When Rosemary Hernandez attended a recent wellness screening at a University Health clinic, she learned her blood glucose levels were trending high and that she was due for several vaccinations.
One was needed to ward off the seasonal flu, another for pneumonia. Hernandez’s immunization records showed she also needed the measles vaccine — just like a dozen others, including children, who stopped in to the clinic on Wednesday.
Amid a growing concern about the spread of the virus that causes measles, and the nation’s first death from measles in a decade, University Health had vaccine doses available for those patients and more.
Claude Jacob, health director at the San Antonio Metropolitan Health District, plans to give a briefing at the council’s Community Health Committee Friday with case numbers and ongoing investigations into potential exposure sites.
University Health also recently released a two-part video series to answer questions about measles for the general public.
“We don’t want people to be alarmed, but being informed is an important part of being prepared,” said Dr. Jason Bowling, an infectious disease specialist and chief epidemiologist at University Health.
Measles cases are on the rise in Texas. In the span of just 20 days, the virus went from small outbreak to fatality, according to reports from the Texas Department of State Health Services (DSHS).
On Feb. 5, the state reported six cases among unvaccinated school-aged children living in Gaines County, southwest of Lubbock. Officials said at the time, given the highly contagious nature of the disease, additional cases would likely occur — and they did.
As of Tuesday, 124 measles cases had been confirmed since the late January outbreak, most of them children, and 18 people were hospitalized with the virus.
On Wednesday, an unvaccinated school-age child died from complications of measles at a Lubbock hospital. It was the first measles-related death in the U.S. since 2015 — from a disease that was preventable and considered eliminated — and came just days after San Antonio health officials warned that an infected person had visited San Marcos and San Antonio over the weekend, heightening concerns the outbreak could spread here.
What is measles?
Measles is a highly contagious respiratory illness transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes, according to DSHS. The virus can remain in the air for up to two hours after an infected person leaves an area.
Measles can cause life-threatening illness to anyone who is not protected against the virus. It is characterized by a flat red rash, and like other common respiratory illnesses, is accompanied by cough and congestion, watery eyes and fever.
The rash usually starts around the hairline on the face and travels to the body, arms and legs.
A person infected with the virus is considered contagious from about four days before they develop the characteristic rash, and for about four days after that, Bowling said.
“Obviously, we’re not outside the risk window from [the recent] exposure, but we haven’t had any cases currently here,” Bowling said. “It is a dynamic situation … and we need to just continue to monitor and continue to have good transparency with the data.”
During a measles outbreak, about one in five people who get sick will need medical care and one in 20 will develop pneumonia.
In children, measles can lead to ear infections and pneumonia, said Dr. Bowling. In about one in 1,000 cases, the measles virus can infect the brain and spinal cord and cause encephalitis (swelling of the brain), and result in coma and death.
“Young children are at higher risk for some of the complications, and particularly things like encephalitis,” Bowling said. “It doesn’t happen very frequently, but it can happen, and it’s one of the reasons we don’t want to see recurrence or resurgence of measles virus infections in the United States.”
Though the virus was considered eliminated in the U.S. in 2000, there have been periodic outbreaks.
Bowling said that changing the status of the disease from “eliminated” to “eradicated” — no longer present anywhere in the world — requires ongoing efforts and interventions, including monitoring for the virus and vaccinations.
“The case fatality rate isn’t high, but in an avoidable disease, a vaccine-preventable disease, any death is really too much,” Bowling said.
The measles vaccine came into widespread use in the early 1960s. Prior to that, the U.S. Centers for Disease Control and Prevention (CDC) estimates 3 million to 4 million people in the U.S. were infected every year, 400 to 500 people died, 48,000 were hospitalized and 1,000 suffered swelling of the brain.
The CDC recommends the MMR vaccine, for measles, mumps and rubella, be administered at 12 to 15 months of age, with a second dose at 4 to 6 years of age.
How many people are vaccinated?
In Bexar County, about 94% of children in kindergarten are vaccinated against measles, according to 2022-23 data from DSHS. (About 88% of schools or districts in the state responded to the immunization survey.)
