While there have been no reported cases of measles in 2018 in the region, a few scares that have involved testing is prompting the Virginia Department of Health’s Piedmont Health District to encourage people to learn more about the highly contagious virus and how they can protect themselves and their loved ones.
Rhonda Pruitt, senior epidemiologist with the Piedmont Health District, said the department has performed tests over the past few months, including on a 5-year-old boy in December, who were suspected to possibly have measles.

The Piedmont Health District spans Charlotte, Buckingham, Cumberland, Prince Edward, Amelia, Lunenburg and Nottoway counties.

Washington state recently declared a state of emergency due to a measles virus outbreak, in which the Centers for Disease Control (CDC) confirmed at the time that 26 people had measles.
Pruitt said the health department performed what are called rule-out tests to determine whether people potentially contracted measles.

These include collecting nasopharyngeal and oropharyngeal swabs, or swabs of the back of the nose, throat or cheek, in addition to blood and urine samples.

Pruitt said the department is relieved to find that the cases were not confirmed to be measles. However, she said with the growing national trend of unvaccinated populations, and the increased accessibility of international travel, measles could possibly present itself not only in communities in the United States, but in the Piedmont Health District as well.

MEASLES VIRUS

Pruitt said the measles virus typically presents in two stages. The first stage has many of the same symptoms as the common cold. Pruitt said the person can develop a fever, a runny nose, redness of the eyes and a cough.

At day three to day seven of the virus, Pruitt said people develop a red, blotchy rash that appears on the face and begins to spread throughout the entire body. She said the rash generally lasts 5-6 days. Patients also often develop small, white spots called koplik spots, which can be found on the gums and the inside of the cheek.

“Measles is extremely contagious,” Pruitt said. “It is so contagious that if one person has it, 9 out of 10 people around him will also become infected if they are not protected.” She said it is spread by an infected person if they cough or sneeze. She said the virus can last in a room for up to two hours. Even if the infected person leaves a room, Pruitt said someone could be exposed to the virus if they enter a room within two hours of the infected person leaving.

Pruitt said the virus could have a long incubation period. Someone exposed to the virus can develop symptoms between 7-21 days.

“Measles develops in two stages, and the early stages are very much like regular cold symptoms,” Pruitt said. “Somebody that has measles and just think that they have a cold and are around other people, they can be spreading measles before they ever develop that rash.”

Complication from measles, Pruitt said, can include a high fever of more than 104 degrees Fahrenheit. One out of four people will require hospitalization, Pruitt said. One out of 1,000 with measles will develop brain swelling, which Pruitt said is called encephalitis. Encephalitis can lead to brain damage.
About one or two out of every 1,000 people with measles will die even with the best of medical care, Pruitt said.

PREVENTION AND CARE

“The most important thing that you can do to prevent contracting measles is to make sure that you have been appropriately vaccinated,” Pruitt said.
She said the vaccine, the Measles, Mumps and Rubella vaccine (MMR), is administered in two doses.

The first dose is typically administered at 12-15 months of age. The second dose is generally administered at 4-6 years of age. Pruitt said the doses vary if an infant or child is traveling overseas. Pruitt said this is due to the measles virus being endemic in many parts of the world. If a baby who is six months through 11 months old is traveling overseas, Pruitt said the baby should receive one dose of MMR vaccine before leaving the country. If a child is 12 months of age or older, they will need two doses of MMR vaccine, and those two doses would need to be administered 28 days apart.

Pruitt said the MMR vaccines can usually be found at one’s doctor’s office. If someone does not have a primary care doctor, Pruitt said they can contact their local health department and schedule an appointment for vaccine.

Cost can depend on the person’s situation. Pruitt said if the person has insurance, their insurance will be billed. The health department has the vaccine for children doses, but people would need to qualify. For questions about the vaccine and potential plans, Pruitt recommended that people call their health care providers or the Virginia Department of Health Piedmont Health District at (434) 392-3984.

Once people receive the two doses, Pruitt said that’s generally all that they need.

“Once they’ve been appropriately vaccinated, that they’ve gotten a vaccine and it’s been administered within the appropriate time frame, generally there’s no booster that’s required,” Pruitt said.

Pruitt said this is because the vaccine has a high effective rate. One dose of measles vaccine has an estimated 93 percent effective rate at preventing measles. Two doses administered appropriately, Pruitt said, have a 97 percent effective rate.

Pruitt said there are communities within the U.S. and within the Piedmont Health District that are not vaccinated, or hold anti-vaccination beliefs.

Pruitt said there has been press and discussion about one belief in particular of a reported correlation between the MMR vaccine and autism.

This correlation, Pruitt said, is believed to have originated from a study published in 1999 by Andrew Wakefield in the peer-reviewed journal, The Lancet, which explored a possible correlation between the vaccine and autism.

Wakefield was convicted of falsifying the data within the study and later was stripped of his medical license.

Pruitt said the highly contagious nature of the virus and risk or brain damage or death that can result should alert people to take preventative action for themselves and their families.

“Nobody ever thinks that it’s going to happen to them, or their child, or to someone in their family,” Pruitt said.

“If people understand how contagious measles is, and when they consider that one out of every four people who get measles will require hospitalization, that one out of every 1,000 people with measles will develop brain swelling that can lead to brain damage, and that one or two out of every 1,000 people with measles will die even with the very best of care,” Pruitt said. “Nobody wants to see their child in the hospital. Nobody wants to see their child develop brain damage. Nobody wants to see their child die when there is a vaccine that is 97 percent effective against preventing that and is easily accessible.”

THE RISK

Pruitt said the United States declared in 2000 that measles was eradicated from the country. She said due to growing populations of unvaccinated people and international travel being more easily accessible, the virus has a opportunity to resurface.

Pruitt said the Piedmont Health District has universities that see more people entering and leaving the district. She said there are international airports that can be reached at a drivable distance.

“The chances of us coming in contact with somebody who is carrying measles is much greater now than it used to be,” Pruitt said.

Pruitt said even one confirmed case of measles can result in an extensive investigation by the health department, called contact investigation, which involves contacting all doctor offices and public places the person may have visited to ensure that anyone around the person has been vaccinated. This can include anywhere from public transportation, to restaurants, schools, churches or stores.

Pruitt said that if someone thinks that they may have come into contact with someone with measles or have been exposed to the virus, they need to immediately isolate themselves, meaning avoid any public place such as work or school, and to immediately contact one’s medical provider.

“Your medical provider will make recommendations to you on how to receive testing and treatment so that you can do so without unnecessarily exposing other people,” Pruitt said.

In the case of the child tested in December, Pruitt said the child needed to be fully masked before they left the doctor’s office, that the exam room that they were examined in has to be thoroughly cleaned and sterilized, and that nobody could enter that exam room for a full two hours after that person leaves.

“I think that for any community in the United States right now, I think that the danger of somebody becoming infected with measles is quite high, and it’s likely going to happen at some point,” Pruitt said.

“We really want to get the message out to our community to please do everything that you can to protect yourself and your loved ones against this disease,” Pruitt said.

For additional information about the virus or for questions, Pruitt recommended visiting the Virginia Department of Health website, http://www. vdh.virginia.gov or the CDC website at https:// www.cdc.gov.