IDSA Media Briefing: Measles, Flu & Vaccines: Staying Healthy in School

Jeanne Marrazzo: [00:00:00] Good morning everyone. Thanks so much for joining us for this morning's briefing. I'm Jeanne Marrazzo. I'm the chief executive officer of the Infectious Diseases Society of America. And IDSA represents more than 13,000 physicians, scientists and public health experts whose focus is the prevention, treatment and cure of infectious diseases. As you know, this morning's briefing is about current infectious disease concerns. As children and young adults head back to school and college and how to protect them. It's been a very notably exciting week with the release of the president's executive order on vaccines, which has further muddied the water for many parents who are trying to do their best to understand what evidence-based recommendations they really should be looking to. So that's what we're going to talk about today. And we have two really fantastic experts to, to join us. The first one that we're going to hear with from is Dr. Julia Rosebush. Doctor Rosebush is an associate professor in the Department of Pediatrics at the University of Chicago and a member of the HIV Medicine Association's board of directors. Next will be Doctor Preeti Malani. Doctor Malani is an adjunct clinical professor at the University of Michigan and an adult infectious disease physician at Michigan Medicine. She's also a fellow of IDSA and the former chief health officer of the University of Michigan. So following the remarks from both of our speakers, 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'm going to turn it over now to Doctor Rosebush.

Julia Rosebush: [00:01:48] Thank you, Doctor Marrazzo. And good morning everyone. As families across the country prepare for or are already finding themselves at the start of a new school year, There's one item on the checklist that deserves special attention and that is vaccination. And as a pediatric infectious diseases specialist, I really want to speak about why back to school immunizations matter more in 2026 than they have in decades. And what parents and caregivers can do right now to protect their children and their communities. So let's start with measles. The United States is experiencing its worst measles resurgence in more than three decades. As of mid-August, the CDC has confirmed over 2500 measles cases across 47 states and territories, with an additional case being reported yesterday in Atlanta, Georgia. We've already surpassed the total for all of 2025 in terms of measles cases, and roughly 9 in 10 of these cases were in people who were unvaccinated or whose vaccination status was unknown. We are at risk as a nation of losing our measles elimination status, a public health achievement that was built over a generation because of this preventable drop in vaccination coverage. What's more concerning is that the MMR vaccine coverage among kindergartners has fallen from over 95% just a few years ago to under 93% nationally. And while that may sound like a small shift, measles is one of the most contagious diseases we know. A single, unvaccinated child in a school full of unvaccinated classmates can start an outbreak that spreads to dozens of families within days.

Julia Rosebush: [00:03:40] The measles, mumps, rubella, or MMR vaccine, two doses typically given between 12 to 15 months of age and again at 4 to 6 years of age, is safe, effective and remains our single best tool to stop this outbreak. And I would argue that tetanus and pertussis deserve equal attention. Beginning in early childhood, at two months of age, we start to vaccinate against tetanus, diphtheria and pertussis, or as it's more well known, whooping cough. Pertussis can circulate quietly in schools or infect older adults whose immunity has waned and can be devastating for infants who are too young to be fully vaccinated themselves. Four cases of tetanus were reported in the United States in 2024, one in Idaho, which was the first case reported in that state in nearly 30 years. None of these children, excuse me, had completed their tetanus vaccine series and all suffered severe complications. Vaccination against pertussis and tetanus is safe and highly effective at preventing disease, and many states require an updated booster for entry of middle school. And thus, this is a great time to review those records and determine whether it is needed. Lastly, I want to turn to something that we don't always connect with back to school, but is definitely something that we should consider, and that is HIV and sexually transmitted infection prevention for our teens.

