of measles. In 2001–2002, there were around 25,000 cases and 14 deaths reported. In 2006 with 44,534 reported cases with at least 2 deaths. 13,517 cases were reported in 2012. In 2019 Ukraine reported over 57,000 cases, over half the total reports in the
WHO The World Health Organization (WHO) is a specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Geneva, Switzerland, and has 6 regional offices and 15 ...
European Region. Ukraine has one of the world's worst measles epidemics with more than 100,000 cases from 2017 to June 2019, with 16 deaths in 2018. In 2016 only 31% of the population had been immunised with the
MMR vaccine The MMR vaccine is a vaccine against measles, mumps, and rubella (German measles), abbreviated as ''MMR''. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, w ...
. Various reasons are given for the low rate of vaccination including: a distrust of the state in the 1990s, a failure to keep vaccine supplies reliably refrigerated leading to ineffectiveness, a poorly informed medical profession and a high level of vaccine distrust in the wider population. Children are required to be vaccinated before entering the school system, but
UNICEF UNICEF ( ), originally the United Nations International Children's Emergency Fund, officially United Nations Children's Fund since 1953, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Development a ...
estimates that as many as 30% of vaccination certificates are falsified.


Germany

Germany has faced repeated outbreaks in the 21st century. 6,037 cases were reported in 2001 with at least two deaths. More than 1,500 cases were reported in 2006. 1,600 cases were reported in an outbreak in 2013. An outbreak in 2015 had more than 1,700 cases had been reported by May 11 with one death.


Netherlands

In September 2008 an outbreak occurred among anthroposophists' children in the cities of
The Hague The Hague ( ) is the capital city of the South Holland province of the Netherlands. With a population of over half a million, it is the third-largest city in the Netherlands. Situated on the west coast facing the North Sea, The Hague is the c ...
and
Utrecht Utrecht ( ; ; ) is the List of cities in the Netherlands by province, fourth-largest city of the Netherlands, as well as the capital and the most populous city of the Provinces of the Netherlands, province of Utrecht (province), Utrecht. The ...
. Some 90 infections of unvaccinated children were recorded by the Dutch National Institute for Public Health and the Environment (RIVM) by September 29. It was expected the outbreak would spread to the region of the
Veluwe The Veluwe () is a forest-rich ridge of hills (1100 km2; 420 sq. mi.) in the province of Gelderland in the Netherlands. The Veluwe features many different landscapes, including woodland, heath, some small lakes and Europe's largest sand ...
, locally known as a ''bijbelgordel'' ("Bible Belt") with a large population of unvaccinated children on religious grounds. In June 2013, another outbreak occurred in the Bible Belt in The Netherlands. According to newspaper ''
Algemeen Dagblad The ''Algemeen Dagblad'' (; ), also known by its initialism ''AD'' () is a Dutch daily newspaper based in Rotterdam. History and profile ''Algemeen Dagblad'' was founded in 1946. The paper is published in tabloid format and is headquartered i ...
'', there were 161 infections, of which 5 infected people were hospitalized critically ill. Two of the hospitalized cases had
meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, intense headache, vomiting and neck stiffness and occasion ...
, two others had
pneumonia Pneumonia is an Inflammation, inflammatory condition of the lung primarily affecting the small air sacs known as Pulmonary alveolus, alveoli. Symptoms typically include some combination of Cough#Classification, productive or dry cough, ches ...
and from one of them, the complications are still unknown. As of 2019, the Netherlands reported over 80 measles cases.


