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Local and state health officials are urging the public to ensure they are up to date on the measles vaccine after three unrelated cases of the highly contagious disease have been confirmed this year in southeast Michigan, prompting fears of an outbreak.
Just one measles case triggers an “aggressive, timely, and prioritized public health response,” according to the Michigan Department of Health and Human Services. The state experienced an outbreak in 2019 with 46 confirmed cases followed by zero cases until this year, according to the state health department.
None of the three measles cases reported in Michigan this year are connected, according to a news release from the state health department.
“Typically we would consider an outbreak to be several related cases where there was transmission or spread from one person to another,” said Laraine Washer, medical director of infection prevention and epidemiology at University of Michigan Health. “If … measles is introduced into a population of under or unvaccinated individuals, then that’s where you’ll see transmission.”
While three cases may not seem like a lot, they can exponentially spread to more, a UM public health professor said.
“We saw in 2019 that in Michigan, this turned into several dozen cases of measles,” said Abram Wagner, an assistant professor of epidemiology at the UM School of Public Health. “There have been states where this has turned into hundreds of cases of measles.”
Being unvaccinated is the largest predictor of whether someone will contract measles during an outbreak, Wagner said, and there are pockets of the state with higher numbers of unvaccinated individuals. Last summer vaccination rates among Michigan’s toddlers reached the lowest levels reported since 2010, and several experts predicted this trend could fuel a resurgence in preventable diseases such as measles.
Roughly 68% of children between the ages of 19 and 36 months had received one dose of the MMR vaccine as of last month, down from 75% in January 2019, according to statewide data from the Michigan Care Improvement Registry. Nearly 73% of teens statewide had received both recommended MMR doses as of January, according to the same data, down from 77% in 2019.
“Right now, we are coming off of the COVID-19 pandemic, so there are still a lot of families which just haven’t gotten all the vaccines that they were supposed to get for their kids during the pandemic,” Wagner said.
The symptoms of measles — which include a high fever, cough, runny nose, red or watery eyes, white spots in the mouth, and a red, raised, blotchy rash — typically begin within seven to 14 days but can appear as many as 21 days after exposure. Roughly one in every five people with measles will require hospitalization, and rarer, potentially fatal complications include pneumonia and encephalitis, according to the Centers for Disease Control and Prevention.
Measles is a vaccine-preventable disease, and most people in the United States as children receive two doses of the measles, mumps, and rubella (MMR) shot, which protects against all three diseases, according to the CDC. Vaccination within 72 hours of exposure to measles can also prevent illness, according to the state health department.
The Detroit Health Department officials are encouraging people who may have been exposed to measles to call ahead before visiting a doctor, urgent care or emergency room to avoid putting others at risk and are working with county and state officials to track cases.
“We want everyone to stay safe and encourage all Detroiters to get vaccinated, especially children,” said Claudia Richardson, medical director for the Detroit Health Department. “If you have questions, please talk to your health care provider or call the Health Department.”
Michigan cases 2024
Michigan’s latest measles cases are linked to international travel.
The first Michigan case of 2024 was confirmed in an Oakland County child last month and has been associated with international travel. Another case was reported Friday at the Trinity Health Ann Arbor Emergency Department in Ypsilanti involved an adult, also with a recent history of international travel. A Wayne County case also involved an adult who recently traveled internationally, and the health department was notified of the confirmed case on Saturday.
Measles was declared eliminated from the United States in 2000, meaning the disease was no longer constantly present, according to the CDC. However, travelers have continued to bring the disease into the country, causing outbreaks among unvaccinated people.
“Somebody goes abroad, contracts measles and then there can be a bit of an incubation period,” UM’s Wagner said. “If they are in a community where less than 95% of people are vaccinated, then it’s very easy for them to start spreading the disease around them.”
At least 95% of a given population must have two doses of measles vaccine to create herd immunity, according to the World Health Organization.
Public health officials do not believe the Oakland County case led to any exposures outside of the child’s household, according to the state health department. The Washtenaw County Health Department said anyone in the Trinity Health Ann Arbor Emergency Department’s triage and waiting areas between 10:30 a.m. and 1:30 p.m. on Friday may have been exposed.
Contact tracing for the Wayne County case is ongoing and individuals who may have been exposed are being contacted, said Abdul El-Sayed, director of Wayne County’s Department of Health, Human and Veterans Services.
Wayne County’s health department has identified four potential community exposure locations:
- Feb. 27, 2-5:30 p.m., Beaumont Urgent Care at 23100 Michigan Ave. in Dearborn.
- Feb. 27, 4-6:30 p.m., CVS Pharmacy, 2701 S. Telegraph Road, Dearborn.
