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)

Virginia’s success in evading the measles this year might be at an end.

Health departments in Northern Virginia are currently investigating a possible case of the highly contagious disease involving a child who traveled internationally, though the case is not related to the ongoing outbreaks in other parts of the country.

Preliminary testing occurred Wednesday, said Christy Gray, director of the Department of Health’s division of immunization. Though the case is not yet confirmed, the department has notified people that they may have been exposed if they visited certain places earlier this week: Dulles International Airport, Novant Health UVA Health System Haymarket Medical Center and Inova Fair Oaks Hospital.

It can take time, sometimes several weeks once samples are sent to the Centers for Disease Control and Prevention, to confirm a case of measles, Gray said. That’s why officials have already moved forward with the public health response to raise awareness for those potentially exposed.

As of Wednesday, measles outbreaks have spread through more than 25 states with 1,001 cases, the highest number recorded since 1992. The U.S. had declared measles eradicated in 2000, but this year the disease has taken off quickly in unvaccinated communities.

There are usually very few, if any, reports of measles in Virginia. According to the Department of Health’s Reportable Disease Monthly Surveillance Report, in 2018 and 2015 there was one case of measles in the state, while 2014 saw two cases.

“Our program has set a public health structure in place in order to respond quickly,” Gray said. “And there are a few different factors involved with preparing the commonwealth for being able to either withstand or prevent outbreaks like this.

“One of the major pillars is to have a strong, responsive public health system with good communication that private providers know to contact the health department, (the) health department responds, provides guidance, we provide testing, we reach out to contacts.”

Virginia enjoys a high immunization rate compared to other states. The measles, mumps and rubella, or MMR, vaccine has been “well-accepted” in the community, Gray said, and Virginia also has low rates of children receiving exemptions from vaccinations.

There are some blind spots in the vaccination data, though, such as homeschooled children. Gray said that’s something the department is interested in exploring to see if there are pockets of the population with low vaccination rates — which is what caused outbreaks to surge in New York.

“Once measles gets into an unvaccinated population, it spreads like wildfire,” she said.

Continuing to battle hepatitis A

Meanwhile, Virginia continues to target another outbreak that reached the state earlier this year: hepatitis A.

The nationwide outbreak has been ongoing since 2016. It’s unique because, while hepatitis A outbreaks are usually related to contaminated food, this time the disease has been spreading through high-risk populations: homeless people, recently incarcerated individuals, men who have sex with men and injection drug users.

So far there have been 55 cases in Virginia related to the outbreak, according to a presentation Gray made Wednesday to the Virginia Board of Health, and the vast majority have been in Southwest Virginia.

“That’s because the neighboring states — Tennessee, Kentucky, West Virginia — have been real hot spots for this outbreak, with thousands and thousands of people having hepatitis A,” explained Dr. Norman Oliver, the state health commissioner, to the Board of Health on Wednesday.

But local health departments in Southwest Virginia have been effective in targeting the most at-risk populations with messaging to keep the outbreak largely under control, both Oliver and Gray said.

The state has gone on a major communications campaign to spread awareness of the hepatitis A vaccine, working with the Pandora music app and Grindr, a dating app geared toward gay, bisexual, transgender and queer people, to develop ads spreading its message.

Virginia also experienced a significant hepatitis A outbreak in 2016 related to frozen strawberries. The ramifications of that, Gray said, might be helping the state withstand the current outbreak.

“That could have created higher adult vaccination rates that we are benefiting from,” Gray said. “There’s no definitive way to know, but I’m sure it’s a factor in that we have some coverage of hepatitis A for adults.”

Sexually transmitted diseases

But neither hepatitis A nor, potentially, measles are presenting the only communicable disease threat to Virginia’s public health at the moment. The increase in sexually transmitted diseases that the entire country and Virginia have seen continues.

Both the rates and case counts of chlamydia, syphilis and gonorrhea have increased substantially. Between 2009 and 2018 the rates of chlamydia and gonorrhea have risen by 30.2 and 42.4 percent, respectively. Meanwhile, the rate of early syphilis, which hasn’t progressed to the more serious tertiary, or late, syphilis, increased by 122 percent. Cases of babies with congenital syphilis, meaning they were born to a woman who had the disease, have gone up by 400 percent.

Those between the ages of 18 and 25 have the highest rates of the diseases.

The Department of Health has taken a two-pronged approach to the increase, Oliver told the Board of Health.

The first is increasing the training and capacity of staff in the field who are conducting case investigations, patient interviews and treatment. That has meant hiring new field and surveillance staff to handle the increasing caseloads.

It has also encouraged local health departments to expand STD clinic availability by staying open later.

“These increases are very concerning,” Oliver said, adding that STDs can be asymptomatic, and “are therefore likely under-diagnosed. … These numbers are probably actually higher than we have here.”