CDC Telebriefing – CDC to announce record-breaking year in reported cases of measles in the United States

OPERATOR: Welcome and thank you for standing by. At this time, all participants have been placed on listen only until today's question and answer session. This call is being recorded. If anyone does have any objections, you may disconnect at this time. And I would now like to turn the call over to Mr. Ben Haynes. Sir, you may begin.

BEN HAYNES: Thank you, Cathy. Good afternoon and thank you all for joining us today for this media briefing on measles. I'm joined today by Dr. Anne Schuchat, the director for immunization and respiratory diseases. Dr. Schuchat will be providing opening remarks and will get to as many questions as possible. Please make sure you state your name clearly and identify your media outlet. Everyone will be allowed one question and a follow-up and then we'll move on to the next question. I'll now turn it over to Dr. Schuchat.

ANNE SCHUCHAT: Thank you, Ben. And I would like to thank everybody who called in for this update. Today, we are releasing an MMWR report showing the U.S. has a record number of measles cases so far this year. We're also releasing a graphic figure on our media web page, and I think if you look at that, you will see that a picture is worth a thousand words. It should be up on the website momentarily. Measles anywhere in the world can reach our communities and unvaccinated Americans are at risk. Measles in the U.S. has reached a 20-year high. This is not the kind of record we want to break, but should be a wake-up call for travelers and parents to make sure vaccinations are up to date. I'm going to discuss some of the details of this year's measles cases and briefly review what can be done to protect individuals and communities. Then I’ll take your questions. Today's report shows that the U.S. is experiencing record numbers of measles cases. From January 1st through May 23rd, there have been 288 cases of measles reported to CDC. This is the largest number of measles cases in the U.S. reported by this time in the year since 1994. Or a 20-year high. An ongoing outbreak in Ohio alone had reported 138 cases by May 23rd. Since May 23rd, the numbers have continued to increase, but I’m going to be describing summary information about the 288 cases reported through May 23rd that are summarized in today's MMWR. Through May 23rd, 18 states have reported measles cases. Cases ranged in age from 2 weeks to 65 years. More than half of this year's cases were 20 years of age or older. 18, or 6 percent, were younger than 12 months or too young to be routinely vaccinated. 48, or 17 percent, were between 1 and 4 years of age. And 151, or 52 percent, were 20 years of age or older. We know of 43, or 15 percent, of the U.S. measles cases that required hospitalization. The most common complication of measles that we have seen so far has been pneumonia. Fortunately, no deaths have been reported so far. To date, 15 outbreaks have been reported. An outbreak includes three or more related cases. Besides the outbreak in Ohio, other large outbreaks have occurred in New York City and California, which has responded to six outbreaks in six counties. Why are we having such a bad measles year? There are two factors. First, measles is coming in on airplanes from places where the disease still circulates or where large outbreaks are occurring. Second, imported measles virus is landing in places in the U.S., where groups of unimmunized people live. That setting gives the measles virus a welcome wagon by providing a chance for outbreaks to occur, and the larger the outbreak, the more difficult to stop. Up to 288 cases in the U.S., 280, or 97 percent, were associated with importations from at least 18 countries. This is a reminder that measles is still common in many parts of the world, including countries in Europe, Asia, the pacific and Africa. In 2014, many of the clusters in the U.S. originated with travel to the Philippines. The large Ohio outbreak that is occurring in multiple Amish communities there has roots with travel to the Philippines, as well. Since October 2013, the Philippines has been experiencing a very large measles outbreak. The Philippines is reporting over 32,000 cases and 41 deaths from measles between January 1st and April 20th this year. Once the virus hits the U.S., unimmunized people are getting infected. 90 percent of all measles cases reported in the United States so far this year were in people who were not vaccinated or those whose vaccination status was unknown. Among the 195 U.S. residents with measles who were not vaccinated, 165, or 85 percent, were not vaccinated for religious, philosophical or personal reasons. That is their reason for not being vaccinated was not because they were too young or had a medical reason they couldn't be vaccinated, like leukemia. As these outbreaks illustrate, clusters of people with like-minded beliefs leading them to forego vaccines can be susceptible to outbreaks when the virus is imported. Measles is one of the most contagious diseases in the world. Unfortunately, when we have larger communities of unimmunized people, it's more likely big outbreaks will occur, making it much more difficult to control the spread of disease, and making us vulnerable to have the virus re-establish itself in our country again. Timely vaccination is the best way to prevent measles. The measles vaccine is very safe and effective. But only if it's used. We want everyone to make sure they are up to date with their measles immunizations. We often think of measles as a childhood disease. But today's report reminds us, there are many adults who never have received the childhood vaccines, but are still traveling the world. Adults and children who never were vaccinated are at risk of developing infections overseas and bringing viruses like measles back to their home communities. People may not think of MMR as a travel vaccine. The way they think of typhoid or yellow vaccines. But acquiring measles while traveling is likely if you have not actually been vaccinated. Reviewing your vaccination history on your packing list before you leave the country, so you won't have measles virus boarding with you on your return home. Infants and young children are at higher risk of getting a serious case of measles, and although the routine schedule for MMR is two doses, one dose at 12 to 15 months and the second dose at 4 to 6 years of age, for younger infants traveling internationally, CDC recommends giving the MMR vaccine as early as 6 months of age, since the risk during travel is so high. Babies who get a shot between 6 and 11 months will still need to receive two doses later on. Rapid public health response to measles is critical. Given how infectious measles is, and the fact that we do have pockets of unvaccinated people, clinical suspicion is crucial, as is rapid investigation reporting suspect cases within 24 hours, obtaining appropriate lab specimens and active response to each and every case. Thanks to our high vaccination rates and intensive public health responses, the outbreaks in 2014 are being contained, though cases do continue in Ohio and the health departments are working closely with the community to bring that outbreak to an end, as well. Today's MMWR is a reminder that we cannot let our guard down. We must remain vigilant to protect our communities from measles. This year, we are breaking records for measles. This is a wake-up call. If you are traveling, make sure you and your family are appropriately vaccinated. If you are a parent or a clinician, you need to know this: measles may be forgotten, but it isn't gone. Protect your families and our communities. I would now be open to take questions, operator.

