The first case of measles in more than 20 years has been reported in Union County and the health department is preparing for more potential cases.
Mary Salimbene Merriman, an epidemiologist at the Union County Health Department, said the Union County case is part of a measles outbreak in central Ohio – the fourth largest outbreak in the U.S. in the past two decades.
Measles commonly causes diarrhea and ear infections, but can also lead to pneumonia or a swelling of the brain that can leave children deaf or with intellectual disabilities.
Merriman noted that 81 confirmed cases have been linked to the outbreak and 29 of those individuals have been hospitalized.
The majority of the cases are in children between the ages of 1 and 5 years old. Merriman described the Union County case as “pediatric” as well.
Among the current central Ohio outbreak, the first case was confirmed on Oct. 22 and the most recent was identified on Dec. 16.
Health Commissioner Jason Orcena said the health department is currently in a waiting period to see if any contacts of the confirmed local case result in more measles diagnoses.
Merriman explained that the general incubation period of the virus is 14 days, but can range between seven and 21 days. That means those in contact with an individual with measles can show symptoms and become a confirmed case up to three weeks later.
Measles is considered by the Ohio Department of Health as a “Class A” disease of “major public health concern,” largely because it is highly contagious, Merriman said.
She noted that the disease is spread through droplets in the air or direct contact with an infected person’s nasal or throat secretions.
The virus particles that cause measles are incredibly small, so they remain in the air for up to two hours, Merriman explained.
Merriman said measles is also categorized as a disease with the highest level of concern, “Class A,” because it was eradicated in 2000. Diseases are considered eradicated when there are 12 consecutive months with no sustained transmission of the virus.
She noted that the measles, mumps and rubella vaccine (MMR) is 93% effective after one dose and 97% effective after two doses. The first dose is recommended for children 12- to 15-months-old and the second dose is recommended for those between 4 and 6 years of age.
Within the current outbreak, 76 of the 81 confirmed cases were among individuals who were not vaccinated. Merriman said it is important to note that 22 affected children were under one year of age, meaning they were not yet eligible to get the vaccine.
Merriman said individuals who have the measles will experience two phases of the infection.
First, infected people may feel generally unwell and could experience a fever, cough, runny nose or red and watery eyes.
Merriman said it can be challenging for individuals to suspect they have measles at this point because the symptoms are similar to those they may feel due to other common illnesses.
However, two to three days after the first symptoms begin, those with measles may notice tiny white spots, known as “koplik spots,” appearing in their mouth.
Three to five days after the first symptoms, those with measles will break out in a rash. Merriman said it generally begins with red spots at the hairline that will migrate down the rest of the body.
Since measles is an infectious disease, the Union County Health Department conducts case investigations – similar to what became common during the height of the COVID-19 pandemic – to try to prevent further spread.
Merriman said healthcare providers, laboratorians and “any individual with knowledge” of the disease (which often refers to school nurses or daycare providers) are required to notify the health department of measles cases.
From there, local health departments report cases to the Ohio Department of Health (ODH).
Once UCHD is notified, public health employees contact either the infected individual or their guardian. Merriman said they identify contacts and try to establish a timeline to determine who may have been exposed to the virus.
Additionally, Merriman said they try to provide information to the person who is ill.
For instance, she said they are alerted not to go into the emergency room or urgent care if they become more ill. Instead, they should call in advance to ensure they can be escorted into the building safely without exposing more people to the virus.
Individuals who are confirmed cases of measles are required to isolate for four days after the rash appears. They are also required to quarantine for 21 days, with some exceptions, including if they can provide proof of vaccination.
The fact that measles is a “Class A” infectious disease, combined with the current outbreak, prompted the Board of Health Wednesday to adopt an on-call policy.
ODH requires all “Class A” diseases to be reported immediately via telephone.
Merriman said that means “it doesn’t matter if it’s 3 a.m. on Christmas Day,” UCHD officials must immediately accept the call and begin the process of the case investigation.
Orcena said he wishes he could tell the board that the on-call policy is just a precautionary measure, but he would not be surprised if UCHD officials receive reports of more confirmed cases over the holiday season between Christmas and New Year’s.
Merriman said UCHD is closely monitoring the central Ohio outbreak.
Public health officials have been in contact with local healthcare providers, daycares and schools to prepare them for the potential of more cases. She said UCHD has also participated in state and regional calls detailing the outbreak.