A massive measles outbreak brings upon a state of emergency in Washington state that began Jan. 25, 2019. With 36 confirmed cases and 11 suspected cases as of Monday in Clark County, which sits just north of Portland, Oregon across the Columbia River, Governor Jay Inslee has declared the outbreak a threat to public health. In a proclamation, Governor Inslee expressed his concern regarding the potential damage of this outbreak.

“The measles virus is a highly contagious infectious disease that can be fatal in small children and the existence of 26 confirmed cases in the state of Washington creates an extreme public health risk that may quickly spread to other counties,” Inslee said on Friday.

Of the 36 cases, 21 are between ages 1 and 10 years old as of Sunday. The Washington State Department of Health has implemented an infectious disease Incident Management Structure and the Washington Military Department has coordinated resources to assist. County officials have stated that infected persons went to multiple public locations, including Portland International Airport, and may have spread the disease further.

Outbreaks of the measles virus in 2019 have drawn attention to a critical global health issue, especially considering that the Centers for Disease Control and Prevention (CDC) declared the disease eradicated in the United States in 2000.

“Measles was declared eliminated (absence of continuous disease transmission for greater than 12 months) from the United States in 2000,” the CDC wrote in its report. “This was thanks to a highly effective vaccination program in the United States, as well as better measles control in the Americas region.”

Deemed an anti-vaccination hot spot, Clark County demonstrates the symptoms of a much larger issue. The number of measles cases worldwide increased by 30 percent in 2017 compared to 2016. Despite the CDC’s claim, 2018 was the second worst year for the disease since 2010 with 349 cases, an approximately 290 percent increase since 2017.

Without immunization, 90 percent of individuals in contact with measles will develop the disease. Numerous communities, including Clark County, fail to develop herd immunity to protect young children or immunocompromised individuals, in which the disease can be fatal.

“Herd immunity describes how a population is protected from a disease after vaccination by stopping the germ responsible for the infection being transmitted between people,” said Dr. Manish Sadarangani, director of the Vaccine Evaluation Center in the BC Children’s Hospital Research Institute. “In this way even people who cannot be vaccinated can be protected.”

Without over 92 percent to 94 percent of the population immunized, herd immunity will not serve as an effective method to protect people who cannot receive immunization. 

“By being vaccinated, an individual is not only protected from being infected themselves but they then also cannot pass this infection onto other people, where it may cause severe disease,” Sadarangani said. “However, for herd immunity to work, a large proportion of the population needs to be vaccinated.”

“Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year and a further 1.5 million could be avoided if global coverage of vaccinations improved,” the WHO wrote.

Without confidence in vaccinations and accessibility of immunization, eliminated diseases may experience a resurgence in the coming years. The Clark County outbreak demonstrates a preventable addition to the return of measles and other diseases around the world.

“All this stuff that we’re going through and the cost, the suffering and potential complications that we’re going through here are completely preventable through an incredibly safe, incredible effective, incredibly cheap vaccine,” said Dr. Alan Melnick, public health director for Clark County. “That’s what frustrates me and keeps me up at night.”