The measles outbreak that began in Texas before spreading to at least two other states swelled to 355 confirmed cases on Friday — and officials say there is no sign it’s slowing.
“I’m worried it’s getting worse,” Katherine Wells, director of public health for Lubbock, told NBC News.
Many people aren’t getting tested for measles, and efforts to increase vaccination in the affected areas have gotten a lukewarm response, Wells said during a media briefing by the Big Cities Health Coalition on Tuesday.
Wells said she thought it could be a year until the outbreak is controlled.
The outbreak that started in West Texas in late January has now infected 309 people in 14 Texas counties. “All of the cases in these counties are related to each other,” Wells said, adding: “We are going to see mini outbreaks” as the virus spreads unchecked.
Measles is doing what measles does: It seeks out anyone and everyone who isn’t vaccinated against the virus and infects them.
Nearly all of the people who have gotten sick have been children and teenagers never vaccinated against the virus. At least 40 patients have been hospitalized.
Neighboring New Mexico reported 42 cases on Friday. Twenty of the people in New Mexico were ages 18 or older, eight were 4 or younger. And as of Tuesday, Oklahoma had confirmed four cases related to the outbreak. All were either unvaccinated or it was unclear if they had gotten the shots.
Two people, a 6-year-old girl in Texas and an adult in New Mexico, have died. The epicenter of the outbreak, Gaines County, Texas, has one of the state’s highest vaccine exemption rates, at nearly 18%, according to health department data.
Vaccine clinics have been set up in the county, but uptake hasn’t been robust, Wells said. Many families in the area remain steadfast in long debunked fears that vaccines cause autism, she said.
Now is the time, Wells said during Tuesday’s briefing, for health departments across the country to boost their vaccination rates.
“Measles is going to find those pockets of unvaccinated individuals, and with the number of cases and ability for people to travel, there is that risk of it entering other unvaccinated pockets anywhere in the United States right now,” she said.
Kansas has reported 10 measles cases in three counties that border Oklahoma. Those cases haven’t been officially linked to the ongoing outbreak.
Cases linked not to the outbreak but to international travel have been reported in Alaska, California, Florida, Georgia, Kentucky, Maryland, Michigan, New Jersey, Ohio, Pennsylvania, Rhode Island, Texas, Vermont and Washington.
“Measles will find a way to continue transmitting until it runs out of a susceptible population,” said Dr. Brian Borah, medical director for vaccine-preventable diseases surveillance at the Chicago Department of Public Health.
The only thing that’s going to stop a national outbreak is a massive effort to find people who aren’t vaccinated and get them the shots as soon as possible, Dr. Simbo Ige, commissioner of the Chicago Department of Public Health, said during Tuesday’s briefing.
“The duration of the outbreak is dependent on your ability to identify everyone who is vulnerable, determine if they have been exposed, and then how quickly vaccination starts,” Ige said.
Last year, Ige’s team faced a measles outbreak that ultimately infected 64 people, mostly associated with a housing shelter in Chicago.
The health department enlisted community health workers and other trusted members in the area, such as politicians and faith leaders, to encourage vaccination, Borah said.
“We put people in the shelter who we knew were trusted messengers,” he said. Nearly everyone who hadn’t been vaccinated got the shots.
Within two months, the outbreak was over.
How the virus develops and causes symptoms
Measles is one of the most contagious viruses in the world. When an infected person coughs, sneezes or even breathes, tiny viral particles are hurled through the air — and stay there, floating around for hours.
“If I’m just sitting in my office and talking, I’m spewing virus around,” said Dr. Ronald Cook, chief health officer at the Texas Tech University Health Sciences Center in Lubbock and the city’s top health official, explaining how easily measles spreads. “If my door is open, that virus can leave my office and go out into the hallway. Somebody walking up and down the hallway can get infected.”
Once a person is infected, the virus quietly multiplies in the body for about seven to 14 days without causing symptoms. This is called the incubation period.
Around day 10 or 11, the body’s immune system becomes overwhelmed and symptoms develop, including a cough, runny nose, high fevers up to 103 and 104 degrees and inflamed, red eyes. “Think of pink eye, but worse,” Cook said.
Then, small, white dots called Koplik spots show up in the mouth and spread into the lungs, causing inflammation. That’s why babies and small children in particular are at risk for trouble breathing. Their tiny airways can’t handle so much inflammation. At this point, the virus can cause bacterial pneumonia.
It’s not until several days later that the characteristic measles rash begins — angry, red splotches that start at the top of the head and work their way down the body.
By that time, the patient has already infected vulnerable people. An infected person spreads the virus four days before the rash ever shows up, as well as four days after. That’s why it’s a mistake, Cook said, to think of measles as “just a rash.”
Measles vaccination guidelines
Two doses of the measles, mumps and rubella (MMR) vaccine are 97% effective in preventing infection, according to the Centers for Disease Control and Prevention. The first dose is given at around age 1, offering 93% protection, but the second isn’t given until around age 5, when a child enters kindergarten. That leaves kids slightly vulnerable for the several years they are in between doses.
The general rules change, however, during an outbreak.
Doctors have the option of giving the second dose early if a child has been exposed to the virus. Pediatricians can give the vaccine to babies at least 6 months old, doctors say, but they will still need the two standard doses when they’re old enough.
