Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and today we're talking about the recent measles cases reported in Los Angeles County and steps you should take to protect you and your children. Joining me is Dr. Anirudh Rai. He's a Primary Care Physician at Henry Mayo Newhall Hospital Primary Care and a fan favorite here on It's Your Health Radio.

Dr. Rai, thank you so much for joining us today. So we're talking about the measles. What's going on with measles? Are we seeing cases right now?

Anirudh Rai, MD: Yeah, that's a good question. Always happy to be on the podcast, honestly, and for measles, it's a really good topic, honestly. If you were to kind of look at the history of how measles has been presented, typically we always talk about the eradication of when the vaccine came out, and now recently we're seeing a rises of cases, and that is a concern.

We'll talk more about why, but the reason for that is essentially, like you mentioned before, vaccinations. And it turns out that down the line, patients have chosen to not vaccinate or to kind of avoid it, if anything, or may have forgotten. There's many reasons for that.

Host: So we are seeing cases and we're thinking that the theory behind that is that now people have been afraid of that MMR vaccine, and they wonder if it causes autism. You want to clear that up for us right now?

Anirudh Rai, MD: Absolutely. This was a very known case, at least in the sixties, when they thought that vaccinations were linked to autism. It's been debunked numerous times, and there's been no linkage to autism associated with any vaccinations in general. More often than not, if people are concerned about it, they think it's the preservative associated in the vaccine.

And for the most part, many vaccines don't even have that component for the most part. So vaccinations are a very safe, safe thing to do. And I would definitely talk to whoever your primary care doctor is on the status because it is important to stay fully vaccinated in certain conditions and measles, I would say it's one of the most important ones to kind of stay vaccinated with.

Host: Yeah, measles is really a bummer. I mean, it can get very serious. It can cause complications. Tell us a little bit about how it spreads. How contagious is it? I mean, it's really contagious, right?

Anirudh Rai, MD: Yeah, I would say it's way more contagious than COVID. To give you an idea, just like COVID, it is spread via droplet and airborne, as in, if someone's coughing or if they're in the same room and they're breathing, it can be spread in that sort of regard. COVID, on the other hand, if you were to going to give a value to it, we use numbers called R0 and that's basically a number saying how contagious a certain virus is. COVID has an R0 of about 5.6, which is 6, meaning that if one person's in a room, they can spread to around six other people with the same vicinity. Measles has an R0 of around 12 to 16, meaning that if one person's in a room, they can spread to around 12 to 16 people around. So it's, I would say twice, if not three times more contagious than COVID.

Host: Is it airborne, Dr. Rai? I mean, how does it spread? Is it on? I remember with COVID, we were afraid for a while, whether it lived on surfaces. And if you touched a surface and is measles an airborne thing, you said if someone coughs, so is that what's going on?

Anirudh Rai, MD: That's a good question. And it is spread via airborne mechanism, meaning if you're breathing it out, not just a cough, airborne, meaning that if you're in the same vicinity and they're breathing in the same room, it can be spread in that regard as well. But the reason for that is a bit more trickier and we could talk more about the presentations because it's linked to when you see the symptoms of it is when we typically see the spread and the contagion factor be really high.

Host: So what are we looking for?

Anirudh Rai, MD: Symptoms. Yeah, that is the age old question. So with the measles, they, they tell you in med school, and I'm sure people look at MD, we look at basically fevers, fevers around 105. They tend to have very high fevers. And, they also have a rash, and we'll talk more about specifically this kind of rash, because it can be a bit scary when you see either a kid or an adult have a rash and are coughing or have fevers, which leads me to my next symptom, which is the three Cs.

Typically, we call it the four Cs, but the three Cs is what they tell you, which is cough when they're coughing up anything like a simple, say, you have a simple, uh, common cold, you'll be coughing. Choriza, which essentially means runny nose, and conjunctivitis, meaning they have redness and irritation around the eyes.

Those are the three main Cs, but the other more common ones that you would see, especially in the physician setting when they do physical exams, something called copelix spots. And we'll talk more about that as we come to it, but the main symptoms are cough, runny nose, red eyes, rash, and high fevers.

Host: I remember my brother had it and I remember it looking like chicken pox, or am I remembering that wrong?

Anirudh Rai, MD: That's a pretty close representation. The rash, they describe it as small raised or flat bumps within the skin. And it has a very unique appearance to it. It typically does occur on your, uh, trunk or on your abdomen area. And it can have similar features to chicken pox, but the way this is differentiated is typically with the fevers and the red eyes and the runny nose and then the cough.

So chicken pox, typically don't have a fever that go that high, but it is similar. You are right.

Host: So, we almost eradicated it. Like polio, smallpox before it, but then people started questioning the vaccination and hoping for herd immunity, so now it's back a little bit. You've seen a few cases. Are they rising?

Anirudh Rai, MD: That's a good question. Typically, in these scenarios, when we do see a case of measles the CDC or the NIH, these organizations do a very good job of isolating these incidents. I remember in 2000, I believe 2008, where they had a similar incident in the military setting, they isolated it, it went away, everything was good.

