IDSA Media Briefing: Measles: Is The United States Adapting to a New Reality?

Jeanne Marrazzo: [00:00:00] Good morning everyone. I'm Dr. Jeanne Marrazzo, chief executive officer of the Infectious Diseases Society of America. And I represent more than 13,000 physicians, scientists and public health experts whose focus is the prevention, treatment and cure of infectious diseases. I know that the headlines have been rife with hantavirus and Ebola virus lately, but we're going to return today to something that remains a very big problem in the United States and globally, and that is the current state of measles. We're going to talk about what infectious disease professionals are seeing from a clinical perspective, and the critical role of public health in managing the spread of measles. This morning, we're joined by two outstanding speakers. First, we'll hear from Dr. Ruth Lynfield, who is the state epidemiologist and medical director at the Minnesota Department of Health. Second, we'll have Dr. Andrew Pavia. Doctor Pavia is the George and Esther Gross presidential professor at the University of Utah. Following our speakers remarks, we'll open the floor to questions. To ask a question, click the Raise My Hand button or for those on the phone, select star nine and you'll be added to the queue. I'll now turn it over to Doctor Lynfield.

Ruth Lynfield: [00:01:17] Thank you Doctor Marrazzo and thank you everyone for joining. I'm honored to be here and want to first clarify that I'm not speaking on behalf of the Minnesota Department of Health, but as an expert in infectious diseases. We are worried about measles because it is so contagious, and for some people, it can result in severe disease and complications, including severe dehydration, pneumonia, encephalitis or brain inflammation, and even death. Measles can attack immune memory cells and may increase susceptibility to other infections for a period of time after the acute measles infection. People at high risk for complications include infants and those who are immunocompromised. A person who is pregnant is at high risk for severe disease, including pneumonia. But there is also a higher risk of miscarriage, stillbirth, low birth weight and prematurity for the baby. A very scary, rare late sequelae of measles, occurring typically years after infection, is a progressive, fatal neurological condition called subacute sclerosing panencephalitis. You will hear more about the clinical manifestations of measles from Doctor Pavia. Because we've had such an effective vaccine that protects us against measles and provides strong lifelong immunity, 93% after one dose, 97% after two doses, we have not had the need to develop antiviral treatments. We can provide supportive care, but we do not have effective antiviral therapy once someone gets severe measles. Over the last two years, we have seen large outbreaks of measles in the US, Canada and Mexico, as well as in many other parts of the world.

Ruth Lynfield: [00:03:46] In the US this year, as of last Thursday, almost 2000. That is 1952 confirmed cases of measles were reported just in 2026. Cases this year have occurred in 39 states and the District of Columbia. Notably, 92% were unvaccinated or had an unknown vaccination. In 2025, 2288 cases were reported in the US, and unfortunately, there were three deaths due to measles. The number of reported cases in each of the past two years is much higher than we had in the prior 25 years, when we had, on average 180 cases per year and many years had less than 100. Mexico has had more than 17,700 cases and 40 deaths due to measles in 2025. Through now, Canada has reported over 6400 cases and two deaths. During this time period. Why is this happened? We've seen measles vaccination levels drop and measles has been circulating in many parts of the world. Overall in the US, in the 2019 to 2020 school year, more than 95% of kindergartners were vaccinated for MMR, the measles, mumps and rubella vaccine. In the 2024 to 2025 school year, it was lower. It was 92.5% on average nationally. Now, this may sound like a small change, but it actually means that a large number of children in kindergarten about 286,000, according to CDC, are not protected. In addition, looking at overall national numbers does not reveal that there are communities that have extremely low rates of immunization among young children and that enables the virus to continue to circulate if it is introduced.

