This article by Rebecca Grapevine first appeared in Healthbeat, republished with permission.

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Georgia successfully contained an outbreak of three measles cases early this year with an “all hands on deck” response as the disease surged nationwide, with seven outbreaks and 712 confirmed cases as of last week.

But the state remains vulnerable, with overall measles vaccination rates below national averages — and below the 95% rate needed to prevent widespread community transmission, known as herd immunity. Georgia’s vaccination rates have been on the decline for years and lag those of neighboring states.

The January outbreak involved three unvaccinated children from the same Gwinnett County family. The first child to fall ill had traveled to New York City. Georgia alerted New York health officials, but no related cases were reported there, according to emails from Georgia health workers obtained by Healthbeat through an open records request.

The first suspected Georgia case was identified on Friday, Jan. 24. Keisha Francis-Christian, epidemiology manager for the Gwinnett, Newton and Rockdale health department, called for an “all hands on deck” response in an email to her team the following Monday.

By Feb. 11, public health workers had identified 290 close contacts, 31 of whom did not have measles immunity or were at high risk. Workers gave 21 of those people an MMR vaccine, state Department of Public Health epidemiology program manager Jessica Pavlick said in an email to colleagues.

“For 21 days, they have to report their symptoms to us. If they don’t report, we’re calling them.” That included working over weekends, Francis-Christian said at a February Gwinnett Board of Health meeting.

DPH did not respond to Healthbeat’s requests for information about the cost of the outbreak investigation, or whether the contact tracers who worked on it are among the 170 laid off due to recent federal funding cuts at the state agency.

The state last year saw six measles cases. This year’s nationwide 712 cases, including the three in Georgia, outstrip last year’s 285 cases. The outbreak centered in west Texas has spread to New Mexico and killed two children and an adult, all unvaccinated.

Georgia epidemiologist Dr. Cherie Drenzek said during a DPH board meeting last week that a widespread outbreak across the country is unlikely because “we do have good, for the most part, overarching MMR coverage.” ​​

Measles vaccination rates have been declining in Georgia

Georgia’s measles vaccination rates have fallen over the past decade, and some counties report very low rates, according to available data from DPH and the Centers for Disease Control and Prevention. That could lead to increases in cases of the highly transmissible disease, which kills up to three in 1,000 unvaccinated people, experts said.

Children typically get two measles vaccinations as part of the “MMR” or measles, mumps, and rubella shot. The first should be between age 12 and 15 months, and the second should be between ages 4 and 6 years, the CDC says.

In most counties in Georgia – 150 of 159 – measles vaccination rates for young children are below the 95% recommended rate, according to the latest data about children between 19 and 35 months from DPH. Statewide, it’s at 87.8%, according to the data from early fall 2023.

DPH does not provide data online about older children’s vaccination rates, although some CDC data are available.

About 95% of people need to be vaccinated to prevent widespread transmission of the virus, or achieve “herd immunity,” according to the CDC. The United States eliminated widespread transmission of measles in 2000.

Since then, vaccination rates have decreased nationwide and in Georgia.

In the 2011-12 school year, 96.6% of Georgia kindergartners had received two doses of the MMR vaccine, above the herd immunity target.

But last year, 2023-24, that was down to 88.4%, according to the CDC’s School Vax View.

Measles is a “highly contagious virus” that can spread up to two hours after a person with measles leaves a room, according to the CDC. Nine of 10 people exposed will get measles if they are not vaccinated.

Cases are transmissible for up to four days before infected people get a rash, a common symptom, said Dr. Jane Seward, who retired in 2016 after about a decade at the CDC, where she worked as the deputy director of the Division of Viral Diseases. People can be exposed to the virus in a supermarket, airport, or hotel lobby.

“Prevention of an outbreak depends entirely on local coverage rates,” said Charles LeBaron, an epidemiologist who retired from the CDC in 2017. “With a world awash in measles, and foreign travel essential to our economy, we can’t stop measles imports, but we can stop outbreaks.

“That’s entirely a function of the immunity rate in the first case’s immediate micro-environment (e.g., kindergarten class). If it’s above 95%, the immunity sprinkler system will put out the outbreak. If it’s lower, then spread is likely,” LeBaron said. “And sooner or later, it finds an immunocompromised or otherwise frail person (like an infant too young to be vaccinated), and somebody dies.”

Measles vaccination rates are even lower for Georgia’s youngest children, who need their first dose by 15 months, according to the CDC.

Nearly a fifth of children born in Georgia in 2021 (18.3%) did not get the shot by 19 months old, four months after the recommended deadline, according to the most recent CDC data. In other words, just 81.7% of Georgia children born in 2021 got the shot on time, compared to 87.9% nationwide.

It hasn’t always been this way in Georgia. For children born in 2011, the MMR vaccination rate was more than 5 percentage points higher, at 87.2% for children at 19 months.

“For measles, you can’t afford to wait till school. … There’s a lot of susceptibility under [age] 6,” Seward said.

The three cases in Georgia this year, as well as 97% of cases in the outbreak that started in Texas, were in unvaccinated people.

Closer to home, Tennessee has reported four cases this year, and last year, all of Georgia’s neighboring states except for Alabama reported measles cases.

Which Georgia counties have the lowest measles vaccination rates?

There are some parts of Georgia where measles vaccination rates are especially low, according to county-level data about vaccinations for young children from DPH from July to September 2023, which has not been updated since then.

Among the five core Atlanta counties, Clayton had the lowest rate, at 86% in the third quarter of 2023. It was 89.6% in Cobb County, 88.4% in Gwinnett, 88.2% in DeKalb, and 86.7% in Fulton.

The low rates in metro Atlanta are worrying, said pediatric infectious disease specialist Dr. Preeti Jaggi of Children’s Healthcare of Atlanta.

“It makes me anxious in the sense that if we don’t have adequate community protection, we have more chance for transmission.” She pointed out that babies typically can’t get the measles vaccine until 12 months old, putting them and others who can’t get it for medical reasons at higher risk.

Dr. Stephen Patrick, a neonatologist and professor at Emory University’s Rollins School of Public Health, agreed, calling the metro Atlanta rates “too low.”

Jaggi and Patrick said they hear more concerns from parents about vaccine safety than in the past. Doctors emphasized the vaccine is safe and helps keep kids from getting sick.

“We have study after study after study …. We know that the MMR vaccine does not cause autism,” Patrick said. Jaggi said she tells parents, “I vaccinated my own children, and I would have not done that unless I thought it was in their best interest.”

“What we’ve seen has not been a change in access over the last few years, to my knowledge, but what we have seen is a change in attitude,” Patrick said, pointing to the rise of social media misinformation as a key reason for downward vaccination rates.

“Parents are just processing a slew of information and they just want to do what’s best for their child,” Patrick said. Conversations with “trusted messengers” like pediatricians and other parents can help reassure parents that vaccines are safe and help protect kids.

“The measles vaccine is the best way to to prevent measles transmission — period,” Patrick said. ”The outbreaks we’re seeing now are preventable.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for their newsletters here.

This article was originally published by Healthbeat, a nonprofit newsroom covering public health published by Civic News Company and KFF Health News.