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Measles Outbreak: Discussion with the Emory Global Health Institute

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September 13, 2019

As measles cases continue to rise in the U.S., the Emory Global Health Institute held a panel discussion this week called “Turning the Tide on the U.S. Measles Outbreak.” WebMD collaborated with the institute by gathering questions from its audience to share with the panel.

The panel answered those questions, along with others from the audience, during the event.

Panelists included:

  • Walt Orenstein, MD, Associate Director, Emory Vaccine Center
  • Andi Shane, MD, MPH, MSc, Marcus Professor of Hospital Epidemiology & Infection Prevention, Emory School of Medicine and Children’s Healthcare of Atlanta
  • Robert Bednarczyk, PhD, Assistant Professor, Department of Global Health & Epidemiology, Rollins School of Public Health
  • Jeffrey Koplan, MD, MPH, Vice President for Global Health, Emory University

A recap of the questions follows:

WebMD: How can pregnant women protect themselves from measles? What’s the added risk, if any, to the fetus, and what happens to a fetus if the mother is infected with the disease?

Shane: A pregnant woman who is unimmunized, is unprotected and has measles has a high risk of herself being ill. One of the most common complications is pneumonia and severe pneumonia, and then the secondary complications to the fetus. There’s been associations between measles infections and premature birth, low birth weight infants, so challenges that really could be prevented by having measles immunization. There’s also an association with still births and potentially early abortions as well. What we really hope to do is have every women who is pregnant be immune to measles through being measles immunized .The vaccine is a live-virus vaccine so it is not recommended that a woman receive measles vaccine during pregnancy if she should be exposed. In that situation, immunoglobulin would be given in the hope that it would prevent transmission to the infant.

WebMD: The CDC is on the verge of declaring that measles is no longer eliminated in the U.S. What is the impact going to be here and globally?

Orenstein: It’s a shame we’ve gone so many years now … almost 19 years without ongoing transmission in the U.S., despite the fact that on average in the past we had about 28 importations into the U.S. Measles can, in my opinion, and should be eradicated. And the issue is to show examples of proof of principle, the U.S. has shown that example with almost 19 years of having terminated ongoing transmission. It moves the world backwards in terms of considering the goal for eventual eradication. I think we need to overcome the hesitancy. We have the tools…we clearly can get rid of this disease … This is a step backwards, and I think the symbolism is of great concern.

WebMD: What else can health officials do to educate people opposed to vaccines about their importance? Do we just accept that more unvaccinated people live among us and adopt new ways of dealing with it?

Bednarczyk: We can’t just use numbers and facts and figures. Education really has to be driven by something tangible. ….Ten percent of those individuals in the current outbreak had to be hospitalized. So there’s this sense that measles is just a rite of passage, it’s a childhood disease, it’s not that big a deal and we hear that for a lot of diseases -- we hear that for varicella….that it’s just a routine illness and kids get over it. But the thing is that they don’t. l think being able to highlight some of that, to use some of those stories effectively but judiciously. We could be out there showing images of children on respirators laying in a bed with tubes coming in and out of them out all over the place, but I think that type of shock value would actually serve us negatively…..but I think helping people to understand that this disease is out there and it’s really making people very ill and trying to communicate some of that.

But I think as we see these outbreaks growing it may be harder for us to escape having measles cases locally. Friends of mine were pregnant at the time when the first case in Georgia came up in this current outbreak and everybody was calling and asking me how worried should they be about that. I used that as a chance to say, ‘This is also your opportunity. I’m just an academic, you’re somebody out there who has these concerns. You can use that position to spread that among your other social networks. In the same way that social media messages against vaccination are widespread, you need to share those concerns and you need to be able share that message out there to the people around you.’ I think we all have the ability to be that type of peer influencer in that way -- to really make that case.

WebMD: Have vaccines been a victim of their own success?

Koplan: In terms of historical amnesia, there are two things here. One, if you don’t see it around and it’s not in the daily news, you’re just not going to be worried about it. There’s so many things to be worried about. Here’s one which we probably should be worried about to some degree, but people just don’t see it, they don’t know anyone who’s had it …. in that sense we’re victims of our own success. ….It’s a bad disease but we have to do some more re-education.

WebMD: Can you get measles twice?

Shane: It depends. If your immune system is wiped out, potentially you could. Measles is one of those diseases where after a natural infection and also after immunization you have very good protective titers. With measles vaccine we don’t have a lot of the challenges we do for example with the influenza vaccine, where the news is constantly promoting the rate of vaccine effectiveness. This is not much of an issue for measles per se.

Audience question: I take care of a lot of immuno-compromised children and my families are really worried and really struggle because the schools won’t even let them know how many kids in the classroom are vaccinated and unvaccinated. They don’t know how to protect their children. Do we need some sort of open records law or something to address that?

Orenstein: Clearly in my opinion, parents ought to be able to understand what the immunization status is of this population in which they’re sending their children. That’s going to require political advocacy in order to get that done. There has been resistance to trying to do that…but to me, it is important and I’d want to know if I’m sending my child to school where there’s substantial numbers of unvaccinated children. There’s a recent survey that is not published yet that I saw, where parents are also concerned about taking their kids to doctor’s offices where there are refusing patients. The American Academy of Pediatrics has basically permitted the firing of patients who refuse vaccination as a way of protecting everybody. My own personal concern is that if you fire patients where will they go? It’s not in the best interest of the child if you want to maintain the relationship. Hopefully at some point, you can convince them. The other big issue ….….is the need to spend time with parents. One of the issues is can we get insurance codes that will reimburse for counseling when vaccine is not given in order to incentivize time spent on that.

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