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Between Jan. 1, 2015 and Feb. 8, 2015, the IHR National Focal Points of Brazil, Canada, Mexico and the United States notified the World Health Organization (WHO) of a total of 147 cases of measles, most of which are related to a large multi-state outbreak in the United States.
A total of 121 measles cases have been reported in the United States from Jan. 1 through Feb. 6 in 17 states and Washington, D.C.:
District of Columbia (1)
New Jersey (1)
New York (2)
South Dakota (2)
For cases with ages reported, the age of case-patients range from less than 12 months to 59 years old (median age is 19 years old). The majority of cases (103) are linked to an amusement park in California, which they visited between Dec. 17 and Dec. 20, 2014. The outbreak likely started from a traveler who became infected overseas with measles and visited the amusement park while infectious; however, no source has been identified.
Canada is investigating two separate measles outbreaks. On Feb. 3, the Lanaudiere Public Health Department of the Agency for Health and Social Services in Quebec province reported a total of eight suspected cases of measles since the beginning of 2015. These suspected cases are members of the same family, who are unimmunized for religious reasons. They are linked to the current outbreak in the United States. On Feb. 2 in Ontario province, the Toronto Public Health reported four laboratory-confirmed cases of measles, involving two children under the age of two and two adults from four different families. As of yet, no source has been identified and there are no known links or contact between the cases. Contact tracing of exposed contacts is underway for the two outbreaks.
The Mexico IHR National Focal Point reported two imported cases of measles with history of travel to the United States. The first case is a 22-month-old female from Baja California Sur, Mexico (rash onset Dec. 30, 2014) with history of travel to California from Dec. 16 to Dec. 18, 2014. The second case is a 37-year-old unvaccinated female from Nueva León state (rash onset Jan. 13, 2015), whose only history of recent travel was to San Francisco, Calif. from Dec. 26 to Dec. 31, 2014. Local and national authorities have implemented appropriate prevention and control measures. So far, no further cases have been registered in Mexico.
Ongoing measles transmission has being reported in the northern states of Pernambuco and Ceará, Brazil for the period 2013 through 2015. Measles virus was first detected in Pernambuco on March 19, 2013. From that time to the end of the outbreak, on March 14, 2014, a total of 224 confirmed cases, including one fatal case, were reported in 24 municipalities. The most affected group was children under 1 year old (44.6%; 110/224). Genotype identified was D8.
This outbreak spread out to the neighbour state Ceará, where the first case was reported on Dec. 25, 2013. As of Feb. 5, a total of 718 cases were confirmed in 31 municipalities. Rash onset of the last confirmed case is Jan. 19, 2015. No deaths have been reported yet. Most cases are in children less than 5 years old (37.1%), followed by adolescents and adults aged 15 to 29 years old (33.2%). A total of 51 cases remain under investigation in 12 municipalities; rash onset of the last suspected case was Feb. 2, 2015. Genotype identified was D8.
Additionally, one case with travel history to Fortaleza, Ceará was reported in a 40-year old male, a resident of the state of Roraima.