By Jacqueline Howard, CNN
A measles outbreak in central Ohio is growing, sickening more than 50 children, with many of them needing hospitalization, according to data updated Wednesday by Columbus Public Health.
None of the children had been fully vaccinated against measles.
Since the start of the outbreak in November, at least 59 measles cases have been identified in Columbus and Franklin, Ross and Richland counties, and there have been 23 hospitalizations, according to Columbus Public Health.
Of those cases, 56 were in unvaccinated children. The other three were only partially vaccinated, meaning they received one dose of their MMR or measles, mumps and rubella vaccine when two are needed for a person to be considered fully vaccinated.
Experts recommend that children get the vaccine in two doses: the first between 12 months and 15 months of age, and a second between 4 and 6 years old. One dose is about 93% effective at preventing measles if you come into contact with the virus. Two doses are about 97% effective.
Nationwide, more than 90% of children in the US have been vaccinated against measles, mumps and rubella by age 2, according to the US Centers for Disease Control and Prevention.
“Measles can be very serious, especially for children under age 5,” Columbus Public Health spokesperson Kelli Newman wrote in an email Monday.
All of the Columbus cases have been in children: 12 in infants younger than 1, 28 in toddlers ages 1 to 2, 14 in children ages 3 to 5, and five in ages 6 to 17.
That corresponds to about 71% of cases being reported in 1- to 5-year-olds.
While the specifics of each hospitalized measles case can vary, “many children are hospitalized for dehydration,” Newman wrote. “Other serious complications also can include pneumonia and neurological conditions such as encephalitis. There’s no way of knowing which children will become so sick they have to be hospitalized. The safest way to protect children from measles is to make sure they are vaccinated with MMR.”
Some of the children visited a grocery store, a church and department stores in a mall while they were contagious, according to Columbus Public Health’s list of exposure sites.
The outbreak has become so widespread and the virus is so infectious that “it could take a few months before we get this outbreak under control,” said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.
Measles is a highly infectious disease that can spread through the air when an infected person coughs or sneezes or if someone comes into direct contact with or shares germs by touching contaminated objects or surfaces. The measles virus is so transmissible that, if an infected person coughs or sneezes, it can remain infectious in the air for up to two hours even after the infected person leaves the room.
“Measles can be a severe illness and can commonly lead to complications which require hospitalization, especially in young children,” Dr. Matthew Washam, medical director of epidemiology and infection control at Nationwide Children’s in Columbus, wrote in an email Tuesday.
In the Ohio outbreak, the hospitalized children have been seen at Nationwide Children’s Hospital.
“Most children can usually recover at home with supportive care and can receive antibiotics for less severe complications, such as ear infections. Some children develop more severe complications, such as dehydration requiring intravenous fluids, pneumonia and/or croup which require respiratory support, or rarely more severe complications such as encephalitis,” Washam wrote.
“The mainstay of treatment for all children with measles is supportive care,” he added. “In the hospital, this can include intravenous fluids, antibiotics for secondary bacterial infections, and respiratory support amongst other supportive care measures. Some children with measles may also be treated with vitamin A given the association of lower vitamin A levels with more severe measles illness.”
‘What’s really driving this is … a lack of vaccination’
The measles outbreak is “very concerning,” said Dr. Nora Colburn, an adult infectious diseases physician at The Ohio State University Wexner Medical Center in Columbus, who has been watching the outbreak closely along with her colleagues.
“What’s really driving this is unfortunately a lack of vaccination, which is just heartbreaking,” said Colburn, who also serves as the medical director of clinical epidemiology for the Richard M. Ross Heart Hospital at the OSU Wexner Medical Center.
“For measles, it is the most infectious disease we have,” she said. “And so it is very concerning as an infectious disease physician, as also a mother of a young child and as a community member.”
During the early days of the Covid-19 pandemic, while most people stayed home and some health-care facilities were closed, many children missed their routine immunizations, including the MMR vaccine — and they still may not have gotten all their recommended shots. That’s true around the world as well as in the US.
“The concern now is that we’ve had this global dip in vaccination coverage as a result of the pandemic, probably not actually from vaccine hesitancy or refusal but just there were a lot of kids that missed their checkups during the pandemic, and we really haven’t completely caught those kids up,” said Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases and professor of pediatric infectious disease at the University of Colorado School of Medicine and Children’s Hospital Colorado.
“Measles is such a contagious disease that when you see those dips, we really worry about the potential for large outbreaks,” he said. “You need to really maintain a high vaccination coverage to keep measles from spreading.”
About 90% of unvaccinated people who are exposed to measles will become infected, according to Columbus Public Health, and about 1 in 5 people in the US who get measles will be hospitalized.
Pediatric hospitals already strained
While the measles outbreak spreads across central Ohio, the United States has been battling a surge of respiratory illnesses, such as flu and RSV, or respiratory syncytial virus, and the ongoing Covid-19 pandemic.
Pediatric hospitals nationwide have been overwhelmed by this rise in respiratory infections and are bracing for the possibility of even more cases over the holiday season.
“I can’t even imagine if your hospital is already chock full and all of a sudden you’ve got to deal with measles, because measles is a really problematic infection-control situation, too. You need negative-pressure rooms, everyone has to wear N95 masks, and it’s incredibly contagious in a hospital,” O’Leary said.
“There’s a lot of risk particularly to immunocompromised patients that are also in children’s hospitals,” he said. “It’s a real problem.”
Nationwide Children’s Hospital confirmed to CNN in an email Tuesday that it has seen a surge in other respiratory illnesses, such as flu and RSV, but remains able to keep caring for patients.
“The current surge in respiratory illnesses such as the flu and RSV is being seen locally. While we are experiencing some visits and admissions related to measles, volumes are relatively low compared to flu and RSV. Measles poses a greater strain on resources related to public health efforts, including contact tracing, containment, education, and immunizations,” the hospital statement said. “While busy, our hospital remains able to continue to provide care for patients.”
With each of these respiratory illnesses, it sometimes can be difficult to determine which infection a person has as the symptoms — such as fever, cough, and runny nose — can be similar.
“To have RSV, influenza, Covid at the same time as the holidays, and then now we have measles on top of it, which can have overlapping symptoms of fever and cough and fatigue, it can be really challenging to kind of sort out which infection is what,” Colburn said, adding that it is important for anyone with symptoms to stay home and get tested.
Measles symptoms may include fever, cough, runny nose, watery eyes and a rash of red spots. In rare cases, it may lead to pneumonia, encephalitis or death.
“Wearing your mask, especially in crowded areas, is really important, especially for our immunocompromised patients. I really worry about measles in adult patients who cannot get the MMR vaccines,” she said. “We can’t give it to severely immunocompromised patients or pregnant women. So it’s really important that everybody else gets vaccinated to cocoon those very vulnerable people and decrease the circulation of measles in our community.”
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