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Measles in Fraser Health

Michelle Murti, MHOFraser Health Authority, BC

CPHA May 27, 2014

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Measles of known and unknown origin

Measles in Fraser over last year Cluster of unknown origin Issues and implications of unknown

importations

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Measles 2010-present, BC

44

Map of Fraser Valley

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FHA, as of May 8, 2014

66

Recent measles 2014

Many suspect measles reported and investigated from across FHA Good level of awareness and

reporting Large outbreak

Only 5 cases not affiliated with religious community (lived in the area)

77

Dutch importations

22 genotypes available – all D8 Same strain circulating in Netherlands Importations to Alberta and Ontario

2 other known clusters from importation in 2013

Netherlands outbreak >2600 measles cases

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Measles 2013

D8 3 lab-confirmed B3

Secondary transmission B3

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Description of 3 B3 cases

32yoM – Fraser North Hx 1 dose MMR, but was IgG Negative Cdn-born, no travel history

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Description of 3 B3 cases

32yoM – Fraser North Hx 1 dose MMR, but was IgG Negative Cdn-born, no travel history

21yoM – Fraser South Foreign-born, no documented imms hx, also

IgG negative No travel, no known exposure

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Description of 3 B3 cases

32yoM – Fraser North Hx 1 dose MMR, but was IgG Negative Cdn-born, no travel history

21yoM – Fraser South Foreign-born, no documented imms hx, also IgG

negative No travel, no known exposure

9 month old male –Fraser South Unimmunized by age Resulted in transmission to 3yo unimmunized

playmate

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Time to genotyping

Early indication that these were different due to H and N genes on PCR Days-weeks to get genotyping

Was this wider spread of our original outbreak or a new cluster? Implications for public health control

measures

1313

Source?

Detailed exposure histories NO connections identified

All exact same genotype of B3 After typing available weeks later

No known recent importations of B3 1 secondary transmission 304 contacts followed up

Significant public health work

1414

B3 Worldwide

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Heightened Surveillance

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Surveillance

Heightened surveillance due to outbreaks Unusual detection?

Frequency of these importations and unrecognized disease? Index case(s)?

Unrecognized importations Unrecognized disease vs unreported

disease?

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Implications

Limited spread in highly vaccinated populations

Risks for under-immunized populations Significant risk in some pockets

Effectiveness and efficiency of follow-up required Public Health interventions

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Acknowledgements

FHA team BCCDC and BC Public Health

Laboratory Ahmed Hashim, PHPM resident