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Press Briefing Transcript

CDC Telebriefing on Measles — United States, 2011

Thursday, April 19, 2012 – 12:00pm ET

OPERATOR: Welcome and Thank you for standing by.  At this time, all participants are in a listen-only mode until the question and answer session of today's conference.  At that time, you may press star 1 to ask a question.  I would like to inform all participants that today's conference is being recorded.  If you have any objections, you may disconnect at this time.  I would now like to turn the conference over to Mr. Tom skinner.  Sir, you may begin. 

TOM SKINNER: Thank you, Jennifer.  And thank you all for joining us today for this telebriefing on an article in today's MMWR on measles, United States 2011.  Joining us today is Dr. Anne Schuchat.  That is spelled S-C-H-U-C-H-A-T.  She is the director of CDC's National Center for Immunization and Respiratory Diseases.  She is going to provide a few opening remarks and we will then go to your questions.  During the question period, we're going to be joined also by Dr. Jane Seward, spelled S-E-W-A-R-D.  She is CDC's deputy director for the division of viral diseases here at CDC.  So we'll have dr. Schuchat provide some comments, and then we'll get to your questions.  Dr. Schuchat. 

ANNE SCHUCHAT: Thanks, Tom.  And thanks everyone for joining us today.  Many of us have the good fortune to travel internationally for work or for pleasure.  I spent almost all of yesterday traveling in three different airports.  And so today's MMWR is a particularly timely report.  There's a lot of things we like to bring back when we travel.  Photographs, local crafts, but last year many U.S. travelers brought back more than they had bargained for.  They returned to our country with measles.  Similarly, we had many international visitors to the U.S. who brought the disease along with them.  Unfortunately, these people cross paths with susceptible, unimmunized people in several communities across the country.  And the results that we reported in today's MMWR are that in 2011, we had the most number of reported measles cases in the United States in 15 years.  222 people were reported to have the disease last year.  We had 17 outbreaks, more than four times the usual number.  Today I want to share some of the details from today's report, and remind everyone about our measles vaccination recommendations, and mention a few words about next week's national infant immunization week celebration. 

