Tag Archives: outbreaks

For the Record | CDC Telebriefing on Measles in the United States – January 29 2015

OPERATOR: Welcome and thank you all for standing by. At this time all participants are in a listen-only mode until the question and answer section of the conference. Today’s call is being recorded.  If you have objections, please disconnect. I would like to turn the call over to Benjamin Haynes.

BENJAMIN HAYNES:  Thank you Holly. Thank you for joining us on the briefing on the U.S. measles outbreak. We are joined by Dr. Anne Schuchat, the assistant surgeon general, United States Public Health Service and director of CDC’s National Center for Immunization and Respiratory Diseases. Dr. Schuchat will provide opening remarks before taking your questions.  I will now turn it over to Dr. Schuchat.

ANNE SCHUCHAT:  Thank you so much for joining us this afternoon. I want to talk to you today about measles and here’s why. It’s only January and we have already had a very large number of measles cases. As many cases as we typically have all year in typical years. This worries me and I want to do everything possible to prevent measles from getting a foothold in the United States and becoming endemic again. I want to make sure that parents who think that measles is gone and haven’t made sure that they or their children are vaccinated are aware that measles is still around and it can be serious. And that MMR vaccine is safe and effective and highly recommended.  From January until January 1 until January 28, 2015, a total of 84 people in 14 states have been reported as having measles. Most of these cases are part of an ongoing large multistate outbreak linked to the Disneyland theme parks in California. CDC is working with state and local health departments to control this outbreak which started in late December.  Many of you know that in 2014, the U.S. experienced the highest number of measles cases we had reported in 20 years, over 600. Many of the people who got measles last year were linked to travelers who had gotten measles from the Philippines, where an extremely large outbreak of over 50,000 cases was occurring. Although we aren’t sure exactly how this year’s outbreak began, we assume that someone got infected overseas, visited the parks and spread the disease to others. Infected people in this outbreak here in the U.S. this year have exposed others in a variety of settings including school, day cares, emergency departments, outpatient clinics and airplanes. The information that we have is preliminary and the data are changing. We will be updating our website every Monday with the latest total counts. However, based on what we know now, we’re seeing more adults than we have seen in a typical outbreak. Children are also getting measles. The majority of the adults and children that are reported to us for which we have information did not get vaccinated or don’t know whether they have been vaccinated.  This is not a problem with the measles vaccine not working. This is a problem of the measles vaccine not being used.  Measles can be a very serious disease and people do need to be protected.  Measles spreads quickly among unvaccinated people and can spread quickly from state to state or around the world. We must insure that vaccination rates remain high among children as well as insure that adults receive MMR vaccine if they’re not already protected against this virus. I want to briefly review the national measles situation this year and remind you about measles around the world as well as briefly go through the main recommendations for the vaccine.  Thanks to the strong immunization system that we have and high vaccination rate here in the u.s. we declared measles eliminated.  Measles continues to be brought into the country by people who get the disease when they’re traveling elsewhere. They can spread the disease to others which can lead to outbreaks.  For several years after measles elimination, our numbers were very low.  Between 2001 and 2010, we saw a median of 60 reported cases of measles each year. In recent years, we have had a higher number of reported cases and as you can see in January alone we have had more cases and was the median for the last decade.  Measles is still common around the world and we estimate about 20 million cases each year. In 2013, about 145,700 people died of measles across the world.  Measles can come into our country easily through visitors or when Americans travel abroad and bring it back. It can be a serious disease for people of all ages, even in developed countries like the U.S. for every thousand children who get measles, one to three of them die despite the best treatment.  In the U.S., 28% of young children who had measles had to be treated in the hospital.  Measles can also result in complications. In children they can develop pneumonia, lifelong brain damage or deafness. Of course measles spreads when an infected person breathes, coughs, or sneezes and people don’t always know they are infectious because you can spread the disease before the rash is evident.  Measles is so contagious that if one person has it, 90% of the people close to the person who aren’t immune will also be infected. You can catch it just by being in the same room as a person with measles even if that person left the room because the virus can hang around for a couple of hours. This year so far as I mentioned from January 1 through 28, 84 cases of measles have been reported to us at the CDC from 14 states. There are an estimated 67 cases since December 28, 2014, that are linked to the outbreak — that are linked to the Disney land reports theme parks.  State and local health departments are investigating the large multistate outbreak related to the theme parks and the initial cases reported visiting the resorts between December 17th and 20th, 2014.  So far we know of 67 confirmed cases of measles linked to the outbreak and they have occurred in California and six other states.  We don’t know exactly how this outbreak started but we do think it’s likely a person who was infected with measles overseas visited the Disney parks in December while they were still infectious. This reminds us that measles exposures can happen in this country in many settings and insuring age appropriate vaccination for all U.S. residents is very important.  Maintaining high vaccination coverage is very important and it’s the best protection we have against disease outbreaks. I’m urging all health professionals to think measles.  Health care professionals do need to know the guidelines for infection control and reporting of measles and they should work that their patients are getting the best protection possible which is on time MMR vaccination to protect them from acquiring this virus whether at home or abroad.  The news this year is concerning and serves as a warning that measles is still coming into the united states and that unvaccinated people can get exposed. These outbreaks the past couple of years have been much harder to control when the virus reaches communities where numbers of people have not been vaccinated and of course when the virus comes into the country and exposing people at venues where many people gather, the chances of exposure are greater. One in 12 children in the United States is not receiving their first dose of MMR on time.  That makes them vulnerable to get measles and spread measles.  9 5% of children are recommended to have received the measles vaccine on time. 17 states have less than 90% of children having received at least one dose.  This sets them up for risk of spread of disease in their communities and in their schools. It’s not just young children that need to be up to date on their vaccines and we are starting to see more adults get measles and spread it. For adults out there, if you’re not sure if you have had measles vaccine or not or if you have ever had measles, we urge you to contact your doctor or nurse and get vaccinated.  There is no harm in getting another MMR vaccine if you have already been vaccinated.  I do want to remind you that unvaccinated people put themselves others at risk for measles for complications. Young babies cannot get this vaccine but they are very vulnerable to measles and complications. Pregnant women and people with compromising conditions like leukemia can’t get the vaccination and they are depending on others to have been vaccinated.  We hope pregnant women have been vaccinated as children but we are learning of some who have not been vaccinated so they have to be protected through other means.  This is not just to protect ourselves and our families but to protect the vulnerable people in our community. If a pregnant woman gets infected it increases the chance of many complications.  We don’t recommend pregnant women receive the vaccination but they need to be vaccinated before pregnancy.  For travel abroad, we don’t have the cut off of one year, but we recommend children six months and over get MMR vaccine before international travel to make sure they are protected when they go to parts of the world where measles is still circulating widely.  A key reminder about the routine MMR vaccinations.  The routine ones are for children to get their first dose at 12 months of age and a second dose between four and six years of age.  But it’s fine for the second dose to be given earlier and doesn’t need to wait until the four to six years of age.  And again for those adults and over that age, two doses are recommended for a full series.  This is a wake-up call to make sure we keep measles from regaining a foothold in our country protecting our most vulnerable babies and others by assuring everyone who can be protected from measles is appropriately vaccinated.  The very large outbreaks we have seen around the world often started with a small number of cases.  I have told you before that France went from about 40 cases a year to over 10,000 cases in a year.  It’s only January and we have already had 84 cases.  Let’s work together to keep these numbers down and to keep measles from returning to plague our communities.  Operator, i think we can go to the questions now.

