The Teton County Health Department last week conducted a table-top exercise designed to prepare county health-care providers, emergency service responders and law enforcement for a potential measles (rubeola) outbreak.
Health Department Director Melissa Moyer said there have not been any reported incidents of measles in Teton County, where inoculation rates are in the high 90 percents, but Washington state is having a measles outbreak and with the ease of travel, Moyer wants the county to be ready to respond.
The state of Montana has not had any measles cases since 1990.
Twenty people participated in the exercise, including staff with the Health Department, Teton County Disaster and Emergency Services, Benefis Teton Medical Center, Sheriff’s Office, Choteau Public Schools, Montana State University nursing students, the county sanitarian, members of the county Board of Health and the county’s public information officer.
Moyer said the exercise was designed to walk all the players through a scenario in which measles is diagnosed in a school-aged child, so they would know, ahead of time, what their responsibilities and duties would be, what kind of timeline would be implemented and what organizations would be involved.
“Measles is a pretty big deal and it can be scary for people,” Moyer said.
Lora Wier, the retired public health nurse in Choteau, helped with the table-top exercise. Up until two weeks ago, she said, the exercise was going to be on a salmonella outbreak, but then she and Moyer conferred and decided to focus on measles instead.
In the exercise scenario, the school notifies the Health Department of an ill child, who has recently traveled to Washington state. The student has been out of school for two days and the mom is taking her to the emergency room at BTMC.
The exercise involved talking with the BTMC providers about what to do, using the Sheriff’s Office to courier samples to the state lab in Helena, and organizing a system to trace all the students’ contacts.
Wier said once the diagnosis was confirmed by lab tests, the county would convene its epidemic team and detail duties to limit the spread of the disease by identifying the child’s contacts and checking their vaccination status.
The exercise also talked about getting information out to the public, having materials to send home from school with children and advising people of symptoms and risks.
Moyer said that the exercise highlighted several valuable lessons in how to manage an infectious disease as the Health Department and BTMC work together. One of those was getting information out to parents that if they suspect their child has measles, they should call BTMC first so that arrangements can be made to prevent the sick child from infecting people in the waiting room or also in the emergency room.
Wier said, “It was just good that everyone who might be involved in this situation knew what would happen and what their potential role would be.”
While the chances of having a measles outbreak in Teton County are low, Moyer encouraged people to check their immune status and their children’s status to make sure their measles vaccinations are up to date.
“There are vulnerable people in our population, including infants who are too young to be vaccinated, individuals who are immuno-compromised, pregnant women, and the unvaccinated,” she said. “It’s important as a community that we put in our best effort to protect those individuals.”
People are considered immune to measles if any of the following are true:
•You are a pre-school age child with one measles vaccine (MMR — measles, mumps, rubella);
•You are a school-age child (K-12) who has had two measles vaccines (MMR).
•You were born before 1957, or have received at least one dose of the measles vaccine;
•You have had measles (diagnosed by a health-care provider and confirmed with a lab test);
•You have had a blood test that shows you are immune to measles.
Moyer said children are normally given their first dose of MMR at age 1 year and their second dose at age 4. One dose of measles vaccine is about 93 percent effective at preventing measles if exposed to the virus. Two does are about 97 percent effective.
For anyone who is not considered immune, the recommendation is to get vaccinated. Vaccinations are available at the Teton County Health Department.
Moyer also said that if anyone becomes ill and suspects measles, they could call the Teton County Health Department at 466-2562. “We would rather know about a case that turns out to be negative than not know about a positive one,” Moyer said.
Those at risk for contracting measles would be unvaccinated people who have traveled to places where there is an outbreak. As of Feb. 28, 206 cases of measles in 11 states have been reported to the federal Centers for Disease Control and Prevention. Most of the cases in 2019 are part of a large outbreak in Clark County, Washington, where there are high numbers of unvaccinated children, and in New York state. Anyone who has been exposed to someone who has the measles should call their doctor immediately.
The incubation period for measles is seven to 21 days with 14 being the average. Symptoms include a high fever (up to 104 degrees Fahrenheit), runny nose, cough, red, watery eyes, red rash that spreads from head to toe and sometimes tiny, white-gray spots on the inside of the cheek’s in a child’s mouth.
Measles is highly infectious and one person can infect up to 12 to 18 other susceptible people, according to the state Department of Public Health and Human Services. Complications from measles can include pneumonia, encephalitis and/or death.
Those who have measles must be quarantined in their homes for four days after developing the rash.