California doctors put on alert for spread of measles from other states

Feb. 04--California's public health officials are alerting doctors and other medical providers to be on the lookout for measles after first New York state and now nearby Washington state wrestle with a wily virus that health experts say can cause deafness and autism in its survivors.

"Most bacteria and viruses, you ... have to breathe in a lot of those viruses to get sick, but with measles, it takes very few," said Dr. Karen Smith, director of the California Department of Public Health. "That means almost everybody who gets exposed is likely to get sick. It also has a very high ... attack rate, so when you are infected, you get sick."

At least 43 people have caught the disease in Washington state and one more in neighboring Multnomah County, Ore. In New York, almost 210 people have had the illness since October.

Each person who gets measles can transmit it to up 12 to 18 people, said Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Medical Center. An infected person can have measles for up to five days before they show any symptoms, Smith said, and in that time, they are coughing the virus into the air or leaving it on surfaces with their hands.

The cough droplets are so small, she said, that they can hang in the air for a considerable period, and if it gets on surfaces, the virus is contagious for as long as it is moist.

When symptoms finally become evident, Smith said, the sniffling, sore throat and itchy eyes mimic the start of a cold. Parents, she said, might be unfazed by those symptoms because colds are a common childhood malady. Medical providers also might diagnose the symptoms not only because it's the season for colds but also because measles is not a disease they see very often.

Consequently, Smith said, she and her team as well as local public health departments are spending a lot of time and energy right now reminding medical providers that measles can present like a respiratory illness. Blumberg said he can tell that doctors are getting the message by the number of calls he's getting for his opinion on patients' symptoms. In a typical year, California will have 15 to 25 measles cases, Smith said.

Vaccination is the only protection against the measles, both doctors said.

Yet there has been a surge in the number of people hesitant to be vaccinated or hesitant to have their children vaccinated. The World Health Organization recently listed the anti-vaccination, or anti-vax, movement as one of the top 10 public health threats.

The growth in the number of vaccine-hesitant U.S. residents has paralleled the explosion of posts by Russia-linked social media accounts stoking division on the safety of vaccines. Most of these accounts are just programmed bots, researchers from Johns Hopkins, George Washington University and the University of Maryland found, and their posts prey upon parental fears.

Often, they promote the idea that the measles, mumps and rubella vaccine, known as MMR 2, causes autism. They cite flawed research long since retracted by a scientific journal, said researchers at the UC Davis MIND Institute, one of the nation's best-known autism research and treatment institutions.

There is bitter irony in promoting that idea, the Davis researchers say, because the opposite is actually true. Measles has been proved to cause intellectual disabilities, including autism, in children.

In 1964, five years before the measles vaccine was widely disseminated, more than 12.5 million cases of measles were reported. A study of 243 children who had the disease during that period found that an astonishing 37 percent of them suffered a post-infection loss of intellectual ability. Of those exhibiting an intellectual disability, 7 percent were diagnosed as autistic.

Roughly 10 percent of the nation's pregnant women came down with the disease in 1964, UC Davis researchers said, and roughly 13,000 fetuses or infants died as a result. About 20,000 newborns suffered major congenital defects, they added, and 10,000 to 30,000 infants displayed moderate to severe medical or cognitive setbacks.

Measles can bring on pneumonia and encephalitis, a swelling of the brain. Those complications can lead to death, Smith said, and worldwide, more than 100,000 children die each year from the virus. Smith and Blumberg emphasized the risk to infants because vaccines do not work on babies under the age of 1. They simply don't have an immune response to the vaccine, Blumberg said.

It's important to remember, Blumberg said, that vaccines are not always compatible with everyone's physiology, so vaccines won't always work on every child or adult who gets one. The measles vaccine has a high rate of effectiveness: 97 percent, he said.

Once you know how effective a vaccine is, Blumberg said, you can use an easy formula to figure out the percentage of the public who have to be vaccinated to create a safe environment for everyone. The answer, when it comes to measles, is 96 percent.

"In the United States as a whole, we're at about 95 percent," Blumberg said. "Although that sounds good, the problem with that is that the immunization rate is not homogenous. It's not the same throughout the country or not even throughout the state."

To illustrate his point, he Googled a report on immunization rates for California kindergartners published by the state's Department of Public Health. In the 2017-18 school year, records showed Sacramento County hit the magic number of 96 percent.

But think of how often you or your friends visit other counties, Blumberg said, and you begin to get a picture of how important it is that every county hits the magic number. In the Sacramento region, it's a mixed bag with Yolo County at 96.3 percent, Placer County at 94.7 percent, El Dorado County at 91.7 percent and Nevada County at 85 percent.

What if a child with the measles goes to a birthday party? Is it possible the birthday girl has an infant sibling at her party? Is that party at an indoor play center where hundreds of children and infants will gather on the same day?

"This is public health, and it relates to the things we do out in public," Blumberg said. "If people who weren't vaccinated didn't interact with anybody, that would pose no threat. But they do interact."

"It's like driving. You can be the safest driver in the world. You can drive a safe car and wear your seat belt and have air bags and all that, but if somebody else is an unsafe driver, that can overcome all your safety measures."

Smith added: "No one is interested in giving children anything that is going to damage their health. We are very concerned that kids not get measles. Making sure we get solid information out there that is based in science is one of the highest priorities for us. Cases of severe side effects are not just rare. They are incredibly rare."

Blumberg noted that the Washington state outbreak has hit hardest in Clark County, home to many vaccine-hesitant residents. Clark County is where the city of Vancouver is located, and it's just across the Columbia River in Portland, Ore., and Multnomah County, Ore., where one case of measles has been reported.

Public health officials in Washington and Oregon have been posting locations visited by people who had the measles. The sites include swim centers, fitness gyms, museums, churches, grocery stores, a Portland Trailblazers game and even Portland International Airport. Portland airport officials estimate that 600 people leave Portland daily on flights to Sacramento, 7,000 on flights to airports all around California.

What's happening right now in Oregon and Washington, Smith said, is that public health officials are attempting to isolate people who are sick and quarantine people exposed to the illness. The whole family loses time at work and time at school.

"We restrict their movement, so they don't potentially spread it," she said. "That's especially important with measles because of that period of time when people are infectious but not symptomatic. That means that an entire family can have their movements restricted to avoid spreading the virus, particularly if none of them is vaccinated."

A disease outbreak places a high degree of stress on the public health infrastructure, Smith said, because it's labor-intensive work. It's also costly, she said, noting that $4 million is a conservative estimate of what public health departments spent to check the spread of measles in the 2015 outbreak associated with Disneyland.

In that instance, 125 people contracted measles. Roughly 20 percent of the people who got measles in that outbreak were hospitalized, Smith said, and that is costly for families.

Washington state officials estimate estimate public health departments there will spend at least $1 million to contain the outbreak there. What many people may not understand, Smith said, is that during a measles outbreak, many public health workers have to be pulled from their regular duties to help out and scientists in labs must be redirected to analyze measles samples.

In Clark County, Ore., for example, public health nurses have been pulled from promoting maternal and child health to conduct interviews that will help to limit new exposures, state officials said..

"We can't just go out on the street and hire somebody to do a contact investigation of a measles case if they haven't had any training," Smith said. "It doesn't work that way. We need to maintain an infrastructure with people who are well-trained in how to control not just measles but other disease like pertussis. We've had significant outbreaks of pertussis."

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