Measles cases send Michigan health authorities scrambling to avoid bigger outbreak

Potentially hundreds of people were exposed to measles in Wayne and Washtenaw counties over the last week as two adults who had traveled internationally and had no record of measles immunization sought care for their symptoms at two urgent care centers, a Dearborn pharmacy and two hospital emergency departments, state health officials told the Free Press.

The exposures sparked a race against the clock for county health leaders to stave off an outbreak among unvaccinated people unknowingly exposed to the highly contagious virus when they visited:

• The emergency department/triage area at Trinity Health Ann Arbor Hospital, 5301 McAuley Drive, Ypsilanti, from 10:30 a.m.-1:30 p.m. March 1.

• The emergency department at Corewell Health Dearborn Hospital, 18101 Oakwood Blvd., Dearborn, from 3-8 p.m. Feb. 29.

• The Henry Ford GoHealth Urgent Care, 26763 Ford Road, Dearborn Heights, from 11:30 a.m.-4 p.m. Feb. 29.

• The WellStreet/Beaumont Urgent Care, 23100 Michigan Ave., Dearborn, from 2-5:30 p.m. Feb. 27.

• CVS Pharmacy, 2701 S. Telegraph Road, Dearborn, from 4-6:30 p.m. Feb. 27.

"Measles is highly infectious, can be transmittable before the characteristic rash, the initial symptoms can be nondescript and the virus can linger in the air for hours," said Chelsea Wuth, a spokesperson for the state health department. "Therefore, crowded and high-traffic areas where persons with measles have been can result in a large number of potentially exposed persons. In these cases, places where infected persons sought clinical care.

"This is important: You don’t actually need to share the same airspace with an infected person at the same time. So that risk can be quite hidden and amplified."

If those newly exposed people could be given the measles, mumps and rubella vaccine within 72 hours or be treated with intravenous immunoglobulin, a pooled antibody, within six days of exposure, new measles infections could be prevented, said Dr. Anurag Malani, director of hospital epidemiology, special pathogens and antimicrobial stewardship at Trinity Health Ann Arbor Hospital.

Working backward to identify exposures

"We were able to take a pretty detailed look at when the (infected) patient presented, how long the patient was in the waiting room, how long they were in triage, and when they got to their room" for isolation, Malani said. "And based on all those things, we looked at the list of who might have been in the waiting area during that time and who might have been in the ED (emergency department) at the time and then kind of worked backwards."

After examining the immunization records of all who were exposed at Trinity Health Ann Arbor Hospital, health officials were able to identify those who needed vaccination or IV immunoglobulin treatment, he said.

"We had a group of less than 10 patients that were identified and we were able to work with the health department over the weekend ... to try to get them post-exposure prophylaxis," Malani said. "And among those there were actually a couple of kids, one who was unvaccinated and one who was partially vaccinated based on the ages when we give the vaccine."

Patients, health care workers exposed to measles

In the case of Trinity Health Ann Arbor, the timing of this patient's arrival was fortuitous in that it wasn't busy in the emergency department that day, Malani said, and the patient was quickly identified as having measles and isolated.

Corewell Health didn't disclose to the Free Press how many patients were potentially exposed at the Dearborn hospital or WellStreet/Beaumont urgent care. Henry Ford and CVS Pharmacy also did not answer questions about the numbers of people they identified who may have been exposed.

Workers at each of those locations also had exposure to the virus.

Henry Ford Health and GoHealth, which jointly operate the urgent care center in Dearborn Heights, both require employees to be immunized "as a condition of employment," said Dana Jay, a spokesperson for Henry Ford Health.

The organizations issued a statement, which read, in part: “We are working alongside health officials to ensure anyone who might’ve encountered this person in our facility has the proper guidance and support. Vaccinations are the absolute best line of defense against diseases like measles, and we strongly encourage anyone who’s not been vaccinated to do so as soon as possible.”

At CVS Pharmacy, where contact tracing of those exposed could prove more difficult than at a hospital or urgent care center where patients must register for care, spokesperson Matt Blanchette told the Free Press: "We’re working to ensure any patients, customers or colleagues who may have been exposed contact Wayne County Public Health and follow the guidance it’s provided."

Corewell Health also said it has a systemwide "immunization guideline" that requires measles vaccination for employees who work on-site. In a statement, it said: "Our teams reached out to inpatients and team members, and the health department reached out to other individuals who might have been exposed. At this time, we are not caring for any inpatients with measles."

Measles can be contagious but asymptomatic for 4 days

Prevention is key. Measles can be dangerous, but that's especially true for unvaccinated children, pregnant women as well as people with compromised immune systems, such as those undergoing cancer treatment and people with HIV.

A single dose of the vaccine is 93% effective at preventing measles; two doses are about 97% effective.

About 1 in 5 unvaccinated people with measles is hospitalized. And among children, 1 in 20 gets pneumonia, which is the most common cause of death from measles in young children. Roughly 1 to 3 out of every 1,000 kids who contract measles die from it, according to the U.S. Centers for Disease Control and Prevention.

