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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 were joined by Dr. Ryan Westergaard chief medical officer with the Wisconsin

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DHS Bureau of Communicable Disease and Dr. 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 detected 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.

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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?

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Yeah, it's it's pretty painstaking. And we give them so much so much credit for their dedication out in the communities. So measles is one of the reportable conditions. So every positive lab tests 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 we support we aggregate the data. But the work that gets done.

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And in the communities involves every single person who is identified with measles gets an interview where an investigator, sometimes a public health nurse or full time disease investigator will meet with them in person face to face with with personal protective equipment when when needed.

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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.

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Status or to get a post exposure profile access, meaning a vaccine. And and so that's that's the work that's being done right now. And we're we're probably going to see more cases as a result of those investigations with childhood vaccination rates, including for measles.

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Sitting at about 85% for incoming kindergarteners in Wisconsin. Was it just a matter of time before this outbreak happened?

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I think the answer is yes to that. We've we've been concerned about the level of childhood vaccinations being too low. Measles, as you said, is probably our most contagious virus.

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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.

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So we have many communities that are below 90 and below 85%. 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.

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The benefit of that is that we were ready and we're we're making the right resources available to our southwestern counties and hopefully we'll take this what is now a medium sized out breaking and keep it that small and prevent it from getting to be a large one like we've seen in some other states.

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How dangerous is it to get measles?

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Measles as a can be a pretty serious infection and it's a 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.

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So measles can 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.

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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.

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A whole body rash that is the characteristic dense red measles rash that starts on the head and then spreads to the whole body.

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And so most anyone that gets measles will have those symptoms and feel pretty terrible.

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But a subset of people with measles can get really severe illness and it can cause pneumonia and cause encephalitis or swelling of the brain and sometimes particularly in children that brain inflammation can cause permanent disabilities like blindness or deafness.

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So it's a serious it's a serious infection. One that we want to prevent and our goal is to is to eliminate measles.

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So there's actually not spreading in our communities at all. That's why the stakes are kind of high.

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What was it like before there was a measles vaccine?

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Yeah, the measles vaccine or version of the current measles vaccine was released in 1963. So a good long time ago.

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And the decades before that essentially everyone got measles during childhood, right?

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And so that's why there's some misconception that this is a sort of a normal part of childhood.

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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.

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So in that decade before we had MMR vaccine, there were three to four hundred deaths in children per year.

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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.

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There were about a thousand cases in Milwaukee. And that was when we realized that two doses are significantly better than one.

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So as a result of that nationwide outbreak in 1989-90, that the standard became two doses of MMR before kindergarten.

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And since that the uptake was high, we had virtually eliminated measles.

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We would have zero cases most years, sometimes one or two from a family in returning.

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But in 2000, the United States actually declared that we had eliminated measles as an eliminated measles transmission.

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So in a normal year, there were no outbreaks that were spreading person to person in the community.

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So it was really a public health triumph to get to that point where we didn't have measles on spreading in our communities.

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And that's what we're struggling with now, is to get back to that standard.

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And it's going to take getting more vaccines, our proportion of people with vaccines back up into that 90% level to get there.

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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,

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what is state of Wisconsin guidance on that idea?

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That's an important question to bring out.

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In Wisconsin, and frankly, most states, and even at the CDC, at the national level, the recommendation has not changed.

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The executive order was stating a preference, if you will, from the White House about how they think the White House thinks about vaccinations.

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There was also information there about having a fewer number of vaccines overall.

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I think the important message is that it's not reflect the medical consensus and the scientific consensus about the best way to prevent vaccine preventable diseases like measles.

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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.

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Specifically on the idea of separating MMR, it's really not a strategy that is viable because those vaccines don't exist.

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They're not manufactured, they're not approved that way.

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So doing that would actually be kind of contrary to the goal of having fewer injections.

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You need more injections, more visits to the hospital.

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And what we've learned, and I think most families can acknowledge, it's tricky to stay on top of all of the things.

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And more doctor visits would almost certainly result in fewer people being protected against measles.

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So we're considering that executive order to be something that we paid attention to.

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We respect the role of the federal government in providing leadership.

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But it's really important to acknowledge that it is contrary actually to the best medical advice about how to prevent measles and related diseases.

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Great. Dr. Ryan Westergaard, thanks very much for your update.

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Yeah, thanks for being for having me.