Understanding Measles – News Update, MMR Vaccine, and Medical History

Stay informed and protect your family from measles! In this episode of Your Checkup, we discuss the current measles outbreak, including the situation in Texas. Learn about measles symptoms, how it spreads, and the potential complications. We emphasize the critical role of the MMR vaccine in preventing measles and discuss the importance of maintaining high vaccination rates to protect our communities. Get the facts about measles and the MMR vaccine.

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[MUSIC]>> Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine resident in the Philadelphia area.>> And I'm Nicole Aruffo, I'm a nurse.>> And we are so excited you were able to join us here again today.>> We're not actually going to start recording the episode right now. What you're going to hear right now is my live reaction of the surprise meal that we had that Nikki made. Because if you listened to the last episode, there was a surprise that she dropped on me live. And she said, when we recorded that, probably like a Sunday, she said, this Thursday, I'm going to make you dinner. It's going to snow, it's going to be cozy, and it's going to be perfect. >> You act like I haven't made you dinner any other day of the week.>> No, that's not true, you have.>> Yeah, I had a very specific dinner in mind that I wanted to make because it was supposed to snow, although it snowed for like an hour. And I don't think it's going to snow anymore, but it's still really cold and we could still have like a cozy dinner.>> So there was an opportunity at some point during the week for me to help out and acquire the ingredients. And so this added to the little game here where I was like, oh, what is she making? And I'm a dunce and had no idea. I went to the store, I got the French baguette, I got the grier. I'm going to pause here and you sit at home and wonder, what did she make? Well, tonight, which will be a Thursday, I had the most delicious step-as-ides Steven star. Goodbye, the best French onion soup that you could possibly imagine. It was delicious. Every time I took a bite, you know, you were a little like hesitation, you were like, is it good? Is it good?>> Well, I've never made it before. This is my first time.>> Knocked it out of the park. I couldn't, I can't even fathom how you come up with this to make these delicious meals out of nowhere. Thin air. And we've gone on here multiple times and like this podcast is half medicine, half food. And oh my God, the way that that was so you chopped up with the little bits of the French baguette. You took the grier, you shaved it, put it on top, put it in the broiler, bought separate bowls for the French oven soup.>> Yeah, we needed the soup. >> The soup crocs, we don't have any of them. Well, now we do. Oh my God. I'm not exaggerating here because I had to after finishing the meal, like, belliest full, I had to get over here. And because it wouldn't have done justice if I left this say like, marinate for a day, two or three. I needed you all to know that I am the luckiest guy ever.>> There's been a lot of yelling tonight, which means he really liked it.>> Oh my God. Well, I'm glad you liked it. And I'm glad that now we can use our soup crocs more because I can make it again. >> Yeah, I mean the magic question was like, oh, like, oh, should I make this again? I was like, make it tomorrow. Oh my gosh. >> Well, I use all of our onions, so I can't do that.>> Wow. Simple thing. A couple of my friends at work actually guessed it in three seconds when I told them the two of them. >> Yeah, because they don't have a wide chromosome.>> I was like, oh yeah, it's a French baguette for a year. I'm like, oh yeah, you're having French on in the soup tonight. I was like, what? I was stuck on quiche Lorraine. Yeah. No. And then I passed it along to them. And then we told Ali that it could possibly not in no way shape or form, as good as his meal. >> No. Our dinners are never as good as his. Then we tell him that.>> Yeah. Well, some people took, took exceptions to that when I, you know, made them aware, but insinuating that we lied to our child. And yeah, shamelessly, we do. I don't want him to feel left out. He gets the good tea words, though, and everyone's in a while when there's a food that's okay for him. >> He does. >> He does. Maybe that's why he goes after the street snacks. That's a whole different conversation. >> Oh my god. >> All right. Well, here we go. Here we go. >> So, what are we going to talk about today, Nick?>> Today, we're talking about a hot topic and also a little bit of a history lesson. We're talking about measles. >> Yeah. Shouldn't be something that we have to talk about, but here we are. Because the latest thing in the news is that there is a measles outbreak. And this information is as up to date as hour recording on February 23rd at around 5 p.m. February 23rd, 2025, around 5 p.m. At this time, there are about 90 measles cases and rising in Texas. We're going to talk about more, but because this is happening, we felt it important to share with you all that we came to learn about measles because people have stopped thinking about measles for a while because at one point, it wasn't a problem. We're going to talk all about that today. >> Yeah.>> But let's get started. And without further ado, we'll do the news break. But let's get started. What is measles? Nick, this was your episode idea. Why don't you take it away?>> Oh my gosh. >> Measles is a very highly contagious disease that is caused by a virus. It is actually one of the most contagious diseases. So contagious that if one person has it, about 90% of the people who are close to that person who are not immune to it will become infected. And then infected people can spread measles to others from about four days. So you got a rash with measles so you can spread it about four days before through four days after you have that rash, which is kind of a long time. >> It's a long time and that is a ridiculous figure. I think we're going to dive in a little bit more later about some other like how it spreads. But that's crazy. That's nine out of ten people who likely are unvaccinated at the time. This is the natural course of the disease. But holy crap. So tell us about the symptoms of measles. What generally happens and what sets it apart from other viruses?