HHS, CDC Address Ongoing Measles Outbreaks

Experts Discuss Efforts to Protect the Public, Emphasize Vaccination

May 01, 2019 01:34 pm Michael Devitt – As the number of confirmed measles cases continues to rise, the CDC is pulling out all the stops to emphasize the importance of childhood vaccination and prevent more people from becoming infected.

That information was bolstered by a Morbidity and Mortality Weekly Report article released shortly after the briefing that summarized all measles cases reported in the United States this year.

Following up on Azar's comments, CDC Director Robert Redfield, M.D., joined the briefing to provide additional details on measles cases reported to date.

"Most of the cases we're seeing in the recent outbreaks have been among people who have not been vaccinated, and most of those cases have been children under 18 years of age," Redfield explained. Although no deaths have occurred at this point, he added, 9% of cases have resulted in hospitalization, and 3% of patients have contracted pneumonia.

Overall, said Redfield, about 94% of school-age children who entered kindergarten in 2017 had received the recommended two doses of the measles, mumps and rubella vaccine. "That means the majority of parents are making sure their children get vaccinated according to CDC's recommended immunization schedule," he noted.

Redfield cautioned that with summer approaching, it is likely more people will be going on vacation, and he repeated the CDC's recommendations for families that plan to travel abroad:

• Infants ages 6 months to 11 months should receive one dose of the MMR vaccine.
  
• Infants who receive one dose of MMR vaccine before their first birthday should get two more doses: one between 12 and 15 months and another dose at least 28 days later.
  
• Children 12 months and older should receive two doses of MMR vaccine separated by at least 28 days.
  
• Teenagers and adults who do not have evidence of immunity should get two doses of MMR vaccine separated by at least 28 days.
  
• People traveling internationally should receive their vaccines at least two weeks before departure, but even if their trip is less than two weeks away, they should still get a vaccine dose.

Redfield also encouraged parents to speak with their family doctor or other health care professional for more information. "They are your partners, and they are committed to caring for your child's health."

Nancy Messonnier, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, updated participants on the agency's efforts to prevent future outbreaks and to support communities where outbreaks are ongoing.

Noting that the outbreaks in New York City and other areas of the state are the largest and longest-lasting since measles was declared eliminated, she warned of the possible consequences: "The longer these outbreaks continue, the greater the chance that measles will again get a foothold in the United States."

Messonier attributed the outbreaks in New York to importation from another country, noting that 44 cases so far this year were directly imported from other countries. Among the 44 internationally imported measles cases over 90% were in people who are unvaccinated or whose vaccination status was unknown. Additionally, all 40 were age-eligible for vaccination.

"When measles is imported into a community with a highly vaccinated population, outbreaks either don't happen or are small," she explained. "However, once measles is in an undervaccinated community, it is difficult to control the spread of disease. Vaccination is our most powerful tool to control the spread of imported measles."

CDC Recommends Revaccination for Some Adults

In 1989, both the CDC's Advisory Committee on Immunization Practices and the American Academy of Pediatrics revised their immunization schedules to recommend that all school-age children receive a second dose of measles-containing vaccine. As a result, anyone vaccinated against measles since 1989 should have received two doses of the MMR vaccine.

For those vaccinated before that, however, the picture gets more complicated.

According to the CDC, adults who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated. People born before 1957 also do not need to be revaccinated because they are assumed to have been infected with measles during childhood and to have developed natural immunity.

However, many people who received the measles vaccine between 1963 and 1989 likely would have received only one dose, which puts them at increased risk of contracting the disease. Those who were vaccinated before 1968 with inactivated measles vaccine or measles vaccine of unknown type, in particular, should receive at least one dose of live attenuated vaccine. "This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective," the agency noted on its website.

In addition, the CDC considers anyone vaccinated between 1957 and 1963 to be at increased risk of contracting measles because they probably received a vaccine that contained inactivated measles virus.

Finally, although a single dose of the measles vaccine is about 93% effective, the CDC also recommendsthat adults who are at increased risk of exposure should have had at least two doses of the vaccine at least 28 days apart. This recommendation applies to

• students at post-high school educational institutions,
  
• health care workers,
  
• international travelers, and
  
• people identified by public health authorities as being at increased risk during an outbreak.

Family Physician's Perspective

AAFP News reached out to AAFP Commission on Health of the Public and Science Chair Beulette Hooks, M.D., of Midland, Ga., for her take on the current measles dilemma, as well as on the merits of vaccination in general.

"As family physicians, it is our responsible to help our patients who are not vaccinated -- to educate them so that they can get vaccinated," Hooks said, noting that vaccine-preventable diseases can take both a financial and a health toll. "As most Americans live paycheck to paycheck, if a child or parent gets infected and someone has to miss work, this can cause hardship for the family.

"As has been said, I do not want to see measles or any of the other childhood illness that have been eliminated in the United States make a comeback. Let us just read about them while we keep our children well and playing together, so we don't have to worry about whether this child or that child has been vaccinated."