It really is a small world, after all.
Visitors to Disneyland learned that lesson recently, after a measles outbreak traced to people who spent part of the Christmas holiday season in the happiest place on Earth.
The federal Centers for Disease Control and Prevention reported a measles outbreak that spread from Disneyland to Southern California before rapidly moving to other states, including Washington.
Among those likely infected at the amusement park was an non-immunized woman in her 20s who flew to Sea-Tac Airport and visited several places in King and Snohomish counties before returning home to California.
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And it all happened before she even knew she had measles.
Public health officials at every level are warning Americans not to become complacent over this potentially deadly disease. In January, more than 100 people from 14 states were reported to have measles, as many measles cases as the United States typically sees in a year.
The News Tribune spoke with local and state health officials, and consulted information published by the CDC and other sources to answer some questions about measles and vaccinations.
Locally, we talked with Nigel Turner of the Tacoma-Pierce County Health Department and Paul Throne of the state Department of Health.
This article also quotes from a transcript of a press briefing by Dr. Anne Schuchat, assistant surgeon general and director of the National Center for Immunization and Respiratory Diseases at CDC.
Q: Did the people at Disneyland who got sick have their measles shots?
A: Most either were not vaccinated, or didn’t know if they had been. This was not a problem of the measles vaccine not working, Schuchat said, but of the vaccine not being used.
Q: Wasn’t measles eliminated in the United States? Why are we seeing a resurgence?
A: In 2000, health officials declared measles had been eliminated in this country. But it is still common around the world, causing about 20 million cases a year. In 2013, about 145,700 people died of measles across the world.
Measles can enter the United States through non-immunized visitors from other countries, or when non-immunized Americans travel abroad and bring it back.
Q: Isn’t measles kids stuff? Why are we seeing it in adults, like the young woman who traveled through Sea-Tac?
A: Most children are vaccinated and most people over 50 were probably exposed to measles as children, got the disease and gained immunity that way. The Sea-Tac traveler was in her 20s, and unimmunized.
In 2014, 79 percent of the unvaccinated measles cases in the United States were in individuals who were not vaccinated because of personal belief exemptions.
Q: What is a personal belief exemption?
A: In Washington state, children must have five types of immunizations (some delivered in multiple steps) by the time they enter kindergarten.
The law grants parents the right to exempt their children for religious reasons, medical reasons or — the most commonly used — personal or philosophical beliefs.
Legislation has been introduced in Olympia to eliminate the personal/philosophical belief exemption. Legislators in other states that offer the exemption, including California and Oregon, are looking at tightening up vaccination laws as well.
Q: What are some of the medical reasons to have your child exempted?
A: Children with a compromised immune system should not be vaccinated. That can include children with AIDS or leukemia, those undergoing chemotherapy, as well as children with other conditions. Certain allergies might mean children should avoid immunizations.
Q: Does the measles vaccine cause autism?
A: Scientists around the world have studied the possible links and found none. Still, the belief persists. Autism Speaks, an advocacy organization, urges all parents to vaccinate their children.
Q: How contagious is measles? How is it spread?
A: In the unvaccinated, measles is highly contagious — more than the common cold or the flu. That’s because the virus is airborne, and can survive in the air up to two hours after an infected person leaves a room.
Q: How bad is measles?
A: Even routine cases can make people seriously ill. Children don’t receive their first dose of the measles vaccine until age 1, so they are especially vulnerable.
Measles can cause the brain to swell and leave permanent brain damage. Measles can also cause deafness, seizures and death. In pregnant women, it can cause miscarriage or premature labor.
Q: How do I know if I or my child has measles? What should I do if I suspect measles?
A: Measles starts with a fever, cough, runny nose and conjuctivitis, or pink eye. Four days later, a red rash appears, often starting first on the face and then spreading to the rest of the body. People can transmit measles to others before and after the rash starts.
The diagnosis of measles must be supported by a lab test. If you think you or your child might have measles, call ahead so people in the waiting room won’t be exposed.
Q: What is herd immunity?
A: If enough people in a population are immune to a disease, there is less chance of it spreading quickly to many others. The goal is to slow or halt the disease early, before it spreads.
Health officials, who prefer the term community immunity to herd immunity, say it protects children who are too young to be vaccinated as well as anyone with a compromised immune system.
Q: What are the five types of immunizations Washington children need to enter school?
A: Hepatitis B, diptheria/ tetanus/pertussis combination, polio, MMR (measles, mumps and rubella) combination and varicella (chickenpox).
Q: What if you don’t remember the dates of all your child’s shots when it’s time to sign them up for kindergarten?
A: Since 1992, the state has kept a registry of vaccines administered. Doctors are encouraged to log the vaccines they administer into a database, which currently has records of more than 80 million doses.
You can request these records from your doctor or through the state health department.
Q: Where can I get my child immunized? Is it expensive?
A: The state provides vaccines at no cost for children. Health care providers might charge an office or administrative fee, but families that can’t afford it can ask for the fee to be waived.
In Pierce County, the health department sponsors free immunization clinics at schools and throughout the community. A schedule is available at www.tpchd.org/resources/immunizations.