CDC: Measles Cases in USA Hit 20 Year High

The USA now has the most measles cases in 20 years and the most since homegrown outbreaks were eliminated in 2000, the federal Centers for Disease Control and Prevention announced Thursday.

The confirmed case count, as of May 23, was 288 and growing, CDC says. That number includes 138 cases from Ohio, where the biggest outbreak is ongoing – and where the actual count is 166 as of today, according to the state health department.

In any case, the total easily surpasses the recent nationwide record, which was 220 cases in 2011, CDC officials say.

While measles remains officially “eliminated” in the USA – because all the recent outbreaks started with travelers who brought the measles virus back from other countries – the trend is not good, health officials say. Outbreaks are occurring among clusters of people with low vaccination rates.

In Ohio, all the cases so far have been in members of the Amish community, says Melanie Amato, public information officer for the state department of health.

While vaccination rates among the Amish were low, members of those communities are lining up to get vaccinated now, Amato says. The state has shipped out more than 13,000 doses of measles, mumps and rubella vaccine to deal with outbreak and more than 8,000 doses have been used, she says.

But, she says, there’s no signs the momentum of the outbreak has yet been broken: “We don’t think it will be over any time soon. We’re looking for this to continue into the summer.”

The most cases, 100, have been in Knox County. “The Amish population in Knox County has been very cooperative in getting vaccinated or self-reporting (if they have symptoms) or staying home if they do get the measles,” county health commissioner Julie Miller said in a statement.

She added: “We’ve been getting calls from people who want to know if it is safe to travel to Amish Country. The easy answer is ‘yes’ if you’ve been vaccinated. And if you haven’t been vaccinated, you should be, regardless of where you are going.”

Measles, once a common childhood disease in the USA, is seen so infrequently today that doctors may not always recognize symptoms. Those include fever, cough, runny nose, red eyes, sore throat and a red rash that appears after three to five days. The virus is highly contagious and spreads through the air by breathing, coughing or sneezing.

MDCH Releases MERS-CoV Guidance for Healthcare and Public Health Providers

The Michigan Department of Community Health recently released a revised guidance for MERS. See the complete guidance at
https://www.michigan.gov/documents/mdch/MERS-CoV_Guidance_Michigan_9-30-13_435636_7.pdf.

Loan Repayment Bill Clears House, Governor Expected to Sign

The Michigan House passed Senate Bill 648, which would modify a program that re-pays student loans to incentivize more medical students to practice primary care in rural and underserved parts of the state. The bipartisan bill, co-sponsored by Sen. John Moolenaar (R-Midland) and Rep. Jim Ananich (D-Flint), heads back to the Senate for concurrence next week, and is expected to be signed soon by the governor.

The bill would remove the four-year limit on loan repayments, increase the maximum annual loan repayment, and establish a lifetime cap on loan repayments. And it would permit the Michigan Department of Community Health to give preference to physicians studying general practice, family medicine, obstetrics and gynecology, pediatrics, or internal medicine.

Nation’s Third Case of the MERS Virus Reported

The nation’s third reported case of the MERS virus underscores how little is known about the illness that first emerged in Saudi Arabia in 2012.

“We don’t know what proportion of infected people are asymptomatic, what proportion of people are symptomatic and what proportion of people have severe disease,” said David Swerdlow, incident manager for MERS response activities at Centers for Disease Control and Prevention in Atlanta.

The latest case was first reported Saturday. Tests show that an Illinois man, who’d had two short business meetings with an infected Indiana man, had contracted the Middle East Respiratory Syndrome virus.

The Illinois man, whom health officials are not naming, did not get sick and was not hospitalized. However, blood tests completed Friday showed he had been infected with the MERS virus, Swerdlow said.

Technically the Illinois man can’t be counted as an official case of MERS because under World Health Organization guidelines, only tests from an active infection count. In this case, antibodies in the man’s blood showed he had been infected and fought the infection off, Swerdlow said.

CDC teams have tested everyone the Illinois man came into contact with and so far all tests “have come back without signs of active infection,” Swerdlow said.

That suggests “this is not an easily passed infection,” said Leonard Krilov, chief of pediatric infectious diseases at Winthrop University Hospital in Mineola, N.Y.

Research at the Center for Infectious Disease Research and Policy at the University of Minnesota appears to show that some individuals can transmit the virus more easily than others.

“We don’t know what the risk is. Any one individual’s chance of transmitting is probably fairly low, but we have no idea right now what makes a person more likely to transmit the virus,” said Michael Osterholm, who directs the center.

MERS first showed up in Saudi Arabia in 2012. As of May 9, 536 confirmed cases of the disease have been reported worldwide, mostly in the Middle East, according to the World Health Organization.

About 27% of those infected with the virus die, according to WHO.