It can cause ear infections, diarrhea, pneumonia and encephalitis (swelling of the brain) that can cause convulsions, deafness or intellectual disability.

"If there's lots of exposures in lots of places ... this isn't going to be the last case that we are going to see," Malani said, especially without widespread vaccination. "We're going to see more cases."

An infected person can be contagious up to four days before the start of symptoms, unknowingly spreading the virus everywhere they go. The measles is so contagious that 90% of unvaccinated people who are exposed to the virus will become infected, according to the U.S. Centers for Disease Control and Prevention.

That's why Wuth and other health leaders are calling on all Michiganders who can get the measles, mumps, rubella vaccine to ensure they have had two doses and are fully immunized.

If you have symptoms, call ahead to doctor

In Wayne County, a news alert went out Sunday, urging anyone who visited the two urgent care centers, the Dearborn hospital or the CVS to send an email to [email protected] and provide their name, best phone number, and address.

The hope was that if they're unvaccinated, they also could have an MMR vaccine or IV immunoglobulin in time to prevent infection. Anyone who has been exposed is urged to monitor themselves for symptoms of measles, which include:

• High fever, which could rise to as high as 104 degrees.

• Cough.

• Runny nose.

• Red, watery eyes (conjunctivitis).

• Tiny white spots on the inner cheeks, gums, and roof of the mouth known as Koplik spots, which typically appear two or three days after other symptoms begin.

• A red, raised, blotchy rash that usually starts on the face and spreads to the trunk, arms and legs. Rashes typically starts three to five days after other symptoms begin.

Health leaders urge anyone with measles-like symptoms to call their health care provider in advance, rather than going to an urgent care center, doctor's office or hospital and potentially spreading the virus along the way. If a doctor's office or other health care provider is aware you're coming, they can take precautions to prevent the spread of measles to others.

3 Michigan measles cases not connected

The Washtenaw County resident with measles was between the ages of 18 and 49 and was admitted at Trinity Health Ann Arbor Hospital, said Susan Ringler Cerniglia, public information officer for the Washtenaw County Health Department.

"They were hospitalized initially but are doing well," Cerniglia said in an email message to the Free Press, noting that the patient could be discharged Tuesday. "... Other than the potential exposures in the ER waiting/triage, there is only household exposure. Household contacts have been vaccinated and are currently quarantining."

None of the three people in Michigan with confirmed measles cases — an Oakland County child with a history of international travel whose case was announced Feb. 23; an adult from Wayne County and an adult from Washtenaw County — has any record of having received the measles, mumps, rubella vaccine, Wuth said. The three cases also are not connected in any way.

Wayne County Public Health didn't disclose any details about the person infected with measles who visited the health care sites in Dearborn and Dearborn Heights.

"To protect patient confidentiality, we cannot provide details on the case investigation or medical care," said spokesperson Kimberly Harry. "The contact investigation is ongoing. We have released public exposure notifications and have been reaching out to individuals who may have been exposed. "

The child from Oakland County was isolated and is not believed to have exposed others to the virus, Faust said.

The U.S. Centers for Disease Control and Prevention reported that, as of Feb. 29, 41 measles cases had been identified in 16 states: Arizona, California, Florida, Georgia, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, Virginia and Washington.

How to get a measles vaccine

Most pharmacies and doctors' offices offer the MMR vaccine. In addition, you can get the vaccine through your local health department. Here are details for Wayne, Washtenaw and Oakland counties:

Wayne County Public Health: MMR vaccines are available at no cost for children with Medicaid and for those who are uninsured or underinsured. The county health department also provides the MMR vaccine to adults who are uninsured or underinsured for no cost or a fee of $10. Vaccines are available at the Public Health Clinic, 33030 Van Born Road, Wayne. Call 734-727-7101 for details. To learn more about measles resources and vaccines in Wayne County, go to www.waynecounty.com/measles.

Washtenaw County Health Department: The MMR vaccine is available for adults or children without insurance for $23. For anyone who can't afford the $23 fee, the cost can be waived, Cerniglia said. Children eligible for the Vaccines for Children program may receive the vaccine for free. To learn more, go to washtenaw.org/health or call 734-544-6700.

Oakland County Health Division: Vaccines are available through the north and south clinics in Pontiac and Southfield. To schedule or to get more details, call 800-848-5533. Those seeking vaccines do not need to live in Oakland County to be eligible for shots at the health division's clinics. For adults, depending on insurance coverage and ability to pay, vaccines can range in cost from the $7 administration fee up to $76 per dose.

Detroit Health Department: Vaccinations for measles and all childhood vaccination series, plus COVID-19, flu, and RSV are available at its Immunizations Clinic at 100 Mack Ave., Detroit. Hours are 8 a.m.-4:30 p.m. Mondays-Fridays. Late hours are available on the first and third Thursdays of each month until 6:30 p.m. For more details, go to: www.detroitmi.gov/health or call 313-876-4667.

Contact Kristen Shamus: [email protected]. Subscribe to the Free Press.

This article originally appeared on Detroit Free Press: Measles in Michigan: Hundreds potentially exposed in Wayne, Washtenaw