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Rapid response to:


Measles cases rise 300% globally in first few months of 2019

BMJ 2019; 365 doi: (Published 16 April 2019) Cite this as: BMJ 2019;365:l1810

Rapid Response:

Re: Measles cases rise 300% globally in first few months of 2019 - how long is a piece of string?

Perhaps the WHO know how difficult it is to come up with meaningful data in regard to measles outbreaks [1]. Some of the pitfalls were memorably described in a letter to the columns by Hilary Butler years ago [2]. How many reported? How many confirmed? How many sub-clinical? How much is simply an artefact of looking for cases? How many merely projected by the WHO? For instance, in a publication last November the WHO had only 28,474 reports of measles cases for 2017 in SE Asia (but how many of those were real cases?), while they projected 35,925 measles deaths for the region [3]. But if there was any reality to that mortality figure would 70 deaths in the Philippines earlier this year be especially worth remarking upon?

Similarly, I commented in relation to an earlier report this year [4,5]:

"Nor is it helpful to cite random "facts" about measles.. .For instance, in Brazil, how many of the 10,262 cases for 2018 were confirmed? Is it really possible to believe there were no cases in 2017? How far is any of this real, and how much an artefact of simply looking? Brazil is a country of approximately 210m, so how many "red rashes" which might have been measles... did not get reported in 2017?"

And if we do not know what was going on in 2017 and 18, how do we know what is going on now? One thing is certain that the WHO, and various other people want us to be extremely worried about measles [5,6], but how much is real, how much smoke and mirrors? It is important that we have real information because increasingly it is not only health but liberty which is a stake [5,6]. How can people make informed decisions with data like this?

[1] Elisabeth Mahase, 'Measles cases rise 300% globally in first few months of 2019',
BMJ 2019; 365 doi: (Published 16 April 2019)

[2] Hilary Butler, 'In response to Peter Flegg's use of data', 29 November 2008,

[3] Dabbagh et al, "Progress towards regionalmeasles elimination – worldwide, 2000–2017", Table 1, WHO, Weekly epidemiological record, 30 NOVEMBER 2018, 93th YEAR,

[4] Owen Dyer, 'Measles: alarming worldwide surge seriously threatens children, says UN', BMJ 2019; 364 doi: (Published 01 March 2019)

[5] John Stone, 'Information and Misinformation: the Global Health Security Agenda', 5 March 2019,

[6] Peter Hotez, 'Measles in America—what’s playing out in New York State is nightmarish',
March 28, 2019,

Competing interests: No competing interests

17 April 2019
John Stone
UK Editor
London N22