Hundreds of people have been tested after cases showed up earlier this year
CLARK COUNTY — Health officials in Clark County are hopeful that they’ve seen their last cases of measles or tuberculosis in a while.
“It’s been a really busy year,” laughs Monica Czapla, the county’s infectious disease program manager.
This past May the county was notified by a local healthcare provider of a patient displaying possible symptoms of tuberculosis. That person was associated with Skyview High School, kicking off a massive investigation of who they may have had contact with between July 1 of last year, and May 1 of this.
“In this particular case we had a home, close contacts, a workplace, several healthcare facilities, a domestic flight, and a school,” Czapla told the county’s Board of Public Health this week. “Busy.”
So far, with well over 300 staff hours invested and around 353 people tested, only two other infections have been identified. “Which is a good sign that the infectiousness of this case was not incredibly high,” says Czalpa.
There are some lingering concerns, however, because people who’ve been exposed to tuberculosis need to be tested at least twice. While most of the Skyview population was tested the first time, many haven’t had a second test.
“This was a senior population, and it happened right around graduation, and it’s not mandatory,” Czalpa told the board. “We can encourage strongly, and that’s about all we can do.”
The person with the initial case of TB also was on board a domestic flight. That would be the purview of the Centers for Disease Control to investigate, but since it wasn’t a long flight, it’s unlikely, though not impossible, that exposure would lead to catching the disease.
“The guidance for TB exposures on airlines is anything less than eight hours is not considered an exposure,” Czalpa explains. “Simply because TB is not one of the more highly contagious diseases, and really does require prolonged close contact.”
There are still some people who had been in contact with the original case, and the two other confirmed infections, who are being monitored, but Czalpa says they’re hopeful this whole thing will be over soon.
While tuberculosis is rare in the United States, in can be incredibly difficult to treat. Many people may have the disease without ever knowing it, though they are not generally considered to be contagious. Symptoms usually include a cough that lasts three or more weeks, including possibly coughing up blood, chest pain, or pain while breathing, weight loss, fatigue, fever, night sweats, chills, and a loss of appetite. Tuberculosis can be fatal if not treated, especially in people with an already weakened immune system.
Perhaps more concerning is a recent confirmed case of Measles in Multnomah County. It was first reported June 27th, and county health officials there linked that person to ten contacts in Clark County.
“This particular scenario is what we would consider a perfect storm,” Czalpa says, “The types of exposures were exactly what you don’t want to see.”
On July 3, county health officials were notified by a local healthcare provider of another possible case of measles. That diagnosis is still being confirmed.
“From that one case we had a healthcare facility exposure, three public setting exposures, and then about 47 close contact exposures, 39 of which were Clark County residents,” Czalpa told the board. “Seven of those required active monitoring, and we’re almost done.”
While measles may not be as potentially deadly as tuberculosis, it is much more virulent. The virus can remain in the air and active for up to two hours. Even worse, a person with measles can be infectious up to four days prior to symptoms appearing, including the tell-tale rash, and four days after symptoms occur.
“Somebody could have gone to Target, to the grocery store, to school, to work, and anybody in those areas a few hours afterwards could have potentially been exposed,” Czalpa says. “As you can imagine, these types of investigations for measles can be massive.”
Many countries in the world where the measles vaccine (MMR) is either not common, or not as effective as the one available in the United States, are seeing massive outbreaks of the disease. Even here in Clark County, there are some populations still at high risk for the disease.
“Given that no vaccine is 100 percent effective, and given how contagious measles is, if you want to prevent a community-wide outbreak, you need 92 percent or more of the population vaccinated or immune somehow,” says Public Health Director Doctor Alan Melnick. “And we do have areas in Clark County, including some schools, where we’re below that level.”
Much of that is due to religious exemptions, though schools are increasingly requiring students who are not current on vaccines to stay home.
In this most recent case, Czalpa says they’re hopeful things will calm down soon. “We’re very fortunate that it was a highly vaccinated population, which is why I think it didn’t develop into what it could have.”
Multnomah County has since confirmed two other measles cases, including one on July 13. It can take two weeks or longer before someone who is susceptible to measles shows symptoms after being exposed. That makes it especially time consuming to monitor people who’ve been exposed, and important that people who are up to date on their shots, or who’ve previously had measles, know their health history. That helps health officials focus on people who are likely to be infected. In some cases, those people can be quarantined inside their home for up to three weeks.
The symptoms of measles usually start like the flu, with a fever, cough, runny nose and red eyes. That’s followed by a rash that usually spreads from the head to the rest of the body. Complications of the disease include diarrhea, lung infections, and ear infections that can sometimes damage the hearing. Measles can be deadly for children in 1 or 2 cases out of 1000.