Julia Rosebush: [00:05:14] Adolescence is when many young people become sexually active, and it's also when they have the least consistent access to confidential and judgment free health information. Every year, teenagers account for a significant share of new STI and HIV diagnoses in the US, and far too many of them don't know their status or realize that prevention exists beyond abstinence, condoms, regular screening and for those at higher risk HIV pre-exposure prophylaxis, or Prep, which is safe and effective for adolescents, though not uptaken as rapidly and as readily as an adult populations and as pediatricians, we have a responsibility to make routine, confidential conversations about sexual health a normal part of adolescent care. I encourage every parent or caregiver to ensure that their teen has a trusted clinician that they can talk to for the most reliable information. So as we send children back to the classroom this year, here is the bottom line. Routine vaccinations are proven to be safe and effective at preventing diseases with high rates of morbidity and mortality. Updating vaccines prior to the start of the school year is essential, so that children have the immunity that is necessary before they hit the books. And lastly, start the conversation about sexual health early and keep it open, ensuring that adolescents know their options for preventing HIV and sexually transmitted infections. Thank you.

Jeanne Marrazzo: [00:06:51] Thank you, Doctor Rosebush. That was a terrific compendium of a lot of concerns. I also think that statements such as you made about the fact that Idaho saw its first case of tetanus in 30 years, um, really speaks to the advances we've made with immunization that are now at threat. I'm going to turn it over to Doctor Malani to talk to us about college students specifically.

Preeti Malani: [00:07:16] Thank you, Doctor Marrazzo. So back to schools and hectic and exciting time certainly for K through 12 students and their families, but also for students continuing their education at colleges and universities. For many college age students, this is the first time they're in charge of their health. They're responsible for making appointments, filling prescriptions, making decisions about their health care since most are now adults. Broadly speaking, I like to think of the college years as a time when students can make that successful transition to independence in many aspects of their life adulting, so to speak, including health related issues. And for this age group, along with children, health care is largely focused on prevention and something that I often spoke about with my own children who are now full-fledged young adults, is make good decisions. Students entering college today were about 12 or 13 during the height of the pandemic, and they might have missed some of the recommended vaccines that they normally would have gotten at around that age entering middle school. So one very basic reminder is to check with your doctor or other health care provider to make sure that your student is caught up on all the routine vaccines, including MMR, hepatitis A, hepatitis B, chicken pox, etc. but there are several vaccines that are of particular importance for college and college presents sort of unique opportunities and unique challenges. The living quarters tend to be crowded. There's lots of close contact with numerous people in both academic and social settings.

Preeti Malani: [00:08:53] And this proximity is something that is very difficult in terms of infections and outbreaks. One of the vaccines that we already heard about today and is important for college students is Tdap, which protects against tetanus, diphtheria and pertussis, known as whooping cough. And, you know, certainly, uh, people can, can spread this to others, including people that are vulnerable. And, you know, if they miss that booster at age 11, normally given around age 11. Uh, this is an important time to, to make sure that this is updated. Uh, HPV vaccine is another one. And this protects against a virus that causes several types of cancer, including cervical cancer and throat cancer. And if the series was not started or completed, it's a good time to discuss this as well. One thing to note is that teens who start the vaccine at age 15 or older need three doses instead of two. So this is one of the vaccines that is, uh, The start time and the age at which it's given is important. And another thing to note is that this is also one of the vaccines that some teens start but they don't finish the series. Every college bound student should also be protected against meningococcal disease, and meningococcal infection is can be a very serious bacterial infection. It can cause meningitis, which is an infection of the brain and spinal cord.

Preeti Malani: [00:10:20] And thankfully, this is a relatively rare infection with a few hundred cases a year. And again, this is largely because of successful vaccination, but it's potentially deadly. And those who do survive are often left with permanent, very serious disability things like hearing loss, loss of limbs. The infection spreads through respiratory and throat secretions. So things like sharing drinks, kissing, even just living in close quarters in residence halls and other congregate settings can increase the risk of infection. So college students comprise a higher risk group, those living on campus. The current recommendations are for children to get the general meningitis vaccine, the meningitis A, C, W and Y vaccine at age 11 or 12 with a booster at 16. But there's another meningitis vaccine for meningitis B, it's a fifth strain that requires two doses six months apart. And this is one that's really important to think about really before starting college if possible. Um, and one thing to remember is that there's a couple different formulations, a couple different brands, and the doses are not interchangeable. Uh, seasonal vaccines are also important. A flu shot against influenza is recommended every year for anyone, everyone aged six months and older, including teens and young adults. And college is the kind of setting where flu can spread very quickly, and getting seriously ill in the middle of a semester Can set you back not just physically, but academically.