OPERATOR:  Thank you.  If you would like to ask a question, please unmute your phone, press star 1 and regard your full name clearly when prompted.  To withdraw your question press star two.  First question is from Eben Brown with Fox News Radio.  Go ahead your line is open.

EBEN BROWN: Thank you very much for doing the call today.  Doctor, what are — a couple questions. One, how are our hospitals ready for this and did the need to further prepare hospitals during the Ebola situation late last year, will we have learned something from that with regard to taking care of measles parents should it become more prevalent? And how frustrating is it that there are these groups of people in the united states who question the effectiveness of the vaccine or potential side effect of vaccines and they don’t vaccinate their kids or themselves when they grow up? And you know, because as you have mentioned, herd immunity aspects that seems to be working counter to that and there seems to be more and more people getting more and more air time if you will about not vaccinating your kids.

ANNE SCHUCHAT:  Thank you for those questions. We are so interconnected and the Ebola problem in West Africa has reminded Americans about health problems around and world and that our best protection is to fight outbreaks where they originate. The efforts to improve hospital preparedness do have relevance for measles. The importance of taking the travel history when people present with febrile illnesses. It’s not just measles and Ebola. Very important to ask about travel history in anyone with fever or rash. A second issue is infection control.  We know with the Ebola concern and with measles that we really need strong infection control in hospitals. That starts with a clinical suspicion of illness, that illness can be spread from infected patients.  And we have seen times where there is hospital spread of measles and a huge effort is needed in the case of hospitals to make sure their workers are protected and to reduce the risk of spread whether it’s in emergency departments or on the wards.  But you know there’s a huge difference between Ebola and measles.  In measles we have a very safe and very effective vaccine that has been given for more than 50 years so there’s an easy way for us to protect our hospitals and communities and I strongly recommend appropriate on time vaccination with the MMR.  It is frustrating that some people have opted out of vaccination. I think it’s very important for people to have good information they can rely on about the safety and effectiveness of vaccines and for our system to serve people in making it easy, efficient, and convenient to get vaccines. But we do have a number — really a generation that has not seen these diseases. So whether it’s clinicians who have never taken care of measles before or parents who wonder whether this disease still exists, I think it’s important for us to educate them and remind them that we have safe and effective vaccines. Most parents are trying to do the best thing they can for their kids and most parents are vaccinating their children against all the recommended conditions.  But some parents have questions and those questions I hope we can answer and I do hope people can realize these viruses and other germs are out there still and our vaccines really are still needed.  Next question?

OPERATOR:  Our next question comes from Anna Edney from Bloomberg News.

ANNA EDNEY:  Hi.  Thanks for taking my question. Are you concerned that the outbreak could get a lot worse with the super bowl coming up in Arizona? We know there are cases there and people have been exposed that might not know it yet?

ANNE SCHUCHAT:  We have cases of measles right now reported from 14 states so it’s important for people everywhere to be on their guard. Very important for people to make sure their kids are vaccinated and if they are traveling abroad to make sure that they have been appropriately protected. Measles can spread in any setting, especially in places where many people are unvaccinated. I wouldn’t expect the super bowl to be a place where many unvaccinated people are congregated. I know it’s a highlight that many people are looking forward to this weekend.

ANNA EDNEY:  Are there any special precautions that you are taking just because it is a large event?

ANNE SCHUCHAT:  No — no.  I think the main thing is that if people are having fever or rash, they need to let their doctor or nurse know about that and that clinicians caring for people with fever or rash need to think measles at this point and take a travel history and take appropriate steps.  I think people really need to know that you can get measles anywhere.  It’s invisible.  And we have importations every year.  As i mentioned, 20 million measles cases around the year in the world. So measles is being acquired in a lot of different contexts. We happen to know that there was transmission at the large entertainment venue in California but we know that measles is also being acquired in the community, schools, and elsewhere. What we can do about that is make sure that people are being vaccinated appropriately.

OPERATOR: Our next question comes from Maggie Fox from NBC News.

MAGGIE FOX:  Thanks so much. Can you tell me a little bit about the hard epidemiology that is being done right now?  How many people are you doing contact tracing on?

ANNE SCHUCHAT:  Thank you for that question. I don’t have the actual numbers of the work in progress because I think that the people doing the work in progress are so busy they haven’t had a chance to put those numbers together this is a reminder that we are so dependent on the state health work force. They are diligently following up suspect illness to the laboratories are testing people to figure out whether it is measles or not and they are following up the contacts and trying to protect them if they recognize the context within a short period of time. They may be able to make sure they’re vaccinated or that appropriate other therapies. This is a huge effort.  It’s a big effort with 84 cases being followed up. We really don’t want that number doubling and tripling or adding digits to it. So we really want people to be thinking about this now and if there are any questions whether your child is up to date or not, make that appointment.

