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ST. LOUIS — As rising measles cases nationwide creep closer to Missouri with outbreaks in nearby Kansas and Oklahoma, area health officials are trying to prepare providers and educate the public about how to prevent the highly infectious virus from taking hold here.

“Making sure that their immunizations are up to date and being aware of what is going on in their community ... that is very much key,� said Dr. , an infectious disease pediatrician with University of Missouri Health Care.

Nearly 700 cases of measles since late January. That’s the third-highest confirmed case count since the United States declared measles eliminated in 2000.

The outbreak began in West Texas, where cases rapidly increased among undervaccinated communities. Most of those sickened have been in Texas, but as many as 22 states have reported cases.

Two elementary school-aged children who were not vaccinated have died. They lived near the epicenter of the outbreak. An unvaccinated adult also died in New Mexico.

The best way to avoid measles is to get the measles, mumps and rubella . The first shot is recommended for children between 12 and 15 months old and the second between 4 and 6 years old before entering kindergarten.

With of Missouri public school kindergarteners vaccinated against measles, health officials say the state is vulnerable.

“In order to keep infections from spreading, a herd immunity or community immunity is required — which we consider a threshold of 95%,� Padhye said. “So the opportunity is there.�

Rates among kindergarteners : Six counties have rates under 80%. The lowest — 61% — is in Scotland County, along Iowa’s border. In the city of ÃÛÑ¿´«Ã½, the rate is 75%.

Exacerbating health officials’ concerns, the federal government at the end of March halted $11.4 billion in funding that was slated to bolster local public health efforts against disease outbreaks. More than $250 million was supposed to go to Missouri, and several efforts to improve the state’s vaccination rates are having to shutter.

“I think it’s going to be very tough when we start getting hit with those measles cases. I don’t think it’s a matter of ‘if,’ it’s a matter of ‘when’ at this point,� said Heidi Lucas, executive director of the .

“It’s like seeing that storm coming and there’s not much you can do about it besides just educating your patients� about the safety and effectiveness of the vaccine, Lucas said. “But, you know, people are still gonna say no, and that’s hard.�

Falling vaccination rates

Vaccination rates have since the COVID-19 pandemic, which intertwined politics with vaccination efforts and fueled resistance.

Lucas blames the especially low vaccination rates in some areas on the contagiousness of misinformation.

“Everybody kind of knows everybody in some of these smaller towns,� she said. “If you have a school and moms start talking about it and decide that they’re not going to do it, and then it just kind of spreads.�

Dr. Kendra Holmes, the president of Affinia Healthcare, a system of safety-net clinics in ÃÛÑ¿´«Ã½ and north ÃÛÑ¿´«Ã½ County, said families are concerned about side effects such as soreness, headache, fever and fatigue.

Parents delay vaccinations for their children because they don’t want several shots in one visit, but they face difficulties getting back to a clinic or keeping track of what’s needed, Holmes said.

Some think their healthy child is fine without it, she said. Others without health insurance fear they won’t be able to pay for the shots.

On March 4, Affinia closed its clinics to educate its 90 staff members on how to address families’ hesitance about vaccines. The training was offered through a .

“Our staff loved it,� Holmes aid. “They said it gave them great talking points and narratives that they could share with parents about vaccination.�

Holmes said staff learned it’s important to not lead with fear, which can cause people to panic and resort to social media fraught with conflicting messages.

“Just asking open-ended questions and really listening to the patients’ concerns about why they may have apprehensions ... just really taking an empowered approach to providing education,� she said.

That training program and others, however, came to a halt two weeks ago with the loss of federal funds.

Mizzou’s program had about a $1 million left of a $2 million grant it planned to spend over the next year on various efforts to increase vaccination rates among children, including training more providers, supporting clinics with outreach staff, providing educational children’s books and distributing local “report cards� on vaccination rates, said Jane McElroy, the professor leading the research.

The nonprofit n also had to cancel its annual educational conference for nearly 300 health care workers at the end of this month and is in danger of having to dissolve altogether.

Lucas said her rural health association, after months of research and gathering input, was about to launch a program focusing on helping rural providers increase their communities’ vaccinations against COVID-19 and flu, skills that can apply to any immunization effort.

“It all just stopped,� she said.

“Many organizations have lost funding recently that were supposed to help with vaccine conversations and awareness campaigns and all of that,� Lucas said. “They are very worried and discouraged.�

Booster shot may be needed

Organizations, hospitals and public health departments are doing what they can to prepare for possible cases, including informing the public and providers — who many have never seen a measles case — about the virus and .

Measles easily spreads through the air when someone coughs or sneezes. Symptoms develop about eight to 12 days after exposure and include fever, cough, congestion and pink eye. A few days later, a red, flat rash starts at the hairline and spreads down the body.

About one in five people who get the measles will need to be hospitalized, Padhye said. And infection can lead to dangerous complications such as pneumonia, blindness, brain swelling and death. It can also suppress a person’s immune system for two to three years.

Two doses of the vaccine are 97% effective at preventing measles.

Padhye said babies not yet old enough to get vaccinated, pregnant women and those who are immunocompromised are most at risk, which is why herd immunity is important in protecting the most vulnerable.

Adults born after 1957 and vaccinated before 1968 depending on what type of vaccine they received. A lab test called an MMR titer can check your levels of measles antibodies if unsure. Holmes said she is providing the test and booster for Affinia staff who need it.

Getting another MMR shot is harmless if there are concerns about waning immunity, disease experts say.

Providers are already working to combat misinformation about preventing measles with vitamin A, which has resulted in . Too much of the vitamin can cause organ damage.

While vitamin A can play a role in treatment, especially in low-income countries where deficiencies are common, Padhye said, “In no way is it a cure or a means to prevent measles.�

In Illinois, which boasts e against measles among students in public elementary schools, the Illinois Department of Health on Wednesday unveiled a ““ to help the public determine the risk of their child being exposed to measles if a case occurs in their school.

The ÃÛÑ¿´«Ã½ County Department of Public Health said it is taking several steps to prepare for possible cases such as developing guidance for schools and child care centers, sending health care providers instructions on testing and infection prevention in their offices and making sure enough staff is available to conduct case investigations.

“We are also working closely with local infectious disease physicians and hospital infection prevention staff to coordinate messaging and ensure that we have 24/7 contact information in the event of a possible measles case,� Sara Dayley, county public information officer, said in an email.