There are now 555 measles cases reported in 20 states across the country as of April 11, according to the U.S. Centers for Disease Control and Prevention. They are concentrated in New York, New Jersey, California, Michigan and Washington, and officials have said the infection is proliferating among people who are not vaccinated.
This is the second-greatest number of cases reported in the U.S. since measles was deemed eliminated in 2000. Public health officials have been urging people to get vaccinated. The measles vaccine is included in the measles-mumps-rubella, or MMR, vaccine, which has become a target of people who believe it is unnatural or unsafe, contrary to widely accepted science.
Measles is spread through coughing or sneezing and secretions from the mouth, and the virus can remain in the air for up to two hours. Early symptoms include fever, runny nose, cough and red, watery eyes. In a day to four days, a red rash normally appears on the face and spreads across the body. Someone is contagious for four days before the rash appears, until four days after it begins.
To help combat the outbreak, the state health department said it has provided 1,200 doses of the measles vaccine to Baltimore County for a clinic Wednesday from 10 a.m. to 3 p.m. at the Bais Yaakov School for Girls, 6302 Smith Ave. in Pikesville. The clinic is only for adults with one or no previous vaccination.
There are no other clinics planned, said Stacie B. Burgess, spokeswoman for the Baltimore County Department of Health and Human Services, adding that the Maryland residents with measles were not county residents.
However, a collection of Jewish rabbis, organizations and schools in the Baltimore area — including Bais Yaakov — issued a letter advising the community that a child in the local Jewish community had been diagnosed with measles. They urged caution when traveling to other areas affected by the highly contagious disease, which includes Orthodox Jewish communities in New York City, where there have been 329 cases, and Rockland County, N.Y., where there have been 186 cases.
The Rabbinical Council of Baltimore had in November called for adults and children to be vaccinated, and for schools to exclude children who were not vaccinated. The council further said medical exemptions for vaccines (which are difficult to obtain) should be respected, while religious exemptions for people of the Jewish faith should not.
Most U.S. measles cases begin with someone who had come from or traveled to Europe, rather than African or Central American countries, said Daniel Salmon, director of the Johns Hopkins Institute for Vaccine Safety. There were nearly 82,500 cases in European countries in 2018 and 72 deaths of children and adults, according to the World Health Organization.
Once a case in imported, measles spreads in geographic or cultural clusters, such as at Disneyland or in Amish or Orthodox Jewish communities.
Salmon said he was less concerned about mass infection in the United States, and particularly Maryland, because vaccination rates are higher.
“That suggests to me that what happens in other places won’t happen in Maryland,” he said. “But we’ll see. Measles is really infectious. It spreads so easily. And you get diagnosed when you have a rash, but you’re infectious for four days before and you’re walking around transmitting measles and you don’t know.”
Those born before 1957 or who previously had measles or had two measles vaccine shots are considered immune because of the vaccine’s high rate of effectiveness. In many states, however, people have been taking advantage of religious and philosophical exemptions to opt out of vaccinating their children.
Maryland allows for medical and religious exemptions, but vaccination rates have remained high, though they have been dropping for kindergartners who normally receive two shots before entering school. The state reported only one case last year, which was imported from Georgia.
Those with symptoms should not go to school or work, and they should call their doctor before going to avoid potentially infecting others. Those who are most at risk of complications from measles infection are: pregnant women, infants less than 1 year old and those who are immune compromised.
Measles can lead to severe complications, including pneumonia or encephalitis. One in 20 children with measles gets pneumonia, which can be fatal.
Those who don’t know if they or their children are vaccinated should check with their health care provider, said Ann Felauer, director of the Pediatric Nurse Practitioner Specialty in the University of Maryland School of Nursing. A blood test can also confirm if measles antibodies are present, which means a person has protection against the disease.
She said high rates of vaccination produce so-called herd immunity, where vulnerable children and adults and vaccinated infants are better protected. Those with cancer and suppressed immune systems do not have the white blood cells to fight measles, even if they have been vaccinated, she said.
“I think of the infants who can’t be vaccinated, and for adults I think of oncology patients,” Felauer said. “You’re not just protecting yourself with a vaccination. I’ve worked in a pediatric ICU, and the last thing anyone wants to see is a child with measles.”
The state health department notes that in addition to doctors and nurses, pharmacists in Maryland can administer any vaccine on the CDC’s recommended immunization schedule for ages 11 to 17 if they have a prescription. Those 18 and older do not need prescriptions.