Measles outbreak in El Paso ends, public health officials handled it 'old school'

El Paso Public Health Director Robert Resendes was hoping the test result was a false positive, that the lab had made a mistake, when the first case of measles appeared in the city.

The discovery earlier this summer signaled a measles outbreak in El Paso — an outbreak that has since ended: On Thursday, the city's Department of Public Health declared it officially over.

But before it ended, three adults and three toddlers in El Paso were infected with a measles virus genetically linked to an outbreak in Orthodox Jewish communities in New York City earlier this year, public health officials said.

Following health protocols, the outbreak was declared over after 42 days of no new cases since it can take up to 21 days for a patient to show symptoms, public health officials said.

The outbreak required a major public health and community response, including among medical staff, labs, schools and workplaces, Resendes said. 

"This event has once again proven that despite the fact that we had gone 25 years without a case, our team of experts was ready to respond," Resendes said. "I extend a thank you to the parents in our community for being diligent in keeping their children’s vaccinations current."

Measles had been eradicated in the El Paso for more than two decades, vaccination rates are high and there isn’t a large anti-vaccination movement in the area, he said. Measles was declared eradicated in the U.S. in 2000.

But measles can live in the air where an infected person was for up to two hours. The Centers for Disease Control and Prevention estimate that 90 percent of unvaccinated people who are exposed to the virus will become infected.

"There’s sometimes some legitimate reasons not to vaccinate," Resendes said. "If the child has a medical condition, the vaccination may be dangerous to them. …That’s why it’s important for all of us to be vaccinated, so that kid doesn’t get measles. It’s got a double-blessing to it. You protect yourself, but at the same time you’re protecting others."

Resendes said measles can kill people or disable them for the rest of their lives. It is spread through coughing and sneezing, and the disease usually begins with fever, cough, runny nose and red eyes. The symptoms are followed by a rash that spreads from the head down to the hands and feet.

He said the CDC has been asking for photos of the measles cases because most photos they have of the disease were taken about 25 years ago.

"We use the word outbreak and that scares people," Resendes said.

El Paso had six cases of the virus. More than three cases is considered an outbreak by the CDC. Resendes said the term outbreak allows the health department to get state and federal funding to buy supplies needed to control the disease.

He said there are doctors who have never seen a case of measles and don’t necessarily know how to recognize it. Patients haven’t seen it either.

Resendes said the reason for the increased cases of measles nationwide is that people aren’t vaccinating.

The state of Texas allows schools to provisionally enroll students who have at least one dose of the measles vaccine. However, this year Resendes and the city's Department of Public Health recommended that schools suspend provisional enrollment and require all students to have two doses of the measles vaccine upon school entry.

Resendes said he wasn’t as concerned with the back-to-school season: El Paso schools have vaccination rates of 90% or more.

"My biggest concern is the toddlers or the day cares because they’ve only had one shot by that time, if they’re current, and they don't get their second shot until they’re four," he said.

One dose of the measles vaccine is about 93% effective, compared with 97% with two shots.

As of Sept. 5, there had been 1,241 measles cases in the U.S. this year, compared with 62 in 2010. Most cases are among people who are not vaccinated and more than 75% of the cases are linked to outbreaks in New York and New York City, according to the CDC.

The states that have reported the cases to the CDC include Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia and Washington.

Resendes said if someone thinks they have measles, they should not go to the doctor because that exposes the public to the disease.

He said they should check their vaccination status, and nurses can visit them in their homes, so they don’t expose others.

"It’s an old disease and we’re handling it old school," he said. "We’re doing house calls."

The first two El Paso cases were both people visiting Fort Bliss and were probably infected together. The people didn’t have any relation, Resendes said. He also said that made it clear immigrants weren’t to blame for the outbreak.

"There have been some people concerned that perhaps the influx of immigrants have been bringing measles to the United States or to our area here," he said. "The first cases were probably at Fort Bliss, and immigrants don't have access to Fort Bliss to be spreading disease, much less even visiting or going in for shopping or to visit a friend. So, at this point, absolutely no tie between the immigrants and our first cases."

The first two El Paso measles cases were discovered in early July and the last case was diagnosed July 23, officials said.

The CDC reported this year has seen the highest number of measles cases reported in the U.S. since 1992. The CDC stated that outbreaks in New York and El Paso were linked to travelers who brought the measles back from other countries, such as Israel, Ukraine and the Philippines, where outbreaks had occurred.