Measles vaccines still important 5 years after local Amish community outbreak

MANSFIELD - It's been five years since a measles outbreak in the Amish community put North Central Ohio in the national spotlight, and healthcare professionals say the importance of receiving measles vaccines is as strong now as ever.

It's a virus that once infected hundreds of thousands of Americans annually, will kill more than 1 million children worldwide this year alone and, despite being eradicated from the United States at the turn of the millennium, seems to be making a fierce comeback.

Just this week, New York Mayor Bill de Blasio declared a public health emergency as more than 250 cases of measles were reported in the city since September.

The unfortunate reality is that nearly all of those cases of measles could have been avoided, but some parents still refuse to have their children inoculated against the virus because of unwarranted fears, according to Susan McFarren, a Richland Public Health nurse for emergency response and preparedness.

"In public health, we're frustrated, because we feel like we're going backwards," McFarren said.

Highly contagious disease

Measles can spread rapidly because a person is contagious during the virus' entire 21-day incubation period, according to Amanda Crawford, a Richland Public Health nurse for communicable diseases.

Generally, a person who might not even know they are infected with measles will sneeze in a crowded area, spraying the virus toward unsuspecting others who inhale as normal, but this time inviting the virus into their throats and lungs where measles will thrive and rapidly spread.

"It could even spread from talking," Crawford said. "It stays in the air for two hours after an infected person leaves the room."

Measles only spreads through infected people. Animals cannot carry the disease, and, unlike bacteria and germs, it does not live in puddles of water or other moist areas.

It spreads when a person whose immune system does not have the adequate antibodies against measles comes into contact with the virus.

In Richland County in 2014, it happened because an unvaccinated Amish person traveled to the Philippines, a place where more than 20,000 known case were reported that year. They unknowingly caught the virus, then brought it back to Ohio.

Last fall, it spread to New York when several unvaccinated members of the city's Orthodox Jewish community traveled to Israel, again unknowingly catching the virus and bringing it back to the United States.

The incubation period of the virus ranges from 7-21 days, with the average person having symptoms first appear at about 14 days after exposure to the virus.

If a contagious person travels across the country during their incubation period, instead of remaining quarantined, they will spread measles to untold numbers of communities.

"That's why New York City is such a concern right now," McFarren said. "You have people walking around who are 21 days out from showing any symptoms."

Vaccinations and immunity

Most Americans have forgotten how severe measles can be. As recently as the 1940s, nearly 500,000 residents of the United States caught the virus each year.

Nearly 1 in every 500 infected people can die from measles.

Acute inflammation of the brain, ear aches and pink eye are just a few of the other complications that can accompany a case of measles.

A person who works for Richland Public Health is partially deaf to this day because they caught measles when they were a child, according to Reed Richmond, the agency's public information officer..

Symptoms include a fever of up to 105 degrees, inflamed mucous membranes, inflamed eyes, sensitivity to light, heavy cough and a red rash that spreads from the face to the trunk of the patient.

The only known treatment for measles is prevention. For patients who survive, symptoms naturally subside after about a week.

The Centers for Disease Control recommend that children receive two vaccines against Measles, Mumps and Rubella (MMR) — which are similar viruses — while they are still toddlers. The first vaccine is typically administered between 12 and 15 months of age, and the second between 4 and 6 years.

But some parents are withholding the life-saving vaccines from their children, in part because they believe the shots can cause other medical complications.

"They do not cause autism," McFarren said sternly.

There's also no longer any mercury in the shots, which McFarren said was once a concern of parents. Now McFarren said the odds of having any complications after a vaccine is less than 1 in 1 million.

The modern vaccine contains a weakened version of the live measles virus, but that wasn't always the case.

The CDC reports that anyone born in 1957 or before likely has a natural immunity to the virus, since their bodies developed antibodies after coming into contact with measles naturally.

Until 1968, the vaccines only contained particles of the dead measles virus, which was not as effective as the modern vaccine. McFarren said anyone born between 1957 and 1968 should check with their doctor to see if they need a new vaccine.

"It's not going to hurt you if you do get another vaccination," Crawford said.

From 1969 to 1989, patients were given just one vaccine of the weakened live virus, which the CDC believes provides a 93% immunity. 

After 1989, patients received two doses of the vaccine, which increased immunity levels to 97%.

Those 3% of immunized patients who do catch the virus often experience a mild form of measles, which McFarren said might lead the patient to not even realize what made them sick.

Richmond said patients can find their immunization records with their parents, their family doctor or even their original pediatrician's office. The CDC encourages everyone to make sure they are immune to measles.

"People get lax because they think this can't happen to them," McFarren said. "But pathogens don't need passports."

Most insurance companies will pay for the vaccine. Richmond said parents who can't afford their children's MMR vaccines can visit the health department and receive the vaccines for free.

Out of pocket, the shots cost about $130 each, and are available at doctors' offices, hospitals and urgent cares.

And in the event of emergency outbreaks, healthcare professionals will hand them out for free.

Emergency response

The outbreak of 2014 affected nine Ohio counties and infected 377 Ohioans. It was centered in Knox County, which had 195 cases, while Holmes, Ashland, Coshocton, Stark, Wayne and Highland counties also saw cases, in addition to Richland and Crawford counties. It was the worst outbreak in the country since 1994, surpassed only by the current outbreak in New York.

The team at Richland Public Health remains prepared if a similar outbreak happens in the future, measles or any virus.

"You have to remember, there are a lot of other vaccine-preventable diseases, like polio, that are just a plane ride away," McFarren said.

She remembers the day she learned there were two active cases of measles in Danville, a rural town in Knox County that is surrounded by Amish communities.

"Because it's so contagious, it quickly spread to five counties," McFarren said.

Her office joined forces with other medical and emergency response offices across the region. They held conference calls each morning, updating one another on the number of active cases, the availability of vaccines and where everyone's efforts would be best focused.

"The goal was to get as many of the Amish vaccinated as possible," McFarren said.

Fortunately, the vaccines give a patient immunity within three days, which is quick enough for an infected person's body to develop antibodies before the virus' incubation period is complete. Despite being infected, they may never catch measles.

The Amish and others who had never received inoculation were happy to receive the vaccines. Healthcare professionals traveled to auctions, produce sales and other community events where dozens of vaccines could be administered in just a few minutes.

"Nurses were giving vaccines out of the back of their cars," McFarren said.

The outbreak ended without any deaths or serious complications, but it did cost public health departments in the region a combined $250,000.

"Those are assets we're never going to see again," McFarren said.

But the experience did prove beneficial to Richland Public Health and its surrounding counterparts. The region's healthcare professionals were nationally recognized for their efforts, and the team developed valuable knowledge on how to mobilize in the event of any future outbreaks or emergencies.

With the growing number of measles cases in New York, it's not just Richland County that's concerned about future outbreaks, either.

"Alarm bells are going off right now at the federal level," McFarren said. "We're seeing numbers we haven't seen in about 30 years."

ztuggle@gannett.com

419-564-3508

Twitter: @zachtuggle