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Wisconsin is experiencing one

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of the largest measles outbreaks

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in several years.

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At last count, the Department of

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Health Services has identified

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48 cases and one

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hospitalization, mostly

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in the southwest part of the state.

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And the case count has grown rapidly

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due to how highly contagious

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measles is among the unvaccinated.

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With the latest, we're joined by Dr.

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Ryan Westergaard, Chief Medical

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Officer. With the Wisconsin DHS

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Bureau of Communicable Disease.

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And, Doctor, thanks very much for

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being here.

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Thank you for having me.

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Describe how fast this has spread

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in this latest outbreak.

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Well, unlike some previous

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outbreaks, we didn't catch this one

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at the very beginning.

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We identified cases that may

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have been associated with some

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families that had symptoms for a few

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weeks. So it might even have been

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going on for a month.

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When we did first detect it a couple

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of weeks ago, it's doubled about

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every four or five days.

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So we started with just two cases

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confirmed, now we're up to 48.

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So that number goes up when our

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investigators in local health

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departments are out in the

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community, following up on people

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who report symptoms.

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Identifying contacts and when they

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find people with note with new

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symptoms or hear about a new test

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that number goes up So this is often

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what we see with measles outbreaks

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How do public health officials get a

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handle on it?

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Yeah, it's pretty painstaking,

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and we give them so much

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credit for their dedication out

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in the communities.

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So measles is one of the reportable

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conditions.

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So every positive lab test and every

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diagnosis made in a clinic we hear

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about in public health.

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And here in Wisconsin it's our local

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health departments, usually at the

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county or sometimes a city level,

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that are the front line.

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So where I work at the state health

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department we support,

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we aggregate the data.

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But the work that gets done in the

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communities involves every single

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person who is identified with

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measles gets an interview where

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an investigator, sometimes a public

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health nurse or a full-time disease

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investigator will meet with

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them in person, face-to-face

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with personal protective equipment

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when needed, and they'll

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confidentially try to understand

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places and people where they've been

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in contact, and then we can then

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spread out and identify other people

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who have been exposed, give them the

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advice that they need about to

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double check their vaccination

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status or to get a

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post-exposure prophylaxis, meaning

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a vaccine.

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And so that's the work that's being

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done right now.

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And we're probably

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going to see more cases as a result

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of those investigations.

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With childhood vaccination rates,

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including for measles,

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sitting at about 85% for incoming

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kindergartners in Wisconsin, was it

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just a matter of time before this

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outbreak happened?

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I think the answer is yes to that.

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We've been concerned about the

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level of childhood vaccinations

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being too low.

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Measles, as you said, is probably

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our most contagious virus.

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And the classical teaching in public

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health school is that you really

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need to have a community with 95%

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vaccine coverage or greater

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to prevent an outbreak if

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there is a case that comes into the

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community through travel, for

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example. So we have many communities

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that are below 90%

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and below 85 percent.

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And so for the past year and a

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half where there have been measles

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outbreaks occurring in different

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places of the country, we've kind

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of been anticipating when is

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it going to come to Wisconsin.

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The benefit of that is that we were

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ready and we're making

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the right resources available to

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our southwestern counties and

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hopefully we'll take this,

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what is now a medium-sized outbreak

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and keep it that small and prevent

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it from getting to be a large one

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like we've seen in some other

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states.

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How dangerous is it to get measles?

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Measles can be a pretty serious

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infection and it's

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a good question to ask and to

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talk about because there's been so

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little measles around in this

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country for so long that many

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physicians that are my generation

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or younger have never seen a case.

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So measles is a

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respiratory virus, so it spreads

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through the air, which is what makes

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it so contagious.

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The other side of the room,

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particles can remain suspended in

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the air and cause an infection.

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But when it gets into the body

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through the nose or mouth...

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Mouth, it causes a whole body,

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a systemic infection,

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causes high fever, sometimes as high

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as 105, a whole-body

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rash that is the characteristic,

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you know, dense red measles rash

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that starts on the head and then

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spreads to the whole body.

