As many as 1,000 people in Arizona, including about 200 children, could be at risk for measles as state officials urged precautions to fight the outbreak days before football fans flood the region.
At least seven cases of measles connected to the Disneyland outbreak have been confirmed around Phoenix. Some of the infected people have moved around, gone to hospitals, grocery stores and a post office, raising the number of contacts and creating the possibility that the highly contagious disease could spread, officials say.
Health experts are focusing their efforts on three counties: Pinal, Gila and Maricopa, where the NFL Super Bowl is scheduled for Sunday.
"When you get any large gathering of people, you are obviously concerned about every type of infectious disease," Jeanne Fowler, a spokeswoman for the Maricopa County Health Department told the Los Angeles Times on Thursday. "We are concerned about all diseases that could be caught, whether measles or flu, which is a bigger concern than measles" for the championship game.
The usual precaution is to remind people to be vaccinated against measles, Fowler said, but that is not really practical for Super Bowl visitors because it takes two weeks to build immunity. She also noted that there are just two confirmed measles cases in Maricopa and officials are already working to "isolate those people to prevent the spread."
State health officials warn that the situation remains fluid and they are worried that the outbreak could spread among those who are not vaccinated and were exposed to someone who had measles.
Children in Pinal, Gila and Maricopa counties who may be at risk and who have not had at least one vaccination dose are being asked to stay out of school or day care for 21 days. Exposed adults who were born in 1957 or later and who haven't had measles or at least one measles vaccine are being advised not to go to work or other public places for the same 21-day incubation period, state Health Services Director Will Humble wrote on his blog.
"To stay in your house for 21 days is hard," he told reporters. "But we need people to follow those recommendations, because all it takes is a quick trip to the Costco before you're ill and, 'bam,' you've just exposed a few hundred people. We're at a real critical juncture with the outbreak."
The epicenter of the outbreak has been traced to one unvaccinated family in Pinal County who visited Disneyland. The first four measles cases, three children and one adult, are all from one family, Kore Redden, the county's acting health director of public health, told The Times by phone.
A fifth confirmed case involves a male who visited the family, she said.
One child from the original unvaccinated family was taken to several urgent care facilities, exposing 18 children to the illness. Many of them were less than a year old and had not yet been vaccinated, according to state officials. In all, 13 of the 18 children were unvaccinated.
Even though all five of the original measles cases have either recovered or are recovering, the danger of a spread will continue to exist during the 21-day incubation period, Redden said. At least one male visited a post office and several convenience stores in the Kearny area. There are about 1,950 people living in Kearny and there are 4,000 people in the area.
Some of those people could have been exposed in the public spaces. There are also some large businesses, with at least 800 employees, Redden said.
Not all will get measles or are even in danger, but officials have begun investigating.
"We're still gathering information at all of these places and looking at the population. We haven't concluded how many people have been exposed," she said.
No measles cases have been confirmed in Gila County.
Officials have confirmed two measles cases in Maricopa County. One person, a woman, was exposed to the Pinal County family who went to Disneyland. The other case is a person who traveled separately to the Disney parks and is not connected to the Pinal County family, Fowler said.
"We estimate that there are upwards of 1,000 contacts," Fowler said. Because of the incubation period, "if we don't see any more case, then everybody is free and clear" by around Feb. 12 in Maricopa and Feb. 13 in Pinal.
The Maricopa County woman, who did not have visible symptoms, may have exposed individuals at the Phoenix Children's East Valley Center on Jan. 20 and 21, according to Stacy Dillier, media relations specialist for the pediatrics facility. The woman is not an employee.
Phoenix Children's and Maricopa County Public Health are following up with the families of the 195 children who may have been exposed.
"Unfortunately, she came down with the disease, and by the time it was recognized, had already exposed a large number of children at the facility," Maricopa County health director Bob England told reporters.
Arizona ranks second to California in the number of cases linked to the measles outbreak at the Disney parks. The rest are in Michigan, Utah, Washington, Colorado, Oregon, Nebraska and Mexico.