Health officials prepare for possible measles cases in Henderson County

As the rate of measles cases nationwide skyrockets to its highest level in decades, local health officials are preparing for if and when the highly contagious virus makes its way to North Carolina.

The Henderson County Department of Public Health is on the front lines, working to make sure the community is well equipped and informed.

“We don’t feel it is a matter of if it will come; it is a matter of when it is going to happen,” Crystal O’Dell, director of nursing with the Henderson County Dept. of Public Health, told health board members during a presentation last week.

No known cases of measles have been reported in North Carolina, as of the Center for Disease Control’s most recent report on May 10. A total of 839 cases have been reported in 23 states. In the last weekly update, the number of reported cases jumped by more than 70.

“I make it very clear there are no known cases,” O’Dell told the board about the state. “We do know that some testing has been going on, but nothing positive yet.”

She noted the close proximity of states that have reported measles, including Tennessee, Georgia, Kentucky and Florida.

“We are starting to get surrounded, so it is making us a little more nervous,” O’Dell said, noting measles is one of the most contiguous communicable diseases.

Measles is most dangerous for those who are immunocompromised and young children/infants. A vaccine is available to protect against the disease.

The local health department has provided detailed information on measles to its community partners, which include private doctor’s offices, hospitals, urgent care centers, minute clinics, EMS/first responders and health department employees and school nurses.

A table top exercise for measles outbreak response is scheduled with community partners. The department has also posted information on its website and social media.

They’ve worked to identify high-risk groups, including local schools with low vaccination rates.

“I don’t know if it will be in Henderson County, but we will definitely see some measles cases in North Carolina,” O’Dell told the board. 

Hospitals put protocols in place

Local hospitals say they are keeping a close eye on measles and working with the health department.

If a patient is admitted to Pardee Hospital and is suspected of having measles, they would be placed on airborne precautions for a period of time, at least four days or potentially longer, depending on their recovery and immune status, according to Dr. Chris Parsons, who is board-certified in infectious disease and medical director of the Pardee Center for Infectious Disease.

“Both the patient and staff entering the room would wear appropriate protective equipment, and we would prioritize use of negative-pressure rooms to reduce potential transmission,” Parsons noted.

The incubation period for measles (time from exposure to illness) ranges from six to 21 days, so persons exposed to a patient suspected of having measles would be asked to remain quarantined at home beginning on day five following exposure to the patient and through a period of 21 days following the exposure, according to Parsons.

“Therefore, close family or other contacts of hospitalized patients would be asked to avoid the hospital,” Parsons said.

Pardee has an infection control committee comprised of members of its infection control department, as well as Dr. Diana Curren, medical director for the Henderson County Department of Public Health.

“Together, we recently reviewed the CDC and North Carolina policy regarding diagnosis and infection control issues related to measles in order to better prepare and collaborate should the need arise here in Henderson County,” Parsons said.

The vast majority of health care providers, especially those more recently trained, have seen few, if any, cases of measles, Parsons added.

“In an effort to address this gap in experience, our infection control department, working with Dr. Curran at the Department of Public Health, recently sent education materials to all hospital staff in an effort to help providers recognize and diagnose measles,” Parsons said.

AdventHealth Hendersonville’s Infection Prevention team is closely monitoring case rates across the country and in states bordering the region, according to Director of Communications Victoria Dunkle.

AdventHealth Medical Group Pediatrics is starting to see an increase in the number of parents coming in to have their children vaccinated against the measles, she noted.

“If we begin seeing confirmed cases in our area, we will implement our safety protocol for managing an influx of infectious patients,” said Michael Duncan, a registered nurse and infection preventionist at AdventHealth Hendersonville. “This includes our standard precautions to reduce risk of infection exposure to other patients, staff and the public.

"It also can include requiring the patients with suspected or confirmed measles to wear masks during any transport and possible placement in isolation rooms to quarantine the infection.”

AdventHealth will also track the situation to determine any need to enhance the standard precautions as warranted by the current CDC guidelines, which pairs with following the recommendations from the N.C. Department of Public Health as well, Duncan added.

If people think they have been exposed to the measles, they should not go to an emergency room or doctor’s office unless it is truly an emergency, according to Duncan.

“If someone thinks that they have been exposed to measles, they should immediately contact their local or state health department for evaluation and further information,” Duncan explained.

If a person calls requesting an appointment because of concern over symptoms of measles, AdventHealth is adhering to the N.C. Department of Health and Human Service’s recommendations and directing them to their county health department for evaluation.

