Local health officials are watching the sharp rise in measles cases among rural West Texas communities, with more cases expected to be confirmed over the next few weeks. Still, they are confident in overall protection from the virus after more than 50 years of immunizations.
The measles, mumps, and rubella (MMR) vaccines were developed in the 1960s and by 2000, many health professionals – including the World Health Organization – considered measles to be eliminated in the United States.
In recent years, there have been concerning spikes in confirmed cases, including the recent outbreak in a spread-out corner of West Texas.
On Feb. 21, the Texas Department of State Health Services reported at least 90 confirmed cases related to this outbreak, including at least 16 hospitalizations.
Health officials confirmed the outbreak started in rural Gaines County in late January. It is about an hour and a half away from Lubbock, where many people from rural West Texas communities go for more extensive medical treatment.
Dr. Ron Cook is the medical authority for the City of Lubbock, where at least one case of measles has been identified. Cook said the case was traced to a local waiting room, where an infected individual had come to Lubbock for medical help.
“They shared the same waiting room, and this individual had not been vaccinated yet and subsequently came down with the infection,” Cook said. “And that's our fear.”
Measles is highly contagious. It spreads through the air when an infected person coughs or sneezes. According to the CDC, measles can be picked up just by being in a room where a person with measles has been, even up to 2 hours after that person has left.
But don’t expect calls for masks or booster shots just yet. Cook advised the City of Lubbock during the COVID-19 pandemic and he said this disease is not the same.
“It's not like the flu,” Cook said. “We'll let people know when we should do that, but we're not at the numbers yet. And most people, most people, have immunity to this virus.”
Though most people with vaccinations are considered protected, health officials have said those vaccinated between 1968 and 1989 likely only received one dose of the vaccine and suggest people in that window check their status and get a second dose.
Those who are unsure of their vaccination status can call their primary care providers to request that information. Cook has also encouraged people to call clinics or providers before traveling, particularly to the doctor’s office.
“What we don't want people to do if they were exposed, we don't want you going into the waiting room,” Cook said.
The CDC reports that symptoms such as coughing, runny nose, high fever, and red, watery eyes can show up 7 to 14 days after infection, with the most notable being a large rash on the skin. However, infected individuals can pass on the virus even before symptoms show.
This creates another concern for health officials in the area, who expect the case number to grow as more people realize they’ve been carrying the virus and are contacted about exposure.
Testing and vaccination can become slower when individuals might have to drive a long distance, like those in rural communities such as Seminole in Gaines County, where the childhood vaccination rate is almost 10% lower than in Lubbock and the rest of the state.
Once the cases have been identified, health officials begin contact tracing to identify who may be at risk of infection.
“That takes a lot of manpower. Down in Seminole, they're really working hard trying to get that done,” Cook said. “We took the AMBUS – which is Lubbock EMS’ 15-passenger van – down there, and we're doing vaccine clinics trying to get vaccine and testing done.”
The most effective tool for protection against measles over the last 50 years has been two doses of the MMR vaccine, often administered with the first dose at 12 to 15 months old and the second dose between 4 and 6 years old. People who receive the MMR vaccine as scheduled by their doctor are usually considered protected for life.
Five cases so far related to the outbreak have been reported among vaccinated individuals. Health officials said when you consider the number of untested cases likely in the area, these breakout cases conform with the 97% effectiveness rate for the vaccine.
In many parts of the world, measles is still considered common and can be brought into the country by unvaccinated travelers who catch the virus elsewhere.
The vaccine is a requirement in many states, like Texas, for entering childcare or public education, but private schools and families who homeschool don’t necessarily carry the same rules. Some Texans can also apply for a non-medical exemption to the rule.
Health officials are mindful of where the disease would be most likely to spread among the unvaccinated, such as those who are pregnant, immunocompromised, or children under 1-year-old.
Executive Director Katherine Wells has been with Lubbock Public Health for 10 years, including as a leader in the city’s response to the COVID-19 pandemic. Her concern goes to the most at-risk children.
“An exposure in a daycare makes me very nervous because they have infants, and they have lots of children under one,” Wells said. “ So how are we going to protect those babies if we had a measles case in a daycare center?”
Statistically, Wells said deaths are possible in measles cases, but that tends to be in very rare cases where infected individuals develop encephalitis, a swelling of the brain, or pneumonia, which is difficult to treat.
“We're lucky here in Lubbock that we have children's hospitals that can take really great care of those very sick kids,” Wells said. “Modern medicine also helps them from not dying from the disease, that doesn't mean there isn't risk there.”
Even with close cooperation between Lubbock Public Health and the South Plains Public Health District, which covers the most exposed areas like Gaines County and neighboring Terry County, Wells said the distance can still make testing slower for rural communities.
“When you're in Seminole, you actually have to drive that specimen up to Lubbock for processing to then get on an airplane to then go to Austin,” Wells said. “So it can add an extra day in the process of getting testing done.”
The confirmed case in Lubbock was the first case for the area in more than 20 years.
“That means that a lot of our physicians that are practicing – even those that have been in practice for 10, 20 years – have never seen a measles case,” Wells said.
According to Wells, immunization campaigns have shown more people coming from surrounding areas to Lubbock for the vaccine since the outbreak was first reported. That means Lubbock’s vaccine clinics and public health workers within the affected areas are going to be ramping up efforts to bring vaccines to the community.
“From the health department perspective, it's difficult because they're residents of another county, but they're coming into Lubbock County,” Wells said. “There has to be a lot of communication between us and the other health department because it's their case, and they're doing the investigation and identifying where that person's been.”
MMR vaccines can be administered up to 72 hours after exposure to measles, which Wells said can help curb potential symptoms.
“The message around vaccinations and what to do is really for that 5-7% of the population that's not vaccinated,” Wells said. “Those people that have been vaccinated or vaccinated as children really have nothing to worry about.”
According to the CDC and WHO, estimates are that in the past 50 years, the MMR vaccine has saved an estimated 94 million lives.
Since the outbreak began in late January, Wells said she referred to it as the “tip of the iceberg” when speaking with state health officials. Now, she’s working with the state to make MMR vaccinations more freely available to the public.
“Then looking at, if we start getting more cases, how can we facilitate quicker testing,” Wells said.
People have also been reaching out and asking questions about the vaccine. Wells said this shows the need for more extensive rural vaccination efforts.
More information on the MMR vaccine can be found here.
KTTZ's Samantha Larned contributed to this report.