OPERATOR:  Our next question comes from Erik German with Retro Report. Go ahead your line is open.

ERIK GERMAN:  Thank you. I just wanted to confirm you said at the top that there are 84 cases in 14 states but then later said there are 67 that can be definitely linked to the Disneyland theme park. I just wanted to know if the other additional cases are from somewhere else or if they just — the link has not been established yet.

ANNE SCHUCHAT:  It’s a mixture there are some that might be linked when further investigation is completed.  In a number of instances, we know of travel history or exposure to travelers from a number of other countries. So — that have another source that is not the Disneyland theme park.  So I would say that so far this year we have a smattering of importations which is actually a greater number of importations than we usually would have in January, but the largest number is linked to the outbreak in California.

ERIK GERMAN:  And that number is 67?

ANNE SCHUCHAT:  Yes and let me clarify. The 67 people associated with the California outbreak includes Californians and people from six other states but it also goes back to December 28th, so it includes a handful of cases from 2014. 84 people i mentioned is the count from January 1.

ERIK GERMAN:  Thank you.

OPERATOR:  Our next question comes from Mike Stobbe with Associated Press. Go ahead your line is open.

MIKE STOBBE: Hi. Thank you, doctor for doing this. Back on the numbers. Let me finish that off. You said there’s two time frames here. Of the 84 this year, how many of them are related to the California outbreak and also could you say a little bit more about the 67 confirmed cases? Were any of them in a country that had a recent measles outbreak? You mentioned there are more adult cases than usual. Could you say how many of the 67 were adult versus children and what proportion of the 67 were vaccinated? Did you say there were pregnant woman and how many pregnant women? What proportions have been hospitalized?

ANNE SCHUCHAT: Thank you. The reality is I won’t have the answer to most of those questions. The ones that I can answer I would like to get correct. In terms of the outbreak that is related to the Disneyland resorts theme parks in 2015, there are 56 cases that are related to that and in 2014 there were 11. That’s where the 67 comes together for the Disneyland issue. The adult and children issue, we don’t have all of the details yet about the ages and so there is quite a bit that’s pending. I think we will be…of course it is going to be important to put this together. The median age of cases has been increasing. It’s over 20 right now. In terms of the hospitalization, so far for the information that we have, which is not on all 84 of these cases, 15 percent have required hospitalization and that is not that different than what we would typically see. I think it’s too soon for us to know whether the whole clinical spectrum and severity for this outbreak for this year is going to be different because of the larger number of adults. You know, one question we get is why are we seeing it in adults? I think a good answer is most children are vaccinated. There are a lot more adults than children and adults travel a whole lot more than children do in general. But we will need to wait for the full statistics to come through. As you know, 50 years ago we didn’t have a measles vaccine. Those of us who are over 50 were almost universally exposed to measles and got measles and became immune to it. Since then we have had more and more people in the U.S vaccinated and protected. We may be seeing a change in the epidemiology over the next few years and it’s an important question. We do have an easy way to not have to get into those questions by just making sure that people are vaccinated and in particular we don’t let ourselves get large communities with high levels of unimmunized people where the disease could be harder to control.

MIKE STOBBE: What about if any of the 67 have been to a country with a recent outbreak?

ANNE SCHUCHAT: The 67 — we don’t — I guess your question is do we know a travel history that will help us understand where measles came from to get into Disneyland whether it’s from an American traveling abroad or somebody from abroad visiting Disneyland. We don’t have that information. We do know that the genotype of the virus that’s associated with the Disneyland outbreak is causing outbreaks in 14 different countries around the world. So the genotyping won’t tell us the specific source yet. But — and we don’t have a travel history from the early case. There may be someone who was here and gone and will never know. But I think the investigation is ongoing. Next question.

OPERATOR: Our next question comes from Dan Childs with ABC News. Go ahead your line is open.

DAN CHILDS: Thank you very much for taking my question. It’s sort of a two-part question. We took a look at MMR vaccination rates in the U.S. throughout the decade and they have stayed pretty stable throughout the last few years and definitely higher rates than we saw in the 90s. We saw that California doesn’t have a rate — they are not that far below the national average in terms of MMR. To what extent is this wholly attributed to the pockets of under vaccination and is it that these pockets are getting worse?

ANNE SCHUCHAT: That’s a great question. The national estimates hide what’s going on state to state. The state estimates hide what’s going on community to community. And within communities there may be pockets. I think we do have some communities with many who have not received vaccines and the — five of those cohorts are increasing. It’s one thing if you have a year where a number of people are not vaccinating, but year after year in terms of the kids that are exempting, you do start to accumulate. We may have a number of communities, but this also may just be that there was a big — a whole lot of people around the virus in Disneyland and started quite a few individual chains that need to be followed up. We track coverage at the state level and the states track school entry MMR coverage. And things generally look good, but there are some schools and some school districts where things are a problem. I really appreciate the states that have been posting their school coverage data and their school exception data so community members have a chance to see what’s going on. But as you see, the overall picture has been getting better, not worse. It’s just the micro communities that we think make us vulnerable.

DAN CHILDS: And just one follow up if it’s okay. Should we in light of this be revisiting the notion of non-medical exemptions and whether they should be allowed? Also, if we have time, I would like to know what the 14 states are where measles has occurred so far in 2015.

ANNE SCHUCHAT: For the states I think we can get you that in follow-up. It may not be efficient for me to read them off. We will get you them. In terms of the non-medical exemptions, medical exemptions are absolutely essential. A six-year-old with leukemia can do not get the vaccine. But when she is well enough to go back-to-school we really want to make sure that she’s not going to get sick from others in the school. There is a reason for medical exemptions. It’s just absolutely essential in terms of not doing harm to a child. A number of states do have other types of exemptions. I know state by state they have been revisiting that sometimes states have made the exemption opportunities easier, sometimes they’ve made them harder. We know the easier it is to exempt, the more people will exempt. When states make it easier to get vaccinated than to exempt, we see higher rates of vaccination. I think it’s just important for us to know that vaccines protect individuals and they also protect the vulnerable people around the people who have been vaccinated. Next question?