The first confirmed case of MERS in a U.S. resident came on April 27. An Indiana man who had been working in Saudi Arabia flew home and was admitted to a local hospital. Lab tests confirmed he had MERS. He has since fully recovered.

The second U.S. case was a Saudi Arabian health care worker who was traveling to the United States and fell ill in Orlando on May 9 but has since recovered.

The virus in the Middle East appears to originate in animals, especially camels, Swerdlow said.

“What we don’t know is what proportion of people have had contact with camels, and we don’t know what other animals could be reservoirs,” he said.

Increase in Reported Measles in United States 2014

The following is an important message from the US Centers for Disease Control & Prevention.

Please share with all primary care personnel, urgent/emergency care clinicians, and infection control/prevention specialists.

This year, the United States is having more reported cases of measles than usual. Many healthcare providers in the United States have never seen a patient with measles and may not recognize the signs and symptoms. Healthcare providers need to be more alert than ever to the possibility of measles.

They should consider measles in patients who:

– present with febrile rash illness and clinically compatible measles symptoms [cough, coryza (or runny nose) or conjunctivitis (pink eye)],
– recently traveled internationally or were exposed to someone who recently travelled
– have not been vaccinated against measles

Healthcare providers should also consider measles when evaluating patients for other febrile rash illnesses, including Dengue and Kawasaki’s Disease.

If you suspect measles, do the following immediately:

1.Promptly isolate patients to avoid disease transmission.
2.Immediately report the suspect measles case to their health department.
3.Obtain specimens for testing from patients with suspected measles, including viral specimens [recommended specimens are 1) serum and 2) throat or nasopharyngeal swab (place swab in viral transport media)].

Additional guidance for healthcare providers can be found at: http://www.cdc.gov/measles/hcp/index.html.

Also, see CDC’s measles surveillance guidance: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html.

Additional Michigan guidance (Key Facts about Measles) is available at:

Click to access KeyFacts_Measles_392862_7.pdf

Mayo Clinic Trial: Massive Measles Vaccine Attacks Blood Cancer

ROCHESTER, Minn. – Mayo Clinic researchers announced a landmark study where a massive dose of the measles vaccine, enough to inoculate ten million people, wiped out a Minnesota woman’s incurable blood cancer.

The Mayo Clinic conducted the clinical trial last year using virotherapy. The method discovered the measles virus wiped out multiple myeloma cancer calls. Researchers engineered the measles virus (MV-NIS) in a single intravenous dose, making it selectively toxic to cancer cells.

Stacy Erholtz, 49, of Pequot Lakes, was one of two patients in the study who received the dose last year, and after ten years with multiple myeloma has been clear of the disease for over six months.

“My mindset was I didn’t have any other options available, so why wouldn’t I do it? I had to have failed all conventional treatment to do that trial. That actually happened last March,” said Erholtz. “It was the easiest treatment by far with very few side effects. I hope it’s the future of treating cancer infusion.”

Dr. Steven Russell, a Mayo Clinic hematologist, spearheaded the study and said the concept was previously tested in mice, but never in humans until now.

“It’s a huge milestone in that regard,” said Russell. “We have known for some time viruses act like a vaccine. If you inject a virus into a tumor you can provoke the immune system to destroy that cancer and other cancers. This is different, it puts the virus into bloodstream, it infects and destroys the cancer, debulks it, and then the immune system can come and mop up the residue.”

Two multiple myeloma patients were chosen because they are immune-compromised, and can’t fight off the measles before it has time to attack cancer. Both had limited previous exposure to measles, and therefore fewer antibodies to the virus, and essentially had no remaining treatment options. Of the two subjects in the study, Stacy was the only to reach full remission. The other patient’s cancer returned after nine months.

Dr. Russell believes it’s still a medical milestone, and he hopes his team can one day transform this research into a single shot cure.

“It’s like a call to action. It’s not just good for our virus. It’s good for every virus everybody’s developing as a cancer therapy. We know this can happen,” said Dr. Russell.

Mayo researchers are also testing the measles virus’s effectiveness at fighting ovarian, brain, head and neck cancers and mesothelioma. They are also developing other viruses that seem to have potential to kill cancer cells.

“I think it’s just remarkable. Who would have thought?” said Erholtz, who said she returns to the Mayo in June for a check up.

The Mayo is moving immediately into a phase two clinical trial involving more patients with a goal of FDA approval within four years.

Health Officials Alert Airports, Customs for MERS

After the diagnosis of a second case of MERS in the U.S., federal health officials have posted warnings at nearly two dozen airports and reminded Customs staff to be on alert for sick travelers.

However, the Centers for Disease Control and Prevention doesn’t recommend travelers change plans because the risk is low from the Middle East Respiratory Syndrome virus, which tends to spread through close person-to-person contact, usually through relatives or health care workers. The World Health Organization, while saying it was concerned about the virus, has stopped short of calling the recent outbreak a public health emergency.

