This young Texas doctor only read about measles. Now she's a leading expert amid outbreak.
This young Texas doctor only read about measles. Now she's a leading expert amid outbreak.
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At least one dead as dozens infected in multi-state measles outbreak
A measles outbreak has infected dozens in multiple states, with at least one reported child death in Texas.
Dr. Leila Myrick had only read about measles in medical school before a girl with the telltale rash turned up in her West Texas emergency room in late January.
The child, who had no immunity to the highly contagious disease but had an underlying respiratory condition, would become one of the first known cases in Gaines County, the epicenter of the nation's largest outbreak, in six years. Nearly 160 known people have been infected since, including 22 people who have been hospitalized. And last week, a school-aged child with no underlying conditions died, marking the first measles death in a decade. The outbreak spread across rural counties and is now suspected to have caused an outbreak nearby in New Mexico.
Myrick, a 38-year-old family medicine and obstetrics physician in the tiny town of Seminole, looked back to medical texts to learn more about the disease, once thought to be nearing eradication in the U.S. Now, she's treated nearly a dozen cases and counting. In just over a month's time, the rural doctor has become one of the nation's only doctors with firsthand experience of how infectious, and serious, measles is. And she is an unwitting expert in a disease she never thought she'd treat.
'Now we're literally seeing when you don't vaccinate, this is what happens,' Myrick said.
Since vaccination rates have dropped across the U.S., doctors and health staff across the country are rethinking preventable diseases such as measles that hadn't been seen in generations.
The U.S. declared measles eliminated in 2000. But American immunization rates have decreased in schools — which normally require vaccines for attendance — below the 95% herd immunity threshold needed to prevent outbreaks, according to the Centers for Disease Control and Prevention. Drops have been attributed to distrust and misinformation around public health and vaccination that led to increases in medical or religious exemptions.
'Measles is the tip of the iceberg,' said Dr. Daniel Kuritzkes, chief of the infectious diseases division at Brigham and Women's Hospital and a professor at Harvard Medical School. 'There are other vaccine-preventable illness that we could see recurring, which could also have catastrophic consequences.'
In Gaines County, just over 80% kindergartners were vaccinated against measles last school year. In the county, Loop Independent School District, with about 150 students, had less than half of students vaccinated.
As of Tuesday, over 100 of Texas' 159 cases were in Gaines County. Most cases are in children, predominantly among those who are school-aged. All but five cases were among people who weren't vaccinated or had no known vaccination status.
From Atlanta to rural health
Five years ago, Myrick moved from her hometown of Atlanta — after studying at Emory School of Medicine and earning a doctorate in neuroscience in addition to her medical degree — to Seminole, where peanuts, oil, natural gas and cotton dominate the Texas plains. Instead of Atlanta's famed research institutions, including CDC headquarters, Myrick sought to practice treating families as a rural doctor. She moved her family to Seminole, population 7,231, where she liked the diversity. It is a mix of white, Mexican and Mennonite families and sits about 80 miles southwest of Lubbock.
She and her husband are raising two children, ages 5 and 8, who attend local schools. Her in-laws live across the street. Seminole is like a village, she said. People look out for each other and their children.
Her commute to work is a 3-minute drive with one traffic light − short enough that she doesn't even bother to turn on the radio. At her local grocery store, people stop her in the aisles with medical questions. She urges them to schedule an appointment so she can examine them.
Before the outbreak, Myrick heard many concerns about vaccines, including in Gaines County's Mennonite community, where the measles first appeared in late January. At the family clinic, parents told Myrick that no one got measles anymore, so there was no need to vaccinate their children. And it only caused mild illness, they said. Others argued vaccines cause harm, despite the vaccine showing decades of safety. As their family doctor, she recommended they get the vaccine, which is safe and effective.
Hesitancy, misinformation on measles vaccine
Such claims have helped to allow measles to return with force. Health experts cite statements made by Health and Human Services Secretary Robert F. Kennedy Jr., who previously advocated against the measles vaccine for years and has contradicted guidance from his own health agencies.