Preeti Malani: [00:11:55] The good thing is most colleges offer flu shots, often at no cost to students in in the fall. So this is something to think about and make a plan for. Um, we are seeing some increase in Covid 19 cases and it's important to stay current on the Covid 19 vaccine as well, especially if you have health conditions that put you at higher risk of severe infection. Now, we've talked about vaccines. I did want to mention another category of infection briefly, which is sexually transmitted infections like chlamydia, gonorrhea, syphilis as well as HIV. And just like with younger, uh, younger people, younger, uh, students, honest conversations between students and their health care team about sexual activity and ways to stay healthy are really important. Things like prep to prevent HIV, as well as doxypep to prevent certain types of sexually transmitted infection, and I just wanted to end my comments mentioning the importance of dedicated campus health resources. The health resources are going to vary on campus, but most larger schools have a full-service health center on campus. And these are places that are very student centered. They're designed to help students in all aspects of their life, not just infection prevention, but mental health injuries. And the goal is to help students thrive and help them get insurance if needed. And, uh, again, prevention, prevention, prevention. So back to school is a great time to think about these things.

Jeanne Marrazzo: [00:13:29] Thank you. Thank you so much. Um, Doctor Malani, that was a really terrific as well. Um, so as we can tell, and as we know, uh, both as parents and family members, school is a vital part of children and young adults development. And we learn that painfully, of course, during Covid when so many young people were unable to participate in the things that these environments offer. So it's really important that we do everything possible to reduce the interruptions to these events, education, sports that infectious diseases can cause. As both of our experts noted, vaccines are the best way to protect from many of the most common ID concerns. As I said in my opening remarks, however, changes in federal guidance, and especially the recent executive order have really muddied the waters, made it very difficult for people and families to find trustworthy information on vaccines. I want to emphasize that in the midst of this confusion, medical societies like the Infectious Diseases Society of America, the American Academy of Pediatrics, the American College of Physicians, the American Association of Family Practitioners, we all remain committed to reviewing the evidence base and to providing patients and physicians with evidence based recommendations.

Jeanne Marrazzo: [00:14:52] And as I said many times this week, we have your back and you can count on us. So you can always come to our websites or find out the information you need from us. We'll now move on to questions and, um, happy to take any questions from any of our reporters. Um, and as a reminder to ask a question, click the raise my hand button or for those on the phone, select star nine and you're going to be added to the queue. All right, so the first question, um, this morning is about the Covid vaccines, not surprisingly. Um, can we comment on what to expect this fall with both flu and Covid vaccines, given the situation with the stalled ACIP? And remember, the American College of Immunization Practices has not been convened recently. So we don't anticipate that they will be giving us guidance. But I'd love to hear from either Doctor Malani and or Doctor Rosebush about that recommendation. Preeti, did you want to give a start?

Preeti Malani: [00:16:05] Well, uh, you know, I'm just reflecting on, uh, the lack of sort of current guidance, and, uh, it's a little bit confusing, I think, for, for families and for, for young adults, you know, on, on what they need. And, um, I am expecting to get some more guidance from the societies that you mentioned. Uh, and I think that'll be, you know, it'll be coming out soon. But in the meantime, what I would say is that particularly if you have health conditions that put you at higher risk of severe disease, you know, this is an easy decision. It's a safe, effective vaccine. It doesn't prevent all infections, but it will help keep you out of the hospital. It will help prevent serious complications. That's the Covid vaccine. And, you know, with flu vaccine there, there's a there's a new vaccine that we're still waiting to hear, sort of this is the mRNA vaccine. And I know we just in preparing for this, we talked briefly about it. Those recommendations are are still forthcoming. Uh, but in the meantime, there are other flu vaccines that are already starting to become available. And generally speaking, that's given a little later than August. So a little later in the fall. And that's for everybody. And I encourage everybody to get it. And it's widely available.