OPERATOR: Thank you. At this time, if you would like to ask a question, please press star1. Please make sure you record your name when prompted. Again, that is star, 1. And one moment, please, for that first question. Mike Stobbe with Associated Press. Your line is open.

MIKE STOBBE: Hi. Thank you for taking my question. Dr. Schuchat, you were talking about the Ohio outbreak and how large that was. Could you tell me when was the last time we had an outbreak that was larger and where was it?

ANNE SCHUCHAT: Yeah, thank you, mike. The last outbreak that was larger than this one was in 1994, and it originated in Summit, Colorado, but it extended.

MIKE STOBBE: I'm sorry, it extended what?

ANNE SCHUCHAT: It included seven states.

MIKE STOBBE: Okay.

ANNE SCHUCHAT: That outbreak had 200 cases. Though we really don't want to break the record of 1994's outbreak in Colorado-- and as I mentioned, the Ohio outbreak is ongoing.

MIKE STOBBE: Could you just say-- you broke up. How many cases in that 1994 outbreak?

ANNE SCHUCHAT: 233 reported cases.

MIKE STOBBE: Thank you.

OPERATOR: And does that finish your question, sir?

MIKE STOBBE: It does thanks.

OPERATOR: Okay, thank you.

ANNE SCHUCHAT: Next question?

OPERATOR: David Beasley with Reuters News Service, your line is open.

DAVID BEASLEY: Yes. Do you have any more details about the Amish outbreak in Ohio? How did someone from the Philippines end up in an Amish community in Ohio?

ANNE SCHUCHAT: The-- very detailed information about the outbreak in Ohio would be available from the health department there. But in general terms, individuals in Ohio traveled to the Philippines to do service work there. We know that many communities of faith are very active in service missions. We think it's critical for them to know that traveling overseas anywhere really needs measles vaccination. So these were Americans traveling to the Philippines and bringing the virus back, and into communities where lots of people were not immunized. I understand that the community has responded really well to the problem, is working very closely with the local and state health departments. And the individuals are really stepping up you to be vaccinated. Thousands and thousands of doses have been administered. It's a sobering thing to have this kind of outbreak, and we appreciate the hard work of people on the ground who are trying to contain the spread. Next question?

