Measles Cases Surpass 700 as Outbreak Continues Unabated
The outbreak is now the worst in decades. Children under age 5 account for about half of the cases.
Via NYTimes, By Donald G. McNeil Jr.
Measles continues to spread in the United States, federal health officials said on Monday, surpassing 700 cases this year as health officials around the country sought aggressive action to stem the worst outbreak in decades.
In New York, an epicenter of the outbreak, city officials closed two more schools for Orthodox Jewish children for failing to comply with an order to exclude unvaccinated children.
In California, hundreds of students and staff members at two universities remained under quarantine following possible exposure to the virus.
And with measles spreading globally, officials at the Centers for Disease Control and Prevention have urged Americans traveling abroad to make sure they are immunized against the disease. On Monday, the agency renewed an urgent call for parents to get their children vaccinated.
Heidi Clarke held her son, Micah Risner, 5, as a nurse, Ann Rowland, administered immunizations in Portland, Ore. Federal officials now fear that measles may regain a foothold in the United States.Credit: Alisha Jucevic for The New York Times
“The outbreaks in New York City and New York State are the largest and longest-lasting since measles elimination in 2000,” Dr. Nancy Messonnier, the C.D.C.’s director for immunization, said at a news conference.
“The longer this continues, the greater the chances that measles will again get a foothold in the United States,” she said.
More than 500 of the 704 cases recorded as of last Friday were in people who had not been vaccinated, the C.D.C. reported. While there have been no deaths, 66 people have been hospitalized, a third of them with pneumonia.
The outbreak in New York, the nation’s biggest city, has been concentrated in Orthodox Jewish communities in Brooklyn and Rockland County.
The city reported on Monday that there had been 423 cases since the virus appeared in October. State officials reported another 236 in counties north and east of the city.
Officials in New York City have now closed seven Orthodox schools for failing to comply with vaccination orders; five have reopened after providing records showing that they were turning unvaccinated students away.
The city has also issued summonses to 57 residents of Brooklyn’s Williamsburg neighborhood — where more than 80 percent of the city’s cases have occurred — for refusing to get themselves or their children vaccinated.
Each summons can lead to a fine of up to $1,000 — or double that if the person it is issued to does not appear in court.
“The longer it takes schools and individuals to comply with our order, the longer this outbreak will continue,” Dr. Oxiris Barbot, the city’s health commissioner, said.
California has had a low-intensity epidemic with a handful of new cases each week, punctuated by occasional scares about widespread exposure at airports or on university campuses.
Franz Hall at U.C.L.A.’s campus. Hundreds of students and staff members were quarantined at the university following possible exposure to measles. Credit: Jenna Schoenefeld for The New York Times
Last week, nearly 800 students and staff members at California State University, Los Angeles, and the University of California, Los Angeles, who may have been exposed to measles on their campuses were quarantined under orders to stay home and not ride public transportation.
As of Monday, more than half of them were cleared after showing proof that they had either had two measles shots or were immune because they had caught the disease in childhood.
About 370 remained in quarantine, mostly at Cal State, Los Angeles.
On Monday, signs reading “POSSIBLE MEASLES EXPOSURE” were posted at the entrance to Cal State’s John F. Kennedy Memorial Library. Anyone who visited on April 11, when a student with measles apparently passed through, was warned to check his or her vaccination records.
Aliyah Johnson, 22, a senior, said she first heard of the scare when her mother called to check on her. “Out of sight is out of mind,” she said. She has had her shots, Ms. Johnson added.
At U.C.L.A., some students were unaware that the possible exposure on their campus had been traced to the very lecture halls they were entering. Still, some said they were more worried about upcoming exams.
Gianna Jimenez, a sophomore studying molecular biology, said she and her peers were disturbed by the spread of unscientific theories, such as the notion that vaccines cause autism.
“People just believe whatever they see on the internet whether it’s true or not,” she said. “The fact that it’s 2019 and we’re dealing with this is outrageous and ridiculous.”
Universities in New York are required by state law to make sure their students are vaccinated against measles.
At New York University, incoming freshmen do not get dorm keys until they produce persuasive evidence of immunization or get vaccinated at the student health center, said John Beckman, a university spokesman.
