Few of the counties around Kansas City have enough vaccinated against measles to prevent spread

Amber Schmidtke, a microbiologist, remembers feeling a tinge of relief five years ago as COVID spread across communities.

At least it wasn’t measles.

“Measles is the most contagious disease we have,” said Schmidtke, who teaches at Kansas City University.

But now, she and other public health experts are watching with alarm as the largely preventable virus marches toward Kansas City in the nation’s largest outbreak since 2019.

So far this year, health officials have confirmed 884 cases across the country, including 46 in southwest Kansas. One Missouri case reported on April 18 involved a child visiting the Branson area.

Marvia Jones, director of the Kansas City Health Department, said her agency will be as prepared as possible when cases reach the metro. But there’s little doubt about whether they will come.

“It’s clear to us that measles is just a car ride away from Kansas Citians,” Jones said at an April 29 press conference that was called to urge people to get vaccinated before the virus gets here.

But rising vaccine skepticism, falling immunization rates and recent major cuts to federal public health funding are all working against efforts to quickly end the current measles outbreak, health officials said.

“This makes me heartsick,” said Lynelle Phillips, president of the Missouri Immunization Coalition. “I think more children will be struck down and killed by a completely preventable outbreak of measles. And I think the question to us as Americans is how many of these children will have to die before we realize the mistake we’ve made?”

Three deaths have been attributed to the outbreak so far, including two children in Texas and an adult in New Mexico.

Unlike the start of COVID when there was no vaccine, a highly effective measles vaccine is widely available. Until recently it was also widely adopted.

By 2000, 37 years after the measles vaccine was introduced, United States health officials could declare measles eliminated because there hadn’t been continuous spread for more than a year.

Now, that designation is in danger as measles cases spread. So far, the outbreak has reached 30 states. The largest cluster is in Texas, where 663 cases have been confirmed since late January.

The rise in measles infections, health leaders said, can be directly linked to low vaccination rates.

Herd immunity for measles, when the virus is unlikely to spread, requires a vaccination rate of 95%. But communities and schools are increasingly slipping below that mark. And where that happens, an outbreak becomes much more likely.

In Kansas City, three ZIP codes fall below the 95% threshold, city health officials said.

• 64114 in the Waldo area has an immunization rate of 93%.
• 64151, where Lake Waukomis is located north of the river, is at 92%.
• And 64155, where the upscale Staley Farms development is located, has a vaccination rate of only 84%.

Jones said these undervaccinated ZIP codes will get special attention as the city works to convince more people to let their kids get vaccines. The health department plans to hold community meetings in these areas in hopes of answering questions and easing hesitancy.

“We are doing all we can to add outreach and have real conversations,” Jones said.

The health department also will extend the hours it offers vaccinations. Beginning May 14, vaccines will be available at 2400 Troost Ave. until 7 p.m., and Saturday hours will begin May 17. For an appointment, people can call 311, but appointments are not required.

Parents, faced with an internet awash in inaccurate information about vaccinations in general and the measles vaccine specifically, are more often skipping routine childhood immunizations.

Two doses of the MMR (measles, mumps and rubella) vaccine are recommended for children. The first dose is recommended at about 1 year old, and a second dose when a child starts school, between 4 and 6 years old.

During the 2023-24 school year, immunization rates for kindergartners fell to 92.7% nationwide, from 95.2% during the 2019-20 school year. In Missouri, the rate went from 94.6% in 2019-20 to 90.4% in 2023-24. In those same years, Kansas’ rate climbed slightly, from 90% to 90.4%.

Six metro counties showed MMR vaccination rates below 95% for kindergartners in the 2023-24 school year.

Schools require children to have the MMR and other vaccinations in order to attend kindergarten, but states allow exemptions for religious or medical reasons. And those exemptions have been on the rise.

The Staley Farms ZIP code’s religious exemption rate doubled to 14% last year from 7% in 2019, city officials said. According to state records, private schools in Clay County, where the ZIP code is located, had a religious exemption rate of 13.4% in 2023, compared with 5.4% in 2019.

In Kansas, the statewide exemption rate was just over 1% in the 2010-11 school year. But by the 2023-24 year, it was up to almost 3%. And Missouri’s statewide rate is getting close to 5%, said Dr. George Turabelidze, Missouri’s state epidemiologist.

Phillips said the increase can also be traced to a change in Missouri law that took effect at the beginning of 2024, lowering barriers for parents to get vaccine exemptions for their children. It’s now as simple as filling out a form online and submitting it to the school.

“Prior to that, you would have to make an appointment at the health department and meet with a public health nurse,” Phillips said.

Parents who oppose vaccines objected to the state’s previous exemption requirements, saying they violated their speech and religious rights.

But Phillips said the added step of going to the health department gave parents an opportunity to learn about the health consequences of choosing to forgo their child’s vaccinations. And they also found out that children who are unvaccinated have to miss weeks of school if they are exposed — even if they don’t get sick.

Public health officials understand that a growing number of people are afraid of having their kids vaccinated. In part, they blame strong anti-vaccination views that took root during the COVID pandemic related to the vaccines developed to treat that virus.

“That (skepticism) spills over to other vaccines as well,” Turabelidze said.

In addition to fueling anti-vaccine views, the pandemic also led to more distrust of public health agencies, which became the face of shuttered schools and businesses and other restrictions that some people abhorred. That distrust has made it even harder to get accurate information to people who may be worried about unfounded claims about vaccines that flourish on the internet.