The CDC’s health advisory posted at 22 airports, including Detroit Metro Airport, urges travelers to prevent spreading germs by washing their hands and avoiding touching their face. It also discourages contact with sick people.

If a traveler develops symptoms such as fever, cough and shortness of breath within 14 days of visiting the Arabian Peninsula, the CDC suggests contacting a doctor and discussing the trip.

Major airports have quarantine stations for travelers exhibiting symptoms. Anne Schuchat, director of the CDC’s center for respiratory diseases, said quarantine staffers and Customs officials have been reminded about symptoms and approaches to take.

The CDC has asked airline crews to report any passengers feeling feverish or with a temperature of at least 100 degrees, or who has a cough or difficulty breathing. The warning applies to flights from Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates and Yemen.

Tom Frieden, director of the CDC, said the agency doesn’t recommend screening all passengers coming off flights because they might not have developed symptoms yet or might be sick with something else.

The two U.S. cases involved health care workers who had returned from Saudi Arabia and were diagnosed Sunday in Florida and May 2 in Indiana.

Airport health advisories are relatively rare. Previous times that the CDC has posted advisories in airports include the December 2013 outbreak in the Caribbean of chikungunya virus, which causes joint pain and is transmitted by mosquitoes, and the April 2009 outbreak of swine flu called H1N1.

The 22 airports with CDC advisory posters about MERS are: the New York area’s John F. Kennedy, LaGuardia and Newark; Los Angeles; Chicago’s O’Hare; Washington’s Dulles; Houston; Dallas/Fort Worth; Atlanta; San Francisco; Seattle; Miami; Denver; Orlando; Boston; Minneapolis/St. Paul; Detroit; San Diego; Philadelphia; Charlotte; Las Vegas; and Baltimore.

Washtenaw County Public Health Dept Welcomes New Leadership

YPSILANTI, Mich., May 14, 2014 – Washtenaw County Public Health is pleased to announce the Board of Commissioners has appointed Ellen Rabinowitz as Health Officer. Ms. Rabinowitz has served as Acting Health Officer since January. During this same time, Kristen Schweighoefer accepted the role of Environmental Health Director. Both Rabinowitz and Schweighoefer bring a wealth of experience and public health expertise to their new roles.

“Ellen is certainly the right person to head Washtenaw County Public Health and to continue leading the Washtenaw Health Plan. With Kristen leading our Environmental Health Division, the entire department is in excellent hands” says Verna J. McDaniel, County Administrator. “Both Ellen and Kristen can hit the ground running, and we are fortunate to have them,” she continued.

As the local Health Officer, Ms. Rabinowitz provides leadership to a variety of health and environmental health activities focused on preventing health problems before they occur. She will maintain her role as Director of the Washtenaw Health Plan, Washtenaw County’s indigent health care program that provides access to health care services for low-income, uninsured residents.

“I am thrilled to help shape local public health during such an exciting time,” says Ms. Rabinowitz. “The way we do our work is changing, as our health and health care environment changes. I look forward to being a part of this transition – and to continually improving and protecting the health of our entire community.”

Prior to leading the Washtenaw Health Plan, Ms. Rabinowitz managed Washtenaw County Public Health’s Health Improvement Plan, a communitywide health assessment program. She holds a Master of Urban Planning degree and has served as an advisor and board member to multiple community-based organizations throughout the area.

As the Environmental Health Director, Kristen Schweighoefer, MPH, RS, oversees the work of the Division to protect and improve the quality of the environment and the health of area residents and guests. Professional staff members inspect food establishments, public pools and beaches, campgrounds, well and septic systems and body art facilities. The Division also provides technical assistance on ground water contamination, mold, radon, pests and more.

Ms. Schweighoefer is a Registered Sanitarian and holds a Master of Public Health degree in Epidemiology from the University of Michigan. She has filled several roles within the Environmental Health Division since 2000, most recently supervising a team of professional staff inspecting and licensing over 1,000 restaurants and food establishments operating throughout the jurisdiction. She contributes to the work of multiple state and local committees and received the Michigan Environmental Health Association’s Distinguished Member Service Award in 2010.

Ohio Measles Outbreak Largest in USA Since 1996

A measles outbreak in Ohio has reached 68 cases, giving the state the dubious distinction of having the most cases reported in any state since 1996, health officials say.

The Ohio outbreak is part of a larger worrisome picture: As of Friday, the federal Centers for Disease Control and Prevention had logged 187 cases nationwide in 2014, closing in on last year’s total of 189. CDC warned several weeks ago that the country could end up having the worst year for measles since home-grown outbreaks were eradicated in 2000.

The last time a state had more measles cases than Ohio has now was 1996, when Utah had 119, according to CDC.

