Measles Outbreaks Continue at Record Pace

In May, AAFP News Now reported on a series of measles outbreaks that had racked up a total of 64 cases between Jan. 1 and April 25 -- the most cases seen in the United States since 2001. According to CDC officials, that tally had reached 131 by the end of July -- the highest year-to-date number since 1996. As of the end of April, nine states had reported cases of the disease; now, 15 states and the District of Columbia have reported measles cases.

But those figures only begin to scratch the surface of the problem.

Of the 131 total cases reported to the CDC, 123 occurred in U.S. residents. Five of these residents had received a single dose of measles-mumps-rubella, or MMR, vaccine; six had received two MMR doses; and 112 were unvaccinated or had unknown vaccination status. Of those 112 cases, 16 occurred in patients who were too young to be vaccinated and one occurred in a patient who was born before 1957 and, therefore, was presumed to have immunity. Finally, of the 95 remaining patients eligible for vaccination, 63 had not been immunized because of their parents' philosophical or religious beliefs.

According to an update in the Aug. 22 Morbidity and Mortality Weekly Report, or MMWR, the number of cases linked to virus importation has expanded from 54 of the 64 cases earlier reported to 116 of the current 131 cases. Yet, at 13 percent, the percentage of cases imported from other countries is the lowest since 1996.

As the MMWR update notes, "This increase was not the result of a greater number of imported cases, but was the result of greater viral transmission after importation into the United States, leading to a greater number of importation-associated cases."

That's an important distinction to make, according to U.S. Assistant Surgeon General Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, or NCIRD. "Once the measles virus is imported here, we're seeing it spread to other children," she said in an Aug. 21 media telebriefing.

"I want to make sure that parents know that measles is still around, that it can cause serious disease, and that it can be prevented," Schuchat said.

Of particular concern, according to the MMWR update, are reports that parents may be second-guessing their physicians when it comes to immunizing their children.

"These importation-associated (measles) cases have occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated," the update notes. "One study has suggested an increasing number of vaccine exemptions among children who attend school in states that allow philosophical exemptions. In addition, home-schooled children are not covered by school-entry vaccination requirements in many states."

Jane Seward, M.B.B.S., M.P.H., deputy director of NCIRD's Division of Viral Disease, joined Schuchat on the Aug. 21 media call, stressing the need for health professionals to keep reinforcing the immunization message with parents of young children.

"As children go back to school -- whether they go to school or are home-schooled -- or if they go to daycare, this is a good time to look at their vaccination status," Seward said.

Family physician Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, said he agrees with the premise of the study mentioned in the MMWR report. "It's true that states that allow easier exemptions have lower rates of immunizations and higher rates of vaccine-preventable diseases," he recently told AAFP News Now. But from his perspective, the "why" doesn't matter nearly as much as the "what to do about it."

"If we family physicians are encountering parents who don't want their kids vaccinated, we need to give them the right information to try to counter that resistance," said Campos-Outcalt, who serves as AAFP liaison to the CDC's Advisory Committee on Immunization Practices and is associate head of the Department of Family and Community Medicine and assistant dean for outreach and multicultural affairs at the University of Arizona College of Medicine, Phoenix.

Talk with parents about their concerns, Campos-Outcalt advised. "You could say, 'I notice your child hasn't been vaccinated; can you talk about why that is?"

FPs also can relate to parents by reassuring them that they've had their own children fully immunized, said Campos-Outcalt. And don't be afraid to ask them point-blank, "Do you realize that your kids, if they haven't been vaccinated, are posing a danger to other kids?"

Evidence-based resources, such as those on the "Parents: What You Need to Know" Web page in the Vaccines & Immunizations section of the CDC Web site, also can be useful in assuaging parents' concerns about the vaccines their children receive, Campos-Outcalt noted. But he warned that the current concern about immunizations "has implications for family physicians in the future."

"To the extent that this tendency (not to vaccinate) grows, family physicians are going to have to spend more time educating parents about this issue," he said. "And we need to have a higher index of suspicion for vaccine-preventable illness.

"If a kid comes in with a rash and fever, we need to think about measles. We need to think about pertussis in a kid with cough. These are things that we're not used to thinking about."