Q&A: Measles cases top 1,000 in US, so what does that mean?

William Schaffner

This week, the CDC reported that measles cases have reached over 1,000 cases in the United States for the year despite a vaccine available that demonstrates 97% efficacy if both doses are given.

In April, the agency said measles cases had reached the highest number since 1994. Measles was not eliminated from the U.S. until 2000.

“We are very concerned that because measles is so highly transmissible that it is the harbinger of other vaccine-preventable diseases that could be introduced and spread among susceptible children,” William Schaffner, MD, professor of preventive medicine at Vanderbilt University and medical director at the National Foundation for Infectious Diseases, said in an interview

Schaffner spoke with Infectious Diseases in Children about the potential implications of this outbreak and what it will take to stop it. – by Katherine Bortz

Q: Based on the newest numbers, do you think that the U.S. might lose its elimination status?

A: Unfortunately, I do think that this is very likely because there will be continuing transmission of measles, and there will be more cases as we go forward through this year. That will demonstrate that we have sustained ongoing transmission of the measles virus that will extend over a year. That is the criterion for demonstrating elimination. Because we have transmission, I fear the elimination status will sadly be removed from the U.S.

Q: Measles is one of the most contagious diseases. Even if we were to start improving immunization rates right now, how long can we expect transmission to continue?

A: Theoretically, if I could see to it that every child who is susceptible to measles in the U.S. were immunized today, the outbreak would stop in 2 weeks because there would still be some children who were exposed to measles during that 2-week incubation period. But, in 2 weeks, the number thereafter would be zero.

That is theoretically possible, but that is not going to happen because there are populations that are still disinclined and even resisting appeals to vaccinate their children. These susceptible children will still be there, and this virus is so contagious that it will find them over a period of time and make them sick.

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Q: What efforts are being made to reach these groups and get them vaccinated?

A: At the moment, we know that there is ongoing transmission among an ultra-Orthodox Jewish population in New York. My understanding is that Jewish religious leaders and people in the public health and clinical community — pediatricians and family doctors — are all trying to reach out to the leaders of that community to bring them in and provide information, reassurance, comfort and to listen carefully to their concerns.

We had a similar issue a couple of years ago in Minnesota in the Somali community. It took a sustained effort from the people in public health and pediatrics to gain the confidence and respect of the Somali community. At the time, there was a particular concern that the vaccine was associated with autism, and that had to be shown to be incorrect. It took time for the local community to accept that notion and be reassured that the vaccine was safe. That was something that took months and a lot of sustained effort and conversation.

It is important not to antagonize the community, but to try to listen, let them know that they have been heard and, gradually over time, gain their confidence and answer all their questions.

Q: What is it going to take to improve immunization rates on a larger scale?

A: It will take sustained reaching out, continuing conversations in an attempt to have them understand the importance of vaccination, to listen to their concerns and provide good information if they have misconceptions.

It is also very important to provide reassurance that vaccination is important for people, and that this is something that is safe for their children and appropriate not only for their individual child but for the entire community. It will make their entire community safe, and it has to do with joining the larger general population in the U.S. to work together to eliminate measles from our country.

Reference:

CDC: History of measles. https://www.cdc.gov/measles/about/history.html. Accessed June 6, 2019.

CDC: Measles vaccination. https://www.cdc.gov/measles/vaccination.html. Accessed June 6, 2019.

Disclosure: Schaffner has served on data safety monitoring boards for vaccine clinical trials for Pfizer and Merck and has currently consulted for Roche Diagnostics.