Ruth Lynfield: [00:06:25] The drop in childhood vaccination is a result of multiple factors, including challenges to pediatric healthcare access in some communities, socioeconomic factors, disruptions in care that were initially occurring during the pandemic, misinformation and vaccine hesitancy. Because we have had a highly immunized population for many decades. Many people younger than 60 years of age, including health care providers, do not have firsthand experience with measles. With the escalation of measles, including congenital cases, as an infectious disease community, we realize we needed to understand what was happening and discuss what was needed to protect our communities. We needed to review the emerging epidemiology and clinical consequences and identify gaps, including how to partner with communities and how to better communicate with families and with the public. We needed to develop new resources to help health care professionals, public health staff and the public be better prepared to respond to the growing challenge of measles circulating in our communities. Earlier in May, the National Foundation for Infectious Diseases, in partnership with the Infectious Diseases Society of America, convened 15 leading medical and professional societies and frontline clinicians and public health experts for Measles Summit. We discuss current challenges and successes and are working together to develop products, including practical tools, to support the prevention and control of and response to measles. Thank you so much for your attention and I will turn it back to Doctor Marrazzo.

Jeanne Marrazzo: [00:08:33] Thanks, Doctor Lynfield, that was a great way to start this conversation. I'm going to turn it over to Doctor Pavia.

Andrew Pavia: [00:08:41] Thank you Doctor Marrazzo. And thank you Doctor Lynfield. And thanks to all of you for joining us today. I, too, am speaking as an infectious disease physician who's seen a lot of measles and not on behalf of the University of Utah. I want to tell you something about the impact of measles during a very large statewide outbreak here in Utah as of last week. We've had 673 confirmed measles infections, 476 of those were in 2026 alone. The initial epicenter of this outbreak was in a community that straddled the Utah-Arizona border in southwestern Utah, and there were an additional 210 cases across the border in Mojave County. So the overall outbreak could be considered to include more than 880 patients. We know, however, that there have been many more infections based on several studies we've done that were not laboratory confirmed. Fortunately, the outbreak in our region does appear to be slowing. Although the outbreak was initially centered in a tightly knit community on the border. It spread to involve the entire state of Utah. Just over 90% of measles cases were in people who were unvaccinated or at unknown status. Two thirds of the patients were. Adults older than 18 and one third were children. These included 23 children under one year of age. Those who are too young to be vaccinated, who depend on community protection. We've had 12 cases of measles among pregnant women, which is Doctor Lynfield mentioned, can be very serious and can result in miscarriage, stillbirth or infection of the baby. Luckily, only one infant developed congenital measles, a condition that can be extremely serious and is often fatal.

Andrew Pavia: [00:10:25] Thankfully, that baby here in Utah has done well. Two babies in Canada were not so lucky, and their mothers lost their newborn infants to congenital measles. 54 or 8% of patients were hospitalized for more than 24 hours, but many, many more were seen and treated in emergency departments. Treatment in the ED included staying for many hours and receiving oxygen IV fluids and pain medication. And remember that emergency departments and pediatric clinics and medical clinics had to alter their practices throughout the outbreak to avoid spreading measles in the clinic or in the emergency department. The hospitalized patients we've seen have been quite sick. Some have developed manifestations of brain inflammation or encephalitis with confusion or brain fog. Some have had measles, I'm sorry, some have had pneumonia as a complication of measles. There have been there are at least four ways that measles can impact the brain, including acute encephalitis during the infection itself. And most patients will recover from that. There's acute demyelinating encephalitis, which occurs several days after the infection, where the body in response to the measles infection attacks the white matter where the insulation of the brain. There's measles inclusion body encephalitis, which occurs in immune compromised individuals, such as cancer patients, when they get measles. And that's much more serious. Very few people recover effectively from that, and many die. And then, as Doctor Lynfield mentioned, there's SSPE. SSPE was thought once to be extremely rare, but more recent studies have shown that it's not nearly as rare as we thought, and it may affect as many as 1 in 700 babies who get measles before the age of one.

