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Q&A: With measles on the rise, vaccine is still best defense

May 8, 2019

The U.S. has recorded 764 measles cases in 23 states as of May 3. That’s the most in a single year since the infectious disease was deemed eliminated from the nation in 2000 – and we’re just four months into 2019.

The previous worst year for measles was 2014, when 667 cases were reported, according to the Centers for Disease Control and Prevention.

One of the measles outbreaks this year was in Vancouver, Washington. On April 29, Clark County Public Health declared that outbreak over, following six weeks with no new cases. There were 71 confirmed cases, mostly in unvaccinated children.

The high number of cases in 2019 is primarily the result of a few large outbreaks – the one in Washington and two large outbreaks in New York that started in late 2018, the CDC reported. The agency attributes the recent outbreaks to measles being imported, when an unvaccinated traveler visits a country where there is widespread measles transmission, gets infected with measles, returns to the U.S. and exposes people who are not vaccinated.

Spokane County hasn’t had any confirmed measles cases this year. The state of Idaho hasn’t either for 2019, the CDC says. It last showed up in Spokane during 2015, when two cases in adults were reported, according to the Washington Department of Health. Before that, measles hadn’t been reported in Spokane County since 1994.

The best protection against measles is to get the measles-mumps-rubella vaccine. As the number of national cases rise, that’s still the main focus for health officials.

But in this era of easy travel, measles can spread easily. An unvaccinated traveler exposed abroad to measles potentially could expose others who aren’t immune, including infants too young to be vaccinated.

With this in mind, The Spokesman-Review talked with local health experts about what individuals can do to protect themselves and what’s being done at the regional level to combat the spread of this disease.

Those who answered questions included Dr. Niranjan Bhat, a clinical associate professor for Washington State University’s Elson S. Floyd College of Medicine; a Spokane Regional Health District epidemiologist; and Lisa Hylsky, Panhandle Health District Immunization.

Q. Why should people be concerned about measles?

A. “Measles is more infectious than other respiratory infections,” Bhat said. The common cold and influenza are more commonly transmitted by contact.

“With measles, you can get it just through the air. It has to do with the size of the little small droplets of infected material. In measles, it’s in really small droplets. Those float through the air and then land on people, so it’s a little bit harder to control.”

In young children, complications from measles can include pneumonia, lifelong brain damage, deafness and death. In developing countries, several thousand children die each year of the disease where there is little vaccine coverage, and younger kids also might be malnourished, Bhat said. Measles can depress the immune system.

“So these kids often get another infection on top or following measles,” including pneumonia and encephalitis. The CDC said the last measles death in the U.S. occurred in 2015.

The World Health Organization says 95 percent of a population needs to be vaccinated against measles for what is called “herd immunity,” providing indirect protection that prevents infection in people too young or sick to be vaccinated.

Q. What happens if there is a regional outbreak?

A. If an infectious case were identified in a school setting, health officials would require proof of immunity for school staff and students. In Spokane, those records can be obtained through https://wa.myir.net/ or health care provider records. Lab test titers (concentration of antibody) are also an option.

During the Spokane cases in 2015, many health care provider offices and hospitals gathered immunization records of staff and made it a policy going forward to require proof of immunity for employment.

Exclusions from class can be ordered in Spokane by the health district if just one case of measles appears in a school, said spokeswoman Kim Papich. Those exclusions last for the entirety of the incubation period for the disease, which is a couple of weeks for measles.

During the recent Clark County outbreak, SRHD staff met with all local school districts and universities to inform them of what would happen if infectious cases were identified in a school setting, while urging records to be in place. Records were obtained for most school staff and students.

Local universities also have improved record-keeping and the requirements for proof of immunity, the SRHD said.

Q. What can I do if traveling with a young child?

A. Parents can ask a doctor about getting a child’s first MMR shot as early as 6 months if a family is traveling internationally or to a measles outbreak area, said Bhat, previously a pediatrician now doing vaccination research for a nonprofit.

For travel to outbreak areas, a child at 12 to 15 months of age can get two MMR shots 28 days apart, he said.

Most kids have a first MMR shot at 12 to 15 months, and a second dose when they’re 4 to 6 years old.

Bhat said that even with an early shot at 6 months, children as they get older will need to get those two additional MMR doses as advised for proof of immunization.

“They’ll need another shot after they turn a year of age and then another shot after that when they are 4 to 6 years old.”

Separately, Washington state leaders are shifting toward a new MMR shot requirement. In the 2019 Legislature, a controversial bill received final House approval April 23 to put an end to a personal exemption parents could use to keep their public school children from receiving the measles vaccine. Gov. Jay Inslee is expected to sign the bill.

The proposal leaves intact exemptions for medical or religious reasons for the MMR vaccine, and the personal exemption for other childhood immunizations.

The Oregon Legislature is considering an even tougher bill than Washington’s, one that would eliminate all nonmedical exemptions. Idaho has one of the highest opt-out rates in the nation with parents choosing exemption to vaccines. Recently, Idaho legislators sought to strengthen the personal exemption for vaccinations by requiring schools and day care centers to tell parents they have the option to opt out of immunizations. The bill did not advance past the state Senate.

The Panhandle Health District said it’s working with local schools that have low immunization rates to educate parents about the dangers of measles.

“Since the recent measles outbreaks, we have also increased our social media outreach to educate parents on when children should receive the MMR vaccine, the dangers of measles and how to protect themselves and others,” said Hylsky with Panhandle Health.

Q. What should an adult do if unsure about vaccination as a child? Should you check through lab tests whether you’re immune?

A. Health providers can check for immunity through routine blood testing that detects antibodies or that someone previously had the disease for current immunity. Those born before 1957 are considered immune, because nearly all children predating that era contracted the disease.

If an adult needs a vaccine, one dose of MMR generally is recommended. In some situations, two doses might be recommended for an adult, such as for college students or health care workers.

SRHD’s website says most people in Washington state are immune to measles, so the public risk is low except for people who are unvaccinated, pregnant women, infants and those with compromised immune systems.

One dose of MMR is 93% effective at preventing measles; two doses is 97% effective.