The first case of measles in Pennsylvania this year has been confirmed, and though there is no sign of the infection in the Lehigh Valley, local health networks are preparing for the worst.
The case was identified in Montgomery County. The infected child has not been to the Lehigh Valley.
Dr. Jeffrey Jahre, St. Luke's University Health Network's chief emeritus of infectious diseases, said the case differs in two major ways from outbreaks reported in the U.S. this year, including one in West Texas that has killed one child. In the Montgomery County case, the child was unvaccinated against measles because they are too young, and they contracted the virus while overseas.
"What also makes it somewhat different is that it is also in an area where the degree of vaccination is much higher," Jahre said.
However, despite no signs of an outbreak in the Lehigh Valley, both St. Luke's and Lehigh Valley Health Network are taking some precautions.
Jahre said St. Luke's has been working to educate its employees and is providing updated guidance as necessary.
"One of the things that we are trying to encourage people to do is that if you think your child has measles to call your [doctor's] office in advance because they're going to want to see that child," Jahre said. "But you don't want a child walking into a full office. We have directions on how their practitioner can meet the child outside of that office or in a private area where there's isolation."
Child vaccination rates 'going in the wrong direction' in the Lehigh Valley. Doctors are concerned
Dr. Tibisay Villalobos, chief of infectious diseases for Lehigh Valley Health Network's pediatrics department, said the network, part of Jefferson Health, is working to update networkwide recommendations, just as it did when there was an outbreak last year in Philadelphia. She said it is also reminding physicians in its pediatric emergency room, express cares and doctors offices about signs of measles so it can be diagnosed quickly.
Measles is a highly contagious respiratory disease caused by a viral infection. The onset of symptoms usually occurs one to two weeks after exposure and includes a rash that starts at the hairline and gradually moves downward, covering the entire body. It can also include a fever up to or higher than 104 degrees, cough, runny nose, and red and watery eyes. However, measles often develops into pneumonia, especially in children, and ear infections, diarrhea and brain swelling can also occur.
Villalobos said brain swelling, called encephalitis, doesn't always occur during the initial infection and instead can happen later in life.
"It may present six, seven or 10 years later when the child starts showing neurological symptoms and neurological decline with loss of functions. It doesn't have treatment and eventually, it will cause the death of the child.," Villalobos said.
Measles is most harmful to children, especially those under the age of 5. During the 1950s, measles caused an average of 400 to 500 deaths and 48,000 hospitalizations each year, according to the Centers for Disease Control and Prevention.
The deadliness of the disease has even played a role in major conflicts. Jahre said measles resulted in about 4,000 deaths on the Northern side during the U.S. Civil War and an unknown but significantly greater number of Southern deaths. Even today, for every 1,000 cases of measles in the U.S., there will be one to three deaths, according to the National Foundation for Infectious Diseases.
Measles is highly contagious. The virus spreads when an infected person coughs, sneezes or talks, and lingers in the air. Entering a room where someone with measles was two hours prior can lead to contracting the virus. People with measles are infectious up to four days before a rash appears and up to four days afterward.
Jahre said that some signs begin to show very early.
"Within two to possibly three days after contact with the virus, you start to see these white spots that are in the mouth, and these are known as Koplik spots," Jahre said. "Then from three to five days afterward, that's when you start to see the measles rash."
There is no cure or highly effective treatments against measles, Jahre said. The best protection is the measles, mumps and rubella vaccine, which is recommended for nearly all children and most Americans have already received.
Children can receive the first dose when they're 1, or at 6 months if the child is going to travel outside of the U.S. The MMR vaccine is highly effective at preventing a measles infection in individuals and if 95% of people in a community are immunized against measles there is almost no chance of an outbreak, and even vulnerable people are protected, something called herd immunity.
Villalobos said the Lehigh Valley is lucky in that the area is not vulnerable as a whole. However, there are pockets where vaccination rates are lower, such as children within Amish communities and in the suburban Easton, Bethlehem and Nazareth area, where a higher rate of children are home-schooled or go to private schools.
Jahre said those born before 1957 or vaccinated after 1989 should have strong immunity but those who were vaccinated against measles before 1968 should get an additional dose.
Measles was declared eliminated in the U.S. in 2000, meaning it is no longer endemic but the disease is still present in other parts of the world and is often brought into the country by travelers or Americans returning from countries like Pakistan, Thailand, India, Indonesia, Russia or Vietnam. Measles cases have become more frequent in recent years due to a growing number of parents not vaccinating their children against the disease.
Currently there are outbreaks in Texas and New Mexico, with cases also reported in Alaska, California, Georgia, Kentucky, New Jersey, New York City, Rhode Island and now Pennsylvania.