Measles outbreaks in the 21st century
Outbreaks of the viral disease measles continue to occur in the 21st century. Although an effective measles vaccine exists, a controversy regarding the popular MMR formulation in the late 1990s has led to reduced vaccination coverage in some countries, which has disrupted efforts towards the eradication of measles.
Southern regions of the province of Quebec witnessed a measles outbreak affecting 94 persons in the Spring and Summer of 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.
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.
Indigenous measles were 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 rural Canada still 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 resulted after a resident became infected in India, and in October 2007, a Michigan girl who had been vaccinated contracted the disease overseas.
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 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 afflicted individuals who had not been vaccinated.
On May 24, 2011 the Centers for Disease Control and Prevention 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.
There was an outbreak of measles in San Diego, California in early 2008. The outbreak is traced to an unvaccinated 7-year-old child who went on a family trip to Europe. The CDC 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. The typical vaccine would be the MMR vaccine. The incident drew attention to the controversy over MMR vaccination. This was San Diego County's first measles outbreak since 1991.
There was an outbreak of measles in Pima County, Arizona in February 2008. 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.
At least 20 members of the Eagle Mountain International Church in North Texas were diagnosed with measles after a few members of the congregation traveled abroad on a mission trip and contracted the disease. The church is part of Kenneth Copeland Ministries, which used to advocate abstaining from vaccinations and immunizations for fear they cause autism. The church has sponsored several vaccination drives.  Senior Pastor Terri Pearson who had previously expressed concerns about potential links between the measles vaccine and autism was encouraging parishioners to get vaccinated but said she "...still has some reservations about vaccines."
Approximately 1000 cases of the disease were reported in Israel 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 2008, Europe faced a measles epidemic, including large outbreaks in Austria, Italy, and Switzerland. In 2010, 30,367 cases were reported from across the 32 European countries reporting to euvac.net (72% of which were reported from Bulgaria, and 17% from France), and 21 measles-related deaths (17 in Bulgaria, 2 in France, and 1 in Romania). The World Health Organization reported over 26,000 measles cases in 36 European countries from January to October 2011, with 83% occurring in western Europe. There were nine deaths, of which six were French, and 7,288 hospitalizations.
In September 2008 an outbreak occurred among anthroposophists' children in the cities of The Hague and Utrecht. 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, 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, there were 161 infections, of which 5 infected victims were hospitalized critically ill. 2 of the victims had meningitis, two others had pneumonia and from one of them, the complications are still unknown.
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 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 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 despite undergoing kidney transplantation in London.
Disease outbreaks also caused casualties in nearby countries. 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.
In 2008, for the first time in 14 years, measles was declared endemic 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 died of measles.
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.
Between January 2008 and April 2011, over 17,000 cases of measles were reported in France, including 2 deaths in 2010 and 6 deaths in 2011. From January to October 2011, there were 14,000 reported cases of measles in France, leading the country to launch an awareness campaign about MMR vaccination.
An outbreak between 25 May 2011 and 24 July 2012 in the Auckland 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, then developing measles back in Auckland.
- NORTH YORK: Measles outbreak may bring new strategy, May 2008
- Ministère de la Santé et des Services sociaux (31 August 2012). Final report on the provincial outbreak of measles in 2011 (Report). http://www.msss.gouv.qc.ca/en/sujets/prob_sante/measles/portrait2011.php. Retrieved 25 May 2013.
- CTV.ca News Staff (9 June 2011). "Quebec measles outbreak could spread, warns expert". CTV News. Retrieved 25 May 2013.
- CBC News (27 October 2011). "Quebec battling major measles outbreak". CBC News. Retrieved 25 May 2013.
- "paho.org". Retrieved 2007-12-05.
- Smith, Stephen (2006-06-10). "Measles outbreak shows a global threat - The Boston Globe". Retrieved 2007-12-05.
- Jesse, David (October 4, 2007). "Measles outbreak may have spread". The Ann Arbor News. Retrieved 2008-07-10.
- "cdc.gov". Retrieved 2008-05-02.
