Vaccinations called best protection against measles; 2 patients sent home

Views from Yale New Haven Hospital Views from Yale New Haven Hospital Photo: Hearst / Hearst Connecticut Media File Photo Photo: Hearst / Hearst Connecticut Media File Photo Image 1 of / 9 Caption Close Vaccinations called best protection against measles; 2 patients sent home 1 / 9 Back to Gallery

NEW HAVEN — Two patients with measles were released from Yale New Haven Hospital Monday, the state Department of Public Health reported, as public health and medical experts emphasized that vaccination is considered the best defense against the disease, which can develop into serious illnesses, including pneumonia and encephalitis, if left untreated.

In a release, the state health department said its staff “is collaborating with local partners to identify contacts and implement appropriate control measures. Investigators have not identified any common links between the first and second cases, although both were probably exposed to measles in early January.”

“Measles is very easily spread from person to person,” Dr. Raul Pino, the state’s public health commissioner, said in the release. “If you have a fever and a rash and you think you might have measles, you should avoid public settings and telephone your healthcare provider before going directly to a healthcare facility so steps can be taken to avoid possibly exposing others.”

The two measles patients were admitted to Yale New Haven Hospital in the past two weeks; three cases is considered an official outbreak by the Centers for Disease Control and Prevention. But public health and medical experts say the vast majority of the public has no major cause for concern because of routine vaccinations of children entering school.

“In general, most people are vaccinated against measles and in general we are protected by that,” said Dr. Goran Miljkovic, and infectious disease physician at Bridgeport Hospital, on Monday. “Most of the case are the case of people who have not immunized for some reason or they’re not vaccinated.”

Miljkovic said people traveling abroad may be exposed and come down with measles if they haven’t been vaccinated.

“It is a highly contagious disease and we have to be on the alert to prevent any new cases to keep the public informed about this,” he said. “For the most part, because of childhood vaccinations, we are exempted from measles.”

Miljkovic said a patient with measles is put in “airborne isolation” in a negative air-pressure room, meaning no air can escape from the room. Anyone entering the room must wear a mask.

Dr. Paul Nee, an infectious disease specialist at Danbury Hospital, said isolation measures are needed because of how highly contagious measles is. “Measles is transmitted through droplets and [is] airborne. The droplets can remain up in the air for up to two hours. ... People can be in one area and people can come through that area and pick it up there, so you don’t have to be in direct contact with the person.”

He said that once the patient leaves the hospital, they should be kept isolated at home as well so as not to expose visitors who might not be vaccinated.

There were three cases of measles reported in Connecticut in 2018 by the state Department of Public Health. Two of them were infants from the same New Haven County household who had caught the disease while abroad. The third was a Hartford County adult.

Washington state Gov. Jay Inslee has declared a state of emergency, where 48 cases have been confirmed, all but one in Clark County, according to CNN. Forty-one of the patients had not been vaccinated against the disease, CNN reported.

According to Connecticut state law, children must be vaccinated for measles and other childhood diseases before they enter kindergarten and seventh grade. Exemptions may be given for medical and religious reasons. According to the state health department, in 2017-18 there were 83,508 students entering school and 1,513 received exemptions, or a 1.8 percent rate. That was a 14.9 percent increase from the 1,317 exemptions in 2016-17.

According to Dean Sten Vermund of the Yale School of Public Health, “It’s possible that an undervaccinated pool of kids might be the source of infection to the adults. There is such a things as a partially vaccinated child” who has not received a booster shot yet.

There are also people with religious or political views or from groups such as undocumented workers who don’t get immunized against the disease, he said. It includes “this anti-vaccination movement that we’re confronting that has celebrity adherence, that tries to convince parents that vaccination their children is not a good idea.”

Others who may refuse vaccinations are “people who are natural food aficionados and they may say something like, ‘I don’t want to put an artificial protein in my children.’” Others, such as some libertarians, don’t trust the government.

He added, “We still have a group of parents that are delaying vaccinations under the false assumption that ... too much immunization will overwhelm the immune system, which is just poppycock. It’s just the opposite. The immune system is strengthened.”

Vermund said that as a result of widespread immunizations, measles is a rare disease and “that lulls people into a false sense of security. They’ve never seen the disease” so they don’t believe they can catch it, he said.

When only a small percentage of people are unvaccinated, they are protected by “herd immunity,” which “protects unvaccinated people by vaccinating a high-enough proportion of the population so the virus doesn’t spread among the community,” Vermund said.

State Rep. Jonathan Steinberg, D-Westport, co-chairman of the General Assembly’s Public Health Committee, said Monday that leaders of the panel have not decided whether there will be vaccine-related legislation this session.

“The state has a high rate of vaccinations,” Steinberg said, noting that eliminating exemptions for religious and medical reasons could spark a daylong public hearing. “We know if we do anything related to vaccines, we’ll have a lot of people. When you start seeing isolated but growing cases of these diseases, it goes to show you can never really relax.”

House Majority Leader Matt Ritter, D-Hartford, former co-chairman of the Public Health Committee, had asked for a study of the 2015 law granting the exemptions.

“We noticed that there was a spike in the numbers to almost 1,200 who opted out,” he said Monday. “We noticed that in the form, you only had to fill it out once. Like in kindergarten you could say, ‘I’m not doing it for medical reasons’ and that was it. We felt like there had to be more times by which you swore by affidavit that you needed to have a medical exemption, so that it was not just a one-time blanket thing.”

Ritter said there should be a debate about what exemptions should be allowed and how they are granted. “Connecticut is still in a pretty good range, don’t get me wrong. We’re still at 98.5 percent, but it’s scary, and we had a debate in 2015 about whether we should get rid of all exemptions but medical. But we haven’t done that yet. I think that conversation has to happen.

“Vaccinations are critical,” Ritter said. “They are important, and the idea that anybody is saying simply, ‘I don’t want to do it’ endangers everyone else’s children. And that’s not fair. We still lag behind other states, but we have a much higher vaccination rate than California and Oregon. ... I still feel very passionate about that issue.”

According to the state health department, the vaccine “can prevent measles if given within 72 hours of exposure to an infected person, but in practice measles exposures are rarely identified and vaccinated in that timeframe, and measles vaccine administered after exposure is less effective than vaccine given prior to exposure.”

Left untreated, measles can develop into more serious illnesses, including gastrointestinal inflammation, conjunctivitis (pink eye), pneumonia and viral encephalitis,or swelling of the brain. In rare cases it can be fatal.

Measles starts out as lethargy and fever and symptoms include a rash that begins on the face and spreads downward through the body.

Once an outbreak occurs, Vermund said, a combination of targeted and mass vaccination is employed. “What is often done is revaccinating, mass vaccination,” he said. “They may go and offer a booster to the vaccinated children, hoping to get the unvaccinated children.”

Public health workers also may check to see if those who contracted measles worked for the same employer or had similar ethnic, religious or political affiliations, Vermund said. They may go to churches or social organizations said say, “We understand that you’ve had some concerns. ... We would very much like to vaccinate the members of your church, of your community,” he said.

The “majority of people exposed to measles are not at-risk of developing the disease since most people have either been vaccinated or have had measles in the past, before vaccination became routine,” according to information from the state health department.

Further, DPH said, “The majority of people (adults and children) who get measles are unvaccinated. Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa. Travelers with measles continue to bring the disease into the U.S. Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.”

edward.stannard@hearstmediact.com; 203-680-9382. Politics Editor Ken Dixon contributed to this story.