In the current outbreak, Kennedy has downplayed measles outbreaks and the severity of disease and has made incorrect statements about the current outbreak, said Dr. Richard Besser, former acting director of the CDC who is now president and CEO of the Robert Wood Johnson Foundation. A recent op-ed by Kennedy called for parents to consult with health providers about vaccination, adding the decision to vaccinate is a "personal one."
'We have conditions here that are so, so highly preventable that we're going to see come back because we have some leaders who don't believe in science,' Besser said.
Pediatricians and family doctors now should learn about diseases relegated to history, Besser added. They should ensure they know what measles, polio and different types of meningitis look like. They should also understand isolation protocols for these illnesses.
Around a fifth of unvaccinated people who get infected with measles end up hospitalized. Children who contract measles can develop pneumonia, the most common cause of death from measles, or brain inflammation that can lead to hearing loss or developmental delays. Death occurs in around 1 to 3 in 1,000 infected children.
The best defense against measles, by far, is vaccination, said Besser, a trained pediatrician. The full two-dose series, first administered around a year old, is 97% effective against measles. Just one shot provides 93% protection.
Measles is highly infectious, spreading through contact with droplets released from coughing, sneezing or talking. Measles can stay in a room or on surfaces two hours after a sick person has left. One contagious person can infect 18 others around them who aren't immunized.
With a measles diagnosis, timing is critical
A fever, cough or a rash can be a variety of different issues. But doctors can't afford to miss a measles diagnosis, said Dr. James Cutrell, an associate professor at University of Texas Southwestern Medical Center, in Dallas.
Given how contagious measles is, he said, the importance of identifying it early in order to isolate the patient, test them and confirm if it's measles is crucial to stopping the spread. Another concern is that symptoms develop typically a week or two after exposure. People can spread measles even when they're not showing symptoms.
Myrick saw this firsthand. In late January, the infected girl arrived in the emergency room with an underlying respiratory condition that put her at increased risk from the potentially deadly virus. After an emergency physician diagnosed her with measles, Myrick went to her medical texts to look up the disease to treat the girl.
She recalled the blotchy, red spots covering the girl's body from head to toe. The child was placed in isolation, with hospital staff in full gowns and masks. Through the course of the child's stay, her rash changed to smaller red dots. Myrick thought she would be the only case.
'We took every precaution we could to try to contain it and keep it isolated to just that one patient,' she said. 'And it didn't work. It didn't work at all.'
At first, the outbreak centered in the region's Mennonite community, which had been under-vaccinated with entire families infected. Myrick and staff have now seen cases among Latino infants too young to be vaccinated but facing serious illness. Pregnant women, who are at particular risk of miscarriage or premature birth from infection, are also at risk.
She expects more cases in the community. Many families call describing measles symptoms, but they won't get tested, and they won't get treatment unless infections worsen.
Outside of Gaines, the outbreak has spread in eight other counties, with exposures hundreds of miles away in and around San Antonio. Officials in New Mexico suspect their outbreak, among nine people infected, is linked to the Texas outbreak just across state lines.
'Hope and prayer' won't end outbreak
Beyond Texas and New Mexico, nearby states have much lower vaccination rates than herd immunity needed to prevent outbreaks. By comparison, Texas and New Mexico had two-dose vaccination rates among kindergartners at 94.3% and 95%, respectively. But surrounding states — including Arizona, Colorado, Kansas and Oklahoma — had immunization rates below 90%, CDC data from last school year showed.
'A hope and a prayer doesn't just make it go away,' said Dr. Kisha Davis, a board member of the American Academy of Family Physicians and a health officer in Maryland. Her health department, in Montgomery County, saw one measles case a year ago in an unvaccinated person. Thanks to high immunization rates, an outbreak didn't occur, she said. 'We need to continue to be vigilant.'
In Seminole, a wooden sign read 'MEASLES TESTING' across from the local health department. In addition to testing, officials have expanded vaccination sites. More people are showing up to get vaccinated, including those that once swore off the shots, said Myrick, who recently became chief medical officer for the town's hospital. Others still don't believe in vaccines.
Myrick said her children worry about catching measles. Their classmates have contracted the disease, and her children are scared about getting a rash. Both of her children are vaccinated, she reminds them. They don't need to be afraid.
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