In this photo illustration, vials of measles, mumps and rubella vaccine are displayed on a counter at a Walgreens Pharmacy on January 26, 2015 in Mill Valley, Calif.. An outbreak of measles in California had grown to 68 cases with 48 of the cases being linked to people who had visited Disneyland. (Photo by Illustration Justin Sullivan/Getty Images)

So far, Virginia has been spared from the blossoming measles outbreaks that have spread to 15 states, the second-largest number seen in the U.S. since the disease was eliminated in 2000, according to the Centers for Disease Control and Prevention.

Public health officials say they’re always on high alert for measles, a highly contagious infection that hasn’t been eradicated everywhere in the world. It’s really just an international plane ride away, said Marshall Vogt, epidemiologist with the Department of Health’s Division of Immunization.

But what about outbreaks on U.S. soil?

“We’re probably at the eyebrow-raised level,” Vogt said. “Sleeping with one eye open, so to speak.”

Virginia hasn’t had any outbreaks so far this year, and it’s had only three cases of mumps, another infection that isn’t quite as contagious as measles.

Because the U.S. eliminated measles in the 1990s, Vogt explained, any cases were imported in, leaving people who have not been vaccinated vulnerable.

“Unfortunately, we do have pockets across the country of people that are not adequately immunized, so when we see an imported case of measles and it hits one of those populations, we see transmission happening again across the United States,” Vogt said.

Most of the measles outbreaks are among those who have not been vaccinated, even prompting a county in New York to bar unvaccinated children and teens from public places. The outbreaks have caused demand for the measles vaccine — the measles, mumps, and rubella, or MMR, vaccine — to rise.

Virginia typically maintains a strong vaccination rate, Vogt said. Between 2012 and 2017, vaccinations for kindergarten, daycare and head start programs have hovered around 80 percent, according to the Virginia Annual Immunization Survey.

Sixth grade vaccinations, though, declined in that time frame, falling by 10 percentage points. Vogt said the Department of Health is monitoring that trend, but the likely culprit in the most recent dip (a five percent drop between 2015 and 2017) was the addition of a two-dose varicella, also known as the chickenpox vaccine, requirement in 2016.

But according to national data from the CDC, Virginia typically performs well compared to other states. Its rate of children age 19 to 35 months who receive the MMR vaccine, for example, is one of the highest in the country. That could be due to a variety of reasons, from public health education campaigns to Virginia’s rules on how to exempt kids from the school vaccination requirements.

Some states have pretty loose rules around how vaccine exemptions can be obtained, requiring little more than parents printing a form and signing it.

But in Virginia, where philosophical exemptions aren’t allowed, a doctor must sign off on a medical exemption, and religious exemptions must be notarized.

“So if people want to use those exemptions in Virginia, they do have to expend a little bit of effort to use them,” Vogt said.

There are far more religious than there are medical exemptions in Virginia. And while the number tends to fluctuate year over year, between 2006 and 2017 they rose from just 0.54 percent of kindergarten students to 1.23 percent.

Vogt said the Department of Health tries to provide resources to families who may be “vaccine hesitant:” They aren’t necessarily staunchly opposed to vaccines, but they may be confused about information they’re reading on social media, for example.

“These diseases and conditions — people don’t realize how serious they can be,” he said. “Because they are so rare these days and because people don’t suffer from them, we don’t see the consequences that we did 50 years ago.”

In the decade before 1963, when a vaccine became available, nearly all children got measles by the time they were 15 years of age, according to the CDC.

“It is estimated three to four million people in the United States were infected each year,” the agency says. “Also each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles.”

A digitally colorized, thin-section transmission electron microscopic image of a single measles virus particle, or virion. (Image via Centers for Disease Control and Invention Public Image Library)

Ear infections happen in about one of 10 children with measles, which can result in permanent hearing loss.

Among other complications, per the CDC: as many as one out of every 20 children with measles gets pneumonia — the most common cause of death from measles in young children — and about one child out of every 1,000 who get measles will develop encephalitis that can lead to convulsions, deafness or intellectual disability.

“For every 1,000 children who get measles, one or two will die from it,” the CDC says.

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Katie O'Connor
Katie, a Manassas native, has covered health care, commercial real estate, law, agriculture and tourism for the Richmond Times-Dispatch, Richmond BizSense and the Northern Virginia Daily. Last year, she was named an Association of Health Care Journalists Regional Health Journalism Fellow, a program to aid journalists in making national health stories local and using data in their reporting. She is a graduate of the College of William and Mary, where she was executive editor of The Flat Hat, the college paper, and editor-in-chief of The Gallery, the college’s literary magazine.