Several things are troubling about the measles outbreak in Kansas.
For one thing, it involved a lot of infants who were too young to be vaccinated. Their parents didn’t get to make a choice about getting vaccinated or getting measles. They got measles.
Also, as the case count climbs to 18, we are only now learning how the outbreak got started.
Greg Lakin, the chief medical officer for the Kansas Department of Health and Environment, said the current outbreak started when an infant who was too young to be vaccinated picked up the virus in Asia. That infant then returned to a Johnson County day care.
What You Need to Know About the JoCo Outbreak
But what does too young to be vaccinated mean?
Remember that if you are traveling out of the country, infants should get their first MMR early, as early as six months of age.
Update on the Measles Outbreak in Kansas
Since the outbreak in a daycare in Johnson County was discovered on March 8, a total of 18 measles cases have been identified, including:
14 Johnson County residents, including one new case
three Linn County residents, including one new case
one Miami County resident not associated with the daycare
Cornerstone Presbyterian Church in the Lobby and Sanctuary; 13300 Kenneth Rd., Leawood, KS; April 8 from 10:30 a.m.to 1:30 p.m.
Blue Mound Federated Church; General Delivery, Blue Mound, KS; April 1 from 10:00 a.m. to 1:00 p.m.
Olathe Health Family Medicine; 302 N.1st St, Mound City, KS; March 26 and 28 from 8:00 AM to 5:30 PM
Olathe Health Family Medicine; 1017 E. Market St, La Cygne, KS; March 27 from 8:00 AM to 5:30 PM, March 29 from 8:00 a.m. to 5:30 p.m, March 30 from 8:00 a.m. to 2:30 p.m., and April 2 from 8:00 a.m. to 3:30 p.m.
Casey’s General Store; 207 S. 9th St, Mound City, KS; March 26 from 11:30 AM to 2:00 PM, March 28 from 12:00 PM to 2:30 PM, March 30 from 1:00 p.m. to 3:00 p.m., and April 2 from 7:30 a.m. to 9:30 a.m
Casey’s General Store; 406 E. Market St, LaCygne, KS;March 27 from 12:00
PM to 2:30 PM
Linn County Judicial Building; 318 Chestnut St., Mound City, KS; March 30 from 1:30 p.m. to 5:00 p.m.
Applebee’s; 16110 W. 135thSt., Olathe, KS; March 30 from 5:30 p.m. to 8:30 p.m.
Main Street Liquor; 411 E. Main St., Osawatomie, KS; March 30 from 9:30 p.m. to 11:00 p.m.
Dollar General; 110 S. 9thSt., Mound City, KS;March 29 from 5:45 p.m. to 8:00 p.m.
Since there is a 10 to 21 day incubation period for measles, all these new cases could have been exposed at:
Auburn Pharmacy; 625 E Main. St, Mound City, KS; on March 13th from 4:15 PM to 6:45 PM
Aldi’s; 15290 W. 119th St Olathe, KS 66062; on March 2nd from 3:00 PM to 5:00 PM
Payless Discount Foods; 2101 E. Santa Fe St, Olathe, KS; on March 6th from 10:00 AM to 12:30 PM
El Potro Mexican Café; 602 N Pearl St, Paola, KS on March 7th from 4:00 PM to 8:00 PM
Children’s Mercy Hospital Kansas Emergency Department; 5808 W 110th St, Overland Park, KS on March 8th and March 10th in the morning
AMC Dine – In Studio 28; 12075 S. Strang Line Rd, Olathe, KS; March 9th from 3:30 PM to 7:30 PM
Budget Coin Laundry; 798 E Main St, Gardner, KS; on March 9th from 8:00 PM – 11:00 PM
Olathe YMCA swimming pool and locker room; 21400 W. 153rd St, Olathe, KS; on March 10th from 9:30 AM to 1:00 PM
Bath and Body Works at Legends Outlets; 1803 Village W Pkwy, Kansas City, KS; on March 10th from 1:00 PM to 3:00 PM
Crazy 8 at Legends Outlets; 1843 Village W Pkwy, Kansas City, KS ; on March 10th after 1:00 PM to 3:00 PM
Orange Leaf; 11524 W 135th St Overland Park, KS; on March 10th from 3:00 PM to 6:00 PM
Chick-fil-A; 12087 S Blackbob Rd, Olathe, KS on March 24th 8:15 PM till Close
Olathe YMCA – ENTIRE FACILITY INCLUDING CHILDCARE AREA; 21400 W. 153rd St, Olathe, KS on March 22nd and 23rd from 8:00 AM to 3:00 PM
Walgreens; 7500 Wornall Rd, Kansas City, MO on March 22nd, 6:00 PM to 8:00 PM
Chuck E. Cheese’s; 15225 W 134th Pl, Olathe, KS on March 21st, 1:00 PM to 4:00 PM
If you were exposed and aren’t immune to measles (two doses of the MMR vaccine provide good protection), then you should watch for signs and symptoms to develop 10 to 21 days after your last exposure (in quarantine).
