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.