MOUNT VERNON – Knox County was the epicenter of Ohio’s last measles outbreak. With the Ohio Department of Health having confirmed the state’s first measles case of the year on Friday, local officials are working to make sure history doesn’t repeat itself.
The ODH announced in a press release late last week that a young adult from Stark County had been diagnosed with measles after returning from a state with confirmed measles cases. The disease had already spread to 28 states – including four of Ohio’s neighbors – before making it into the Buckeye State.
The U.S. is currently battling its most serious measles outbreak in nearly three decades. According to the CDC, 1,123 individual cases had already been reported as of July 11. That marks the country’s highest 12-month total since 1992 – with five months remaining.
This is Ohio’s first measles case since 2017, when only one person was diagnosed. The state’s last outbreak occurred in 2014, when there were 382 confirmed cases.
According to Pam Palm, public information officer for the Knox County Health Department, over half of those cases occurred in Knox County, where the outbreak originated.
“The 2014 outbreak started with one Knox County man who contracted the virus while on a missionary trip to the Philippines,” Palm explained in an email. “After he returned to Ohio, he began showing symptoms on March 23. By April 8, two other people began showing symptoms and by the week of April 20, there were 18 confirmed cases. By the first week of May there were an additional 83 confirmed cases and by the end of the month there were another 80 confirmed cases.”
Those in the local Amish community were affected most by the outbreak, Palm said. The Knox County Health Department distributed the MMR (Measles, Mumps and Rubella) vaccine to approximately 1,000 people that year, which helped contain the disease.
This year, the Health Department has been proactive in an effort to keep measles out of Knox County. The department sent a health advisory in May to local healthcare providers, warning them of the possibility of transmission during out-of-state travel.
“We asked them to encourage immunization among their patients,” Palm said.
The Health Department also created a flyer titled, ‘Don’t let measles make a comeback,’ which was distributed at various locations. The department designed and distributed a special version of the flyer to the local Amish community, Palm said, “since they were affected by the outbreak in 2014.”
The Knox County Health Department currently has “plenty of doses” of the MMR vaccine in stock, Palm said. Two doses are recommended for protection from the disease.
The measles virus is both dangerous and highly contagious. According to the Ohio Department of Health, if one person has measles, up to 90 percent of those who come into contact with that person and who are not immune will also become infected. The measles virus can live for up to two hours in air where an infected person coughed or sneezed.
Symptoms include a rash, high fever, runny nose, cough, loss of appetite and red, watery eyes. Diarrhea and ear infections are also common complications of measles. The rash “doesn’t appear for a few days,” Palm explained. Once it does, it typically lasts 5-6 days, beginning at the hairline and proceeding down the body.
Those infected can transmit the disease four days before they develop the rash until four days after the rash appears. If someone is not immune to measles, the illness can begin anywhere from seven days to 21 days after exposure, Palm said.
According to the CDC, about 1 in 4 people in the U.S. who get measles will be hospitalized. Those most at-risk for severe measles complications are children younger than 5 years old, adults older than 20 years old, pregnant women and people with compromised immune systems.
According to the ODH, as many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with an intellectual disability. One to three of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.
Measles may cause pregnant women who have not had the MMR vaccine to give birth prematurely, or have a low-birth-weight baby.
“The only way to avoid contracting measles is to be immunized with the MMR vaccine or to avoid contact with anyone who has measles,” Palm said.
Medical officials speculated this spring that, if the disease were to reach Ohio, it could spread quickly due to the state’s low vaccination rates.
According to state vaccination statistics obtained in May by Knox Pages, 5.3 percent of Ohio kindergartners in the 2017-18 school year enrolled without complete vaccinations, and without a vaccination exemption – meaning a religious, medical or philosophical excuse as to why a vaccination could not be issued. Of the 27 states that reported such data, Ohio’s percentage was the second-highest in the United States, the AP found. Only Arkansas had a higher percentage of incomplete vaccinations.
Data also shows that Knox County has had a particularly high rate of incomplete student vaccinations. In the 2018-19 school year, 53 percent of Knox County 12th-graders submitted an incomplete vaccination record, or no record at all. According to Palm, this was the second-highest percentage in the state, behind Holmes County (which connects Knox to Stark County).
While Palm said the Health Department is still looking into the reason behind Knox County’s lagging vaccination rates, she’s heard through school nurses that families tend to prioritize vaccinations less as children grow older (this trend is mirrored statewide, according to Ohio Department of Health Data).
School nurses have also suggested that some area families might be opposed to the concept of vaccination, potentially due to religious or philosophical beliefs.
As of Monday, the Stark County measles case was still the only one confirmed statewide. Only time will tell how Ohio reacts to this year’s threat, Palm said.
“The next few weeks will indicate the extent of the transmission of the virus in Ohio,” Palm said. “We can’t stress enough the importance of being immunized. It’s the only way to avoid the measles.”