With the new exposures, that means that we could expect to see new cases associated with this outbreak any time between now and April 29th (the last exposure and the longest incubation period).
A History of Measles Outbreaks in Kansas
Some folks probably recall that this isn’t the first big measles outbreak in Kansas.
One of the largest measles outbreaks of 2014 was in the Kansas City metropolitan area. That year, at least 28 people developed measles, including a newborn who was only two weeks old.
In addition to the outbreak in Kansas City, there was another large outbreak that year in Sedgwick County – Wichita, Kansas.
And like most measles outbreaks, other states were affected too. Someone from Texas developed measles after getting exposed to measles at a softball tournament in Wichita.
More recently, outbreaks in Kansas have included:
a suspected case at William Allen White Elementary School in Lyon County, Kansas which has led to the quarantine of unvaccinated students for 3 weeks (2017)
a case in Butler County, Kansas. (2017)
a case in Sedgwick County, Kansas, a child too young to be vaccinated who may have been exposed at a church. Three other exposed infants who were too young to be vaccinated and who were considered at risk to get measles in this outbreak received immunoglobulin treatment. (2017)
a second case in the Wichita, Kansas area, this time in Sedgwick County, with exposures at a church, dental office, elementary school, and multiple stores over at least 3 days. (2017)
Why are there still so many measles outbreaks in Kansas?
Like in other places with outbreaks, it is likely explained by relatively high levels of non-medical exemptions and clusters of unvaccinated children and adults.
Hopefully this outbreak will be a good reminder that vaccines are necessary and everyone will get their kids caught up and protected.
What to Know About the Measles Outbreak in Kansas
Kansas is in the middle of another large measles outbreak and as usual, it is mostly among those who are unvaccinated, including many too young to be vaccinated.
Breaking News – There are now six cases of measles in the San Francisco Bay Area, all unvaccinated, in an ongoing outbreak that has also spread to Nevada.
Is anyone surprised that a student in California has measles?
Actually, a lot of folks are probably surprised. After all, didn’t lawmakers in California recently pass a law that mandated everyone in school get vaccinated?
Well yeah, but SB277 didn’t apply to all students. Only new students and those transitioning to a new grade span (for example, moving from K-6th to 7th grade) have to meet the new minimum immunization requirements. That means it will take more than a few years until all of the kids already in school whose parents have skipped or delayed any vaccines have gotten caught up or have graduated.
When you think of measles and California, most people probably think of the 2015 Disneyland outbreak, which was linked to:
134 cases in California, including at least 50 cases without a known source
13 cases in Arizona, Nebraska, Utah, Colorado, Washington, and Oregon
1 case in Mexico
159 cases in Canada
The Disneyland outbreak included a lot of intentionally unvaccinated kids and kept unvaccinated kids from school, closed daycare centers, and led to hospitalizations of more than a few people.
“The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing antivaccination movement and the prevalence of vaccination-hesitant parents.”
Majumder et al. on Substandard Vaccination Compliance and the 2015 Measles Outbreak
The Disneyland outbreak wasn’t the first big measles outbreak in California in recent years though.
No, I’m not talking about the really big outbreaks from the pre-vaccine era. Or even the outbreaks in the late 1980s, just before we started giving an MMR booster. Believe it or not, 75 people died between 1988 and 1990 with measles – just in California.
More recently, there was the 2008 outbreak in San Diego that was triggered by an unvaccinated 7-year-old boy who had traveled to Switzerland with his family.
He returned with measles and got at least 10 other unvaccinated children sick, including four infants who were too young to be vaccinated and were unknowingly exposed at their pediatrician’s office.
“Almost 100 children (including babies who were too young for the MMR vaccine) were quarantined or hospitalized after they were exposed at the pediatrician’s office, Whole Foods or day care. In all, 11 children caught the measles. As it turns out, the boy who spread measles is a patient of Dr. Bob Sears…”
OC’s Dr. Bob Sears discusses measles outbreak on NPR
One of those infants was hospitalized when his fever spiked to 106 degrees and he wouldn’t eat or drink.
“We spent 3 days in the hospital fearing we might lose our baby boy. He couldn’t drink or eat, so he was on an IV, and for a while he seemed to be wasting away. When he began to be able to drink again we got to take him home. But the doctors told us to expect the disease to continue to run its course, including high fever—which did spike as high as 106 degrees. We spent a week waking at all hours to stay on schedule with fever reducing medications and soothing him with damp wash cloths. Also, as instructed, we watched closely for signs of lethargy or non-responsiveness. If we’d seen that, we’d have gone back to the hospital immediately.”