The university, he added, has just told all students with medical or other exemptions that, if the school has a case, they may be barred from campus.
More than 94 percent of American parents vaccinate their children against measles and other diseases, Dr. Robert Redfield, director of the C.D.C., said on Monday.
About 100,000 children in this country below age 2 have not been vaccinated, he said, meaning they are vulnerable in this outbreak.
Some infants are not immunized because their parents avoid vaccination. Others cannot be protected either because they are allergic to components of the vaccine or for other medical reasons.
This year’s outbreak, the C.D.C. said, was sparked by 126 infections acquired by travelers overseas since early 2018. The bulk of them occurred in Israel, Ukraine and the Philippines, but cases have also come from Thailand, Germany, Britain and other countries.
Of the 44 cases imported so far this year, the C.D.C. said, 34 were not in immigrants or foreign visitors, but in Americans who had traveled overseas.
Even with modern medical care, the disease normally kills about one out of every 1,000 victims, according to the C.D.C.
Pneumonia and encephalitis — swelling of the brain — are the most common severe complications. Epidemics among malnourished children who cannot get modern hospital care have mortality rates of 10 percent or more, according to the World Health Organization.
Measles is among the most contagious of diseases. Virus-laced droplets can hover in still indoor air for up to two hours after someone infected has coughed or sneezed. Up to 90 percent of people who are exposed will catch the virus if they are not immunized.
The vaccine is considered very safe, and two doses are about 97 percent effective at conferring immunity. The vaccine is normally given at ages 1 and 5, but during outbreaks pediatricians may give it to healthy children as young as six months old.
But two years ago, cases began rebounding, driven by a combination of poverty, warfare, tight vaccine supplies and, in some countries, hesitation about vaccination.
Earlier this month, the W.H.O. said there were three times as many measles cases around the world this year as there were in the first three months of 2018.
Before measles vaccination became widespread in the United States in 1963, up to four million Americans got measles each year, the C.D.C. said. Of the roughly 500,000 cases that were reported to medical authorities annually back then, about 48,000 were hospitalized, 4,000 developed encephalitis, and 400 to 500 died.
The C.D.C.’s case count on Monday said 503 of the 704 measles infections were in people who were not vaccinated. Of the remaining 201 cases, vaccination status was unknown for 125 patients, meaning that 76 patients said they had been vaccinated but got sick anyway.
The agency does not yet know how many shots each of those 76 had, “but under extreme disease pressure we know there can be vaccine failures,” Dr. Messonnier said.
She suggested that adults likely to encounter the virus, including health workers, travelers and anyone in affected neighborhoods, get a blood test that can show how immune they are to measles, mumps and rubella.
Anyone born before 1957 is assumed to have had the measles as a child and therefore immune.
Americans born between 1957 and 1989 are in a middle ground. Some got the early “killed virus” vaccine, which later proved to be too short-lived and was replaced by a “weakened virus” vaccine.
Until 1989, it was routine to give one shot; now children get two. One shot of the new vaccine provides 93 percent immunity in the overall population, while two shots drive that up to 97 percent, which is considered more than enough to keep the virus from spreading.
Vaccination levels vary from state to state, largely dependent on how easy state legislatures make it to get exemptions. All states permit exemptions for children who are allergic to the vaccine, have a compromised immune system or have another medical reason to avoid it.
Some states permit religious exemptions, even though no major religion opposes vaccination, and a few states also permit “philosophical” or “personal choice” exemptions.
Some states with high vaccination rates have “pockets of unvaccinated people,” the C.D.C. said. At various times, some religious minorities like Orthodox Jews and the Amish in Ohio have had low vaccination rates.
Some wealthy liberal communities, like Vashon Island in Washington State, have also had low rates. Recently conservative groups opposed to vaccines have sprung up, such as Texans for Vaccine Choice, which is associated with the Tea Party.
Julie Turkewitz contributed reporting from Denver, Jose Del Real from Los Angeles and Dana Goldstein from New York.