First, a few reminders about measles, thanks to the very high immunization rates we have in the United States, we declared measles eliminated in 2000.  After we were able to interrupt the transmission of disease from person to person here in the U.S.  since then, we saw a median number of only about 60 reported measles cases a year, between 2001 and 2010.  But there is measles still in most of the rest of the world.  Worldwide, recently, about 20 million people get measles each year.  And about 164,000 die from it.  The virus can come into our country easily through visitors or through Americans traveling abroad who bring it back.  Measles can be serious.  Even in developed countries like the United States, for every 1,000 children who get measles, between 1 and 3 may die from the infection, despite very good treatment.  Measles spreads when an infected person breathes, coughs or sneezes, and it's extremely contagious.  You can catch measles just by being in a room where a person with measles has been;  even after that person has left the room.  And you can catch measles from an infected person, even before they realize they're ill, even before the rash develops.  During 2011, 222 measles cases and 17 measles outbreaks were reported to CDC from 31 different states.  The most measles we have seen in this country since 1996, when we had 508 measles cases.  Two factors played a key role in the increased number of outbreaks.  Importations related to foreign travel and susceptible unimmunized people in our communities.  200 of the 222 measles cases were associated with importations from other countries.  In 22 cases, we weren't able to determine the source.  When we say associated with importations, that includes people who themselves traveled or imported the virus, as well as the cases that were spread or linked to those importations.  There were 72 actual importations from other countries, and nearly half of them were from the European region.  Most of us don't think of Europe as a place where you can catch an infectious disease, but recently there has been a lot of measles in Europe.  In 2011, more than 37,000 measles cases were reported from Europe, and some of the countries that have been hardest hit are places that Americans frequently travel.  Like France and Italy and Spain.  It's very important for travelers heading off to Europe to make sure they are up to date on their immunizations and to make sure their children are, as well.  Second factor besides importations with susceptible people.  Now, in the U.S., we are fortunate to benefit from very high levels of vaccination coverage.  More than 90 percent of the country's children have been vaccinated against measles.  But measles is extremely infectious, and it's very good as a virus in finding those few people who aren't immunized or protected.  Some people are too young to be vaccinated and can't be protected.  And others may have not gotten around to getting vaccinated yet or may have actually refused or declined to be vaccinated.  So what happened in 2011 was that many of the people who became ill from measles had actually declined or exempted from vaccine.  Most of the measles cases or 86 percent were not vaccinated against measles, or they did not know if they were vaccinated.  65 percent had not been vaccinated, and 21 percent, most of them adults, didn't know whether they had been vaccinated or not.  Of the 166 U.S. residents who were unvaccinated or had unknown vaccination status, 141, or 85 percent, were eligible to get the MMR vaccine.  Of the 141, 66 were between the ages of 16 months and 19 years of age when they should have already gotten the vaccine, and when school requirements or daycare requirements would have been good reminders they were eligible and expected to be vaccinated.  Of those 66, 50 or 76 percent had a philosophical objection or a religious or personal belief exemption to vaccination.  The other cases occurred in children who were too young to be vaccinated or an adult who may not have had the accurate histories.  Measles can cause serious complications and even death.  You may be surprised that one out of three of the people who got measles in the United States last year had to be hospitalized.  Each case of measles requires a rapid, intensive investigation to make sure measles doesn't take hold again in the United States.  We have had extreme activity in our public health community this past year responding to each of these cases, investigating them, and making sure that the virus doesn't take hold in the community.  Thanks to a very high vaccination rate, and the aggressive public health response from local and state health departments, the outbreaks in 2011 remain small and contained, and did not re-establish transmission here, which has been happening in some of the European countries.  There were 17 outbreaks, unlike the usual 4 we see each year.  Now, we don't have to have this much measles, because measles is preventable.  Unvaccinated people put themselves and other people at risk for measles, and its complications.  They particularly put at risk people who are too young to be vaccinated, who can sometimes have the worst complications from measles.  The continuing story of measles is that we're still having importations and disease this year, with more than 25 cases reported so far in 2012, most of them associated with importation.  So who should get the measles vaccine?  We strongly recommend that people of all ages keep up to date with all of their vaccinations, and we specifically recommend the children receive two doses of the measles, mumps and rubella, or MMR vaccine.  The first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age.  You can actually give the second dose earlier, any time, as long as it's 28 days after the first dose.  Unless they have evidence of already having been immune to measles, we recommend that college and other students, health care personnel and anyone traveling internationally should have two appropriately spaced doses of vaccines.  Other adults need to make sure they've had one dose of vaccine.  For those who travel internationally, we also recommend that U.S. residents older than 6 months be protected from measles and receive the MMR vaccine early, at 6 months or later, instead of at the 12-month point.  This is really important, something we highlighted in an MMWR last year, because very young babies are so susceptible.  And if they are going to be traveling abroad or in contact with international visitors, should get the vaccine early.  Before long, we know schools will be out, people will be taking their spring and summer vacations, some people might even be going to the Olympic Games if they're lucky.  We want to make sure all those travelers get vaccinated and bring home proper souvenirs, not measles.  I want to make a couple comments about next week.  It's national infant immunization week, which we celebrate April 21st to 28.  And this is a chance for us to celebrate the successes that immunization has provided to our families and communities.  And recognize the great work of front-line providers.  We're starting something new next week.  We'll be in combination with the CDC foundation, celebrating childhood immunization champions, and I look forward to celebrating with these champions their incredible frontline work.  We'll also be launching radio and TV public service announcements and celebrating with the world health organization and regions all around the world, including PAHO the first world immunization week.  This is an exciting expansion of what started 18 years ago with the first national infant immunization week, a real chance to remind ourselves of the lives saved and family health that's protected through immunization.  What I’d like to do next is remind you that you can get more information about today's MMWR report and about the national infant immunization week at our website, CDC.gov/vaccines and begin answering the questions you have.  Operator? 

OPERATOR: If you would like to ask a question, please press star 1 and record your name.  To withdraw your request, you may press star 2.  Once again, to ask a question, please press star 1.  Just one moment for the first question.  Our first question comes from Mike Stobbe of the Associated Press.  You may begin. 

MIKE STOBBE: Hi, doctor, thanks for taking the call.  Two Questions, There were a lot of numbers that went by.  I want to make sure i got some of them correctly.  You were saying in 2011, many of the people who became ill had actually declined or exempted.  The numbers on that were out of 196 U.S. residents, you have information that 50 of them declined or exempted.  Is that correct? 

