Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and today we're discussing the measles, what you really need to know. Joining me is Dr. Neela Sethi. She's a Pediatrician on staff at Henry Mayo Newhall Hospital. Dr. Sethi, always such a great guest and so great to have you with us.

Why don't you first tell us a little bit about the measles, what we know about the evolution, kind of when we saw it disappear, and what we're seeing now?

Neela Sethi, MD: Well, we're definitely seeing a resurgence, which, you know, every pediatrician out there is like shaking in their boots because, we really don't want to be in this place, but here we are. What we noticed is vaccine efficacy was great and we had a couple decades where we were really seeing minimal cases, and then when vaccine compliance decreased, we noticed that measles cases started rising. And now, we're seeing more cases than we should with obviously the outbreaks that we know. And we're just on a mission to one, spread vaccine safety awareness, and two, just tell people what to look for because this is a really real sort of threat and something that we want to inform patients about.

Host: How serious is it? Because when we do hear some of the misinformation going around and people say, just have these measles parties. Measles parties are not like chickenpox parties that they used to have in the seventies. Tell us a little bit about how really dangerous the measles are.

Neela Sethi, MD: Measles is a big deal. It's a big virus. It's a nasty virus. It's highly, highly contagious, and it has a lot of serious complications. One of the things we've talked about in the past, Melanie, is what we do as pediatricians is to prevent death. That is our main thing.

That is why we get up every day, is to keep your child from passing away. That is what our bread and butter is and why we do what we do to save lives of children. And one of the complications of measles is death. We're going to get into complications later, but you can get encephalitis, you can get pneumonia, and you can get something called subacute sclerosing panencephalitis.

We're going to get into that later. That's fatal. It's just fatal. And the scary thing about that is that happens seven to ten years later after the infection. So if you can imagine, you think you're in the clear, your kid gets it, and then seven to ten years later, they pass away from a complication of measles.

These are the things that are not being reported in the mainstream media. These are the things that scare pediatricians and keep us up at night. And this is the type of information that we need to be screaming from the rooftops, that it's not just a cough and cold. That is incorrect. Yes, it starts out that way just like many other viruses do.

But, and unlike any other virus, it leads to more severe complica complications in the short course, death and in the long course, seven to ten years later at the possibility of death. So that is what I want to talk about today and what I want to inform patients and parents of, and basically discuss that the vaccine is affecting effective against preventing them.

Host: Wow. I never knew that, and I bet that so many parents listening never knew that seven to ten years later, your child can have some serious complications. And let's speak for a minute, Dr. Sethi about incubation. You mentioned that this is a rapidly spreading virus and it's easy to spread. I'd like you to speak about how it's transmitted and how long, because some people say, oh, well if you're with someone with the measles, how long does it take for you to see symptoms? Before you even tell us symptoms, tell us about incubation.

Neela Sethi, MD: So incubation, seven to 14 days from you getting into contact with that virus. It's passed in respiratory droplets. It's highly contagious, meaning you, and it can live on surfaces as well. So yes, someone sneezing, coughs in your face or daycare or you know, boogers or, saliva or any of those kind of fluids.

The other part is that it can live on surfaces, so, you touch something and then you touch your face, which is why hand washing is so important and you can catch it that way as well. And like I said, it's just a very highly contagious virus. There are some viruses where it hits a surface and dies. There are other viruses that you can even kind of touch your nose and mouth and maybe not catch it.

This one, unfortunately, is very contagious. It's a wicked virus. And so seven to 14 days is when the incubation period is. So you have that period of time to literally be exposed to the virus, even spread the virus and not have any symptoms. And that's the other scary part about it.

Host: So there is asymptomatic carrying with this virus. Right? We first heard about that with COVID and we'd never really heard about asymptomatic and that you can carry something, but you can with the measles. Yeah?

Neela Sethi, MD: You can, and that's why it goes rampant in daycares because yes, babies, they can spread it to one another in their saliva and their drool and their mucus and their boogies. And parents don't really know that they have it. And yes, when they start getting the symptoms that we'll talk about, the more severe symptoms or even just the symptoms that look like a common cold, you're contagious then.