- Feb. 29, 11:30 a.m.-4 p.m., Henry Ford GoHealth Urgent Care, 26763 Ford Road, Dearborn Heights.
- Feb. 29, 3-8 p.m., Corewell Emergency Department, 18101 Oakland Blvd., Dearborn.
“If an individual knew that they were exposed to measles, the first question is whether they have immunity either through vaccination or prior disease,” UM Health’s Washer said. “If they have, there would be low concern about contracting measles.”
People who are exposed and don’t have any prior measles immunity may be required to isolate, Washer said. If people can’t locate their vaccination records, they can take an antibody blood test to determine if they have any form of immunity, she added.
The virus can remain in the air where an infected person was present for up to two hours, so exposure can sometimes be hidden, according to the state health department. Infected individuals can also transmit the virus for up to four days before they start showing symptoms.
The most vulnerable populations are those without immunity, said Anita Shallal, associate medical director of infection prevention and control and antimicrobial stewardship at Henry Ford Hospital in Detroit. These can include people who chose not to get the vaccine or populations that cannot, including people with certain types of cancers, organ transplants and infants under the age of 1, Shallal wrote in an email.
“The general public should not be concerned, but those who are unvaccinated and able to receive the MMR vaccine should consider immunization,” Shallal wrote.
People born before 1957 likely had measles and are considered immune, according to the CDC. But immunity may wane in people who are considered immunocompromised, such as those with organ or bone marrow transplants, UM Health’s Washer said. If these people are exposed to measles they can be treated with antibody injections, Washer said.
The first dose of the MMR vaccine is recommended for children when they reach 12 months of age and the second dose when they turn 4 years old. Children younger than the age of 5 and pregnant people are also at high risk for measles-related complications, according to the CDC.
Declining vaccination rates
A decline in vaccination rates has driven concern about the potential spread of measles.
In the early 2000s, very few families whose students attended school requested vaccination waivers for philosophical, religious or medical reasons. As of 2014, to obtain such a waiver in Michigan, families must attend an education session on vaccines at their local health department. The proportion of Michigan’s sixth and seventh graders getting waivers was 2.1% in 2009.
But the number spiked in 2010 to 10.6%. The percentage slowly declined, reaching 3.1% in 2015, before climbing again to hit 4.6% in 2022, according to the Michigan Department of Health and Human Services.
The proportion of school waivers among kindergartners, sixth and seventh graders as well as new school entrants has followed a similar pattern, rising from 3.4% in 2009 to 8.6%, falling to a low point of 3.1% in 2015 and increasing to 4.8% in 2022.
The numbers alarmed public health officials, especially in 2015, when Disneyland in California reported an outbreak that spread to other states. Michigan avoided the outbreak, reporting one confirmed measles case in 2015, according to the state.
About 61% of Michigan children in Wayne County between the ages of 19 and 36 months had received one dose of the MMR vaccine as of December 2023, according to the state health department, while roughly 74% of Wayne County teens between the ages of 13 and 17 have received two doses.
In Washtenaw, nearly 72% of children between 19 and 36 months and almost 69% of teens had received the age-appropriate dosage of the MMR vaccine as of December 2023, according to the state health department. Coverage rates in Oakland are similar, with roughly 70% of young children and teens having received at least one MMR shot as of December 2023, according to the State Health Department.
Detroit, Michigan’s most populous city, is measured on its own, and 51% of children ages 19 to 36 months had received one dose of the MMR vaccine as of December 2023. Almost 71% of teens had received two doses at the end of last year, according to the state health department.
Some groups, such as Michigan for Vaccine Choice, a St. Clair Shores-based nonprofit that provides information about vaccines while supporting people who choose against getting vaccinated, attribute the vaccination decline to people educating themselves and doing more research.
“Three people in three different counties presented with a measles rash,” Connie Johnson, a board member for Michigan for Vaccine Choice, wrote in an email on Wednesday. “What the health department fails to mention is that a recently vaccinated individual can shed virus, which can cause infection in others. Instead, a ‘history of international travel’ is always to blame.”
The MMR vaccine injects live but weakened forms of the viruses, causing a harmless infection in the otherwise healthy individual, according to the CDC. The federal health authority does not list transmission as a risk of the MMR vaccine, but the CDC does warn that it may cause an infection that may be life-threatening in people with serious immune system problems. These people should not get the vaccine, according to the CDC.
“Measles is a mild infection, which lasts about a week and results in lifelong immunity,” Johnson wrote. “As is the case with all infections, those who are susceptible or have immune deficiencies can become very sick.”
But public health officials argue the lack of vaccination is the problem.
“The reason why these outbreaks are happening is because our … public health system is breaking down,” UM’s Wagner said. “We’re not getting enough people to be vaccinated, so then these pockets of measles are popping up.”
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