As public health experts nationwide anxiously watch the growing measles outbreak in west Texas, New Mexico and other small pockets of cases in a growing number of other states, Arizona officials are particularly concerned that this southwestern state may be making headlines next.
There are places in Arizona where measles "could spin out of control, just like it has in Texas. The conditions are right here for that to happen in some parts of the state," Arizona Public Health Association Executive Director Will Humble told Axios. "All it takes is a spark.“
That spark could be fanned into flames by a vaccination rate below 95%. At least four counties in Arizona do not meet that vaccination threshold, creating an environment where a measles outbreak like those in other areas of the southwest could take hold. Nearly 400 cases of measles have been diagnosed in 18 states, with most of the reported cases in Texas.
Throughout the country vaccination rates are declining. While U.S. public health officials declared victory over the highly contagious measles virus back in 2000, thanks to the highly effective measles, mumps and rubella (MMR) vaccine and conscientious vaccination programs, social and political tides as well as the Covid-19 pandemic have eroded that public health win.
The public needs to take note, because measles may pose serious risks for young children and for those whose immune systems are compromised, including those with cancer. Because measles is so contagious, remaining unvaccinated can be risky for everyone.
In this article we will examine:
- Measles in Arizona
- Impact of Measles on Cancer Patients
- How Southwestern Cancer Patients Can Protect Themselves from Measles
If you or a loved one has been diagnosed with lung cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.
Measles in Arizona
Four counties in Arizona have vaccination rates below the necessary 95% threshold that experts say provides effective community immunity from measles.
For the 2023-24 school year, Gila, Mohave, Navajo and Yavapai counties all had vaccination rates at 82% and below, according to the latest Arizona Department of Health Services (ADHS) statistics. The county at the epicenter of the west Texas measles outbreak has a vaccination rate of just under 82% for last school year, according to the Texas Department of Health Services. Nationwide, the U.S. Centers for Disease Control and Prevention (CDC) statistics for last school year show the vaccination rate for the MMR vaccine is 92.7%.
Theories on why the state’s vaccination rates are falling include rising numbers of people using Arizona’s personal belief exemption. Arizona law requires children to be vaccinated for certain contagious diseases in order to attend school, unless they receive an authorized exemption for medical, religious or personal belief reasons. Medical exemptions are rare, but the ADHS has seen an increase in personal vaccination exemption rates for kindergarteners. For the 2021-2022 school year the department recorded a 6.6% personal exemption rate, while for the 2023-2024 school year that rate was 8.7%.
State | Vaccination | Non-medical | Exemption |
|---|---|---|---|
Arizona | 89.3 | Religious, personal | 8.5% |
New Mexico | 95 | None | 1.6% |
Oklahoma | 88.3 | Religious, personal | 5.7% |
Utah | 88.8 | Religious, personal | 9/3% |
Texas | 94.3 | Religious | 3.9% |
Colorado | 88.3 | Religious, personal | 4% |
Contributing factors may also include vaccine hesitancy due to misinformation about vaccination risks as well as the lack of access to quality healthcare.
"We have our pockets of kiddos that are not well-covered, and we do try and do outreach to those areas, but, obviously, that can be a challenge,” Crystal La Tour Rambaud, program manager for Pima County Health Department Vaccine and Preventable Disease, told the Cochise County Herald/Review.
Building trust between health care providers and the public to address vaccine hesitancy is key, Rambaud says, but that is a time-consuming process that is hard to implement once an outbreak is underway.
The current outbreak in west Texas, like previous outbreaks in 2019 in New York, started in a close-knit community where many individuals were unvaccinated. According to Humble, most of the cases seen in Arizona in the past have been “travel cases,” in which someone traveled abroad and brought the virus back to the state, but in communities where vaccination rates are high, that would likely not lead to an outbreak. In 2024, he says there were five unrelated cases of measles in Arizona.
The problem is, when a too many people in a community are unvaccinated — under the 95% threshold — if someone contracts the illness and enters that community, the virus will rapidly spread.
“If you have one case and you have a group of people, 90% of them, if they are unvaccinated, will get measles,” says Dr. Gary Kirkilas, a Phoenix Children’s Hospital pediatrician. Dr. Kirkilas told KPHO-TV in Phoenix that this “super contagious” virus is spread through airborne droplets that can remain contagious for up to two hours. “If you have to be sharing the space with someone or even walk past them after they’ve left a room that is enough to get measles.”