The Ohio outbreak, like ongoing outbreaks in California and elsewhere, has been linked to unvaccinated travelers bringing the measles virus back from countries where the disease remains common. In Ohio, all of the cases have been among the Amish, health officials say. The outbreak began after Amish missionaries returned from the Philippines. The Philippines is experiencing a large, ongoing measles outbreak with more than 26,000 cases reported, according to CDC.

The California outbreak, also linked to the Philippines, had reached 59 cases as of Friday, according to the California Department of Public Health.

The center of the Ohio outbreak is Knox County, where 40 cases have been reported. Thousands of Amish in Knox and surrounding areas have lined up to be vaccinated, says Pam Palm, spokeswoman for the county health department. Though the Amish traditionally have low vaccination rates, “they have been very receptive to coming in and getting immunized,” to stem the outbreak, Palm says.

Some of the unvaccinated missionaries told local health officials they would have been vaccinated for measles before going to the Philippines if they had been told there was an outbreak there, Palm says: “One guy we spoke to feels just terrible that he brought the measles back and exposed his family.”

Ohio also is in the midst of a mumps outbreak of more than 300 cases. Given the outbreaks, state health officials are urging families to check vaccination records and get up to date before summer camps and gatherings begin. “Activities that bring large groups of people together can accelerate the spread of these diseases,” state epidemiologist Mary DiOrio said in a news release.

Before the measles vaccine became available in 1963, the virus infected about 500,000 Americans a year, causing 500 deaths and 48,000 hospitalizations. Case counts since 2000 have ranged from 37 in 2004 to a high of 220 in 2011, CDC says.

While most people recover from the fever, rash and other symptoms associated with measles after a few days, complications can occur, especially in children. Those complications can include ear infections and pneumonia or, more rarely, brain infection. One or two out of 1,000 children with measles will die, says CDC.

MERS Imported to US

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has caused severe illness and death in people from several countries. On May 11, 2014, the second imported case was confirmed in a traveler to the United States.

The first confirmed case of MERS-CoV was reported in a traveler to the United States on May 2, 2014. The patient, a healthcare worker who traveled from Saudi Arabia to a city in Indiana by way of London and Chicago, was isolated in a hospital during the course of illness and later discharged, having fully recovered.

On May 11, 2014, a second U.S. imported case of MERS was confirmed in a traveler who also came to the U.S. from Saudi Arabia. The patient is hospitalized and doing well. The patient flew from Saudi Arabia to the United States by way of London, England; Boston, Massachusetts; Atlanta, Georgia; and Orlando, Florida. CDC is working very quickly to investigate this second U.S. case of MERS and respond to minimize the spread of this virus.

For additional information, see the CDC MERS website
http://www.cdc.gov/coronavirus/mers/index.html

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first reported in 2012 in Saudi Arabia. It is different from any other coronavirus previously found in people. We don’t know where the virus came from or exactly how it spreads. However, it likely came from an animal source. All reported cases to date have been linked to the Arabian Peninsula.

Most people infected with MERS-CoV developed severe respiratory illness with symptoms of fever, cough, and shortness of breath. More than 30% of people with MERS have died. Most of the people who died had an underlying medical condition. Some infected people had mild symptoms or no symptoms at all.

Countries with Lab-Confirmed MERS Cases/Countries in the Arabian Peninsula with Cases

Saudi Arabia
United Arab Emirates (UAE)
Qatar
Oman
Jordan
Kuwait
Yemen
Lebanon

Countries with Travel-associated Cases

United Kingdom (UK)
France
Tunisia
Italy
Malaysia
Turkey

*This includes 1 case reported by Greece, 2 cases reported by Jordan, and 2 cases reported by the U.S., as the cases are residents of Saudi Arabia.

It is different from the coronavirus that caused SARS (Severe Acute Respiratory Syndrome) in 2003. However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats.

Coronaviruses are named for the crown-like spikes on their surface. They are common viruses that most people get in their lifetime. These viruses usually cause mild to moderate upper-respiratory tract illnesses.

Coronaviruses may also infect animals. Most of these coronaviruses usually infect only one animal species or, at most, a small number of closely related species. However, SARS coronavirus can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.

Global Partners Working to Understand MERS

The World Health Organization (WHO), CDC, and other partners are working to better understand the possible risks from MERS-CoV to the public’s health.

CDC Does Not Recommend Anyone Change Travel Plans

CDC does not recommend that anyone change their travel plans because of MERS. The current CDC travel notice is an Alert (Level 2), which provides special precautions for travelers. Because spread of MERS has occurred in healthcare settings, the alert advises travelers going to countries in or near the Arabian Peninsula to provide healthcare services to practice CDC’s recommendations for infection control of confirmed or suspected cases and to monitor their health closely. Travelers who are going to the area for other reasons are advised to follow standard precautions, such as hand washing and avoiding contact with people who are ill.