Franklin County Health Department Director Angie Hittson

Franklin County Health Department Director Angie Hittson says news reports of a measles outbreak in Missouri aren’t true and no enhanced response has been directed.

In fact, since Jan. 1, only one measles case has been reported in Jefferson County, and is not considered a part of the national outbreak.

Hittson said she spent two days last week in Jefferson City meeting with Department of Health and Senior Services (DHSS) staff and other directors around the state, and measles was discussed.

“Some national television news shows identified Missouri with the outbreak in the United States,” Hittson said. “That is not correct information. Franklin County has not had any cases.”

Hittson added the state DHSS has partnered with the Centers for Disease Control and Prevention for further guidance as more cases are reported.

“I want to make sure that we are giving the most current guidance and consistent information around the state,” she said.

In the meantime, she encourages anyone who does not have, or is unsure if they have current measles vaccinations, to get one.

“We can provide the MMR vaccine here at the health department,” Hittson said. “For the uninsured or underinsured (meaning insurance does not cover the vaccine) we can provide it for an administration fee of $20. We can also accept most insurance plans and Medicaid.”

Persons who have been exposed to measles should contact their health care provider if they develop cold-like symptoms with a fever and/or rash consistent with measles. They should not go to any health care facility without calling first.

Given that ongoing measles transmission has not been identified in Missouri, the MMR vaccine schedule recommendations have not changed at this time. 

There is no recommendation from the Centers for Disease Control and Prevention (CDC) for vaccination campaigns among adults or individuals in nonaffected areas to prevent measles outbreaks. 

One dose of measles, mumps, rubella (MMR) vaccine, or other presumptive immunity, is sufficient for most U.S. adults born on or after 1957.

Background

According to the latest numbers from the CDC, from Jan. 1 to May 3, 764 individual cases of measles have been confirmed in 23 states.

This is an increase of 60 cases from the previous week and is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.

In 2018, there were 372 measles cases reported nationwide and the highest number in the last decade was 667 cases in 2014. The lowest was just 55 cases in 2012.

The states that have reported cases to the CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Texas, Tennessee, and Washington.

These cases occurred primarily among unvaccinated communities and are linked to travelers exposed to measles in countries with ongoing outbreaks, such as Israel, Ukraine, and the Philippines. 

Epidemiology

Measles is one of the most contagious of all infectious diseases; approximately 9 out of 10 susceptible persons with close contact to a measles patient will develop measles.

The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes.

Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. Patients are considered to be contagious from four days before until four days after the rash appears.

Health care providers should maintain a high index of suspicion for measles among febrile (fever) patients with a rash consistent with measles. A typical measles rash appears on the forehead or the back of the head, then spreads downward to the trunk and extremities over the next three days.

Patients of all ages with clinical signs/symptoms compatible with measles (febrile rash plus cough, coryza, and/or conjunctivitis) should be asked about recent travel and contact with returning travelers, or contact with someone with a febrile rash illness.

It is also important to verify the patient’s vaccination status.

Individuals who have been previously exposed to measles antigen may have a modified disease presentation. All persons exposed to measles, regardless of vaccination status, should monitor for symptoms of measles for 21 days after the last exposure.

Prevention

The best way to stop the spread of measles is to be vaccinated. Two doses of MMR vaccine provides 97 percent protection against the disease. One dose provides 93 percent protection.

The current general recommendations for MMR vaccination in areas not affected by measles outbreaks are:

• Children should have their first dose of MMR between 12 and 15 months of age and their second dose between 4 and 6 years of age.

• Adults who do not have evidence of immunity (written documentation, laboratory evidence of immunity such as titers, laboratory confirmed measles infection, or birth after 1957) should receive at least one dose of MMR vaccine.

• Individuals who are considered high risk, such as health care workers and students attending colleges or vocational schools, should receive two doses of MMR vaccine separated by at least 28 days.