United Kingdom

After the MMR vaccine controversy began, the MMR vaccination compliance dropped sharply in the United Kingdom, from 92% in 1996 to 84% in 2002. In some parts of London, it was as low as 61% in 2003, far below the rate needed to avoid an
epidemic An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infection ...
of measles. By 2006 coverage for MMR in the UK at 24 months was 85%, lower than the about 94% coverage for other vaccines. After vaccination rates dropped, the incidence of two of the three diseases increased greatly in the UK. In 1998 there were 56 confirmed cases of measles in the UK; in 2006 there were 449 in the first five months of the year, with the first death since 1992. Cases occurred in inadequately vaccinated children. The age group affected was too old to have received the routine MMR immunizations around the time the paper by Wakefield ''et al.'' was published, and too young to have contracted the natural disease as a child, and thus to achieve a
herd immunity Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become i ...
effect. With the decline in infection that followed the introduction of the MMR vaccine, these individuals had not been exposed to the disease, but still had no immunity, either natural or vaccine induced. Therefore, as immunization rates declined following the controversy and the disease re-emerged, they were susceptible to infection. Measles cases continued in 2006, at incidence rates 13 times greater than 1998 levels. Two children were severely and permanently injured by
measles encephalitis Measles (probably from Middle Dutch or Middle High German ''masel(e)'', meaning "blemish, blood blister") is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Other names include ''morbilli'', ''rubeola'' ...
despite undergoing
kidney transplantation Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantat ...
in London. Disease outbreaks also caused casualties in nearby countries including Ireland. In 2008, for the first time in 14 years, measles was declared
endemic Endemism is the state of a species being found only in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also foun ...
in the UK, meaning that the disease was sustained within the population. This was caused by the preceding decade's low MMR vaccination rates, which created a population of susceptible children who could spread the disease. In May 2008, a British 17-year-old with an underlying
immunodeficiency Immunodeficiency, also known as immunocompromise, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that aff ...
died of measles. An
outbreak In epidemiology, an outbreak is a sudden increase in occurrences of a disease when cases are in excess of normal expectancy for the location or season. It may affect a small and localized group or impact upon thousands of people across an entire ...
centered on the
Swansea Swansea ( ; ) is a coastal City status in the United Kingdom, city and the List of urban areas in the United Kingdom, second-largest city of Wales. It forms a Principal areas of Wales, principal area, officially known as the City and County of ...
area of
Wales Wales ( ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by the Irish Sea to the north and west, England to the England–Wales border, east, the Bristol Channel to the south, and the Celtic ...
started in November 2012; as of 22 April there have been 886 cases. In March 2013, an epidemic was declared in
Swansea Swansea ( ; ) is a coastal City status in the United Kingdom, city and the List of urban areas in the United Kingdom, second-largest city of Wales. It forms a Principal areas of Wales, principal area, officially known as the City and County of ...
, Wales, UK with 1,219 cases and 88 hospitalizations to date. A 25-year-old male had measles at the time of death and died from giant cell pneumonia caused by the disease. There have been growing concerns that the epidemic could spread to London and infect many more people due to poor MMR uptake, prompting the
Department of Health A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their o ...
to set up a mass vaccination campaign targeted at one million school children throughout
England England is a Countries of the United Kingdom, country that is part of the United Kingdom. It is located on the island of Great Britain, of which it covers about 62%, and List of islands of England, more than 100 smaller adjacent islands. It ...
. In April 2019 a senior epidemiologist at
Public Health England Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...
said that confidence in the immunization program was high and that timing, availability and location of appointments were the main barriers to vaccination. In 2021, the United Kingdom reported 2 total measles cases in the country.


Ireland

1,500 cases and three deaths were reported in the Irish outbreak of 2000, which occurred as a direct result of decreased vaccination rates following the MMR scare.


Italy

In 2017, there were 4,991 cases and four deaths, representing almost six-times the number of cases in 2016. The number of cases for 2013 through 2016 were 2211, 1674, 251 and 844. In 2020 and 2021, Italy reported 4 confirmed cases of measles.


Bulgaria

Beginning in April 2009 there was a large outbreak of measles in Bulgaria, with 23,791 cases, including 24 deaths, reported up to 28 July 2010. From Bulgaria, the strain was carried to Germany, Turkey, Greece, Macedonia, and other European countries.


France

Between January 2008 and May 2012, 22,000 measles cases were reported in France. 5,000 patients were hospitalised including 1,023 with severe pneumonia, 27 with encephalitis and/or myelitis, and 10 died. An awareness campaign about MMR vaccination was launched.


Portugal

Most recent reported cases of measles in Portugal are originally imported from other European countries (United Kingdom, France and Romania), Africa (Angola, South African and Ethiopia) and Asia (China). Since 2004, Portugal reported 22 confirmed cases of measles. Virus isolates from 2005 and 2008 outbreaks belong the genotype D4. Vaccination coverage in Portugal is ≥95% (since 2006) but pockets of reduced immunization coverage (85-94%) still persist in the population. In 2021-22 Portugal has reported 0 cases of measles.


Romania

On December 5, 2023, the Romanian Ministry of Health announced in a press communique that there is a measles epidemic in Romania with over 2,000 cases registered. Anti-measles vaccination in Romania is continuing a descending trend, with 72% of the eligible population having received the first dose and 62% the second dose.