And yes, parents then are like, okay, my baby has these symptoms, I'm going to pull them from daycare. But you're contagious before then. And so that's really the big concern. And that's why when parents are like, oh, they're not that sick. Well it comes, it comes.

Host: Wow, I never realized that. So now, tell us about symptoms. You've mentioned a few times cough and flu symptoms, cold and flu symptoms that seem like there's something normal, but then the spots tell us about sort of the way that the symptoms appear.

Neela Sethi, MD: Perfect. So this is like one of my favorite topics to talk about because it informs patients of timeline and timeline's really important when you're a mom or a dad. So, seven to 14 days from the start, from the time that you get exposed, you develop a few things that like, we call it the three Cs in pediatrics, cough, coryza, which you don't need to remember that word, that means runny nose and conjunctivitis, which is like a pink eye type situation. So cough, coryza, conjunctivitis. So fever, coughing, runny nose and then red, pink eyes or like a conjunctivitis. Those fevers can be quite high and alarming that, which is why those fevers will bring people to the pediatrician.

You can get up to 104, so it can look like a kind of normal co cold virus with a pink eye, but I mean, there are tons of viruses that do that out there, and pink eye's extremely common. We're in a pink eye season right now. I'm seeing tons of that in the office. So it's very difficult in those early stages to know like, are we just dealing with a normal virus or are we dealing with measles?

But anything in that zone, the cough, the coryza, the runny nose, the conjunctivitis pink eye or the fever should take you to your pediatrician at that like moment just because that's when we start getting alerted that this could be an issue. Two to three days after that is when you can develop something called koplik spots. These are like little tiny white spots in the inside of the mouth, either sides of the tongue and in the throat. They're tiny. They're pinpoint, they're difficult for the layman to kind of catch, but we as pediatricians know what to look for, so two to three days later, then you get the koplik spots and that's when we start thinking, oh gosh, we're going to start doing swabs and studying and to figure out what we're dealing with. Now three to five days later from the start of that cough coryza. So two to three days for the spots, three to five days later you can get the measles rash. The measles rash is what is a little bit more telling, but again, there are a lot of viruses out there that have rash, so it's very difficult to know in those early stages if you're really dealing with measles, and that's why the testing is really important.

The measles rash starts as these like flat red spots. And they're kind of dramatic and they start on the face and then they go down. It's almost like we, we joke that it's like if you were to pour a can of paint on your head, it goes and then down the body. So, cheeks, mouth, neck, chest, arms, legs, feet and then gone.

And that happens three to five days later. And the little red spots can conjoin and like make friends with each other. And you can get a rash that like really looks like, almost like your whole body's red and it goes top to bottom. And so those are the things that you need to go into.

Host: Is it painful for the kids?

Neela Sethi, MD: It can be uncomfortable. Yeah, it can. The mouth spots can be uncomfortable. The rash is uncomfortable. The pink eye can be irritating for them. Even just regular pink eye is irritating. So the pink eye can be irritating. And then the fevers are very high and fevers in kids, we all remember having our kids and moms and dads out there, kids with fevers, just fevers in and of itself can make kids feel miserable.

So imagine having all those symptoms together. I think the big take home point here is that like there are many viruses that do this, so it's difficult for pediatricians to know whether this is measles or something not that serious. And the only way to know is to run the tests.

Host: So if our children have been vaccinated, for people that have kids a little bit older, tweens, teens and above. How long does that vaccination, because we're going to also talk about the little ones and that vaccination schedule, but for the ones that have been vaccinated, how long is this good for? For you and I, and I'm a lot older than you are, but I mean, is my measles vaccination still going to help me in this outbreak that we're seeing?

Neela Sethi, MD: I mean, that's the beauty of the measles vaccine is it got a really bad rap like 20 years ago and was falsely blamed for a lot of things. And, but the measles vaccine, the MMR vaccine is highly, highly effective. Two vaccines over the course of one, like you get it at one and then you get it again at five.

