Update of Measles in Texas- 2019Jennifer A. Shuford, MD, MPH

Infectious Disease Medical Officer, DSHS

Measles in Texas

• Measles Basics

• Measles Epidemiology in Texas- through 2018

• Measles Epidemiology in Texas- 2019

• DSHS Response

Image courtesy of CDC

Measles in Texas

Measles Basics

• Prior to widespread vaccination, measles caused an estimated 2 million deaths per year globally1

• Responsible for ~90,000 deaths worldwide in 20162

• Measles was declared eliminated from the US in 20003

• Measles remains common in many parts of the world, including regions within Asia, Africa, and Europe

Available at: 1. https://apps.who.int/iris/bitstream/handle/10665/44855/9789241503396_eng.pdf;jsessionid=AB9998C91A86973EE2DF6A

97FFD85C57?sequence=1; 2. https://www.who.int/immunization/diseases/measles/en/; 3. https://www.cdc.gov/measles/about/history.html. Accessed 3/26/2019.

Measles Basics- Signs and Symptoms

Image courtesy of CDC, available at: https://www.cdc.gov/measles/parent-

infographic.html.

Measles Basics-Transmission

• Measles is highly contagious

• Up to 90% of close contacts who are not immune will become infected

• Spreads through respiratory secretions

• Can remain suspended in the airspace for up to 2 hours

• Incubation period ranges from 7 to 21 days

• Usually 10 to 12 days

• Infected individuals can spread measles from 4 days before until 4 days after the rash appears

Image courtesy of CDC

Measles Basics-Complications

Image courtesy of CDC, available at:

https://www.cdc.gov/measles/parent-infographic.html.

Measles Basics-Vaccine

• Measles has an effective vaccine available

• MMR- mumps, measles, rubella

• MMRV- mumps, measles, rubella, varicella

• CDC recommends children get two doses of MMR

• First dose at 12-15 months

• Second dose at 4-6 years

• Effectiveness for measles

• 93% after one dose

• 97% after two doses

Image courtesy of CDC, available at: https://www.cdc.gov/measles/travel-infographic.html

Measles in Texas-2006-2018

Measles in Texas- 2019*

• As of 4/8/19, Texas has:

• 15 confirmed cases of measles

• 9 counties

• DSHS lab has tested close to 300 specimens for measles

• Continues to receive 5-10 specimens/day

*As of 4/8/2019

Texas Measles Cases-2019*

• Total 15 confirmed cases

• 5 cases are epi-linked to one other case

• That is, 5 “pairs” of cases

• One pair involves a child, all others adults

• 12 cases are PCR-positive

• 11 have been genotyped

• 9 cases are B3

• 2 cases are D8

• Both B3 and D8 are wild-type strains and are covered by the vaccine

*As of 4/8/2019Image courtesy of CDC

Measles Genotypes- Worldwide

Notes: Data Source: MeaNS database (Genotypes) and IVB Database (Incidence) as of 2019-01-09 and covering the period 2017-12-01 to 2018-11-30 - Pie charts proportional to the number of sequenced viruses

Map available at: https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/. Accessed 4/9/2019.

Texas Measles Cases by Age and Vaccine Status- 2019*

* As of 4/8/2019

Age (yrs)

Total # of cases

Cases with prior vaccination

Cases with vaccinationduring incubation period

Cases who report priorvaccination, no records

Caseswho report unsure/no prior vaccine

<1 0 - - - -

1-4 5 2 2 - 1

5-17 1 1 - - -

18-54 9 1 1 4 3

55+ 0 - - - -

DSHS Measles Response

• DSHS

• Sent out health alert on 2/8/2019

• Has responded to numerous media requests

• Is maintaining an up-to-date case count by county on the DSHS website: https://www.dshs.texas.gov/news/updates.shtm

• Stands ready to assist LHDs with testing, investigations, vaccines, or other needs pertaining to measles response

Measles in Texas-Summary

• Measles can cause serious, even fatal, disease• An effective vaccine is available

• 2019 Texas measles case counts have already exceeded 2018 counts

• Public health workers and healthcare providers need to be aware of the increased incidence of measles in Texas

• DSHS stands ready to assist measles response activities in Texas

Questions?

Thank you

Jennifer A. Shuford, MD, MPH

jennifer.shuford@dshs.texas.gov