OPERATOR: Our next question comes from Rosanna Xia with LA Times. Go ahead your line is open.

ROSANNA XIA: Hi Dr. Schuchat. Thank you for taking our question. Real quick for the other non-Disney related 67 cases, are there any links that you have identified or are they individual cases per state from international travel?

ANNE SCHUCHAT: I believe most of what we are seeing is individuals. You know, of course these are active investigations, but and the incubation periods may not have been followed because it is only January 29th. It may be too soon whether they will be related cases. At this point California’s Disneyland related outbreak is the one we’re following closely.

ROSANNA XIA: In your experience from looking at outbreaks, is the number of cases right now state to state from one specific epicenter like Disneyland, is this rate right now concerning? It seems slower than what a typical outbreak would be. Could you talk a little bit about how well officials are containing this outbreak or whether or not they should be doing more.

ANNE SCHUCHAT: We have had outbreaks that are of variable sizes. If we look at the outbreaks going back to 2008, you know, a number of the outbreaks were only 20 or 30 cases total and we have already got 67 cases from this and we know the number is going to be somewhat larger at least.  The largest outbreak we had in recent years in the U.S. was related to the Amish community in Ohio.  That was quite unusual because it was a large population where vaccine use was very low at the time.  In most of these other settings, we are not seeing the virus introduced into a very large population with hardly any vaccination.  So, the situation here is that we know that already, a number of states are following up cases related to this and we really don’t want chains of transmission to begin in those states or gain a foothold.  We don’t expect this to be like thousands but we don’t want to give it an opportunity to become that.  And again this cautionary tale that there are countries where they have started with 40 to 50 a year and gone to the many thousands in just another year.  We don’t want to let that happen here.  We want people to realize they should be checking vaccine records and thinking about this before they travel. Next question.

OPERATOR: Next question comes from Betsy McKay from the Wall Street Journal.

BETSY MCKAY: Hi and thanks.  I have a couple of questions.  One is, again, on the cases which are not part of the Disneyland resorts outbreak that you said were — looked like a smattering of importations.  Do you know what countries those are from and in particular, I’m wondering if the — what you’re see something more from the Philippines if that outbreak is still going on.  The second question or if not, is there a big outbreak going on someplace else in the world that is causing a larger number to come into the states right now.  And the other question was about vaccines.  There is a pretty sizable percentage it looks like in Disneyland outbreak who were vaccinated including something like 13% in California who had had two doses of the vaccine so I’m wondering, is there any indication or are you looking into at all into the possibility that vaccine effectiveness or immunity may wane with age?

ANNE SCHUCHAT: Thank you.  Let me read a few countries where we have a history to links of recent measles case with a different country of origin, not to say that the person was of origin of the other country but there was a travel history.  Indonesia, India and Dubai at a minimum and there is probably some additional ones that are under investigation.  That’s for the 2015 importations.  So we don’t have a definite Philippines travel history in any of our 2015 cases.  Of course last year there were a number of importations that were associated with the Philippines last year.  Now in terms of the vaccine history, the coverage of MMR is very high and the higher the coverage that you have, the more chances that you will have some fully vaccinated people get measles even though the vaccine is highly effective.  We think two doses is probably like 97 percent effective but if you have really, really high coverage, if 95 percent or more are protected you will get some people who are two-dose failures.  We’re at too early a stage to measure whether there is a problem of waning immunity or some unexpected vaccine efficacy but based on what we have seen so far we are not suspecting that.  We like to keep an open mind and fully investigate but so far what we are seeing is consistent with a highly effective vaccine and a number of people that have not been vaccinated.  Next question?

OPERATOR: Our next question comes from Matthew Stucker with CNN.  Go ahead your line is open.

MATTHEW STUCKER: Thank you.  Can you tell me how many people have been quarantined or isolated in this outbreak and of those people, how many did have measles or became infected or who didn’t become infected and also if there are still in people in quarantine or isolation?  And also just to go back to the super bowl thing, there is tons of contacts that are still being watched.  It didn’t seem like a place where people with measles would be congregating, but i don’t think that the people that went to Disneyland expected to get measles.  I’m wondering why there is no precautions being taken there, especially in phoenix where they are still trying to track down 200 people from that hospital.

ANNE SCHUCHAT: Thanks.  I don’t have the number of people who are being followed up and interventions that are being recommended for those people.  What i can say is that if you have been vaccinated appropriate to age and are exposed to someone with measles, there is no special steps that need to be taken.  So the easiest thing for the public health departments and families who are traveling is to be appropriately vaccinated and to have documentation of that.  Certainly these are ongoing investigations in terms of what is being done.  We — we don’t have those numbers.  Now in terms of the super bowl, what i can say is that it’s — there are large public gathering in many places and they are cherished and valued events.  The important thing in terms of our usual recommendations is if you’re ill, we recommend you not travel that you don’t get on an airplane if you’re sick or having fever.  Of course it’s flu season.  We’re seeing an enormous amount of people with illness right now and we are trying to suggest that people who are ill rest and stay away from others so that others can enjoy festivities.  And just a reminder with an event like the super bowl going on that good vaccination can keep you healthy and able to go to these kinds of events.  I think we have time for two more questions.

OPERATOR: Our next question comes from Jodie Tillman with Tampa Bay Times.

JODIE TILLMAN: the cases where the patients were not vaccinated, were some of them on the so-called alternative schedule where they didn’t get their second dose — had their first dose but delaying their second dose for whatever reason?  If so if you could talk a little bit about the risks of that strategy?  You do hear it sometimes from some of the parents.