DAVID BEASLEY: One follow-up question, if I could.

ANNE SCHUCHAT: Yeah, okay.

DAVID BEASLEY: There is no endemic measles, in other words, no home-grown measles still, right? In other words, these are all we have identified?

ANNE SCHUCHAT: That's right. The United States eliminated measles. Which means that we don't have spread within our country for more than 12 months. We have documented that we have eliminated measles. In fact, we were recently recertified as having eliminated measles. It was in the year 2000 that the U.S. was declared to have eliminated the indigenous spread of measles. All of the Americas eliminated measles, and were pretty excited about that. But it's a very fragile state. While there is still measles circulating in most other parts of the world, protecting that elimination status takes a really active public health response. It also takes clinicians thinking about measles and working people up for it. Clinician versus forgotten what this disease looks like. In fact, in this particular instance, we understand that the individuals involved, because they were traveling back from overseas, were first suspected to have more exotic things, like dengue, because they were traveling overseas, rather than tried and true measles. So we really want measles on the differential for any kind of illness in people returning from overseas with high fevers. Next question, please?

OPERATOR: And does that finish your question, sir?

DAVID BEASLEY: Yes, thank you.

OPERATOR: Okay, thank you. Next, Dan Childs with ABC news.

DAN CHILDS: Thank you so much for taking my question. What i was wondering about, if there had been 288 cases now reported, does the CDC have any projection of how many cases may not have been reported to the CDC? In other words, the total size of this iceberg.

ANNE SCHUCHAT: We think that measles reporting is better than most infectious disease, notifiable disease reporting. Measles does have a fairly distinct rash illness, although we've had to remind people what it looks like. And every possible measles case that is reported gets investigated with appropriate lab tests. So we do have better reporting for this than in most diseases. On the other hand, some people may not seek care, and often in large outbreaks, not everybody gets diagnosed officially and reported. So I can't tell you how many cases were missing. I thought your question was going to be, where are we going to end up. Not because of people that haven't been reported, but about cases that are yet to happen. And our key message today is that we can stop this from being an even greater problem, if people who are not yet appropriately vaccinated get their vaccines, and people who are going to be traveling make sure that they get vaccinated if they have not already got proof of immunity. Really important, because we are seeing, you know-- this is much earlier in the year for us to have large numbers of cases. We haven't yet begun the spring and summer travel seasons which is when we usually have a lot of cases here in the U.S.

DAN CHILDS: Thank you.

OPERATOR: Thank you. Our next question comes from Sarah Mimms with National Journal. Your line is open.

SARAH MIMMS: Hi. Thanks for participating in this call. My question is about whether or not you've seen a rise in people who are choosing not to get vaccinated for either religious or philosophical reasons, and whether you have any comment on if it's related to people in sort of that autism scare over the last couple of years where there has been some misinformation out there about how vaccinations can cause autism in some children.

ANNE SCHUCHAT: We're tracking closely the issue of people not being vaccinated, in addition to tracking coverage with measles in toddlers and in kindergarten at school entry. We're also tracking the number or percent of children who get no vaccines at all. And fortunately, we're remaining at our target of less than 1 percent of toddlers that have received no vaccines at all. On the other hand, those are national statistics. And we know there are communities where large numbers of individuals have decided not to be vaccinated. In some states, the number that are exempting is increasing, in some states the number that are exempting is decreasing. There has been a lot of attention to this issue with these visible outbreaks of measles, and so we don't feel that there is a national upward swing in people defaulting or exempting or deciding not to get measles vaccines. We don't think that the current outbreaks are related to concerns that were alleged some time ago about an MMR association with autism. We don't believe that has any-- that concern is why these outbreaks are occurring. But we know that there are many different factors that go into why people choose to get themselves or their children vaccinated. We think it's really important for people to know that measles vaccine is safe and effective and is necessary to protect you or your family from measles. Measles is extremely infectious and will find you if you haven't been vaccinated. You have a follow-up?

SARAH MIMMS: No. Thank you.

OPERATOR: Thank you. Our next question comes from Leonard Bernstein with Washington Post. Your line is open.

