A measles outbreak where you live? Study ranks US places at highest risk

A new study ranks the US counties at highest risk of a measles outbreak, with the areas surrounding Chicago, Los Angeles and Miami topping the list.Th...

Posted: May 10, 2019 7:33 AM

A new study ranks the US counties at highest risk of a measles outbreak, with the areas surrounding Chicago, Los Angeles and Miami topping the list.

The authors say places like these should be kept under close surveillance because they "could serve as the fulcrum of continuous importation of the measles virus into the USA." Their paper was published Thursday in the journal The Lancet Infectious Diseases.

"What we're trying to do is identify what are the areas that are most likely to be affected by this [anti-vaccination] movement that's happening," said study co-author Lauren Gardner, an associate professor in the Department of Civil Engineering at Johns Hopkins University.

In order to rank the counties at greatest risk, the authors didn't even have to consider the locations of actual measles cases in the United States. Instead, they looked at factors including nonmedical vaccine exemptions, international air travel and the incidence of measles in countries people are traveling from.

"These outbreaks can only happen if someone brings measles into the country and there's a low vaccination rate in a population," Gardner explained.

"The places where measles outbreaks are happening this year were the ones that we ranked really highly in our risk model," which had largely been completed by February, she added.

According to the paper, of at least 45 counties reporting measles cases this year, 30 were among or adjacent to the researchers' top 25, including outbreaks in states like New York, Washington and Oregon.

This year, the United States has seen the highest number of confirmed cases since measles was declared eliminated in the country in 2000: now more than 760 cases, according to the US Centers for Disease Control and Prevention.

The new paper isn't the first that has tried to predict outbreak risks in the United States, but previous efforts did not include international travel, Gardner said.

"What's going to happen as we move into the summer months, with all that back-and-forth travel between Europe and the US ... there's opportunities to introduce a lot more measles into this country," said Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine.

"Europe is a disaster right now, even worse than North America, in terms of measles," added Hotez, who is also co-director of the Texas Children's Hospital Center for Vaccine Development.

This week, the World Health Organization announced that there had been more than 34,000 cases in its European region during the first two months of 2019. That's triple what it reported during the same time last year.

Last year, Hotez published an analysis in the journal PLOS Medicine, analyzing a subset of states that allow nonmedical exemptions for philosophical or personal beliefs, as opposed to religious ones. Nearly half of the top 15 hot spots identified in his paper have been stricken with measles this year, Hotez said.

"That's an all-star batting average in Major League Baseball," said Hotez, who was not involved in the new paper but whose previous study was one of its data sources.

The latest paper -- "version 2.0," he called it -- looks at the entire country and picks up hot spots that his analysis missed.

"The one we missed totally was the New York epidemic," Hotez said. "It wasn't even on our radar because it's not a state that has personal belief exemptions. And there, what seems to have happened is the anti-vaccine lobby ... identified the Orthodox Jewish community as a vulnerable group to target. And they flooded them with phony pamphlets and misinformation.

"That's something we could never have predicted."

In the new model, Queens -- which is adjacent to Brooklyn, one of the focal points of the ongoing New York measles outbreak -- is ranked fourth.

A total of 47 states allow nonmedical vaccine exemptions: all but West Virginia, Mississippi and California. Some allow only religious exemptions, while others allow exemptions based on personal or philosophical beliefs.

Hotez said that these maps can help target public health vaccination efforts where they're needed most. But he said the maps shouldn't just be coming from academics like himself; he believes they should be generated every year by public health agencies like the CDC.

Hotez, who was criticized this week by a Texas lawmaker who called his vaccine work "sorcery," said that "the anti-vaccine movement has become mainstream. It is now fully integrated into public life of this country.

"It's the consequence of allowing the anti-vaccine movement to run unopposed for so many years."

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 450762

Reported Deaths: 6079
CountyCasesDeaths
Hennepin935111486
Ramsey40220742
Dakota33243348
Anoka31118366
Washington20282231
Stearns17957188
St. Louis13777244
Scott1203597
Wright11688106
Olmsted1062075
Sherburne823966
Carver698338
Clay654681
Rice613969
Kandiyohi555772
Blue Earth544833
Crow Wing486877
Otter Tail459367
Chisago455036
Benton421587
Winona391948
Douglas376666
Nobles372446
Mower369429
Goodhue351259
Polk330059
McLeod326546
Beltrami313248
Morrison312945
Lyon303338
Becker286939
Itasca285943
Isanti283241
Carlton282243
Steele275810
Pine267814
Freeborn249523
Todd232530
Nicollet226437
Brown215834
Mille Lacs214745
Le Sueur211716
Cass208424
Meeker200633
Waseca190716
Wabasha17293
Martin171326
Roseau166117
Hubbard149938
Redwood140627
Houston139014
Renville137840
Dodge13624
Chippewa131732
Cottonwood127818
Fillmore12535
Wadena120417
Rock110612
Sibley10897
Aitkin108533
Faribault107416
Watonwan10678
Pennington100315
Kanabec98018
Pipestone95523
Yellow Medicine93916
Murray8995
Jackson86310
Swift83818
Pope7425
Marshall70315
Stevens7038
Clearwater68614
Lac qui Parle65716
Lake65615
Wilkin6299
Koochiching59910
Lincoln4892
Big Stone4663
Unassigned43968
Grant4298
Norman4248
Mahnomen4137
Kittson37220
Red Lake3184
Traverse2553
Lake of the Woods1951
Cook1150

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 308737

Reported Deaths: 4391
CountyCasesDeaths
Polk46313460
Linn17916278
Scott15694167
Black Hawk13964242
Woodbury13064179
Johnson1220051
Dubuque11504157
Pottawattamie9086114
Dallas901872
Story875536
Webster470677
Cerro Gordo469972
Sioux458757
Clinton455065
Warren452039
Marshall429262
Buena Vista395230
Muscatine393078
Des Moines389243
Plymouth352269
Wapello347598
Jasper328559
Lee321132
Marion307252
Jones272949
Henry265831
Carroll257434
Bremer248048
Crawford233124
Washington221333
Boone221017
Benton210950
Mahaska196337
Jackson193931
Tama189559
Dickinson188129
Kossuth177744
Delaware174736
Clay170721
Wright166024
Fayette164123
Buchanan161023
Hamilton161030
Winneshiek159120
Harrison157362
Hardin156130
Cedar154419
Clayton153049
Butler149824
Page145415
Floyd140536
Cherokee139527
Mills138016
Lyon137033
Poweshiek134124
Hancock130824
Allamakee130029
Iowa126722
Calhoun12309
Grundy121927
Jefferson121625
Madison12169
Winnebago120829
Mitchell116436
Louisa115530
Cass114743
Chickasaw113312
Appanoose111540
Emmet111232
Sac111215
Union110223
Humboldt105819
Shelby104027
Guthrie103624
Franklin103118
Unassigned10000
Palo Alto91411
Montgomery87224
Keokuk85826
Howard84819
Monroe81419
Clarke8017
Pocahontas77811
Ida75430
Davis69721
Greene6977
Adair69320
Lucas6619
Monona65017
Osceola64510
Worth6154
Taylor5969
Fremont5206
Van Buren49914
Decatur4944
Ringgold44611
Audubon4188
Wayne41721
Adams2983
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