One of the most persistent myths — that the MMR vaccine is linked to autism — has been especially common, Turabelidze said.

“It’s been debunked so many times, I can’t even count,” he said. “But people keep repeating this myth.”

Now, many fear that the vaccine doubts have been given more credibility with the appointment of vaccine skeptic Robert F. Kennedy Jr. as the U.S. secretary of Health and Human Services.

As Missouri’s immunization rates have slipped, Turabelidze said the state Department of Health and Senior Services has been working to increase outreach and education efforts, especially to schools or communities with lower vaccination rates.

Those communities are sitting ducks for such a highly contagious virus, health experts said.

Nine out of 10 unvaccinated people exposed to measles will get sick. And the virus can infect people who don’t even come into contact with someone who has it. Measles spreads when people talk, cough or sneeze, but can linger in the air for three hours.

“If I had a person in my class that had measles and didn’t know it and they left, everyone who enters that classroom for the next several hours could get it,” Phillips said. “It’s really difficult to manage transmission when you realize just how infectious measles is.”

And the measles virus can be dangerous. One in five people who get the virus end up in the hospital, Dr. Susanne Luedtke, an infectious disease specialist at University Health, told reporters during the April 29 press conference hosted by the Kansas City Health Department.

One in 20 children contract pneumonia with measles. The disease can cause brain swelling and serious long-term side effects like seizures, hearing loss and a condition called immune amnesia, which can destroy a child’s immune response. And between one and three of every 1,000 children who get measles will die.

“Measles is not a rash and a fever,” Luedtke said. “It’s a serious disease with real risks.”

Before the measles vaccine came along in 1963, almost everyone came down with measles before they turned 15. The telltale rash would begin at the hairline and move down the torso and out to the extremities. A high fever developed, along with symptoms like a runny nose and cough.

Of course, most people recovered as they would from the flu or another viral infection. But before the vaccine, every year an estimated 400 to 500 people died, 48,000 were hospitalized and 1,000 developed encephalitis or brain swelling.

“This is not a disease you joke around with,” Turabelidze said. “It’s highly contagious. And it can put you in the hospital. We already have three persons dead in this country. And you can also have long-term consequences.”

The Missouri Department of Health and Senior Services operates a 24-hour helpline that doctors can call if they run into a potential case of measles. Turabelidze said calls have increased as doctors, many of whom have never run into a case of measles before, grow increasingly wary of unidentifiable rashes.

“More often it’s not really measles,” he said. “But we would rather have a consultation” than an undetected case.

The state also has added capacity for the state laboratory to conduct PCR tests for measles. That service, which began in March, will reduce the time test results take, which could make a big difference in quelling an outbreak.

“We wanted to have a very, very quick response time because measles is so highly contagious,” Turabelidze said.

When measles is detected, public health agencies play a crucial role in quickly locating anyone an infected person has been around. They also track down people who have shared an inside space where the infected person could have left behind the virus.

Public health is critical in managing an outbreak. But for the system to work, experts said, the public needs to trust public health. And public health agencies need to be available to answer questions to assuage concerns, provide information to doctors and patients and offer easy access to the vaccine.

“Vaccines in the refrigerator never yet prevented a single case of infection,” said Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center. “They have to be administered… This takes human beings and it takes time.”

It also takes money. But recent federal funding cuts by the Trump administration have slashed support for public health outreach efforts.

On March 24, the Missouri Immunization Coalition, Phillips’ organization, lost all of its funding from the U.S. Centers for Disease Control and Prevention (CDC). That money funded the group’s entire budget, which means it is now “on life support,” Phillips said.

And like other public health organizations that had relied on those funds, the work the coalition had been doing — educating people about vaccines, providing transportation and other resources to improve access — is hanging by a thread.

“Vaccination rates are not going to raise themselves,” Phillips said. “The organizations involved with all of the education and logistics and support … have been dismantled. At a time when we’re witnessing a resurgence in measles, these are the ingredients of a perfect storm.”

Missouri’s Department of Health and Senior Services lost a combined $255 million in the March 24 CDC cuts. That included $135 million in projects currently underway to support the state’s public health system and about $119 million for projects that hadn’t been determined.

Turabelidze said it is unclear how the cuts will affect the state’s vaccine efforts.

The Kansas City Health Department has seen federal cuts so far of about $3 million, money that was allocated to pay for adult vaccinations and outreach, enhanced laboratory capacity and community health workers.

On April 25, the city announced it had joined a coalition of other local governments and a labor union representing government workers in a lawsuit challenging the U.S. Department of Health and Human Services funding cuts.

In a statement announcing the lawsuit, Kansas City Mayor Quinton Lucas said, “It’s important that we as cities and people stand up for common sense and public health in the courts.”

It’s also worth remembering, Schmidtke said, that eliminating outreach programs may save money in the short term. But if measles cases increase as a result, the ultimate cost will be much more. While each MMR vaccine dose costs around $2, she said, managing a case of someone who contracts measles can cost $50,000.

“I know money isn’t everything,” Schmidtke said. “But when we don’t have enough money to get the outreach, to educate the public about the importance of vaccination, to educate them about where to find it, we run the risk of really expensive outbreaks that are hard to control.”

This story was originally published by The Beacon Kansas City, a fellow member of the KC Media Collective.