Although no additional cases of measles have been reported in Hawaii since two unvaccinated visitors developed the disease and were quarantined in January, state health officials continue to monitor mainland outbreaks as nationwide measles counts continue to climb.
In January, the state Department of Health confirmed two cases of measles in unvaccinated children visiting the Big Island from Washington state, where an outbreak had been declared.
At that time, the DOH was notified by Washington health officials who were aware of and monitoring a case that exposed a traveling family.
“That family could have exposed a bunch of people on Hawaii Island …,” said state epidemiologist Sarah Park on Friday.
Fortunately, she said, the two children were not infectious while traveling, but if the DOH hadn’t been able to identify them and ensure they were in isolation, “it could have been much worse than the two individuals.”
Because they were identified and maintained isolation during the illness, the state didn’t have any other cases related to those two.
“It’s scary,” Park said. “It just demonstrates how easily it can happen — an introduction of measles into our state.”
Not long ago, measles was thought to be a problem that was mostly solved, the Associated Press reported. The once-common disease became increasingly rare after a vaccine became available in the 1960s. In 2000, health officials declared the disease eliminated in the U.S., meaning all new cases stemmed from infected travelers and not from homegrown transmission.
According to the Associated Press, the cases numbered fewer than 100 a year a decade ago, but they have climbed since.
On Monday, U.S. health officials said the national tally already has eclipsed the total for any full year since 1994, when 963 cases were reported, an Associated Press report said.
According to the Centers for Disease Control and Prevention, as of April 26 there have been 704 individual cases of measles confirmed in 22 states this year, the greatest number of cases reported in the United States since 1994 and since measles was declared eliminated in 2000.
“We’ve been monitoring (measles) for a while,” Park said. “It’s very alarming. The number of measles cases have just surpassed the highest number since it was eliminated two decades ago. I never thought we would see this day. … I’m hoping some control will come sooner rather than later, but it is a very big concern, considering we’re (not) halfway through the year.”
According to Park, the measles component of the MMR (measles, mumps and rubella) vaccine is “extremely effective, with a 98-99 percent efficacy.”
To see the number of measles cases increase is “very disheartening to those of us in health care and public health.”
Park said Hawaii also has to worry about international introductions — measles or other vaccine-preventable diseases introduced by international travelers. Many other countries are seeing outbreaks of measles, too, she said.
It is “really disturbing in this day and age, after all the advances, the amazing ground we have covered in terms of … moving towards eliminating (this) disease nationally … we’re taking huge steps back now because of these outbreaks.”
Measles is not a “benign” disease, and causes high fever and a rash, Park said.
“Individuals who are sick are not happy. You’re pretty miserable with measles. At a minimum, you’ll have a high fever and feel rotten.”
But measles also could put individuals at risk for pneumonia or brain inflammation, which Park said could lead to more severe outcomes such as death or blindness. Some people might require hospitalization.
“We’re not talking about a cold,” she said. “This is pretty serious.”
According to the Associated Press, no deaths have been reported this year, but 66 patients were hospitalized.
The disease also is highly contagious.
For example, Park said if there are 10 susceptible individuals in a room and someone sick with the disease is introduced, “at least nine, if not all 10, will be infected just by being in the room.”
The best method of prevention is vaccine.
According to Park, those born before 1957 will have a natural immunity, and those born since then and who have had two doses of the MMR vaccine “can feel confident they’re immunized.”
But those who have not received the MMR vaccine or those whose immune systems are compromised could potentially be at risk for infection. And infants younger than 1 year old are not eligible for the first dose of the vaccine.
“All of us in the community need to all pull together and think about how we can protect the community,” Park said.
Those with questions about the measles vaccine should talk to their health care provider, she said.
Individuals also should check their MMR status to ensure they had two doses.
For more information about the illness, visit bit.ly/DOHmeasles.
Email Stephanie Salmons at ssalmons@hawaiitribune-herald.com.
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Signs and symptoms
According to the state Department of Health, symptoms of measles include high fever, cough, runny nose and red, watery eyes followed 3-5 days later by a rash that begins at the hairline and moves to the face and neck before spreading to the rest of the body.
First symptoms usually start 1-2 weeks after infection, with the rash appearing about 14 days after a person is exposed.
Measles is spread by direct contact with an infected person through the air and is so contagious that an individual can catch the disease just by being in a room where someone with measles has been, up to two hours after that person is gone, the DOH said.
An infected person can spread measles to others four days before developing the rash through four days after.
