New details on death caused by measles infection

The first person to die from a measles infection in the U.S. in a dozen years was a 28-year-old former dental hygienist and college student who suffered from a rare inflammatory muscle disease.

Catherine J. Montantes of Port Angeles died April 8, 2015, of measles-caused pneumonia, according to a death certificate filed with the Washington State Department of Health.

The infection wasn't detected until after an autopsy, health officials said. And the death - the first confirmed fatal measles case in the U.S. since 2003 - wasn't announced until almost three months later, on July 2. The death came in a year when a measles outbreak linked to the Disneyland theme park in Southern California dominated health care headlines.

Family members of Montantes, who was born in Juneau, Alaska, remembered her as a sister fiercely protective of her three siblings - Ralphenia Dybdahl, Steven Montantes and Jimmy Refuerzo - and as a funny, strong young woman.

"Cathy was just a real go-getter," said her mother, Ralphenia Knudson, 53, of Juneau. "Whatever Cathy sought to achieve, she would find ways to achieve it."

Montantes had been diagnosed with dermatomyositis, a rare disease that causes chronic muscle inflammation and weakness. Drugs to control the inflammation also suppress the immune system, leaving people vulnerable to infections.

Health officials deduced that Montantes was among nearly three dozen people exposed to the measles virus at the Lower Elwha Health Clinic on Jan. 29, 2015. Among visitors to the clinic was a 52-year-old man who was later confirmed as the first case of measles in Washington's Clallam County in 20 years.

Eventually, the man may have exposed 149 people to the disease, according to emails and documents released in response to a Seattle Times public records request.

Montantes didn't develop a rash or other symptoms typical of measles, but the virus was present in a lung tissue sample collected in February, emails showed. She fell ill about six weeks later and sought care at Olympic Medical Center in Port Angeles on March 19. On March 26, she was sent to the University of Washington Medical Center, where she died April 8.

An autopsy later confirmed that she had measles virus giant cell pneumonia.

State health officials notified the family of the infection, Knudson said.

Pneumonia is a common side effect of measles infection and it can be lethal, especially in people with underlying medical conditions, said Dr. Manisha Patel, a medical epidemiologist with the Centers for Disease Control and Prevention.

"Immunocompromised hosts are complicated," Patel said. "Even if they're vaccinated, they may be susceptible."

Knudson said Montantes was vaccinated against measles as a child. State officials said they didn't have documentation of her immunization status, so they listed it as unknown.

The immunization status of the man who may have infected her remains unknown, state officials said. The death underscores the need for widespread vaccination against measles and other preventable diseases, said Chas DeBolt, a Washington state senior epidemiologist.

"This is a tragic reminder of the severity of measles, of the importance of immunizations to protect not just the individual people who receive the vaccinations, but also to reduce the risk of measles transmission to the broader community, which includes medically fragile persons who may be at increased risk of severe disease," DeBolt said in an email.

Last year, 189 people were infected with measles in the U.S., with 11 in Washington state, including Montantes. That followed 667 measles cases reported in 2014. This year, four measles cases have been reported nationwide.

The death certificate lists Montantes' most recent job as a dental hygienist. She last practiced in Arkansas, her sister said.

Montantes was studying criminal justice to become a border patrol officer, but her illness ended those hopes, her family said.

"I am in awe and amazed by everything that young lady survived and went through," Knudson said. "Her strength that I saw was amazing."

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