Andrew Pavia: [00:12:21] Remember that these are the children who are too young to be vaccinated, who depend on the protection from their community. SSPE is a ticking time bomb for measles, which develops 1 to 10 years after infection. It causes a really heartbreaking progressive neurologic deterioration that inevitably ends in death. A number of years ago, I saw one girl who had SSPE and followed her for 3 or 4 months to her death. And it was literally one of the most horrible things I've witnessed in the past 40 years, including taking care of HIV patients for many, many years. Measles attacks the immune system and cause short term and more persistent loss of the ability to fight certain infections. As a result of that, we've seen more cases of bacterial pneumonia and other bacterial complications, and these are due to what we call the immune amnesia of measles. But, you know, one thing we don't really talk about enough is that an ordinary or uncomplicated case of measles is miserable, and you never know how it's going to turn out. Our mothers knew that, and they were fearful every time their children got measles. They didn't just think this was a rite of passage and nothing's going to happen. I've heard patients and parents tell me, no one told me that measles was going to be this bad. I wish somebody had told me, I wish I had known.

Andrew Pavia: [00:13:47] Another question that I'm frequently asked is, why did we have several very large outbreaks like Florida, West Texas, South Carolina, or the Utah/Arizona outbreak? And I think it's worth thinking about that. We know that measles is one of the most infectious diseases known to man. It's many times more contagious than Covid, Ebola or hantavirus. And we've been lucky for the past several decades that we've been protected by very high vaccination rates. But that's no longer true here in the U.S. and in many other countries. One way that I think about measles outbreak, familiar to those of us who live in the West, is to think about it in terms of wildfires. First, you need fuel, and that fuel is in the form of unvaccinated people. When you have more than 95% of the people are vaccinated, there's not enough fuel to start or sustain a fire. Next, you need a spark. That's an imported case of measles from somewhere in the world or in the US that arrives in that forest. So there are plenty of sparks. When that spark hits, you do have a limited amount of time to contain it before it spreads. Similar to a wildfire. With wildfires, you have hotshots and smokejumpers who can get there quickly. And if they work, if there are enough of them and they work fast enough and the conditions are favorable, they contain the fire so that you have an outbreak perhaps of three, 10 or 20 cases. But if you can't contain it, if it gets past several generations of cases, it's similar to when the wind comes whipping out of the mountains across LA and you have megafires, as we've seen all too often. In the case of measles, the equivalent of the hotshots and the smokejumpers are public health workers who have to identify case, keep those cases isolated, trace all their contacts and ask them to quarantine for 21 days. It's the equivalent of building fire lines around a big fire. And this is much more difficult in tightly knit, isolated communities. As we've seen, public health also needs to mount vaccination campaigns which remove the fuel from the fire. But anti-vaccine rhetoric has made this all the more difficult. But we have to realize that most state public health departments are firefighters, are stretched very, very thin, limiting their ability to contain measles. $11 billion was taken away from state, public health and local public health agencies early in this administration, and that has had a major impact on their ability to respond. Quarantine is one of the most effective tools we have to contain measles. But the trauma of Covid, the backlash against restrictive measures has likely made it more difficult to use quarantine effectively and to contain measles. So I'm afraid that until we can restore faith in vaccines and restore funding for our public health agencies and increase measles vaccine coverage, we have to anticipate that there will be many more outbreaks, and some of these may blow up into very large conflagrations. We can do something to stop this, but the time to start is now. Thank you very much.

Jeanne Marrazzo: [00:17:03] Thanks so much, Doctor Pavia, for that very sobering and informed overview. Just a couple of remarks from me before we turn to the Q&A. As both speakers have emphasized, this current measles outbreak could have been prevented. Measles was eliminated in the United States in 2000 due to widespread use of a tested, safe and proven vaccine. And as infectious disease experts, a large part of our work is to prevent the spread of infectious diseases. We know that vaccines are effective at preventing measles, and it's really disheartening to see this principle undermined and the consequences. The rise of vaccine preventable diseases like measles and others kicks off a really dangerous domino effect or wildfire. If you want to use Dr. Pavia's metaphor and take it further, this is bigger than measles. It affects the entire health care and public health system. As you heard, it creates a lot of work for public health workers who already have very full plates and, as we heard, have been really lessened in their strength over the last several years. So it's a really big problem. Um, we are seeing consequences of measles that I certainly never saw as a, as a trainee and many of us thought we would never see in our lifetimes.

