Measles outbreak spreads
to 6 cases in Portland area

Health officials are investigating whether five others
also have the disease, which might have taken hold in
the area after two children apparently were
misdiagnosed in December

Thursday, January 21 1999

By Patrick O'Neill of The Oregonian staff  http://www.oregonlive.com/

Measles: What to do

Health officials are trying to contain a measles outbreak
that has spread to as many as six people in the Portland
area.

In addition to the six confirmed or presumptive cases,
health officials are investigating five other possible cases.

Physicians apparently misdiagnosed two cases of measles
in December, possibly giving the highly contagious disease
a toehold in the Portland area. Health officials are warning
doctors to be on the lookout for measles. Before the live
virus vaccine became available in 1963, virtually all young
people contracted measles. But it's rare enough now that
many doctors have never seen it.

Measles has been confirmed in four Oregonians -- three in
Multnomah County and one in Clackamas County. But
Jan Poujade, manager of the disease control office of the
Multnomah County Health Department, said she expects
laboratory confirmation of yet another two cases.

In addition, she said, her office is investigating three other
cases of illness that include a rash but which don't show
the classic symptoms of measles. There are two cases
under investigation in Clackamas County.

Poujade said it's not unusual for health workers to
misdiagnose a case of measles. In the previous two years,
no measles cases were reported in Oregon.

"We have a lot of providers out there who haven't seen
measles," she said. "Health providers go for years without
seeing measles. It's concerning to us, but it is very
understandable."

She said a variety of childhood diseases, including
roseola, strep throat accompanied by a rash, and fifth
disease, caused by human parvovirus B19, can mimic
measles. Measleslike symptoms also can be caused by
reactions to antibiotics.

The six confirmed or presumptive measles cases range in
age from 6 months to 20 years. All six apparently were
acquainted with one another.

Immunization is the best defense against measles. But it
isn't completely effective. Of the total 11 cases either
confirmed or under investigation, two are men, ages 18
and 20. Both were immunized as children when only single
doses of vaccine were given, Poujade said.

She said the illnesses underscore the importance of new
state and national immunization guidelines recommending
two doses of vaccine -- one at ages 12 to 15 months and
another between ages 4 and 6.

This is the first school year in which kindergartners and
first-graders are required by law to have a second
measles, mumps and rubella vaccination before entering
school. Under state law, children who don't have proof of
vaccination by Feb. 17 will be excluded from schools.

The school exclusion rule will extend to seventh-graders in
fall 2000.

Poujade said one vaccination dose is 95 percent effective.
State health guidelines recommend second doses only for
children, extending to college-age people, and health-care
workers.

The reason for that breakdown, she said, is that
youngsters often congregate in large groups in school.
Health-care workers should have the extra protection to
avoid the possibility of passing measles along to other sick
patients.

Immunization guidelines don't specifically recommend a
second dose for most adults, Poujade said.

Disease can be fatal
Dr. Paul Lewis, an assistant professor of pediatrics at
Oregon Health Sciences University and a specialist in
infectious diseases, said measles is a "serious disease" with
complications that include severe pneumonia and
encephalitis, an infection of the covering of the brain or
spinal cord.

Just how serious?

For every thousand people who get measles, one to two
die and one has lifelong neurological disorders.

Lewis estimates that without measles vaccinations, 40 to
80 young Oregonians would die and another 40 would
have neurological impairment.

Vaccination programs have held down the incidence of
measles in the United States to fewer than 300 cases a
year, according to the national Centers for Disease
Control and Prevention in Atlanta.

Lewis said it's important for as many people as possible to
be vaccinated. Vaccinations protect not only the individual
vaccinated but also others for whom the vaccine won't
work.

"Not everybody has the luxury
of getting vaccinated," he said.
"Children don't get vaccinated
until they're 1 year old because
the vaccine doesn't work
before that age. So you have a
lot of little babies out there who
don't have immunity to
measles."

In addition, people with
weakened immune systems --
those undergoing
chemotherapy, who have HIV
infections or who have diseases
such as leukemia -- can't
benefit from such
immunizations. Immunization
requires an intact immune
system to work.

Adults born before 1957 have probably already had
measles and are presumed to be immune.

Source still unknown
The Oregon Health Division announced the first two
measles cases on Jan. 12. Dr. Beletshachew Shiferaw, a
Health Division epidemiologist, said the newly confirmed
cases include two children who became ill in December
but whose cases were misdiagnosed by physicians.

"We're still investigating to find out the source," she said.
"We're looking at the contacts of the confirmed cases to
determine their immunization status. And we're telling
people that if they have measles symptoms, they shouldn't
just drop in to emergency rooms."

Shiferaw said people who think they have measles should
telephone their doctors to make arrangements to be seen
away from other patients.

Poujade illustrates how easily the disease can be spread:
In the early 1990s, a 12-year-old girl who had measles
used a restroom in a Portland doctor's office. Four hours
later, a 5-year-old boy used the same restroom and
developed measles.

Measles, which causes 1 million deaths among children
younger than 5 years old worldwide, has been targeted
for eradication by the World Health Organization by
2010.

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