Measles Outbreak – Just the Facts

You may have noticed that a lot of the people whom you are connected to through social media have started talking about measles. This is not entirely unexpected, considering that there is measles outbreak happening in the United States (as well as several other countries). Measles is a topic that people tend to have very strong feelings about. As a result, the information you’ve come across online could be a mixture of facts, emotional outbursts, and misinformation.

The internet is an excellent resource for finding information about a specific topic. Unfortunately, the very nature of the internet also makes it extremely easy for people to pass around misinformation (often without the person realizing that the information is incorrect).

The facts end up scattered across the internet, on a bunch of different websites, that are not directly connected to each other. In this blog, I will provide the facts about measles and the MMR vaccine (from credible sources). I will also update the blog with new information about confirmed cases. My goal is to have a “one-stop” resource for people who are seeking facts about the measles outbreak.

What is measles?
The Mayo Clinic describes measles as “a childhood infection caused by a virus”. Measles is also called Rubeola. The Center for Disease Control and Prevention (CDC) describes Measles this way: “Measles is a highly contagious respiratory disease caused by a virus.”

How is measles spread?
According to both the Mayo Clinic and the CDC, measles is spread when an infected person coughs or sneezes and sprays infected droplets into the air and another person breathes in those droplets. A person can also catch the measles virus by touching a surface that had infected droplets on it and then touching their eyes, nose, or mouth. The measles virus can live for up to two hours in an airspace or on a surface.

These facts could lead some people to assume that all that need to do to avoid catching measles is to stay away from people who have it. Others may question why a parent of a child who has measles would bring him or her out into public areas where the virus could affect a whole lot of other people.

The answer is simple: people who are infected with measles are contagious from four days before the rash appears to four days after the rash appears. A parent could be unaware that their child has the measles before the rash shows up. The CDC notes that “Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will become infected.”

What are the symptoms of measles?
Symptoms of measles starts with a fever, dry cough, runny nose, and sore throat. It can also include inflamed eyes (also called conjunctivitis or “pink eye”). At first glance, those symptoms sound a lot like a cold. Many doctors would have diagnosed these symptoms as a cold in part because measles had become quite rare and also because it would have been unlikely that a doctor would have actually seen a patient who had measles.

After the current outbreak, the CDC is instructing doctors “to consider measles when evaluating patients with febrile rash and ask about a patient’s vaccine status, recent travel history, and contact with individuals who have febrile rash illness.”

The febrile rash mentioned by the CDC is another symptom of measles. The Mayo Clinic describes it as a skin rash made up of large, flat blotches that often flow into one another. Again, by the time this rash appears, the person has been contagious for four days. Another symptom of measles is Koplik’s spots, which the Mayo Clinic describes as “tiny white spots with bluish-white centers on a red background found inside the mouth and inner lining of the cheek.”

What complications can come from having the measles?
Both the Mayo Clinic and the CDC provide a similar list of complications. The CDC includes statistics about how often a complication occurs. Children who are under 5 years of age, and adults who are older than 20 years of age, are more likely to suffer complications after catching the measles.

* Ear Infections – This occurs in about 1 out of every 10 children who have the measles. This complication can result in permanent hearing loss.

* Diarrhea – This occurs in less than 1 out of every 10 people with measles. Obviously, having diarrhea is unpleasant. The World Health Organization points out that the most severe threat posed by diarrhea is dehydration. Severe dehydration can result in death.

* Pneumonia – The American Lung Association points out that pneumonia is not a single disease. It is an infection that happens in one or both of a person’s lungs. Pneumonia can come from germs, bacteria, viruses, and fungi and has more than 30 different causes. About one-third of the pneumonia cases in the United States are caused by respiratory viruses.

The American Lung Association notes that pneumonia has its own potential complications. It can result in respiratory failure (which requires a breathing machine or ventilator). It can result in sepsis, “a condition in which there is uncontrolled inflammation in the body which may lead to widespread organ failure.” It can lead to Acute Respiratory Distress Syndrome (ARDS) which is a severe form of respiratory failure. It can use cause lung abscesses (an infrequent, but serious complication of pneumonia). They occur when pockets of pus form inside or around the lung. These pockets may need to be drained with surgery.

Those who are most likely to experience complications from pneumonia include older adults, very young children, people whose immune systems do not work well, and people who have serious medical problems. People who are suffering from other illnesses (such as measles) and who then catch pneumonia, lower their chances of a fast recovery from pneumonia. The CDC notes: “About one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.”