Jared Kushner spoke about Russian election interference during the Time 100 Summit 2019 in New York City. Credit: Brian Ach/Getty Images for Time
I’m pretty much done characterizing Donald Trump. There’s long been nothing more to learn about this man that people don’t already know.
Jared Kushner, on the other hand, is a different story. He lays low and has an ounce of measured judgement about when to open his mouth in public. Combine that with his immediate proximity to Trump on all fronts, and the curiosity of his influence, if any, is strong.
To date, Kushner has done nothing to distinguish himself from the tribe. That does not mean he isn’t instrumental behind the scenes, and a meaningful influencer of how our country moves forward, or backward.
At best, he is what he projects-a docile, entitled elite, with little more than a dilettante’s interest in mixing it up with politics or governance. At worst, he is a charade of a diplomat concealing a hard-core, cold blooded capitalist with malleable ethical and legal boundaries, and questionable instincts to anchor thoughtful judgement on complex issues.
Even if he is parts of both, his rare public comments are not encouraging.
FACT CHECK: Russian Interference Went Far Beyond ‘Facebook Ads’ Kushner Described
Via NPR, Miles Parks
In a rare public appearance on Tuesday, Jared Kushner, President Trump’s son-in-law and one of his closest advisers, said that the multiple investigations into Russian election interference have been more harmful to American democracy than the original interference itself.
“The whole thing is just a big distraction for the country,” Kushner said at a Time magazine event in New York City. “You look at what Russia did — buying some Facebook ads to try and sow dissent. And it’s a terrible thing, but I think the investigation and all the speculation that’s happened over the past two years has had a much harsher impact on our democracy.”
In describing Russia’s efforts leading up to the 2016 election, Kushner emphasized what he called the relatively small amount of money Russian agents spent advertising on social media.
“They said they spent $160,000. I spent $160,000 on Facebook in three hours during the campaign,” Kushner said. “If you look at the magnitude of what they did and what they accomplished, I think the ensuing investigations have been way more harmful to our country.”
Fact check: Were Facebook ads the extent of Russian election interference?
The short answer: No.
The long answer: The redacted version of Justice Department special counsel Robert Mueller’s report revealed a years-long plot by the Russian government to interfere in the U.S. that investigators called “sweeping and systemic.”
As to the amount of money expended on Facebook ads, the company said Russian operatives did spend less than $200,000 on advertising on the platform — but that doesn’t account for the organic content the operatives created and shared.
Not only were influence specialists within Russia’s Internet Research Agency purchasing normal advertisements, they were authoring their own posts, memes and other content as they posed as American users.
They also reached out to politically active Americans, posing as like-minded supporters, and helped organize rallies and other events in the real world.
Facebook says the Internet Research Agency may have reached as many as 126 million people. Separately, Twitter announced that about 1.4 million people may have been in contact with IRA-controlled accounts.
The social media aspect of the interference was just one dimension. Cyberattackers also went after political victims in the United States — whose emails and other data were released publicly to embarrass them — and state elections officials and other targets. And there may have been other avenues of interference as well.
The origins of the scheme
Russian operatives lied to get into the U.S. as early as 2014 on “intelligence-gathering missions.” They traveled across the country to get the lay of the land before ramping up efforts to try to interfere with American politics.
By September 2016, two months before the U.S. presidential election, the Internet Research Agency was working with an overall monthly budget that reached over $1.25 million. It employed hundreds of employees, a graphics department, a data analysis department, a search-engine optimization department, an IT department and a finance department, according to an indictment filed last year by Mueller’s team.
And it hasn’t stopped.
The U.S. military reportedly blocked the Internet access of the IRA during last year’s midterm elections to keep it from interfering with the midterm election. U.S. Cyber Command also targeted Russian cyber operatives, according to a report by The New York Times, with direct messages letting them know that American intelligence was tracking them.
And in October, a Russian woman was accused, according to a criminal complaint filed in federal court, of conspiring to sow discord and division in the U.S political system.
That conspiracy, the complaint said, “continues to this day.”
Buy something on Amazon and want to send it back? Kohl’s will take it off your hands for you. The department store chain announced Wednesday that starting in July, it will accept Amazon returns at all of its 1,150 stores.
