Tom Charlier

The (Memphis) Commercial Appeal

MEMPHIS — Shelby County health officials have confirmed a measles outbreak of six cases here as of Wednesday, dwarfing the four reported across the USA in the first three months of this year.

The county's cases involve a diverse group of patients in terms of age, gender and place of residence, said Dr. Helen Morrow, the Shelby County Health Department's health officer. She would not release more details, citing privacy laws, but did say that all the patients are expected to recover.

The outbreak, the largest since a multi-state outbreak last year was linked an unknown patient who visited Disneyland, could grow. Tests for additional cases here are pending and include a child who came to the Collierville United Methodist Church nursery on April 17, the suburban Memphis church said on its Facebook page.

"We do need to be concerned. We can't ignore it," said Dr. Manoj Jain, a Memphis-based infectious-disease specialist. "It's going to be imperative that parents get their children vaccinated if they are called by the health department."

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County health officials have identified more than a dozen sites — everywhere from a thrift store to a pharmacy — that people later found to be infected had visited.

In the past decade, the entire state of Tennessee has had only nine measles cases, health officials said.

Though the source of the outbreak has not been pinpointed, Jain said it likely was an unvaccinated traveler who brought the disease home from abroad. All of the patients diagnosed so far in the Memphis area had not had a measles-mumps-rubella vaccine, generally administered to children around their first birthdays and again before they go to school.

Measles, once a rite of childhood with more than 90% of Americans infected by age 15, was eliminated in the United States in 2000, according the federal Centers for Disease Control and Prevention. But agency officials note that the disease is still common in some countries in Africa, Asia, Europe and the Pacific.

"The reason we see outbreaks is a larger number of children are being unvaccinated," Jain said. "That population is highly vulnerable because measles is so contagious."

The first vaccines to prevent measles became available in 1963. The disease was targeted for elimination not only because of the annoying fever, aches and rash that accompany it but also because of its complications:

Pneumonia. About 1 in 20 children develop pneumonia, the most common cause of death in young children with measles, according to the CDC.

About 1 in 20 children develop pneumonia, the most common cause of death in young children with measles, according to the CDC. Encephalitis. About 1 in 1,000 develop encephalitis, a swelling of the brain that can lead to convulsions and permanent damage.

About 1 in 1,000 develop encephalitis, a swelling of the brain that can lead to convulsions and permanent damage. Death. About 1 or 2 of every 1,000 children who contract measles die from it. From 1956 to 1960 an average of 450 measles-related deaths were reported yearly.

Statewide, almost 96% of school-age children in Tennessee have had at least one dose of the vaccine to prevent measles, according to the CDC's National Immunization Survey for 2014, the most recent data available. That compares with 91.5% nationwide, and only Nebraska and Maine had higher statewide immunization rates than Tennessee, where the state health department extends the requirements to child care, preschool and school.

The state allows a parent to request an exemption from all of the required vaccines based on the family's religious practices, and doctors or public health nurses are allowed to exempt a child from specific vaccines if they are determined to have a risk of harming the child.

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Multiple studies have ruled out vaccines as a cause of autism. The gastroenterologist who made the first claim in 1998, Andrew Wakefield, subsequently lost his medical license and the British medical journal Lancet, which published his research, retracted its article.

"All the signs are very clear that it's a safe vaccine," Jain said. "It will protect the child much more than the chance of harming the child."

Unvaccinated people who come in contact with a contagious measles patient have a 90% of getting the disease, he said. People with one dose of the vaccine have a 7% of contracting measles; those who received two doses have a 3% chance.

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"Measles is like a tracking device for unvaccinated individuals. It's that contagious," he said.

The virus, carried in the nose and throat of an infected person, is spread through coughing, sneezing, even breathing. It remains alive for up to two hours in the air or on surfaces, the CDC said.

People who contract measles are contagious for four days before the red rash characteristic of the disease emerges and for four days after it goes away. The rash itself generally lasts a week.

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Those who have been exposed won't see a rash for seven to 21 days.

But if they know they've been in contact with someone infected, they have a 72-hour window in which they can be vaccinated and likely spared from the disease. For those exposed more than 72 hours beforehand, injections or intravenous doses of immune globulin can prevent or lessen the severity of measles but don't provide long-term protection.

"If you child has a fever runny nose, has symptoms that could potentially be measles and was exposed, call ahead at the hospital or doctor's office. Why? Because you want the health provider to be prepared," Jain said. People who suspect they have measles shouldn't be sitting in a waiting room with others. "You could potentially infect a lot of other individuals whose immune systems are compromised."

Follow Tom Charlier on Twitter: @thomasrcharlier