Reporting, school vaccination rates

All children entering child care or public/private school in North Carolina are required to be vaccinated against multiple diseases, including measles. Religious and medical exemptions are allowed under state law.

Currently, 3% of kindergartners in Henderson County Public Schools have a religious exemption, according to the annual kindergarten immunization report from the N.C. Deptartment of Health and Human Services for 2018-19.

Henderson County’s rate is the 11th highest in the state, O’Dell said. She noted that the initial rate does not account for children who receive a vaccine late.

Many surrounding counties have much higher rates of religious exemptions, which places Henderson County at risk due to decreased herd immunity, O’Dell explained. Herd immunity is when a sufficient proportion of the population is immune to a disease through vaccination or prior illness.

Buncombe County has a 4.9% religious exemption rate; Transylvania County’s is 5.1% and Polk County’s is 10.3%.

Henderson County’s religious exemption rate for charter school kindergartners is 14.5%, and is 6.3% for private schools. Medical exemptions are 0.1% in the county.

Private schools are required to report on the immunization status of children annually, according to Kelly Haight with the N.C. Department of Health and Human Services’ office of communications. Home schools are not required to file an immunization report, and the school health assessment requirement is for public schools, she added.

Both O’Dell and Health Director Steve Smith noted there may be errors in the report at Tuesday’s board of health meeting. O’Dell said the numbers for Henderson County appear to be accurate.

AdventHealth Hendersonville’s Graham Fields, who also sits on the health board, noted that since there has been such a drastic decrease in measles cases over the years, many local health care providers have not seen a case before.

“That is a scary moment for our community when even seasoned pediatricians admit (they) don’t know if they’ve seen it,” Fields said.

Measles statistics, how to prepare

This is the most reported measles cases in the U.S. since 1994. The CDC considered measles eliminated in 2000 following a strong vaccination campaign.

Two doses of MMR vaccine provide the best protection against measles, according to the CDC. The vaccine protects against measles, mumps and rubella.

The CDC recommends children get the first dose of the vaccine at ages 12 to 15 months, and their second dose at 4 to 6 years of age. Teens and adults are also recommended to be up to date on their MMR vaccination.

About one in four people in the U.S. who get measles will be hospitalized, according to the CDC. One out of every 1,000 people with measles will develop brain swelling, which could lead to brain damage. One or two out of 1,000 people with measles will die, even with the best of care, according to the CDC.

Some of the more common measles symptoms include high fever, which may spike up to more than 104 degrees; cough; runny nose; red, watery eyes; and a rash three to five days after symptoms begin.

One of the top concerns surrounding measles is that it's highly contagious. It spreads through the air when an infected person coughs or sneezes.

It is so contagious that if one person has it, up to nine out of 10 people around him or her will also become infected if they are not protected, according to the CDC. A child can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left.

Risk factors for the measles include being unvaccinated, traveling internationally and having a vitamin A deficiency, according to the Mayo Clinic.

Most cases start with someone who has traveled internationally, according to O’Dell. She noted the concern with approaching summer camps, and how they bring children in from all over.

Typically, someone with the measles ends up going to several physicians before being diagnosed because they are becoming increasingly ill.

“Every time they leave their home they are exposing someone else until we get to diagnosis,” O’Dell said.

An infected person can spread measles before they know they have the disease, from four days before developing the measles rash through four days afterward.

Those born after 1957 need at least one dose of measles vaccine unless a lab has confirmed they had a past measles infection, or are immune to measles, according to the CDC. Certain adults may need two doses.

Before the measles vaccination program started in 1963, an estimated three to four million people got measles each year in the U.S., according to the CDC. Of that figure, approximately 500,000 cases were reported each year to the CDC; of these, 400 to 500 died, 48,000 were hospitalized and 1,000 developed encephalitis (brain swelling) from measles.

Adults going into a setting that poses a high risk for measles transmissions are recommended to make sure they have had two doses separated by at least 28 days. These groups include: students at post-high school education institutions, health care personnel, international travelers and those public health authorities determine are at an increased risk for getting measles during an outbreak.

Those unsure about whether or not they are up to date on their measles vaccine are encouraged to speak with their doctor. The CDC answers a wide range of measles-related questions at www.cdc.gov/measles/about/faqs.html. For more information from the Henderson County Dept. of Public Health, go to www.hendersoncountync.gov/health/page/procedures-reporting-healthcare-providers.