LEONARD BERNSTEIN: Thanks for taking my call, my question. I'm wondering if the large number of people over 20 years old-- looks like 52 percent here -- is unusual. And if so, does that tell us anything about this outbreak?

ANNE SCHUCHAT: You know, I think it's too soon for us to make many conclusions about that. Many of those individuals had never been vaccinated, and we probably have a mature enough population now where families decided not to be vaccinated, you know, 20 or so years ago, that those people have reached adulthood. There is not evidence of vaccine failure in any great extent. The vast majority of our cases were never vaccinated, or couldn't confirm that they had been vaccinated. It's important to say that measles will affect adults if they didn't already have measles or get the two doses that are recommended. And we have been really pushing good documentation of measles vaccine. For instance, for healthcare workers. Because there are adults out there providing healthcare who haven't been fully vaccinated. SoIi think it's too soon to conclude much about the adult pattern. Certainly, the-- the travelers-- the traveling public is a bit more of an adult population. But, you know, these larger outbreaks are not necessarily in young children but affecting adults, as well. Essentially, if you haven't been vaccinated and measles is in your neighborhood, you're going to get measles, whatever your age.

LEONARD BERNSTEIN: Okay. And just to follow up, are you finding the adults in any particular place among the ones that you mentioned? For example, are most of the Amish folk in Ohio who have gotten measles adults?

ANNE SCHUCHAT: I don't have that data. We'll be looking at it at year's end. And, of course, the health departments in Ohio are working very actively to control the response. So we'll be looking in more detail at how things break out in the different outbreaks and in the national totals.

LEONARD BERNSTEIN: Thank you.

OPERATOR: Thank you. Our next question comes from Elizabeth Mechcatie with Frontline Medical News. Your line is open.

ELIZABETH MECHCATIE: Hi. I was interested in what you would recommend for healthcare providers who are caring for adults, since some adults have been affected. But you just clarified some of the reasons why they're affected, because they weren't vaccinated.

ANNE SCHUCHAT: I think that people take for granted that everybody got the recommended vaccines. And, you know, I’m old enough that I actually had measles, not measles vaccine. But as people are caring for middle-aged and younger adults, they shouldn't take for granted that they got all the recommended vaccines when they were a child. Particularly these days where the world is smaller than ever, people enjoy traveling for pleasure and do a lot of traveling for business. It's really important to make sure people have gotten vaccinated. And if you don't have the records and nobody remembers, get another dose of MMR. So that's really our recommendation. For very high-risk people like healthcare workers, the proof of immunity requirements are very strict, and that's all posted on our website. Exactly what documentation is needed.

ELIZABETH MECHCATIE: Alright. Thank you.

OPERATOR: Thank you. Our next question comes from Robert Lowes with Medscape Medical News, your line is open.

ROBERT LOWES: Thanks for taking my call, Dr. Schuchat. I have two questions. One, could you sort of parse what makes this year a record-breaking year? I think you said that the number had to do with cases reported as of-- as of this time in the year, as opposed to a year total. Can you just break that down, what makes it a record year? And the number in '94 that is being compared to?

ANNE SCHUCHAT: Right. There are a couple reasons why this is a record-breaking year, and I encourage people to look at the graph that we have on our website, which reviews measles-- month-by-month measles cases from 2001 to 2014. What you can see on that graph is that earlier in the year than usual, we started to have many cases of measles. So that by April, we were already at about 150 cases, which is more than we have in most years. But since then, we've gone even higher in terms of year-to-date totals. Part of the reason for the early increase is that the Philippines is having this large outbreak, and the season of measles in the Philippines is the wintertime here. Usually measles in the U.S. is occurring in the spring and sometimes in the summer, because of the people coming back from travel overseas. But what we had was people doing missions and other travel in the Philippines in the winter, when they were having this huge outbreak, and so we had a lot of importations in the first couple months of the year. The other factor, of course is that when measles arrived in the U.S. earlier than usual, it found these communities with a large number of unimmunized people. Different populations in the different states. But what they had in common was they were unimmunized.

ROBERT LOWES: So what was the grand total in '94 as of May 23rd? Can you answer that?

ANNE SCHUCHAT: Right. The-- okay. So in 1994, the end of year was higher than what we are at now. It reached 740--

ROBERT LOWES: 740?

