Michigan health officials miss crucial notification window for most 2025 measles cases

Yahoo

29-04-2025

When measles cases pop up, notifying the public quickly of exposure sites is critical.
That's because people without immunity to measles — those who are unvaccinated or immunocompromised — can be treated with post-exposure prophylaxis to prevent the most severe complications of infection, but only if the treatment can be given fast enough, according to the U.S. Centers for Disease Control and Prevention.
A single dose of the measles, mumps rubella (MMR) vaccine can be administered within three days of exposure to protect a person from severe illness. If the three-day window is missed or if a person can't have the MMR vaccine, a treatment called immunoglobulin also can be given within six days of exposure.
Once that six-day window has passed, however, the only thing people can do is monitor for measles symptoms for 21 days and report them to public health officials if they appear.
In just three of Michigan's nine confirmed measles cases in 2025 — identified April 2 in Kent County, March 14 in Oakland County and April 14 in Ingham County — public announcements were made within six days, in time for immunoglobulin to be an option for people who were exposed, according to a Detroit Free Press review of state and local health department data.
In five of the nine measles cases reported in Michigan this year — four in Montcalm County and one in Macomb County — there was no public notification of exposure sites.
The remaining case — involving a second 1-year-old child in Ingham County — the public announcement came too late for post-exposure prophylaxis to be given to those who were exposed.
The U.S. is on track for the worst year for measles in decades, said Dr. Natasha Bagdasarian, Michigan's chief medical executive, as 884 cases have been confirmed in 29 states, including nine in Michigan, as of April 24.
'The epidemiology of measles in our country is changing before our eyes,' she said, noting that vaccination rates have steadily fallen since 2000, making more people vulnerable to the highly contagious virus.
As many as 20% of children who contract measles go on to be hospitalized. Some people develop neurologic complications like encephalitis or swelling around the brain, and can have lifelong problems as a result, including hearing loss or seizure disorders.
Lynn Sutfin, a spokesperson for the Michigan Department of Health and Human Services, said several factors can delay the identification of measles infections and public notification of exposure sites.
"Measles cases are often unique and circumstances under which we get reporting varies for each case," she said. 'It's often difficult to get people within an appropriate PEP (post-exposure prophylaxis) window, particularly within 72 hours of symptom onset."
Since measles symptoms typically present first with runny nose, cough, red, watery eyes and fever, people can spread the virus before they know they have it and can confuse measles with a respiratory infection. A person with measles is contagious for up to four days before the telltale rash begins, according to the CDC.
"There might not be suspicion of measles until the rash develops," Sutfin said. "This means that public communications indicating a small window for (post-exposure prophylaxis) do not necessarily imply delays in testing or diagnosis. Instead, they may reflect that the individual's exposure occurred earlier in the infectious period, which is common given the subtlety of early measles symptoms.'
Once measles is suspected, the state Bureau of Laboratories typically is able to turn around a test result within three days, said Liana Stebbins, a spokesperson for MDHHS.
Two of those days often are tied up in shipping the sample to the lab. And sometimes, that timeline can be slowed. Among the reasons, Sutfin said:
Problems with testing. Specimens might not have been initially collected appropriately or weren't of sufficient quality.
Shipping delays of the specimens to the Bureau of Laboratories.
Health care providers sometimes send specimens to commercial labs, which can have longer turnaround times than the state lab in returning test results.
Delays in notification to public health from a health care provider.
The details that are provided when measles cases are publicly announced can vary widely.
One of Michigan's measles cases this year — confirmed April 18 in Montcalm County — was not publicly announced at all. For other cases, scant information has been released to the public. And for yet another subset of cases, a robust list of exposure sites, and specifics about vaccination status, age and sex of the people infected was disclosed.
The Ingham County Health Department, for example, detailed that both of its confirmed measles cases this year involved 1-year-old children — a boy and a girl — who each had gotten one dose of the MMR vaccine. It also provided a list of potential measles exposure sites.
