The Cascade County City-County Health Department, along with Great Falls Public Schools and area hospitals, are working to educate the community about the potential impact of measles cases here.

In March, CCHD sent a letter to all daycares and private schools in the county to provide guidance and Great Falls Public Schools sent a similar letter.

Additional guidance will be distributed in the event of any confirmed measles cases in Cascade County.

As of April 7, three people have died so far this year of measles-related illnesses, amidst measles outbreaks in Texas, New Mexico, Kansas, Ohio and Oklahoma.

“There have not been any identified cases of measles in Montana since 1990, and with continued diligence we hope to maintain that trend,” according to CCHD.

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Heather Hoyer, GFPS superintendent, said during the March 24 school board meeting that measles is on their mind, knowing that people often travel during the upcoming spring break.

She said they’re working to be prepared and hoping GFPS doesn’t have to deal with any cases.

CCHD said in their letter to daycares and private schools that there’s a multi-state outbreak and that those traveling should be aware of the local measles risk in the places they plan to visit.

“CCHD is working closely with partners within the school systems and other organizations to prepare for a possible measles response. In the event of a measles outbreak within a school building, childcare facility, or similar setting, all families will receive a general notification to make them aware and provide any other CCHD guidance,” according to CCHD’s letter.

Students who are under-immunized against measles, meaning they do not have two doses of the measles, mumps and rubella, or MMR, vaccine and are identified as exposed to measles will be contacted through CCHD and given information regarding exclusion from schools or daycares.

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“Please note, it is public health policy that anyone under-immunized against measles be excluded for up to 21 days or more if there is a continued presence of measles within the school community. This will include attendees with medical or religious exemptions on file for the MMR vaccine,” according to CCHD.

The Cascade County city-county health board has been discussing the potential for measles cases and legislation currently being considered that would impact CCHD’s ability to manage such cases.

The board voted unanimously during a March 20 meeting to approve a resolution supporting the use of vaccines, particularly for school aged children, and opposing any legislation that would broaden the availability of exemptions.

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“This one does have pretty significant impacts I think on public health’s ability to respond,” Abigail Hill, county health officer, said during the meeting.

The resolution states the importance of vaccines and their impact on advancing health, curbing and reducing childhood illnesses and deaths, and protecting vulnerable populations, Hill said.

The resolution calls attention to the existing system in place for medical and religious exemptions for vaccinations within schools and that it doesn’t need to be changed, she said.

Hill said that as written, some proposed legislation includes language that makes considering a person’s vaccination status a form of discrimination, which could have a significant impact on managing illness within schools.

Hill said that currently, if there was a case of measles in schools, CCHD would work with the schools to identify kids that were underimmunized and exposed to be excluded from school for the required 21 day quarantine period.

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If proposed legislation is adopted making that a form of discrimination and vaccine status couldn’t be considered, Hill said that would create a situation in which the entire school would have to be quarantined for 21 days if they can’t identify those who are underimmunized.

“There is a potential significant impact with some language that would impede public health to be able to use our mechanisms of quarantine and isolation to control and contain disease,” Hill said. “That piece is pretty concerning to public health.”

Hoyer, a member of the health board as GFPS superintendent, said that she appreciated the resolution pointing out that they already have a mechanism in place to handle vaccine exemptions.

During their April 2 meeting, the health board discussed SB474, which passed the Senate and is now scheduled for a hearing in the House on April 9. The bill is sponsored by Sen. Daniel Emrich, R-Great Falls.

The bill would add a provision to the law allowing for “informed consent” if a “person enrolled or seeking to enroll in school may attend the school without obtaining the immunizations if the person files with the governing authority a signed statement, letter or notarized affidavit on a form prescribed by the department stating that the signed received information about the required immunization and declined to be immunized.”

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Hill said the bill, and others related to vaccine status, could create contradictions in the law and legal confusion.

Carey Ann Haight, deputy civil attorney, said that often once the Legislature concludes, there’s litigation because of a variety of issues.

“We’ll see how it plays out. It’s too early to really tell,” Haight said of SB474.

The fiscal note for the bill found that if approved, the bill could cause the loss of about $41 million in federal funding and 25 employees at the Montana Department of Public Health and Human Services.

Federal law requires states that receive the Child Care and Development Fund funding to assure children receiving the services are age-appropriately immunized and “informed consent” exemption isn’t recognized under state law.

The bill, if approved and implemented, would require DPHHS to notify all schools of its requirements, which would involve mailing about 1,026 schools at a cost of about $876.20.

In a rebuttal, Emrich, the bill’s sponsor, wrote that there would be no fiscal impact because “the informed consent exemption provided for in the bill is based on the medical doctrine of informed consent, a simple definition for which is listed in the Oxford Dictionary: permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.”

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Emrich continued that “informed consent was originally developed after World War II when the National Socialist German Workers Party (Nazi Party) subjected millions on Jews and others to medical experiments without informed consent.”

Emrich is apparently referring to the Nuremberg Code, which was developed from the Nuremberg Military Tribunal’s decision, that addresses permissible medical experimentation on human subjects.

According to CCHD, the symptoms for measles:

• usually start with fever, runny nose, cough, red eyes, and sore throat seven to 14 days after exposure
• the individual typically then develops a rash that spreads from head to toe, three to five days after symptoms begin
• about 1 in 5 unvaccinated people in the U.S. who get measles are hospitalized with more serious symptoms

“Measles is highly contagious and spreads through coughing and sneezing. The virus may remain airborne in an enclosed space for up to two hours after an infected person has left,” according to CCHD. “Vaccination is the single best way to avoid measles and prevent the spread of the disease.”

CCHD has released this vaccination guidance for measles.

Dr. Mark Lacy, the infectious disease specialist at the Great Falls Clinic, told The Electric that “measles is one of the most contagious of all infectious diseases and documented epidemics in some groups have wiped out entire populations.”

People may become ill 10-14 days after infected with the virus and are typically ill for 10-14 days, at least, Lacy said.

Infected persons can infect other people for three weeks after the onset of illness, which is why those exposed would be excluded from school for 21 days under CCHD policy.

Complications from measles include pneumonia, severe diarrhea, and encephalitis, which can be lethal. Children are most susceptible to measles but in unvaccinated communities, adults are susceptible to infection also, Lacy said.

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“There is no effective antibiotic against measles virus. The best way to reduce the chance of infection and debility from measles is vaccination. The measles vaccine has been around for 60 years and is very effective in stimulating immunity. Two doses of vaccine are 97 percent protective. The vaccine is safe and does not cause autism, but it should not be given to women during pregnancy or young infants since their immune responses differ from everyone else. Your doctor can advise on the best time for vaccination,” Lacy said.

On April 7, Health and Human Services Secretary Robert F. Kennedy Jr. posted that “the most effective way to prevent the spread of measles is the MMR vaccine.”

He said that he had also instructed the U.S. Centers for Disease Control and Prevention to “supply pharmacies and Texas run clinics with needed MMR vaccines,” along with other medical supplies, according to NPR.

Vaccines are available at CCHD (406-454-6950), Alluvion Health (406-454-6973), or from your primary medical provider.

If you are experiencing symptoms of measles, call ahead to your medical provider or health care facility before visiting, since measles is highly contagious, according to CCHD.