A measles outbreak in Texas that resulted in the death of a child has health officials across the nation on high alert as cases of the highly infectious disease grow.
As of Tuesday, Texas health officials reported that 422 cases had been identified across the state since January, including the death of that one unvaccinated school-aged child.
There also have been outbreaks in Minnesota in recent years, and the state Department of Health reported last week that the state’s first case of measles this year was diagnosed in a resident who had traveled to Washington D.C. State health officials and health professionals say they’re ready to respond to this latest outbreak. But much of their work involves prevention, which includes getting children in underserved communities vaccinated, and combating anti-vaccine rhetoric.
What is measles and how does it spread?
Measles is one of the most infectious diseases in human history, which makes it very difficult to contain once the virus starts to spread within a community.
“People who are susceptible to measles can get infected just by being in a room with someone who has measles, or being in that room up to two hours after that person has left,” said Jayne Griffith, a senior epidemiologist at the Minnesota Department of Health (MDH).
Measles has a long incubation period, meaning someone can contract the virus and not show symptoms for three weeks. The virus can be infectious for up to nine days after contracting the virus, from four days before the onset of the rash to four days after.
What are the symptoms?
Someone who contracts measles will start to show flu-like symptoms, like a dry cough, sore throat and a runny nose. What follows is a fever, then the rash for which the disease is known, which starts at the head and goes down the body.
Measles is known for causing complications like dehydration, diarrhea and ear infections that can often lead to hospitalization. More serious complications include pneumonia and encephalitis, or brain swelling.
How is measles treated?
“There’s actually no treatment for measles,” said Sheyanga Beecher, medical director of Hennepin Healthcare’s Pediatric Mobile Health Program. “We know that measles can be prevented quite well, actually, based on the vaccine itself. But when a child gets hospitalized for measles, typically they are treated for secondary infections or complications from measles.”
The measles, mumps and rubella (MMR) vaccine is highly effective. One dose is 93% effective in preventing measles, and the second dose boosts effectiveness to 97%.
The first dose is given to a child around their first birthday, though some children can receive it a few months sooner if traveling. The second dose is administered between 4 and 6 years old, typically before a child starts kindergarten.
Following the development of the MMR vaccine in the 1960s and the ensuing vaccination campaigns, measles cases worldwide began to drop. An aggressive vaccination campaign that began in the 1980s allowed the United States to declare measles eliminated by 2000, which meant the disease was no longer circulating around the nation.
How do outbreaks begin?
The various outbreaks in the U.S. since 2000 have been caused by travelers bringing the disease from elsewhere, which then spread in unvaccinated populations. Griffith said due to the outbreak in Texas, the origin of which is also linked to international travel, there is a concern whether the U.S. will be able to retain its elimination status.
A big outbreak in the New York City area in 2019 went on for almost 11 months, she said.
Minnesota experienced two measles outbreaks in the past decade, one in 2017 and another last year. The 2017 outbreak included 75 reported cases statewide, which mostly affected unvaccinated Somali-American children. Last year’s outbreak lasted from May to November, and included 70 reported cases, 11 of which reported exposure to measles outside of the U.S.
Griffith said the experience gained during those recent outbreaks put Minnesota public health officials and health care providers in the unique position of being ready to quickly take action.
“We’re always on heightened awareness and able to respond really quickly.” she said.
How does Minnesota respond when a case is reported?
When someone seeks treatment for symptoms resembling measles, namely a fever and a rash, health care providers first conduct a blood test. If the test comes back positive for measles, the health care facility immediately notifies MDH through a system developed to enable fast communication during public health emergencies.
The hospital and the state agency then start the contact tracing process, figuring out where the person has been and where they may have been exposed to the virus. Simultaneously, MDH begins to alert local public health agencies where the case was reported, which Griffith said can really help deter any further spread.
“All of that notification can take place within a couple of hours of us finding out about a positive case,” Griffith said. “That will help us if, for example, the new measles case is in a child and maybe that child goes to school or goes to daycare, then right away we can start identifying who might have been exposed at the school or the daycare.”
Why are some children not getting the vaccine?
Hundreds of scientific studies have debunked a potential link between autism and vaccines, but the idea still persists. The claim was first made in a research paper published in 1998, which was later discredited and retracted. It contributed to the 2017 outbreak among unvaccinated children in Minnesota’s Somali community, and has contributed to lower immunization rates.
According to the Centers for Disease Control and Prevention (CDC), about 92.7% of kindergartners nationwide last school year had the two doses. That is lower than the recommended 95% needed to achieve herd immunity.
Beecher said the lower immunization rates can allow the virus to spread more quickly and to more people.
“If you have a community with a low immunization rate, and you’re sitting in a congregated area, whether that’s a church, a mosque, school cafeteria, it’s very easy to spread,” she said. “Within Minnesota, if you break it down by different communities or different races, we find that when there is higher vaccine hesitancy, there may be lower vaccine rates and therefore more susceptibility to measles infection.”
Exacerbating the issue are prominent figures like President Donald Trump and U.S. Health and Human Services Secretary Robert F. Kennedy, Jr., who have both trafficked in anti-vaccine rhetoric. Under their direction, the CDC announced it is researching possible links between autism and vaccines, and hired a known vaccine skeptic who has published papers claiming the link exists to head the study.
“There is no link between autism and the MMR vaccine. We know this unequivocally,” Beecher said. “Spending this money and spending this time to re-evaluate something that we know is inaccurate is actually a disservice to our patients and our families.”
To combat that, Beecher said health care professionals at Hennepin Healthcare meet Minnesotans where they live to address any questions and concerns they may have. Among other locations, that includes a mobile clinic team that goes out into the community to provide care, as well as popup clinics at Head Start programs or school gymnasiums.
Town halls are another method Beecher and her team employ in order to encourage dialogue between communities and their health care providers.
“The point is to have long conversations and discussions between community and health care without judgment, without intimidation, without even any type of vaccine or medical equipment,” she said. “We’re just there to have a conversation, and I’m hopeful that these conversations and this dialogue will start to give people pause when they see a TikTok video that says vaccines cause autism, or that it gives them the confidence to take our information back to their community.”