>> So we have the classic fever and cold like symptoms. Also might see a loss of appetite, probably because you get these spots and like sores in your mouth. Cloth one sore through red-running eyes and your eyes can be sensitive to light. And then the trademark of measles is the red rash that will start on your face and then spread through the rest of your body. >> The rash and the red eyes are really and the complex spots is what they're called the white spots on them inside of the mouth are the big things that set this apart from other viruses. Let's talk about this is one of the reasons why measles is so important. We've talked about other viruses on the show and we've been kind of blase. We're like, yeah, common cold, whatever, blah blah blah. Everyone gets sick. But one of the key pieces about measles is how quickly it spreads. You mentioned not too long ago that if someone's in contact with someone in measles and they're not vaccinated, nine out of ten people in that room could get measles. How is it transmitted? >> So it's spread through airborne transmission which essentially means it stays in the air longer than just like, for instance, a cold or a flu or the COVID, the COVID. That spreads by droplet transmission. So the droplets of a sneeze or a cough have to come in contact with you essentially. Whereas airborne transmission is in the air and it stays in the air specifically with measles. It can stay in the air for two hours after an infected person leaves that space. >> Crazy. >> Yeah, it's crazy. Like tuberculosis is a scary one and that's also airborne. So it's spreading just like these other crazy awful things that you don't want. I think also just to reiterate, like, okay, for example, I have measles. I go into a room. I'm breathing in the air. I leave. And hour later, someone who's not immune to measles can come in and just like be in that air and like breathing in those airborne particles and then you're now infected.>> Right. So that's like a real life system. >> So that is, yeah, you don't need someone to sneeze in your face or cough on you to get measles. All you have to do is breathe the same air that they are.>> Yeah. So this is like any immune compromised individual. You can probably look at your TV tonight after you listen to this episode and see if you really paid attention, you could probably come up with like five to ten drugs that are on there that in some way shape reform make you immune compromised. That's one. And two, infants born less than 12 months old. We're going to talk about when infants get the vaccine, but those who don't have the vaccine are extremely susceptible to this. And we're going to, in just a moment here, we're going to take our bridge into another reason why measles is so bad. But I love that real life example that like you, like, if you have it, you really need to be careful. >> Yeah. >> Because this is no joke. I mean, they were at like a couple cases and it took like a matter of days to get up to 90 in Texas. And like former FDA leadership is like very concerned that this is going to take months to calm down because they spiked it. Like who knows what the news is going to break Monday when this comes out. We had 93 was at in Texas was the closest information. But to speak more on that, so there is this measles outbreak that is currently happening as of February 23rd when looking up this information. There were 93 measles cases reported in eight different jurisdictions. This included Alaska, California, Georgia, New Jersey, New Mexico, New York City, Rhode Island, and most Texas. There are three outbreaks have been reported in 2025 so far. And outbreak is defined as three or more related cases. 92% of the cases are associated with outbreaks right now. And so for really minute to minute information, there we have the Texas Department of Health and New Mexico Department of Health because these are the places where these are the places that are experiencing the measles outbreak the most right now is where it's the most active in our country. Should we talk about some complications of measles? Yeah, this is part of the like the media's part of the episode about why measles is so important. We spend some time talking about why it's so transmittable, why it's so contagious. But the real meat of it is that approximately 30% of measles cases result in one or more complications. So something else that happens like aside from just those symptoms that you beautifully described earlier most deaths are due to respiratory tract complications or encephalitis. What the heck is encephalitis? It is quite literally inflammation in the brain. That's bad. What a terrifying thing. You probably you might not have even heard of this until this episode here. Diarrhea is probably the most common complication and otitis media which is an inner ear infection occurs in 5 to 10% of cases and a number of those result in permanent hearing loss. Another type of complication that happens is immune suppression and what we call secondary infections. A secondary infection is an infection that happens after the viral infection. So the measles infection the measles virus can lead to immune suppression. I get literally they took in studies they've looked at the blood of people who've had measles and the immune cells were less in number after the measles infection. And so some of these secondary infections can include bacteremia or literally bacteria in your blood. Nomonia, a lung infection, gastroenteritis, puke vomit, puke vomit, we've talked about that on like the norovirus episode and otitis media that inner ear