ANNE SCHUCHAT: Yeah, let me go through the numbers in a little more detail.  There were 141 of the U.S. residents who were eligible to receive the MMR vaccine, because they were old enough to get it.  And they weren't so old that we don't actually recommend it.  Because if you were born before 1957, we're not routinely recommending you be vaccinated.  Of those 141, 50 were confirmed to have had a philosophical, religious or personal belief exemption.  But it's important to state that those 50 came within the ages of 16 months and 19 years of age, where we would be more likely to know about an exemption or get that information.  So there were only 66 of the cases that were in residents between the ages of 16 months and 19 years.  And 76 percent of them, or 50, had one of these personal belief or religious exemptions.  So we do think that exemptions are common in some parts of the country.  And we think it's really important for families to know that measles is still a threat, that it can be serious, that the MMR vaccine is very safe and very effective, and that we strongly recommend children get their vaccines. 

MIKE STOBBE: Were most of those 50 cases clustered in any particular state or community? 

ANNE SCHUCHAT: No.  You know, we had cases all over the country.  There were, as i mentioned, 17 outbreaks.  And when outbreaks occur, that is usually because there are more susceptible within the area.  But we had cases really in many, many states.  As you know, we've been tracking the exemptions around the country, and there are a couple places where it's much more frequent for children to be exempted from vaccines.  The northwest has been a hot spot for several years.  We have good news in 2010-'11 that in some cases it's getting a little bit better.  The state of Washington actually had improvement in their exemption rate between 2009-'10, 2010-'11, but in other cases it's getting higher.  We really think it's important for parents to know the MMR vaccine is safe, very effective.  Measles can be serious, your child can get it, and your child can spread it to people who can't even get the vaccine because they're too young or they have problems like leukemia.  Next question? 

OPERATOR: Our next question comes from Richard Knox of National Public Radio.  You may begin.  Mr. Knox, your line is open. 

RICHARD KNOX: I’m sorry.  I had to unmute myself here.  Thanks very much.  You actually just answered some of what i was going to ask about exemptions.  But I just wondered how much CDC knows about the reasons why people still don't trust the vaccine or what not, to take it.  And how you're responding to those particular reasons. 

ANNE SCHUCHAT: You know, we've been doing in-depth interviews with providers.  We've been doing focus groups with families.  We've been trying to understand what's going on.  What i would like to say is that there are many different factors.  In some places, it's easier to exempt from a vaccine than to actually get a vaccine.  Sometimes parents are busy, and just want to sign the form and turn it in and get their children back to school.  And may not realize that they're putting their child's health at risk.  We believe that for many parents, a reason to decline vaccines is that they really don't think there is a threat of disease.  They think these diseases are gone.  Unfortunately, measles is not gone.  It is around.  I like to think of the warning that we have with what's been going on in Europe.  You know, as i mentioned, more than 30,000 cases, in France alone, more than 15,000 cases, including several deaths.  No one wants their child to die from measles in 2012.  We can prevent those deaths; we can prevent those severe hospitalizations, cases of encephalitis and other complications.  So we think a factor is the question of whether this disease is even still a threat to my child.  There have been questions over the years about the safety of vaccines, but MMR vaccine has been studied extensively.  It's very safe.  We think that is less of an issue right now than the convenience issue.  Next question? 

OPERATOR: Our next question comes from David Beasley of Reuters.  You may begin. 

DAVID BEASLEY: Yes.  If you were an adult and you either had measles as a child or you were immunized as a child, at what point should you be immunized, if, say, for example, you're going to Europe? 

ANNE SCHUCHAT: Right.  If you had measles as a child, you know, there's a doctor's confirmation that you had measles, then you don't need to be reimmunized.  But many adults may have gotten just a single dose of measles vaccine, and we do recommend two doses of measles vaccine to make sure that you're protected.  One of the factors in the MMWR report is that there were a number of cases in adults, many of whom had no records of what vaccines they have gotten.  There's no problem with getting another measles vaccine if you're not sure, and not ruining your vacation or bringing the virus back to your friends and family.  Most people born before 1957 we're pretty sure have been infected with measles, because that was before the vaccine was commonly used and before we started our campaigns in the 1960s.  But we did actually even have a reported case in a person who was 83 -- or 84, excuse me.  So some adults somehow managed to escape the actual virus when it was circulating widely here in the states.  So we have a lot of recommendations for vaccinations for adults that are on our website at www.CDC.gov/vaccines.  But if you're not sure of your history and you aren't sure you got two doses and you're heading to Europe, why not get another MMR vaccine.  Next question, please. 

OPERATOR: Our next question comes from Dan DeNoon of WebMD. 

