Dr. Hector Ocaranza knew El Paso would see the moment it began spreading in and eastern New Mexico.
Highways connect his border city with the epicenter of , which is up to 663 cases. They're the same roads used by thousands of families and commercial truckers who cross into Mexico and back each day.
鈥淒iseases know no borders," said Ocaranza, El Paso's top public health doctor, "so as people are mobile, they're going to be coming and receiving medical attention in El Paso but they may be living in Juarez.鈥� It took a couple of months, but El Paso now has the highest measles case count in the state outside of West Texas with 38. Neighboring Ciudad Juarez has 14 cases as of Monday.
North America's three biggest measles outbreaks continue to balloon, with more than 2,500 known cases; three people have died in the U.S. and one in Mexico. It started in the fall in Ontario, Canada; then took off in late January in Texas and New Mexico; and has rapidly spread in Chihuahua state, which is up to 786 cases since mid-February.
These outbreaks are in areas with a notable population of certain Mennonite Christian communities who trace their migration over generations from . Chihuahua health officials trace their first case to an 8-year-old Mennonite child who visited family in Seminole, got sick and spread the virus at school. And Ontario officials say their outbreak started at a involving Mennonite communities.
Mexican and U.S. officials also say the genetic strains of measles spreading in Canada match the other large outbreaks.
鈥淭his virus was imported, traveling country to country,鈥� said Leticia Ru铆z, director of prevention and disease control in Chihuahua.
North and South American countries have struggled to maintain the 95% measles vaccination rate needed to prevent outbreaks, said Dr. Jarbas Barbosa, director of the . And a recent report said measles activity in the Americas region is up elevenfold from the same time last year and that the risk level is 鈥渉igh鈥� compared to the rest of the world's 鈥渕oderate鈥� level.
Measles cases have been confirmed in six of the region鈥檚 countries 鈥� Argentina, Belize, Brazil, Canada, the United States and Mexico 鈥� and investigating the disease's spread is labor-intensive and pricey. The response to each measles case in the U.S. costs an estimated $30,000 to $50,000, according to Dr. David Sugerman, a U.S. Centers for Disease Control and Prevention scientist.
Measles at the U.S.-Mexico border
The cases in Ciudad Juarez have no direct connection to the Mennonite settlement in Chihuahua, said Rogelio Covarrubias, a health official in the border city. The first measles case in El Paso was in a child at Fort Bliss, Ocaranza said.
More than half of El Paso's cases are in adults, which is unusually high, and three people have been hospitalized. The health department is holding vaccination clinics in malls and parks and says hundreds have gotten a shot. The vaccines are free 鈥� no questions asked, no matter which side of the border you live on.
Communication about measles between the two health departments is 鈥渋nformal鈥� but 鈥渧ery good,鈥� Ocaranza said. Covarrubias said his team was alerted last week to a case of someone who became sick in El Paso and returned home to Juarez.
鈥淭here is constant concern in Ciudad Juarez 鈥� because we have travelers that pass through from across the world,鈥� Covarrubias said. 鈥淲ith a possible case of measles without taking precautions, many, many people could be infected.鈥�
Measles at the U.S.-Canada border
Michigan health officials said the outbreak of four cases in Montcalm County are linked to Ontario.
The state's chief medical executive, Dr. Natasha Bagdasarian, expects to see more cases. Michigan has a 95% vaccination rate for measles, mumps and rubella, but it hides weak spots 鈥� counties with 70% vaccination rates and individual schools where just 30% of kids vaccinated.
鈥淚f we think about measles as a forest fire, we've got these burning embers that are floating in the air right now," Bagdasarian said. "Whether those embers result in another wildfire just depends on where they land.鈥�
In Canada, six out of 10 provinces have reported measles cases. Alberta has the second-most with 83 as of April 12,
Case counts in Ontario reached 1,020 as of Wednesday, mostly in the southwest part that borders Michigan. In one of the hardest-hit regions, Chatham-Kent Public Health officials announced a public exposure at a Mennonite church on Easter Sunday.
鈥淚t sometimes feels like we're just behind, always trying to catch up to measles,鈥� Dr. Sarah Wilson, a public health physician for Public Health Ontario. 鈥淚t's always moving somewhere."
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Janetsky reported from Mexico City. Shastri reported from Milwaukee.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute鈥檚 Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
Devi Shastri And Megan Janetsky, The Associated Press