ANNE SCHUCHAT: Oh, I’m sorry. Okay --764 by the end of the year. But by this time, that year, it was at an earlier number. Is this right, not right? Okay, I’m so sorry. Why don't we get you that information later? Because I’m looking at a few different things. So the current number of 288 through May 23rd is higher than the end of year number going back to 1996. But the year-to-date number is the highest that we have had since 1994 when the year-to-date number-- I’m sorry-- yeah, the year-to-date number in 1994 was 764. So it was higher in 764 by May than we're at now. But we're breaking all the records since then to now. And that is probably something we'll verify with you, because of how many scribbles I’m getting. But essentially what I think the key point is that we are at a 20-year high right now, and we don't want to get to a 21-year high. So we really like folks to get vaccinated and protect their families and themselves. Next question?

OPERATOR: Thank you. And just a reminder, to ask a question, please press star, 1 and record your name. Our next question comes from Miriam Falco with CNN Medical News. Your line is open.

MIRIAM FALCO: Hi, Dr. Schuchat. Thanks for taking my call. Just two points of clarification. You mentioned one while I was dialing in. I apologize if you're repeating yourself. Is there any harm in getting vaccinated again if you're not sure about your status? And then number two, I got a little confused with your little description just now. Is the highest case number at this time in 1994 and since then we're now at the highest? Because first you said it was 764 cases by the end of 1994. And then you said year-to-date it was 764. So I’m a little confused.

ANNE SCHUCHAT: Yes. Thank you, Miriam, for the chance to correct. It is fine to get another MMR if you're not sure if you've had one before. In fact, everybody is supposed to get two at least one month apart. So if you're middle-aged and you really don't know if you got your doses in the past, absolutely fine, completely safe to get an MMR. The only people who shouldn't get MMRs, it's a live vaccine, so people who are immuno-suppressed, like with leukemia, if you're pregnant, shouldn't get MMR during pregnancy. So fine to get another dose if you're unsure. Now, let me clarify the issue of the 20-year high. If it we take data through May 23rd or year-to-date, we have to go back to 1994 to find a year when we had a higher number by this far in the year than we do now. In 1994, the year-to-date number, you know, in May, was 764. That year continued to be a tough year, and they went on to have 963 cases by the end of that year according to data that I’m looking at here. The-- essentially, the key thing is that by this point in May, 288 cases is a lot. We're not done yet with May, and we know there are going to be additional cases coming in from the ongoing investigations in the state. So we do think that this is a wake-up call. More cases than for the past, you know-- than since 1994. Certainly since elimination, we're really diverging from the usual annual trend of cases with a great acceleration early in the spring. Did you have a follow-up?

MIRIAM FALCO: No, that's it. And I too had the measles, so I guess I’m dating myself.

BENJAMIN HAYNES: Next question?

OPERATOR: Thank you. Our next question comes from Jane Derenowski with NBC Nightly News. Your line is open.

JANE DERENOWSKI: Hi, good afternoon. I was going to ask the exact same thing. Who can get the vaccine again, if you're not sure, like I’m not sure as a middle-ager, before summer travel season. Did you say you have to get two shots?

ANNE SCHUCHAT: We recommend two doses of MMR for full protection. The usual timing is for babies to get it at 12 to 15 months, and a second dose at 4 to 6 years of age. But for babies under 12 months who are traveling or in an outbreak, we recommend starting at 6 months. For adults born before 1957, we think that they likely had measles. But for adults born since 1957, our routine recommendation is one dose of MMR. But if they're a high-risk adult because they're a healthcare worker, or childcare attendant or they're going to be traveling, we recommend the two doses. So that's the high-risk-- you're going into a circumstance where you're more likely to encounter measles or if you got measles, it would be harmful. Most people born before 1957 had measles. Some people born since 1957 had measles. The vaccine for measles was first rolled out in the U.S. in 1963. If that helps anybody in terms of being on the cusp. And then it was not until 1989, I believe, when we came up with our two-dose recommendation. Lots of universities make you prove that you have had your doses of measles before you come in. So many people got that second dose sometime as an older adult.

JANE DERENOWSKI: So it's not harmful if you get it again if you can't recall if you had it as a kid.