Two of those vaccines are, have a lifetime protection, if you can imagine that. So, yeah, for my kids, they're 13 and 15. I am honestly counting my lucky stars. They both have their measles vaccine. It's that effective that with those kids when they get the like cough and this coryza, conjunctivitis, we literally don't worry about measles because that vaccine is so effective.

So one years old, and then typically at four or five you'll get a booster before kindergarten.

Host: Now tell us about the MMR vaccine. Now, you and I have been on together for podcasts where we've talked about clearing the air, about the misinformation about autism, which is, we're hearing it again, even though it's been dispelled by the American Academy of Pediatrics more times than I can count. I've done so many shows on dispelling just that myth.

Now you are such a well-respected pediatrician, Dr. Sethi, please tell parents why it's so important to trust the information of the pediatricians that we love, that, as you say, are there to save our kids life.

Neela Sethi, MD: I mean, if you can imagine, this is my 20th year being in private practice, why would I choose to give children something that would cause harm? That just makes no sense. It goes against my like moral compass. It was falsely blamed. It's been proven to actually not cause autism. There are plenty of children in my office that haven't received the MMR and still have autism.

So how do you do, how do you explain that? And, it's one of those things that I wish we could move past, but I will say it clearly and I'm look straight in the camera and say, MMR vaccine has not proven to have a link to autism. MMR vaccine has been falsely blamed for autism. MMR is a highly effective vaccine to prevent measles. Because we're having vaccine non-compliance, we're seeing measles numbers rise. That is causational. We have seen that. We know that to be true, and we have not seen autism numbers decrease with vaccine noncompliance with MMR. So I'm not sure how to say it clearer to reassure parents more other than to say there is some element of trust, but isn't there an element of trust when you get in your car, when you wear your seatbelt, when you do all of these things to protect your children, you have to trust your pediatrician.

You have to have the vaccine conversations. I do that all day, every day in my office and I try to reassure parents as best I can by giving them the right information. But vaccines, MMR vaccine does not cause autism, period.

Host: They don't cause autism, period. And you just heard it from Dr. Neela Sethi, Pediatrician at Henry Mayo Newhall Hospital, an expert in everything that we want to know about our children and their health. Now, Dr. Sethi, we're not done yet. So what do we do if we know that like in Texas, in certain states, they're seeing this cruising around now, so.

What do we do if we know our kids are vaccinated? We want to make sure that they wash their hands, that do all the precautions. Do we steer clear of the unvaccinated? What if there is measles is going around our community? What do you want us to do?

Neela Sethi, MD: If you have two MMR vaccines, you're good. You just have to wash your hands and do all the normal things to prevent a cold virus. If you are unvaccinated, you should highly consider yourself. If your child is unvaccinated, you should consider getting the vaccine. It's that effective.

It's so effective that for the ones that can't qualify for the vaccine, like normally we would give it at one, but you can give it as low as six months. There are parents that are choosing to bring their six month old in and get an extra MMR vaccine at six months, then again in a year because they're so fearful.

And that's something that we're doing in our office right now where if your child is in daycare or you're traveling, or you're going somewhere, or you're going to be like at a wedding or at an airport, we have considered giving that MMR vaccine down to six months old. So that's something that you can do.

Another thing that you can do is boost. So if you got the one year vaccine, but you and your child is now four at four years old, you can get a second. So if your child's going into K to pre-K or TK or kindergarten, you can get a second MMR, which even more sort of boosts that vaccine response at four or five years old.

So we've been recommending that. I want to touch on complications because I think it's really important for us to talk about that. Because that's something that we as pediatricians really want to inform parents of that like, yes, you get the runny nose, yes, you get the cough. Yes, you get the congestion. Yes, you get the rash. Yes, you get the fever. Those things are scary. Those things we can deal with. What we can't deal with and what causes us fear is you can get a really nasty pneumonia and pass away. You can get an encephalitis and pass away you. It causes hospital complications that we have no control over and it can take over your body and we can't give you the things that you need in an office setting to control that.

