DCPH says no further information will be released to protect private patient confidentiality.

“Vaccination is the most effective way to prevent measles,” stated Dr. Matt Richardson, Director of Public Health in Denton. “Unfortunately, people think that measles is just a rash and fever but measles can cause serious health concerns, especially in young children, and is highly contagious. Vaccination is incredibly effective at protecting those we love from this infection."

This information comes only days after a national study published in the Public Library of Science, names Fort Worth as a hot spot for the anti-vaccine movement. Texas is one of 18 states that allows kids to opt out of vaccines as a philosophical exemption.

In the year 2000, the CDC declared that measles had been eliminated in North America and we thought we were well on our way to relegating measles to the trash heap of history. Now, thanks to declining vaccination rates, measles is making a comeback. Along with the cases in Texas, 55 people in Washington and neighboring Oregon have gotten sick with the virus.

So, since we are starting to see measles again, we thought it would be important for people to know a few things about this incredibly contagious disease from Jason Terk, M.D., a Cook Children's pediatrician in Keller and a nationally known advocate for vaccines:

1. Measles starts out looking like a bad cold with runny nose, cough, red and watery eyes, and high fever.
2. Two or three days after the initial symptoms begin, tiny white spots may appear in the mouth that are only seen with measles called Koplik spots.
3. Three to five days after the initial symptoms begin, a rash will appear as flat red spots on the face at the hairline and spread downward to the neck, torso, arms, legs and then feet. Small raised bumps may appear on top of the flat red spots.
4. The spots may become so numerous that they combine to create an overall red appearance to the entire body.
5. Fevers as high as 104° F will be present when the rash appears.
6. Measles is the most contagious infectious disease known and is spread by coughing and sneezing. The virus particles are suspended in the air for up to two hours where an infected person has coughed or sneezed.
7. If you are exposed to the measles and have not been vaccinated, you have a 90% chance of getting the measles.
8. A person with measles is contagious from 4 days before through 4 days after the rash appears.
9. One out of every 4 people with measles will be hospitalized.
10. One out of every 1000 people with the measles will develop swelling of the brain which can lead to brain damage and death.
11. One out of every 20 children with measles gets pneumonia which is the most common cause of death from measles in children.
12. For every 1000 children who get measles, one to two will die from it.

So, if you don’t want any of the above, get yourself and your child vaccinated! Tarrant County has been identified as a location where a measles outbreak is considered likely. Only we can change that!

Learn more on this topic:

• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles
• Vaccines and Immunizations
• Frequently Asked Questions About Immunizations
• Immunization Schedule
• Information for parents
• Talking to your child about immunizations
• What teens should know about immunizations

According to The Washington Post, the number of confirmed cases have been steadily rising from a handful last week to 23 cases on Tuesday, Jan. 22.

“The vast majority of those who had have fallen ill had not been immunized,” the Washington Post wrote.

While this news is alarming to health care officials, it does not come as a surprise. The World Health Organization (WHO) says the number of measles cases has grown 30 percent worldwide and that “vaccine hesitancy” is one of the top 10 threats to global health in 2019.

The WHO defines vaccine hesitancy as “the reluctance or refusal to vaccinate despite the availability of vaccines.”

The organization says vaccine hesitancy threatens to reverse progress made in tackling vaccine-preventable diseases that currently prevents 2-3 million deaths a year. But the WHO states a further 1.5 million could be avoided if global coverage of vaccines improved.

In New York, NBC News reports that an outbreak among Orthodox Jews has led to 177 cases. The Centers for Disease Control and Prevention states that 349 cases of measles were confirmed in 26 states in 2018, making last year the second-worst year for measles since 2000.

“Almost none of the cases had been vaccinated against measles,” NBC reports.

Measles is one of the most infectious viruses known to man and will infect 90 percent of unimmunized people who breathe it in. What frustrates health care providers is that the spread of this highly contagious disease can be contained.

And while the vaccine has been found to provide about 95 percent protection, a recent poll of Texas parents found 13 percent say they believe the risks of vaccines outweigh the benefits and 16 percent say they should be able to opt out of vaccinating their children.

Texas has one of the highest rates of unvaccinated children in the U.S., partly due to a 2003 state law allowing parents to opt out of getting their children immunized for medical reasons or conscientious and religious beliefs.

In an editorial in the Fort Worth Star-Telegram, Peter Hotez, M.D., director of the Texas Children’s Hospital Center for Vaccine Development, urged parents to provide immunization for their children, Dr. Hotez warned that “we are extremely vulnerable to a measles outbreak in Texas.”

Dr. Hotez identified Tarrant County and Fort Worth as national “hot spots” for a potential outbreak. A study co-authored by Dr. Hotez found that parents of at least 518 kindergartners in Tarrant County schools last year opted to not get preventive shots for their children.

“This news is frustrating to physicians and other health care providers because measles is a disease once thought to be all but gone from the planet. It’s not a coincidence that as we have seen more people hesitant to receive the vaccine, we have seen the number of measles cases increase nationwide,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “The numbers are very concerning. In 2000, the United States declared that measles was eliminated from this country. Now, more and more kids aren’t getting immunized and diseases like measles have returned. Measles is very serious and can cause pneumonia. Children under the age of 5 have a higher risk of hospitalization.”

Keeping vaccination rates relatively high (somewhere around 90 percent) helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

"Populations who choose to not follow the recommended vaccine schedule are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," Jason Terk, M.D., a Cook Children's pediatrician.

Learn more:

Measles

Vaccines and Immunizations

Frequently Asked Questions About Immunizations

Immunization Schedule

Out of 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage, according to researchers at The University of Texas System and UT Health Northeast. HPV is the most common sexually transmitted infection and is responsible for 90 percent of cervical cancer cases as well as thousands of oral cancer cases each year.

The study found that only 39.7 percent of females and 26.5 percent of males in Texas between the ages of 13 and 17 were up-to-date with the vaccine in 2016. The national average was 43.4 percent.

“This study is particularly frustrating because a routine vaccine recommended by the CDC and other leading health organizations around the world can prevent HPV,” said Jason V. Terk, a Cook Children’s pediatrician. “A simple shot can mean the difference in life and death. Unfortunately, most Texans are not getting the importance of this message.”

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

“Epic fail.”

A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.

That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.

Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the Human Papillomavirus (HPV) vaccine to patients.

Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots – and also complete them – lags far behind what it should be. (The HPV vaccine is given as a series of shots.)

So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12 year old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to we physicians!

The article describes findings from an online survey sent to 2368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: Endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely vs using a risk-based approach); and urgency (whether they recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported that they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!