Measles outbreaks in California strain public health agencies

from Kristen HuangCalMatters

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When a possible case of measles is identified in California, the phone rings at the local health department and the clock starts ticking.

Laboratory workers must process the samples as soon as possible to confirm the case. A nurse should call the patient to find out where he has been and with whom he has been in contact recently.

If the test results are positive, the communicable disease team has 72 hours or less to identify anyone who has been exposed and may be at high risk of infection or serious illness. These people should be quarantined or take a dose of post-exposure prophylaxis to prevent the spread. Over the next 21 days, nurses will monitor the group for symptoms.

Measles is the most contagious vaccine-preventable viral infection in the world, and California is battling multiple outbreaks. In a room where one person is infected, nine out of 10 unvaccinated people will also contract the disease. The virus particles also linger in the air long after the infected person leaves, risking exposure to those who enter the room up to two hours later.

“It’s ridiculously contagious,” said Dr. Sharon Balter, director of the Division of Acute Communicable Disease Control at Los Angeles County Public Health. “It’s blowing up very quickly, and because measles spreads very quickly, we have to deal with it now. We can’t say we’re going to wait until tomorrow.”

California has a high enough vaccination rate – about 95% of kindergartens — to provide herd immunity against measles, but in states, pockets of unvaccinated communities are causing outbreaks, experts say.

Shasta and Riverside counties are working to contain localized outbreaks. These are the state’s first measles outbreaks since 2020 and come at a time when health departments have less money and less staff than in recent years. Seven in total counties reported a total of 21 measles cases this year, according to the California Department of Public Health.

Nationwide, 26 states have reported measles cases since the start of the year, including a huge one outbreak in South Carolina where officials identified nearly 1,000 cases, mostly among unvaccinated children. This is the largest outbreak ofThe Centers for Disease Control and Prevention has declared measles eradicated more than 25 years ago.

“The United States is experiencing the highest number of measles cases, outbreaks, hospitalizations and deaths in more than 30 years, driven by populations with low vaccination rates,” Dr. Erica Pan, California’s public health official, said in a statement earlier this month. “We must all work together to share the medical evidence, benefits and safety of vaccines to give families the information they need to protect children and our communities.”

Restriction comes with high costs

Researching any infectious disease is time-consuming and expensive. The first three measles cases reported in Los Angeles County this year cost an estimated $231,000, according to a health department analysis.

Why does it cost so much? Because investigating a disease often requires a legion of nurses, doctors, epidemiologists and lab scientists to trace hundreds of contacts, Balter said.

This sometimes involves visiting homes or exposure sites. For example, a recent exposure at a daycare center required nurses to squeeze urine from used diapers to test babies for measles. County health workers monitored 246 people who were exposed to the first three measles cases — and the work continues.

On February 19, the district announced its fourth case of measles. All of them were related to international travel. Other cases in California are also mostly linked to travel abroad or to states where there are outbreaks. Ann an unvaccinated child in Napa County contracted measles in January after a trip to South Carolina.

Riverside County health officials said one case of measles in which the child did not travel recently, and Shasta County health officials suspect their first case may be related to a trip to Southern California, but are awaiting DNA tests to confirm.

Orange County has reported two travel-related cases this year.

Health departments have fewer resources, more cases

Local health departments rely heavily on federal funding to prevent the spread of infectious diseases, but last year the Trump administration cut nearly $1 billion in public health funding from California. This year, it tried to claw back another $600 million from California and three other Democratic states.

Pending lawsuits have frozen the cuts, but local health departments are treating the money as a lost cause because they can’t take the financial risk if a judge ends up ruling in the Trump administration’s favor.

Therefore, health departments closed clinicscut programs and laid off dozens of workers.

“What we can do with less is less unfortunately,” Balter said. LA County faces a A $50 million shortfall due to federal, state and local cuts and recently closed seven community health clinics.

Health departments also face reduced public trust: Seniors casting doubt on the safety of the vaccine and efficiency by US Secretary of Health and Human Services Robert F. Kennedy Jr. has complicated public health’s fight to limit the spread of preventable infections.

Democratic leaders in California are aggressively fighting Kennedy’s direction. They sued to block the administration’s new vaccine guidelineswhich removed the universal recommendation of seven vaccines for children. They blame Kennedy and the Trump administration for “dismantling” the Centers for Disease Control and Prevention and fueling fears of debunked claims that vaccines cause autism.

The country also publishes its own vaccine guidelines and forms an alliance among four Western countries to share public health information and recommendations.

“Everything, including the outbreaks, the funding cuts, the questions from the federal government that are coming up, it makes our job very difficult,” said Dr. Regina Chinsio-Quong, Orange County public health officer.

twelve years ago Orange County was the site of California’s largest measles outbreak in decades. Ann exposure at Disneyland from an unknown source infected 131 Californians and spread to six states, Canada and Mexico.

The four-month outbreak prompted lawmakers to pass some of the nation’s strictest childhood vaccine requirements.

But even a single case of measles requires “huge amounts of infrastructure” to contain, Chinsio-Quong said. On average, the department identifies and monitors 100 exposed persons per case. Since the beginning of last year, Orange County has lost $22 million in federal public health cuts. The department is trying to protect its work on infectious disease surveillance, but it’s getting harder with each disruption.

“We are trying to prioritize our communicable disease control department,” said health official Chinsio-Quong. “There are a lot of different federal cuts, but we put this front and center: This has to be saved no matter what.”

Measles spreads in unvaccinated groups

Six hundred miles north, Shasta County is grappling with its first measles cases since 2019 and the state’s largest outbreak of the year.

In late January, a sick child visited a health clinic in Reading with symptoms of measles, which laboratory tests later confirmed. Health officials interviewed 278 people and identified them six places where others were exposed: restaurant, church basketball game, gym, park, Costco and the clinic.

They also identified seven other cases among family members or neighbors who had been in close contact with the child.

It can take 21 days from the time of exposure for measles symptoms to develop. On February 19, just before the end of this period, health officials have confirmed a ninth case.

That person didn’t recognize the symptoms and visited several places while infected, including a school, a church service, a basketball game and a clinic, said Daniel Walker, Shasta County’s supervising epidemiologist. Now the contract tracking process started all over again. The infectious disease team expects to interview even more people this time around.

All cases were among children who were unvaccinated or did not know their vaccination status.

“It’s a great time to get immunized because you never know when you’re going to be exposed next time … especially because we’re in an outbreak situation,” Walker said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.