* Encephalitis – The Mayo Clinic points out that about 1 in 1,000 people with measles develop encephalitis. It is an inflammation (or swelling) of the brain that can cause vomiting, convulsions, or (rarely) coma or death. They note that encephalitis can closely follow measles or can occur months later. The CDC notes that encephalitis can cause a child to become deaf or to have intellectual disabilities.

* The Mayo Clinic notes that “If you’re pregnant, you need to take special care to avoid measles because the disease can cause pregnancy loss, preterm labor, or low birth weight”. This is definitely something to keep in mind for moms who are pregnant and who have a child that catches the measles.

* The CDC states: “For every 1,000 children who get the measles, one or two will die from it”.

How to prevent catching the measles.

* The only way to prevent a person from catching measles is to make sure the person is fully vaccinated. The Mayo Clinic points out that people who were born after 1957, and who haven’t been vaccinated, should be vaccinated as soon as possible. They also note that infants older than 6 months should be vaccinated. (There are some people who cannot be vaccinated, and I will get into that a little bit later).

The CDC states that one dose of the measles vaccine is about 93% effective at preventing measles if exposed to the virus and two doses is about 97% effective at preventing measles if exposed to the virus.

The Mayo Clinic has some advice that will help prevent the spread of measles. If your family member has measles, that person should be isolated. They should not return to work, or school, or other activities where they will interact with people from four days before the rash appears through four days after it has appeared. Make an effort to keep non-immunized people away from the person who has the measles. For example, if an unvaccinated five year old catches the measles, it would be a good idea to keep their younger sibling, who is too young to receive the vaccine, away from the infected child.

What vaccine prevents measles?
The vaccine is called the MMR vaccine. It protects from not only measles but also mumps and rubella.

The National Health Service (NHS) in the UK explains how the MMR vaccine works: The MMR vaccine contains weakened versions of live measles, mumps, and rubella viruses. The vaccine works by triggering the immune system to produce antibodies against measles, mumps, and rubella. This is how the body develops immunity to measles, mumps and rubella.

What about that study from Andrew Wakefield?
Many of the people who are fearful of the MMR vaccine feel that way because they heard about a study done by Andrew Wakefield that suggested that the MMR vaccine caused children to develop autism. It is important to know that his work has been discredited. The BMJ (British Medical Journal) has extensive details about the study and and explanations about why it was inaccurate. I’ll post a short summary with facts from that source.

* Andrew Wakefield’s study was published in The Lancet in 1988. It was authored by Andrew Wakefield, John Walker-Smith, and 11 others from the Royal Free medical school in London, England. The study reported a proposed “new syndrome” of enterocolitis and regressive autism and associated that “new syndrome” with the MMR vaccine. It suggested that the vaccine was a “precipitating event” that caused autism.

* The study involved 12 developmentally challenged children.

* Three of the nine children in the study who were reported to have regressive autism did not have autism diagnosed at all. Only one child in the study had regressive autism.

* The study claimed that all 12 children were “previously normal” before receiving the MMR vaccine. In reality, five of the children had documented pre-existing developmental issues.

* Nine of the children in the study had unremarkable colonic histopathology results. Their results showed no fluctuations, or minimal fluctuations in inflammatory cell populations. In other words, they did not have the “new syndrome” of enterocolitis.

* The parents whose children were involved in the study were sent to Andrew Wakefield from a group called JABS which stands for “Justice, Awareness & Basic Support”. It is an anti-vaccination group in the UK. Why does that matter? It shows that the small group of children who were involved in the study were specifically selected because their parents distrusted vaccines. It was not a random sample.

* In February of 1998, Andrew Wakefield held a press conference in which he stated that he had “sufficient anxiety” about the MMR vaccine in combination. He suggested that the MMR vaccine should be suspended in favor of the single vaccines.

In 1995, Andrew Wakefield filed a patent for a diagnostic test for Crohn’s disease. Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. It most commonly affects the end of the small bowel (the ileum) and the beginning of the colon. (Note: His study did not find that the children had Crohn’s disease, so he made up a “new syndrome” called “autistic enterocolitis”.)

In 1996, a lawyer named Richard Barr was hoping to bring a lawsuit against vaccine manufacturers. He just so happened to also be connected with the JABS anti-vaccine group. He put together a paper with signs that parents should look for and directed parents who thought their children had those signs to contact JABS who would put the parent in touch with Andrew Wakefield. Richard Barr paid the school Wakefield was working in £25000 for a “clinical and scientific study”. This first installment (and subsequent ones) were not disclosed in the study that Wakefield (and others) produced.

In 1997, eight months before Andrew Wakefield’s study (which, as I mentioned, has since been debunked), he filed a patent for a single shot for measles. His business plan aimed to raise £2.1m from investors for the detection of Crohn’s disease, the treatment of autism, and “a replacement for attenuated viral vaccines”.

