Dr. Valerie Smith

Measles cases have made their way into Northeast Texas, and officials are speaking out about how the disease can be prevented.

After an outbreak in West Texas of measles among children and adults — the majority of which are unvaccinated — five cases have now been reported in Lamar County. Their ages range from 5 months old to adults and all were unvaccinated, according to the Paris-Lamar County Health District.

The infected individuals traveled to Gaines County during the outbreak. The Paris-Lamar County Health District is working with Texas Department of State Health Services Region 4/5 to investigate the cases. On Saturday, the health district reported two additional measles cases in Lamar County, and DSHS is investigating the cause of the cases. Region 4/5 includes Smith County, Gregg County, Panola County and Henderson County among other counties. However, due to how contagious measles is, officials expect to see more cases, according to a statement on the website of the health district.

“Measles is a serious yet preventable disease,” said Dr. Amanda Green, PLCHD local health authority. “Staying up to date on vaccinations is the most effective way to safeguard yourself, your loved ones, and the community from this highly contagious illness. With these recent cases, it’s more important than ever to ensure your immunizations are current.”

Since January, an outbreak of measles in West Texas has grown from two cases to 279 cases as of Tuesday. The majority of cases have been children — 120 cases were children ages 5 to 17 and 88 were ages 0 to 4, according to Texas DSHS data.

Of the 279 cases connected to the West Texas measles outbreak, 277 are labeled as unvaccinated or unknown and two cases as vaccinated with two doses or more, according to DSHS. In addition, a child and an adult — both unvaccinated — died from measles, according to Texas DSHS and the Center for Infectious Disease Research and Policy.

This is the first death of a child due to measles in a decade in the United States, according to Smith County Health Authority Dr. Valerie Smith. The child was healthy and had no underlying health conditions. As a pediatrician, it is difficult to see preventable deaths occur.

While at a conference, Smith said pediatrician Paul Wise commented on the child who died of measles, noting the death of any child is tragic but a child’s death due to a preventable disease is “unjust.”

In the United States, measles was considered eliminated in 2000 due to an effective vaccine and high vaccination rates, according to John Hopkins School of Public Health. Previous measles cases originated from people who traveled outside the U.S. to countries where measles was not eradicated, and this is the first outbreak of measles originating domestically, according to Smith.

There are currently 38 cases in New Mexico, according to New Mexico Department of Health. In addition, Oklahoma is monitoring four probable cases of measles due to possible exposure and symptoms, according to the Oklahoma Department of Health.

“It’s important for people to realize that if we learned nothing else from COVID, viruses do not respect county borders, state borders, (or) international borders. They will spread wherever there is an opportunity,” Smith said.

What is measles?

Measles is a respiratory virus spread from person to person through sneezing, coughing or breathing, said Smith. Although it spreads similar to the common cold, it is more contagious.

“The challenge with measles is that it is the most contagious virus that we know of, so that means that if you are unvaccinated and you are in a room with someone with the measles, there’s a 90% chance you will contract the measles,” Smith said.

Symptoms include high fever, coughing, watery eyes, a runny nose and, within two to five days, a red spotted rash appears, which is sometimes confused with chicken pox.

“Most of the time, it’s just the rash, and the kids do OK,” Gregg County Health Authority Dr. Lewis Browne said Friday. “But some of them develop a high fever, a severe lung infection, or encephalitis. That’s inflammation of the brain.”

An infection is considered serious but is preventable with the measles, mumps, and rubella vaccine (MMR), which combines three common vaccines developed in the 20th century into a single product.

After being exposed to measles, it can take up to 21 days before symptoms begin to appear. It is recommended people quarantine for 21 days. However, this can be difficult for many. Due to the long incubation period, people who contract measles can still get vaccinated. However, the vaccine will not be effective for 14 days.

Immunizations

Vaccinations are an important part of public health and mitigation efforts, Smith explained. They help reduce the severity of diseases and, in the case of measles, can prevent death.

