BY Ted Shaw, President/CEO, Texas Hospital Association
Measles ranks as one of the leading causes of childhood mortality in the world. Prior to the availability of the measles vaccine, measles cases were estimated at 130 million a year. Despite the progress made in measles control with the introduction of measles vaccination, it is estimated that nearly one million deaths from measles still occurred in 1997. And outbreaks of measles continue to occur even in highly vaccinated populations today.
International outbreaks in Israel, the Philippines, central Africa, and eastern Europe have led to imported cases and outbreaks in the U.S. The Centers for Disease Control and Prevention reports that measles cases in the U.S. have increased to nearly 1,200 as of August 2019—the greatest number of measles cases the U.S. has seen in 25 years.
Since the introduction of the measles vaccine, nearly all cases and outbreaks of measles in the U.S. and Texas since 2000 have occurred among individuals exposed to imported cases from countries where measles still is endemic, according to the Texas Department of State Health Services.
This phenomenon occurred in 2013 when measles cases in Texas jumped to 27 from zero in 2006. An individual who recently had traveled from Asia, returned with measles and interacted with a vaccine-hesitant community.
In Texas, the Texas Department of State Health Services confirmed one measles case in 2017 and nine in 2018. The 10th reported Texas case was an adult traveler visiting Guadalupe County from the Philippines. TDSHS has confirmed 21 measles cases in Texas as of July 2019—a 2,000% increase from 2017.
As measles cases continue to rise, physicians, hospitals, and health professionals must increase vigilance against the highly communicable yet preventable infection.
Measles-mumps-rubella vaccination is the most effective way to prevent measles transmission. The Centers for Disease Control and Prevention recommends children and students receive two doses of the MMR vaccine. Adults, however, are protected with a single dose of the MMR vaccine.
Health care professionals who do not have written documentation of adequate vaccination or laboratory evidence of immunity should receive two doses of MMR vaccine, separated by 28 days.
In addition to vaccination, promptly identifying measles cases and implementing control measures immediately can reduce the risk of measles transmission and avoid the need for epidemiological investigations of potential health care contacts.
Because measles is a notifiable condition in Texas, health care providers, physicians, hospitals, and health care facilities also must report all confirmed and suspected measles cases immediately to their local and regional health department.
While vaccination and prevention are the best strategies, an infection with a 90 percent secondary attack rate that can live for up to 2 hours on a surface or in an airspace where the infected person coughed or sneezed can have serious implications if spread among vaccine-hesitant individuals. People with measles can spread the disease four days before symptoms show so all health care professionals and providers must be ready to deploy strong infection control measures as well.
Hospitals always are on the frontlines of disease outbreaks, caring for their patients and communities. From flu to measles, hospitals know all too well the devastating impact that highly contagious diseases can have on individuals and a community and work diligently to ensure patient safety and the highest quality of care.
Additional information on measles control and prevention is available from the Centers for Disease Control and Prevention.