Megan Campbell on 106 Degrees: A True Story
Measles cases also began rising in 2011, as unvaccinated travelers brought measles back from trips to Europe, Asia, and Africa, where there were large outbreaks. There were 31 measles cases in California in 2011.
While 31 cases might not seem like much, consider that between 2001 through 2006, there were just 66 cases in California, with only 4 cases in 2005!
Will we ever get to a year with just 4 cases in California again?
It didn’t happen in 2017.
Last year started with a big outbreak in Los Angeles County that grew to include at least 24 cases and a few surrounding counties. There was also a case involving an unvaccinated student at Laguna Beach High in Orange County which led to the quarantine of at least 6 unvaccinated students.
The Latest California Measles Outbreak
What kind of a measles year will we see in 2018 in California?
It started when an unvaccinated student returned from a trip to Europe and developed measles, exposing others between February 28 through March 2 in Santa Clara County at a school in Campbell and at the Westgate Center food court in San Jose.
With an average incubation period of 10 to 12 days, that means exposed people might begin to show symptoms by March 14. Keep in mind that the incubation period can be as long as 21 days though, so be on the watch for measles symptoms until at least March 23 if you could have been exposed.
Since we don’t know when the new cases began to show symptoms, it is hard to know how much longer we can expect to see new cases. Hopefully these folks were already in quarantine and didn’t expose anyone else.
Would you recognize measles?
It is important to understand that the first symptoms of measles don’t include a rash. Instead, you get a high fever, runny nose, cough, and pink eye. The measles rash comes a few days later, as the high fever continues.
It is also important to understand the the MMR vaccine is safe and works very well to prevent measles.
This exposure is a great reminder that vaccines are necessary and that you shouldn’t wait for your kids to get exposed to get them caught up and vaccinated and protected.
What to Know About Measles Outbreaks in California
A recent outbreak of measles in California, this time in Santa Clara County, is a good reminder that the MMR vaccine is necessary to keep your kids protected.
Still, mumps is not nearly as contagious as other vaccine-preventable diseases, such as measles. You generally have to have close contact with someone with mumps to catch it.
“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”
CDC on Mumps for Healthcare Providers
Unless you were on the same team as the person with mumps (if it was a cheerleader), your risk of getting sick probably isn’t that high. Of course, the risk goes up the more contact you had.
Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed.
At this point, whether or not your child is vaccinated, all you can do is wait and watch to see if they develop signs or symptoms of mumps.
With an incubation period of 12 to 25 days, that means that those who were exposed could get sick between March 7 and March 22.
While there is no treatment for mumps, you do want to watch for complications and make sure you don’t expose anyone else.
Why cheer? It’s not cheer, but the nature of cheer competitions. You just have a lot of older kids together at these competitions from a lot of different places and the MMR vaccine is known to have an issue with waning immunity.
Fortunately, most of these kids are vaccinated, which helps keep these outbreaks from really getting out of control, like they did in the pre-vaccine era.
What to Know About Mumps at the NCA All-Star Nationals
Tens of thousands of kids could have been exposed to mumps at a cheerleader competition in Dallas.
Even before you get to talk about problems with flu vaccine effectiveness, it becomes clear that everyone wants a better flu vaccine.
One big problem with the current generation of flu vaccines?
You have to get them each and every year.
Developing a Better Flu Vaccine
So what would we all want in a new and better flu vaccine?
last longer, so you didn’t have to get a new vaccine every year
be more effective
cover more flu vaccine strains, so it wasn’t a “guess” about which flu strains to include in the flu vaccine each year and we didn’t have to worry about drifted flu vaccine strains or new and emerging strains for which there is no vaccine
A universal flu vaccine, which covers all possible flu strains, would be ideal.
So why haven’t we been working on developing a universal flu vaccine?
Well, we have.
It just isn’t that easy.
Many different research teams have been working on a universal flu vaccine for years and some have already had some success.
Does that mean we will see a universal flu vaccine soon?
Unfortunately, of the almost 40 organizations working on improved flu vaccines, including a universal flu vaccine, about 30 are still in preclinical or phase 1 trials. So the answer is no, we will not see a universal flu vaccine soon.
The Strategic Plan to Develop a Universal Influenza Vaccine
Maybe that will change now that more and more folks are pushing for a better flu vaccine and we see the effects of severe flu seasons without a good vaccine.
Of course, talk isn’t enough.
“A priority for the National Institute of Allergy and Infectious Diseases (NIAID) is development of an influenza vaccine providing durable protection against multiple influenza strains, including those that may cause a pandemic, i.e., a universal influenza vaccine. To invigorate research efforts, NIAID developed a strategic plan focused on knowledge gaps in three major research areas, as well as additional resources required to ensure progress towards a universal influenza vaccine. NIAID will use this plan as a foundation for future investments in influenza research and will support and coordinate a consortium of multidisciplinary scientists focused on accelerating progress towards this goal.”
