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We can predict where measles will occur. Why not us?



In late February, a research team submitted a report to the medical journal The Lancet, predicting the 25 most measles-threatened US states in 2019. Worst in measles outbreaks since 1992, their study looks more forward-looking. Of the counties mentioned in the May newspaper, 14 had measles cases. At least 12 districts on the list are adjacent to districts where measles have occurred this year. This includes two of the districts most affected by measles: nearly 500 confirmed cases in the districts of Queens and Kings, New York.

The 25 Highest Measles Risk Areas

The US districts most susceptible to measles have been evaluated by researchers. Calculations of how likely an outbreak was in 201

9 and whether cases were reported this year

Rank County State 2019 cases
1 Cook Illinois [19659011]
2 Los Angeles California
3 Miami-Dade Florida
4 Queens New York [19659011] ✓
5 King Washington
6 Maricopa Arizona
7 Broward [19659009012] Florida 8 Clark [19659009] Nevada
9 Harris Texas
10 Honolulu Hawaii
11 [19659009009] Wayne Michigan 12 Tarrant Texas
13 Multnomah Oregon ✓ [1965900914Orange Florida
15 Essex New Jersey
16 Denver Colorado
17 Hillsborough [19659009
18 San Mateo California [19659011]
19 Salt Lake Utah
20 Suffolk Massachusetts [19659019009] 21 Georgia
22 Travis Texas
23 Hennepin Minnesota
24 Loudoun Virginia [19659011] San Diego California

* The relative risk is the likelihood that an event will occur in an exposed group, divided by the probability that it occurs in a non-exposed group.

Sources: The Lancet, The New York Times, State Departme Ministry of Health, Washington Post, Reuters, Centers for Disease Control and Prevention

But that was not so special about this prognosis. In the 19 years since the elimination of measles in the US, according to experts, domestic outbreaks have followed a reliable pattern that is likely to be easily understood in epidemiological data. Everyone knows that the pattern exists, so it's not surprising that anyone could make predictions about where measles are most likely to appear. Instead, experts say, the circular list is remarkable because it was created by whom. It came from independent researchers and not from the government collecting the data.

Basically, there are two things you need to trigger a measles outbreak in the US. The first is a local community with a low vaccination rate. Although 91 percent of Americans are vaccinated nationally against measles, isolated bags can have far lower rates – 70 percent, 50 percent, or even less. Island communities that share a common culture, religion or a single school provide a place where measles can spread and spread, said Peter Hotez, a professor of pediatrics and molecular virology at Baylor University. If a measles outbreak is a fire, you can imagine that as a tinder.

But you still need a lighted match, and this is where international travel comes into play.

Measles outbreaks no longer start anywhere by itself America. The cases must come from somewhere else. "Normally someone goes to Europe, the Philippines or Israel," said Daniel Salmon, a professor at the Johns Hopkins Bloomberg School of Public Health. That is, Americans travel abroad and we are exposed to measles in countries where the disease is still endemic. If we are not vaccinated and return to a community with a low total stimulation rate, the fires burn.

This predictive study in the Lancet reached the list of vulnerable districts by correlating low-coverage communities with vaccination rates and high rates of nursery vaccination exceptions in communities whose hubs often offer flights to countries with ongoing measles outbreaks. In the case of the New York eruption, the data linked a close-knit Orthodox Jewish community with Israel, where measles are endemic and infected more than 3,500 people between March 2018 and February 2019.

In response, New York has mandated vaccinations for those living in some severely affected postcodes and being threatened by those who have no chance. Vaccination mandates in the US are usually tied to schooling – not traveling, said Saad Omer, new director of the Yale Institute of Global Health. There is a legal and constitutional framework that gives States the right to ban vaccines in public schools, he told me. However, the same does not apply to the requirement to be vaccinated before traveling to Israel, Ukraine or any other country where measles outbreaks are common.

In the meantime, no major effort has been made at the national level to reach the public, predicting which vaccinated communities in the US are at greatest risk, making it difficult to target prevention efforts in those locations. Even data on where measles outbreaks occur in this country are often vague and scattered in several states through public health agencies. For example, in the Centers for Disease Control and Prevention, there are data that break down confirmed measles cases by county and postal code, but do not publish them. Sahotra Sarkar, a professor of philosophy and integrative biology at the University of Texas at Austin, one of the lead authors of the 2019 study, said if the agency provided this data, he and his colleagues could use it to refine their maps. 19659100] The CDC told me that they have the counties and postcodes where measles occurred, and information about which countries triggered the sparks – but that the information is not collected in one place or is readily available. They refused to comment on the reason. That's a problem, Hotez said. With more detailed maps showing low vaccination coverage, vaccine exemptions and the countries from which each outbreak originated, outbreaks could be averted. This becomes particularly important as the outbreaks increase and the US loses its status as a country where it lives. Measles have been eliminated. According to Hotez, predictions like Sarkar's should come from the CDC annually. But they are not.


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