It has to be done in a hospital. If that's done too late, it can cause death. Then let's go back to subacute sclerosing panencephalitis. It's SSPE. Seven to ten years later, it takes. The measles virus lives in your body. It reoccurs and causes a panencephalitis and it's fatal, and that's seven to ten years later.

Those are the things that the vaccine is preventing. Death, pneumonia, encephalitis, sepsis. That's what we're trying to do here. We've talked about this, we talked about this with the varicella vaccine. Melanie, where it's like we don't care about the pox. If you think that we're giving a vaccine for pox, you're mistaken.

We're giving the vaccine to prevent chickenpox encephalitis, chickenpox meningitis, chickenpox hepatitis. These are complications that we don't have control over and that we can't help you with in our office. That's what keeps us up at night. That's the things, those are the things that we need to talk about, and those are difficult conversations.

No one wants to talk about death. No one wants to talk about pediatric death, but that is real and that is something that we are scared about and that is why I'm on here today to say the vaccine prevents death, period.

Host: Is there an upper limit for the vaccine? If some parents have changed their minds, if they were not into the vaccination schedule, they were worried about all of these things, but now they've got a nine or a 10 or an 11-year-old at school and they're like, I'm afraid now. Is there an upper limit?

Neela Sethi, MD: No, that's the beauty of it.

Host: So

Neela Sethi, MD: I got a boost.

Melanie Cole, MS (Host): you can get the vaccine at any age?

Neela Sethi, MD: At any age. That's the beauty. I got a vaccine, I got an MMR vaccine, which is very common. I got a vaccine when I started med school. I got a third. So you can get it at any point. You can be in your twenties and be like, my parents didn't vaccinate me, but I want to vaccinate myself and you can go and get the vaccine.

So, and it's that effective. And so that's what we want to kind of inform patients of, and I think have empathy for the poor parents out there that do believe in vaccines and their kid doesn't qualify for vaccines. Think about the zero to six monthers that are literally sending their kids to daycare.

Do you know how many people are reaching out to me in tears every day, deathly afraid because they can't give their kid that vaccine and they're afraid that their kid is going to get it because somebody else decided to make a choice to not vaccinate their child. That is a discussion. And something that really just makes me sad and scared too.

And every rash that comes in now we're having to think about measles. And that's not fair to the pediatricians out there that have spent their life work promoting vaccine safety and promoting vaccine efficacy and have just taken us back 20 years in time and we don't have the choice about that.

Host: Bummer. It is what we're seeing, and it is scary, as you said. Best advice here. You've given us so much great advice, Dr. Sethi, as you always do. But I'd like you to speak to parents right now that are concerned about the measles and the spread, but that are also concerned about vaccinations, and have these questions that you get every single day. Wrap it up for us with your real best advice.

Neela Sethi, MD: Trust your pediatricians when you're hearing like random things on Instagram or TikTok that we're getting these like bonuses or you're getting misinformation or you're choosing to trust somebody without a medical degree. Think twice. Think about where you're getting your, information. Are you going to believe an influencer? Or are you going to believe a doctor that spent 11 years in training and 20 years in private practice? This is my 31st year practicing, practicing and being in medicine. Who are you going to believe? You need to make informed decisions for your kids. I understand that you love your child. I love your child.

You want to protect them. I want to protect them. Let's be on the same team and have frank conversations. Let's believe what research has shown. I understand that you are nervous. I understand that you are feeling a little distrusting. Find a pediatrician that you can have a frank conversation with. But from my perspective and what I will fall on the stake for is that the MMR vaccine is safe. It's effective, it works, and measles is a scary virus that you do not want your child to get. End of story.

Host: Dr. Sethi, you're a wealth of knowledge and you're passionate and you're compassionate, and we can hear that. I just know that your patients just absolutely are so lucky, and I know that they love you and their kids too. Thank you again for joining us, and to learn more about the measles at Henry Mayo Newhall Hospital, you can try the free online health library at library.henry mayo.com and then type measles in the search box and you'll get so much great information there. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.