Jeanne Marrazzo: [00:17:22] Yeah. If I could just piggyback onto that two quick things. Um, the Covid vaccine that's being recommended for this season, um, really hasn't changed much. It's a single lineage. It's the JN.1 lineage. It's the XFG variant. That is what is matching currently circulating strains, although we really don't have a ton of epidemiologic surveillance right now in what's going on with these strains, because a lot of that has been kind of rolled back or de-emphasized. That said, I fully agree with Doctor Malani that the people who really need the Covid vaccine are older adults, high risk individuals, anybody who has chronic underlying health conditions, diabetes, lung disease, heart disease, compromised immune systems, pregnancy, pregnancy is a really vulnerable time, as we all know, for infectious disease, uh, as infectious disease specialists. So I would really focus on those groups, those groups. And then for flu, everybody should get a flu vaccine. Just lots of data coming out about the protective benefits of flu. We are not going to be able to see this year, even if we could get it on an mRNA vaccine, Moderna, we're not going to be able to see the benefit of Moderna's, the mRNA platform, being able to specifically target the strains that are around, because obviously it's just coming out. We haven't had time. But next season, very hopefully we may have a flu vaccine that will be much more fine tuned to the circulating strains. So thanks for that question. Um, this is a great question. And I may ask Doctor Rosebush to kick this off, if you don't mind, because I suspect you deal with this a lot. What would the experts say? I think that means us to people who might be hesitant about getting vaccines, either for their children or themselves?

Julia Rosebush: [00:19:15] This is such a great question. Um, and I, I want to say that, you know, vaccine hesitancy, um, is, is certainly something that we as infectious diseases providers are encountering irrespective of age, right? Whether it's our children who we're seeing in clinic or as you said, you know, the, the parents or caregivers themselves. I think one of the best things that one can do as a provider, um, is not just start spewing forth scientific information, right? I think the most important thing is to really try to get at the basis or at the foundation of what is fueling the hesitancy. Um, I think it's really important, um, to try and ensure that we have an understanding of where the patient or guardian is coming from, because it's only then that we're going to be able to appropriately craft, uh, our recommendations and make sure that we are truly addressing the concerns. So I think at the, at the root of this is really trying to get to the bottom of what is fueling that hesitancy and then utilizing that to be our guide and understanding that this is not something, um, that you will necessarily be able to do in a single visit. Right. And that's, I think a unique piece of this is that this can be a conversation over time. And, um, if you're, you're able to, to meet with them on multiple occasions and try to develop a relationship that's built on trust and rapport. I think your, your likelihood of, of success and of, um, allowing them to understand what's behind vaccination and how safe it is that that will come to fruition. But that does take time. Oh, I think you're muted.

Preeti Malani: [00:21:09] Muted. [laughs]

Jeanne Marrazzo: [00:21:11] Rookie mistake. Uh, I think it's really important to note as you did, that we use this big bucket called vaccine hesitancy, but it is a multifactorial, multidimensional, uh, sort of matrix of, of why people are concerned and considering whether or not to proceed with vaccination. So really, really nice. Um, overview. So we have a couple of questions that we're going to take live. The first one is Mike from the Associated Press. Mike, please unmute your line to ask your question.

Caller #1: [00:21:44] Hi. Thank you for doing this call and for taking my question. Um, I was curious about HPV. Doctor Malani mentioned HPV, um, back when we had, uh, a different ACIP, um, during the Biden administration. Earlier times, they, the group had started to discuss HPV shots and the possibility that maybe one dose was sufficient. And we had that study last December that suggested that was the case, I think it was for girls, but we have not had an ACIP. We haven't had presentation of evidence. I don't know if it's a black box lately. Can you tell me what, uh, research has come out recently? And if families saw that study and they're wondering, hey, maybe one dose is sufficient. Do you have any guidance for them? What's the science saying right now? Thank you.