- JS Online: Measles outbreak brewing, city health officials say
- U.S. On Verge of Measles Outbreak?, foxnews.com, May 2008
- "cdc.gov MeaslesUpdate". Retrieved 2008-05-02.
- Dunham, Will (July 9, 2008). Julie Steenhuysen and Peter Cooney, ed. "Measles outbreak hits 127 people in 15 states". Reuters. Retrieved 2008-07-10.
- Roos, Robert (May 24, 2011). "US measles surge this year is biggest since 1996". CIDRAP News.
- Outbreak of Measles --- San Diego, California, January--February 2008, Centers for Disease Control and Prevention
- Measles Outbreak in San Diego, The California Report, KQED-FM
- County measles outbreak close to ending officially, San Diego Union Tribune
- Pima County Health Department press release
- Health Officials: Measles Outbreak Fading, KOLD News 13, May 2008
- Megachurch Changes Vaccination Stance After Outbreak, HealthLine News, August 26, 2013
- Plaint, Phil (August 26, 2013). "Measles outbreak tied to Texas megachurch sickens 21". Retrieved August 27, 2013.
- USA Today http://www.usatoday.com/story/news/nation/2013/08/23/texas-measles-outbreak/2693945/
|url=missing title (help).
- Stein-Zamir, C.; G. Zentner, N. Abramson, H. Shoob, Y. Aboudy, L. Shulman and E. Mendelson (February 2008). "Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem.". Epidemiology and Infection 136 (2): 207–214. doi:10.1017/S095026880700845X. PMC 2870804. PMID 17433131.
- Rotem, Tamar (August 11, 2007). "Current measles outbreak hit ultra-Orthodox the hardest". Haaretz. Retrieved 2008-07-10.
- "The Public Health Agency of Canada Travel Advisory". Retrieved 2008-05-02.
- Norrie, Justin (May 27, 2007). "Japanese measles epidemic brings campuses to standstill". The Sydney Morning Herald. Retrieved 2008-07-10.
- "Measles once again endemic in the United Kingdom". Eurosurveillance 13 (27): 18919. 2008. PMID 18761933.
- EUVAC annual measles report 2010 http://www.euvac.net/graphics/euvac/pdf/annual_2010.pdf
- "WHO issues Europe measles warning". BBC News. 2 December 2011. Retrieved 3 December 2011.
- "Mazelen onder antroposofen zet door (Dutch)" (– Scholar search). Nederlands Dagblad. 2008-09-29.[dead link]
- Murch S (2003). "Separating inflammation from speculation in autism". Lancet 362 (9394): 1498–9. doi:10.1016/S0140-6736(03)14699-5. PMID 14602448.
- McIntyre P, Leask J (2008). "Improving uptake of MMR vaccine". BMJ 336 (7647): 729–30. doi:10.1136/bmj.39503.508484.80. PMC 2287215. PMID 18309963.
- Asaria P, MacMahon E (2006). "Measles in the United Kingdom: can we eradicate it by 2010?". BMJ 333 (7574): 890–5. doi:10.1136/bmj.38989.445845.7C. PMC 1626346. PMID 17068034.
- "England and Wales in grip of mumps epidemic - 13 May 2005 - NZ Herald: World / International News". The New Zealand Herald. Retrieved 2008-07-10.
- "HPA - Mumps". Retrieved 2008-07-10.
- "Confirmed cases of measles, mumps & rubella". Health Protection Agency. 2007-03-22. Retrieved 2007-09-05.
- Pepys MB (2007). "Science and serendipity". Clin Med 7 (6): 562–78. PMID 18193704.
- Smith, Rebecca (20 June 2008) Teenager dies of measles as cases of disease rise The Telegraph, Retrieved 21 April 2013
- Public Health Wales: Measles Outbreak: Data (accessed 24 April 2013)
- "Measles outbreak in Bulgaria: update as of week 29, 2010". Retrieved 2010-08-26
- Kupferschmidt, K. (2012). "Europe's Embarrassing Problem". Science 336 (6080): 406–407. doi:10.1126/science.336.6080.406. PMID 22539695.
- "More cases confirmed in Christchurch measles outbreak - YahooXtra News". Retrieved 2009-09-20.
- "Measles". Retrieved 2013-10-04.