But vaccine usage in the U.S. is variable, increasing the potential risk for outbreaks in some areas. Gaines County, where the recent cases were found, has a vaccination rate of almost 82%, one of the lowest childhood vaccination rates in Texas.
“You ideally want to see an uptake rate of 95% or higher … because that’s where you get to that herd immunity concept,” Bowling said.
While Bexar County is close to that number, “it also means we don’t have any wiggle room,” Bowling said. “If that trend were to continue to further decrease, we would potentially be at higher risk.”
In Texas, parents can opt out of vaccinations for their children if they claim a conscientious exemption. To claim an exemption due to reasons of conscience, including religious beliefs, a student’s parent or legal guardian must request, sign and submit an official DSHS affidavit form to the child’s school.
Data from the DSHS shows that the highest percentage rates of conscientious exemptions in Bexar County are mostly filed with private schools, which also have much lower student enrollment compared to public school districts.
San Antonio Christian School, which has about 1,000 students in grades PreK-12, and is located on the far North Side, has a 20% vaccine exemption rate for the measles vaccine.
Another Northside Christian school with about 200 students, the PreK-8 Buckner Fanning School at Mission Springs, has a 17.14% conscientious exemption rate for all required school-age vaccines.
Conscientious exemption rates for the measles vaccine in Bexar County public school districts range from zero to 2.7%. The lowest rates (0%) are in the Lackland and Fort Sam independent school districts; the highest rate of exemptions is at Judson Independent School District (2.7%). Judson ISD has roughly 25,000 students enrolled.
The district with the highest number of exemptions is Northside Independent School District, which reported 144 exemptions for the measles vaccine, or a percentage rate of 2.29% of its student population. Northside ISD serves more than 100,000 students.
“While we have no reason to believe at this time that any exposures have affected our schools, out of an abundance of caution we have reminded our families to review their children’s immunization records to ensure they are current on vaccinations,” Barry Perez, a spokesman for Northside ISD told the Report.
“As we do every year, these requirements are communicated to families,” Perez added. “We have also coordinated with outside agencies to provide access to immunizations for our families prior to the start of each school year.”
The district also recommends that a child with a fever of 100°F or more stay home until he or she has had no fever for at least 24 hours without fever-reducing medication.
How many people were infected?
Measles is a mandatory, notifiable condition in the state. Doctors and labs are required to report positive cases to DSHS immediately.
After Metro Health said Monday that a West Texas resident has been diagnosed with measles following a weekend visit to San Antonio, the department began “getting an influx of calls,” said Metro Health spokeswoman Sonia Lopez.
She could not provide an exact number of people who have contacted Metro Health to report they were in the identified exposure areas on Saturday and Sunday.
“We’re just continuing to monitor our residents and doing contract investigations with those who are reporting that were exposed,” Lopez said.
In the meantime, she said health authorities are using boosted social media posts to promote vaccinations, messaging that began on Feb. 20, and updating the Metro Health website.
Metro Health has also begun offering additional “pop-up” clinics to provide low-cost vaccinations for those who qualify for the Access Vaccine for Children or Adult Safety Net programs. Metro Health also accepts Medicaid and the Children’s Health Insurance Program.
Others can get the vaccine at a federally qualified center, she said, such as CentroMed and Communicare clinics, or at local pharmacies and private health care providers.
How effective is the vaccine?
One dose of the MMR vaccine is 93% effective against measles, 78% effective against mumps and 97% effective against rubella, states the CDC. By comparison, the flu vaccine is 30% to 60% effective though it can blunt the severity of symptoms.
Measles is unlike the influenza virus which can be harbored in both humans and animals, Bowling said.
“So even if people are protected, we’re never going to be able to fully eliminate [the flu] because it could pop back over from animal species into people again.”
For measles, humans are the only known reservoir, he said. “If we could get everybody vaccinated … measles potentially could be eradicated.”
The vaccine is not recommended for certain individuals, including those with severe, life-threatening allergies or a relative with immune system problems.
Washing hands frequently and avoiding people who are sick are other ways to help prevent a measles infection. Bowling said wearing a face mask in crowded indoor spaces can also be effective.