infection. And there's some evidence out there that says measles associated immune debt defects may account for increased mortality for up to three years following infection. You can tell if there's a lot of impassioned conversation behind this because we're going to get to why this shouldn't be happening period. So to speak on gastrointestinal complications, we mentioned that diarrhea happens most commonly. This happens in about eight percent of cases, eight out of a hundred. So we have about 93, probably about seven of them have diarrhea as well. Other GI specific complications are like inflamed gums, inflamed liver, inflamed lymph nodes in the gastric system and appendicitis. And as we mentioned earlier, pneumonia is the most common cause of measles associated death in children. Respiratory tract infections occur most frequently among patients who are less than five years old and greater than 20 years of age. And these include these types of pulmonary complications aren't just limited to pneumonia, but they can include broncho pneumonia, loringo, tracheolitis or group and bronchiolitis, which we've talked about in other episodes. These next complications, I know we talked about pneumonia being terrifying because it causes death, but neurologic complications are insidious or obvious and we'll explain why next here. So we talked about encephalitis and that is it would be a more evident inflammation of the brain. It would result in different neurologic dysfunction, behavior changes, headache, irritability, but that happens in about one in a thousand measles cases. So take it what you will. There is another brand, a cousin of a neurologic deficit called acute disseminated encephalomyelitis. That is happens in about one in a thousand measles cases and then this one, which we like learn in med school because it's so terrifying, is subacute sclerosing panencephalitis. And we talked about these neurologic symptoms happening in and around the time of getting a measles infection. The scary thing about this is this can occur seven to ten years after natural measles infection. So far after. And it's fatal if you didn't catch onto that. Yes. This happens less frequently than one in a thousand. I think when you get to that level of like one in however many it can get a little hairy. So it's rather rare, but it has been described and associated with natural measles infections. And so there's a lot of complications there essentially to say that none of this stuff should be happening. Yeah. Why shouldn't it be happening, Eddie? Let's see. It shouldn't be happening because measles was eliminated from the United States. In fact, it was declared eliminated in 2000. If I'm at this right, that is 25 years ago. Elimination is defined as the absence of endemic measles transmission in a region for greater than 12 months in the presence of a well performing surveillance system. Why did this happen? A lot of reasons. We're going to talk about the measles vaccine very soon. But it turns out there is increasing global measles activity. The world has become a much more global community with travel. And so measles travels as well. I mean, we literally talked about it can live in like the air for two hours after someone's there. And probably most importantly, the declining vaccination rates have led to reemergence of this virus. Yeah. And not to sound. I actually was not to sound like back in my day, like this didn't happen, but quite literally back in our day when we were school age children, this wasn't a thing. And that was only 20, 25 years ago. Yeah. Tell us a little bit more about this vaccine against measles because it's a part of the routine pediatric schedule. But what can you tell us? Well, the measles vaccine is in the MMR vaccine. It's like what you'll hear when you're at the pediatrician. And so you get it in two doses. The first one is between 12 to 15 months. And then the second is a couple years later, around like four to six years old. Doing two doses is 97% effective. And the one dose is 93% effective. So even that's still a lot. 97% effective at preventing measles. If you just participate in the routine recommended pediatric schedule for vaccinations, the concept of immunity doesn't just extend for someone's individual immune system. If we are to get back to a place where measles has been eliminated, and the reason that that was able to happen is the concept of herd immunity. That concept is one the paraphrase is that there are so many people who are immune to a certain virus. This commonly came up in the COVID conversations. If so many people are immune from either natural infection or vaccination whole point, there is no place for the virus to go to be contagious. And so to hit thresholds of herd immunity, we need very high vaccination rates, like higher than 85. I think 95% is really the threshold. And in certain geographies in our country, the MMR coverage of the MMR vaccine is below that 95% target of herd immunity. And so that's how situations like this can arise. Because we need 95 out of 100 children to have this MMR vaccine, both doses to be able to say this won't go everywhere. But we're not there right now. We're not there because probably deserves a whole episode on why people don't get vaccinated. When it comes to the MMR vaccine, we talked about this last week. There was a false study that came out that used fraudulent data. Yeah, the fact that this is still even a thing is like actually infuriating. And it used fraudulent data. And it posed that the MMR vaccine causes autism. And so vaccination rates dropped dramatically after that study came out. It was later investigated with something like 18 and counting extremely high quality studies. That refuted that point over and over and over again time six, 18 times. They all looked at it against that one study, which they found uses falsified data and pulled to be retracted. But once that got out there, the misinformation monster, like of the century, probably I would