* 10 of the 13 authors of the study have retracted the findings. In 2010, British authorities stripped Andrew Wakefield of his medical license. The Lancet retracted the paper. The UK’s General Medical Council found Andrew Wakefield guilty of 30 charges, including four counts of dishonesty and 12 of causing children to be subjected to invasive procedures that were clinically unjustified.  Several of the children had an ileocolonoscopy which the Medical Dictionary defines as: “endoscopic examination of the distal gastrointestinal tract, including the rectum, colon, and terminal ileum.”

What causes autism?
Autism is not caused by the MMR vaccine. The real cause (or causes) of autism are still being studied. The NHS has a brief summary of what researchers have found regarding autism (or ASD, which stands for Autism Spectrum Disorder).

Scientists aren’t certain about what causes ASD, but it’s likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with ASD have found irregularities in several regions of the brain. Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that ASD could result from the disruption of normal brain development in early fetal development cause by defects in genes that control brain growth and that regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function. While these findings are intriguing, they are preliminary and require further study. The theory that paternal practices are responsible for ASD has long been disproven.

What is in the MMR vaccine?
The easiest to understand explanation of the ingredients in the MMR vaccine comes from an article at NBC News. The information comes from Dr. Walt Orenstein, who is a vaccine expert at Emory University and a former assistant surgeon general and former head of the United States Immunization Program. Or, you could read the same information from the Food and Drug Administration (FDA).

* The MMR vaccine contains attenuated viruses (for measles, mumps, and rubella). A live attenuated virus is one that has been grown in a lab and weakened until it is unable to replicate well (or at all) in human cells. The weakened virus provokes the immune response in the person who has been given the MMR vaccine. It “teaches” the body to fight those viruses and gives the body weakened opponents to fight against as it is learning to recognize those viruses.

* The attenuated measles viruses, and the attenuated mumps viruses, are grown in cultures of chick embryos (which are unhatched live eggs). NOTE: Human embryos are not used in the MMR vaccine.

* The attenuated rubella viruses are grown in the lab from human lung cells. This is a point of confusion for some people. The rubella virus is grown in WI-38 human diploid lung fibroblasts. A fibroblast is a cell that makes up the structural framework of the extracellular matrix and collagen in animal tissues. It is the cell that creates a framework that holds tissues together.

The original cells in the WI-38 human diploid lung fibroblasts came from one female human fetus that was aborted at four months of gestation. Leonard Hayflick obtained human lung cells from that fetus in 1962. The cells used to grow the rubella virus that is used in vaccines today are descendants of those original cells. I think it is important to point out that the cells came from one fetus that was aborted in 1962. Nobody is out harvesting aborted fetuses today in an effort to obtain cells that they want to use in vaccines. There simply is no need to do so.

There are some people who allow their negative views about abortion to influence them to avoid getting their children vaccinated because the MMR vaccine contains attenuated viruses that were grown in cells that descended from cells obtained from an aborted fetus. This viewpoint results in children who are not vaccinated with the MMR vaccine and who are not protected from catching measles, mumps, or rubella.

* The growth medium for measles and mumps is Medium 199. It is made from salt, vitamins, amino acids and fetal bovine serum. Serum is the liquid part of blood. The fetal bovine serum comes from a calf fetus. It has been screened for the absence of adventitious agents. The growth medium also contains SPGA which includes sucrose, phosphate, glutamate, and recombinant human albumin.  The SPGA mixture is used as a stabilizer.

Sucrose is table sugar.  Phosphate is an ion (charged particle) that contains a mineral called phosphorus. Glutamate is also called monosodium glutamate or MSG.

What is recombinant human albumin? Recombinant refers to an organism, cell, or virus in which genetic recombination has taken place. Genetic recombination is something that naturally happens in cells during meiosis. In short, it shuffles the genetic material that was inherited from the parents. Human albumin is a concentrate of plasma proteins that come from human blood. It is a component of human blood. The human serum albumin comes from blood donations that have been screened.

* Neomycin is an an antibiotic that fights bacteria in the body.

* The growth medium for rubella is Minimum Essential Medium (MEM). It, too, is a salt solution that contains vitamins, amino acids, and fetal bovine serum. It also contains recombinant human albumin and neomycin. In addition, sorbitol and hydrolyzed gelatin stabilizer are added. Sorbitol is a type of sugar alcohol that is manufactured from cornstarch.

Hydrolysis is a chemical process that splits a molecule into two parts by the addition of a molecule of water. Something that has been hydrolyzed has been through this process. Gelatin comes from collagen which is a natural protein that is in the tendons, ligaments, and tissues of mammals. This gelatin is different from the kind that is used in food. The gelatin in the MMR vaccine comes from pigs.