Erbelding et al on A Universal Influenza Vaccine: The Strategic Plan for the National Institute of Allergy and Infectious Diseases
That’s why it is also encouraging that we have seen the:
the Pathway to a Universal Influenza Vaccine workshop convened by the National Institute of Allergy and Infectious Diseases (NIAID) in 2017
the Strategic Plan for Developing a Universal Influenza Vaccine by the NIAID that was announced in 2018
U.S. Sen. Ed Markey (D-MA) introduced the Flu Vaccine Act, which would invest $1 billion towards development of a universal flu vaccine
Knowing that developing a universal flu vaccine is a priority of the NIAID and that so many organizations are already working towards this goal is very reassuring.
Hopefully we are a lot closer than some folks thing.
While pediatricians, parents and kids loved it, since it wasn’t a shot, it hasn’t been available since 2016 because it was found to be less effective than flu shots against the H1N1 strain of flu.
The History of FluMist
The FluMist nasal spray was first approved in 2003 for healthy kids over age 5 years and adults up to age 49 years.
In 2007, the age range was expanded to included healthy children between the ages of 2 and 5 years.
It quickly became a favorite of kids who didn’t like the idea of getting a flu shot each year, although some kids didn’t like getting something sprayed into their nose.
Next, in 2012, FluMist Quadrivalent, with protection against four strains of flu virus, was approved.
While some experts initially thought it might work better than traditional flu shots and it actually became the preferred flu vaccine for kids in 2014, by 2016, FluMist was no longer recommended in the United States.
The Return of FluMist
On February 12, 2017, at a meeting of the Advisory Committee on Immunization Practices (ACIP), members voted to once again recommended FluMist Quadrivalent to prevent the flu. It will be available for next year’s flu season, although the recommendation still has to be approved by the director of the CDC.
What happened to FluMist?
“In the 2013-2014 influenza season, when lower than expected effectiveness of FluMist Quadrivalent was first observed, Influenza A (H1N1) was the predominant circulating influenza virus strain. When the data showing lower than expected vaccine effectiveness became available, FDA began working with MedImmune to investigate potential reasons for this finding.”
FDA Information Regarding FluMist Quadrivalent Vaccine
Although they worked on a fix after the 2013-2014 influenza season, the following season showed poor effectiveness for all flu vaccines because of a drifted flu strain. So it wasn’t until the following year that it was noticed that FluMist still didn’t work as well as a flu shot against H1N1 flu strains, at least not in the United States.
Surprisingly, studies in other countries, including Finland and the UK showed that FluMist did work.
And now MedImmune, the company that makes FluMist, has replaced the H1N1 seed virus it uses to make FluMist, and preliminary testing shows that it is more effective and should be as effective as a flu shot.
That’s why the ACIP voted 12-2 to make FluMist available for the 2018-2019 flu season.
Will you get it for your kids next year, instead of a regular flu shot? If the number of parents and kids asking for FluMist this year is any guide, many will be glad it’s back.
What to Know About the Return of FluMist
FluMist has hopefully been improved, been made more effective, and will be ready to help prevent the flu for the 2018-2019 flu season. It will be an especially good option for those kids who don’t want a shot.
MenHibrix was removed from the schedule, which was expected, as this combinationmeningococcal vaccine for high risk kids was discontinued in 2016 because of low demand. Fortunately, this doesn’t mean that any kids will be left unprotected. They can just get one of the other meningococcal vaccines if they need it, with a separate Hib vaccine, just like other infants.
Menomune was removed from the schedule, which was expected, as this older meningococcal vaccine was discontinued in 2017, as it was replaced with the newer meningococcal conjugate vaccines (Menactra and Menveo).
Shingrix, the new recombinant shingles vaccine is added to the schedule for adults aged 50 or older. They should get 2 doses 2 to 6 months apart, even if they have had shingles in the past or have had the older Zostavax already. And Shingrix becomes the preferred shingles vaccine for those who are at least 60 years old.
The other changes are to the formatting of the schedule and schedule footnotes.
“The schedule footnotes are presented in a new simplified format. The goal was to remove unnecessary text while preserving all pertinent information and maintaining clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes.”
CDC on Changes to This Year’s Schedule
So, unless your child is in a mumps outbreak, the new immunization schedule shouldn’t mean any extra vaccines.
What to Know About the 2018 Immunization Schedule
The 2018 immunization schedule from the CDC, AAP, ACOG, and AAFP incorporates the latest recommendations from the ACIP, including that folks in a mumps outbreak might need a third dose of MMR.