ANNE SCHUCHAT: It’s not harmful to get it again. And, in fact, while you're thinking of things like typhoid and yellow fever, measles at this point, we're seeing more Americans come back with this disease than with some of the other sort of travel-related conditions. We have time for just two more questions. Operator?

OPERATOR: Thank you. Our next question comes from Alexandra Sifferlin with Time. Your line is open.

ALEXANDRA SIFFERLIN: Great, thank you. I wonder if you can give us a bit more information about the communities where vaccination rates are especially low. You mentioned some faithful communities. But I’m wondering if you have any other demographic or any other information where you guys see this being particularly high.

ANNE SCHUCHAT: It’s difficult to generalize. We track measles vaccination status at the state level and report that every year for toddlers and for kindergarten entry. But what we know is that the state level is just an average or aggregate, and that there are many areas where at a school level or a neighborhood level, or a community level, coverage may be much less. In the past couple years, we've seen some measles outbreaks in different faith-based communities. There's nothing specific to a religion that identified against getting measles vaccines, but there are sometimes cultural beliefs or similar habits in different groups. Certainly in the U.S., school requirements help us sort of track and make sure that people get measles vaccine. And so there may be communities where home schooling is common, where there wouldn't be that check or that reminder that your children are supposed to be vaccinated by age 5. So I think there are many different factors that lead people to decide not to get themselves or their family vaccinated. The most important thing for people to know is that measles vaccine is very safe and effective. And measles can be serious. It's very infectious, as this year shows. It is being imported regularly here to the U.S. from other parts of the world. And if you or your family haven't been vaccinated and you encounter the measles virus, they will get sick. So we really hope people will take advantage of a safe and effective vaccine and protect themselves and their families. Last question?

OPERATOR: Thank you. Our next question comes from Michael Smith with Medpage Today. Your line is open.

MICHAEL SMITH: Yes, thank you. Dr. Schuchat, just a quick one. The-- over the last 20 years, presumably, most of those cases have also all been imported. When would-- when would sort of local indigenous measles have ceased?

ANNE SCHUCHAT: The year 2000 we declared indigenous measles transmission to have stopped here in the U.S. and so all of the years since 2000, measles has been essentially associated with importation. As control of measles in different parts of the world improved, we saw fewer importations or importations from different areas. We used to have a lot of importations from Latin America, but the Americas have done a really good job of eliminating measles. And so we don't see those importations very often from South America, for instance. The other point, though, is that sometimes an outbreak really grows in enormous size quickly. You know, in the Philippines, we have this outbreak with 32,000 cases. We didn't used to think about the Philippines as a place where people needed to get their measles vaccine. We didn't used to think of France as a place where people should worry about measles, but they had an outbreak a couple years ago with almost 20,000 cases. So measles can really get out of control quite quickly. And what we do not want to have happen here in the U.S. is to have an out-of-control situation and to get indigenous spread. You can get indigenous spread if you can't break the chains of transmission, and you really have to keep following up everybody with possible measles and make sure that everybody around them has been vaccinated. You don't want this to spread into other individuals or communities. So we hope that this upward trend that we're seeing this year will not continue. We know that there's lots of measles still in countries where Americans will be traveling. And we don't want them to bring measles back with them. So-- did you have a follow-up then?

MICHAEL SMITH: Just a quick follow-up. You mentioned the sort of seasonality effect in the Philippines. I'm assuming that any seasonality in North American measles is a function of travel in general.

ANNE SCHUCHAT: That’s right. That's right. Before we eliminated, we did often have this spring timing to measles. But currently, it's more associated with when the virus is coming back in. So thank you for that question, and I do want to thank everyone on the call. I just want to remind you that this year we are breaking records for measles, and it's a wake-up call, because we don't have to let this get even worse. If you're a parent or clinician, remember that measles may be forgotten, but it isn't gone. Please get vaccinated and suspect this illness and protect the patients you're caring for. Thank you all for your participation. I think you're going to close things up, Ben?

BENJAMIN HAYNES: Yes. Once again, thank you for joining us. A transcript of this briefing is going to be available on our media relations website as soon as possible. If you need additional information, please call our main media office at 404-639-3286.

OPERATOR: And this now concludes today's conference. Thank you for your participation. You may now disconnect.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES