Tag: quarantines

Measles on a Plane, Train, and a Cruise Ship

What to most folks worry about when they go on a cruise?

That’s right. Norovirus…

While it isn’t as common as most folks think, norovirus is still often thought of as the cruise ship disease.

Measles on a Plane, Train, and a Cruise Ship

Not surprisingly, many of the same conditions that put you at risk for getting norovirus, including that it is very contagious and you are in close quarters with a lot of other people on a ship, puts you at risk for getting other diseases.

Even measles?

Especially measles.

In 2014, 136 people got measles after an unvaccinated person developed measles on a cruise ship, including 28 people on the cruise.

More recently, an unvaccinated teenager exposed others to measles on a Norwegian Cruise Lines ship while visiting Alaska. It seems like the same person also exposed folks to measles on a few planes and trains too.

How did they get measles? In Thailand.

This is almost certainly the same person who arrived at Vancouver International Airport from Tokyo on an Air Canada flight (July 30), leaving for Portland on Air Canada Jazz that same day.

While in Portland, they exposed people to measles at multiple locations:

  • Leno Medoyeff Bridal, 710 NW 23rd Ave., Portland, 3:30—5:30 p.m. (July 31)
  • Tom’s Pancake House, 12925 SW Canyon Rd., Beaverton, 7—9:30 a.m. (Aug. 1)
  • Max Red Line, Beaverton Transit Center to Pioneer Square, 12:30—1 p.m. (Aug. 2)
  • Max Red Line, Pioneer Place to Beaverton Transit Center, 5:30—6 p.m. (Aug. 2)
  • Verde Cocina, 5515 SW Canyon Ct., Portland, 2—4:30 p.m. (Aug. 5)

They weren’t done yet though.

You really shouldn't have to worry about measles when you board a plane, train, or cruise ship with your kids.
You really shouldn’t have to worry about measles when you board a plane, train, or cruise ship with your kids.

They then traveled back to Vancouver International Airport on an Alaska Airlines flight (August 6) and boarded a Norwegian Jewel cruise ship to Alaska.

Fortunately, the teen was placed in medical isolation shortly after boarding the ship and may have left the typically 7 day cruise early, as they were transferred to PeaceHealth Ketchikan Medical Center on August 8.

How can you protect yourself?

Get vaccinated. You never know when someone who is unvaccinated is going to expose your family to measles or put them at risk for other vaccine-preventable disease.

More on Measles on a Plane, Train, and a Cruise Ship

Costs of a Measles Outbreak

The endemic spread of measles was eliminated in the United States in 2000, but unfortunately, that hasn’t stopped us from having outbreaks of measles each year.

Since reaching a record low of just 37 cases of measles in 2004, other milestones in the measles timeline we should all know about include that there were:

  • 220 measles cases in 2011, a 15-year record and the highest number of cases since 1996 at least until 2014, when we had at least 667 cases
  • 58 cases in the 2013 New York City measles outbreak and for a short time, the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 382 cases in the 2014 measles outbreak in Ohio and now the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 170 measles cases in the first few months of 2015, including a large outbreak in California that was linked to Disneyland.
  • 188 cases and a measles death in 2015

That’s still far below where we used to be though, especially when you consider that before the first measles vaccine was licensed, there was an average of about 549,000 measles cases and 495 measles deaths in the United States each year.

Containing a Measles Outbreak

Several factors help to limit the measles outbreaks that we continue to see in the United States. Most important is that fact that despite the talk of personal belief vaccine exemptions and vaccine-hesitant parents not getting their kids vaccinated, we still have high population immunity.

In the United States, 90.8% of children get at least one dose of the MMR vaccine by the time they are 35 months old and 91.1% of teens have two doses. While not perfect, that is still far higher than the 81% immunization rates the UK saw from 2002 to 2004, when Andrew Wakefield started the scare about the MMR vaccine. Instead of overall low immunization rates, in the U.S., we have “clusters of intentionally under-vaccinated children.”

It also helps that the measles vaccine is highly effective. One dose of a measles vaccine provides about 95% protection against measles infection. A second, “booster” dose helps to improve the effectiveness of the measles vaccine to over 99%.

To further help limit the spread of measles, there are a lot of immediate control measures that go into effect once a case of measles has been suspected, from initiating contact investigations and identifying the source of the measles infection to offering postexposure prophylaxis or quarantining close contacts.

That’s an awful lot of work.

A 2013 measles outbreak in Texas required 1,122 staff hours and 222 volunteer hours from the local health department to contain.

Costs of a Measles Outbreak

In addition to requiring a lot of work, containing a measles outbreak is expensive.

A study reviewing the impact of 16 outbreaks in the United States in 2011 concluded that “investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts.”

We still don’t know what it cost to contain many big outbreaks, like the ones in New York City and Ohio, but we do know that it cost:

  • over $2.3 million to contain the 2017 outbreak in Minnesota – 75 people got measles, 71 were unvaccinated, and more than 500 people were quarantined over a 5 month period
  • up to an estimated $3.91 million (but likely much more) to contain the 2015 outbreaks in California
  • two unrelated cases in Colorado in 2016 cost $49,769 and $18,423, respectively to investigate
  • $50,758.93 to contain an outbreak at a megachurch in Texas
  • $150,000 to contain (13 cases) an outbreak in Cook County, Illinois
  • $223,223 to contain (5 cases, almost all unvaccinated) to contain another outbreak in Clallam County, Washington, an outbreak that was linked to the death of an immunocompromised woman.
  • more than $190,000 of personnel costs in Alameda County, with 6 cases and >700 contacts, it is estimated that over 56 staff spent at least 3,770 hours working to contain the outbreak
  • $5,655 to respond to all of the people who were exposed when a 13-year-old with measles was seen in an ambulatory pediatric clinic in 2013
  • $130,000 to contain a 2011 measles outbreak in Utah
  • $24,569 to contain a 2010 measles outbreak in Kentucky
  • $800,000 to contain (14 cases, all unvaccinated) a 2008 measles outbreak at two hospitals in Tuscon, Arizona
  • $176,980 to contain a 2008 measles outbreak in California
  • $167,685 to contain a 2005 measles outbreak in Indiana – unvaccinated 17-year-old catches measles on church mission trip to Romania, leading to 34 people getting sick, including an under-vaccinated hospital worker who ends up on a ventilator for 6 days
  • $181,679 (state and local health department costs) to contain a 2004 measles outbreak in Iowa triggered by a unvaccinated college student’s trip to India
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994. How much did these outbreaks cost to contain?

It is important to keep in mind that these costs are often only for the direct public health costs to the county health department, including staff hours and the value of volunteer hours, etc. Additional costs that come with a measles outbreak can also include direct medical charges to care for sick ($14,000 to $16,000) and exposed people, direct and indirect costs for quarantined families (up to $775 per child), and outbreak–response costs to schools and hospitals, etc.

We should also consider what happens when our state and local health departments have to divert so much time and resources to deal with these types of vaccine-preventable diseases instead of other public health matters in the community. Do other public health matters take a back seat as they spend a few months responding to a measles outbreak?

There were 220 cases of measles in the United States in 2011. To contain just 107 of those cases in 16 outbreaks, “the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

In contrast, it will costs about $77 to $102 to get a dose of the MMR vaccine if you don’t have insurance. So not only do vaccines work, they are also cost effective.

What to Know About the Costs of a Measles Outbreak

Containing a measles outbreak is expensive – far more expensive than simply getting vaccinated and protected.

More on the Costs of a Measles Outbreak

How to Avoid a Quarantine During an Outbreak at Your School

Believe it or not, hundreds of kids get caught up in quarantines for vaccine-preventable diseases in the United States each year.

Quarantines were routine in the pre-vaccine era.
Quarantines were routine during pre-vaccine era epidemics.

Wait, what?

Caught up in quarantines for vaccine-preventable diseases?

Then why do we have vaccines?

How to Avoid a Quarantine During an Outbreak at Your School

Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?
Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?

As you have probably already guessed, these aren’t usually vaccinated kids that are getting sick or quarantined in these outbreaks of measles, meningococcemia, and chicken pox, etc.

That’s right, they are unvaccinated.

Typically intentionally unvaccinated, although they are sometimes too young to be vaccinated or may have a medical exemption.

