Measles: 142 000 people died in 2018, mostly aged under 5
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6830 (Published 05 December 2019) Cite this as: BMJ 2019;367:l6830
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Editor,
The figures reflect too large a price being paid in terms of mortality in the twenty first century. Children under five have been a vulnerable subgroup. Doubts, reservations, reluctance and outright refusals have been general impediments in vaccine programmes. There also exists a feeling about certain adult vaccines being 'pushed' and controversies generated. Yet utmost efforts are required to ensure that time tested and those with a track record have the widest possible reach and easy access.
Dr Murar E Yeolekar, Mumbai.
Competing interests: No competing interests
Dear Editor
It is stated ( in the section headed Preventable Deaths) that in the past eighteen years, the measles vaccination alone is estimated to have saved 23 million lives.
If it is correct , perhaps you could name the countries where MEASLES VACCINE ALONE is available and used.?
Clearly the vaccine used - the name of the manufacturer and batch numbers - should be given wide publicity.
Thank you
Competing interests: No competing interests
Resurgence of Measles in the USA
Dear Editor,
From January 1 to December 5, 2019, the USA reported 1276 confirmed measles cases spanning 31 states, among them 124 were hospitalized and 61 have serious complication like pneumonia and encephalitis, compared with 372 reported cases in 2018, 120 in 2017, 86 in 2016, 188 in 2015, and 667 in 2014 [1]. This is the greatest number of cases reported in the USA since 1992 while measles was declared officially eliminated in the US in 2000 [1]. More than 75% of the cases this year are linked to recent outbreaks in New York.
These high numbers show that the USA remains at risk for large measles epidemics such as those recently seen in Europe [2]. Two main factors are believed to contribute to the resurgence of measles cases in the USA: low vaccination rates fueled by non-medical exemptions (NMEs) [2] and reintroduction of the virus at individual localities through travel from countries experiencing outbreaks [3]. The seriousness of this risk is underscored by the ease of transmission of measles, which is caused by the highly contagious measles morbillivirus that is capable of airborne spread [4].
This spatial relative risk profile at a county resolution for the USA is derived from a multiplicative risk function that compounds four factors: NME rates in the county [5, 6], international air travel volume to the destination county [7], county population [8], and the incidence rate of the measles outbreak at travel origin [9].
In recent years, the most important vaccine-preventable disease that has returned to the USA is pertussis and it has already been shown that outbreaks are spatially associated with high NME rates [10].
Surveillance should also be directed towards those counties with the high incoming passenger volume from these countries. The top countries ordered by the risk posed are Ukraine, Mexico, Cuba, Israel, Japan, Thailand, and the Philippines. The most troubling aspect of this development is the global increase in measles cases.
Undervaccinated, close-knit communities are not unique to the United States and exist around the world. These communities are at high risk for outbreaks of vaccine-preventable diseases, which threaten the health and safety of vulnerable persons within, as well as outside of, these communities. Therefore, public health authorities need to identify pockets of unvaccinated persons to prevent these outbreaks, which require substantial resources to control. A preventive strategy to build vaccine confidence is important, especially one that uses culturally appropriate communication strategies to offset misinformation and disseminate accurate information about the safety and importance of vaccination in advance of outbreaks. Countries and the global health community needed to urgently invest in high-quality national immunization programs and disease surveillance said WHO.
References:
1. Centers for Disease Control and Prevention. Measles cases and outbreaks. 2019. https://www.cdc.gov/measles/cases-outbreaks (accessed December 29, 2019)
2. Hotez, P. J. 2019. America and Europes new normal: the return of vaccine-preventable diseases. Nature 2019 (DOI:10.1038/s41390-019- 0354–53).
3. Hyle EP, Fields NF, Fiebelkorn AP, et al. The clinical impact and cost-effectiveness of measles-mumps-rubella vaccination to prevent measles importations among international travelers from the United States. Clin Infect Dis 2018(DOI:10.1093/cid/ciy861).
4. Moss WJ. Measles. Lancet 2017; 390: 2490–2502.
5. Olive JK., Hotez PJ, Damania A, Nolan MS. 2018. The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties. PLoS Med 2018; 15: e1002578.
6. Seither R, Calhoun K, Street EJ, et al. Vaccination coverage for selected vaccines, exemption rates, and provisional enrollment among children in kindergarten—United States, 2016–17 school year. MMWR 2017; 66: 1073–80.
7. International Air Travel Association. Passenger Intelligence Services (PaxIS). 2019. http://www.iata.org/services/statistics/ intelligence/paxis/Pages/index.aspx (accessed December 29, 2019)
8. United States Census Bureau. Geography Program. 2019. https://www.census.gov/geo/maps-data/data/cbf/cbf_counties. Html (accessed December 29, 2019).
9. United Nations DESA/ Population Division. World population prospects 2017. 2019. https://population.un.org/wpp/Download/Standard/ Population/ (accessed December 29,, 2019).
10. Aloe C, Kulldorff M, Bloom BR. Geospatial analysis of non-medical vaccine exemptions and pertussis outbreaks in the United States. Proc Natl Acad Sci USA 2017; 114: 7101–05.
Competing interests: No competing interests