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Dec. 9, 2019

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Clark County measles outbreak: ‘It’s totally preventable’

Clark County’s public health director debunks myths about vaccination, the measles outbreak response effort and more

By , Columbian staff writer
Published: January 28, 2019, 6:05am

Clark County Public Health Director Dr. Alan Melnick, 65, remembers when he had measles as a kid and remembers spending days in bed with the blinds drawn due to the conjunctivitis and photophobia measles causes.

“I have a healthy respect for measles and how scary it can be,” Melnick said.

Melnick is now leading the charge against the outbreak of that very virus. He said this outbreak is one of the largest and scariest communicable disease events in which he’s been involved. Last week, Melnick sat down with The Columbian for an interview covering myths about vaccination, protocol for fighting an outbreak and the safety and effectiveness of vaccination.

The size and length of the outbreak:

“As we get into generations of the outbreak, this can persist for weeks, if not months. Each generation, you have more people exposed, more people get sick, then they have multiple contacts in multiple places they’ve been. It’s not quite an exponential function, but you can see the numbers can increase over time. We’re trying to limit that as much as we can by the messaging we’re giving out. My concern is that this can go on for weeks, if not months, and we can see a lot bigger numbers.”

The unseen costs:

“This is putting stress on the schools; think about the cost to the state Department of Health, which has mobilized, and then you have to think about the medical costs. We’ve had one child hospitalized already. Hospitalization is expensive. The doctors visits and everything else being done. What we’ve spent at Public Health is a fraction of what is being spent communitywide on this. Besides the human suffering going on, this is money that we’re throwing down the drain, that could have been put to other uses.”

How outbreak control works:

“When we have a confirmed case, it gets reported to us. We’re certainly concerned about their health, but a provider has seen them and taken care of them. We’re concerned about where they’ve been. We will interview the confirmed case and identify when their symptom onset was, and where they’ve been for the entire time they’ve been contagious — which goes from the moment their symptoms start, which generally occur several days before the onset of rash — and then you’re contagious during that time as well as four days after the rash onset. So our staff will spend time interviewing the family if it’s a child and the adult if it’s an adult, identifying every place this person had been during the contagious period and identifying potential exposure sites.”

How school outbreak control works:

“It gets pretty complicated, because not only do we have to identify what school they’re in, we also have to identify if that school shares buildings with other schools, and what bus route that child might have been on and whether that bus actually went to more than one school because you can get exposed two hours after the person with measles has left. We’re looking at half an hour before they got there as reported and two hours after they reported leaving.”

How hospital outbreak control works:

“If it’s a clinic or emergency department, we’re going to work with them to get the list of anyone who might have been in the clinic for a half-hour before and two hours after the patient with the measles case left. We will contact them, and not only will we contact them and ask them about their immunization status, but we’ll also ask them if they brought anybody with them. If you’re not immunized, we’ll start doing what we call active monitoring where we contact folks all day because we want to know whether they develop symptoms or not.”

On people asking if the early cases are still sick:

“When we’re trying to control an outbreak, we can’t use resources calling these people to see, ‘Are you better yet? How are you doing? Are you eating yet? Are you sleeping?’ The bottom line is, we expect people to see physicians and physicians to care for them. There really is no treatment for measles, but putting our resources into contacting people to see how they’re doing or having them call us when they get better is an abuse of resources in trying to control this outbreak, and I can’t fathom why people are asking us how long the infected cases are sick for. I think they’re trying to prove their belief that this is not a bad disease.”

Is the vaccine safe?

“The vaccine is incredibly safe. There’s a lot of myths going on around it. It’s effective, and it protects against a disease that’s so much more horrible, exponentially more horrible than anything that would happen for the vaccine. The vaccine is safe. Before we had a vaccine program in this country, measles killed 400 to 500 people a year in the states. We had close to 50,000 hospitalizations every year. We had 4,000 cases of encephalitis, which is swelling of the brain, and some of them ended up deaf. We’ve already had one hospitalization. Any number more than zero of measles to me is too large a number here. Kids don’t generally end up in the hospital. Old people like me may end up in the hospital more often. So don’t tell me that this is not a serious illness. This is mythology here. We have evidence right before us. It’s totally preventable.”

How effective is the vaccine?

“If you’ve had the two vaccines, it’s 97 percent effective and it lasts a lifetime. Certainly the measles will confer lifelong immunity. I have a choice between measles, potentially deadly, for lifelong immunity, or two cheap and safe shots. I go for the shots. Hands down.”

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