Since Jan. 1, 63 people in Washington state have come down with the measles. So far, the cases have been largely contained to one Washington county.
But across the border in Idaho, officials are nervously watching the outbreak and response closely. A handful of Idaho epidemiologists and nurses are currently in Washington assisting with their control efforts, and the Idaho health districts are receiving daily reports on the situation.
Measles is a particular concern for Idaho, home to eight of the 10 counties in the country with the highest rates of non-medical vaccine exemptions. Although rates of measles vaccinations have remained steady across the country for the past decade, the counties and towns with clusters of unvaccinated children are vulnerable to outbreaks of diseases like measles.
“Unfortunately, we have laws in place that allow people to refuse to immunize for any reason,” Elizabeth Fore, chair of the Department of Community and Public Health at Idaho State University, told the Daily Beast. “It’s a problem where public health and our laws are not on the same page.”
Idaho’s seven public health agencies are each pulling out their emergency response plans and engaging with local schools and doctors to brace for measles cases.
The question for them isn’t if, but when. “We do know that the [Washington] outbreak is likely to spread,” Fore said.
The South Central Public Health District, which is home to the county with the highest non-medical exemption rate in the country, started reaching out to health-care providers immediately after the cases in Washington appeared. All cases of measles have to be reported, so they’re making sure that doctors know what to look for.
“We’re making sure they know what kind of tests to do,” Cheryle Becker, public health division administrator in the South Central district, told the Daily Beast. “We want to start getting discussions going around how they would deal with a patient that might want to come in.” They remind doctors that patients with suspected measles who can should wear a mask, and where they should sit in the office.
They’re also speaking with daycares, to encourage them to look within their own records to see if children and staff are immunized, and to schools—spring break is coming up, Becker said, and students might be traveling to Washington. “Anyone who does not have complete immunizations or a record of them would get notified that they could potentially be at risk,” she said.
Having a list of children and students who aren’t vaccinated serves two purposes, Becker said: it helps them find the people they need to encourage to get vaccines, and also allows officials to react quickly to identify people who are at risk if they were exposed to a hypothetical measles patient. “When we have a case of measles, we have to work fast to contain it,” she said. “If daycares have a list of people who aren’t vaccinated, they can react and get to those people.”
Public health officials in the Central Health district have been fielding questions from childcare providers about the measles, and the district has been sending out reminders to schools and daycares about the rules and protocols in the event of an outbreak. “They’re not something that are often used, so we want to remind people,” said Rob Howarth, division administration for community and environmental health in the Central District health department.
And when the crisis hits, officials are prepared for it to hit hard. “We’re preparing for how to handle an influx of calls from the public, and how we’ll respond to individual cases,” Howarth told the Daily Beast.
In the Panhandle health district, which shares a border with Washington and contains the county with the second-highest non-medical vaccine exemption rate in the country, officials are pushing out information on measles.
“We’ve just been trying to be proactive,” Katherine Hoyer, public information officer in the district, told the Daily Beast. “On all of our social media, we’ve been trying to hit it a little heavier to let people know the vaccine is safe.”
In Washington, demand for the measles vaccine has skyrocketed in response to the outbreak. However, Idaho officials haven’t seen the same response in their state. “If it gets any closer to home, the same would probably happen here, but I haven’t witnessed that myself yet,” Hoyer said.
Becker said that the South Central district has had a handful of people looking for the measles vaccine. “They’re not coming in droves,” she said. “A few people who are on a different vaccine schedule that get maybe one at a time are saying, I want this one at the front of the line, because I see the risk. But they’re not beating down the door.”
In addition, anti-vaccine groups in Idaho are pushing back in the other direction. Health Freedom Idaho is hosting a talk entitled “Worried about the measles? Learn the facts to counter the fear” next week, and is posting misinformation about the measles, mumps and rubella vaccine on its Facebook page. The group also encouraged people to travel to Washington state to protest a bill that would make it more difficult for people to opt out of vaccinations.
A state representative in Idaho also just introduced a bill that would require schools to inform parents about their right to opt out—which, if passed, could push vaccination rates in the wrong direction, Fore said.
Though they watch them closely, policy issues like exemptions and vaccine legislation are outside the bounds of the health district’s control, Howarth said. “That’s something we don’t necessarily like at the local health department level, but it’s not something we can influence.”
Their role, he said, is to continue to work towards higher vaccination rates, and to prepare for any measles cases. Even if it doesn’t reach Idaho, the ongoing Washington outbreak is an opportunity for the health districts to stay sharp on their response.
“Situations like this heighten our awareness. We kind of dust off old policies and plans and bring people together,” Howarth said. “Our preparedness program has been around for almost 20 years, and we feel pretty good about it. We don’t always think about measles, but we’re always thinking about situations where we need to provide good and timely information or treatment.”