Measles can be a relatively minor infection, with symptoms including cough, sore throat, fever and a telltale red rash. But the measles virus can also lead to encephalitis, a brain inflammation that can result in brain damage; blindness and secondary bacterial infections including ear infections, diarrhea and pneumonia. The CDC estimates that one to three children out of 1,000 who become infected with measles will die.
The good news is, an extremely safe and effective vaccine exists to provide immunity. If an individual receives two doses of the MMR vaccine in their lifetime, usually administered to infants and toddlers, they are likely immune to measles.
Some adults born between 1957 and 1968, may have received a less effective version of the vaccine and should check with their doctor to see if a booster is recommended.
An adult may be vaccinated at any time, even if they have already been vaccinated and are unsure, according to public health experts at Johns Hopkins University. Cancer patients, however, should not be vaccinated since the measles vaccine is a live virus. If the patient’s immunity is compromised, as is common among cancer patient receiving chemotherapy, a stem cell transplant or other treatments, they may actually get a case of the measles, which can have devastating consequences.
Impact of Measles on Cancer Patients
Because there is no treatment for measles other than alleviating symptoms, being infected with the measles virus can be life-threatening for cancer patients.
For vaccinated cancer patients, the risks are less than for those who are unvaccinated for measles. Because the measles vaccine is a live virus, getting vaccinated once you are undergoing cancer treatment is not recommended since you could get the infection.
Cancer patients, particularly those receiving chemotherapy or stem cell transplantation are more susceptible to viral infections like the measles due to suppression of their immune system.
Studies have shown that cancer patients who do contract measles may have the common symptoms associated with the condition, but perhaps more severe. For instance, the majority may get a high-grade fever, cough, runny nose and congestion, white spots inside the mouth as well as conjunctivitis, although this eye infection, also known as pink eye, is less common.
“Measles can cause several complications in the immunocompromised including, pneumonia, corneal ulcer, which can lead to blindness and neurologic complications, like encephalitis and subacute sclerosing panencephalitis, a potentially fatal brain disorder that may be caused by the measles infection,” says Suji Mathew, M.D., an infectious disease physician at City of Hope says.
The severity of the symptoms may depend on how immunosuppressed the patient is. Some cancer patients infected with the virus may not exhibit typical measles symptoms, making identification and diagnosis of measles more challenging for doctors. In about 20% of cases, there may not be the typical measles rash.
Some patients may not have a fever, cough or respiratory symptoms, but weeks after exposure to the virus may develop a rare, subacute type of encephalitis, according to a study published in the journal Biology of Blood and Marrow Transplantation. With compromised immunity, particularly among child cancer patients, secondary bacterial infections like pneumonia may be likely with the measles and can be life threatening.
With the severe risks cancer patients may face with a measles infection, preventing an infection in the first place is crucial.
How Southwestern Cancer Patients Can Protect Themselves from Measles
The surest defense against a measles infection is vaccination. While cancer patients cannot receive the vaccination, family members, friends and caregivers who are in close contact with the cancer patient should ensure they are fully vaccinated against the measles. If unsure about vaccination status, check with a health care provider. A booster shot may be recommended to be on the safe side.
Avoiding areas where there is an active outbreak, currently in southwestern states like New Mexico and Texas, or overseas destinations where the virus is endemic as well as communities with low vaccination rates, is another way to minimize risk of transmission of the virus.
Since the measles virus is passed through airborne droplets, wearing a properly fit N95 face mask may reduce risk of contracting the virus. Social distancing also is highly recommended.
Family members and care givers should also familiarize themselves with the signs and symptoms of measles in case they or the cancer patient have been exposed to the virus and seek prompt medical attention.
The health care teams at City of Hope® Cancer Center Phoenix work with experts specially trained to minimize the risks to cancer patients of communicable infections like measles. The abiding goal is to keep patients safe and healthy and ensure their cancer treatment is not compromised.
City of Hope has policies in place to ensure proper procedures are followed to prevent transmission. These include:
- Immunization of personnel
- Access to personal protective equipment
- Screening for travel and symptoms
- Special airflow precautions to prevent the transmission of airborne particles.
If you or a loved one has been diagnosed with lung cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.