In El Paso, measles is infecting more adults than children

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As soon as measles started spreading in West Texas, El Paso health officials began preparing schools and day care facilities for the day the virus would inevitably arrive.

But now that it's here, it’s not kids who are making up the brunt of the cases — it’s adults. Two-thirds of El Paso’s cases so far are among people over the age of 18, and only 7% are among school-age children.

Anyone unvaccinated can contract measles, but it tends to hit children first and hardest. Most children are not fully vaccinated until they are five years old and they spend more time than adults in congregate settings where the virus can spread quickly. More families of young children are opting out of vaccines, leaving them exposed.

Gaines County, the epicenter of the outbreak, followed this traditional path, starting with school-age children before spreading to adults. Almost six months into what is now the country’s largest measles outbreak since 2000, Texas’ 722 cases are about evenly spread between the three age groups the state divides them into: under four, 5-17 and adults.

El Paso stands out for its high rate of adult infections. The county only has 56 cases so far, the third-highest among Texas counties but still too small of a sample size to conclude much, public health experts say. But if this trend holds, it may be a credit to El Paso’s high vaccination rates among kids — 96% of kindergartners and 98% of seventh graders are fully vaccinated for measles, higher than the percent required to maintain herd immunity. The state does not track adult vaccination rates.

“That is one of the protective factors that we feel is helping us,” said El Paso public health authority Hector Ocaranza. “But still we’re going to continue to see cases of measles that are going to be clustering in some of the schools or day cares that have low immunization rates.”

These surprising initial statistics have required public health officials to change their outbreak response on the fly. They’re aiming more of their vaccination events specifically at adults, especially as many health care providers who serve adults do not have the measles-mumps-rubella vaccine on hand the way pediatricians do.

“Most of the adults, they don’t remember whether they’ve had the MMR vaccine,” Ocaranza said. “They were kids, and nobody has a shot record.”

Adults unsure of whether they were vaccinated as children can safely get another round of the shots, said Patsy Stinchfield, past president of the National Foundation for Infectious Diseases and a measles expert.

“If you did have two [shots] already, it will only make your full antibody cup even fuller,” Stinchfield said.

Older adults especially should consult with their doctor about their immunization status, she said. People born before 1957 are presumed immune, since the virus was so common back then, but some people who got an early version of the vaccine between 1963 and 1967 may not have gotten the same protection as later shots.

The exceptions, she said, are people who are immunocompromised, pregnant women or the tiny minority of people who have had a bad reaction to the vaccine in the past. Those people are counting on everyone else’s vaccination status to keep them healthy.

Healthy adults are generally able to fight off the worst of a measles infection, but anyone who gets infected runs the risk of it morphing into pneumonia or worse, said Ben Neuman, a virologist at Texas A&M University. Three of the five hospitalizations in El Paso so far are in adults.

And anyone with measles will spread it in the community, potentially to children too young to be vaccinated who are especially vulnerable to the worst outcomes, like encephalitis, deafness, blindness and permanent brain damage.

“Especially kids two years and under, their immune systems are just bad at everything,” Neuman said. “We’re all sort of helping them out with our herd immunity.”

Neuman said it’s possible that El Paso’s high rate of adult cases is “the first sign of something weird,” but he anticipates the data will start to look more normal as more people get tested.

El Paso borders the Mexican state of Chihuahua, where the outbreak that originated in Texas has taken hold due to the large Mennonite communities in both places. Ocaranza said measles doesn’t respect borders, and he anticipates it spreading vociferously on both sides of the U.S.-Mexico line now that it’s in El Paso.

The messaging is the same, whether it’s children or adults who are testing positive, in Mexico or the United States, he said: Get vaccinated.

“We welcome anybody who needs the vaccine,” he said. “We can vaccinate regardless of their place of residence, regardless of their immigration status, regardless of the ability to pay … Everyone needs to join forces to stop this.”

Disclosure: Texas A&M University has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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