Preeti Malani: [00:22:32] Yeah. Thank you. Mike, this is a good question around the dosing of HPV. And I've actually got a couple experts on this call with me. But, um, and again, this is where we see the lack of having ACIP where they can really dig in to the evidence. You know, the quality of the studies and the location of the studies can, can differ. Uh, the place where I have heard about this is actually in a more global health setting. Um, and it's, you know, truly where it's resource limited and trying to get a single dose in someone. And again, like the multiple doses does give you added protection, uh, with a number of vaccines, including HPV. Um, and what I would say right now is, is to stick with the current recommendation. And if you can get that vaccine in earlier, you can do it in two doses. Um, but I'd love to hear from my colleagues who really work closely in this space.

Julia Rosebush: [00:23:36] I'm happy to speak to that just a little bit as well. So, um, I appreciate the question. And I had a feeling we'd be hearing about this. So I want to caution that the study that was published, um, referring or investigating the one dose as opposed to, to two, um, you know, only looked at a five year period. Um, and, you know, if we want to think about long term effectiveness, um, you know, we don't have data beyond a five year period. We also don't have data, uh, in its effectiveness around the prevention of HPV, but non-cervical cancers that are due to HPV. So I think that that's an important thing to bring up. So, you know, as Doctor Malani stated, um, the data remains to be seen. And at the current time, it is really appropriate to proceed with the current recommendation of the 2 or 3 doses, depending upon the age at which vaccination is complete. Um, so that's my, $0.02 on that.

Jeanne Marrazzo: [00:24:44] Thanks very much, Mike. That was an excellent question. And I would just really to pound it into the pavement. The really key thing is to get at least one dose before sexual debut, as we call it, in the field, before people start having sex and that sex of any kind, oral sex to other, other kinds of sex, because HPV is incredibly transmissible. And, uh, and, you know, I mean, you can transmit it from hands to hands, as we know, with warts. So very important to get it early and at least get one dose in. Uh, next is Aubrey from the Philadelphia Inquirer. Aubrey, please unmute your line to ask your question.

Caller #2: [00:25:26] Hello. Thanks for taking my question. Um, I have been working on, um, some data stories on, um, measles vaccination coverage in Pennsylvania. Um, the state has recently released, um, school level data for the most recent school year 2025-26, which is super helpful. Um, and what we're seeing, at least in the Philly region is that, um, counties overall have kind of, um, pretty decent MMR coverage. Everyone's sort of hovering around the 95% herd immunity rate. Um, but then when you look at individual schools and communities, um, places are really losing immunity. Schools that went in a year from 100% vaccination coverage for the kindergarteners to 80% vaccination coverage for the kindergarteners. Um, and this isn't like immediately apparent unless you kind of dig into the data. And I was wondering if you could talk a bit about like how public health workers can a. Like, sort of assess a situation like this where like, things seem covered, but might there might be these pockets of vulnerability and how do you target, um, you know, schools that, that are at much greater risk of a measles outbreak than the public might know, or public health workers might know. From just looking at kind of overall county level numbers, if that makes sense.

Jeanne Marrazzo: [00:26:51] Great question. Doctor Rosebush, you look like you're eager to take that.

Julia Rosebush: [00:26:56] I'm happy to do my best to to attempt that question. So, um, you know, when I think about risk, um, we know that risk is not created equal. And while I can't comment on which schools, um, were found to have dips in, in the immunization rates, I'm going to guess that social determinants of health, things like segregation, um, and um, you know, social constructs such as that are going to be playing a big role. And that's something that we, we see here in the city of Chicago, um, where in communities that are historically marginalized, Um, there's already a history of, of mistrust and distrust. And when we are hearing, um, the political rhetoric that is perhaps suggesting that vaccination is unsafe or linked to conditions like autism, um, these patients and these families, these communities may be disproportionately impacted in a negative way. Um, by not being able to or not being willing to, to be vaccinated. I think, um, in addition to that, some of these communities may face barriers to care, um, such as lack of transportation access. So, you know, what can be, um, what can be done? Um, I think this is really where we call upon community health workers, um, to have people going into schools to speaking with school officials. Um, this is something that we do readily at, at my institution is we really have an investment with the community and with the Department of Public Health and teaming up to be able to talk with the schools in this way would be incredibly effective.