Essentially, it is, finding out where the spread is, what's happening, and, and honestly, confining it and treating it in that regard does prevent it from spreading very well, and we've done a really good job of essentially doing, the uh, isolation, I would say the best way to describe it, but that also gets to my next point, which is where are we seeing these patients?

As you mentioned, vaccinations are a big key, but more often than not, we see patients typically who are traveling abroad who aren't vaccinated. They bring it back. So that's one of the main things we tend to kind of see when we saw the past cases of patients who had measles in the U.S.

Host: Then let's talk about vaccination. Who should be vaccinated? Who should not be? Tell us about what the schedule is for this vaccine.

Anirudh Rai, MD: Yeah, that's a really good question. So typically, um, this vaccination is always on the schedule. It's usually meant for, uh, kids who are around 12 to 15 months, the first dose they typically get at that time frame. The second dose they get around four to six years or so. So it's a two part vaccine and it's extremely effective.

The first dose when you get it, you're about 93 percent protected. The second dose, it goes up to 97%. So it's a very effective vaccine. And this is a vaccine we all, we always tell our children and our pediatric population to say, yeah, this is a good vaccine for kids to get vaccinated with.

Host: If someone does contract measles, what are the treatments? What are we looking for as parents? Is it an emergent condition? Do we rush them to the emergency room? We don't want to spread this highly contagious disease.

Anirudh Rai, MD: That's a really good question. Overall treatment wise, it is somewhat self limiting to a certain set group of patients. Though the way we treat this is essentially just monitoring it. There are certain antivirals that are being tested for it as well, but they are specific for the cases. But for the most part, the patients who are more at risk for it are those who are less than five years old or greater than 20 years old.

We found that in, in a, in a study, and measles is pretty dangerous about one in four who have measles do end up in the hospital, but about one in thousand do have a chance of dying from it. And in fact, gettingfurther complications form it. We do have a treatment for it, but it is very specific and it is well guarded on the agencies that actually regulate it and contain, the outbreaks for the most part.

So it is something treatable and we do test it. I wouldn't say rush them to the hospital because the hospital itself would isolate them. It is something that we want to kind of prevent spreading. If anything, we would keep the patient in that setting or in the hospital, and essentially just get those precautions going.

Host: So tell us a little bit about the community outbreaks, if that were to happen. What do parents need to know if there is an outbreak? And if they've seen a few cases, you mentioned a little bit about what the community says about it and containing that outbreak. What happens next? How do we find out at these things?

Anirudh Rai, MD: That's a good question. And there are ways we could test for measles. One blood, one thing we could do is do a blood test, which is pretty easy enough to do and we could check what we call IgM markers and IgG markers, but they aren't very specific or sensitive, meaning you can have some false positive.

Thankfully, we do have swabs and we could actually do what we call a nasopharyngeal swabs, similar to how we did COVID swabs. Initially, we swab the patient and run it and kind of see if we are having measles or not. And it is very sensisive and specific for measles, it is a very good test when it comes to testing for measles. As for what type of patients we're seeing, ideally we see patients who travel to certain regions of the world who are unvaccinated.

For instance, if you're unvaccinated and traveling to a place like India, the Philippines, China, Pakistan, or UK, people tend to come back with measles from time to time. We've known at least in the past. So these are areas where we would say, if you're going, it's good to get vaccinated or make sure you're vaccinated before traveling to certain regions as well.

Host: Ooh, that's a really great point and something to discuss with your doctor before you're going places like that. Discuss with your physician any vaccinations that they might feel are important. Can adults, if they are going over, get a booster at some point in their life?

Anirudh Rai, MD: Yes. That's a very specific schedule for that. If you haven't been vaccinated, we can get you up to date on that regard. But to back up a bit about what parents should do when they see a kid with a rash or measles, I'll say notify their doctor immediately about that and say, Hey, I'm kind of worried about measles. Do you think this is what I'm seeing? And then the physician could kind of assess to see, yeah, this is, these are the next steps.

Host: Dr. Rai, you are such a great guest. You're just a wealth of information and expertise. As we wrap up, your most important information about the recent measles outbreak, however small it may be, it, as you said, it's extremely contagious and can spread very quickly. And we don't want to see that. And I know there are people that are really reliant on herd immunity and they don't choose to vaccinate, but I'd like you to speak to them and to the community at large about what you want them to know about this important vaccination and the safety and efficacy of it and why it's so important to protect our families from measles.

Anirudh Rai, MD: Absolutely. I would say measles is one of the few things we can eradicate and, and the vaccines have been vastly, not only safe, but effective in guarding against this illness, particularly. If there's any concerns or questions, I would definitely give you at least some reprieve saying these vaccinations have been tested time and time again, proven to be safe, not linked to autism.

You might get some side effects taking it, which is just some headaches and some pains at the site of injection, but, patients are well, well tolerated with these vaccines. People do well with these vaccines and as I always say, all my patients, prevention is better than treatment.

Host: It certainly is. And that's a nasty one. So we don't want to catch it. Listeners, hear what Dr. Rai said. He is the expert and such a great guest. Thank you so much for joining us. To learn more about the measles, visit Henry Mayo Newhall Hospital's online health library. And you can find that at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please always remember to subscribe, rate, and review It's Your Health Radio on Apple podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.