ENC Health Currents: Is NC Prepared For Measles Outbreak?

Jun 5, 2019

UPDATED: The Centers for Disease Control reports 1,022 cases of measles in the U.S. this year, the greatest number of cases since the disease was declared eliminated in 2000. No cases of measles have been identified in North Carolina, but are we prepared for an outbreak?




1,022 individual cases of measles have been reported from Jan 1 to June 16.
Credit CDC

Measles is highly contagious and spreads through coughing and sneezing. The virus can easily live up to two hours in the air. It starts as a respiratory illness with symptoms including fever, cough, runny nose and conjunctivitis. Days later, white spots may appear in the mouth followed by a rash that covers a person’s body.


“Measles is an acute viral disease that is very contagious,” said Justin Albertson, the vaccine preventable disease epidemiologist with the North Carolina Division of Public Health. “It is probably one of the most contagious diseases that we know of.”


Measles spreads easiest among people who are unvaccinated. Those who cannot get the vaccine, including infants less than 2 months and people who are immunocompromised, are also susceptible. Measles outbreaks have been confirmed in 26 states, including Tennessee, Virginia, and Georgia.


“There isn’t measles currently circulating in North Carolina but it can always be brought in from other countries or in the situation that we have now, it can be brought in from other states since there is transmission ongoing in other parts of the county,” said Albertson.


While rarely fatal, measles can cause pneumonia, seizures, blindness or inflammation of the brain. If an outbreak were to happen, Albertson says it is unlikely that it would get out of hand because North Carolina has a high vaccination rate.


“We do have pockets of unvaccinated persons in some of our communities that have high rates of vaccine exemptions. And if the measles virus got into those groups of people who are unvaccinated, it could spread among those groups.”


The last major outbreak of measles in North Carolina occurred in 2013 after an unvaccinated traveler returned from India to a community with a low vaccination rate. Twenty-three cases were reported. Last year, North Carolina had three reported cases.


“So our typical procedure when there’s a case of measles is to quickly isolate the case so they can’t expose any other people and then to track contacts to the case to make sure they’re immune to measles,” said Albertson. “If they aren’t immune, it’s possible they would have to be excluded from work or school or even quarantined in their home.”


Hospitals in Eastern North Carolina have directives to address a number of highly infectious diseases, including measles. The plan involves getting the patient quarantined and contacting the health department, said Cathy Fischer, Manager of Infection Prevention at CarolinaEast in New Bern.


“Let’s say a patient walked into the ER and we suspected that they had measles. So the first thing we would do is isolate that patient, put a mask on that patient, and put them in a room, it’s called a negative air pressure room and basically it takes the air in that room and rather than recirculating it, it takes it straight outside.”


If the individual doesn’t require hospitalization, they would be treated and sent home where they would remain in quarantine for up to 21 days.


“We’re continually working with public health agencies and infectious disease professionals to fine tune our plan, to evaluate and monitor where the outbreak is and how it’s spreading so that if we were to have that experience, we would be prepared for it,” said Fischer.


The North Carolina Division of Public Health sent a memo to health care providers, health departments, and laboratories with recommendations on how to identify measles cases and prevent the disease from spreading. Since measles isn’t a common disease , Paul Cook, Professor of Medicine at East Carolina University’s Brody School of Medicine’s Division of Infectious Diseases, said it can be tricky to diagnose. The last case of measles he saw was in 1989.


“There’s an increased awareness of trying to identify a condition that quite frankly most younger physicians and providers have never seen, which is a problem. So you see it in a textbook or you see it on some webpage but you’ve probably have never seen a case in your life.”


Measles can be prevented with the MMR vaccine. One dose is considered to be 93% effective at preventing measles and two doses are 97% effective. Health experts say if you’ve received two vaccines in your lifetime or you were born before the year 1957, you’re considered immune to measles. For everyone else, it’s recommended that you talk with your doctor to determine if a booster is needed. Prevention is key since there is no specific antiviral treatment if measles develops.


Vaccination FAQs: Prepared by the DHHS Division of Public Health and Office of Communications

Are vaccines safe?

Vaccines are safe and highly effective in protecting you, your children, and the community from serious illness and disease. They do not cause autism. It is important to keep up to date on vaccinations, and if someone is planning to travel out of the country, he or she should check with a health care provider about additional vaccinations as well.

Why are vaccines important?

Controlling the spread of infectious diseases through immunization is one of public health’s most significant accomplishments. Vaccines have reduced the number of many diseases that can cause serious illness, complications and death. Vaccination is the best and safest way to protect everyone, especially children, from potentially life-threatening diseases including measles, mumps and meningitis. Vaccinations also help prevent the spread of diseases in student populations.

Patients and parents should regularly talk with their primary medical provider about what vaccines they are scheduled to receive, any boosters they may need or other vaccines they may want to receive.

What vaccines are required in North Carolina?

