CDC Telebriefing: National Update on Measles Transcript

OPERATOR: Welcome and thank you for standing by.  At this time, all participants are in listen-only mode until the question and answer of today’s conference.  At that time, you may press star one on your phone to ask a question.  I’d like to inform all parties that today’s conference is being recorded.  If you have any objections you may disconnect at this time.  I will now turn the conference over to Kathy Harben.  Thank you.

KATHY HARBEN: Thank you, Denise.  Thank you all for joining us to discuss the latest on the measles outbreaks in the United States.  We’re joined today by Health and Human Services Secretary Alex Azar.  Assistant Secretary for Health, Admiral Brett Giroir.  CDC director Dr. Robert Redfield.  CDC Principal Deputy Director Dr. Anne Schuchat and CDC Vaccine Director Dr. Nancy Messonnier.  I’ll now turn the call over to Secretary Azar.

HHS SECRETARY ALEX AZAR: Good morning and thank you all for joining us today. Today’s the start of National Infant Immunization Week, an annual observance and opportunity for us to highlight the importance of protecting infants from vaccine-preventable diseases and to celebrate the achievements of immunization programs in promoting healthy communities throughout the united states.  This year, we’re celebrating 25 years of national infant immunization week.  When this observance was established in 1994, health departments and immunization programs were facing significant challenges.  The nation was in the midst of a serious measles outbreak and communities across the United States were seeing decreasing immunizations rates among children.  Today, the overwhelming majority of parents choose to protect their kids with vaccines.  However, we’re very concerned about the recent troubling rise in cases of measles, which was declared eliminated from our country in 2000.  Today, CDC is reporting 704 cases of measles from 22 states.  This is the greatest number of cases reported in the U.S. since measles was eliminated.  While most parents are getting their children vaccinated, the vast majority of cases involve children who have not been vaccinated.  Everyone should be vaccinated against measles and other vaccine-preventable diseases.  As Dr. Redfield will explain, measles is not a harmless childhood illness, but a dangerous, highly contagious disease.  Most of us have never seen the deadly consequences that vaccine-preventable diseases can have on a child, family or community, and that’s the way we want to keep it.  Vaccine-preventable diseases belong in the history books, not in our emergency room.  Vaccination is a simple, safe and effective way to protect our loved ones and neighbors from the scourge of measles, and the suffering we are seeing today is completely avoidable.  I’ll repeat it one more time, we know vaccines are safe because they are among the most studied medical products we have that’s why this week across the department of health and human services we’re reminding all Americans to talk to their doctor and ensure they’re up to date on CDC’s recommended vaccination schedule which provides guidelines for people of all ages and with particular health conditions.  Now, I’d like to turn the call over to our CDC Director Robert Redfield to talk about what’s being done and what else can be done to prevent these outbreaks.

ROBERT REDFIELD: Thank you, Mr. Secretary.  Many of you are familiar with the consequences of measles. There are no treatment and no cure for measles and no way to predict how bad a case of measles will be.  Some children may have very mild symptoms.  Others may face serious complications.  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.  Measles can be serious in any age group, but particularly children younger than 5 and older adults.  They’re likely to suffer complications. Of the cases in 2019, 9% of them have been hospitalized and 3% have had pneumonia.  At this time, there have been no deaths.  Measles is incredibly contagious.  A person who has measles can make other people sick four days before they get a rash.  If an infected person enters a room of ten unvaccinated people nine of them will get measles.  The united states has high rates of vaccination coverage among kindergartners entering school in 2017 about 94% had the recommended two doses of measles, mumps and rubella or the MMR vaccine.  That means the majority of parents are making sure their children get vaccinated according to CDC’s recommended immunization schedule.  Two doses of MMR vaccine are about 97% effective at preventing measles.  One dose is about 93% effective.  When you get vaccinated, you also protect others around you who are at high risk for complications but can’t get vaccinated because they’re too young or have a health condition.  As the holidays and summer approach, and families are traveling abroad, CDC strongly recommends that one, infants 6 months through 11 months of age get one dose of MMR vaccine before travel. Two, children 12 months of age or older need two doses separated by at least 28 days.  Three, adolescents and adults who have not had measles or have not been vaccinated should get two doses separated by at least 28 days.  People traveling internationally should try to be fully vaccinated at least two weeks before traveling.  But even if your trip is less than two weeks away you should still get a dose before you depart.  I encourage parents to speak to your family healthcare providers, they’re your partners and committed to caring for your child’s health.  Now, I’d like to turn the call over to Dr. Nancy Messonnier.

