In North Dakota, the rate of measles vaccination in infants is higher than the national average, but lower than the desirable level in children entering kindergarten, said an official with the state health department.

Measles cases, and some outbreaks, have been reported in 10 other states and the illness could spread to this state if, for example, a traveler becomes infected elsewhere and spreads the illness to unvaccinated people here, said Molly Howell, immunization program manager in the department's Division of Disease Control.

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"It's only a plane ride away," Howell said.

"Europe is experiencing a large number of cases; there's an outbreak in Washington; Texas has had a number of cases now; New York is having an outbreak," she said. "It would just take one (infected person) to come to North Dakota."

The last case of measles in North Dakota was an adult living in Cass County in 2011, Howell said.

Public health officials recommend all children be vaccinated against measles at ages 12 to 15 months and 4 to 6 years. Measles is included in a combination vaccine with mumps and rubella, called the MMR vaccine.

In North Dakota, the MMR vaccination rate of infants is 95.7 percent, above the national average of 91.1 percent. But the state's rate for MMR vaccination of children entering kindergarten for the 2018-19 school year was 93.83 percent, short of the state's goal of at least 95 percent.

"Measles is so contagious; that's the goal you need to prevent the spread of measles," Howell said. "It's the rate you need to reach what we call 'herd immunity.' "

The department conducts informational initiatives to alert parents to the need for and reasons behind childhood vaccinations, and works closely with schools and health care providers to encourage vaccination, she said.

Between Jan. 1 and Feb. 7, 101 cases of measles have been confirmed in California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas and Washington, according to the Centers for Disease Control and Prevention.

In 2018, 372 cases were reported to the CDC, preceded by 120 cases in 2017; 86 cases in 2016; and 188 cases in 2015.

Measles outbreaks are attributable to an increase in the number of travelers who get measles abroad and bring it into the United States, or the further spread of measles in U.S. communities with pockets of unvaccinated people, according to the Centers for Disease Control and Prevention.

"About 4 percent of kids entering kindergarten this year have parents who have chosen not to have them vaccinated," Howell said. "Basically, if you're not vaccinated and you're exposed to measles, nine times of out 10, you will contract measles. That's how contagious it is."

From a public health perspective, measles is difficult to combat because it's airborne, whereas the spread of other diseases requires close contact, and the infected person can identify who may have been exposed, said Howell.

"With measles you have to cast a wider net, so to say," she said. "There are more public places (where exposure could occur); it's more easily spread."

Symptoms include fever, dry cough, runny nose, sore throat, inflamed eyes, tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek, and a skin rash made up of large, flat blotches that often flow into one another.

"If you're infected and you're sitting in a walk-in clinic or emergency room, because it's airborne, you can spread the disease to everybody who's in the waiting room area," she said. "(The virus) also can hang in the air for a couple of hours."

Emergency response

The North Dakota Department of Health has sent a five-member team of volunteers to Washington state in response to a measles outbreak there.

The response team is composed of one member from Fargo, one from Jamestown and three from Bismarck. They are working in logistics, operations and planning to relieve members of the Washington state response team who is dealing with an escalating measles outbreak in Vancouver, Wash., said Tim Wiedrich, section chief of the Emergency Preparedness and Response unit of the state health department.

Washington Governor Jay Inslee declared a state of emergency Jan. 25 because of the outbreak. Since Jan. 1, health officials there have confirmed 53 confirmed cases and two suspect cases in Clark County, Howell said.

Of the 53 confirmed cases, 47 were unvaccinated; in five cases, vaccinations were unverified, and in one case the person has had one dose of the MMR vaccine-it is recommended that people have two doses.

Washington state requested the specialized team through the Emergency Management Assistance Compact, which permits a disaster-impacted state to request and receive assistance from other member states quickly and efficiently, Wiedrich said.