ANNE SCHUCHAT: Thank you.  We do know that some of the reported measles cases this year had exempted from vaccines.  We don’t have all the details yet to know what proportion had delayed vaccine.  We just, you know, had not yet gotten around to it yet versus who didn’t want it.  We do know that the measles cases we have been seeing have generally been in people who have been unvaccinated and many of them not vaccinated due to personal belief exemptions.  We do have some cases where people were at the doctor’s office and didn’t get the vaccine because of another illness or something.  We recommend you should get vaccinated unless you have a severe illness.  In 2014, 79 percent of the unvaccinated cases of measles in the U.S. were unvaccinated due to personal belief exceptions.  Whether that data will hold up this year we don’t know.

JODIE TILLMAN: Do you know, if they have got their children —

ANNE SCHUCHAT: That’s a great question.  Because i have spoken to parents who think, oh, you know, 12 months, do i really want to get my baby vaccinated at that age?  Can’t i just wait?  The reason that the MMR vaccination is recommended routinely at that age is because babies are vulnerable to measles and complications of measles and 12 months is the age where it reliably works well.  We would give it routinely earlier if it were highly effective at much earlier ages for instance, less than six months.  Between six and 12 months, measles vaccine will protect but it doesn’t last that long and you need to give two more doses so we recommend in the setting of outbreaks or if you are traveling internationally babies between six and 12 months babies get a vaccine they will just need two more doses.  People who think my baby is too young to be vaccinated, that’s when your baby is at a vulnerable stage.  The concerns that people had about whether the vaccine may not be safe or linked to autism have not borne out at all.  The MMR vaccine, very safe, very effective, really necessary.  And the 12 month routine first dose we strongly recommend.  As we look through cases we have seen a lot of cases in infants and toddlers who were planning to get it but didn’t want to get it at the 12 month period and i would revisit that if that’s your children that I’m talking about.  Last question?

OPERATOR: Last question comes from Lenny Bernstein from the Washington Post.

LENNY BERNSTEIN: I wanted to follow up on the 79 percent  Do you have any good data of the number of people, the percentage of people in the United States who have chosen not to get the vaccine?  Not the medical reason?  Personal beliefs?

ANNE SCHUCHAT: No.  In terms of the general population, we don’t.  We have been tracking a number of things over time.  One of the things we have been tracks something the percent of infants and toddlers who get no vaccines at all.  There is a misunderstanding that when we talk about vaccine acceptance that everybody is dropped out of the system.  We continue to have less than 1% of toddlers in the u.s. have received no vaccines at all.  Almost every toddler is getting vaccinated with some vaccine most of the time.  We don’t have data on, for the whole nation on exemptions.  We do track kindergarten entries every state.  And we report that every summer.  Our website has that information.  So state by state you can see what percent of kindergartners have gotten MMR vaccine as recommended and what percent are exempting due to medical or other exemptions.  That is a number that we are following.  Our effort has been to make the data easier to compare state to state and year to year.  Measles is still around with 20 million cases around the world and this year we’re off to a bumper start.  I strongly recommend people make sure their children are appropriately vaccinated and that they are vaccinated before travel or are protected against measles.  Thank you for following the story and we will be updating our website on a weekly basis with the latest numbers.  And thank you to the state and local health departments that are working day and night to follow up on all of the cases.

BEN HAYNES: Thank you. This is going to conclude today’s briefing.

Europe | H5N8 bird flu continues to spread in poultry – Outbreaks in Italy, the Netherlands and Germany

Vital signs:

  • Highly Pathogenic Avian Influenza (HPAI) H5N8
  • New outbreaks reported in Italy, the Netherlands, and Germany
  • Ongoing outbreaks in Japan and the Republic of Korea
  • No cases of H5N8 in human beings

On 16 December 2014, the World Organization for Animal Health (OIE) was notified of an outbreak of HPAI H5N8 on a turkey farm in Porto Viro in northeastern Italy. Over 1200 birds had been infected and had died. Culling started as of 16 December. Restriction zones were established, and control measures (disinfection, culling and movement control) are ongoing. Genetic analyses are currently under way to confirm that this virus is similar to those observed in other European outbreaks.

A new outbreak of HPAI H5N8 was reported in the week beginning 15 December 2014 on a poultry farm in Niedersachsen, Germany, prompting the culling of birds at this location, as well as on a neighbouring turkey farm. It was confirmed that the virus was similar to that of the November outbreak.

According to the OIE, two more outbreaks of HPAI H5N8 have been reported in the Netherlands. As of 3 December 2014, several disease control measures were applied in protection and surveillance zones surrounding the outbreaks, including culling, disinfection, control of wildlife reservoirs and movement control.

No further outbreaks of H5N8 have been reported in the United Kingdom since November and the protection zone around the previous outbreak was lifted on 12 December 2014. There remains only the larger surveillance zone, where disease control measures are still applied.

In addition to the cases in poultry in Europe, widespread outbreaks of HPAI H5N8 were reported earlier in the Republic of Korea and Japan, some of which are still ongoing. In the United States of America, HPAI H5N8 was detected in a captive wild bird last week but has not been found in poultry.

Risk to the general public?

No cases of H5N8 in human beings are known, and the risk to the general public is extremely low. Nevertheless, national authorities are taking appropriate precautions, as some avian influenza viruses can infect humans and other H5 viruses, such as H5N1, have affected humans in the past. The H5N8 virus in Europe appears to be highly pathogenic, meaning that it is highly likely to cause disease and death in poultry. People in close contact with live poultry should watch for any signs of illness in their flocks and immediately inform their veterinarians if they notice any cause for concern. It is safe to eat properly cooked poultry products.

What authorities are doing

Veterinary and public health authorities are working together in line with national, European Union and WHO guidelines, and have taken every reasonable precaution. For example, a protection zone and a surveillance zone have been put in place around affected premises to prevent the spread of disease. The poultry affected by the outbreak are being culled by personnel wearing personal protective equipment. Such personnel and anyone working on a farm who might have been exposed are being monitored and offered antiviral medication as a precaution. Their contacts are also being monitored for 10 days.