Jeanne Marrazzo: [00:18:24] It's a big problem also because we don't have enough infectious disease physicians or teams in the United States. We really do need people who have been able to control, see and manage these infectious diseases. On top of it all, of course, we've had the de-prioritization of science and vaccines at the federal level, and that's going to continue to limit not just how ID professionals handle this, but how our public health workforce, um, handles these kinds of things. So bottom line is that we as a professional society will continue to advocate for federal policies that support the ID workforce, restore research funding and invest in public health. And we need Congress to take action for the benefit of everyone in the United States. We're going to go ahead and move on to questions. As a reminder. To ask a question, please click the Raise My Hand button, or for those on the phone, select star nine and you'll be added to the queue. Our first question comes from Meg from Infectious Diseases special edition. Meg, please go ahead, unmute your line and ask your question.

Caller 1: [00:19:30] Hi. Thank you for calling on me. I have, uh, two, uh, general questions. One, maybe for Doctor Lynfield. You had mentioned that there's no antivirals for measles. And I'm just wondering, um, do you advocate for the development of them with the current situation? Um, is, uh, are there reasons why they haven't been in development before? And would patients who refuse to get vaccinated actually take the antivirals? And then my other question generally, which I don't know who this would be for, would be about our, uh, countries elimination status. Um, how does that get reviewed? And, um, is there a threshold that we're getting towards that we're going to hit? Is that like what, what should we be looking out for? Thank you.

Ruth Lynfield: [00:20:17] Thank you so much, Meg. Really appreciate the questions. Very insightful, uh, because we had and have such an amazing vaccine. When you think about 97% effective after two doses and it's lifelong immunity, we haven't had the need to develop measles antivirals. It has not been a priority. I do think we need to invest in that now, unfortunately, uh, I think we need to be prepared to treat. Prevention is always, always so much better than having to treat. So it would never replace the vaccine. But we also have a lot more immunocompromised people now. There are a lot of medications, transplants, other reasons why people, uh, may not respond as well or may be at risk even if we do get our vaccination levels up. So I do think we need to invest in that. You had asked, would people take antivirals. If your infant is on a vent, you are going to want to do everything you can to help your infant. And then you also had asked, uh, about elimination status. So elimination is a very complicated area. And CDC has been working on trying to do whole genome sequencing and epidemiological tracing to understand the cases that have occurred over the past year.

Ruth Lynfield: [00:22:10] In order for the US to maintain elimination status, you can't have one large ongoing outbreak. And so it is really important to be able to understand, is it the same strain of virus that has been circulating in the multiple outbreaks that have occurred throughout the US? And that information is being compiled. It is going to be reviewed this fall and we will know more this fall. But I will tell you, we have a lot of cases. And no matter what, this is different than what we have been seeing prior to 2025. And when we look at our immunization rates, they are too low. In order to be sure that you can protect a community, you need to have immunization rates of about 95%, in order to stop measles in its tracks. We are nowhere near that in many of our communities, and it is devastating to families and to communities. We have an amazing tool, and I hope we use this moment to go out and ensure that our children, as well as others who hadn't gotten the vaccine, go out, get the vaccine, are protected. They need their parachute. Thank you.

Jeanne Marrazzo: [00:23:58] Thanks, Doctor Lynfield. We have a whole bunch of people lining up. Doctor Pavia, did you want to add something quickly?

Andrew Pavia: [00:24:05] I was just going to add that we've done some sequencing work using specimens from Texas, Utah, Arizona and while we haven't seen the full CDC report, I strongly believe that we will lose elimination status based on the chains of transmission. But if you can hear thunder and see lightning, 4000 cases in 18 months means we've lost elimination status.

Jeanne Marrazzo: [00:24:30] Yeah, I think I think we can all agree on that. Um, just going to be a matter of the official Sad certification. Um, which is really unfortunate. Um, let's go to Erin from Science News. Erin, go ahead.

Caller 2: [00:24:44] Hi. Thanks for taking my question. Um, Doctor Lynfield, you mentioned that, you know, obviously with the effectiveness of the vaccine, like there hasn't been a lot of antiviral research, but I was curious if you knew of any like efforts in that particular direction that have like started to come up or whether you any thoughts on like what an antiviral might look like? I don't know if we're starting from zero at this point, or whether there's some prior research that we can pull from in that effort. Thank you.