And that brings up to a few very easy ways to avoid getting quarantined during an outbreak:

  1. make sure you are always up-to-date on all of your vaccines
  2. if you think that you have natural immunity (already had the disease) or were vaccinated, but don’t have your immunization records, then getting a titer test might keep you out of quarantine if you can prove that you are immune
  3. get vaccinated, if possible, at the first sign of the outbreak, which might help you avoid quarantine in the case of measles and chicken pox

“Persons who continue to be exempted from or who refuse measles vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That’s right, especially in the case of measles, you can often avoid being quarantined if you simply get vaccinated.

Unvaccinated children exposed to measles are quarantined for at least 21 days.
Unvaccinated children exposed to measles are typically quarantined for at least 21 days.

Why are quarantines important?

Can’t you just isolate yourself if you get sick?

The problem with that strategy is that you are often contagious before you develop symptoms. That’s especially true of measles, when you likely won’t even realize that you have measles until you get the measles rash, after having a high fever for three to five days. That’s why people with measles are often seen at clinics and emergency rooms multiple times, exposing many people, before they are finally diagnosed. It is the classic signs of a rash with continued fever that helps to make the diagnosis.

Without quarantines of unvaccinated people, especially those who are known exposures to other cases, today’s outbreaks would be even bigger and harder to control.

If you don’t want to take the risk of being quarantined and missing weeks or months of school or work, then don’t take the risk of being unvaccinated. Tragically, that’s not the only risk you take when you skip or delay your vaccines. In addition to getting sick, you also risk getting others sick, including those who didn’t have a choice about getting vaccinated yet.

What to Know About Avoiding Quarantines During an Outbreak

The easiest way to avoid getting caught up in a quarantine for a vaccine-preventable disease is to simply make sure your kids are up-to-date on all of their vaccines.

More on Avoiding Quarantines During an Outbreak

 

The Latest Measles Outbreak in Kansas

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.

There are at least 18 cases of measles in current Kansas outbreak.
An ongoing measles outbreak in Kansas is up to 18 cases.

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

The latest cases could have exposed other people to measles at:

  • 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.

More on the Measles Outbreak in Kansas

Updated on April 21, 2018

The Hospital Rock Engravings of Farmington, Connecticut

Vaccines are a lot safer than they used to be in the old days.

No, I’m not talking about the “crude brew” that was the original DTP vaccine.

This older vaccine used more antigens than the DTaP vaccine that replaced it, so could cause more side effects. Even before that though, there was less oversight of vaccine manufacturers in the early 20th century. This could lead to vaccines that were contaminated or which simply didn’t work.

That certainly was a problem with the early smallpox vaccine, which is typically considered to be the most dangerous vaccine ever routinely used.

Variolation and Smallpox

But even before the smallpox vaccine was developed by Edward Jenner in 1796, we had variolation.

While the smallpox vaccine involved the cowpox virus, variolation actually infected someone with smallpox. The idea was to give the person a milder form by exposing them to a weaker, or attenuated, form of the virus.

They got this weakened virus from the smallpox scabs of someone who had already recovered and:

  • blowing dried smallpox scabs into their nose
  • applying pus from smallpox scabs to a small puncture wound on their skin

Variolation worked, giving the person immunity to smallpox – if they survived.

Unfortunately, about 1 to 3% of people who underwent variolation died.

And people who had recently undergone variolation could be contagious, leading to smallpox epidemics.

So why did folks undergo variolation if they had a chance of dying from the procedure?

It’s simple.

A natural smallpox infection was so much more deadly. Up to 30% of people who got smallpox died, and many people eventually got caught up in the regular smallpox epidemics that plagued people in the pre-vaccine era.

The Hospital Rock Engravings of Farmington, Connecticut

We don’t have to worry about smallpox anymore.

Well, not about natural smallpox infections, since smallpox was eradicated back in 1980.

And there are many other diseases that we get vaccinated against, with it being extremely easy to get that protection, especially compared to what folks did in the old days.

Do you know how far folks went to make variolation safer?

“Every year, thousands undergo this operation, and the French Ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries. There is no example of any one that has died in it, and you may believe I am well satisfied of the safety of this experiment, since I intend to try it on my dear little son. I am patriot enough to take the pains to bring this useful invention into fashion in England…”
Lady Mary Wortley Montagu On Small Pox in Turkey (1717)

They actually went to smallpox hospitals to get vaccinated, remaining in quarantine for up to three weeks so that they wouldn’t get others sick.