New York | Measles outbreaks reaching highest numbers in years – Vax importance emphasized

With the number of measles outbreaks for the first four months of 2014 at the highest level since 1996, Governor Andrew M. Cuomo and the State Department of Health today alerted New Yorkers about the importance of being vaccinated to protect against the dangerous disease.  

“Measles is a serious, highly contagious disease that is not just limited to young children,” Governor Cuomo said. “While many New Yorkers have likely already received measles vaccinations, with the number of outbreaks at a higher level in years the State is taking the opportunity to urge New Yorkers check with their healthcare provider to make sure they and all of their family members’ immunizations are up-to-date.”

The Centers for Disease Control and Prevention (CDC) reports that measles has infected 129 people in 13 states in 2014, the most in the first four months of any year since 1996; 29 of those infections have been in New York. In 2013, an outbreak of 58 cases in New York City was the largest reported localized outbreak of the measles in the U.S. since 1996.

About Measles

Measles is so contagious that if one person has it, 90 percent of the people close to that person who are not immune will also become infected with the measles virus   It is spread by contact with nasal or throat secretions of infected people. You can be infected by measles virus suspended in the air for an hour or more after the infected person has left the room. The most common complications of measles are diarrhea, pneumonia, and ear infection, but it may also cause brain damage and rarely death. It is particularly harmful to persons with immunosuppression, pregnant women and very young children.

Measles symptoms usually appear in 10 to 12 days, but can occur as late as 18 days after exposure. Symptoms generally appear in two stages:

  • In the first stage, which lasts two to four days, the individual may have a runny nose, cough and a slight fever. Eyes may become reddened and sensitive to light while the fever gradually rises each day, often peaking as high as 103° to 105° F. Small bluish white spots surrounded by a reddish area may also appear on the gums and inside of the cheeks.
  • The second stage begins on the third to seventh day, and consists of a red blotchy rash lasting five to six days. The rash usually begins on the face and then spreads downward and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from head to extremities. Although measles is usually considered a childhood disease, it can be contracted at any age.

The single best way to prevent measles is to be vaccinated. Most New Yorkers have been vaccinated, but if unsure, they should check with their healthcare provider.  Individuals should receive 2 doses of Measles, Mumps, and Rubella (MMR) vaccine to be protected.  The first dose should be given at 12-15 months of age and the second dose is routinely given at 4 to 6 years of age, but may be given as soon as 28 days after the first dose. Anyone at any age who is not immune to measles, and has no condition that would prohibit receiving the vaccine, should receive 2 doses of MMR vaccine at least 28 days apart.

Individuals are not at-risk of contracting measles if they are immune. A person is considered immune if he or she has received two doses of MMR vaccine, or if he or she was born before January 1, 1957, or has a history of laboratory-confirmed measles, or has a blood test confirming measles immunity. Any of the above confers immunity.

It is also important to note that travelers should be up-to-date on their vaccinations; since January 2014 there have been 34 cases of measles reported in the United States from travelers to foreign countries.

More information about measles can be found at: http://www.health.ny.gov/diseases/communicable/measles/fact_sheet.htm.

More information about vaccine safety and the importance of vaccines can be found at:

Denmark | Salmonella Enteritidis and Shigella sonnei in connection with vacation travels to Turkey in 2013

Since June, Statens Serum Institut has recorded an increasing number of patients who have been infected with Salmonella Enteritidis during vacation travels to Turkey. Concurrently, an outbreak at a hotel in Alanya was shown to have been caused by several pathogenic gastrointestinal bacteria including S. Enteritidis and Shigella sonnei.

In the course of the summer, subtyping of Salmonella Enteritidis has identified an increase of four closely related subtypes. By 3 September, bacterial strains had been received from a total of 81 persons who had been diagnosed with one of these four subtypes of S. Enteritidis since June 2013. Among these, 47 persons had known previous travels to Turkey. In the same period in 2010-2012, between 27 and 39 persons were recorded with S. Enteritidis infection after having travelled to Turkey. Interviews with the patients have shown that they lived in different towns and at different hotels in Turkey. Poor hygiene at a single hotel, restaurant or other establishment can therefore not explain the observed cases.

Additionally, over the course of the summer, cases of Shigella sonnei have been recorded in Denmark and in other Nordic countries in patients who had returned from Turkey. A joint Nordic epidemiological study – including all persons who have lived at a certain hotel in Alanya – is currently on-going aiming to identify the source of this probable outbreak. In a limited number of patients with gastroenteritis who had stayed at the hotel in question, other pathogenic gastrointestinal bacteria than Shigella sonnei were detected, including: S. Enteritidis and verocytotoxin-producing Escherichia coli (VTEC).

On this basis, Salmonella, Shigella and VTEC infections should be suspected in patients with symptoms that are consistent with bacterial gastroenteritis following travel to Turkey. For Shigella and VTEC, specific guidelines are in place for persons in sensitive occupations EPI-NEWS 50/03. General travel advice for the prevention of food-borne diseases is avaliable at the SSI’s website.


Previously, S. Enteritidis was the most frequently occurring salmonella type in Denmark. However, over the past 15 years, the number of S. Enteritidis infections has decreased steadily, EPI-NEWS 12/13. Since Danish chickens and egg-layers were declared salmonella-free, the majority of the recorded cases of infection have been acquired abroad, and the latest recorded outbreak of S. Enteritidis associated with a Danish source occurred in 2009, EPI-NEWS 36/09.

In Denmark, the country of infection of all salmonella cases has been monitored through telephone interviews since 2008. In the 2008-2012-period, a total of 37% of all salmonella cases with known country of infection were acquired abroad. In the same period, however, a total of 60% of all S. Enteritidis cases with known country of infection were acquired abroad. Since 2010, more than 75% of all S. Enteritidis cases with known country of infection have been acquired abroad.

Every summer sees an increase in the number of S. Enteritidis patients who have become infected during travels to Turkey, Figure 1. The numbers for 2013 were not included in the figure as the country of infection has yet to be established in a considerable number of cases. It remains unclear if the currently observed increase in S. Enteritidis cases from Turkey indicates a higher than normal level of food safety issues at the destinations, or if the cause is increased travelling activity to destinations in Turkey. Unfortunately, the total number of Danish tourists who have visited Turkey annually over the years is not known.