Oceania


Australia

Fourteen cases have been reported in multiple
Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...
n and
New Zealand New Zealand () is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and List of islands of New Zealand, over 600 smaller islands. It is the List of isla ...
cities including
Melbourne Melbourne ( , ; Boonwurrung language, Boonwurrung/ or ) is the List of Australian capital cities, capital and List of cities in Australia by population, most populous city of the States and territories of Australia, Australian state of Victori ...
and
Auckland Auckland ( ; ) is a large metropolitan city in the North Island of New Zealand. It has an urban population of about It is located in the greater Auckland Region, the area governed by Auckland Council, which includes outlying rural areas and ...
in the period between December 7, 2013, and January 3, 2014. The outbreak is believed to have begun at the 2013 World Supremacy Battlegrounds dance festival held in
Sydney, Australia Sydney is the capital city of the state of New South Wales and the most populous city in Australia. Located on Australia's east coast, the metropolis surrounds Sydney Harbour and extends about 80 km (50 mi) from the Pacific Ocean ...
.


New Zealand

Ten cases were reported in
Christchurch Christchurch (; ) is the largest city in the South Island and the List of cities in New Zealand, second-largest city by urban area population in New Zealand. Christchurch has an urban population of , and a metropolitan population of over hal ...
in July 2009. An outbreak between 25 May 2011 and 24 July 2012 in the
Auckland Auckland ( ; ) is a large metropolitan city in the North Island of New Zealand. It has an urban population of about It is located in the greater Auckland Region, the area governed by Auckland Council, which includes outlying rural areas and ...
region had 489 confirmed or probable cases of measles, 82 of which required hospitalisation. The outbreak was started with an unimmunised child becoming infected on a family trip to
England England is a Countries of the United Kingdom, country that is part of the United Kingdom. It is located on the island of Great Britain, of which it covers about 62%, and List of islands of England, more than 100 smaller adjacent islands. It ...
, then developing measles back in Auckland. In June and July 2014, 124 confirmed cases of measles were reported in
Hamilton Hamilton may refer to: * Alexander Hamilton (1755/1757–1804), first U.S. Secretary of the Treasury and one of the Founding Fathers of the United States * ''Hamilton'' (musical), a 2015 Broadway musical by Lin-Manuel Miranda ** ''Hamilton'' (al ...
. Eighty percent of persons infected were aged between 10 and 20, and all but four were not immunised. Most of those infected were linked with Fraser High School in the city's west, resulting in the school cancelling all school trips and cultural and sporting events. In 2019, New Zealand saw its worst outbreak in two decades. As of 5 September 2019, there had been 1,051 reported cases, mainly in
Auckland Auckland ( ; ) is a large metropolitan city in the North Island of New Zealand. It has an urban population of about It is located in the greater Auckland Region, the area governed by Auckland Council, which includes outlying rural areas and ...
which has seen 877 cases. There were also reported cases in the
South Island The South Island ( , 'the waters of Pounamu, Greenstone') is the largest of the three major islands of New Zealand by surface area, the others being the smaller but more populous North Island and Stewart Island. It is bordered to the north by ...
's
Canterbury region Canterbury () is a region of New Zealand, located in the central-eastern South Island. The region covers an area of , making it the largest region in the country by area. It is home to a population of The region in its current form was estab ...
,
Otago Otago (, ; ) is a regions of New Zealand, region of New Zealand located in the southern half of the South Island and administered by the Otago Regional Council. It has an area of approximately , making it the country's second largest local go ...
and Southland regions. In response to the epidemic, the Government established a National Health Coordination Centre in Auckland. On 5 September, the United States
Department of State The United States Department of State (DOS), or simply the State Department, is an executive department of the U.S. federal government responsible for the country's foreign policy and relations. Equivalent to the ministry of foreign affairs ...
and the
Center for Disease Control The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency under the Department of Health and Human Services (HHS), and is headquartered in Atlanta, ...
issued a health travel advisory for US citizens traveling to New Zealand. By 17 September, the number of measles cases had reached 1,327, with 1,108 reported in Auckland. Over 54,000 doses of vaccination had been distributed that month with 52,000 more doses arriving from Belgium on that date.


Samoa

An outbreak in November 2019 resulted in the deaths of 24 children and one adult from over 2,200 cases as of November 25, 2019. The Health Ministry estimates two-thirds of its 200,000 residents are vaccinated, while UNICEF puts the vaccination rate even lower at 28-40 per cent. The death toll had increased to 39 by November 28, 2019. The death toll reached 53 on December 2. The government had declared a state of emergency on November 15, when schools were closed and children were banned from public gatherings.Death toll from Samoa measles outbreak rises to 53, mostly young children
MORGAN WINSOR, ABC News, Dec 2, 2019


References

{{Eradication of infectious disease Measles Epidemiology Vaccine hesitancy