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There have been no reported cases of measles in the state of Montana as of Tuesday morning, but at least one local health official believes it is likely the virus will be seen at some point in Montana due in part to the state's proximity to areas with known recent outbreaks.

"I fully expect that at some point along the way we'll get a case," said Kim Bailey, the communicable disease program manager at RiverStone Health in Billings. "With the outbreak that was in Washington, they're very close neighbors with us and there are a lot of people that travel back and forth and it just is very likely to happen." 

Currently, known measles outbreaks are in Maryland, Georgia, California, New Jersey, Michigan, and New York. An outbreak that began in southwest Washington state and afflicted more than 70 people is believed to be over, due to no new infections having been discovered within the past six weeks, the Associated Press reported Monday. That outbreak was first reported about four months ago.

In 2019 cases of measles have also been reported in Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kentucky, Massachusetts, Missouri, Nevada, New Hampshire, Oregon, Texas and Tennessee.

The United States has the greatest number of measles cases reported since 1994. Measles was declared eliminated in 2000, according to the Centers for Disease Control. Through April 26, 2019, a total of 704 individual cases of measles have been confirmed in 22 different states, according to the CDC.

A fever, runny nose, cough, red eyes and sore throat are all beginning signs of measles, which can then develop into a body rash, according to the CDC. Children younger than 5 and adults older than 20 are the most likely groups to suffer complications from measles.

Those complications can be fatal. Common complications include ear infections and diarrhea. Pneumonia, also known as an infection of the lungs, occurs in one out of every 20 children with measles. Brain swelling, known medically by the term encephalitis, is another complication that has been observed in children with measles. One out of every 1,000 children with measles develops brain swelling, which can cause "intellectual disability," deafness, or death, per the CDC. Both pneumonia and brain swelling complications from measles can kill children. The CDC reports that between one and two children out of every 1,000 infected by measles die. 

The measles virus is present in the nose and throat mucus of infected people and can be spread through coughing and sneezing. The CDC reports the virus can live for hours in airspace where an infected person coughed or sneezed, and that an infected person remains contagious for four days before they develop the measles rash and four days after. 

"Measles is so contagious that if one person has it, up to 90 percent of the people close to that person who are not immune will also become infected," according to CDC information. 

Bailey recommends people be informed about their own vaccination status and act accordingly. The measles vaccination is administered in what is called an MMR vaccine, which vaccinates against mumps and rubella in addition to measles.

In order to be effective the vaccine must be administered twice, and at least 28 days must pass between the first and second doses, Bailey said. 

The earliest a child can be vaccinated for measles is at 6 months of age. 

If someone believes they've been exposed to measles Bailey said RiverStone's "strong preference" is that they call a health care provider rather than showing up at the facility. 

"We don't want them just going to the emergency room or same day care when they could possibly be infectious and exposing large numbers of people," Bailey said. "So we would want them to call ahead and talk with the receptionist at their provider and tell them what their situation is and get some advice about where to go and how to be seen."

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Someone who thinks they have been exposed to measles would likely be asked about their travel history, if they've had out-of-state visitors from areas with known measles cases, what kinds of signs and symptoms they've experienced and the timing of those signs and symptoms. 

"And we would just do an assessment like that to get a feel for what their unique situation is," Bailey said. "We would look at their immunization record and we'd take those things into consideration and then if we felt like it was very possible we would help make that arrangement for where a person could be seen and provide other direction as needed."

Vaccines do not cause autism, but the unfounded fear that they do has cut into vaccination rates in recent years. One of the more common debunked theories is that mercury-based preservative thimerosol, which the CDC says is used to prevent contamination of multidose vials of vaccines, causes autism. The CDC states on its website that it has funded nine different studies since 2003 "that have found no link between thimerosol-containing vaccines and ASD (autism spectrum disorder), as well as no link between the measles, mumps and rubella vaccine and ASD in children."

The Washington Post reported in October 2018 that the percentage of children younger than 2 who haven't received any vaccinations "has quadrupled in the last 17 years."

In Yellowstone County, data from 2016 shows that 86 percent of kids from 24 months to 35 months have had at least one measles, mumps, rubella immunization, according to Bailey. That puts the area below the national average for 2016, which was about 91.1 percent, she said.

Currently, 97 percent of students in Yellowstone County from pre-kindergarten through 12th grade are up-to-date on their immunizations, Bailey said. 

Ultimately, Bailey said vaccination is something that benefits not only individuals but the communities they live in.

"There are always those people who are vulnerable who will contract the disease and will have very serious complications from it and could even die from it," she said. "It's not just about that particular person, it's about our community as a whole and doing the right thing not only for ourselves but for others."

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Night Reporter

General assignment reporter for The Billings Gazette.