Jeanne Marrazzo: [00:28:50] Thank you. Did you want to add something?

Preeti Malani: [00:28:52] Yeah, I just wanted to add to that, and I appreciated the comments of my colleague very much, is that I think it's easy to look at that 80% and assume it's just people who refuse to vaccinate. And to reiterate, there are a lot of barriers to getting vaccinated for certain individuals, and those barriers are not equal. So hopefully that those data are not just used to sort of point fingers, but to really bring resources in and bring in trusted voices, both from the community and from healthcare, and really to make it easy for families to, to choose vaccination.

Jeanne Marrazzo: [00:29:30] Thanks for that, Doctor Malani. And I think it's a great point to emphasize that playing the blame game for people, quote unquote, not getting vaccinated is not getting us anywhere. Um, we really need to continue to have open dialogue and cultivate spaces where people can ask their questions about vaccines and other health interventions and know whether they information they get, um, that can, should be able to help them make an informed decision. Um, I have one more question and then I think we can wrap it up because it's now 930 for both of you. Um, given the extraordinary burden of measles that we are seeing now across the country, new states every day increases in cases every week. How do you advise teenagers who are going to college, whether or not they need to get an MMR vaccine? What is the if they don't know if they've been vaccinated, is there any problem with getting another vaccine if they're not sure. Can you just outline your approach to that?

Preeti Malani: [00:30:34] Can I defer to Doctor Rosebush on that? Who's much closer- I will say you need to be immune when you come to college. Please, please be immune.

Jeanne Marrazzo: [00:30:43] And that's. Yeah.

Preeti Malani: [00:30:44] And, and I will say at the University of Michigan at my institution, um, the vaccination rates are very, very high, well above that 95%. Uh, but I'm curious to know since that discussion is really happening, you know. Yeah. Before they arrive.

Julia Rosebush: [00:31:00] Yeah. So I, I will say that typically repeating the vaccine at, at high school entry is, is, you know, not required, um, if there is documentation, but of course, as you know, we've already discussed, it's not always clear, um, that, you know, vaccination has happened and people don't have records. A lot of states have databases now, which makes this a bit easier. Um, but still, we do see our fair share of persons who may be coming into the state for the first time and don't have a copy of immunization records. I would say that there's no harm in giving a booster dose or a dose of vaccine. Some physicians may also opt to do a titer check, so to look for the antibodies to the measles virus that would be generated by administration of the vaccine. Certainly in areas where there may be an ongoing outbreak or, um, you know, there is concerns for a potential outbreak. I think that that's a really important time to consider another dose. But we really don't have at this point in time, um, you know, a strict recommendation or a scientifically backed, uh, recommendation for how to approach this. So, um, those are a few of the thoughts that I, that I have about that.

Jeanne Marrazzo: [00:32:21] Yeah. Thanks, Doctor Rosebush. And I should mention that in May, we, along with the National Foundation for Infectious Diseases and a few other organizations sponsored a measles summit, um, in San Diego where we talked about a lot of this. And that will generate probably some recommendations that we anticipate will come out in the coming months. The good thing about measles vaccination is if you've got it, you've got protection. If you've got two doses, you have protection for life. It's highly effective. And so really, I think the major indications for getting another dose are, if you don't know if you've been immunized, you think you might have only gotten one dose, or if you're really, you know, facing an outbreak situation and you really, again, do not know whether or not you're immune. So, um. Great. Thank you so much for those comments. Okay. Well, I think that's the last question we have time for this morning. Again, thank you both for being with us. Thank you for the reporters to the reporters who joined us. Um, for those of you who want more information on the Infectious Diseases Society of America, please visit us at idsociety.org. And again, thanks for joining us and we appreciate your time. Take care.

Julia Rosebush: [00:33:36] Thank you.