say. Yeah. And now we're seeing it right before our eyes play out in the national media. And so the reason one of the highest reasons that we talk about every day is at least at work. Well, I was just going to say that the timing of the MMR vaccine and the like timing of when a child will start to kind of regress and show more symptoms of autism are basically the same. Like that first dose of the MMR vaccine around 12 to 15 months is kind of like that prime age of when you might notice a regression or showing some signs of autism. But the two are not linked. We will sit here until we're blue in the face. It's been proven like you said over and over and over and over and over again. And that is the two are just not related. I'm looking at you RFK. Yeah, it's just another misinformation thing. And all right, I don't know if you're going to cut this because this might be too harsh. Go ahead. But like this is also probably just like the pediatric nurse in me, but you know, with this vaccine, with all the vaccines and people not trusting them, you know, whatever. At the end of the day, do whatever you want for like your family and your kid. My kids are going to be protected. So like I won't have to worry about this. But you know, you don't trust doctors. You don't trust science. The science that took years to, you know, come to fruition and make all these bad things stop. You don't trust that. But then suddenly your kid has measles. You're in the hospital with them. And that's the time that you decide to trust the same doctors in the same science when you're in crisis mode to now save your kid's life. When let's go back into a full circle, the thing that would have saved your kid's life is getting the vaccine in the first place. Like you can't, I actually remember having kind of like a thought with a mom one time. She was, you know, very down into the vaccines, yada yada yada. And then because her thing was like big pharma. She didn't like big pharma, you know, whatever. It's your right to not like them. But then had this whole conversation with the team during rounds. Because her like, it was like an infant. They were there for a while. We're like, all right, it's like time for whatever vaccines. And had a whole discussion. She didn't want to do it. And then like 20 minutes later after rounds, she came up to me and she asked me where our outpatient pharma seal is because she had to go get her capra, which is a seizure medicine. Like, you know, very popular made by big pharma. So then in my head, I'm thinking like you just went on this whole diet tried that you don't trust big pharma. But you're trusting big pharma with your seizure medicine that's keeping you alive. Yeah. It's just there's definitely a full age reasoning and breakdown in the logic. Yep. I think one other piece that I commonly hear is a autonomy and like ability to make a decision for your own body that people don't like being told what to do. Yeah. And like they hear that like something's over choir man and no one wants to be required to do anything. Yeah. And if we didn't say it out loud, the measles vaccine is safe and effective at preventing measles. And like, okay, so a lot of people listening to this who maybe they have young children, they're probably like our age, maybe a little older. And the reason that when you were in school, measles wasn't a thing is because your parents got you vaccinated. Yeah. That's why like you never got measles and you never, you know, you never got any of the things that were vaccinating against. Yeah. So just, you know, some food for thought. And if you've made it this far through the episode, we'll talk a little bit about some practical tips how to handle it. If God forbid, you or a loved one or a neighbor get measles. So if you suspect measles, call your doctor or nurse, especially if your child has a fever and a rash, don't go to the doctor's office without calling first. That's a big one. And then in another sense, if you're wondering, like if you don't have vaccine records, I've seen this come up a couple times. What you are able to do is you can request lab drawn that will look at something called titers. Titers are the levels of antibody that are present in the blood. And they can look at antibodies specific for different things. So there's an antibody for measles, mumps and rubella. And there's a lab that can be drawn. So if you're curious, you weren't sure if you were vaccinated, you can do that. And there's an associated catch-up schedule that is very commonly used. The CDC has it published online that you can use if you don't have the MMR vaccine and you would like to get it. And stop the madness. So in conclusion, we just want to reiterate that this is an incredibly important vaccination that all of this could have been prevented. And here we are. Miesels has its complications and it is incredibly contagious. We I really encourage you to talk to your own doctor or your own nurse about the MMR vaccine if you're concerned about it. And most importantly, thank you for coming back to this week's episode of your checkup. Hopefully today you were able to learn something for yourself. I love one. Or a neighbor. Please check out our website. Send us some fan mail. You can send us an email if you would like. Messages forever. We'd love to hear from you. We appreciate all of our abroad listeners who have been coming back fast and furious. We got a bell jump this last week. And we have. We did. So it's wanted to shout them out. France, we see you coming out to party all the time. Japan is well, Germany, Turkey, Ukraine. So thank you all. Thank you for our local listeners who always come back and support us. Please come back next time. But until then, stay healthy, my friends. I'm Ed Delesky. I'm Nicole Ruto. Thank you. And goodbye. Bye. This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly display an reliability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. 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