Measles Outbreak 2nd Largest Since 2000; Blamed on Import from International Travelers in High Risk Countries and Groups of Unvaccinated People in US

For the period January 1 to March 28, 2019, 387 individual cases of measles (rubeola) have been confirmed in 15 states, marking the second-greatest number of cases reported in the U.S. since measles was declared eliminated in 2000. With only three months into the year 2019, there have been 58% as many measles cases as in the entire year of 2014 when there were 667 measles cases — the highest number of measles cases since the year 2000. Cases are updated every Monday, and these figures do not include April 1, 2019.

Names for Measles
Morbilli, rubeola, red measles, and English measles

In 2019, the states that have reported cases to the Centers for Disease Control or CDC are Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington.

Six outbreaks (defined as 3 or more cases) are currently ongoing in 2019 in the following jurisdictions:

New York State, Rockland County
New York City
Washington State, Clark County and King County
California, Santa Cruz County
New Jersey
California, Butte County

Oregon is tracking their own cases, and has 4 cases in Multnomah County linked to one case in Clark County, Washington.

These outbreaks are linked to travelers who brought measles back from other countries such as Israel, Ukraine, and the Philippines, where large measles outbreaks are occurring. The CDC advised people to be vaccinated against measles before traveling internationally.

In a given year, more measles cases can occur for any of the following reasons:

• an increase in the number of travelers who get measles abroad and bring it into the U.S., and/or

• further spread of measles in U.S. communities with pockets of unvaccinated people.

Reasons for Increase Measles Cases in Recent Years

2018: The U.S. experienced 17 outbreaks in 2018. Three outbreaks in New York State, New York City, and New Jersey, respectively, contributed to most of the cases. Cases in those states occurred primarily among unvaccinated people in Orthodox Jewish communities. These outbreaks were associated with travelers who brought measles back from Israel, where a large outbreak is occurring. Eighty-two people brought measles to the U.S. from other countries in 2018. This is the greatest number of imported cases since measles was eliminated from the U.S. in 2000.

2017: A 75-case outbreak was reported in Minnesota in a Somali-American community with poor vaccination coverage. The total cases for the year were 120.

2015: The United States experienced a large (147 cases), multi-state measles outbreak linked to an amusement park in California. The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious; however, no source was identified. Analysis by CDC scientists showed that the measles virus type in this outbreak (B3) was identical to the virus type that caused the large measles outbreak in the Philippines in 2014. In 2015, 191 measles cases were reported; 28 (15%) were importations, and 142 (80%) of 178 cases among U.S. residents were unvaccinated or had an unknown vaccination status. The total cases reported were 188 (table) to 191 (update).

2014: The U.S. experienced 23 measles outbreaks in 2014, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio. Many of the cases in the U.S. in 2014 were associated with cases brought in from the Philippines, which experienced a large measles outbreak. A high proportion (92%) of cases involved U.S. residents who were unvaccinated or who had unknown vaccination status. In 2014, there was more spread from imported cases than in other years. The total cases for the year were 667. The number of cases translated to a reported incidence of 2.08 cases per million.

2013: The U.S. experienced 11 outbreaks in 2013, three of which had more than 20 cases, including an outbreak with 58 cases. For more information see Measles — United States, January 1-August 24, 2013. The total cases for the year were 187.

2011: In 2011, more than 30 countries in the WHO European Region reported an increase in measles, and France was experiencing a large outbreak. These led to a large number of importations (80) that year. Most of the cases that were brought to the U.S. in 2011 came from France. For more information see Measles — United States, January-May 20, 2011. The total cases for the year were 220.

2008: The increase in cases in 2008 was the result of spread in communities with groups of unvaccinated people. The U.S. experienced several outbreaks in 2008, including three large outbreaks. The total cases cases in 2008 from January to July were 131. The average number of cases from 2000 to 2007 had been 63 cases per year.

Measles is an acute viral illness caused by a virus in the family paramyxovirus, genus Morbillivirus. Measles is characterized by a prodrome of fever (as high as 105°F) and malaise, cough, coryza, and conjunctivitis, followed by a maculopapular rash. The rash spreads from head to trunk to lower extremities. Measles is usually a mild or moderately severe illness. However, measles can result in complications such as pneumonia, encephalitis, and death. Approximately one case of encephalitis and two to three deaths may occur for every 1,000 reported measles cases.

Measles is a highly contagious disease caused by Morbillivirus that spreads through the air when an infected person coughs or sneezes, or when a person directly contacts or touches objects or surfaces contaminated by the virus.

One rare long-term sequelae of measles virus infection is subacute sclerosing panencephalitis (SSPE), a fatal disease of the central nervous system that generally develops 7–10 years after infection. Among persons who contracted measles during the resurgence in the United States (U.S.) in 1989–1991, the risk of SSPE was estimated to be 7–11 cases/100,000 cases of measles. The risk of developing SSPE may be higher when measles occurs prior to the second year of life.

The average incubation period for measles is 11–12 days, and the average interval between exposure and rash onset is 14 days, with a range of 7–21 days. People with measles are usually considered infectious from four days before until four days after onset of rash with the rash onset being considered as day zero.

The settings of measles transmission have included households, educational institutions (e.g., schools, day care), churches, health care facilities, homeless shelters, and other congregate settings. Lack of adherence to existing recommendations for measles prevention among groups of people that area at high risk, such people who travel internationally where measles is present, can spread measles to susceptible populations, including infants who are too young to be vaccinated, or unvaccinated people who have failed to get the measles vaccine.

In recent years, most of the importations of measles were the result of unvaccinated U.S. travelers who had traveled to measles endemic countries, including countries in the World Health Organization (WHO) European and Western Pacific Regions.

Measles Vaccination for High Risk International Travelers

For prevention of measles among adults, two doses of MMR vaccine are also recommended for adults at high risk, including international travelers, college and other post-high school students, and health care personnel born during or after 1957. All other adults, born during or after 1957, without other presumptive evidence of measles immunity, should be vaccinated with one dose of MMR vaccine.

Routine Measles Vaccination for Children

For prevention of measles, two doses of MMR vaccine are recommended routinely for children, with the first dose at age 12 through 15 months and the second dose at ages four through six years (school entry).

Live attenuated measles virus vaccine is incorporated into combination MMR vaccine and combination measles, mumps, rubella, and varicella (MMRV) vaccines. Monovalent measles vaccine is not available in the United States. Rubella is a milder measles illness, also known as German Measles; however Rubella can harm a developing baby in pregnancy. Varicella, also known as Chickenpox, is usually mild, but can be serious in infants under 12 months of age, adolescents, adults, pregnant women, and people with weakened immune systems.

Serious Varicella Complications:
skin infections
infection of the lungs (pneumonia)
inflammation of blood vessels
swelling of the brain and/or spinal cord coverings (encephalitis or meningitis)
blood stream, bone, or joint infections

CDC | Chickenpox VIS

MMR (Measles, Mumps, Rubella) is manufactured by Merck with the trade name M-M-R® II. MMRV is manufactured by Merck with the trade name ProQuad®.

See also …
CDC | Measles Cases and Outbreaks

CDC | Manual for the Surveillance of Vaccine-Preventable Diseases Chapter 7: Measles

CDC | Rubella (German Measles, Three-Day Measles)

CDC | U.S. Vaccine Names



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