The state’s first case of measles this year was confirmed in Allegheny County — the Pittsburgh area — the Pennsylvania Department of Health announced Tuesday.
The news comes amid the highest U.S. case count since 1994 — and even before it broke, Lancaster County residents had been asking if they should get re-immunized against it or speed up the standard vaccination schedule.
Local doctors say the answer varies by situation, but is more likely to be yes if someone is planning to travel overseas or somewhere there has been an outbreak, or is otherwise at increased risk of getting the serious, super-contagious disease.
Dr. Mandy Fannin of WellSpan Family Medicine Trout Run said a patient told her that a family member died of measles not many years before the vaccine came out in 1963.
“Where we’re seeing the outbreaks are people who were not vaccinated,” she said.
There have been no reports of vaccine shortages, according to Penn Medicine Lancaster General Health patient safety officer Dr. Deborah Riley.
According to the CDC, one dose of vaccine is about 93% effective in preventing measles, and two doses are about 97% effective. The normal schedule is one dose at 12 through 15 months of age, and a second dose at 4 through 6 years of age.
In addition to the other ills of measles, CDC Vaccine Director Dr. Nancy Messonnier said recently that the disease “can be extremely costly and disruptive to public health, costing an average of around $32,000 per case.”
Per the Pennsylvania Department of Health:
• The most recent outbreak of measles in Pennsylvania occurred in 2017. There is no record of a measles outbreak occurring in Lancaster County, and there has not been a case recorded since 2001.
• From 2000 to 2018, an average of two confirmed measles cases were reported per year in Pennsylvania.
• The most recent measles death in Pennsylvania occurred in 2003.
Who needs vaccinations?
For starters, the doctors say, anyone who has never been vaccinated against measles, unless they were born before 1957 or there’s some medical reason not to.
According to the CDC, anyone born 1956 or earlier — roughly age 63 or older — is probably immune because the disease circulated so widely before the vaccination was available.
Anyone not sure could take a blood test to check for immunity, or just get another dose — the CDC says there’s generally no harm in that.
If traveling, the CDC recommends speeding up the schedule and making sure that infants age 6 through 11 months have one dose of the vaccine, ideally at least two weeks before travel begins.
Traveling children 1 year or older should have two doses separated by at least 28 days, according to the CDC, and teenagers and adults who do not have evidence of immunity should have the same.
The CDC defines evidence of immunity as being born before 1957 in the U.S.; having lab confirmation of immunity or of having had measles; or having written documentation of adequate vaccination.
For school-age children and adults at high risk, including travelers, adequate vaccination is two doses, according to the CDC, and for preschoolers and adults at low risk it’s one dose.
However, there are two caveats. One is for those vaccinated between 1963 and 1968, when some people got a less effective “killed” version of the vaccine.
The other is for people who probably only got one dose because they were born between 1957 and 1989, when the CDC started recommending a second dose.
People in those two groups should consider getting another dose, experts say.
Kelly Burkholder is spokeswoman for School District of Lancaster, which is the largest district in the county.
Asked if the district is taking any action because of the outbreaks in neighboring states, she responded in an email,
"The students who would be most affected by the outbreak are those that do not have a second measles (MMR) immunization. These are primarily rising kindergarteners so we are encouraging them to get one; however, they are not required to have the second dose until they enter kindergarten in the fall."
The district has sent letters to that effect and nurses have also made some phone calls, she wrote.
Where can I get it?
Pediatricians and family doctors provide the vaccinations. Some pharmacies may too, especially those with clinics; those considering that option should check ahead of time.
There’s also a federally funded program called Vaccines for Children for the uninsured or those whose insurance doesn’t cover immunizations.
More information on that program is available by calling Lancaster County State Health Center at 717-299-7597 or Lancaster Health Center at 717-299-6371 or Welsh Mountain Health Center at 717-354-4711.
And for children ages 1 month to 18 years who have Medicaid or are not insured, Lancaster General’s Child Protect program offers free immunizations at a series of clinics.
Upcoming clinic dates are May 20 in Columbia and June 18 and 19 in New Holland and Bart, respectively; more information is available by calling 717-544-3807.
Dr. Mandy Fannin of WellSpan Family Medicine Trout Run said one resource she recommends to families a lot is the Vaccine Education Center of CHOP, the Children's Hospital of Philadelphia.
How much do they cost?
This is health care, so there’s not an easy answer; it will vary.
Local doctors say insurance should cover the vaccine for children, but may not for adults; they recommend checking.
The websites for Walgreens and CVS clinics list MMR costs of $99.99 and $135 respectively for patients who are uninsured or paying out of pocket.
Where are the outbreaks?
Outbreaks, which the CDC defines as three or more cases, have been reported in six states and linked to travelers who brought measles back from other countries such as Israel, Ukraine, and the Philippines.
Pennsylvania’s not on that list, but three of its neighbors are: New York in New York City and Rockland County; Maryland; and New Jersey.
The others are in Georgia, Michigan and Butte, LA and Sacramento counties in California.
Before the Pennsylvania case was confirmed Tuesday, the CDC record showed that 22 states had reported measles cases since January.
The Pennsylvania Department of Health warned Lancaster County residents about exposures to two suspected cases of measles in the past four years, in January 2015 and August 2018.
Tests done on both cases came back negative, according to the department.
#DYK: The symptoms of measles generally appear 7-14 days after a person is infected. Find out what symptoms to watch out for: https://t.co/gJ0ROTyqIy #WednesdayWisdom #WednesdayMotivation pic.twitter.com/OiG33N0EVN— HHS.gov (@HHSGov) May 22, 2019