NANCY MESSONNIER: Thank you.  I want to discuss the reasons why we’re seeing so many measles cases and what can be done to prevent them and to stop the outbreak, and what CDC is doing to support communities.  The high number of cases in 2019 is primarily the result of a few large outbreaks, one in Washington State, two, in New York, that started in late 2018.  The good news is that last week the Washington state department of health declared their outbreak over.  However, the outbreaks in New York City and New York State are the largest and longest lasting since the measles elimination in 2000. The longer these outbreaks continue the greater the chance that measles will again get a foothold in the United States. The recent outbreak started through what we call importation.  Measles is imported when an unvaccinated traveler visits a country where there is widespread measles transmission, gets infected with measles and returns to the United States.  That traveler then exposes people in their community who are not vaccinated.  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.  Including two infant travelers, aged 6 to 11 months.  When measles is imported into a community with a highly vaccinated population, outbreaks either don’t happen or are small.  However, once measles is in an under vaccinated community it’s difficult to control the spread of disease.  Vaccination is our most powerful tool to control the spread of imported measles.  Another factor contributing to the outbreaks in New York is misinformation spreading in some counties about the safety and effectiveness of the MMR vaccine.  Sadly, these communities are being targeted with inaccurate and misleading information about vaccines.  Stopping these measles outbreaks is a priority for the CDC.  We’re working 24/7 to protect Americans.  Measles can be extremely costly and disruptive to public health, costing an average of around 32,000 dollars per case.  That does not capture cost from the community perspective the tragic impact measles can have on individuals and their families.  CDC’s addressing the current outbreak in several ways.  We have implemented an incident management structure within the national center for immunization and respiratory diseases to respond to the measles outbreak.  We’re reinforcing to health care providers the guidelines for recognizing and preventing measles.  Because misinformation about vaccines is circulating in communities the CDC has developed a toolkit with resources that physicians can use with parents and other patients to reinforce what we know about measles and vaccines. CDC is also working to address vaccine hesitancy.   Including creating new resources and updating existing resources to counter misinformation.  CDC continues outreach to the medical associations to help spread clear, consistent, incredible vaccine information through trusted sources.

Before taking questions.  I want to thank the local and state and health officials that have been tirelessly working to control these outbreaks they’re on the front lines following up with contacts and answering questions anyone may have.  We at CDC appreciate the work you do today and every day to keep America healthy.

KATHY HARBEN: Thank you, Secretary Azar, Dr. Redfield and Dr. Messonnier.  Denise, we’re now ready for questions.  We’ll be joined by Admiral Giroir and Dr. Schuchat.

OPERATOR: If you’d like to ask a question, please press star one.  To withdraw a question, press star two.  Please stand by.  First question comes from Mike Stobbe with the associated press.  Sir, you may ask your question.

STOBBE/AP: Thank you for taking my question.  I want to ask, it was mentioned that the outbreak in Washington state was declared over, what was the final number, was it 72?  I also was wondering, Dr.  Messonnier, you mentioned that this misinformation in certain communities, i think you were talking specifically about ultra-orthodox communities in New York, and you said they were targeted.  Who targeted them and why did they target that community or those communities?

NANCY MESSONNIER:  So 72 is the right number of cases in Washington State.  And those numbers should be up on our website by 11:00.  In terms of targeting, we have definitely seen misinformation about vaccines being sent to susceptible communities, that is communities susceptible to that misinformation.  I can’t explain why.  I think you’d have to talk to people who are spreading that misinformation.  We definitely see that information targeted and these vulnerable communities are the communities in which we’re seeing these outbreaks right now.

Next question comes from Helen Branswell -Stat News, your line is open.

HELEN BRANSWELL: thank you very much.  I have a couple.  First one is, people who had at least one dose of vaccine, can you unpack that and let us know, you know, were they partially vaccinated or fully vaccinated by age?  My second question relates to recommendations around vaccines now in places where the virus is spreading, would it make sense to push forward the second dose of vaccine in young children if, as long as there’s 28-day window between the two doses.

NANCY MESSONNIER: Your numbers are right in terms of the first question.  There are cases in the 704 that we’re reporting that are fully or partially vaccinated and we’re still trying to pin down the numbers.  What i would say about those, in a setting where there is extreme disease pressures we know that there can be vaccine failures.  That’s why it’s important not just to protect individuals with vaccination but to get the community vaccination numbers up so we can get herd immunity that cushion of protection that helps all of us.  So there are some adults in those numbers.  We are recommending that adults, especially those who are in high risk settings, those who are traveling internationally but also who are health care workers and those that live in communities that have ongoing outbreaks we especially want to make sure they’re checking on their status to make sure they’re protected against the measles disease.  Your second question which was, should we be moving forward the second dose so that younger kids get two doses of measles vaccine?  That’s not where we’re seeing disease yet.  We’re focused on getting the first dose in these affected areas and also for people traveling internationally.  But were obviously, going to be looking closely at all these cases to make sure that we don’t need to update our recommendations.