You may have noticed that I didn’t mention thimerosal. That ingredient is another one that people tend to be confused about. When it comes to the MMR vaccine, there is absolutely no need to worry about thimerosal. It hasn’t been an ingredient in the MMR vaccine since 2001.

Who shouldn’t receive the MMR vaccine?
Earlier, I mentioned that there are some people who should not get the MMR vaccine. The CDC does not recommend the MMR vaccine for infants who are younger than 6 months of age. In general, the recommendation is to get the first MMR dose at 12 to 15 months of age.

Other people who should not get the MMR vaccine (or who should wait to get it) include:

* Anyone who has had a life-threatening allergic reaction to neomycin (or other components of the MMR vaccine). Tell your doctor if your child has severe allergies.
* Anyone who has had a life-threatening allergic reaction to a previous dose of MMR or MMRV vaccine. This group of people should not get a second dose.
* People who are sick at the time the vaccine is to be administered. Wait until you (or your child) recovers and then go get the vaccine.
* People who are pregnant should not get the MMR vaccine. Instead, they should wait to get it until four months after giving birth. Ideally, people should wait to get pregnant until 4 weeks after being vaccinated with the MMR vaccine.

The rest of the people who should not get the MMR vaccine (or who should wait to get it) are those with weakened immune systems.
* A person who has HIV/AIDS or another disease that affects the immune system
* A person who is being treated with drugs that affect the immune system (for example, steroids)
* A person who has cancer (of any kind)
* A person who is being treated for cancer with radiation or drugs
* A person who has ever had a low platelet count (in other words, a blood disorder)
* A person who has recently gotten another vaccine within the past 4 weeks (Wait a while and try again to get the MMR vaccine later).
* A person who recently had a transfusion or received other blood products.
* Some elderly people who have certain medical problems should not get the vaccine.

What protects people who cannot have the MMR vaccine from catching the measles?
It may sound strange, but the people who cannot have the MMR vaccine (because they are too young to get it, or their immune system is weakened, or due to autoimmune diseases, pregnancy, cancer, or other health issues) are protected by the people who can get the MMR vaccine. This concept is called herd immunity.

An entire community can be protected from a disease thanks to two things – vaccinations and herd immunity. It works like this: First, all the people who are healthy enough to be vaccinated (who aren’t among the above listed groups) receive a vaccine. Those people are now immune to the disease. The vaccine protects them from catching it. If they cannot catch the vaccine, then they cannot spread it to others – including the people who are too young, or who have health issues, and who cannot receive the vaccine themselves.

Herd immunity works when a population has a certain percentage of people who have been vaccinated. This percentage is called a “threshold”. To prevent measles, 83% -94% of the population needs to have received the vaccine. (Or, some small percentage of that group could be people who are now elderly and who had measles when they were a child). For mumps, the threshold is 75% – 86%. For Rubella it is 83% – 85%.

There is a very simple way to think about herd immunity. A parent who makes sure that their healthy child receives the MMR vaccine is protecting that child from catching measles, mumps and rubella. At the same time, they are protecting the child’s infant sibling, who is too young to receive the vaccine, from catching it from the older sibling. An adult who was properly vaccinated as a child is helping to prevent his neighbor, who is immune-compromised, from catching measles, mumps, and rubella.

What happens if we fall below the threshold?
It is entirely possible for a community to fall below the threshold that grants herd immunity. All it takes is for a large enough portion of a population to refuse to vaccinate their children with the MMR vaccine. Once that happens, all it takes is for the highly contagious measles virus to infect one person who has not been vaccinated. The virus can quickly spread through his home (and his workplace or classroom) and infect everyone else who was not vaccinated. This is how a measles outbreak occurs.

A list of known cases of measles (since Disneyland):

* January 18, 2015:  One infant, a four-month-old named Mobius Loop has a confirmed case of measles. He is too young to have been vaccinated. He caught the measles when his parents brought him to Disneyland on January 18, 2015. His mother, Ariel, is a registered nurse.

* January 23, 2015: The California Department of Public Health confirmed 78 cases of measles in seven states and Mexico. 48 of those cases were directly linked to being at Disneyland or Disney California Adventure in December of 2014.

Patients range from 7 months old to 70 years. Of the 39 cases in California, 32 were unvaccinated. Five Disneyland employees were diagnosed with measles. There were confirmed cases of measles in Utah (3), Washington state (2), and one in Oregon, Colorado, Arizona, Nebraska, and Mexico.

