Here & Now

Dr. Ryan Westergaard on Measles Cases in Southwest Wisconsin

Frederica Freyberg:
Wisconsin is experiencing one of the largest measles outbreaks in several years. At last count, the Department of Health Services has identified 48 cases and one hospitalization, mostly in the southwest part of the state, and the case count has grown rapidly due to how highly contagious measles is among the unvaccinated. With the latest, we’re joined by Dr. Ryan Westergaard, chief medical officer with the Wisconsin DHS Bureau of Communicable Disease. And doctor, thanks very much for being here.

Ryan Westergaard:
Thank you for having me.

Frederica Freyberg:
Describe how fast this has spread in this latest outbreak.

Ryan Westergaard:
Well, unlike some previous outbreaks, we didn’t catch this one at the very beginning. We identified cases that may have been associated with some families that had symptoms for a few weeks. So it might even have been going on for a month. When we did first detect it a couple of weeks ago, it’s doubled about every four or five days. So we started with just two cases confirmed. Now we’re up to 48. So that number goes up when our investigators and local health departments are out in the community, following up on people who report symptoms, identifying contacts, and when they find people with new symptoms, or they hear about a new test, that number goes up. So this is often what we see with measles outbreaks.

Frederica Freyberg:
How do public health officials get a handle on it?

Ryan Westergaard:
Yeah, it’s pretty painstaking and we give them so much credit for their dedication out in the communities. So measles is one of the reportable conditions. So every positive lab test and every diagnosis made in a clinic we hear about in public health. And here in Wisconsin, it’s our local health departments, usually at the county or sometimes the city level that are the front line. So where I work at the state health department, we support, we aggregate the data, but the work that gets done in the communities involves every single person who is identified with measles gets an interview where an investigator, sometimes a public health nurse or a full time disease investigator will meet with them in person, face to face with personal protective equipment when needed, and they’ll confidentially try to understand places and people where they’ve been in contact. And then we can then spread out and identify other people who have been exposed, give them the advice that they need about to double check their vaccination status or to get a post-exposure prophylaxis, meaning a vaccine. And so that’s the work that’s being done right now. And we’re probably going to see more cases as a result of those investigations.

Frederica Freyberg:
With childhood vaccination rates, including for measles, sitting at about 85% for incoming kindergartners in Wisconsin, was it just a matter of time before this outbreak happened?

Ryan Westergaard:
I think the answer is yes to that. We’ve been concerned about the level of childhood vaccinations being too low. Measles, as you said, is probably our most contagious virus. And the classical teaching in public health school is that you really need to have a community with 95% vaccine coverage or greater to prevent an outbreak if there is a case that comes into the community through travel, for example. So we have many communities that are below 90 and below 85%. And so for the past year and a half, where there have been measles outbreaks occurring in different places of the country, we’ve kind of been anticipating when is it going to come to Wisconsin. The benefit of that is that we were ready and we’re making the right resources available to our southwestern counties, and hopefully we’ll take this what is now a medium-sized outbreak and keep it that small and prevent it from getting to be a large one like we’ve seen in some other states.

Frederica Freyberg:
How dangerous is it to get measles?

Ryan Westergaard:
Measles can be a pretty serious infection. And it’s a good question to ask and to talk about, because there’s been so little measles around in this country for so long that many physicians that are my generation or younger have never seen a case. So measles is a respiratory virus. So it spreads through the air, which is what makes it so contagious. The other side of the room, particles can remain suspended in the air and cause an infection. But when it gets into the body, through the nose or mouth, it causes a whole body, a systemic infection. It causes high fever, sometimes as high as 105. A whole-body rash that is the characteristic dense red measles rash that starts on the head and then spreads to the whole body. And so most anyone that gets measles will have those symptoms and feel pretty terrible. But a subset of people with measles can get really severe illness, and it can cause pneumonia and cause encephalitis or swelling of the brain. And sometimes, particularly in children, that brain inflammation can cause permanent disabilities like blindness or deafness. So it’s a serious infection, one that we want to prevent and our goal is to eliminate measles so there’s actually not spreading in our communities at all. And that’s why the stakes are kind of high.

Frederica Freyberg:
What was it like before there was a measles vaccine?

Ryan Westergaard:
Yeah. The measles vaccine or version of the current measles vaccine was released in 1963. So a good long time ago and the decades before that, essentially everyone got measles during childhood, right? And so that’s why there’s some misconception that this is a sort of a normal part of childhood. But what we don’t remember is that when 3 to 4 million children in the U.S. get measles in a year like they did in the ’50s and ’60s, that means that several hundred children, young babies, will die from the serious complications. So in that decade before we had MMR vaccine, there were 300 to 400 deaths in children per year.

Frederica Freyberg:
Dr. Ryan Westergaard, thanks very much for your update.

Ryan Westergaard:
Yeah, thanks for having me.