But the department did not include as an exposure site the preschool where the first infected child in Ingham County attended classes. That's because the school's leaders were "very cooperative in terms of giving us a list of the students in the school, the staff, the people who have been there," said Dr. Nike Shoyinka, the county's medical health officer.
Shoyinka said health department nurses were confident they were able to reach out directly to the all of the people who were exposed.
"We have the information that we need already," she said.
More: What are the symptoms of measles? And other answers to common questions.
More: Montcalm County has Michigan's first measles outbreak of 2025
And when the state's first outbreak since 2019 was identified April 16 in Montcalm County, neither the Mid-Michigan District Health Department nor MDHHS issued any kind of public announcement right away.
Instead, notification went out to health care providers via email. The following day, the Free Press confirmed the outbreak and published a story. Soon after, a public release was issued to news organizations.
No details were provided about public exposure sites, the sex or ages of any of the four people from Montcalm County who were infected as part of the outbreak. Their vaccination status also was not released. Those details were excluded from a Macomb County measles case announced April 4 as well.
What was disclosed, however, was that the Montcalm County outbreak and the individual Macomb County case all had been traced to travel to Ontario, Canada. Nearly 1,000 measles cases in Ontario have been linked to a Mennonite wedding in New Brunswick province, the CBC reported.
Bagdasarian did not answer a question from the Free Press about whether those Michigan cases also were among members of the Mennonite, Amish or Anabaptist communities.
Instead, she said: "When we're dealing with such small numbers, it's really important that we are maintaining people's confidentiality in public health. It's so important that people want to work with us, that they feel comfortable sharing their personal information with us. ...
"For each of these cases, the local health departments in both of those jurisdictions are hard at work doing contact tracing, making sure that they're doing in-depth interviews with anyone involved in those cases to see where exposures could have happened. So when we say we don't think that there are public exposures that we need to announce, that means after in-depth interviews and conversations, we don't think that there is information that we need to share with the public.
"For folks who think we're trying to hide anything, we are just trying to protect our communities, protect our relationships, make sure nobody feels intimidated, discriminated against, threatened."
Bagdasarian said there isn't always a need to inform the public of measles infections.
"If there was an exposure that impacts the larger public, and we need to notify people that that an exposure happened here or Detroit Metro Airport, or a grocery store, or wherever ... that is our duty to inform, and we will inform," she said.
It is pivotal, Bagdasarian said, to ensure people take the measles seriously, and consider getting immunized to protect themselves and their loved ones from the virus.
"This is not a mild childhood rash we're talking about," she said. Without immunity, 90% of people who are exposed to measles will get infected.
"We also know that pregnant women who contract measles can undergo stillbirth or miscarriage," Bagdasarian said.
A measles infection is like a hit to the immune system, she said, making people more likely to develop secondary infections such as pneumonia. So far this year, three people have died from measles in the U.S.
"People don't really think about measles as being something that can have long term complications, but it absolutely can," Bagdasarian said.
The best way to prevent measles is to get vaccinated, said Ryan Malosh, director of the division of immunizations for MDHHS. Of the U.S. cases so far this year, 97% have been among people who were either unvaccinated or had an unknown vaccination status, according to the CDC.
Although two doses of the MMR vaccine are 97% effective in preventing measles, immunization rates in Michigan have continually fallen since 2020, Malosh said.
About 79% of Michigan children ages 19-35 months old have been vaccinated for measles, he said, compared with 85% five years ago.
"We've seen a pretty substantial decline in vaccination coverage, and particularly for measles, what we know is in order to protect communities from outbreaks of measles, you need to have vaccine coverage of about 95%," Malosh said. "So, we are well below that number now in Michigan."
Contact Kristen Shamus: [e-mail]. Subscribe to the Free Press.
This article originally appeared on Detroit Free Press: Health leaders miss crucial window for most Michigan measles cases