DAN DENOON: Thanks for taking my question.  Good to talk to you.  I wonder, is there any estimate -- obviously, these reports are never quite as many cases as actually occurred.  Is there any sense of how many unreported cases are out there? 

ANNE SCHUCHAT: You know, your question raises the issue of the sensitivity of our surveillance.  And we often do have that problem, that there's more disease than we know about.  We eliminated measles from the United States in 2000, and since that time, have had very intensive surveillance to try to find every case, and try to confirm whether it's measles or not with laboratory testing.  And report actively and look at contacts and make sure none of them get sick.  We have better surveillance for measles than for most infectious diseases.  That said, when we review all of the virology data, we may have missed cases here and there.  We don't think we are missing a lot of the measles cases, but we know that it takes an enormous amount of effort to keep the number down to what it is, both to report every case, to get it clinically confirmed or laboratory confirmed.  I also want to say that the clinicians in the country, pediatricians and internists and family physicians, many of them have never seen measles.  What happened in some of these outbreaks was that the families went to doctors multiple times, visited emergency rooms; it took a while for the case to be diagnosed.  And during that period, measles was spread to other people.  So we may be missing cases because clinicians have forgotten what measles looked like or have never known since they're younger.  And we also may not have all of the laboratory testing done as well as needs to be at every clinical lab.  So, again, the public health labs and CDC provide that safety net to make sure we can do the lab testing and confirm the cases and to help support clinicians and recognize what the disease is.  Next question? 

OPERATOR: Our next question comes from Lisa Schnirring of CIDRAP News.  You may begin. 

LISA SCHNIRRING: Thanks, Dr. Schuchat.  There was a report in medical news a few weeks ago about different legislative efforts and in different states about philosophical exemptions.  And there are a handful that are thinking of tightening them.  But it was kind of startling that there are states that are considering relaxing them, including my own state, which is embarrassing.  But I’m just wondering what can be done to kind of influence these debates that are happening right now. 

ANNE SCHUCHAT: You know, it's so important for communities to be aware of the health threats they face.  And i think we have forgotten how bad a problem of measles can be.  I think in Africa and parts of Asia, babies are still dying from the disease.  And we have a chance to prevent it worldwide.  The decisions about school requirements are state or local matters.  But CDC strongly recommends that every child receive measles vaccine and get their second dose before they enter kindergarten, so they'll be protected and cannot spread the disease to others.  I think that we're learning a lot about the relationship between the exemption policy and disease rates, not just for measles, but for diseases like whooping cough that are much more common.  We know that -- where there are more people exempting from vaccines, there have been more outbreaks of whooping cough and more cases of whooping cough.  So there is a relationship between the policies that people have, the decisions that families make, and the disease rates.  And i think it's very important for parents to get the information they need.  In this case, the MMR vaccine is very effective, and extremely safe.  And is strongly recommended to protect your child and your family from measles.  Next question? 

OPERATOR: As a reminder, if you would like to ask a question, please press star 1 and record your name.  Our next question comes from Deborah Kotz of the Boston Globe.  You may begin. 

DEBORAH KOTZ: Hi, there.  Thank you very much for taking my question.  Dr. Schuchat, you had mentioned there are some places where it was getting worse in terms of the rates were getting higher in terms of philosophical objections to vaccines.  And I was wondering if Massachusetts, if you had seen any statistical indication that Massachusetts was one of the states.  We have had a few outbreaks of measles last year, and was wondering if any of that was related to vaccine rates. 

ANNE SCHUCHAT: I don't believe that – Massachusetts is on that list.  But what i can say is that the exemption rates are a very crude indicator of the actual activities.  What we track is exempting from any vaccine.  We're not tracking specifically the measles -- the MMR vaccine.  Some people who are tracked as an exemptor may have declined or refused one vaccine but not others.  So the statewide statistics wouldn't be so helpful.  Massachusetts also has very high immunization coverage in general.  But that doesn't mean there are communities that don't have a lot of susceptibles.  And what we see around the country, this can be a neighborhood thing.  It can be a school community issue, and not something that shows up at the city level or the full state or national level.  And so we do think that making sure that you and your family and your neighbors are protected is a personal responsibility.  It's not just the school enforcement, but people really taking an effort to protect themselves and their community.  Next question? 

OPERATOR: Our next question comes from Joette Giovinco of WTVT. You may begin. 