* February 3, 2015:  One case of measles has been confirmed in Washington, D.C. The case is related to international travel.

* February 4, 2015: One confirmed case of measles in Port Angeles, Washington. A middle-aged man caught the measles. The source of the exposure is unknown.

* February 5, 2015: One case of measles was confirmed in Ontario’s Niagara region. A woman, who had been in Toronto twice in late January, was hospitalized with complications of measles (but was recovering). The woman was in her early 20’s and said she was unvaccinated.

* February 6, 2015: The total number of confirmed measles cases in California has grown to 103.

* February 6, 2015: One case of measles was confirmed in New Jersey. An infant, who is 1-years-old, caught measles and recovered. The infant had not yet been vaccinated.

* February 6, 2015: 6 people in Toronto were diagnosed with measles. One was a patient who was at St. Joseph’s Health Centre emergency department from January 27 through 29 of 2015. Other measles cases include two children (each under 2 years of age) and three adults. One of the adults was born before 1970.

* February 7, 2015: 5 infants who attended a KinderCare Learning Center in Palatine, Illinois, have tested positive for measles.At least two of the children were not vaccinated for measles (due to their age).

* February 7, 2015: 9 confirmed cases of measles identified in Nevada. One of the children was a student at Spanish Springs Elementary School, which is a school where relatively few students are vaccinated against measles (due to parent’s personal beliefs).

* February 7, 2015: 7 cases of measles have been confirmed in Arizona. 5 were from people who had visited Disneyland. One of the five people, a woman in her 50’s, returned home to Maricopa County, Arizona. The other four people were all from the same family (who had not been vaccinated) returned home to Kearney, Arizona, in Pinal County. A sixth case was confirmed in a woman who visited the Phoenix Children’s East Valley Center after the family from Kearney had been there. The seventh case is a man who also caught measles from the family in Kearney.

* February 7, 2015:  One case of measles has been confirmed in New Jersey. The case was a 1-year-old baby in Jersey City. This baby has recovered. This baby had not been vaccinated, but health guidelines recommend the first measles vaccine be given between 12 and 15 months. This case does not appear to be connected to the Disneyland cases.

* February 7, 2015: One case of measles has been confirmed in New Mexico. It was an unvaccinated baby who was hospitalized in December of 2014 and has since recovered. The origin of the baby’s infection is unknown, but is unrelated to the California outbreak because it pre-dates the first Disneyland infection.

* February 8, 2015: The number of confirmed measles cases in Illinois is now at 6. This includes the 5 babies from the KinderCare. It now also includes an adult who became ill in late January of 2015. This case is unrelated to the cases from the KinderCare.

* February 9, 2015: One case of measles has been confirmed in Georgia. It was confirmed by the state’s Health Department. The case was in an infected infant that arrived in Atlanta from outside of the United States. The infant is being cared for at Egleston at Children’s Healthcare of Atlanta.

* February 9, 2015: The number of confirmed measles cases in Cook County, Illinois, is now at a total of 8. This includes 6 infants at a KinderCare in Palatine, Illinois. It also includes 2 adults. (One was an adult who was not an employee at the KinderCare.) All eight people were unvaccinated. (The infants were too young to be vaccinated.) Illinois health officials do not yet know how the infants caught the measles. There is no connection between these cases and the Disneyland ones.

* February 9, 2015: The number of confirmed cases of measles in California is now at 107. 39 cases can be directly linked to visitors or employees at Disneyland during the holidays. 25 cases are family members or people who came in close contact with someone who had the measles. At least 5 cases of measles were caught by being in a public area such as an emergency room where a confirmed case was known to be present.

* February 10, 2015: The number of confirmed measles cases in Cook County, Illinois, is now at 9. This includes the 6 infants at the KinderCare in Palatine, Illinois, and the 2 adults. In addition, there is now one more confirmed case of measles in another infant from the KinderCare (bringing the number of measles cases in infants from that KinderCare to 7).

* February 10, 2015: The number of confirmed measles cases in Illinois is now at 10. This includes the 7 infants at the KinderCare in Palatine, Illinois, and 2 adults. The infants were too young to be vaccinated and the 2 adults were unvaccinated. The new case of measles is from a student at Elgin Community College in Cook County, Illinois.

* February 10, 2015: Health Department officials have confirmed 4 cases of measles in Pasadena, California.

* February 11, 2015: There are officially 10 confirmed cases of measles in Quebec, Canada. Health officials say that these cases stem from a visit to “a California theme park where other cases have been reported”. The 10 people who caught the measles were unvaccinated. The ages of the measles patients has not been released.