All children entering child care or public/private school in North Carolina are required to be vaccinated against:

  • Diphtheria
  • Hepatitis B
  • Hib Disease
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis (whooping cough)
  • Pneumococcal
  • Polio
  • Rubella
  • Tetanus
  • Varicella (chickenpox)

The CDC also recommends children be vaccinated against the following diseases, although immunization against these diseases is not required for children in North Carolina:

  • Hepatitis A
  • Influenza (every year)
  • Rotavirus
  • Human Papillomavirus

More information about immunization requirements can be found at https://www.immunize.nc.gov/family/index.htm.

As children move into adolescence, it is still important to stay current with immunizations. For preteens, ages 11-12, the following four vaccines are recommended:

  • Meningococcal conjugate vaccine (MCV4) to protect against some of the bacteria that cause meningococcal disease, including meningitis.
  • Tdap vaccine to protect against tetanus, diphtheria and pertussis (whooping cough).
  • Human papillomavirus vaccine to help protect from HPV infection and cancers caused by HPV.
  • Influenza vaccine to protect against the flu. The Centers for Disease Control and Prevention recommends that everyone 6 months of age and older get a seasonal flu vaccine.

Immunizations continue through the teen years. A booster dose of MCV4 is needed at age 16 to maintain protection against bacteria that can cause meningococcal disease. Depending on risk factors, some teens may need serogroup B meningococcal vaccine as well. Those with teenagers should talk to their pediatrician or family physician about what is appropriate.

Does North Carolina allow exemptions to this requirement?

Religious and medical exemptions are allowed under state law and the Department of Health and Human Services acts in accordance to the law. DHHS provides education to help providers keep an open dialogue with parents and patients to address concerns of vaccines and vaccine hesitancy.

What is herd immunity?

Herd immunity is when a population or community is protected from disease through vaccination by preventing the spread of disease. Herd immunity is especially important in protecting children and adults who cannot receive immunizations due to medical reasons (allergies, weakened immune system due to cancer, auto-immune diseases, etc.) and in protecting infants who may be too young to get the vaccine.

What is North Carolina’s coverage rate?

North Carolina has experienced varied coverage levels over the past 10 years. Some factors include the national Haemophilus influenzae type b (Hib) vaccine recall that resulted in a suspension of the NC immunization requirement for Hib in January 2008. Then the US was affected by the H1N1 pandemic in 2009-10 which impacted the entire state of North Carolina.

Coverage rates are also affected by the circulation of false information and alternative schedules delaying immunization of children. The DHHS Division of Public Health discourages the use of alternative schedules. Overall, North Carolina coverage rates are holding steady and we continue to strive for improvement.

National Immunization Survey data, 2007-2017 — North Carolina Coverage by Report Year:

2007       (70.1 percent)

2008       (64.4 percent)

2009      (40.2 percent)

2010      (52.1 percent)

2011      (65.6 percent)

2012      (75.4 percent)

2013      (72.0 percent)

2014      (80.8 percent)

2015      (76.4 percent)

2016      (77.8 percent)

2017       (70.9 percent)

See also https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxview/data-reports/7-series/trend/index.html.

At what coverage rate are we at risk for severe outbreaks?

The Division of Public Health reviews the school report data annually and looks for trends in school reporting data that is summarized by county to determine low coverage areas. DPH monitors communities or geographic clusters with higher vaccination exemption rates and/or higher incidence of vaccine preventable diseases, works with local health departments to recommend steps to increase vaccination and prioritizes achievable activities that the best available evidence indicates will improve and sustain vaccination coverage levels in these areas.

How contagious are measles?

Measles is highly contagious and the virus is easily transmitted. It spreads through coughing and sneezing, and the measles virus can live for up to two hours in an airspace where an infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface — and then touch their eyes, nose or mouths — they can become infected. The MMR vaccine is highly effective and the best way to protect yourself and your family against measles, mumps and rubella

There were three measles cases reported in North Carolina in 2018, which was considered an outbreak.

How much do vaccines cost?

For those with private health insurance, vaccines are very affordable through your health care provider or pharmacy.

Vaccination programs are proven to be a cost-effective means of disease prevention that have saved millions from death. The North Carolina Immunization Program works in conjunction with the federal vaccine supply program, called the Vaccines for Children (VFC) program. The VFC program is a federal initiative created to help families of children who may not otherwise have access to vaccines by providing free vaccines to doctors who serve them.

The NCIP provides many of the vaccines required for school entry at no charge for eligible children from birth through 18 years of age. Through the NCIP, vaccines are distributed to health care providers at no charge. More than 95 percent of pediatricians who administer vaccines to children in North Carolina participate in this program. Health care providers may not charge a patient for the cost of an NCIP vaccine; however, they may charge vaccine administration fees.

Additional Resources:

More information about communicable diseases can be found at https://epi.publichealth.nc.gov/cd

Statistics on reportable communicable diseases in North Carolina can be found at:

The CDC also has available information and resources online at: