Texas measles outbreak hits 500 cases, but expert says it could be 4 times higher
The measles outbreak in Texas is likely four times the size of the reported numbers because of a lack of availability of testing and the lack of willingness to come forward to get tested, Dr. Amesh Adalja of the Johns Hopkins Center for Health Security, said in a news briefing Tuesday. His estimate is based on the number of measles deaths compared with the number of cases reported.
Two children have died, and 57 patients have been hospitalized, mainly because of high fever and breathing problems.
"Two deaths would tell you it should be 2,000 cases in Texas," Adalja said. It probably means that this is a much bigger outbreak than we've seen in the past, he said.
Texas State Health and Human Services is now reporting 505 cases in West Texas, and that includes a growing number of cases in urban areas, including Lubbock. Gaines County, which is the origin of this outbreak in a Mennonite community, still has the most cases. Of the 505 West Texas cases, 495 were in people who were unvaccinated or their vaccination status is not known.
"What happened in Gaines County is really a lesson for the whole country," Adalja said.
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Adalja expects the cases to continue to grow. "This is going to take maybe a year to contain," he said.
Now with more cases in the Lubbock area, a faster spread is also possible, said Katherine Wells, director of Public Health for the city. Previously, Lubbock was helping to support the people in rural West Texas who were needing to be hospitalized.
"Now we're actually seeing transmission within our community," she said of the 36 Lubbock County cases. "Now I'm worried about exposures in grocery stores and malls and those types of places that don't exist as much out in rural communities. ... One case can be exposing more individuals."
Measles is one of the most contagious diseases. It spreads by airborne particles, and has a 90% infection rate among unvaccinated people if they are exposed to a person with measles. The virus can live on the surfaces of a room for two hours after the exposure.
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There have been six cases in areas outside West Texas, including one in Travis County of an infant. That case has now resolved without any further infections.
Texas has expanded the number of counties in the outbreak zone to 21 and changed the vaccine recommendations for that area, Wells said. All children in that area can now get vaccinated with the measles, mumps and rubella vaccine beginning at 6 months old instead of at one year, and children ages 1 to 4 can get a second vaccine before they turn 4.
The Lubbock area now has a day care facility with six to seven confirmed measles cases, Wells said, but more children from that day care are waiting to be tested.
Any child who is not vaccinated at that center has been sent home for at least 21 days. Kids who have any of the early symptoms such as goopy eyes and runny nose are being sent home, she said. If they have measles, they cannot return until four days after the rash appears and they are symptom- and fever-free.
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Measles is now in 22 states and is actually six separate outbreaks, Adalja said. The Texas outbreak, which has expanded to New Mexico and Oklahoma, makes up the majority of the cases.
After federal cuts to the Centers for Disease Control and Prevention, public health departments have lost personnel on the ground to do the vaccination clinics and the epidemiologists to do contract tracing and control the spread, said Dr. Phil Huang, director of Dallas County Health and Human Services.
Near Dallas, a person with measles recently traveled to Grapevine and the Great Wolf Lodge water park hotel, which is causing that area concern.
Earlier San Marcos, New Braunfels and San Antonio were concerned about a person who later became positive with measles who had visited that area over Valentine's weekend, but no additional cases are known to have come from that.
Most years, 100,000 deaths happen globally from measles, Adalja said, but not in the U.S. What is happening in the U.S. will affect other countries in South America and North America, he said.
"It's not just the U.S. on the line here," he said. "It's the whole region of the Americas." That region had received elimination status for measles, but that might be lost, he said.
Measles also has long-term consequences.
"Measles is not just an acute illness," Adalja said. It causes "immune amnesia," which means people lose their immune protection to other diseases. They also can develop swelling of the brain and other complications years later.
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After seven to 14 days of being exposed, measles starts with:
Cough
Runny nose
Conjunctivitis
Usually a fever of 103 to 104
Four days later:
A rash starting at the head and working its way down the body appears.
The rash can start as sore spots in the mouth.
In severe cases:
Inflammation of the lungs
Pneumonia from a secondary infection
Inflammation of the brain
People born before 1957 are presumed to have immunity because of the amount of measles that was present during that time. People born after that time need to make sure they have been vaccinated with two doses. If you were born between 1957 and 1968, you might not have immunity because the vaccine at the time didn't use a live virus.
Vaccine protection does wane over time. You can get a blood test to check your immunity level to be sure. If you have been pregnant in the last 30 years, you have already had your titer check for rubella, which is in the MMR vaccine and would have been told if you did not have immunity.
For vaccinations, contact your primary care provider or you can go through Austin Public Health. You can get vaccinated as an adult if you have not been vaccinated previously.
Austin Public Health offers vaccinations for free or at reduced rates for children and adults who do not have insurance, have Medicaid or are underinsured. The typical cost is $13 for children and $25 for adults. You can make an appointment at 512-972-5520 for the clinics at 405 W. Stassney Lane in South Austin or 7500 Blessing Avenue in Northeast Austin.
This article originally appeared on Austin American-Statesman: Texas measles cases hit 500, but expert says it could be 4 times that
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