* February 11, 2015: There are now officially 4 cases of measles in Nevada. The first case was an vaccinated student at Valley High School. The second case was an unvaccinated adult. This case was unrelated to the case with the high school student, but may be connected to the Disneyland strain. Third strain was an under-immunized adult who is employed at Emeril’s New Orleans Fish House inside MGM Grand. The fourth case is a young child who received a single dose of the measles vaccine (which requires boosters). This case is unrelated to the other three cases.

* February 11, 2015: There is now one more confirmed case of the measles in California. This case is from an adult who rode the San Francisco Bay Area Rapid Transit system (BART). The adult is an office worker at LinkedIn. No further details have been released.

* February 11, 2015: There are now officially 11 cases of measles in Illinois. These cases include the 8 infants and 1 adult from the KinderCare in Palatine, Illinois. The infants were too young to be vaccinated and the adult was unvaccinated. It also includes the student at Elgin Community College in Cook County, Illinois, who was unvaccinated. The newest confirmed case of the measles is from another infant from the KinderCare (bringing the total number of infants to 9).

* February 11, 2015: Public health officials have confirmed one case of measles in the York Region. This person was fully vaccinated. The Toronto Star reported that the person is an adult male under the age of 30 who has not traveled outside Canada recently. This brings the total number of cases in the York Region to 7.  That number includes the earlier confirmation of 6 cases of measles in Toronto, Canada.  One was a patient who was at St. Joseph’s Health Centre emergency department from January 27 through 29 of 2015. Other measles cases include two children (each under 2 years of age) and three adults. One of the adults was born before 1970.

* February 13, 2015:  A 5th case of measles has been confirmed in Nevada.  The new case involves a person who has been identified as the source of the confirmed case of measles caught by an under-immunized adult who was employed at Emeril’s New Orleans Fish House inside MGM Grand (the third case of confirmed measles in Nevada). The first confirmed case involved an unvaccinated student at Valley High School. The second case was an unvaccinated adult.  That case was unrelated to the case with the high school student but might have been connected to the Disneyland outbreak.  The fourth case was a young child who received a single dose of the measles vaccine (which requires boosters).  That case is unrelated to any of the other cases.

* February 13, 2015:  2 more cases were confirmed in Ventura County, California. This brings the number of cases in Ventura County to 14 and the total number of measles cases in California to 110.  One of these new cases involves a Ventura County resident that visited Disneyland and the Magic Mountain Theme Park in December of 2014.  Nothing is being reported about the second case other than the places that person recently went to.

* February 13, 2015: The total number of confirmed measles cases in Illinois, is now at 13.  The 2 new cases are in two infants, each of whom is under 1 year of age.  Both of the infants were associated with the KinderCare Learning Center in Palatine, Illinois.

* February 13, 2015: The total number of confirmed measles cases in Washington state is now at 5.  The newest case involves a 5 year old kindergartner who attended Olympic Christian School in Port Angeles, Washington.  She was unvaccinated.  This child had direct contact with a 52 year old Port Angeles man who was hospitalized with measles last month.  Neither of these cases is connected to the Disneyland cases.  This is the second case of measles in Port Angeles, Washington.

* February 14, 2015:  3 more cases of measles have been confirmed in Ontario, Canada.  This bring the total number of confirmed measles cases in Ontario to 11.  Previous cases include: two children (each under two years of age) and five adults, all from separate families, with no recent travel history.  One of the new cases involves a 14-year-old girl who had been confirmed as the 9th case in the Greater Toronto Area.  She was unvaccinated.  Another is an adult in the Toronto area who had no recent travel history and an unknown vaccine history.  There is no information on third case other than it was an adult.

* February 14, 2015: There is now a total of 22 confirmed cases of measles in Canada.

* February 15, 2015:  5 more cases of measles have been confirmed in Canada.  One of the newly confirmed cases involved a person who attended the “Acquire the Fire” Christian youth event in Ontario on February 6 and 7, 2015.  The other four cases are connected to that case.

* February 16, 2015: Health officials in Arizona think the measles outbreak in their state is “likely over”.  They have had a total of 7 confirmed cases of the measles in Arizona.  All of those cases were connected to the Disneyland outbreak.  No new cases have been confirmed in Arizona.

* February 17, 2015: There is now a total of 14 confirmed cases of measles in Illinois.  The new case involves yet another infant from the KinderCare in Palatine, Illinois.  Thirteen of the 14 cases are connected to that KinderCare, including 12 babies and 1 adult.  There was also a case of measles in an adult who was not associated with the KinderCare.

* February 17, 2015:  The CDC reported today that it had confirmed 141 cases of measles since January 1, 2015.  As of February 13, cases linked to the Disneyland outbreak numbered 113.  There were 10 cases linked to another outbreak, and 18 more cases that weren’t linked to a specific outbreak.

