Wisconsin is experiencing one
of the largest measles outbreaks
in several years.
At last count, the Department of
Health Services has identified
48 cases and one
hospitalization, mostly
in the southwest part of the state.
And the case count has grown rapidly
due to how highly contagious
measles is among the unvaccinated.
With the latest, we're joined by Dr.
Ryan Westergaard, Chief Medical
Officer. With the Wisconsin DHS
Bureau of Communicable Disease.
And, Doctor, thanks very much for
being here.
Thank you for having me.
Describe how fast this has spread
in this latest outbreak.
Well, unlike some previous
outbreaks, we didn't catch this one
at the very beginning.
We identified cases that may
have been associated with some
families that had symptoms for a few
weeks. So it might even have been
going on for a month.
When we did first detect it a couple
of weeks ago, it's doubled about
every four or five days.
So we started with just two cases
confirmed, now we're up to 48.
So that number goes up when our
investigators in local health
departments are out in the
community, following up on people
who report symptoms.
Identifying contacts and when they
find people with note with new
symptoms or hear about a new test
that number goes up So this is often
what we see with measles outbreaks
How do public health officials get a
handle on it?
Yeah, it's pretty painstaking,
and we give them so much
credit for their dedication out
in the communities.
So measles is one of the reportable
conditions.
So every positive lab test and every
diagnosis made in a clinic we hear
about in public health.
And here in Wisconsin it's our local
health departments, usually at the
county or sometimes a city level,
that are the front line.
So where I work at the state health
department we support,
we aggregate the data.
But the work that gets done in the
communities involves every single
person who is identified with
measles gets an interview where
an investigator, sometimes a public
health nurse or a full-time disease
investigator will meet with
them in person, face-to-face
with personal protective equipment
when needed, and they'll
confidentially try to understand
places and people where they've been
in contact, and then we can then
spread out and identify other people
who have been exposed, give them the
advice that they need about to
double check their vaccination
status or to get a
post-exposure prophylaxis, meaning
a vaccine.
And so that's the work that's being
done right now.
And we're probably
going to see more cases as a result
of those investigations.
With childhood vaccination rates,
including for measles,
sitting at about 85% for incoming
kindergartners in Wisconsin, was it
just a matter of time before this
outbreak happened?
I think the answer is yes to that.
We've been concerned about the
level of childhood vaccinations
being too low.
Measles, as you said, is probably
our most contagious virus.
And the classical teaching in public
health school is that you really
need to have a community with 95%
vaccine coverage or greater
to prevent an outbreak if
there is a case that comes into the
community through travel, for
example. So we have many communities
that are below 90%
and below 85 percent.
And so for the past year and a
half where there have been measles
outbreaks occurring in different
places of the country, we've kind
of been anticipating when is
it going to come to Wisconsin.
The benefit of that is that we were
ready and we're making
the right resources available to
our southwestern counties and
hopefully we'll take this,
what is now a medium-sized outbreak
and keep it that small and prevent
it from getting to be a large one
like we've seen in some other
states.
How dangerous is it to get measles?
Measles can be a pretty serious
infection and it's
a good question to ask and to
talk about because there's been so
little measles around in this
country for so long that many
physicians that are my generation
or younger have never seen a case.
So measles is a
respiratory virus, so it spreads
through the air, which is what makes
it so contagious.
The other side of the room,
particles can remain suspended in
the air and cause an infection.
But when it gets into the body
through the nose or mouth...
Mouth, it causes a whole body,
a systemic infection,
causes high fever, sometimes as high
as 105, a whole-body
rash that is the characteristic,
you know, dense red measles rash
that starts on the head and then
spreads to the whole body.
And so most anyone that gets measles
will have those symptoms and feel
pretty terrible.
But a subset of people with measles
can get really severe illness and
it can cause pneumonia, cause
encephalitis or swelling of the
brain. And sometimes particularly
in children, that brain inflammation
can cause permanent disabilities
like blindness or deafness.
So it's a serious infection,
one that we want to prevent and our
goal is to eliminate measles
so there's actually not spreading in
our communities at all.
That's why the stakes are kind of
high.
What was it like before there was a
measles vaccine?
Yeah, the measles vaccine or version
of the current measles vaccine was
released in 1963,
so a good long time ago.
And the decades before that,
essentially, everyone got measles
during childhood, right?
And so that's why there's some
misconception that this is sort of a
normal part of childhood.
But what we don't remember is that
when three to four million children
in the US get measles in a year,
like they did in the 50s and 60s,
That means that several hundred
children...
Young babies will die
from the serious complications.
So in that decade before we had MMR
vaccine, there were three to 400
deaths in children per year.
Going back then to
about the 90s, which was the last
time that we had an outbreak bigger
than the one that we're currently
experiencing Wisconsin was 1989,
90. There were about a thousand
cases in Milwaukee.
And that was when we realized that
two doses are significantly better
than one.
So as a result of that nationwide
outbreak in 1989 and 90,
that the standard became two doses
of MMR before kindergarten.
And since that, the uptake was high.
We had virtually eliminated measles.
We would have zero cases most years,
sometimes one or two from a
failure in returning.
But in 2000, the United States
actually declared that we had
eliminated measels as,
or eliminated measle's transmission.
So... And a normal
year there was no outbreaks that
were spreading person to person in
the community. So we really, it was
really a public health triumph to
get to that point where we didn't
have measles on spreading in
our communities.
And that's what we are struggling
with now is to get back to that
standard and it's gonna take getting
more vaccines, our proportion
of people with vaccines back up into
that 90% level to
get there.
Meanwhile, coming out of Washington,
including an executive order from
the president to separate
the MMR into three
different visits to
a pediatrician or a clinic
for a vaccine,
what is state of Wisconsin guidance
on that idea?
That's an important question to
bring out that in Wisconsin
and frankly most states and
even at the CDC
at the national level, the
recommendation has not changed.
The executive order was stating a
preference if you will from the
White House about how they
think the White house thinks about
vaccinations.
There was also information there
about having a fewer number of
vaccines overall.
I think the important message is
that is not reflect the
medical consensus and
the scientific consensus
about the best way to prevent
vaccine preventable diseases like
measles.
So the recommendation in Wisconsin
has not changed from this executive
order or a previous one in January
which was talking
about ways to reduce the number of
vaccines.
Specifically on the idea of
separating MMR,
it's really not a strategy
that is viable because those
vaccines don't exist.
They're not manufactured.
They're not. They're not approved
that way.
So doing that would actually be
kind of, you know, contrary to the
goal of having fewer injections.
You'd need more injections,
more visits to the hospital.
And what we've learned, and I
think most families can acknowledge,
it's tricky to stay on top of all
of the things. And more doctor
visits would almost certainly
result in fewer people being
protected against measles.
So we're considering that executive
order to be.
Something that we paid attention to.
We respect the role of the federal
government in making, in
providing leadership, but it's
really important to acknowledge that
it is not, it is contrary actually
to the best medical advice about how
to prevent measles and related
diseases.
Dr. Ryan Westergaard, thanks very
much for your update.
Yeah, thanks for being, for having
me.
Your misery and not ask those last
two questions. No, that was really
good, really important.
Yeah.
I am interested in that kind of