(S. Gillesberg Lassen, S. Ethelberg, and L. Müller, Department of Infectious Disease Epidemiology, M. Torpdahl and S. Persson, Microbiological Monitoring and Research)

North Carolina | Pertussis outbreaks continue across state

After continued outbreaks of pertussis (whooping cough) across the state, state health officials are encouraging people of all ages to be immunized against this highly contagious but preventable respiratory disease.

As of August 14, state public health officials had tracked 326 cases of pertussis, including 50 cases in infants.

Because of high numbers of pertussis cases in Davidson, Forsyth and Rockingham counties, DHHS has authorized local health departments in those counties to provide vaccine at no charge to anyone, regardless of insurance status.

“State law requires that kindergartners and all rising 6th graders be up to date on pertussis vaccination before going to school,” said Acting State Health Director Robin Cummings, M.D. “But as parents are getting their children ready to go back to school, it is also a good opportunity for parents to check on immunizations for the whole family. Any adults or older siblings, especially those who will be around newborns, should be vaccinated against pertussis.”

Infants who are not fully vaccinated against pertussis are susceptible to severe complications. According to the U.S. Centers for Disease Control, in infants younger than 1 year of age who get pertussis, about half are hospitalized. Of those infants who are hospitalized, 1 or 2 in 100 will die.

T-dap vaccination is especially important for the following groups:

  • women who are pregnant or may become pregnant
  • all close contacts of infants under 12 months of age (parents, siblings, grandparents, household contacts, child care providers)
  • anyone with pre-existing, chronic respiratory disease; and
  • healthcare providers

Some children through the age of 18 are eligible to receive their immunizations at no cost through the federally funded Vaccines for Children (VFC) program which provides vaccines to those who are Medicaid eligible, American Indian or Alaskan Native, uninsured or underinsured. There is no fee for the cost of the VFC vaccine for eligible children; however a provider may charge an administration fee.

In addition to pertussis, all school children in North Carolina must be vaccinated against:

Hepatitis B
Hib Disease
Varicella (chickenpox)

Individuals should contact their health care provider or local health department to determine what vaccines they should receive or visit www.immunize.nc.gov for more information.

Tennessee | Measles and mumps outbreaks reported – MMR vax urged

Recent outbreaks of measles and mumps in several states are prompting health officials to issue reminders about the importance of Measles-Mumps-Rubella, or MMR, vaccinations. 

While some may think of measles and mumps as diseases of the past, the viruses are still common in much of the world, including Western Europe. Both are very contagious and can infect anyone who has not had measles or mumps and has not been properly vaccinated.

“We urge everyone to be vaccinated for measles and mumps, especially those traveling abroad, not just to protect themselves, but to protect all people they may come in contact with when they return,” said Kelly Moore, MD, MPH, medical director of the Tennessee Immunization Program. “While many people assume they have been properly immunized, some may not have the adequate protection needed.”

Almost everyone born before 1957 had these diseases in childhood. Those born more recently who are unsure should discuss vaccinations with their health care provider, who may suggest at least one dose before traveling abroad. Two doses of MMR vaccine are recommended for the best protection, and middle-aged adults might have had only one because the second dose was first recommended in 1989.

Parents traveling internationally with infants that are at least six months old should be sure the infant gets a dose of the MMR vaccine before traveling. If the infant is between six and 12 months of age, he or she will still have to get their usual two doses later, but the early dose will help protect the infant. Infants younger than six months cannot be vaccinated, and the Tennessee Department of Health recommends they should not be taken on international trips into risk areas.

In addition to measles, the MMR vaccine also provides protection against the mumps virus, another infection of childhood that is rare in the United States but common overseas. Outbreaks of mumps are currently known among students in multiple colleges in Virginia and Maryland, highlighting the fact that, once introduced, this virus also readily spreads among susceptible people.

Some parents may have lingering concerns about the MMR vaccine because of old allegations that the vaccine might be associated with the development of autism. These claims have repeatedly been disproven by medical research over the last decade; there is no evidence of any connection between MMR vaccine and autism-related conditions. On the other hand, children who do not receive or delay MMR vaccine can develop serious illness if they come in contact with a sick person; they also can spread measles or mumps to children or adults with weak immune systems, or vulnerable infants who are too young to be protected by vaccine.

MMR vaccines are required in Tennessee for children attending daycare, all school children and college students, and two doses have been required since 1990. Children routinely get the first dose at 12 to 15 months of age and the second dose before Kindergarten.

Symptoms of measles typically include high fever, cough and runny nose for up to three or four days before red eyes develop and a red rash starts on the head and chest. If a patient develops symptoms like measles, he or she should call ahead to their doctor’s office or ER so the staff can put them directly in a room away from other patients. Because the virus easily spreads in the air to others, this step is very important to protect other patients from exposure. Unfortunately, measles can cause death in some patients.

Symptoms of mumps include low-grade fever, muscle aches, headaches, feeling weak or tired, losing appetite and most typically, swelling of cheeks due to inflammation of salivary glands near the jawline. Complications may occur and are more prevalent in those who have reached puberty. Complications may include inflammation of the testicles, brain, the covering of the brain and spinal cord, ovaries or breasts. Temporary or permanent deafness may occur.

Vaccines and immunization services are available through all county health departments in Tennessee and at more than 1,500 physicians’ offices across the state. Doctors enrolled in the federal Vaccines for Children program may give free, federally-funded vaccine to eligible children from birth through 18 years of age.

For additional information about measles, please visit:


For additional information about mumps, go to www.cdc.gov/mumps/

England | Measles at highest level for 18 years

There were 2,016 confirmed cases of measles in England and Wales reported to the Health Protection Agency (HPA) in 2012, which is the highest annual total since 1994.

The measles cases identified during 2012 have been associated with prolonged outbreaks in Merseyside and Sussex, as well as several smaller outbreaks in travelling communities across England and Wales.

