This spring, two children attended a Portland-area school while infected with measles. Both were exposed at home and were showing symptoms.
The kids were contacts of a known measles case that public health officials were monitoring. Adults in the household were told to keep the children home from school if they developed symptoms.
But, according to Multnomah County Health Officer Dr. Richard Bruno, that didn’t happen, and the children were sent to school without public health’s knowledge.
As a result, 40 unvaccinated students and staff at the school were exposed to the virus and forced into quarantine for three weeks.
The story is an example, Bruno said, of how mistrust between people falling ill with measles and public health workers is making it challenging to stop transmission of the virus in Oregon — and nationwide.
Measles is easily preventable with a vaccine, but there is no antiviral treatment for it. An infection can lead to hospitalization and lifelong complications, particularly for children under 5.
In the last 18 months, the United States has had more reported measles cases than in the previous 25 years combined.
There have been 2,260 confirmed measles cases so far this year, with the overwhelming majority from local transmission of the virus. Only a handful of cases are from international travel.
Bruno first shared details about the school exposure in remarks on Tuesday at a press conference of the Big Cities Health Coalition, a not-for-profit group that represents 36 of the largest health departments across the country and lobbies for public health funding. The group is urging families to get their children up to date on their measles vaccines before the upcoming school year.
Public health departments, they said, are stretched thin by a historic increase in measles cases, emerging threats like Andes virus and the cyclospora outbreak, and federal funding cuts.
In Multnomah County, the lost funding includes cuts to a federal grant that had supported outreach and vaccination campaigns to reduce racial and ethnic health disparities.
“I think we’re all hitting challenging budget years in our health departments,” Bruno said. “We have less staff to organize vaccination events and interface with community on the importance of protecting themselves and their loved ones.”
Bruno didn’t name the school in the anecdote he shared. In April, the Oregon Health Authority reported repeated measles exposures at Centennial Middle School in Southeast Portland, prompting a major public health response.
In other instances, the county has had better luck building rapport with unvaccinated people. In April, during a measles outbreak that sickened farmworkers, nurses from Multnomah County and neighboring counties vaccinated more than 150 farmworkers during a vaccine event at a farm.
Oregon has reported 30 cases of measles and two hospitalizations due to the virus so far this year. Oregon’s state health officer has previously said that number is likely an undercount — wastewater data suggests people with mild infections may be spreading measles undetected.
Nearly all of Oregon’s confirmed cases were in people who were unvaccinated or had unknown vaccination status. Two were people who had been vaccinated.
Another challenge amid the resurgence of the virus, officials said, has been limiting exposures in hospitals and clinics. Earlier this month, the Oregon Health Authority reported that people were exposed to measles at two Providence hospitals and an urgent care facility.
Public health officials ask households with known measles cases to call ahead of time if a new family member develops symptoms and needs to come in for care or testing, Bruno explained, but the message doesn’t always get through.
The best practice, he said, is for the family to call their regular provider and explain that they need a measles test. Then, the patient can remain in their car while they are swabbed, getting the test they need without exposing anyone else.
Limiting exposures is critical because measles is generally considered the most contagious respiratory virus. While vaccinated people or people with immunity are unlikely to get it, a contagious person who coughs or sneezes will infect up to 9 out of 10 unprotected people around them, and the virus can remain in the air for up to two hours.
Another challenge is the course that measles typically takes. The first symptoms are a high fever, cough, runny nose and red eyes — symptoms common to several respiratory viruses that might not signal a measles diagnosis.
People can later develop a rash that starts from their head and spreads downwards. By that point, they may have been contagious for up to four days.
Bruno said if people know they were around someone who was potentially exposed to measles, or have spent time with someone who was unusually sick, that’s important information to share with healthcare providers.
Other clues that a childhood illness could be measles include recent travel through an airport — even for domestic travel — and visiting large venues like theme parks that are popular with international travelers.