Jeanne Marrazzo: [00:25:17] Uh. You're muted. There you go.

Ruth Lynfield: [00:25:22] Thank you. Andy, it looked like you were interested in commenting.

Andrew Pavia: [00:25:28] Yeah. So, you know, I've worked on antiviral drugs for a long time, as has Doctor Marrazzo. Uh, there are two drugs in development that are antivirals, one of which has had pretty good success in animal trials but is not yet in humans. The other is a little farther behind. Um, and then there are some very exciting new technologies to bring very effective monoclonal antibodies forward. That would be, uh, replacement for, uh, for IVIG or immunoglobulin as a treatment. But we have to remember that there isn't a huge market for these drugs. That's why they haven't been developed. It's not because there aren't thousands of children who die of measles every year. It's because there isn't a market incentive for companies to spend the billions of dollars to bring these drugs to market.

Jeanne Marrazzo: [00:26:20] Yeah. Thank you. And I just also remind people, antivirals are are hard, right? We don't have a lot of viruses that we have very effective antiviral agents for. So when you have a vaccine that's effective, you really want to sort of go down that road for sure. Uh, next is Sophie from Politico. Sophie, are you on? Great.

Caller 3: [00:26:43] Hi. Thank you guys for doing this. Can you hear me?

Jeanne Marrazzo: [00:26:46] Yes.

Caller 3: [00:26:46] Yes. Okay. Um, I just wanted to ask, um, with the World Cup coming up, how big of a concern is measles? And what are some of the things that you're hoping to see from state health departments? Um, from, you know, local health departments to prepare for that?

Jeanne Marrazzo: [00:27:05] Would either of you want to want to comment on that? I can, I can, uh, You can go ahead, Andy. Please.

Andrew Pavia: [00:27:11] Um, well, it's sort of a public health question, and I'm peripherally involved in public health. It's more central to that.

Jeanne Marrazzo: [00:27:17] Go ahead Ruth.

Ruth Lynfield: [00:27:18] I'm happy to come in on that. Yes. Public health, uh, staff are very concerned about measles and the World Cup and travelers measles not only circulating in North America, but is circulating widely in many parts of the world. And we are very concerned. We're all preparing, uh, we everyone has their toolkits laid out. Uh, we are watching for measles as well as other communicable diseases, but it will be a lot of work. And it is expensive. It's very. Doctor Pavia spoke a little bit about the efforts that go into tracking down cases, then tracking down their contacts and sorting out are they protected? Are they immune? If they're not protected? Really figuring out where people have been a challenge with measles is that you are contagious four days before the rash appears, and people may not even know they're contagious. So yes, it's a lot of work. I had mentioned it's expensive, and a recent study estimated that it costs about $245,000 on average, to investigate an outbreak with an additional $16,000 per case. So that gives you a sense of when you have hundreds of cases. What a challenge that can be.

Jeanne Marrazzo: [00:29:10] Thank you very much Doctor Lynfield. I also want to mention that next week we are doing a briefing on June 11th about preparation for the World Cup. And we'll be joined by some folks who are really involved, including Rebecca Katz from the Georgetown Center for Global Health Security. Um, all right. We're going to go to Tina from Science News. Tina. Do we have you here? Maybe not. Okay, um, we'll come back to you if you either want to put your question in the chat or raise your hand again. Um, Jennifer from Medpage today. Great. Go ahead. Jennifer.

Caller 4: [00:29:49] Hi. Good morning. Thanks so much for having this briefing. Um, one thing that we have heard about, um, as we watch outbreaks in a number of states are breakthrough infections, particularly among physicians and other health care professionals who are vaccinated. And I just wanted to ask, you know, how big of a concern is it that we might see more breakthrough cases, you know, amid large scale outbreaks, you know, even amongst the general public and what would be sort of the most important public health messaging around those types of breakthrough infections?

