A deadly West Texas measles outbreak that has so far been linked to two fatalities and hundreds of sick patients could be much more widespread than originally feared, according to health experts.
If that is the case, authorities would need to act quickly and decisively to halt its continuing spread, which could potentially prove fatal in additional largely unvaccinated communities.
So far, 223 cases have been identified across the Lone Star State since late January, and 29 patients have been hospitalized. Last month, the Texas Department of State Health Services warned that an infected individual may have exposed people — potentially hundreds of thousands — while traveling between San Marcos and San Antonio before they knew they were infected.
But it’s the deaths, in particular, that are concerning. The first fatality was reported in an unvaccinated child who had no underlying conditions and lived in the outbreak area. A second death was reported in New Mexico’s nearby Lea County, also an unvaccinated patient. Their official cause of death remains under investigation, but the state’s Department of Health confirmed the presence of the measles virus. New Mexico has reported 33 cases.
With this many deaths, experts wonder if there should be more cases. In the U.S., death from complications of the virus occur in one to three of every 1,000 cases, according to the University of Chicago Medical Center. Infection can also lead to brain inflammation that can result in permanent damage.
“These two individuals could just be incredibly unlucky,” epidemiologist Katelyn Jetelina told STAT News on Wednesday. “It’s just surprising, particularly given how few deaths we’ve had over the past 10 years.”
“My gut tells me there are cases that are unreported — you don’t have to come in and get tested for measles,” Katherine Wells, the director of public health in Lubbock, told the outlet. “It’s going to be a long process to get everything measles-free again in this area, but I can’t tell you if that’s 500 cases or a thousand.”
Texas says that, due to the nature of the measles virus, additional cases are likely to occur in the outbreak area and surrounding communities.
Several obstacles are getting in the way of capturing the full scale of the country’s largest outbreak in six years. Many of those in areas that could have exposures may not be cooperative or report infection.
It’s also possible that people don’t know they are infected, especially in breakthrough cases. According to the Mayo Clinic, measles symptoms generally appear 10 to 14 days after exposure to the virus. Breakthrough infections in vaccinated people are linked to milder disease. Those cases are rare, but people near the outbreak are more susceptible.
However, what is known is that measles is preventable through vaccines, and the risk of infection is present, thanks to dipping vaccination rates. Childhood vaccination rates have declined nationwide since the pandemic, and San Antonio-area schools are reportedly seeing more students opt out of vaccines, according to the San Antonio Express-News.
It’s not unexpected to see one or two cases in communities with high vaccine coverage. But Johns Hopkins University’s Dr. Bill Moss cautions that another outbreak could occur if someone with measles goes to another community with a large population of unvaccinated individuals, which could leach into other areas.
“If your population around you has a measles vaccination rate of 95 percent or greater, that keeps the risk of an outbreak pretty low because even if one person had it, everybody else around that person is going to be vaccinated,” Dr. Erica Kaufman West, director of infectious diseases in the department of science, medicine and public health at the American Medical Association, said. “Once it drops under 95 percent though, that’s where you start to see these pockets of outbreaks.”
