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LETTER TO THE EDITOR
Year : 2016  |  Volume : 15  |  Issue : 1  |  Page : 42-43  

The 2015 measles outbreak in America: Identified shortcomings and recommendations to the health authorities


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

Date of Web Publication8-Feb-2016

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.153986

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. The 2015 measles outbreak in America: Identified shortcomings and recommendations to the health authorities. Ann Afr Med 2016;15:42-3

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. The 2015 measles outbreak in America: Identified shortcomings and recommendations to the health authorities. Ann Afr Med [serial online] 2016 [cited 2020 Dec 2];15:42-3. Available from: https://www.annalsafrmed.org/text.asp?2016/15/1/42/153986



Sir,

Measles is an acute infectious disease caused by Morbillivirus, which commonly affects the children.[1] It is clinically characterized by fever and catarrhal symptoms of the upper respiratory tract, followed by a typical maculo-papular rash.[1] The disease is highly contagious and is generally transmitted by droplet infection and droplet nuclei.[1],[2] In general, most of the cases recover from the disease within 2 to 3 weeks, nevertheless, serious complications (such as blindness, encephalitis, ear infection, pneumonia, etc.) have been reported in malnourished children.[2] In the year 2013, worldwide almost 145,700 deaths have been attributed to measles, which nearly accounted for 16 deaths every hour.[3] The only way to prevent the disease is by immunizing the children with a cost-effective measles vaccine (as almost 75% reduction in the number of deaths has been observed between the year 2000 and 2013 globally).[2],[3]

The American region has been declared as measles-free owing to the maintenance of high levels of immunization coverage.[4] In fact, measles has been eliminated from the Americas since 2002, mainly because of the absence of endemic transmission.[4] However, on January 5, 2015, a suspected measles case was reported in an 11-year-old unvaccinated child. Subsequently, by January 7, around seven cases of measles were diagnosed.[5] In response, the California Department of Public Health issued a notification to other states regarding the recent measles outbreak.[5] This measles transmission is on-going, and till the recent report available, almost 147 measles cases have been reported in the United States (total 121 cases, with California accounting for 88 cases alone), Brazil, Canada, and Mexico.[6] Most of the cases which have been reported in California and other parts of the United States (n = 103), gave a positive history to visit a Disney theme park in California (the probable source for acquiring the infection).[4],[5],[6]

Since, the declaration of America as measles-free, around 5077 imported measles cases have been reported (2003–2014), nevertheless, almost none resulted in a significant outbreak.[4] However, the current outbreak has exposed the presence of gaps in immunization services that have not only allowed measles, but even other vaccine-preventable diseases to increase in a number in the region.[4],[7] Findings of epidemiological studies have identified multiple factors such as parental attitudes toward immunization, education status of parents, mothers' involvement in deciding about immunization, nearby government facility, lack of awareness (like wrong idea that parents have to pay for immunization), absence of concerted efforts from the health professionals, etc., which eventually result in low immunization coverage in heterogeneous settings.[8],[9]

As definitive evidence is available to suggest the relationship between the occurrence of a measles outbreak, and human mobility (viz., travel of an infected person to a region filled with susceptible individuals), it is high time to strengthen the surveillance activities and implement timely and appropriate measures to protect the residents.[7],[10],[11] In fact, the Pan American Health Organization and World Health Organization has recommended that two doses of measles-containing vaccine should be given to children before they attain 5 years of age, so that the spread of imported cases can be prevented in future.[4] In addition, in view of the recent outbreaks other measures have also been proposed such as maintaining high levels of measles vaccination coverage at all levels; advising travelers over the age of 6 months to be fully vaccinated against measles and rubella at least 2 weeks before departure; informing travelers about symptoms of the disease and what to do if they suspect the disease (during or after the travel); sensitizing all health professionals to notify any suspected cases; and organizing contact tracing activities to trace the possible source of infection, if confirmed measles case has been diagnosed.[4],[5],[6] Finally, it is the responsibility of the public health authorities to disseminate the above-mentioned recommendations by organizing public awareness campaigns and involving travel/tourism agencies.[4],[7]

In conclusion, the recent outbreak of measles in America, has reiterated the importance of sustaining a high level of immunization coverage for vaccine-preventable disease, and for maintaining optimum health standards among the international travelers.

 
   References Top

1.
Park K, editor. Epidemiology of communicable diseases. In: Textbook of Preventive and Social Medicine. 21st ed. Jabalpur: Banarsidas Bhanot Publishers; 2011. p. 136-40.  Back to cited text no. 1
    
2.
Pan American Health Organization. Measles; 2015. Available from: http://www.paho.org/hq/index.php?option=com_topicsandview=articleandid=255andItemid=40899andlang=en. [Last cited on 2015 Feb 22].  Back to cited text no. 2
    
3.
World Health Organization. Measles-Fact Sheet No. 286; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs286/en/. [Last accessed on 2015 Feb 22].  Back to cited text no. 3
    
4.
5.
World Health Organization. Global Alert and Response – Measles: The Americas; 2015. Available from: http://www.who.int/csr/don/13-february-2015-measles/en/. [Last accessed on 2015 Feb 19].  Back to cited text no. 5
    
6.
Zipprich J, Winter K, Hacker J, Xia D, Watt J, Harriman K. Measles outbreak – California, December 2014-February 2015. MMWR Morb Mortal Wkly Rep 2015;64:153-4.  Back to cited text no. 6
    
7.
Pan American Health Organization, World Health Organization. Epidemiological Alert-Measles Outbreaks and Implications for the Americas. Geneva: WHO Press; 2015.  Back to cited text no. 7
    
8.
Cockcroft A, Usman MU, Nyamucherera OF, Emori H, Duke B, Umar NA, et al. Why children are not vaccinated against measles: A cross-sectional study in two Nigerian States. Arch Public Health 2014;72:48.  Back to cited text no. 8
    
9.
Lin W, Xiong Y, Tang H, Chen B, Ni J. Factors associated with delayed measles vaccination among children in Shenzhen, China: A case-control study. Hum Vaccin Immunother 2014;10:3601-6.  Back to cited text no. 9
    
10.
Chen M, Zhang Y, Huang F, Wang H, Liu D, Li J, et al. Endemic and Imported Measles Virus-Associated Outbreaks among Adults, Beijing, China, 2013. Emerg Infect Dis 2015;21:477-9.  Back to cited text no. 10
    
11.
Marguta R, Parisi A. Impact of human mobility on the periodicities and mechanisms underlying measles dynamics. J R Soc Interface 2015;12:20141317.  Back to cited text no. 11
    




 

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