Situation Summary
In 2019 to date, 12 countries in the Region have reported confirmed measles cases: Argentina, the Bahamas, Brazil, Canada, Chile, Colombia, Costa Rica, Mexico, Peru, the United States of America, Uruguay, and the Bolivarian Republic of Venezuela. No fatal cases have been reported in 2019 in the Region. There was one additional confirmed measles case reported in the Region onboard a cruise ship that sailed between Aruba and Curacao.
Since the prior PAHO/WHO Epidemiological Update on Measles published on 18 April 20191, 9 countries have confirmed new cases of measles: Brazil (70 cases), Canada (12 cases), Chile (1 case), Colombia (27 cases), Costa Rica (1 case), Peru (1 case), the United States of America (284 cases), Uruguay (6 cases), and the Bolivarian Republic of Venezuela (63 cases). Argentina, the Bahamas, and Mexico did not report new cases during this period.
The measles outbreak in the Americas, caused by genotype D8 lineage MVi/HuluLangat.MYS/26.11 and that began in Venezuela in 2017, subsequently spread to Brazil and Colombia in 2018 and later to Argentina, Chile, Ecuador, and Peru, where imported or import-related cases with the same genotype and lineage were reported. In 2019, Brazil, Colombia, and Venezuela continue to report cases associated with the same genotype and lineage, indicating the continued circulation of this virus. This situation, along with the occurrence of imported cases from outside this Region, has led to an increase in the weekly number of reported cases since the beginning of 2019, with a peak observed in epidemiological week (EW) 12 of 2019 and an average of 78 cases during the 4 following weeks (Figure 1).
The following is the measles epidemiological situation for countries where new confirmed cases or an update has been reported since the prior PAHO/WHO Epidemiological Update on Measles published on 18 April 2019, as well as the case onboard a cruise ship.
Argentina has reported 4 confirmed measles cases, of which 3 were imported and one was import-related. The details of the 4 cases were published in the PAHO/WHO Epidemiological Update on Measles published on 18 April 2019.
For the first case, the genotype identified was B3. For the second case, genotype D8 lineage MVi/Delhi.IND/01.14 was identified, similar to that reported among cases associated with a cruise ship outbreak in Brazil. For the third and fourth cases (primary and secondary case, respectively), genotype D8 lineage MVs/Gir Somnath.IND/42.16 was identified; this strain has widespread distribution in Asia and Europe.
In Brazil, between EW 1 of 2018 and EW 16 of 2019, there were 19,036 suspected measles cases reported (18,428 in 2018 and 608 in 2019), of which 10,424 were confirmed (10,351 in 2018 and 73 in 2019) including 12 deaths (all in 2018).
The cumulative incidence rate at the national level is 5.09 per 100,000 population. Among confirmed cases with available information, 4,691 were male and 5,715 were female.
In 2018, 11 federal units reported confirmed cases of measles: Amazonas (9,803 cases, 6 deaths), Bahía (3 cases), the Federal District (1 case), Pará (104 cases, 2 deaths), Pernambuco (4 cases), Rio Grande do Sul (46 cases), Rio de Janeiro (20 cases), Rondônia (2 cases), Roraima (361 cases, 4 deaths), São Paulo (3 cases), and Sergipe (4 cases). In 2019, 7 federal units have reported confirmed measles cases: Amazonas (4 cases), Pará (43 cases), São Paulo (20 cases), Santa Catarina (3 cases), Rio de Janeiro (1 case), Roraima (1 case), and Minas Gerais (1 case).
In the states of Pará, Roraima, and Amazonas, genotype D8 lineage MVi/HuluLangat.MYS/26.11 was identified, similar to that circulating in Venezuela and other countries in the Region. However, a different D8 genotype lineage was identified in the states of São Paulo, Santa Catarina, Rio de Janeiro, and for a recent outbreak reported on a cruise ship in Brazil, as described in the 18 April 2019 Epidemiological Update on Measles. In addition, 2 cases imported from Europe were reported in the states of São Paulo and Minas Gerais.
The most recent confirmed case in Brazil had rash onset on 20 March 2019 and was reported in Pará State.
The most recent confirmed cases imported from Venezuela had rash onset in EW 6 of 2019 and were reported in Roraima State.