* February 17, 2015: There is now a total of 2 confirmed cases of measles in Washington D.C.  The second case is not related to the Disneyland outbreak.  The first case was related to international travel.

* February 18, 2015:  A 6th case of measles in the Niagara Region.  The newest one involves an unvaccinated female who is connected to the first person in Niagara to have been diagnosed with measles earlier this month.  All the measles cases in the Niagara Region are connected to the original case.  The Globe and Mail says this brings the number of measles cases in the Niagara Region to 17.

* February 19, 2015:  One more case of measles has been confirmed in San Bernardino County, California. This brings the total number of confirmed measles cases in that county to 9. The newest case is related to the Disneyland outbreak.

* February 19, 2015:  One more case of measles has been confirmed in Port Angeles, Washington. This bring the total number of measles cases in the county to three.  The new case involves a 43-year-old Port Angeles man who was a personal acquaintance of a 52-year-old man in Port Angeles who was previously confirmed to have the measles.  The 43-year-old man has been in quarantine since February 5, 2015.  The other case involves a five-year-old girl who was a student at Olympic Christian School in Port Angeles.  She was unvaccinated and had direct contact with the 52-year-old man.  None of these cases are connected to the Disneyland outbreak.

* February 20, 2015:  There are now 4 confirmed cases of measles in Washington.  The new case involves a teenage boy who is a sibling to the five-year-old girl that has previously been confirmed with measles.  The report did not state where the teenager is from, but the other three confirmed cases of measles were in Port Angeles, Washington.

* February 20, 2015: The number of confirmed cases of measles in California is now at 123.  75 of them are in people who visited or worked at Disneyland or had contact with a sick person who was a Disneyland.  The California Department of Public health isn’t sure how the other 48 people got the measles, but note that the virus strain is similar to the one from the Disneyland outbreak.  Most of the people who caught the measles were not vaccinated.

* February 20, 2015: The total number of measles cases from the Disneyland outbreak is now at 149.  These cases include patients from across eight states, Canada, and Mexico.  About 56% of the confirmed measles cases were adults.  Of those whose vaccination status was know, the majority of those adults were unvaccinated.

* February 21, 2015: The total number of confirmed measles cases in Quebec is now at 19.  The first 18 cases are connected to the Disneyland outbreak.  One new case has been confirmed but public health officials haven’t released any details about it.  Previous to that case, all of the confirmed cases of measles in Quebec involved people who were unvaccinated.  There is also now a total of 18 confirmed measles cases in Ontario, and one confirmed case on Manitoba.

* February 21, 2015:  A 6th case of measles has been confirmed in Nevada.  The newest case involves an adult who recalled being immunized as a child but who doesn’t have shot records.  The five previous confirmed cases of measles in Nevada include: The fifth case involves a person who has been identified as the source of the confirmed case of measles caught by an under-immunized adult who was employed at Emeril’s New Orleans Fish House inside MGM Grand (the third case of confirmed measles in Nevada). The first confirmed case involved an unvaccinated student at Valley High School. The second case was an unvaccinated adult. That case was unrelated to the case with the high school student but might have been connected to the Disneyland outbreak. The fourth case was a young child who received a single dose of the measles vaccine (which requires boosters). That case is unrelated to any of the other cases.

* February 25, 2015: There is now a total of 15 confirmed cases of measles in Illinois.  The newest case involves an adult in suburban Cook County.  This case is not connected to the cases from the KinderCare Learning Center in Palatine, Illinois, and is also not connected to an earlier case where an adult became infected with measles in January of 2015.  The previous cases include: 12 infants from the KinderCare (who were too young to be vaccinated), an adult who was associated with the KinderCare (and who was not vaccinated), and student at Elgin Community College (ECC) who was unvaccinated.

* February 26, 2015:  One more adult, who has since been confirmed with a case of measles, rode the BART in San Francisco, California. No further information has been released about this person other than the person is an adult. That’s the second person who rode the BART while contagious with measles. The total number of confirmed measles cases in San Mateo County, California, to 4.

* February 26, 2015: The total number of confirmed measles cases in Washington is now 7.  The newest case involves an adult man in Whatcom County, who was exposed to measles while visiting a contagious relative in Los Angeles, California.  It is unknown whether or not this man had been vaccinated, and unclear whether or not this case is connected to the Disneyland outbreak.

