Porter stays vigilant for measles outbreak

MIDDLEBURY — A major measles epidemic that has invaded 22 states has yet to breach Vermont’s borders, but if it does, Porter Hospital and state Department of Health (DOH) officials are putting procedures in place to contain the disease and provide expert care to patients.
As of this writing, the national Centers for Disease Control (CDC) had confirmed a combined total of 704 measles cases in what is being described as the worst outbreak in decades. One of the current measles hot spots is just across the border in New York.
“We are definitely getting calls from people who are concerned about it,” said Dr. Natasha Withers, medical director for all of Porter’s affiliated provider practices. “We’ve put together protocols on how to appropriately triage patients who might be calling and are concerned they might have either been exposed to measles or may have measles.”
Measles is a highly infectious disease caused by a virus. Symptoms show up about seven to 14 days after a person is exposed, and include high fever (usually the first symptom), cough, runny nose, red, watery eyes, and rash, according to the CDC. The rash begins at the hairline, moves to the face and neck and then down the body.
Measles is transmitted by airborne particles, droplets, and direct contact with the respiratory secretions of an infected person. Infected individuals are contagious from four days before rash onset through the fourth day after rash appearance, according to the CDC.
The disease is most prevalent in children and often remains benign, running its course in a week or two. But measles can lead to hospitalization and even death. People with measles can experience complications like diarrhea, ear infections, pneumonia, acute encephalitis, or a brain infection that can lead to permanent brain damage, according to the CDC.
Getting measles during pregnancy increases the risk of premature labor, miscarriage and low birth weight, according to health officials.
People born in or before 1957 are generally considered to have measles immunity, but health officials said older folks should inquire about the requisite measles, mumps and rubella (MMR) vaccine, especially if they don’t have records to prove past immunization.
The MMR vaccine is part of the regular schedule of immunizations for children.
Even though measles was declared eliminated in the U.S. in the year 2000, outbreaks still happen in communities with low immunization rates. Some parents choose to not immunize themselves or their children based on objections steeped in religious beliefs or concern about the vaccine itself and its potential side effects.
DOH officials stress the MMR vaccine is safe. Side effects are typically confined to soreness and/or swelling for a short period after the shot.
“I think pediatricians generally do a really great job at hearing parents’ concerns and addressing them appropriately,” Withers said.
Jeffrey Heath, RN, is a public health nurse supervisory with the DOH’s Middlebury office. He is working closely with Addison County providers to make sure any measles cases are properly diagnosed and minimized.
“People are concerned, and local providers have questions,” Heath said on Thursday about calls he’s been receiving from people who are reacting to the measles coverage they’ve been seeing in the media.
He stressed Vermonters shouldn’t worry about measles while traveling in-state. But they should be vigilant and proactive if they’re planning international travel or will be visiting one of the 22 states currently dealing with measles cases. More details are available at cdc.gov/measles. Those traveling a region with confirmed measles cases will want to make sure their MMR vaccines are up to date.
These are the CDC guidelines for MMR vaccines if traveling into confirmed measles areas:
•Infants six through 11 months should receive one dose of MMR vaccine before departure.
•Children one year or older should have documentation of two doses of MMR vaccine, separated by at least 28 days.
•Teenagers and adults with no evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days.
“I think Vermont overall has pretty good vaccination rates,” Heath said, though he added it only takes one unvaccinated person to spread the disease into an entire region.
Withers noted unvaccinated people can avoid measles when they’re surrounded by a majority of people who have had the inoculation. But she’s not recommending that people depend on “herd immunity.”
“If everyone around you gets immunized, you’re kind of protected,” she said. “The more people who are not immunized, the less protection there is. That creates issues.”
If a measles patient were to show up at Porter Hospital, he or she would be quarantined, according to Withers. Hospital officials would immediately call the DOH about the suspected measles case. Health care workers would collect blood and throat/nose swab samples from the patient that would be tested by the DOH, Wither said.
If someone simply calls thinking they might have measles, a provider will ask for their symptoms.
“Measles is pretty specific,” Withers said. “(The symptoms) are triggers for us. Also, if they’ve been exposed to someone who has measles or of they’ve traveled internationally, and if they’re not immunized against measles — those are also triggers.”
Porter officials have a plan in place for anyone who’s been exposed to measles.
“Typically, if they have not been vaccinated, we would give them the MMR vaccine,” Withers said. “If they are particularly immune-compromised or have multiple medical problems, they recommend giving immunoglobulin (within six days of exposure) to try to prevent them from getting measles. If you give the vaccine to a non-immune individual, it should ideally be within 72 hours of exposure.”
Withers added she and her colleagues are receiving regular updates from the DOH on the measles epidemic.
In related news, Middlebury-based Rainbow Pediatrics was recently recognized by the CDC as one of 25 primary care practices in Vermont that achieved “high” child or teen immunization rates in 2018.
In order to earn this recognition, at least 90 percent of the practice’s child patients must be up to date with immunizations for 11 vaccine-preventable diseases, including measles, mumps and whooping cough. At least 80 percent of teen patients must be vaccinated to prevent meningitis and cancers caused by human papillomavirus (HPV). To be eligible for consideration, providers must have at least 20 teen or child-age patients.
Reporter John Flowers is at [email protected].

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