Caitlin Whyte (Host): Welcome to another episode of the Peds Pod by Lebonheur Children's Hospital. I'm your host, Caitlin Whyte. Today, we're diving into an important and timely discussion on measles outbreaks, featuring insights from Dr. Nick Hysmith, the Medical Director of Infection Prevention at Lebonheur Children's Hospital.

Dr. Hysmith will guide us through the complexities of measles, vaccination queries, and protective measures for children and families. Let's start with the basics here, doctor. What is the measles and what are the common symptoms?

Dr. Nick Hysmith: So, measles is a very highly contagious viral illness that was really prevalent in the early 1900s. Luckily, in the late 1950s, we had a vaccine that was developed and we've been using that since the mid-60s. It is a virus that causes initially a really high fever and some cough. And that will transition about three to four days after the fever to a diffuse rash that covers the whole body. And it'll usually last a few days after that. And kids will usually recover pretty nicely. However, we do see some pretty severe side effects that can occur. 

Host: And is the measles actually dangerous?

Dr. Nick Hysmith: No, that's a great question. It is dangerous. I think, you know, we have gotten into this period of time where we don't see vaccine preventable illnesses such as measles or chicken pox very commonly. So, we forget that these things can have severe consequences and even lead to death. Prior to the vaccine, about 40,000 individuals every year were admitted to the hospital with measles, and we would see about one in a thousand deaths from measles.

And that's just looking at deaths. When you look at other sequelae or outcomes of the virus, you can see brain swelling, you can see pneumonia. So, it is usually not very severe. But as cases increase, we start to see some of those more severe complications, which can be pretty bad.

Host: Well, let's talk about that. Why are the measles making a resurgence?

Dr. Nick Hysmith: One big reason, and that's undervaccination. So, like I said, in the mid-60s, the vaccine was introduced in 1963. It was tweaked a little bit in 1968 to make it the current vaccine that we've been using ever since then. Unfortunately, over the last decade, we've seen pockets throughout our country of undervaccination or vaccine resistance.

Like I said a second ago, measles is highly contagious. So if one person with measles walks into a room with 10 individuals that are not vaccinated, then nine of those individuals will go on to acquire measles. So highly contagious, one of the most contagious viruses that we know of. So if you have these pockets of folks that are unvaccinated or undervaccinated, and then you introduce a case of measles, it'll spread like wildfire in that population.

Host: So, how early can I vaccinate my child then? And how effective is that vaccine?

Dr. Nick Hysmith: Right. So as of right now, and we're thinking that this may change in the next coming years, you can vaccinate your child at one year of age. So, they'll get two vaccinations usually. So, that's at one year, and then again at the time they enter kindergarten, so four to five years. There's a window there from four to six years where you can vaccinate.

During an outbreak situation, you can vaccinate down to six months of age. So in some areas of Texas right now where there is an ongoing outbreak, they've recommended that those children be vaccinated who are six months to one year. And we're thinking that, in the next several years, there may be some guidance from the CDC to go ahead and start making that a common vaccination down to six months of age.

Host: And how safe is the vaccine? Are there any side effects that we should be aware of?

Dr. Nick Hysmith: Right. No, it's an incredibly safe vaccine. Like I said, it's one of the first vaccines, you know, we started giving in the early 1960s. We've been giving it for decades now with a ton of safety data that we've acquired over that period of time. There are some side effects like there are with any other vaccination, and those are incredibly rare.

So, one of the most common is actually developing a rash. You can get a rash right after receiving the measles vaccine. However, it's not the measles rash. It looks similar to it and sometimes it can make folks nervous, but it is a vaccine-associated rash. And then, there are some other incredibly rare side effects that you can see such as seizures and things of that nature. But those are incredibly, incredibly rare and don't lead to any permanent sequela.

Host: Vaccines of course are a touchy subject for some folks. So, what would you say to someone who is anxious about having their child receive the vaccine for measles?

Dr. Nick Hysmith: You know, I think just looking back at history, if you look at the consequences of having measles, you look at the consequences of having chicken pox, you look at the consequences of polio, we know that those can be really severe. We know that vaccines are safe, they're effective. Over the last 40 years, we have simplified the vaccines as much as possible to make them more effective and to contain less and less additives. So at this point in our history of vaccine production, we have very simple yet effective vaccines. And I would just urge parents to talk to their primary care provider, talk to those who they trust in the medical community, and just remind themselves what we're trying to prevent, and what the consequences are of not getting vaccination, and then to please go ahead and do that, to keep their children safe as well as the community at large safe. 

Host: I know you mentioned there were two vaccines as part of this vaccination, but do you need a booster to protect your children?

Dr. Nick Hysmith: Great question. So, the first vaccine dose that you get is about 93% effective. That's why we give two. So when we give the second one, you bump yourself up to about 97% or 98% effectiveness. And this is lifelong immunity. So, anyone that was born essentially after 1968 has had two doses of the measles, mumps, rubella combo vaccine, and they are protected for life. So in that case, you do not need a booster.

The issue comes when you have older folks who were born in that-- and I guess some people may have issue with me calling those folks older folks-- but people who were born 1968 and younger, those individuals may or may not have had adequate immunity to the measles. So, it's recommended that they get one dose of MMR as a booster.

Host: Great. Well, what should I do if I think my child has the measles or if I know they've been exposed to the measles?

Dr. Nick Hysmith: So, the very first thing you should do is call your primary care physician. I think it's really important that you make them aware that your child may have measles. That way, they can make appropriate accommodations in their clinic before you show up there. Just give them a call, have a chat, tell them why you think that your child may have measles. And then, follow their instructions on how to come and see the physician.

Obviously, if they're in any way ill-appearing, not taking good p.o. intake, not making urine, that sort of thing, having trouble breathing, then in that case take them to the emergency department. But I think the biggest thing is talking to your primary care provider, having them weigh in on how they would like for you to bring your child to their office, and then going to see them. 

Host: Great. And my last question today, what should I do if my child is too young to be vaccinated right now? Or they have a health condition where they cannot be vaccinated?

Dr. Nick Hysmith: That's a great question. So, as I mentioned earlier, you know, kids less than six months of age are unable to be vaccinated at this point. So, the big thing is having those around the child be vaccinated. We do have, luckily, maternal antibody that'll hang around in the child until about six months of age. So, they're protected in that way.

As far as kids who are immunocompromised and can't receive the vaccine such as those who are on chronic steroids or have had bone marrow transplant or something solid organ transplant, the big thing there is trying to prevent exposure. So, that's where that ring vaccination plays a huge role.

And then luckily, if they are exposed, we do have medications that we can give such as immunoglobulin to help prevent the infection from taking hold. 

Host: Thank you so much, Dr. Hysmith, for sharing your expertise with us today on the Peds Pod by Lebonheur Children's Hospital. It's important for all of us to stay informed and take the necessary steps to protect our children and communities from infectious diseases. To explore more about similar topics and access our full library of podcasts, please visit lebonheur.org/podcast. Thank you for listening, and stay tuned for our next episode where we continue to delve into the fascinating and vital world of pediatric healthcare.