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Upstate health experts stress importance of measles vaccinations

Herald-Journal - 6/11/2019

Jun. 11--Amid the worst nationwide measles outbreak since President George H.W. Bush's administration, public health officials continue to push a consistent message.

Make sure you and your children have been properly vaccinated.

The U.S. Centers for Disease Control said last week that more than 1,000 individual cases of measles have been confirmed in 28 states so far this year, including Virginia, Tennessee, Georgia and Florida.

"The Department of Health and Human Services has been deeply engaged in promoting the safety and effectiveness of vaccines, amid concerning signs that there are pockets of under-vaccination around the country," according to a statement last week by U.S. Health and Human Services Secretary Alex Azar. "The 1,000th case of a preventable disease like measles is a troubling reminder of how important that work is to the public health of the nation."

North and South Carolina, so far, remain unaffected this year, though Spartanburg County did have six confirmed cases of the virus in late 2018, according to the South Carolina Department of Health and Environmental Control.

Why should you care?

Health experts warn the virus is "highly contagious," and lives in the nose and throat mucus of people infected and can live in the airspace for up to two hours after someone coughs or sneezes.

Kathy Bryant, the infection prevention manager for Spartanburg Regional Healthcare System, said Monday the virus' airborne contributes to its spread.

"There are things that are spread by contact -- you touch something with your hands -- or via droplets, like the flu," Bryant said. "If you keep your distance from someone with the flu, you can decrease your risk. Measles is spread through the air. It's tiny and light and carries on the air, almost like a scent would. And it can float around in the air and stay suspended which makes it hard to deal with."

It's so easy to transmit, according to the CDC, that if one person has the virus, up to 90 percent of people close to that person who are not immune will also become infected.

Symptoms typically appear one to two weeks after contact with the virus, and can lead to high fever spiking higher than 104 degrees Fahrenheit, along with cough, runny nose and watery eyes, according to the CDC, with a rash that appears three to five days after the first symptoms.

Infected people can spread measles to others from four days before through four days after the rash appears.

Roughly a quarter of people infected will be hospitalized, according to CDC estimates, and as many as 5 percent of children who get measles will get pneumonia, the most common cause of death from measles in young children.

A fraction, one-in-1,000, will develop swelling of the brain that can lead to convulsions, leaving children deaf or intellectually disabled, and up to two-out-of-1,000 of those infected with measles will die from respiratory or neurological complications.

Even for people who have seemingly recovered from the virus, the CDC says, it can have long lasting impacts. A rare but fatal disease of the central nervous system, Subacute Sclerosing Panencephalitis, can occur seven to 10 years after a child's measles infection.

Vaccination is the key

Prior to the availability of a vaccine in 1963, public health officials estimated some 48,000 individuals were hospitalized each year due to the virus. Two doses of measles vaccine, for instance, is roughly 97 percent effective at preventing measles for those exposed to the virus, according to studies.

By 2000, the CDC said the virus had been eliminated in the United States, which means the "absence of continuous disease transmission for greater than 12 months."

The virus still exists in many parts of the world, however, and unvaccinated populations both here and abroad continue to be at risk.

The CDC said there were 17 outbreaks in 2018, with those in the northeast states of New York and New Jersey experiencing the greatest number, particularly among unvaccinated people in Orthodox Jewish communities. A year prior, a 75-case outbreak was reported in a Somali-American community in Minnesota with poor vaccination coverage.

While the SCDHEC requires students to have certain vaccines before enrolling at a public school, exemptions can be given for medical or religious reasons.

During the 2018-2019 school year, Spartanburg County led the state on a percentage basis, totaling approximately 14.4 percent, in requested exemptions. Out of more than 50,600 enrolled students, 1,608, or or 3.17 percent, sought an exemption. Statewide, more than 11,100 students sought immunization exemptions.

Dr. Erin Bailey, a pediatrician with Medical Group of the Carolinas -- Pediatrics -- North Grove in Spartanburg, said Monday immunizations are among the most crucial of services a pediatrician can provide their patients.

"It's that important," Bailey said. "Well visits and vaccines are really the forefront of what we spend our days doing."

She stressed that vaccines bolster herd immunity, a concept that describes the protection offered by communities which are immune to certain diseases. Immunity makes it less likely for a virus like measles to easily spread.

"Herd immunity protects those children who may be unvaccinated or too young to be vaccinated," Bailey said. "Children under 12 months can't be vaccinated or those with immune compromising conditions, for instance. Vaccines are safe and it's been proven over and over and over. We wouldn't offer them if we didn't believe in their safety."

How to prepare

Part of Bryant's job description entails preparing SRHS's constellation of campuses in the event a measles outbreak does hit Spartanburg County or surrounding areas.

"Part of our job is monitoring for infectious conditions in patients that warrant special precaution," Bryant said.

If a case of measles was suspected or confirmed, Bryant said doctors would seek to separate the patient from other people.

"If it happens in a hospital we have special airflow rooms where we'd house that patient," Bryant said. "If it happens in an ambulatory setting, you'd try to physically relocate that person from the rest of the waiting area, for instance. Whatever you can do given your geography to remove them from other people because of the way it spreads."

Putting those precautions in place quickly is made more difficult by the fact that few providers have actually treated a patient with measles, thanks in part to its relative scarcity, she said.

"Some of our less veteran folks have never seen it," Bryant said. "But the first task is going to be able to identify the rash. The person who presents with measles is typically going to be sicker than someone who comes in saying they've used a new detergent and have a rash on their arm. Measles is going to make you sicker, you're going to feel worse."

If you suspect you have the measles, or have been exposed, Bryant said the best thing you can do is to call ahead and alert medical providers ahead of time. She said they can more quickly make their assessment, and do so in a way that endangers fewer patients and staff.

"From there, treatment is basically addressing those symptoms," Bryant said. "You're looking to reduce the fever if it's bad enough, or reduce the risk of seizures."

Another consideration? Those who have been exposed to measles could expect extended time off from work or school to reduce the chance of passing the virus on to someone else, Bryant said.

"Measles is preventable and the way to end this outbreak is to ensure that all children and adults who can get vaccinated, do get vaccinated. Again, I want to reassure parents that vaccines are safe, they do not cause autism. The greater danger is the disease the vaccination prevents," according to a statement last month by CDC Director Dr. Robert Redfield. "Your decision to vaccinate will protect your family's health and your community's well-being."

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