The MMR vaccine is given in two doses; one at 12 to 15 months of age, which is 93% effective and a second dose at 4 years old which is 97-98% effective, Smith said.

For those who work in public health, the goal is to have a 95% rate of vaccinations in order to have herd immunity. This protects those who are most vulnerable, have underlying diseases or can not get the vaccination themselves.

Children are particularly vulnerable to measles because babies under 12 months can not receive the vaccine and children do not get full immunity until the age of four. In addition, those who are pregnant, undergoing chemotherapy or taking immunosuppressants can not receive the vaccine because it is a live virus.

“Which means that it’s really important for everyone who can receive the vaccine to do so,” Smith said. “We know that when the threshold of people in a community who’ve been vaccinated falls below 95%, it makes it more likely that if a measles case occurs in that community, that it will spread, that it will not just be contained to the one individual who contracted the measles, but that they will spread it to other people.”

For people born between 1957-1968, they likely received one dose of the vaccine and would need a second dose. People born before 1957 were likely exposed to measles as children giving them natural immunity. Those born in that time period received the first doses of the measles vaccine at 12 to 15 months but no booster at 4 years old.

After a measles outbreak in the early 1990s, health experts realized one dose was not enough for measles due to the number of people who contracted measles and had received one dose. The vaccine schedule was adjusted to add the second dose for 4-year-olds. For those who were adults, it is likely they did not receive the booster because they were not going to pediatric offices, Smith said.

“So they may be susceptible to be at more risk to contract measles, even if they’ve been vaccinated, because they only got the one dose, and that immunity likely has gone down over time,” Smith said.

Scientists often reevaluate vaccine schedules based on what is needed in the community. They look at best practices, recommendations and data. After the implementation of the MMR vaccine, measles plummeted for decades. Later on, the outbreak in the nineties led scientists to reevaluate.

“This is a great example of how we learned from an outbreak and made a change in how we approach the vaccination schedule in order to help reduce or prevent further outbreaks,” Smith said.

Gaines County — where the West Texas measles outbreak originated — has a vaccination rate of 82%. This is below the 95% threshold experts recommend and lower than vaccination rates in East Texas, Smith said.

“It means it would be more difficult for measles to spread here, but some of the surrounding counties that are being impacted do still have high vaccination rates. We’re still seeing some spread there,” Smith said.

Long-term issues

Measles can cause complications or lead to hospitalizations for about 20% of those who get the illness. The most common complication is pneumonia.

“So patients can get pneumonia and have everything from needing to be in the hospital for antibiotics, from the secondary bacterial pneumonia to needing to be on oxygen, to needing to be on a ventilator. And some people — most often children — will die from measles, pneumonia,” Smith said.

In addition, getting sick with the measles can lead to neurological complications. When an individual is first sick with measles, they can get encephalitis or inflammation of the brain. The symptoms are delayed and do not show up until seven to 10 years later, according to Smith.

“It can be fatal. And even if it’s not, can often leave someone with permanent neurologic problems, deafness, vision, loss, developmental delays or intellectual disabilities,” Smith said.

Since COVID-19, vaccination rates have declined overall. This has contributed to further spread of viruses and diseases such as measles. Smith encourages people to use trusted sources when researching vaccines such as www.immunize.org and www.healthychildren.org from the American Association of Pediatrics. She also recommends reading advisories from the state health department.

“The most effective way we have to stop the spread of measles is vaccination,” Smith said.

While many are anti-vaccines, health officials encourage them.

“We’ve got more and more people who believe vaccines are dangerous,” Browne said. “They think all of them are bad, but there used to be a lot of kids that died from childhood illnesses which would sweep through communities until vaccines started getting introduced in the ‘50s, ‘60s and ‘70s.”

“The MMR vaccine is very safe,” Browne added. There is no reliable scientific evidence linking the measles vaccine to autism, one of the central concerns among vaccine skeptics.