Kohl’s says it will accept “eligible Amazon items, without a box or label, and return them for customers for free.” The program will expand a pilot introduced at Kohl’s stores in the Los Angeles, Chicago and Milwaukee markets in 2017.
The move highlights a major headache of shopping online: You often can’t try something before you buy it, and if the item doesn’t work out, it can be a hassle to return it.
The Kohl’s-Amazon partnership offers one solution, at least for people with a Kohl’s nearby. (Kohl’s stores are often located in suburban strip malls, not city centers, so the partnership won’t help many carless urbanites.)
And why might Kohl’s want to partner with its online competitor? Foot traffic and new customers. If Amazon shoppers go to Kohl’s to make a return, perhaps they’ll pick up a few items while they’re at it.
The United States is having its worst year for measles since the disease was declared eliminated in the country in 2000. Federal health officials said Wednesday that 695 individual cases have been confirmed in 22 states in 2019.
The growing number reflects the rise of the antivaccination movement in the country and the spread of international outbreaks that have infected American travelers.
New York has been particularly hard hit, with 200 confirmed reported cases in suburban Rockland County, and at least 334 cases in New York City, almost all in Brooklyn. This week, public health officials in Los Angeles declared a measles outbreak in the county, making it the latest metropolitan area to be hit by the illness.
Five cases of measles are being investigated there. California requires childhood immunizations to attend public or private school, with exemptions allowed if a doctor confirms that there is a medical reason to not have all or some shots. It is one of the strictest laws in the country.
Here’s what you need to know about the disease and the risk of getting it.
What is measles?
Measles is an extremely contagious virus. It can cause serious respiratory symptoms, fever and rash. In some cases, especially in babies and young children, the consequences can be severe. Measles killed 110,000 people globally in 2017, mostly children under 5.
According to the Centers for Disease Control and Prevention, one in 10 children with measles gets an ear infection, which can lead to permanent deafness. One in 20 children with measles develops pneumonia and one in 1,000 develops encephalitis (brain swelling that can cause brain damage). Pregnant women with measles are at greater risk of having premature or low-birth-weight babies.
One or two in 1,000 children who contract measles will die. In countries where measles vaccination is not routine, it is a significant cause of death, according to the World Health Organization.
How is measles transmitted?
Measles is transmitted by droplets from an infected person’s nose or mouth. If you’re in a room with someone infected with measles, you can inhale their virus when they cough, sneeze or even talk. Infected people can transmit the measles virus starting four days before they develop a rash, so they may be contagious before they realize they have the disease. They remain able to spread the virus for about four days after the rash appears.
The virus can also live on surfaces for several hours, and is so contagious that, according to the C.D.C., “you can catch measles just by being in a room where a person with measles has been, up to two hours after that person is gone.”
What are the symptoms of measles?
According to the Mayo Clinic, people show no symptoms up to two weeks after being infected. Then they develop symptoms typical of a cold or virus: moderate fever, cough, sore throat, runny nose, red and swollen eyes.
But after two or three days of that, fever spikes to 104 or 105 degrees and the telltale red dots appear on the skin, first on the face, then spreading down the body.
Abel Zhang, 1, being helped back into his clothes by his mother, Wenyi Zhang, center, his grandmother, Ding Hong, left, and Dr. Lauren Lawler, after receiving inoculations for measles, mumps and rubella at a clinic in Seattle. Credit: Elaine Thompson/Associated Press
Is there a cure for measles?
No. The vast majority of people who contract measles haven’t been vaccinated, and giving them the measles vaccine within 72 hours of being exposed to the virus might help — at least by reducing the severity and duration of the symptoms. The Mayo Clinic says that pregnant women, babies and people with weak immune systems can receive an injection of antibodies called immune serum globulin within six days of being exposed to measles, which might prevent or lessen the symptoms.
How safe and effective is the measles vaccine?
Extremely safe and effective. The measles-mumps-rubella (M.M.R.) vaccine causes no side effects in most children. Small numbers may get a mild fever, rash, soreness or swelling, the C.D.C. says. Adults or teenagers may feel temporary soreness or stiffness at the injection site. Rarely, the vaccine might cause a high fever that could lead to a seizure, according to the C.D.C. Contrary to misinformation that some anti-vaccine activists continue to repeat, the vaccine does not cause autism.