In Farmington, Connecticut, two doctors established the Todd-Wadsworth Smallpox Hospital and had a lot of success with variolation.

Patients were no longer starved before inoculation, and many had begun to doubt the efficacy and safety of vomiting, sweats, purges, mercurials (toxic mercury salts such as calomel), and bleeding which had previously weakened both inoculees and those who “took the pox in the natural way.”

Charles Leach, MD on Hospital Rock

There, up to 20 patients at a time stayed in quarantine to get variolated, as a smallpox epidemic hit nearby Boston.

Patients engraved their name on Hospital Rock in the late 1700s near Farmington.
Patients engraved their name on Hospital Rock in the late 1700s near Farmington. Photo by Keith Wilkens

Between 1792 and 1794, many who got variolated wrote their names on what is now known as Hospital Rock.

“Many have supposed that the names on this rock were those who had did of the small-pox, but this is a great mistake. Every name on the rock is that of a person who was living when the name was placed there. Norris Stanley lived to own ships which were captured in the war of 1812 by Algerian pirates and still later to receive from the United States an indeminity therefor amounting to a large sum.”

James Shepard on The Small Pox Hospital Rock

The nearby town of Durham seemed to go a different way.

Instead of an inoculation hospital, they had a pest house to quarantine folks with natural smallpox infections.

Adding to the history of smallpox in Connecticut – a smallpox burying ground in Guilford.

Why wasn’t variolation popular everywhere? Folks didn’t have to wait for the first vaccine for the anti-vaccine movement to get started.

What to Know About Smallpox and the Hospital Rock Engravings

Hundreds of people got safely inoculated against smallpox and left their names on Hospital Rock near Farmington, Connecticut just before Edward Jenner discovered the first smallpox vaccine.

More on the Hospital Rock Engravings

Measles Returns to California

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.

There are now six cases of measles in the San Francisco Bay Area as the outbreak grows.

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.

And that means we will still see some of these outbreaks of vaccine preventable diseases.

There is also a little issue with medical exemptions somehow rising being abused after the personal belief exemption was eliminated in the state…

Measles Outbreaks in California

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

Schools in California were closed for at least two weeks in 1917 because of measles epidemics.

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?

There is just one case, so far.

Well, it was just one case. There are six cases now… Seven if you count the linked case in Nevada.

Did you eat lunch at the Westgate Center food court on Friday, March 2?
Did you eat lunch at the Westgate Center food court on Friday, March 2?

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.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
The measles rash begins 3-5 days after other measles symptoms, which is why measles is often hard to diagnose.

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.

More on Measles Outbreaks in California

Updated April 7, 2018

What to Do If Your Child Is Exposed to Mumps

Although things are much better than they were in the pre-vaccine era, we still have mumps outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Mumps?

Mumps is contagious, but not nearly as contagious as other vaccine-preventable diseases, such as measles.

“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”

CDC on Transmission of Measles

Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.

“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”

CDC on Mumps Outbreak-Related Questions and Answers for Patients

How do you get mumps?

Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:

  • cough or sneeze
  • use a cup or eating utensil that you then use
  • touch an object or surface that you then touch (fomites)

And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.

“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

The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.

Is Your Child Protected Against the Mumps?

Tips to prevent getting sick with the mumps.
You can prevent the mumps.

The MMR vaccine protects us against mumps – and measles and rubella.

One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.

Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.

“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.

What to Do If Your Unvaccinated Child Is Exposed to Mumps

To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.

“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”

Surveillance Manual

If your unvaccinated child is exposed to mumps, you should talk to your pediatrician or local health department, but unlike measles and chicken pox, there are no recommendations to start post-exposure prophylaxis.

Mumps quarantine sign

Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.

“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.

Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.

If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.

It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!

What to Do If Your Vaccinated Child Is Exposed to Mumps

If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?

Again, it depends on what you mean by fully vaccinated.

It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?

And is your child fully vaccinated for his age or has he had two doses of MMR?

Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.

“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”

Ask the Experts about MMR

In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.

And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.

An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.

“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

And in some cases, folks should now get a third of dose of MMR.

This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.

You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.

Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.

What to Know About Getting Exposed to Mumps

Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.

More on Getting Exposed to Mumps