Here & Now

How Vulnerable is Wisconsin to Measles?

Frederica Freyberg:
In tonight’s look ahead, with the worst measles outbreak in decades spreading across the U.S., lawmakers here are now looking at eliminating Wisconsin’s personal conviction vaccine waivers. Exemption waivers for medical or religious reasons would still be allowed. Wisconsin ranks fifth in the country for the highest number of exemptions for the measles mumps rubella vaccine for a non-medical reason. Public health officials worry it’s only a matter of time before cases of measles could crop up here. Dr. James Conway is a professor at UW-Madison School of Medicine and Public Health. Thanks for being here.

James Conway:
Thanks for having me.

Frederica Freyberg:
So how alarm is it for public health officials like yourself to see these cases of measles spreading to 22 states?

James Conway:
It’s really quite concerning. It’s a really troubling virus to manage because of the long incubation period and because of how contagious it is. So it’s really alarming that it’s been spreading and will probably continue to spread for some time.

Frederica Freyberg:
Given Wisconsin’s law allowing children to forego vaccines, how vulnerable do you think this state is to an outbreak?

James Conway:
Yeah, it’s actually more remarkable to me that we haven’t had a case yet even though we’re surrounded by states that have had cases. We’re looking at probably 91, 92% of kids are immunized. And understanding that only about 95% of kids that have been vaccinated are actually fully protected and knowing that we need well over 90% of people to be protected to really control an outbreak, we are sort of an outbreak waiting to happen.

Frederica Freyberg:
Given that the MMR vaccine virtually eliminated the risk of measles, it doesn’t really feel that threatening, but how serious is that disease?

James Conway:
Well, it’s a miserable disease. I mean these kids start with fever and then really bad runny nose and cough and look like they just have a flu or something like that. Then rash, but a fair number of kids will get pneumonia. Diarrhea is pretty significant obviously. You know, more than 100,000 kids die every year from measles around the world mostly either from the secondary pneumonia or the diarrhea.

Frederica Freyberg:
For whom is it most serious?

James Conway:
For the youngest kids, they really do the worse with it. People with immune deficiencies, the elderly, but it’s really very unpredictable. So about 1 in 1,000 people are going to get encephalitis, a central nervous system version, and about 25% of them die.

Frederica Freyberg:
Infants, I understand, can’t get the vaccine. So they’re particularly at risk, I would think.

James Conway:
It’s interesting because moms that have some immunity will transmit that to baby. And so baby is temporarily protected. We generally wait until over 12 months of age because they don’t respond well to the vaccine because of that left over maternal immunity. But for outbreak situations or kids that are going to travel or are going to go into a measles endemic area, we actually will give the vaccine to 6 to 12 months olds.

Frederica Freyberg:
Meanwhile you’re saying that your phone is kind of ringing off the hook with other providers wondering how to handle this.

James Conway:
It’s really interesting because I think we’ve become a victim of our own success in some ways. I think a lot of providers, although we learn about measles, haven’t seen it very frequently. And as I said, it’s a little bit puzzling, a little difficult early on because it looks like just a regular respiratory virus until the rash starts. The whole illness lasts about 10 to 14 days but the incubation period is also 10 to 12 days. So it’s really hard once it gets established to shut down outbreaks because you’ve got people walking around that are incubating. People are contagious before they even have any symptoms. And they get into a pocket of people that are unimmunized and that’s really how the immunization issues manifest, is that most of the time these groups are clustered together. And so once you get into a cluster of people who are unimmunized, it’s like dropping a match into gasoline. It just gets going and it’s really difficult to stop.

Frederica Freyberg:
Is there a risk to this vaccine itself for autism or other things?

James Conway:
No, I mean that was one of those old wives tales almost really sort of a rumor that was started largely and then unfortunately some falsified data that was generated in the late ’90s by some researchers sort of led to this misconception. But vaccines are held to a completely different standard from other pharmaceutical products, for instance, that are introduced in the communities. And they are very closely monitored for safety. So we’ve got well over — we’ve been doing the routine MMR vaccine in the United States since 1983. We have literally tens of millions of patients that have been watched closely and there’s no association whatsoever with anything resembling autism.

Frederica Freyberg:
Very briefly, with less than half a minute left, what about older people, should they get a booster or something like that?

James Conway:
Yeah, one of the things we’re realizing is we’ve always presumed everybody born before 1957 had had measles but now that a lot of that population is traveling, those people really need to think getting vaccinated. People that sort of thought they might of had measles but never had it confirmed really do need to think about this.

Frederica Freyberg:
Dr. Conway, thanks very much.

James Conway:
Thanks for having me.