Andrew Pavia: [00:30:23] Yeah. Thanks, Jennifer. I'll take that. That's a great question. Breakthrough infections are rare because most health care workers are vaccinated. But with now 4000 cases of measles over the course of the last two years and thousands upon thousands of health care workers being exposed, even with that low rate of breakthrough, you're going to have some breakthrough infections. Um, the good news is that breakthrough infections are usually much milder. People shed less virus. They're less contagious. The difficult part is that these are people who are on the front lines. And so even though they're not very contagious, they might spread the virus. And if you have a breakthrough infection that's milder, you may not have that very typical measles progression. So it's harder to recognize. But we have a way around that and that is that we use personal protective equipment, PPE, when caring for known or suspected measles cases. And that can prevent the risk to health care workers. The problem, of course, is that particularly during cold and flu season, you don't know which cough with high fever is influenza and which one is measles. So you have to protect yourself against everyone.

Jeanne Marrazzo: [00:31:38] Thank you very much, Doctor Pavia. Um, I think we're going to go to Martha from Cure right now. Go ahead Martha.

Caller 5: [00:31:47] Hi. Thanks for taking my question. I have a question for Doctor Pavia. I was wondering if you could talk a little bit more specifically about Utah. You mentioned that, you know, cases look like they're beginning to slow, but I guess what are you going to be watching closely as we move forward. Is there anything that you're concerned about moving forward in Utah? Like if we're going to be seeing reoccurring measles cases or outbreaks, just what are you what's on your mind?

Andrew Pavia: [00:32:09] Well, every time we get together with our colleagues across the state and in the state health department, we say this isn't over yet because we still have pockets of very low immunization. And any place, you know, whether it's Utah or a state that hasn't yet experienced bad measles, that you have these pockets of low immunization rates, you're at risk. So we're watching what happens during the summer holidays, watching for large gatherings as occur around the 4th of July or Utah State holiday on the 24th of July. And then, of course, even if things die down, it only takes introduction to one of the schools that has very high exemption rate in the fall for us to see an outbreak again. So we are going to stay on high alert, although hopefully we're going to get a break here for a couple of months.

Jeanne Marrazzo: [00:33:00] Thanks, Andy. Um, let's go to Alicia from Medscape.

Caller 6: [00:33:06] Yes. Hi. Thank you for doing this and for taking my question. Um, we've heard pretty much almost nothing from CDC about, um, all of these measles cases. And I'm wondering if any of you can tell me what might be happening behind the scenes. Is CDC still making, uh, staff available to help with state health departments? And where clinicians turning to for support and help if, uh, CDC isn't really doing COCA calls or anything out in front on this.

Andrew Pavia: [00:33:47] We can probably all say something about that. You know, in past outbreaks, whether it was measles or anything else, CDC has been at the forefront of keeping clinicians and public health informed, and they've held weekly briefings, they've done COCA calls, they've had more to report on breakdowns of specific outbreaks. And we've seen very little of that. And we know that our colleagues are working really hard on collecting measles data, on helping out and outbreaks in analyzing the data, but it appears that they're not being allowed to communicate. They're not being allowed to publish MMW articles or to have frequent briefings. Um, but, you know, we do know that the experts are still there, although they've been reduced in force and they're still working really hard and would be a great resource if only they were unmuzzled.

Ruth Lynfield: [00:34:40] I would add they are helping, uh, state health departments, local health departments. They have sent people out there to help. They provide technical assistance. So as Doctor Pavia says, the experts are still there and they are still working hard.

