As measles cases continue to climb in the state and now beyond, the Texas Department of State Health Services (DSHS) urges physicians to promote vaccination, connect with health departments to coordinate testing, and bolster their ability to identify its clinical presentation.
DSHS shared this message alongside the Texas Medical Association at a webinar March 17. Members can view the recorded webinar, which is eligible for 1 AMA PRA Category 1 Credit™ and 1 credit in ethics and/or professional responsibility.
State actions
Despite reaching elimination status in 2000 (defined as the absence of endemic transmission for more than year), measles has made a comeback in pockets of the U.S. As of this writing, 309 cases of measles have been confirmed in Texas, according to DSHS, including 211 in Gaines County, where the outbreak emerged.
The state is counting on its physician partners to help contain the current outbreak and fend off a future one, says DSHS Chief State Epidemiologist Varun Shetty, MD.
“Doctors are the trusted messengers in communities, we know that. We really rely on their partnership for public health initiatives like this and to be able to end outbreaks,” he said. “We need them to be sharing that message: MMR (measles, mumps, and rubella) vaccination is highly safe and highly effective at preventing measles, so we can prevent things like this from happening in the future.”
The outbreak is a good opportunity for physicians to brush up on their training, he says.
“Start dusting off your knowledge and making sure you can recognize the signs and symptoms; [make sure] you can recognize a classic measles rash. Because it can be challenging to diagnose – the early stages of measles can look like a lot of other respiratory illnesses and so having that on your differential diagnosis is going to be really important.”
Alongside its overarching vaccination guidance, DSHS is including in its measles communication toolkit a flyer that describes measles symptoms that should prompt a patient to immediately seek emergency care.
Dr. Shetty described it as “something that we have felt is important for people who might become sick with measles and not immediately present for care. Hopefully we are preventing people from being sick at all, but if you do get sick, what are the things to watch out for?”
Frontline resistance
On the ground in Gaines County, Leila Myrick, MD, doesn’t see the spread slowing anytime soon.
“The numbers keep rising. We had a big push for people to come get vaccinated so we can contain this outbreak, but there’s been a lot of pushback from the community of people not feeling safe, not wanting to get vaccinated, and so we’re kind of at a standstill,” said the family physician and obstetrician-gynecologist.
Per the National Foundation for Infectious Diseases, the typical hospitalization rate for people older than 5 in the U.S. who aren’t vaccinated against measles is about 20%. Dr. Myrick’s hospital district in Seminole, however, is seeing closer to a 30% hospitalization rate. After what she calls the “huge health care achievement” of reaching elimination status for measles, she’s disheartened by the disease’s return as families turn down immunizations.
“We’re just not doing our job of educating the public properly,” she said.
Most side effects post-vaccination are mild, like soreness at the injection site and low-grade fever. More serious side effects are rare. For the MMR and MMRV vaccines, the Centers for Disease Control and Prevention cite studies showing only one in 3,000 to 4,000 children under the age of 7 experience febrile seizures in the weeks following vaccination; additionally, the American Academy of Pediatrics confirms there is no link between autism and the MMR vaccine.
Dr. Myrick, who has practiced medicine in Seminole for about five years, has worked to establish relationships and build rapport with her patients “from day one.” If they decline to vaccinate, she takes the time to nonjudgmentally ask their reasons.
“As they unfold what their concerns are, I can give proper education to them about it,” she says.
Some of those patients are easily and quickly persuadable after gentle discussion, she finds. Others might listen and consider.
“They might not vaccinate now, but because I develop a relationship with them over time, later on they [may] change their mind. I always keep the conversation open,” she said. “The crucial part is you have to have a good relationship with your patients. They need to trust you. And if you don’t take that time to get to know them and ask what are your fears, what are your concerns, then you’re missing an opportunity.”
Find the most updated number of cases on the DSHS measles outbreak webpage, and get more resources on TMA’s Infectious Diseases webpage, including practical guidance for navigating the measles outbreak from the TMA/DSHS webinar.