Recent outbreaks of measles in different areas of the United States are an alarming reminder that its threat is not gone. Luckily, confirmed cases have so far remained outside of Wisconsin’s border. This may give us a false sense of confirmation that we are doing something right, however it could instead be a warning sign that we may be getting complacent.
Data from the Wisconsin Immunization Registry shows a sharp decrease in measles vaccination rates among two-year olds from 88.16% (2013) to 81.58% (2023). A closer dive into the data reveals particular counties in the state showed sharper declines than others amongst this same pediatric population:
Although not all counties showed the same degree of decline, almost every single Wisconsin county showed decreasing measles vaccination rates including Milwaukee, Dane, and Eau Claire counties. Only four counties showed increases.
The Centers for Disease Control and Prevention (CDC) has provided a nice overview of current measles cases/outbreaks versus historical, as well as general measles information and the vaccine. They have established a 95% community vaccination rate to prevent outbreaks of measles. Based on most recently available data, children in Wisconsin have the second worst measles vaccination rate in the United States. Based on their data, approximately 84.8% of Wisconsin kindergartners were appropriately vaccinated for measles (two doses at this point) for the 2023-2024 school year. The only state to rank lower was Alaska. By using this link to see the Morbidity and Mortality Weekly Report (MMWR) article, you can see rates for other recommended vaccines as well, including diphtheria/tetanus/acellular pertussis, poliovirus, and varicella vaccines.
It is difficult to know the true reason for the declining vaccination rates seen. Public health officials in some cases cite an increase in waivers being requested to either delay or forego pediatric immunizations. Others have noted that they don’t feel a threat from such diseases given perceived low incidence rates. Vaccine hesitancy has also increased over time, particularly since the COVID-19 pandemic.
This information should be a reminder of the importance of spending the time during visits with our patients to discuss the importance of vaccinations in promoting health to one’s self, children, families, and the overall community. It is important to listen carefully (while avoiding judgement) to the concerns noted by patients, parents, and caregivers, and offer fact-based education in an easy to understand delivery. Including our clinic support staff in finding ways to best improve successful delivery of vaccines can be a very effective tool for you to use in your practice. If access is an issue, remember that public health offices and pharmacies are excellent alternatives for where vaccines can be given.
In a letter dated March 31, 2025, the United States Food and Drug Administration (FDA) alerted the Federation of State Medical Boards, National Association of Boards of Pharmacy and National Council of State Boards of Nursing to make them aware of the regulatory status of compounded retatrutide, as there are important consumer safety concerns with these products.
Retatrutide, the first of so-called “3G” drugs, is a triple agonist of glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and glucagon. It is currently in phase 2 and 3 clinical trials in the United States for a variety of medical indications, including obesity, diabetes, and osteoarthritis of the knee. Results to date are promising, but while retatrutide is commercially available in other countries, it is not yet FDA approved in the US. The latest predictions suggest that Retatrutide could be available in the US in 2026 or 2027.
Because retatrutide is not an FDA approved entity, it is not qualified for an exemption under sections 503A and 503B of the Food, Drug and Cosmetic Act allowing for compounding: for example, when approved, commercially-available products are unavailable in the drug marketplace or a medical need cannot be met with a commercially-available option. (As an aside, compounded GLP1 agonists currently available from online pharmacies have been granted temporary exemptions due to back order and supply chain challenges. However, most GLP1 shortages have been declared over, and these exemptions are now in dispute).
FDA has been made aware of companies illegally selling unapproved retatrutide-containing medications that are falsely labeled ‘for research purposes’ or ‘not for human consumption’ directly to human consumers for human use, including dosing instructions. These companies have since been formally warned by the FDA.
Meanwhile, consumers are advised to refrain from the use of these products. FDA cannot attest to the quality, purity, safety and efficacy of retatrutide as a chemical entity because clinical research is still ongoing, dosing has not yet been established, and trial data has not yet been submitted for formal review by the agency. Furthermore, compounded products are outside the purview of FDA, and therefore unregulated.
Instead, consumers are urged to continue to obtain FDA-approved products pursuant to prescriptions from their personal physicians and filled at state- licensed pharmacies in an effort to protect their safety and welfare.
Why? After crafting an “indications table” for the different GLP1-RA products last month, I noted it was also time to update approximate equivalent doses based on data and clinical experience with tirzepatide, which was new to the market the first time we created this chart.
Of note:
Clinical Pharmacy Practitioner in Primary Care
Mike Grunske, PharmD, BCPS
Mike Grunske is a Board-Certified Pharmacotherapy Specialist (BCPS). Mike transitioned his practice to the Clement Zablocki VA Medical Center where he has since practiced in the Primary Care Clinics as a Clinical Pharmacist Practioner. Within this role, his practice involves direct care and management of patients’ medication regimens. He has worked as an active preceptor for both pharmacy students and residents throughout his entire career. Mike is also Past-President and former Foundation Chair of the Pharmacy Society of Wisconsin (PSW).
Mike is married to a fellow PharmAid contributor (Vanessa Grunske). Together they have a teenage daughter and son. He enjoys traveling with his family, attending his kid’s cheer, baseball, and basketball events, and spending any available leftover time running and hunting.
Pharmacist at Advocate Aurora Health
Vanessa Grunske, PharmD, BCACP
Vanessa practices with Advocate Aurora Health in Milwaukee, where she sees patients at Aurora Sinai Medication Management Clinic and maintains a dispensing practice at St. Luke’s Medical Center. Board-certified in ambulatory care pharmacotherapy, her practice interests include diabetes, hypertension, smoking cessation, geriatrics, improving health literacy, and medication adherence. She particularly enjoys and spends a good share of her work hours teaching and mentoring pharmacy students, family medicine residents and pharmacy residents.
She and her husband, Mike, live in the Milwaukee area with their two teenage children. In her free time, she enjoys cooking, baking, visiting our national parks with her family or relaxing on a beautiful Caribbean beach.
Professor at Concordia University Wisconsin School of Pharmacy
Beth Buckley, PharmD, CDCES
Beth Buckley, PharmD, CDCES (Certified Diabetes Care and Education Specialist), is a Professor of Pharmacy Practice at the Concordia University Wisconsin School of Pharmacy, where she has a teaching role within all years of the curriculum with a focus on Applied Patient Care Skills Lab, Diabetes Pharmacotherapy, and electives in the areas of diabetes and wellness. Her current role is ambulatory care pharmacist where she works with a Collaborative Practice Agreement to provide chronic disease state management within a primary care clinic.
When not working, she enjoys reading, gardening, traveling with her husband, volunteering within the community, and active fun: hiking, biking, dog walking, practicing yoga, mindfulness, and living with intention and gratitude.
Disclaimer: The Wisconsin Academy of Family Physicians (WAFP) has entered into a business relationship with Pharm Aid to offer our members discounts and exclusive savings. This or other affinity program relationships presented by the WAFP in no way implies a WAFP endorsement of the program, supplier, or vendor.
