Measles tent at Kaiser
A mobile treatment center has been set up outside Kaiser Permanente’s Maui Lani Clinic in Wailuku to test and treat patients exposed to two confirmed cases of measles at the clinic.
Marsha Bruhn of UNITE HERE! Local 5, the union that represents Kaiser workers, said Friday that the confirmed measles cases involved a patient and a nurse. In reporting the treatment tent in the parking lot, she said that workers were concerned about their and the public’s safety and wanted to know what steps were being taken by Kaiser to stem the spread of the disease.
There are four confirmed measles cases on Maui, said state epidemiologist Dr. Sarah Park on Friday afternoon. Statewide, there are 11 cases with six on Kauai and one on Oahu that is particularly problematic because that person traveled to Kauai and Maui, she said.
The Health Department had previously reported three cases on Maui, all tied to a person who returned from the Philippines, where there is a major outbreak. The fourth case revealed Friday involved a person who traveled to the Mainland, where the exposure occurred, said Park.
This is “obviously very concerning,” she said.
A Kaiser spokeswoman did not confirm the number of measles cases at the clinic but did say that the managed care health organization has been contacting patients who may have come in contact with the measles patients. Kaiser is notifying them of possible exposure and providing information and advice.
“Because measles is a highly contagious airborne disease, patients seeking followup care are being seen outside the clinic in a mobile treatment center, as a precaution to prevent additional exposure,” said Laura Lott, Kaiser spokeswoman, on Friday.
In the tent, which was loaned to Kaiser by Maui Memorial Medical Center, blood is drawn and tested for measles virus antibodies. Results from the test can be available in one to two days, Dr. Chad Meyer of Kaiser said Friday.
He said that the tent has been up a day or two and will remain up “until we feel we have cleared everybody who is a potential risk.”
Meyer, who said that he is not an infectious disease expert but has seen the disease while overseas in Africa and Asia for the State Department, said that measles has a 21-day incubation period – but that infected individuals can spread the disease four days before they show the coldlike symptoms and rash.
Measles is nothing to sneeze at. Severe complications include pneumonia and encephalitis, or swelling of the brain, which can cause deafness and mental disability; one or two children per thousand who contract measles die from the disease, Meyer said. One in 20 children with measles gets pneumonia, the most common cause of death from measles in young children, he said.
Measles may cause pregnant women to give birth prematurely or have a low-birth-weight baby, he said.
The U.S. is experiencing a record number of measles cases, with 603 confirmed cases reported to the Centers for Disease Control and Prevention through Oct. 31. A particular worry for Meyer is the ongoing measles epidemic in the Philippines, which the CDC also cites as a cause for the increase in U.S. cases. Meyer said there have been 47,000 measles cases reported in the Philippines since the beginning of the year.
“This places Hawaii at high risk for outbreaks of measles,” he said.
“Importation measles” is occurring on Maui and Kauai, he said. The public health term refers to measles brought by travelers, who are asymptomatic when they arrive but become infectious later.
“Since the infectious period begins four days before the onset of symptoms – fever and cold symptoms followed by the measles rash – there is high risk for continued Maui outbreaks,” Meyer said.
Maui is at particular risk because of “perfect storm” conditions, which include many travelers between the Philippines and Maui; the “large population” of nonimmunized people; the infectious nature of measles (90 percent of nonimmunized people exposed to the virus become infected); and easy transmission by air through coughing and sneezing and the survivability of the virus for several hours on clothing and other surfaces, he said.
The CDC has posted a “Level 1 watch” for travel to the Philippines, which means “practice usual precautions.” Travelers to undeveloped and developing countries should check their immunization status before travel; if not vaccinated for measles, they should do so at least two to three weeks before travel, Meyer said.
Park added that travelers should get two doses of the vaccine separated by 28 days.
If someone returns from places such as the Philippines and develops measles symptoms, they immediately should isolate themselves and call their doctor’s office to make special arrangements to see the physician to prevent exposure, he said.
Maui Memorial Medical Center has a protocol in place that keeps suspected measles patients away from the emergency waiting room, said Carol Clark, hospital spokeswoman. A sign outside the emergency room asks suspected measles and other infectious disease patients to wait outside until triaged by a nurse.
If the patient is suspected of having measles, the person is led outside to an isolation room, where he or she is diagnosed and treated, Clark said.
Due to privacy rules, she could not say if the hospital has treated measles patients.
The two most vulnerable groups are children under a year old and people suffering from immunosuppressive diseases like leukemia, said Meyer and Park. Babies do not receive their first immunization until 1 year old, leaving them “wide open” to contracting measles and developing the deadly and debilitating complications, said Park.
Park, Meyer and Kaiser officials said that getting immunized is the key to stemming the spread of the disease. Meyer noted that Maui has a large population of nonimmunized people who are at risk for the infection.
Routine vaccinations for measles began in 1963, though Park noted that a portion of the population requires a booster to maintain immunized. She said it used to be that only those visiting the islands had measles; now the disease is hitting residents.
“Now unfortunately, we have a rather large population of parents who do not vaccinate their children,” Meyer said, adding that this is a major frustration of many of the island’s pediatricians.
There has been a push back against immunizations by some parents, who believe that they could be linked to autism.
“We are taking steps backward,” lamented Park, adding that “it’s only a matter of time . . . when it will be tragic.”
At times like these, though, with an outbreak of measles, the nonimmunized population is “putting the community and their contacts in the community at risk,” she said.
* Lee Imada can be reached at firstname.lastname@example.org.