Previous confirmed cases of measles in Washington include: a 43-year-old Port Angeles man who was a personal acquaintance of a 52-year-old man in Port Angeles who was previously confirmed to have the measles. The 43-year-old man has been in quarantine since February 5, 2015.  Another involves a five-year-old girl who was a student at Olympic Christian School in Port Angeles. She was unvaccinated and had direct contact with the 52-year-old man. None of these cases are connected to the Disneyland outbreak.  Another case involves a teenage boy who is a sibling to the five-year-old girl who was confirmed with measles.  There were also 2 confirmed cases of measles in Grays Harbor County that were connected to the Disneyland outbreak.

* February 27, 2015:  There are now a total of 9 confirmed cases of measles in Nevada.  The three newly diagnosed cases involve two staff members and a patron of Emeril’s New Orleans Fish House at the MGM Grand in Las Vegas, Nevada.  None of these cases are connected to the Disneyland outbreak.

The previously confirmed cases of measles in Nevada include: an unvaccinated student at Valley High School, an unvaccinated adult (who was unrelated to the high school student but might be connected to the Disneyland outbreak), an adult who recalled being immunized as a child but who didn’t have shot records, an adult who was employed at Emeril’s New Orleans Fish House, an adult who has been confirmed as the source of the measles for the employee at Emeril’s New Orleans Fish House, and a young child who received a single dose of the measles vaccine (which requires boosters).  The infant was too young for the MMR vaccine.  That case is unrelated to any of the rest.

* February 27, 2015:  One student at Amelia Earhart Middle School in Riverside County, California, has been confirmed with a case of measles.  The student is now doing fine and is no longer contagious.  Staff at the school do not know how this student caught the measles.  They staff is not allowed to disclose whether or not the student had been vaccinated (due to privacy laws).  This case is not connected to the Disneyland outbreak.  This brings the total of confirmed cases of measles in Riverside County to eight – three adults and five children.

* February 27, 2015: The total number of confirmed cases of measles in California is now 130.  This number comes from the California Department of Public Health.

* March 2, 2015: The US Centers for Disease Control and Prevention (CDC) report that the total number of confirmed measles cases in the United States is at 170.  The measles cases are in 17 states and the District of Columbia.  The majority of those cases are linked to the Disneyland outbreak.

* March 2, 2015: The California Department of Public Health says there have now been 131 confirmed cases of measles in California. That’s one more case than was confirmed on February 27, 2015. There are no further details.

* March 3, 2015:  One case of measles has been confirmed in Merced County, California.  This case involves a child who is under the age of 5.  The child had received one of two vaccinations recommended to protect against measles.  It is estimated that the child was infected around February 23, 2015.  The child is not in school or day care and has not traveled outside of Merced County.

* March 5, 2015: The Los Angeles County Department of Public Health confirmed one case of measles in Santa Clarita Valley, California. The case was diagnosed at a pediatric care facility. No further information has been revealed (including the age of the person who had measles).

* March 6, 2015: Cara Christ, chief medical officer and deputy director for public health at the Arizona Department of Health Services declares that the measles outbreak is officially over. The state had a total of 7 confirmed cases of measles.

* March 9, 2015: The Centers for Disease Control and Prevention report that there have been 173 confirmed cases of measles this year.  About 73% of the cases are linked to the Disneyland outbreak.  The cases have been reported in 17 states and Washington D.C. from the beginning of 2015 through March 6, 2015.

* March 11, 2015: The number of confirmed measles cases in Quebec’s Lanaudière region is now at 119. The Lanaudière Public Health Department states that all of the 119 cases are related. All of the confirmed cases involve children or adults from the same religious community, L’esprit Saint, and all of the people who caught measles were unvaccinated.  These cases are connected to the Disneyland outbreak.

* March 12, 2015: The health minister for the Ontario region in Canada has declared that area is now “measles free”.

* March 12, 2015: Valerie  Jaeger, a medical officer of health with the Niagara Region Public Health (in Niagara, Canada) declares that the measles outbreak in that region is over.

* March 14, 2015: California state health officials say that the measles outbreak that started in Disneyland is now “fading away”.

* April 17, 2015: California health officials declare the measles outbreak over.

UPDATE:  On July 2, 2015, the Washington State Department of Health reported that a woman who died in Clallam County, Washington, during the spring of 2015 died due to an undetected measles infection that was discovered at autopsy. They believe she was exposed to measles at a local medical facility during the recent outbreak in Clallam County.

The woman had several other health conditions and was on medications that contributed to a suppressed immune system. She didn’t have a rash, so the measles infection was not discovered until after her death. This situation shows how important herd immunity is for people who are immunocompromised. Her death was the first death due to measles in the United States in a dozen years.

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Image by Dave Haygarth on Flickr.

Measles Outbreak – Just the Facts is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites.

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