Measles Outbreak Risks: Dallas, Texas

A recent study highlighted the measles risk in the state of Texas related to the increasing ‘under-vaccination’ rate of students.

On August 21, 2019, David R. Sinclair, Ph.D., of the University of Pittsburgh, and colleagues published research that estimated the potential risk of future measles outbreaks in Texas cities.

Dr. Sinclair’s modeling study suggests that a 5 percent decrease in vaccination rate could be associated with a 40 to 4,000 percent increase in measles cases, depending on the metropolitan area.

"At current 2018 vaccination rates, there's a significant chance of a measles outbreak in some Texas cities," said Sinclair in a press statement.

This is important news since the Centers for Disease Control and Prevention (CDC) says measles is a highly infectious disease with approximately 30 percent of patients having complications.

As of August 22, 2019, there have been 125 individuals who got measles this year who were hospitalized, and 65 reported having complications, including pneumonia and encephalitis.

While this study identified outbreak risks from negative trends in academic vaccine exemptions, the actual risk to an area such as the Dallas - Fort Worth (DFW) metroplex could be far greater for 3 reasons.

In addition to academic vaccine exemptions, the vast number of the DFW area’s international visitors and large events create significant measles exposure risks, such as the following:

Risk #1  - International travel measles risk

• The DFW airport is the world’s 12th busiest, receiving about 68 million passengers a year, with nearly 4 million international travelers from more than 60 international destinations. These international tourists are a positive influence, contributing nearly $1 billion dollars in economic impact annually.
• And the worldwide measles outbreak continues in 2019. Already this year, there have been over 90,000 cases of measles confirmed in Europe. Which is an unfortunate trend when compared with just 84,000 cases during 2018.
• During 2018, international travelers from Europe were identified as a source of the expansive measles outbreak in Brooklyn, New York. According to the CDC, the state of New York is responsible for over 75 percent of all measles cases in the USA during 2019.
• And the international measles risk is expanding during 2019. As of August, there have been 4 countries that lost their measles-free certification, including the United Kingdom. This impacts DFW because London’s Heathrow airport is a leading destination for travelers to and from the DFW airport.

Risk #2 - Increasing academic vaccination exemptions

• As of June 2019, vaccine exemptions for religious or personal reasons are permissible in 45 states. And, Texas is one of a few states that grant school vaccine exemptions on the basis of ‘reasons of conscience’, which encompasses philosophical or religious objections.
• Since 2003, the number of reported conscientious exemptions, including personal and religious exemptions, among Texas students has continuously increased from 2,300 to 64,000, which is a growth factor of 28.
• And, since 2006, when the state of Texas first reported this data, the vaccination exemption rate for kindergarteners in Texas has risen from 0.3 percent for the 2005-06 school year to 2.15 percent for the 2018-19 school year.
• Furthermore, private schools in the DFW area appear to be leaders in vaccine exemptions, with the Alliance Christian Academy in Fort Worth reporting the 2nd highest exemption rate in Texas at 40.6 percent.

Risk #3  - Attending large events includes measles exposure risks

• The CDC said in July 2019, ‘attending large events increases a person’s risk for becoming infected with the measles virus.’ This CDC warning is because measles is a very contagious virus, which can be easily spread with a ‘sneeze’ from an infected person. This means anyone not immune from the measles virus could become infected while in a large crowd.
• Since the state of Texas does not require ‘measles immunity’ verification to attend music concerts, theatrical performances or community festivals, an unvaccinated person has an unquantifiable risk when attending large events.
• Moreover, Texas’s football traditions create significant health risks for under-vaccinated individuals. In the DWF area, over 500,000 sports fans aggregate in various football stadiums during the Fall season. From the Texas ‘Friday Night Lights’ high school games, followed by exciting college games at TCU and SMU on Saturday afternoons. Best known of all is ‘America’s Team’, the Dallas Cowboys football franchise. The ‘Boys’ draw over 75,000 fans to Arlington, Texas, on most Sundays.
• The best example of proactively reducing infectious disease risks during a sporting event was the Indianapolis 500 Race. At the 103rd Running of the Indianapolis 500 in May 2019, on-campus vaccination clinics were offered to 200,000 patrons by local health departments and the Indiana University.

But, does the Dallas area really have a measles outbreak risk?

The Texas Department of State Health Services (DSHS) reported the DFW area has only 1 measles case during 2019.

But, Texas’s overall measles risk appears to be increasing. 

There have been 21 measles cases as of July 29, 2019, which compares with 9 confirmed measles cases in 2018 and just 1 in 2017, reports DSHS.

The CDC says the best way to avoid the measles virus and help protect those who are immunocompromised is by completing the 2-dose vaccination series. 

And in some cases, receiving a 3rd booster dose to mitigate ‘immunity-waning’ concerns.

The CDC says either the MMR II or Proquad vaccine can protect yourself, your family and others from this infectious disease.

‘You are at risk of measles infection when you travel to areas where measles is spreading (in the USA or internationally) and have not been fully vaccinated against measles or have not had measles in the past,’ says the CDC.

"In light of the resurgence of measles in the United States, it is becoming more important than ever to get vaccinated," said Chris Felton, PharmD, Clinical Pharmacist, MTM and Immunization Specialist for Brookshire Grocery Company. 

"If you have not received the measles vaccine or you are not sure about your immunization status, talk to your pharmacist or doctor. Get immunized for yourself, for your loved ones, and for your community," continued Felton.

In the Dallas, Texas area, measles vaccines are available in most pharmacies, including Brookshire's Grocery Pharmacy and United Supermarkets. 

Measles vaccine financial aid programs can be found at Vaccine Discounts.  

And, the CDC says vaccines can cause side effects, which should be reported to a healthcare provider, or to the CDC.