Next question is from Lena Sun from The Washington Post.

LENA SUN: I don’t know if secretary azar is still on the line and available for questions.

AZAR: I am, yes.

Okay, Mr. Secretary, thank you.  In statements last week you said, you talked about the importance of vaccination and why this is happening.  I’m wondering, given that we have been racing toward these record measles cases for some time now, why it took so long for you to say something?

AZAR: So, we’ve been very active across the entire department on the measles outbreak and vaccination.  I have been a vigorous advocate for the public health importance of vaccinations and i have been a proponent dating back to my confirmation hearings that  vaccines are one of the greatest public health advances of the 20th century and we need to be taking advantage of that and modeling that behavior myself, having my flu shot recorded.  Unfortunately, we have some individuals that are not getting vaccinated, who are indicated for it and it would be appropriate for them to be vaccinated.  We encourage all individuals to talk to their healthcare providers to see if they’re up to date on their recommended vaccinations and also to ensure that their children are being vaccinated.

LENA SUN: Well, if i could just follow up, i know you have that record, i wonder why you didn’t specifically come out and say something until last week in regards to the rising number of measles cases, this has been going on for several weeks i didn’t know if there was hesitation because of president trump’s previous position on vaccines and the erroneous and discredited link to autism.  I know he shifted positions.  But i was just curious why you didn’t say anything until last week on this outbreak.

AZAR: Your factual predicate is not accurate.  I have repeatedly shared the op-ed from our public health leaders, Dr. Redfield, Admiral Giroir and Surgeon General Adams on vaccines that they published on March 6th.  And I’m also delighted by the president’s very strong leadership last week making clear that people have to get the shots, vaccinations are so important.  We encourage everyone to talk to their healthcare professional to make sure they have the vaccines they need and encourage people to protect themselves, protect their families and protect their communities.

The next question comes from, Arthur Allen with Politico.  Your line is open.

ARTHUR ALLEN: Yes, two questions.  One, in regard to older adults, there are number of us who are between — who were born after 1957 and before live measles vaccine became –you know was commonly used, given to children.  I don’t know really personally whether i got a catch-up dose when i was older.  10% is not a very large number.  Do you feel that there is any necessity to give special instruction or advice to adults born before 1989, who are one dose or possibly no-dose group. The second question is, do you think it would be good, Secretary Azar, for the president to refute his earlier comments which, certainly may have contributed to people’s attitudes toward vaccines.  He has said several times during the campaign and previously that he believed that vaccines caused autism.

MESSONNIER: Secretary Azar, I’ll answer the first question.  Thank you for the question about the dose.  It’s really important to get this right.  Most adults are protected against measles that’s what the science says.  Including people who were born before measles vaccine was recommended and even people who only got a single dose of measles.  We really are focused on adults who are at higher risk and those who are traveling internationally, university students and adults specifically living in these communities that are having outbreaks.  The data really strongly supports that they are already protected against measles.

AZAR: Aas I mentioned earlier, as you know, the President last week was very firm last week that people need to get their shots, vaccinations are so important.  As you know, some years ago there was a debate about this issue that was partly fueled by data that has since been discredited.  The scientific community has generated new and definitive information that there’s no association between vaccines and autism.  There’s no link between autism and vaccinations.  Credible science everyday shows that vaccines are very safe and don’t cause autism spectrum disorders.  CDC, ACIP, and others are always reviewing data to ensure that vaccine recommendations are based on the latest available science to provide safe protection against serious diseases.  In one such recent study of more than 650,000 Danish children at greater risk of developing autism, study research showed there was no risk of autism from vaccines.

The next question is from CNN (Elizabeth Cohen for John Bonifield)

ELIZABETH COHEN: Hi, at the beginning of this conference, Dr. Redfield mentioned about getting a shot, babies getting shots between 6 months and 12 months.  Did he mean for all babies or just babies who are going to traveling internationally, babies in outbreak communities?

REDFIELD: Yeah, my comment was for — normally we don’t recommend the measles vaccine to begin in infants until 12 months of age.  But because of the current situation globally, if infants were to travel, we recommend in their 6 months to 11 months before they would get their 12-month shot, we recommend those infants do get a dose of the MMR vaccine prior to travel.  That was the comment that i made.

The next question is from FOX News channel, David Lewkowict.  Your line is open.

DAVID LEWKOWICT: Good morning and thank you for doing this conference.  Quick question, the spike we’re seeing in measles cases can be linked to vaccine skepticism.  Are there other examples in recent history where we see misinformation leading to spikes like this in other diseases?