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And so most anyone that gets measles

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will have those symptoms and feel

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pretty terrible.

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But a subset of people with measles

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can get really severe illness and

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it can cause pneumonia, cause

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encephalitis or swelling of the

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brain. And sometimes particularly

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in children, that brain inflammation

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can cause permanent disabilities

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like blindness or deafness.

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So it's a serious infection,

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one that we want to prevent and our

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goal is to eliminate measles

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so there's actually not spreading in

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our communities at all.

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That's why the stakes are kind of

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high.

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What was it like before there was a

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measles vaccine?

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Yeah, the measles vaccine or version

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of the current measles vaccine was

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released in 1963,

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so a good long time ago.

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And the decades before that,

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essentially, everyone got measles

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during childhood, right?

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And so that's why there's some

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misconception that this is sort of a

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normal part of childhood.

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But what we don't remember is that

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when three to four million children

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in the US get measles in a year,

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like they did in the 50s and 60s,

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That means that several hundred

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children...

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Young babies will die

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from the serious complications.

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So in that decade before we had MMR

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vaccine, there were three to 400

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deaths in children per year.

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Going back then to

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about the 90s, which was the last

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time that we had an outbreak bigger

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than the one that we're currently

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experiencing Wisconsin was 1989,

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90. There were about a thousand

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cases in Milwaukee.

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And that was when we realized that

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two doses are significantly better

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than one.

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So as a result of that nationwide

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outbreak in 1989 and 90,

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that the standard became two doses

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of MMR before kindergarten.

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And since that, the uptake was high.

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We had virtually eliminated measles.

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We would have zero cases most years,

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sometimes one or two from a

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failure in returning.

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But in 2000, the United States

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actually declared that we had

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eliminated measels as,

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or eliminated measle's transmission.

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So... And a normal

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year there was no outbreaks that

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were spreading person to person in

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the community. So we really, it was

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really a public health triumph to

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get to that point where we didn't

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have measles on spreading in

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our communities.

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And that's what we are struggling

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with now is to get back to that

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standard and it's gonna take getting

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more vaccines, our proportion

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of people with vaccines back up into

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that 90% level to

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get there.

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Meanwhile, coming out of Washington,

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including an executive order from

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the president to separate

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the MMR into three

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different visits to

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a pediatrician or a clinic

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for a vaccine,

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what is state of Wisconsin guidance

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on that idea?

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That's an important question to

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bring out that in Wisconsin

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and frankly most states and

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even at the CDC

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at the national level, the

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recommendation has not changed.

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The executive order was stating a

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preference if you will from the

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White House about how they

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think the White house thinks about

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vaccinations.

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There was also information there

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about having a fewer number of

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vaccines overall.

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I think the important message is

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that is not reflect the

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medical consensus and

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the scientific consensus

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about the best way to prevent

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vaccine preventable diseases like

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measles.

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So the recommendation in Wisconsin

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has not changed from this executive

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order or a previous one in January

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which was talking

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about ways to reduce the number of

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vaccines.

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Specifically on the idea of

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separating MMR,

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it's really not a strategy

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that is viable because those

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vaccines don't exist.

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They're not manufactured.

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They're not. They're not approved

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that way.

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So doing that would actually be

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kind of, you know, contrary to the

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goal of having fewer injections.

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You'd need more injections,

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more visits to the hospital.

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And what we've learned, and I

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think most families can acknowledge,

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it's tricky to stay on top of all

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of the things. And more doctor

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visits would almost certainly

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result in fewer people being

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protected against measles.

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So we're considering that executive

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order to be.

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Something that we paid attention to.

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We respect the role of the federal

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government in making, in

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providing leadership, but it's

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really important to acknowledge that

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it is not, it is contrary actually

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to the best medical advice about how

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to prevent measles and related

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diseases.

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Dr. Ryan Westergaard, thanks very

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much for your update.

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Yeah, thanks for being, for having

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me.

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Your misery and not ask those last

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two questions. No, that was really

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good, really important.

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Yeah.

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I am interested in that kind of