DENVER — Colorado has yet to report a measles outbreak, but weeklong reporting delays of the highly contagious disease are raising concerns that the virus may now be spreading undetected in susceptible communities throughout the state.
So far, two of Colorado’s three measles cases have been reported to state health officials more than a week after patients first sought treatment for their symptoms.
The Southern Colorado Clinic in Pueblo waited nine days to report a suspected measles case to state health officials and did so only after test results came back positive for the virus. It took eight days for the state’s most recent case in Archuleta County to be reported to state health authorities.
Per state health regulations, both should have been reported to the Colorado Department of Public Health and Environment (CDPHE) within four hours of a suspected diagnosis.
Dr. Rachel Herlihy, the CDPHE’s state epidemiologist, told Denver7 Wednesday that most infectious diseases in Colorado are submitted to the state health department through an automated, electronic laboratory system.
When it comes to diseases that pose a danger to public health, like COVID-19 or measles, for example, “there’s some differences where we are asking providers to pick up the phone and call either us at the state health department, or their local public health agency to report a condition,” Herlihy said.
Herlihy was the first to admit just how challenging that can be for health care staff working in clinical settings.
“When you think about a busy clinical practice, an emergency department or an urgent care [facility] or a clinic, you know… reporting to public health is not necessarily top of mind for them, their focus is going to be treating that patient,” she said. “We recognize that it can be tough to remember to report to public health.”
Which is why Herlihy said the CDPHE has been working directly with providers to remind them just how important it is to immediately report any suspected measles cases that may pop up in the state as the country continues to deal with a multi-state outbreak that has so far killed two children and one adult.
Reporting measles cases to the state isn’t that simple
As the number of measles cases continues to tick up across the state, people might think reporting a measles case to the state is as easy as just picking up the phone.
Herlihy was quick to dispel that notion. “It’s, of course, not black and white. There’s going to be some gray here.”
She said what happens typically is that if a clinician suspects a patient may have a measles infection, they’ll pick up the phone and contact the CDPHE or their local public health agency. After the call is answered, a consultation will then follow.
“The call is not just to say, ‘I have a suspected measles case.’ The call is collaborative with public health; it's a risk assessment,” Herlihy said.
- Following the announcement that an unvaccinated Denver County infant had contracted measles, Denver7 took parents' concerns to a pediatrician. Hear their recommendations for how to protect your family in the video below.
The state’s top epidemiologist told Denver7 the risk assessment will involve talking with the clinician about that patient’s symptoms as well as their exposure history.
“Did this patient travel internationally? Travel out of state? And then [we ask], is this patient vaccinated or unvaccinated? And is that known or is that unknown?” Herlihy explained. “Unfortunately, it's frequently unknown, especially for adults.”
Taken together, all that information will lead to a risk assessment of the case which the CDPHE will then categorize as either low, moderate or high risk. “And depending on that prioritization or risk level, that is really where we decide the next steps on testing,” Herlihy said.
If it’s a high-risk case, the state will send a sample from that patient to the CDPHE’s state lab for expedited testing. The same will likely be recommended for a moderate case. Low-risk cases will be left up to the clinician, who may decide that the risk is so low that testing is probably not necessary, she said.
CDPHE “not focused on punitive actions” against clinics
Despite delays in reporting by clinics in Pueblo and Archuleta County that could put public health at risk of measles outbreaks, Herlihy said the agency was not looking to punish those clinics for not alerting them immediately about those measles cases.
“Our focus is, really, being proactive and educating providers about the importance of reporting these suspect cases. We're not focused on punitive actions, especially in the setting of these clinics who are really being very collaborative, working with public health, wanting to do the right thing here.
“I think that clinics and urgent care [facilities] and emergency departments are complex environments with lots of competing priorities, and so we recognize that it can be challenging,” she said. “Of course, we want providers to report to us proactively, and we are urging them to do that, but that's really the focus here.”
Where do Colorado’s measles cases stand and how can I protect myself?
It's still too early to tell whether Colorado is experiencing a measles outbreak as measles symptoms typically begin seven to 14 days after exposure but may take up to 21 days to appear, according to Herlihy.
Those symptoms can be anything from a fever, a cough, a runny nose, and red, watery eyes that develop into a rash that starts on the face and then spreads to the rest of the body about three to five days after symptoms first start; a person with measles is contagious four days before and four days after the rash appears, she said.
- Where are Colorado's measles cases? Check out the map below to see which counties have been affected so far.
Colorado’s Pueblo case has still not cleared the incubation period — that should fall around Passover. The state’s second and third cases won’t cross the incubation period threshold until about April 23 and April 27, respectively.
In the Pueblo case — the first in the state — people could have been exposed at the Southwest Deli and Cafe (1873 S. Pueblo Blvd.) between March 17 and March 21, and the Southern Colorado Clinic (109 South Burlington Drive) between 3:30 p.m. and 6 p.m. on March 22.
The state’s second case in Denver could have exposed people who visited the Denver Health Emergency Department on Sunday, April 6, between 10:30 a.m. and 4:30 p.m.
In Archuleta County — the state’s third case — people visiting Wolf Creek Ski Area and Resort could have been exposed between Friday, March 28, and Sunday, March 30; at the City Market in Pagosa Springs on March 31 between 10 a.m. and 12:45 p.m.; and at the Pagosa Medical Group on March 31 between 9:05 and 12:15 p.m. and on April 2 between 3:45 p.m. and 6 p.m.
This latest case is raising concerns among state health officials as it does not appear to be linked to the other two and the patient did not travel outside Colorado, which could mean the virus is already spreading undetected among susceptible individuals.
People worried about potential exposure to measles should call their health care provider before trying to seek treatment to avoid other people from becoming potentially infected with the virus.
While vitamin A has a role in treating measles cases, state health officials have said that role is not preventative and giving vitamin A to people with measles should be done under the supervision of a health care provider as too much of it can cause liver damage and, in pregnant women, it can lead to birth defects.
State
CDPHE addresses use of vitamin A for measles after confirmed case in Pueblo
The best way to prevent a measles infection is through vaccination, state health officials continue to stress.
A single dose of the MMR vaccine confers 93% protection against measles, while a second one ups that number to 97%, according to the U.S. Centers for Disease Control and Prevention (CDC). People who have received the full series of the MMR shot don’t need another one after exposure to the virus, though people who received a measles vaccine before 1968 should talk to their health care provider about possibly getting a booster as the vaccine used before that year wasn't as effective. Unvaccinated people exposed to the virus can get the MMR vaccine 72 hours after exposure (but before symptoms are present) to prevent an infection, state health officials have previously said.
Measles was declared eliminated in the U.S. in 2000, meaning it is no longer constantly present in the country, though there is always a risk of small measles outbreaks when unvaccinated travelers come to the U.S. from countries that have not yet eliminated the disease.
That status is now at risk due to “an unusual and constant increase in confirmed cases of this disease” over the past several years, according to a recent report from the Pan American Health Organization (PAHO).
As of Friday, 607 confirmed measles cases were reported across 22 states in the U.S., with the overwhelming majority of those cases occurring among unvaccinated youth between the ages of 5 and 19 years old, according to the CDC.
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