Markian Hawryluk
The Bulletin

MEASLES: What to do

Oregon public health officials are advising people who believe they have symptoms of measles to first call their health care providers to arrange to be seen without exposing others in the waiting room.

The symptoms of measles start with a fever, cough, runny nose and red eyes, followed by a red rash that usually begins on the face and spreads to the rest of the body.

Measles is extremely contagious — the virus is transmitted through the air when someone coughs or sneezes and can stay up to two hours in the air of a room after an infected person leaves. If people breathe the contaminated air or touch a contaminated surface, then touch their eyes, noses or mouths, they can become infected. Measles is so contagious if one person has it, 90 percent of the people close to that person who are not immune will also become infected.

Whom to call: People seeking more information about measles can call 211 to receive answers to frequently asked questions. Anyone who is not fully vaccinated and frequented the Mountain Air trampoline park Jan. 19, or the Juniper Swim & Fitness Center on Jan. 20, is urged to call Deschutes County Health Services at 541-322-7418.

The Oregon Health Authority has confirmed that a visitor from Clark County, Washington, was infectious with the measles virus when visiting Bend on Jan. 19 and 20.

Public health officials had announced Monday a possible exposure but were waiting on tests to confirm the person actually had measles. The virus can be transmitted about four days before symptoms appear. Testing has now confirmed that person was in the region during the early contagious period of that person’s illness.

People visiting the Mountain Air trampoline park from 9:30 a.m. to 2:30 p.m. Jan. 19, or the Juniper Swim & Fitness Center from 9:30 a.m. to 4 p.m. Jan. 20, could have been exposed to the virus. It is unlikely that people who are fully vaccinated or who have natural immunity from being exposed to the measles are at risk of contracting the virus.

Both facilities are now considered safe.

Mountain Air provided Deschutes County Health Services with contact information for about 350 customers who visited the trampoline part that Saturday and provided that information on their liability waivers. Juniper officials provided a list of about 400 passholders who were at the fitness facility that Sunday. But another 300 people entered the fitness center on a day pass, and Juniper does not have names or contact information for them.

The health department is contacting those customers to determine their immunization status, starting with the children. Jill Johnson, Immunization Program Coordinator for Deschutes County Health Services, said staff has only identified a handful of unvaccinated children who were at those facilities at the time in question.

Because symptoms usually arise 10 to 14 days after exposure, health officials said this is the week when cases could arise.

“We’re at day 11,” Johnson said. “So we’re kind of looking at Feb. 10. That will be the 21st day. Then we’ll kind of be in the clear if we don’t see any cases.”

Concerns are greater for those who are not vaccinated, including infants who are too young to be vaccinated. The Clark County health department has identified 38 confirmed cases and 13 suspected cases so far. All but one have occurred in children, and 34 of the people infected were unvaccinated. The immunization status of the remaining four has not been established.

Central Oregon Pediatric Associates in Bend has fielded a flood of calls from concerned parents, including Kayla Collins whose 8-month-old son, William, is too young to be vaccinated.

“I do have to take him to get his flu booster,” she said. “That’s what made me the most nervous, if he’d be OK.”

The clinic said to bring her son in but to keep him on her lap just in case. She has decided to limit his exposure, leaving him with his father when she takes her fully vaccinated 2-year-old daughter, Gracelynn, with her to the grocery store.

“I pretty much just have to keep him inside and make sure everybody around him is vaccinated,” Collins said. “I have a cousin in Texas that’s an anti-vaxxer. It just makes me nervous.”

The pediatric clinic heard from many parents who had frequented the trampoline park or the swim center with their older, vaccinated children, but like Collins, had younger children at home. Measles is spread when an infected person coughs or sneezes, and those fluids come in contact with some who does not have an immunity to the disease. It’s unlikely that a healthy person with immunity to measles could be a carrier for the virus.

Vaccination age guidelines

Current guidelines call for vaccinating for measles at age 1 and then again at 2 to 4. Most children will have strong immunity with just one dose. The second is intended to catch the small percentage of children who didn’t have a good response to the first dose.

“I think that’s reassuring for people, if they’ve only had one dose,” Dr. Logan Clausen, a COPA pediatrician, said. “The chance of that one dose working is really high.”

The clinic typically gives the second dose when the child turns 2.

“We give it on the early end because it’s a pretty aggressive disease and we’ve seen outbreaks in California,” Clausen said.

Many parents are contacting the clinic to see if they can get the second dose even earlier. Children can receive the second dose earlier than two years as long as there is a 28-day period between the first and second doses.

Since the start of the outbreak in Clark County, which is just over the state borderline from Portland, COPA has been screening callers to the nurse line for measles symptoms and vaccination status. They have yet to identify any suspected cases among their patients.

“I think the really hard part about the timing of this measles outbreak is we’re still in the middle of winter sick season,” Clausen said. “A lot of the symptoms are going to look like the other common viruses going around.”

Measles typically starts with a fever and fatigue, progressing to a cough, congestion, red eyes and runny nose. The red eyes is a better early sign. The telltale measles rash usually starts two to four days after the fever.

“That’s why people often spread it for a while before they realize they have the measles,” she said.

The news of the possible exposure worried Katrina Boswell, a Bend mother of three. She wasn’t sure whether her 2-year-old had already gotten a second dose.

“Those places, the trampoline park and Juniper fitness center, those are places that all of us frequent, and our friends frequent,” she said. “We hadn’t been there those exact days but we had been around so many kids that could have been.”

Her daughter had been sick for a couple of days, and panic sunk in. She called the clinic Tuesday morning but couldn’t get through. She posted a question on the clinic’s Facebook page and received a call back later that day confirming her daughter was fully vaccinated.

The clinic is urging parents to call before showing up in the waiting room with a sick child, where they could potentially expose others to the virus. The staff have a protocol in place to bring suspected measles patients wearing masks through a side door into a designated room. If the doctors suspect measles, the room will be shut down for hours afterward to prevent transmission.

The Bend Park & Recreation District has also taken a number of calls from Juniper members who wanted more information about the potential exposure. District spokeswoman Julie Brown said she’d spoken to about a dozen concerned patrons.

The district didn’t learn of the potential exposure until a week later.

“By that time there wasn’t much of anything we could have done, just our typical cleaning and sanitizing of the equipment,” Brown said. “We have regular air circulation and water circulation, so we just continued all of that.”

Mountain Air owner Patrick Booher said customers coming back to the trampoline park this week have expressed no ongoing concerns.

“I feel the same with my children,” he said. “We’re confident — very, very confident — that our facility is safe and has been since 2:30 on Jan. 19.”

— Reporter: 541-633-2162, mhawryluk@bendbulletin.com

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