JOETTE GIOVINCO:  Thank you for taking my question. You have answered a lot of questions that I had previously, but I want to concentrate on the people born before 1957.  If these individuals are traveling overseas to an area say, the Olympics or an area where there have been high rates of measles, what should they do, should they get a titer check, presume they are immune, or these 4% who got the measles were not immune or maybe their immunity had waned? 

ANNE SCHUCHAT: I think it's best to take the individual cases with one clinician.  But in general, almost everybody born before 1957 actually got measles.  Sometimes people know, you know, i never got measles.  My mom told me that was so weird, never got measles.  That's the kind of person i would recommend get vaccinated before heading off to Europe.  And as I mentioned, MMR vaccine is safe and effective and not a problem to get it.  I wouldn't recommend a measles titer. 

JOETTE GIOVINCO: Okay, thank you. 

ANNE SCHUCHAT: I think this is the last question now. 

TOM SKINNER: Actually, Anne, I think we've got just two more questions.  Let's try to get to two more questions.  And then we'll close up. 

ANNE SCHUCHAT:  All right. 

OPERATOR: Our next question comes from David Beasley of Reuters.  You may begin. 

DAVID BEASLEY:  Yes.  Do you know when the last fatal case in the U.S. of measles occurred?  How long ago someone actually died? 

ANNE SCHUCHAT: Let me defer to Dr. Seward who may recall that, and if not, we can try to get that information out through our news office.  I don't know that myself. 

JANE SEWARD:  Yeah, I don't know the exact year.  But we have had -- we had two measles deaths between -- 2001 and 2008. 

DAVID BEASLEY:  Okay. 

JANE SEWARD: One was in a 13-year-old boy who had some underlying disease.  And the other was in a 75-year-old international traveler.  We haven't had any deaths since 2008. 

DAVID BEASLEY:  Great.  Thank you so much. 

ANNE SCHUCHAT: but as i mentioned, you know, we think that it's about one to three deaths per thousand cases of measles in a well-nourished, healthy population like the U.S.  So as many years we were just having about 60 or 70 cases of measles, it would take quite a few before just by statistics we would see one.  I would hate for the next one to be tomorrow.  So I really strongly recommend people get their measles vaccinations and keep their kids protected. 

JANE SEWARD:  One more comment from me.  One case last year in a child, a young child, involved in one of the outbreaks, he was in intensive care for about a week.  And it was really touch and go as to whether or not that child would -- would survive or not.  And fortunately, he did.  But he was extremely sick. 

TOM SKINNER: We’ve got time for one more question, Jennifer. 

OPERATOR: Our final question comes from mike Stobbe of the associated press.  You may begin. 

MIKE STOBBE:  Thanks.  This is the second question i meant to ask you earlier.  Just looking forward, Dr. Schuchat, i think you said there have been 25 cases reported so far this year.  I was wondering how the year is shaping up, and should we expect that we're looking at, you know, 200 or more cases again for 2012?  I mean, have the circumstances changed much since last year? 

ANNE SCHUCHAT: You know, it's -- it's more than 25 so far.  I believe it's 27 as of last Friday.  But what i can say is, it's too soon in the year for us to know whether this year will be as bad or even worse from last year.  But i want to give people a couple statistics.  You can go from a small number to a very large number very quickly.  And the annual reports from France are that they were having 30 to 40 cases a year between 2005 and 2007.  In 2008, they got 604 reported cases.  Then more than 1,500 in 2009, 5,000 in 2010,and over 15,000 in 2011.  So going from 40 a year to over 15,000 in just a couple years.  So that's why we have this incredible alertness to make sure that we don't let that happen here.  What would happen if people didn't get vaccinated, we would have thousands and thousands of cases.  And you may recall 1989 to 1991 when there were 55,000 children with measles in this country and more than 100 deaths.  So we really don't want to go back to those days.  And I think in some of the European countries, they're working very hard to get out of that problem.  So we don't know what this year will be.  We do know there's an awful lot of international events, and people love to visit the United States and Americans love to visit elsewhere.  And it's a great time to be protected against measles if you're going to do that.  So I want to thank everybody for being on the call, and just remind you that for those of you traveling abroad, bring back memories and not measles.  Thanks. 

TOM SKINNER:  Thanks Dr. Schuchat.  And Jennifer, this concludes our telebriefing.  Should reporters have additional questions, or need additional information, they should feel free to call the CDC press office at 404-639-3286.  Thanks again for joining us. 

OPERATOR: That concludes today's conference.  Thank you for your participation.  You may disconnect at this time.  

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