The UK along with France, Italy, Spain and Romania accounted for 87 per cent of the total 7,392 measles cases reported throughout the European Union countries up to the end of November 2012.

Dr Mary Ramsay, head of immunisation at the HPA, said: “Coverage of MMR is now at historically high levels but measles is highly infectious and can spread easily among communities that are poorly vaccinated, and can affect anyone who is susceptible, including toddlers in whom vaccination has been delayed. Older children who were not vaccinated at the routine age, who may now be teenagers, are at particular risk of becoming exposed, while at school for example.

“Measles continues to circulate in several European countries that are popular with holidaymakers. Measles is a highly infectious disease so the only way to prevent outbreaks is to make sure the UK has good uptake of the MMR vaccine, and that when cases are reported, immediate public health action is taken to target unvaccinated individuals in the vicinity as soon as possible.”

Symptoms of measles include:

  • cold-like symptoms
  • red eyes and sensitivity to light
  • fever
  • greyish white spots in the mouth and throat
  • After a few days a red-brown spotty rash will appear. It usually starts behind the ears, then spreads around the head and neck before spreading to the legs and the rest of the body.

Dr Ramsay continued: “Measles is often associated with being a disease of the past and as a result people may be unaware that it is a dangerous infection that can lead to death in severe cases. Parents should ensure their children are fully protected against measles, mumps and rubella with two doses of the MMR vaccine. Parents of unvaccinated children, as well as older teenagers and adults who may have missed MMR vaccination, should make an appointment with their GP to get vaccinated.

“If you are unsure if you or your child has had two doses of the vaccine, speak to their GP who will have a record.”

Montana | Pertussis outbreaks continue as state passes 200 cases

Montana | 18 May 2012

The Montana Department of Public Health and Human Services (DPHHS) and local health agencies are continuing to report local outbreaks of pertussis, also known as whooping cough.  The number of cases has passed 200, the highest number since Montana’s 2005 outbreak that resulted in almost 600 cases.

Health officials are encouraging everyone, including adults, to take advantage of available vaccines and visit a medical provider if you have a persistent cough to help slow the spread of the disease.

Since January 2012, 18 of the state’s counties and tribal health jurisdictions have reported pertussis cases with outbreaks in Gallatin, Lewis and Clark, Ravalli, Lake , Missoula, Rosebud and Yellowstone counties. Local and state public health officials are concerned that the number of reported cases will continue to increase unless people take action to protect themselves and others.

According to DPHHS health officials, pertussis is a highly contagious respiratory illness spread by coughing and sneezing, but one that can be prevented by getting vaccinated. Although it initially resembles an ordinary cold, pertussis can turn more serious, particularly in infants.  Over half of infants diagnosed will require hospitalization.

Several states are reporting increases in reported pertussis, Washington State is leading the way with 1,300 cases reported this year.

“We continue to see cases of pertussis and most are preventable,” said DPHHS Director Anna Whiting Sorrell. “Making sure parents and caregivers are up to date on their vaccines is our best long term strategy. Anyone caring for children can take advantage of the vaccine to prevent spreading pertussis.”

People who are vaccinated are unlikely to become ill after an exposure or spread the illness to others.

Local health jurisdictions continue to follow-up on each case to help stop the spread of the disease to close contacts such as classmates and family members.  Close environments such as schools and daycares are ideal for easily and quickly spreading pertussis and present challenges to health officials.

“We are getting great cooperation from schools who assist us by referring ill children to providers and are helping with immunization reviews”  said Karl Milhon, manager of the state’s Communicable Disease Program.

Pertussis vaccination begins at age two months, but young infants are not adequately protected until they have received a series of vaccinations.  Because protection from the vaccine can fade over time, a booster is recommended for pre-kindergarten age, pre-teens, teens, and adults.  A relatively new pertussis vaccine is available and is now recommended for all teens and adults.

More information is available from local health providers and public health departments, or go to www.dphhs.mt.gov/publichealth/immunization/pertussis.shtml

Montana | Pertussis outbreaks continue to occur throughout the state

Helena | 30 April 2012

The Montana Department of Public Health and Human Services (DPHHS) reports that outbreaks of pertussis, also known as whooping cough, are being reported in several areas of Montana and is urging vaccines for all children and adults to help prevent the disease.

Since January 2012, nearly 90 cases of pertussis have been reported statewide, compared to approximately 50 cases for the same period last year.  Recent cases have been reported in Broadwater, Gallatin, Lewis and Clark, Ravalli, and Stillwater counties. Local and state public health officials are concerned that the number of reported cases will continue to increase unless people take action to protect themselves and others.

According to DPHHS health officials, pertussis is a highly contagious respiratory illness spread by coughing and sneezing, but one that may be prevented by getting vaccinated. Although it initially resembles an ordinary cold, pertussis can turn more serious, particularly in infants.  Over half of infants diagnosed will require hospitalization.

Washington State has reported a large increase in reported pertussis, with nearly 800 cases reported over the last 4 months.

Montana health officials do not want what is occurring in Washington State to happen here.

“Most cases of pertussis are preventable,” said DPHHS Director Anna Whiting Sorrell. “All parents and caregivers of children need to make sure their children are up to date on this and other vaccines. Anyone who cares for children should also be up to date on their vaccinations to prevent spreading pertussis.”

People who are vaccinated are unlikely to become ill after an exposure or spread the illness to others.
Local health jurisdictions with recent cases are working hard to control or stop the spread of the disease.  Close environments such as schools and daycares are ideal for easily and quickly spreading pertussis and present challenges to health officials.  “We encourage parents to not send children who are ill to schools and daycares because pertussis spreads quickly in these settings,” said Karl Milhon, manager of the DPHHS Communicable Disease Program.

Pertussis vaccination begins at age two months, but young infants are not adequately protected until they have received a series of vaccinations.Because protection from the vaccine can fade over time, a booster is recommended for pre-kindergarten age, pre-teens, teens, and adults.

More information is available from local health providers and public health departments, or go to