After nearly a decade, measles has returned to Kentucky.

The Kentucky Department of Health has reported two cases of measles in the 10-county Barren River region.

“These are the first two cases we’ve had since 2010,” said Dr. Mel Bennett with the Infectious Disease Branch of the Kentucky Department for Public Health. “Neither kid was vaccinated.”

Hospitals throughout the region are on high alert for measles activity. At The Medical Center at Bowling Green, “measles is suspected” in anyone with a high fever and rash, according to Dr. Suman Shekar, pediatrics and internal medicine specialist at The Medical Center Primary Care.

Through March 28, there have been 387 cases of measles confirmed in 15 states in 2019. Four states have reported “outbreaks” – defined by three or more cases – according to a Centers for Disease Control and Prevention report released Monday.

Measles is transmitted when droplets from the nose, mouth or throat of an infected person come into contact with another person’s mucus membranes. It is highly contagious.

Within about 10 to 12 days of infection, people will begin to experience a high fever, runny nose, bloodshot eyes and tiny white spots on the inside of the mouth. Several days later, a rash will develop on the face or upper neck.

“Measles itself can be bad. It’s 10 times worse than the flu,” Shekar said. Between the high fever, malaise and rash, “kids are very miserable.”

But on top of that, there is no treatment for measles, and there’s an increased risk for secondary infections. “They’re more prone to other bugs,” Shekar said.

Potential complications include pneumonia, ear infections, diarrhea, hepatitis, vision loss and encephalitis, which is inflammation of the brain. Pneumonia is the most common cause of measles-related death.

That’s why the vaccine is so important.

“It prevents the child from getting all of these things,” Shekar said.

All but one K-12 school in the Barren River region have 95 percent or higher vaccination rates, according to Bennett.

“Common sense would say an easy way to protect the population is to require the vaccine,” Bennett said.

In 1963, U.S. researchers introduced the measles vaccine, which was later combined with vaccines for mumps, rubella and sometimes varicella, now called MMR or MMRV. Before 1963, 3 or 4 million people were infected with measles each year, and about 48,000 people were hospitalized, according to the CDC.

By 2000, measles was declared eliminated in the U.S. – though not worldwide. Globally, measles deaths decreased by 84 percent, according to the World Health Organization.

But there have been recent spikes in measles due to anti-vaccination campaigns. In Europe, there were about 60,000 measles cases, a 20-year high, in 2018, according to the WHO, which identified “vaccine hesitancy” as one of the top 10 threats to global health in 2019.

The anti-vaccination movement is largely associated with Andrew Wakefield, a former physician from England who lost his medical license after publishing a dubious case report of 12 children that linked autism with vaccination.

“Every time a patient comes into my office, I tell them that guy (should be) in prison,” Shekar said.

Recently, researchers in Denmark monitored more than 650,000 children to determine whether there was a link between the MMR vaccine and autism. There wasn’t, according to the paper published in the Annals of Internal Medicine last month.

These findings weren’t surprising. It was just another major study to disprove the association.

“There is zero, no, nil, nada, pick a language, there is no link between vaccines and autism,” Bennett said.

Shekar’s clinic has seen four or five patients who refused vaccinations in the past six months. “That’s a huge number,” she said.

There are individuals who can’t get vaccinated, such as children with cancer or Crohn’s disease, and herd immunity – widespread vaccination – helps protect these vulnerable populations from the highly contagious virus, which can linger for hours in an area that an infected child has been.

“When large groups of people don’t get vaccinated, herd immunity goes down,” Shekar said.