Children should receive two doses of the vaccine: the first when they are 12 to 15 months old; the second when they are between 4 and 6 years old. If infants who are between 6 and 11 months old are about to travel from the United States to another country, the C.D.C. recommends they receive one dose of the vaccine beforehand.
People who don’t get the vaccine are at very high risk for contracting measles. “Almost everyone who has not had the MMR shot will get measles if they are exposed to the measles virus,” the C.D.C. says.
If I’m not vaccinated, is it too late to get the shot?
It’s not too late. In fact, if measles is occurring in your community, it’s a good idea to get vaccinated unless you are sure you have previously received two shots of the M.M.R. vaccine; or you’ve had all three of the diseases the vaccine protects against (which gives you lifelong immunity); or you were born before 1957. (The vaccine was made available in 1963 and in the decade before that, virtually every child got measles by age 15, so the C.D.C. considers people born before 1957 likely to have had measles as children.)
But people who received the vaccine in the 1960s should consider getting immunized again. One of two vaccines available from 1963-67 was ineffective, the C.D.C. says. The effective vaccine during those years was the “live” vaccine; the ineffective one was the inactivated or “killed” vaccine. If you’re not sure, consult with your doctor.
If most people are getting vaccinated, why does it matter if I don’t vaccinate my child?
You are probably thinking of the concept of herd immunity, which means that if a large number of people are protected from a disease by a vaccine, the disease will be less likely to circulate, diminishing the risk for people who are unvaccinated. The threshold for herd immunity varies by disease — for a highly contagious disease, a very high percentage of people need to be vaccinated to meet that threshold.
Because measles is so contagious, between 93 percent and 95 percent of people in a community need to be vaccinated to achieve herd immunity. Remember, some people can’t be vaccinated for medical reasons: infants, pregnant women and people who are immune compromised.
During the Disneyland outbreak in 2015, a 9-month-old child whose parents were planning to immunize contracted measles from an older child who hadn’t been vaccinated, said Dr. Annabelle De St. Maurice, an expert on infectious diseases at U.C.L.A. So vaccinating your child not only protects your child, it helps protect others in your community.
Wait, didn’t we eliminate measles?
In 2000, measles was declared eliminated from the United States because the country had gone for more than 12 months without any “continuous disease transmission” within its borders. “Eliminated” doesn’t mean the disease was completely eradicated; it means the United States no longer had any places where the disease was endemic or homegrown.
There have been a small number of measles cases in the United States since then, ranging from 37 in 2004 to 667 in 2014, largely among people who were not vaccinated.
Most of the American cases since 2000 have been the result of people traveling to or from countries where measles is endemic because there is little vaccination.
How many people haven’t been vaccinated?
A small number in scattered pockets. Measles immunization in the United States is stable and high — more than 90 percent — according to C.D.C. tracking.
Who are the people not getting vaccinated?
One way to measure is by looking at the annual assessment of kindergarten vaccinations. It shows only Colorado, the District of Columbia, Idaho and Kansas dipping below the national 90 percent vaccination rate, though in certain communities the rate can be lower.
Generally, those who do not immunize their children are demographically more white and more educated, Dr. De St. Maurice said. “In part due to the success of vaccines, people are not as familiar with these diseases, so they question their effectiveness,” she said. Conversely, when the disease reappears, as it did in Washington, demand for vaccines rises.
Don’t states have laws requiring parents to vaccinate their children?
Every state has these laws. Three states allow only medical exemptions: Mississippi, West Virginia and, more recently, California, following the Disneyland outbreak. The rest grant exemptions for personal, philosophical or religious beliefs as well.
Signs warning patients at a clinic in Vancouver, Wash.Credit: Gillian Flaccus/Associated Press
Are the states with lax laws the ones with the most measles cases?
There have not been enough cases to warrant a major survey, but Dr. Saad Omer of the Emory Vaccine Center in Atlanta warned that with a rising number of cases, that could change.
