A person suspected of having measles visited Bend on Jan. 19-20, potentially exposing residents to the virus.
Deschutes County health officials said the person is connected with the measles outbreak in Clark County, Washington, but the Oregon Health Authority is still waiting for test results to confirm whether that person is infected.
The potential exposures occurred in Bend on Saturday, Jan. 19, at Mountain Air trampoline park from 10:30 a.m. to 2:30 p.m., and on Sunday, Jan. 20, at the Juniper Swim & Fitness Center at unknown hours. Deschutes County health officials are urging anybody who is unvaccinated and was at those locations at those times to contact the health department. Both locations are now considered safe.
Central Oregon health officials have been keeping close watch on the measles outbreak in Vancouver and Portland, knowing the disease could easily make the jump to the region.
“There is always a concern when its measles, because of the side effects and because of how contagious it is,” said Muriel DeLaVergne-Brown, health and human services director for Crook County. “Part of it is just reminding people that this is still a concern.”
Health officials in Clark County, Washington, have now confirmed 35 cases of the measles in the ongoing outbreak, and on Friday, the Multnomah County Health Department confirmed one of the cases occurred in Oregon. Officials have listed a number of public sites in Vancouver and Portland where people may have been exposed to the virus. Because of the lag time between infection and the first symptoms, people are often out in public while they are contagious.
“When one gets measles, one is contagious for a period of about eight days, including four days before you get the rash, before you even know you have measles,” said Dr. Paul Cieslak, medical director of Communicable Diseases and Immunizations at the Oregon Health Authority’s Public Health Division.
County health departments in Oregon and Washington, he said, are tracking unvaccinated people who have been exposed to the measles virus, calling them regularly to ensure they haven’t developed symptoms. Those people are being encouraged to stay at home until they are past the incubation period for the disease.
Of the 35 Clark County cases, 31 cases occurred in unvaccinated patients, while the immunization status for the remaining four have not been confirmed. All but one of the cases are in children, including 25 in children under age 10. One person was hospitalized, and other nine are suspected of having the measles.
Cieslak said most Oregonians are well-protected: After two doses, the measles vaccine has an effectiveness rate in the high 90s.
Measles was once so common that nearly everyone was exposed to it, so people born before 1957 are considered immune. School vaccination rates in Oregon are above 96 percent, with vaccination rates among adults even higher.
As recently as 2000, only 1 percent of Oregonian school kids claimed exemptions. But in recent years, myths about the safety of measles vaccines took hold and rates dipped. Once those rates dip below 95 percent in a given community, the herd immunity effect that prevents the transmission of the disease is lost.
“I worry about those pockets that have a lot of unvaccinated people,” Cieslak said.
Measles transmission has stopped in the U.S. thanks to the vaccine, but sporadic outbreaks occur when travelers bring the virus from other countries. A current outbreak in New York City among Orthodox Jews has been linked to a traveler coming from Israel. Officials in Clark County have not disclosed whether they have found the original source of the Vancouver outbreak, although there are signs that outbreak is affecting Russian-speaking immigrants. Clark County officials have released measles information sheets from the state health department in English, Spanish, Russian and Ukrainian. Officials have also chronicled locations where infected people had gone before they were diagnosed. Those include two Russian-language churches in Vancouver and one in Portland.
According to a 2012 report from the Washington State Department of Health, Russian-speaking communities in the state have the lowest childhood immunization rates of any population. The report found many families that immigrated to Washington, Oregon and California from Russia, Ukraine and other former Soviet republics had negative beliefs or misperceptions about the safety, efficacy and cost of vaccines, in addition to cultural and language barriers in accessing care. Those immigrant populations are less common in Central Oregon.
“But we are also very concerned with the overall increase in individuals opting out of immunizations for nonmedical reasons throughout Central Oregon,” Jefferson County Health Director Michael Baker said. “Historically, Jefferson County has had very high rates for on-time and up-to-date immunizations. We have started to see those numbers decline throughout the region.”
In the 2017-18 school year, Jefferson County schoolchildren had the highest rate of measles vaccination in Central Oregon at greater than 98 percent. Crook County had a 97 percent rate, while Deschutes County had 94 percent.
The three counties are now cooperating in their communicable disease work under a federal grant. Baker said that has helped relieve pressure on his health department, which relies on a single nurse for immunization work.
“When a situation like this arises, she is near the breaking point,” he said.
The cooperative efforts includes tracking the measles outbreak and keeping area health care providers informed about proper protocols when it comes to diagnosing and treating measles. Many local providers have never seen a patient with measles.
“I’ve been a bug doctor for 25 years and I’ve never seen a case,” said Dr. John Lutz, an infectious disease specialist with Summit Medical Group Oregon-Bend Memorial Clinic. “We did such a good job stamping it out in this country.”
Immunization is recommended starting with a first dose at 12 to 15 months old, and a second dose between age 4 and 6. Those who have missed doses can get caught up at any time.
Health officials are also warning parents that if they suspect their child has developed the measles to call ahead rather than showing up in the waiting room of the doctor’s office. Clinics can then make arrangements to see the child without exposing others.
“Measles is actually one of the most, if not the most, contagious viruses that we know about,” said Dr. John Lynch, medical director of the Harborview Medical Center in Seattle. “If you take an unimmunized group of people and you expose them, 9 out of 10 of them will become infected.”
Transmission occurs when people cough or sneeze, leaving droplets with the virus in the air or on surfaces where others can pick it up.
“Actually, a room is contagious for a couple of hours after a person with measles leaves it,” Lynch said. “That’s why the cough and the runny nose are so concerning, because that’s how people transmit the virus.”
The Oregon Health Authority has posted more information about measles on its website and has provided replies to frequently answered questions to the 211 information line. County health department immunization clinics are already full with the school exclusion date for students who are not fully vaccinated looming Feb. 20. But the outbreak is likely to generate additional demand.
“You do have an increase in interest when something like this happens,” Brown, the Crook County health director, said.
— Reporter: 541-633-2162, firstname.lastname@example.org
Editor’s note: This article has been corrected. Due to incorrect information provided to The Bulletin, the original version contained the incorrect dates of potential exposure. The Bulletin regrets the error.