Jeanne Marrazzo: [00:35:03] Yeah, thank you both. I think it's incredibly important to recognize that. I do know that several people who are still working at at CDC are really, really facing some significant challenges, both in terms of the workforce depletion as well as the inability to be quite as up front and out front as they traditionally have been. You may have seen recently that the epidemic curve report of the hantavirus outbreak was actually published in the New England Journal of Medicine instead of the CDC MMWR, which, you know, hard to say whether CDC would have been in the lead and done that. But certainly in the old days, there would have been a lot more involvement from CDC folks. Just to comment on your question about who's standing up in the absence of CDC, this is where professional societies have really had to shine and step in. We have never, I don't think, as far as I know, um, taken quite such an aggressive stance in terms of countering misinformation, getting information out there in the form of press briefings, doing the equivalent of COCA calls. We're doing one later this week, uh, on actually tomorrow on managing, um, emerging infections of concern like Ebola virus and hantavirus. So I think people are stepping up, but it's taking a lot of extra coordination time and work that we're really having to, to duplicate systems that have done this very well in the past. Um, one of the things we'll talk about on our, on our, excuse me, on our call about the World Cup is how other entities have essentially including health departments are setting up surveillance systems to make sure we don't miss an emerging problem, uh, coming from the influx of, of people getting together for the World Cup. Andy, go ahead. Sorry.

Andrew Pavia: [00:36:52] I was just going to say you've heard from. I'd say you've heard from the American Academy of Pediatrics. I wanted to call out our colleagues in the American College of Obstetrics and Gynecology, who've also worked very hard to inform their providers about the risks to pregnant women and their babies.

Jeanne Marrazzo: [00:37:07] Thank you. Appreciate that. Um, I think our last question is from Joe, who is with the Central Florida Public Media. Joe. Go ahead.

Caller 7: [00:37:17] Yes. Hello. Uh, again, uh, thank you all so much for doing this. I had a question about, uh, the role of public health, uh, when it comes to these kinds of outbreaks. Um, when, when an outbreak is reported in an area and an epidemiological investigation is beginning, uh, our local departments of health, uh, required or obligated to notify the public that an outbreak has been spotted or are they obligated to notify healthcare providers in an area.

Jeanne Marrazzo: [00:37:54] I think Doctor Lynfield is best positioned to answer that.

Ruth Lynfield: [00:37:57] You know it's it's general good practice. This is what we do. When we see something of concern, we meaning public health, we notify health care providers. And certainly when there's something as contagious as measles that is circulating in our communities, we notify the public as well. Different state and local public health departments have different ways of doing this. I will say, for example, in Minnesota, I have a monthly call with all the infectious disease providers in the state. So we are continuously in conversation. People are always emailing me or calling me. If we have a case of measles, you do a press release. People are um, have different mechanisms of reaching out. But certainly this is a very important piece of what public health does. Now, having said that, loss of resources means loss of expertise and that many state and local health departments, that expertise is gone. And so it it may take a bit longer. Uh, it may be a little harder to reach the networks that you may have reached in the past. And so it, it really is crucial to maintain a strong public health infrastructure. It is an important piece of keeping our communities healthy.

Andrew Pavia: [00:39:37] I'll just add that if you've been to one state health department into one state health department, some are decentralized, so the local health departments call the shots about how to get information out. Others are centralized, uh, like Minnesota. And so you may see variation in the response, uh, depending on resources, politics, capacity. But here in Utah, we meet every two weeks with a huddle between the infectious disease docs and the people in the state health department covering a wide variety of issues, not just measles. It can be Ebola, hantavirus, Covid, influenza, uh, multi-drug resistant organisms. So those channels of communication are vital to us as clinicians and academic docs.

Jeanne Marrazzo: [00:40:25] Yeah. Thanks to you both. And it's a great reminder that not all public health departments, state health departments function the same way or have as seamless, um, a conversation and communication between the specialist clinicians and the people who are actually looking at the outbreak from an epidemiologic and control standpoint. So you're both in excellent places in terms of the capacity to do that. Um, so I'm going to wrap this up. I'll just remind people that this is um, clearly a global problem. You may have seen this week. There have been many, many cases, over 62,000 cases of measles in Bangladesh with over 500 children dying, um, all because of a lapse in vaccination, largely around the pandemic. But that's persisted. So this really highlights the fact that this again, is a preventable disease. These deaths are needless. They did not need to occur. And we really need to work hard to earn people's trust and make sure that we counter misinformation about the safety and efficacy of vaccines. Um, so I'm going to thank you very much for showing up this morning. If you'd like more information on the Infectious Diseases Society of America, please visit us at idsociety.org. Thanks to Doctors Pavia and Lynfield. And thank you for joining us.