Dr. Omer, who studies immunization coverage and disease incidence, said research had shown that states that allow more exemptions have increased pertussis (whooping cough) outbreaks.
Studies have also shown that people who refuse vaccines are disproportionately represented in the early stage of outbreaks. “They’re providing the tinder that can start the fires of the epidemics,” Dr. Omer said.
How does the U.S. compare with other countries?
Measles cases have been increasing around the world, too. Worldwide, there was an 80 percent drop in measles deaths from 2000 through 2017. But reported cases of measles have increased 30 percent since 2016, according to the World Health Organization.
Ninety-four percent of children in the United States get the recommended two-dose vaccine. According to the World Health Organization, more than a dozen countries reached the 99 percent mark, including Cuba, China, Morocco and Uzbekistan. Canada, Britain and Switzerland are a few of the Western countries that are below 90 percent.
In Europe overall, only about 90 percent of children receive the recommended two-dose vaccine. Worldwide, about 85 percent of children receive the first dose, but the number drops to 67 percent for a second dose, data shows.
Worldwide cases of measles have increased 30 percent since 2016, the World Health Organization said last year. Credit: Yahya Arhab/EPA, via Shutterstock
Does this mean mumps and rubella cases are re-emerging, too?
The M.M.R. vaccine has also greatly reduced the threat of mumps and rubella in the United States. It is not quite as effective against mumps, with 88 percent effectiveness, according to the C.D.C., and cases have increased in recent years, from 229 in 2012 to 6,366 in 2016.
Rubella used to cause millions of infections in the United States. According to the C.D.C., 12.5 million people got rubella in an epidemic from 1964 to 1965, and the disease caused 11,000 women to lose their pregnancies, 2,100 newborns to die and 20,000 babies to be born with congenital rubella syndrome, which can cause brain damage and other serious problems.
Rubella was declared eliminated in the United States in 2004, and the C.D.C. says that fewer than 10 cases are reported each year. But, as with measles and mumps, there are still many countries where it persists because of lack of vaccination, and every case since 2012 has been traced to people infected while traveling or living in another country.
Pam Belluck is a health and science writer. She was one of seven Times staffers awarded the 2015 Pulitzer Prize for International Reporting for coverage of the Ebola epidemic. She is the author of “Island Practice,” about a colorful and contrarian doctor on Nantucket.
Overuse of the medicines is not just a problem in rich countries. Throughout the developing world antibiotics are dispensed with no prescription required.
Try your luck at writing a caption for this photograph. Better yet, try an analysis of it.
The story headline is bad. The story is bad. On a smaller scale though, I am struck by the photograph of the man on the cell phone. He’s smiling as we walks across mountains of garbage where (he, and his?) people live, raise children, and go about daily living.
In this staggering story, Kenya is referred to as an emerg-ing economy. A develop-ing country. I’ve added the hyphens because in my eyes, as I have read and witnessed this story play out for decades, it is my conclusion, that too many countries in Africa have not emerged from anything. Media and scholars try to be polite and avoid confrontation by using the “ing” after the country’s name’s, because to label them as un-developed, is a smear. But, I don’t see any other way to put it. It is a smear. It is worse. It is atrocious to witness these realities in the modern age of developed economies all around the planet. Its not just Africa. Its in Asia, South America, and to a lesser extent, small pockets in our own country. But nothing compares with this. What goes on here is astounding, and its been going on as long as I have been alive. There’s no emerging. There’s no developing. Any development or emerging that’s going on is on such a small incremental basis, that its no match to the magnitude of the scourge.
Africa is a complex quagmire of dueling, feuding, conflicted, often rudderless countries, who move in and out of exploitative control of its peoples from one masquerading despot to another. I am not worthy to shine a true scholar’s shoes on this subject, but I do know what I see, or don’t see. I do see serious health consequences bordering on the continent of a nationwide crisis. I don’t see sustained action of several African countries united to work together. Globally, its the same story. Since decolonization, Africa has not been able to rise out of its troubled history of slavery and European exploitation. Yet, they affect us when we stop and take notice when an article like this one lands in front of our eyes. >MB
