Updated 6:30 p.m. with additional information about the local exposure

The Cascade City-County Health Department was notified June 3 of a measles exposure in Great Falls to a person from Hill County who has since been a confirmed measles case.

Abigail Hill, county health officer, told the county health board during their regular June 4 meeting that they were notified by the Montana Department of Health and Human Services that one of the case in Hill County was a person who had come to Great Falls on May 27 for an appointment.

When they returned to Hill County, the person started having symptoms on May 29, which is in the window of contagiousness while the person was in Great Falls, she said.

CCHD recommending early measles vaccinations for infants traveling to Hill County

CCHD is investigating the exposure and working with the building where the exposure occurred, which was not publicly disclosed during the meeting, to develop a list of people who were in the building at that time to determine exposure.

Since the offices in the building share a ventilation system, Hill said currently, CCHD is considering the entire building as exposed if anyone was unvaccinated or not otherwise immune.

Hill said her staff is working with businesses in that building to determine the exposures and what quarantine and isolation measures are needed.

She said they hope anyone exposed is quarantining themselves if they’re unvaccinated or don’t have immunity to prevent local community spread.

Based on the date of exposure, Hill said June 4 would be the earliest day any of those exposed would show symptoms, but more likely that will occur next week.

First measles cases confirmed in Montana

CCHD sent a release several hours after the health board meeting and said that the exposure was May 27 from 1:30-5:30 p.m. at the Prospect Heights Medical Center, 401 15th Ave. S.

The building includes Central Montana Orthopedic Specialists, Sun River Health, Atlas Neurology, office of Dr. Susan Avery, Quest Diagnostics and Northwest Physicians.

Anyone present in the building or any businesses within the building during those hours is considered likely exposed to measles, according to CCHD.

As CCHD conducts their investigation to determine who was exposed, depending on the contact information available, CCHD will notify those individuals and provide further instructions by phone call, text message and/or letter.

Anyone who thinks they were exposed but aren’t contacted by CCHD in the next few days, may contact CCHD at 406-791-9242 for directions.

Those exposed with presumed immunity don’t need to quarantine but should monitor for symptoms for 21 days after the exposure.

Those who don’t have presumed immunity are advised to state home for 21 days and monitor for symptoms.

“Anyone exposed to measles should also talk to their healthcare provider to understand their individual risk of measles and should consider postponing routine medical care at least 21 days from their last exposure,” according to CCHD.

The first symptoms of measles usually appear about 7-14 days after exposure: fever, cough, runny nose, red watery eyes and/or white spots in the mouth. A red rash—usually beginning near the hairline and moving downward—typically begins about 2-3 days after the first symptoms, according to CCHD.

Anyone who develops symptoms should stay home except for testing or urgent/emergency treatment.

Call Benefis Health System at 406-731-8300 to arrange for testing or urgent care.

“It is extremely important that you do not enter a clinic building without calling ahead to the clinic so that precautions can be taken to avoid exposing others,” according to CCHD.

Hill County now has three confirmed cases, according to Hill and DPHHS.

Hill said they don’t yet know if the person from Hill County had lunch or went anywhere else in Great Falls while they were here for their appointment, but the health agencies are investigating.

The person in question got the MMR vaccine after developing symptoms, but it was outside the recommended 72 hours from exposure.

She said there’s a chance the case tested positive because of the vaccine, but the person is symptomatic so it’s being treated as a positive case unless determined otherwise.

Hill said that it’s still recommended to get the measles vaccine after an exposure, even outside the 72 hour window, since it can lessen symptoms and chance of hospitalization and can impact isolation or quarantine measures.

CCHD recommending measles vaccines while local agencies preparing for potential cases

For anyone who isn’t vaccinated or immune who’s exposed to a positive measles case, Hill said it will be recommended that they quarantine for 21 days due to the high transmission of the virus and its incubation period.

Hill County has its first positive measles case in late May and the person had been at a private event with people who were unvaccinated, so public health officials have been anticipating community spread there.

“They are on alert,” Hill told the Cascade County health board.

Since that’s a close neighbor, CCHD worked with DPHHS to issue last week a recommendation for an early and accelerated vaccination schedule for anyone traveling to Hill County, including infants aged 6-12 months. Typically children are recommended to get the MMR vaccine at one year.

Hill County now has three cases.

As of June 3, there are 17 total measles cases in Montana, including two hospitalizations, according to DPHHS.

Two were added in Yellowstone County, but those were people who had returned after being sick elsewhere, Hill said.

There are two cases in Flathead County and 10 in Gallatin County.

Since there’s no positive cases yet in Cascade County or community spread, Hill said they’re not currently recommending early vaccines for infants unless they’re traveling to Hill County.

If there is community spread here, she said CCHD will look at holding vaccine clinics.

Hill said CCHD is working with community partners to remind the community that if you’re symptomatic, not to walk into a facility, but to call ahead and providers can do testing in their cars to limit the spread. If a symptomatic person enters a facility, that creates a wider exposure, she said.

The health board further discussed their quarantine and isolation measures during their June 4 meeting.

The 21 day quarantine or isolation is due to the high transmission and incubation period.

“That is a big ask” for anyone to say they can’t go to work or daycare for 21 days, Hill said.

State law gives health boards the authority to adopt measures to prevent the spread of infectious disease and authorizes public health officers to implement those measures.

Isolation applies to a positive case when a person is sick, quarantine is for those exposed but not symptomatic or positive at that point.

She said there’s some complications in preventing spread since under state law they aren’t able to discriminate based on vaccine status for the most part, but the law carves out some exceptions for schools and daycare facilities.

Those facilities are allowed to have vaccine requirements and can exclude children during illness or outbreaks.

Michele Levine, a deputy county attorney, said that DPHHS had issued guidance in 2023 after a 2021 state law went into effect regarding vaccine status discrimination.

She said there were some failed attempts during the most recent legislative session to revise that law so there have been no changes to the law.

DPHHS has culled that guidance and is now saying they don’t think it applies to the law, but “we see no change in the law for a change in interpretation.”

She said that exception for daycares and schools was a key part of passing the 2021 law to ensure the ability to manage infectious disease and outbreaks since the other option if they weren’t able to consider vaccine status would be to shut down entire daycares.

But, the exception only applies to children and does not apply to staff, she said.

Levine said county legal staff has discussed with their counterparts in other counties and so far, they agree there’s no change in the interpretation of the law.

She said given the rise in measles cases, the issue could be litigated and “would be a novel and new area of litigation.”

The board and county officials said they have concern with the issue since school’s about to be out and the exceptions don’t necessarily apply to summer camps, which could be vectors for measles.