By Tim Gardner
Measles, a dangerous disease that was all but wiped out nearly two decades ago due to widespread vaccinations, is making a comeback worldwide, including in North Carolina. As a result of recent confirmed measles cases, local, state, national and international health departments and other medical treatment organizations are urging vaccinations to thwart the potentially deadly virus.
The U.S. Centers for Disease Control and Prevention said this week that 127 cases of measles have been confirmed in 10 states since the start of this year and five outbreaks of 3 or more cases have occurred, according to the most recent update from the Centers for Disease Control and Prevention (CDC). The states that have reported cases to CDC are California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington. And North Carolina had three confirmed cases late last year.
Measles usually strikes children, but adults can also contract the disease.
Fortunately, there have been no confirmed cases of measles in the Appalachian Regional Healthcare System which includes Watauga Medical Center in Boone, Cannon Hospital in Linville and The Foley Center At Chesnut Ridge in Blowing Rock, according to Vicki Stevens, the System’s Director of Marketing.
Jessica Farley, spokesperson for the Toe River Health District of Avery, Mitchell and Yancey counties said there was rumored to be a case of measles in that health district area recently, but that the person suspected of having the disease was diagnosed with another ailment after being examined by a health care professional.
“Sometimes people suspected of having measles actually have another ailment with similar symptoms, which may not be as serious,” Farley noted. “But you have to remain aware that with an outbreak of measles elsewhere in the country and also elsewhere in North Carolina, that the disease could strike locally. Parents who suspect that his or her child or children, or even themselves, might have measles, should make sure to have their child or children or his or her self examined by a primary care doctor, in a hospital emergency room or at a medical clinic or health department.”
Farley added: “The key is to make sure you and all your family members are vaccinated for the measles. That’s the best way to combat the disease.”
According to medical professionals, those born before 1957 who do not have a medical contraindication should receive at least one dose of the MMR (Measles, Mumps, & Rubella) Vaccine, unless they have documentation of vaccination with at least one dose of measles-containing vaccine or other acceptable evidence of immunity to the disease.
Measles is a highly contagious and infectious disease caused by the measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104.0 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik’s spots may form inside the mouth two or three days after the start of symptoms.
A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea (in 8% of cases), middle ear infection (7%), and pneumonia (6%). Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Rubella, which is sometimes called German measles, and roseola are different diseases caused by unrelated viruses.
And about 1 out of 4 people who get measles will be hospitalized. And 1 out of every 1,000 people with measles will develop brain swelling due to infection (encephalitis), which may lead to brain damage. Additionally, 1 or 2 out of 1,000 people with measles will die, even with the best medical care.
The risk of death from measles is higher for adults and infants than for children.
Medical professionals warn that an unvaccinated or immune person who shares close space with an infected person who sneezes or coughs has a 90 percent chance of contracting measles. The virus is hearty, and can live for up to two hours in an airspace where an infected person coughed or sneezed. The measles virus lives in the nose and throat mucous of an infected person. And people who have measles can spread it from four days before a rash appears to four days after it has cleared.
The good news is that the MMR Vaccine is extremely effective in protecting against measles and also protects against mumps and rubella. The CDC notes that the vaccine also is very safe to take. Two doses of the vaccine are approximately 97 percent effective at preventing measles and one dose is about 93 percent effective, according to the CDC.
The CDC said the rise in measles in the United States can be traced to outbreaks in countries to which Americans often travel — including England, France, Germany, India, the Philippines and Vietnam.
College and university students, healthcare personnel and international travelers are at increased risk for measles, and should receive two doses of the MMR vaccine to ensure adequate protection, the CDC recommends.
According to the CDC, most of the people who contract measles are those unvaccinated.
“Measles can spread when it reaches a community where groups of people are unvaccinated,” the CDC said in a press release.
A 1978 goal by the CDC to eliminate measles in America by 1982 fell short, but widespread vaccination programs caused the agency to finally declare measles eliminated in the United States by 2000. But the past couple years they have made a horrid return.
Globally, measles cases saw a 30 percent increase in 2017 and killed an estimated 110,000 people, according to the WHO. The main reason for the increase in Europe, where 41,000 people were infected in the first six months of 2018, was the refusal by parents to have their children vaccinated, sometimes because of religious beliefs, the health agency said.
Some parents refuse to vaccinate their children amid incorrect claims around the world linking the vaccines to autism, but the CDC and global health agencies like the World Health Organization (WHO) recommend that children receive two doses of measles-rubella or measles-mumps rubella.
In 2015, North Carolina lawmakers considered barring parents from claiming an exemption from vaccinations unless they could show that vaccinations violated their faith. However, those lawmakers backed down because of some protests.
Since then, the number of N.C. families declaring religious exemptions has continued to rise. North Carolina has endured chicken pox outbreaks in 2016, 2017 and 2018, including one last November that afflicted 36 students at an Asheville school with a high concentration of vaccine exemptions.
But most major mainstream religions — including all Christian denominations — have no prohibition on vaccinations, and many advocate for immunization, according to studies. The Amish, long rumored to forbid vaccinations, have no such prohibition, and Jehovah’s Witnesses have softened their stance on immunizations and now allow them.
North Carolina’s current statute requires vaccinations for measles, mumps and other diseases for children attending day care, K-12 schools, and colleges and universities. Like many states, North Carolina allows exemptions for medical reasons and religious beliefs. The medical exemption needs to be signed by a doctor, but the religious exemption requires only the name and date of birth for whom the request is being made. No explanation of the religious objection — or even evidence of religious affiliation or faith — is required.
Still, statistics show that North Carolina remains among the states with the highest vaccination rates, but between the 2012-2013 and 2016-2017 school years, the number of kindergarteners excused from immunization more than doubled. Those came mostly from western North Carolina.