Health officials hoping not to see a repeat of earlier this year
VANCOUVER — News this week of a confirmed case of measles in a Clark County child who had traveled outside the country set off alarm bells for health officials.
The child, who was unvaccinated, arrived at Portland International Airport on Nov. 14, and was apparently contagious while at PDX. The child also visited PeaceHealth Southwest Medical Center that same afternoon, and Randall Children’s Hospital on Nov. 16-17.
“This is an unfortunate reminder that measles is only a plane, car, bus or train ride away,” said Dr. Alan Melnick, Clark County Public Health director and county health officer in a news release.
Measles is a highly infectious viral disease that most frequently causes fever and a rash. But its initial symptoms include watery eyes, runny nose, and a sore throat.
“A lot of its symptoms, especially early on, are very similar to any upper respiratory virus,” says Dr. Jason Hanley, Emergency Department medical director for PeaceHealth Southwest Medical Group, “and it takes a tremendous amount of resources to protect not only the patient but everyone else.”
The measles outbreak that sickened 71 people in Clark County nearly a year ago ultimately cost the state of Washington well over a million dollars. Clark County Public Health employees, along with staff from the state health department, clocked in 12,684 hours responding to the crisis. In total, the cost to the county was $864,679, though the state ultimately refunded most of that.
Public Health identified and contacted more than 4,100 people who were exposed to measles and made daily monitoring phone calls to more than 800 people considered susceptible to contracting measles. Local schools identified and excluded 849 susceptible students who were exposed to measles.
“We’re still hopeful that this is not going to be a repeat of last year,” said Clark County Manager Shawn Henessee, “but we also have to be realistic that measles is extremely contagious.”
Infected individuals can spread the virus simply through breathing, and are often contagious 3-5 days before the telltale rash appears.
Dr. Hanley says people who haven’t been vaccinated or previously exposed to the virus have a 90 percent chance of catching the disease if exposed. Groups opposed to vaccinations have said increasing intake of vitamin A and other supplements can help either avoid the disease or lessen the symptoms. Hanley says good health is important to reducing the risks associated with measles, but there is no evidence that these supplements can help avoid being sickened.
“In my opinion,” Hanley says, “I would be very leery of trying any natural methods to avoid measles if you have the option.”
“I don’t question their intent or their passion,” Henessee says of the many individuals who have sent him information about the alleged dangers of the MMR vaccine, “but I continue to believe, and I believe it’s also the policy of the council to believe, that vaccinations are one of the best things that they can do to prevent the spread of this.”
Of the 71 confirmed cases in Clark County last year, 52 were in children ages 1-10. Three of the cases had had one MMR vaccine, 61 were unvaccinated, and the immunization status of seven could not be verified.
“PeaceHealth Southwest spent a tremendous amount of resources and money to protect the community last year,” says Dr. Hanley, “as did Clark County and as did the state. But all of our learning happened very quickly with a great group of people.”
That learning involved figuring out how to address potential cases in a way that didn’t expose anyone else unnecessarily. Hospitals often contain large percentages of people who might be especially vulnerable to a disease such as measles.
“We coordinate with the patients to not enter the emergency department of the hospital at all,” says Dr. Hanley. “We come out to the parking lot, meet them there, mask them, then put them in a special room in the emergency department that protects the airflow from all the other patients. And we perform a thorough work-up and decide on the next course of treatment.”
This is also the first school year since Washington state made the MMR vaccine mandatory for anyone attending or working in a public or private school, as well as in childcare.
Clark County Public Health says that, as of the end of last year, 78 percent of 6- to 18-year-olds had received both doses of the MMR vaccine, and 81 percent of 1- to 5-year-olds had received their first dose. Those numbers have likely increased following the outbreak earlier this year, as the number of people coming in for vaccines climbed sharply before tailing off in the Summer.
But even with vaccination rates climbing, measles remains prevalent in many other countries, opening the chance that it could be reintroduced in the United States, especially in areas with higher unvaccinated rates, says Dr. Hanley.
“The case that popped up earlier this week is a perfect example of, with international travel, if there’s measles anywhere in the world it can always end up in your neighborhood,” he says.
To read more measles and the MMR vaccine, click here.