ANNE SCHUCHAT: There have been some other reports of delayed vaccination or missed vaccination accounting for severe disease.  We saw this tragically in a young child who had haemophilis influenza B. and whose family had deferred vaccination.  We recently reported on a very severe case of tetanus that occurred in an unvaccinated child.  The risk of disease occurs when vaccines are foregone.  Right now, the country has a very large multistate outbreak of hepatitis A that’s ongoing.  Hepatitis A vaccinations have been routine for young children for some years, and the outbreak occurs primarily in adults.  We know when communities have low immunization coverage with measles that high rates of disease can follow.

The next question comes from Kathleen Doheny with WEBMD.  Your line is open.

KATHLEEN DOHENY: Any predictions on when the outbreak in the east can be eliminated or contain.

NANCY MESSONNIER:  We should expect to see additional cases associated with this outbreak this year.  The public health community, the community organizers are all working together to correct misinformation and get folks vaccinated.  I think these outbreaks can end with all of those groups working together.  But we’ll expect to see additional cases before this is all over.

The next question is from Betsy McKay with Wall Street Journal.  Your line is open.

BETSY MCKAY:  A couple of questions if i might.  I wanted to press the point about adults and vaccinations a little more.  What about adults who are born before 1989, may have one dose, but also don’t have their vaccination records or recall being vaccinated?  Is it’s clear from what you have said that adults who fit this category, traveling internationally, healthcare workers and so forth, should talk to their providers and get a second dose.  What about people who are not in the areas that may be concerned.  One question.  The second question, some people who know they had the vaccine but it was decades ago have found they’re not adequately immunized.  So, you know, i could appreciate that is anecdotal information.  I wonder — we also understand that the vaccine is believed to have very good durability.  In light of this, are there studies have been done or under way to — to look at the durability of vaccines now that we have many decades since this vaccination began?

MESSONNIER:  Let me start with the last one.  As you know, we continue to monitor the safety and effectiveness of the vaccine.  We’re certainly monitoring for any signs of waning immunity.  We don’t see signs of waning immunity yet.  The immunological tests can be helpful to a clinician but, in general, the documentation of vaccination trumps any immunological test.  They need to talk to their healthcare provider who can give them specific guidance.  It’s our focus to focus on the adults in these higher risk settings.

The next question is from Dennis Johnson.  Your line is open.

My question has already been answered.  Thank you.

The next question comes from Melissa Jenco with AAP news.  Your line is open.

My question was also answered.  Thank you.

Thank you, this next question comes Robert Stein, National Public Radio.

ROBERT STEIN: Wanted to double-check the total number, is it 704 or 705?  And where are the additional cases coming from, primarily from the New York outbreaks, and what do you think is going to take to really start to turn this around and get the numbers to start going down?

MESSONNIER: The numbers as of Friday are 704.  As i said, we expect to see addition measles cases and so, you know, by today, there have been additional cases that occurred over the weekend.  By Friday, 704.  The increase we’re seeing primarily in New York and California.  In terms of what it’s going to take, what it’s going to take is everybody working together to identify people at risk who are unvaccinated and getting them vaccinated.  We’d like to get ahead of this thing which means not just retracing contacts in these communities where measles is circulating, getting to all the folks who are under vaccinated.  Getting them correct information not only from CDC but local public healthcare providers.  All those folks working together to get scientifically valid information so people can go ahead and make the safe choice which is to vaccinate to protect their children.

Thank you, Brian McEneny from CBS news.  Your line is open.

BRIAN MCENENY: Hi, i just wanted to make something clear about the import point.  I was wondering if we knew exactly what country or where this came from in its first reiteration in the U.S.

MESSONNIER: So, we do.  We tracked closely where these importations are coming from.  The top three country where importation are coming from, Ukraine, Israel and the Philippines.

And the last question comes from Shamard Charles, NBC news.  Your line is open.

SHAMARD CHARLES: Hi, how are you?  Thank you for taking my call.  My question is about immune amnesia.  Can you tell us a little bit about it and how many cases of that have we seen?

MESSONNIER: I’m not sure that concept directly applies here.  It’s true that an individual may not have immunological evidence of protection but still be able to mount an appropriate immune response that would keep them from getting measles if they’re exposed.  Perhaps that’s what you’re referring to.  But it’s important here to note two things, one, is most Americans are protected against measles through vaccinations and most of these patients who are getting measles right now are unvaccinated.

HARBEN: All right.  Thank you, everyone.  Thank you, Denise.  Thanks again for joining us today.  If you have follow-up questions, you can reach us at media at cdc.gov or call 404-639-3286– a transcript of this telebriefing will be posted on the CDC newsroom site later today.  This concludes our call.

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