Measles: Local clinic issues 190 vaccinations so far

The State Epidemiologist is referring to measles -- the dangerous and highly contagious disease surfaced in Spencer, creating an ongoing emergency public health threat Thursday night.

Health officials are especially concerned because the unnamed Clay County child may have exposed the disease to residents at a nursing home, customers at a series of retail hubs, patients at a medical clinic and families at a community-wide Easter egg hunt last weekend.

Almost 190 vaccines were administered at emergency measles immunization clinics Thursday night and Friday. Another free immunization clinic will be held Saturday, from 9 a.m. to to 2 p.m. at the Spencer Medical Arts Building located at 116 East 11th Street. It is intended for residents who have any doubts about whether they previously received a pair of measles vaccinations. People in their mid 50s or older do not need the vaccine as long as they recall contracting the disease as a child.

It will take more than a month before health officials know whether they successfully contained the outbreak. The incubation period for measles after exposure can be up to 21 days according to Quinlisk. The time line becomes more complicated because health officials don't know where the Clay County child got the measles.

"When we have these situations, usually we say we have go out at least two incubation periods, which would be 42 days, with no cases at all, before we would say we are probably out of the situation and there's no more danger," Quinlisk said.

The Spencer case is first report of measles in Iowa since 2004 and only the 12th case of measles reported in the state since 1992. A pair of of MMR (measles, mumps, rubeola) vaccines are especially effective in marginalizing the disease. The doses are much more effective than the vaccines for the flu and should give a person lifetime protection.

"If you get one dose of vaccine, that will be somewhere around 90 to 95 percent effective," Quinlisk said. "But, what that means, unfortunately, is 5 to 10 percent of people are not protected if they get one dose. Now, when you get the second dose the rate goes up to: It's 98 or 99 percent, so then only one out of every 100 persons, who have two doses of vaccine, remain susceptible. The other 99 percent of people are fully protected and will not get measles if they are exposed. This is one of the best vaccines we have, but there is no vaccine that is 100 percent guaranteed to always work."

Public health officials have kept details of the Spencer measles case confidential, including the child's age and gender.

"We can't give either of those out just because of privacy issues," said state public health spokeswoman Polly Carver-Kimm. "Our code requires that ... sometimes we only give a region, not even a county. It's very strict."

They do want local residents to take note of where the child was.

"Make sure they weren't at any of these venues," Quinlisk said. "If they were, go in and get yourself extra protection."

On Friday, April 10:

--Spencer Fareway Grocery Store from 3:30 p.m. to 7 p.m.

On Saturday, April 11:

--Spencer Indoor Soccer Complex (Easter Egg Hunt) from 9:15 a.m. to 12:15 p.m.

--Dayspring Assembly of God Church from 10:30 a.m. to 3 p.m.

--Spencer Burger King from 1:30 p.m. to 5:30 p.m.

--Spencer Wal-Mart from 7:45 p.m. to 10:15 p.m.

Anyone who may have been exposed to the virus on Friday, April 10, or Saturday, April 11, is no longer eligible to receive immune globulin as of Saturday. The antibodies will not be effective. Saturday's clinic could help anyone who was at the following venues:

On Sunday, April 12:

--Hope-The Junction Church in Spencer from 10:30 a.m. to 2 p.m.

--Spencer Burger King from 12:30 p.m. to 3:30 p.m.

--Spencer Hy-Vee Grocery Store from 12:15 p.m. to 2:30 p.m.

--Longhouse-Northshire nursing home in Spencer from 12:30 p.m. to 3:30 p.m.

--Spencer Hospital emergency room from 7:45 p.m. to 11 p.m.

On Wednesday, April 15:

--Avera Health-Spencer Family Care from 10:30 a.m. to 1 p.m.

Quinlisk also didn't want to address the Spencer case directly, saying: "The family was doing everything they should have been doing and it was just an unfortunate circumstance."

Health officials are still investigating how the Clay County child was exposed to the disease.

"To be honest, that's not that unusual for measles," Quinlisk said. "Measles is so highly contagious that you can walk into a room where a measles case was two hours before that -- and the person left -- and you're still exposed to measles. It's not like the flu where: 'Oh yeah, I was around Joe, Joe coughed on me and that's how I got the flu.' Measles is not like that. You could have no face-to-face interaction with the person with measles and still contract measles."

Area residents should look for symptoms including fever, cough, conjunctivitis, runny nose, and rash.

"But the rash usually doesn't develop until the second or third day, so if you, for example, went to this Easter egg hunt. You didn't hear about it (the measles case) in time to go in and get another vaccine -- now you have a high fever or your kid's got a fever and they're getting conjunctivitis and they're getting a runny nose -- even if they don't have a rash yet, that could be measles and I want you to call your doctor and say 'I might have measles.'"

Quinlisk encourages residents to err on the side of caution because there is no harm to have a repeat vaccination. Children under age 1 are not vaccinated, but if the mother was vaccinated she typically passes along the antibodies to her infant for the first six to nine months of age.

"Since we don't know who the original person was, and that person could have exposed people, we need everybody in the community to be aware of the symptoms of measles," she said. "If they start showing the symptoms of measles, do not go and sit in a clinic waiting room or an emergency room waiting room and expose all of those people. What you need to do is call your healthcare provider, say 'I think I may have measles,' and then arrange to be seen in a way that does not expose anybody else. If that means the doctor or nurse comes out to your house -- that's happened in the past when we've had measles cases; I've worked measles cases where we've had them sit out in their car in a parking lot."

People have come in the back door of clinics to avoid contact with others in the waiting room.

Quinlisk cautions, it's not your typical case where you go in for an evaluation: "It's a little bit different. You've got to call ahead of time and arrange it."

Spencer-area residents who take advantage of the free measles vaccine clinic Saturday are asked to use the north door.

"The county health department is doing an amazing job," Quinlisk said. "We really appreciate all of the work they're putting into this and we appreciate all of the people in the community helping out."

A RARE FLASHBACK:

Generations of Iowans recall days of skin rashes, high fevers and quarantines. The state averaged 5,300 measles cases annually in the 1930s and 40s. The total nearly doubled when the disease was at its peak in the 1950s. Vaccination practices improved, and the number of cases went from a spike of 10,753 in 1962 to 362 cases in the final year of the decade.

Epidemics still occur in the vaccine era -- 4,333 Iowans contracted measles in 1977 -- but better education and medical practices have made the disease rare. Vaccines are a mandatory part of the school registration process, unless the family provides a waiver in rare cases for health or religious purposes.

As a result, the state has reported zero measles cases in 13 of the last 16 years. This week's diagnosis in Spencer was a rarity, though other cases have surfaced, earlier this month, in Maryland and western Pennsylvania.

"I will tell you, I worked in another country where a lot of the children were malnourished. Measles went through and there were a lot of children dying by the side of the road," said State Epidemiologist Patricia Quinlisk. "This is a disease that children die of all over the world. In fact, it is one of the major causes of disease in children prior to the era when we started vaccinating children. It's just a horrible disease.

"I had a physician who passed a child in a hallway who had measles -- passed him in a hallway, that's all he did," Quinlisk continued. "He didn't see the child, he passed the child in the hallway. He got measles and pneumonia, spent five days in an ICU and almost died. Again, it's not a disease that we play around with. But one to two out of every 1,000 children who are healthy, well-nourished children in this country with good access to medical care will still die."