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Alexis M. Elward, M.D., M.P.H. (Guest): Hi. I'm Dr. Alexis Elward. I'm a Washington University infectious diseases pediatrician and a mom doc at St. Louis Children’s Hospital.

Melanie Cole, MS (Host): Hello. This is Mom Docs, the podcast from St. Louis Children’s Hospital. I'm Melanie Cole. Today we’re talking about the recent outbreak of measles which has scared so many parents all over the country. Dr. Elward, I'm so glad to have you with us. Tell us about what’s going on right now with measles and the recent outbreak.

Dr. Elward: Yes. Well measles is a very contagious disease. It’s caused by a virus. The reason we’re so concerned about measles is that it is very, very contagious. There can be very, very serious consequences from having measles. So about one in every four people who catches measles in the United States will be hospitalized. There’s also an increased frequency of complications with measles, like pneumonia, and even more serious illnesses like brain swelling. About 1 in every 1,000 people who get measles will have this very serious infection of the brain. About 1 in every 1,000 will die from complications from measles.

So we’re very concerned about this because we’ve seen a big decrease in the numbers of cases of measles in this country since we started vaccinating in the 1960s. We actually don’t see it anymore just circulating wildly in the U.S. So we’re now in the middle of one of the largest outbreaks in the country that we’ve seen in decades. A lot of these cases are coming from out of the country where vaccination rates are lower, but they're now being spread among people who are not immune to measles either from not having the vaccine, from being too young to have the vaccine. So it is something that we really are paying a lot of attention to in terms of public health circles.

Host: So let’s talk about how it spreads. What makes it so dangerous? Why is it so contagious?

Dr. Elward: Well, it’s very, very easily spread. It’s a virus that easily infects people. It spreads through coughing, sneezing, droplets. The particles of the virus can actually travel through very long distances on currents of air. So it’s actually one of the most highly infectious kinds of organisms that we have. It’s an infectious as something like TB or chicken pox.

Host: Yikes. That is so scary. Now. How would we know if we have been infected? If our children have been infected? Tell us about the signs and symptoms that we would start to see really early.

Dr. Elward: Sure. Well measles is a little bit tricky because it starts out looking like many other viral infections with pretty non specific signs and symptoms. So you can start with having just a cough, a really runny nose. You might have some red eyes or conjunctivitis. Then you might have a fever with it. Then it’s typically about four days after the fever starts that you would break out with the rash. The rash of measles is pretty characteristic. It’s tiny red dots that usually start on the head and then move down the body. The tricky thing about measles is that rash doesn’t appear until you’ve been sick for about four days. You can be contagious during that time. So you can spread it to other people. So this is another reason why measles can spread and travel. Because by the time it becomes really recognizable to healthcare providers, to physicians and nurses, and that we know to have people stay away from others, they’ve already been out and circulating.

Host: Tell us about the vaccine Dr. Elward. Who is having this vaccine? We are even hearing now that if you were born before a certain year, you might need a booster now. Tell us about the vaccine itself.

Dr. Elward: Sure. This is one of the most effective vaccines that we have. It just does a really great job if people get two doses of it at the appropriate ages. So right now in the United States our vaccine schedule is for children to get their first dose between age 12 and 15 months, and to get a second booster dose between ages four and six years. When you get those two doses, you have a 97% chance of being protected against measles. So this is better than almost any other vaccine that we have in our arsenal to fight infectious diseases. Now, even just one dose of the vaccine can provide up to 93% protection.

We are learning that immunity to measles can wane a little bit over time. We’re still learning a lot about this. So if you're in an environment about healthcare, we take extra precautions to check people’s antibodies or blood titers against measles. If there’s any question, we give them another booster before they start working because we’re in an area where we’re more likely to see people who are sick with measles who could be contagious. If you have any doubt about your immunity to measles, you should be talking to your doctor. If you can't be sure that you had two doses of the measles vaccine, then your doctor might recommend doing a blood test to see if you’re immune. Then you might be recommended to get another dose of the MMR vaccine, the measles, mumps, and rubella vaccine if there’s any question about that.

Now there are a few people who should not receive this vaccine. Pregnant women should not receive this vaccine. You should wait until after you’ve had your baby. If you are severely immunocompromised, you should not get this vaccine. Then if you're a baby under six months, we don’t give those babies the vaccine. They don’t respond to it very well. Babies who are older than six months can get the vaccine, especially if they’ve been exposed to somebody with measles. They absolutely should get it. If a baby over six months of age is going to be travelling out of the country, they should get the vaccine. They will still need to get their two regular doses after age 12 months if they get it before they are 12 months of age just because it doesn’t produce such good long-lasting immunity. It will give you good short-term protection if you're in the middle of an area where there’s a lot of measles circulating, but it doesn’t give you that long-term immunologic memory that you’d need.

Host: That was an excellent description. Dr. Elward, is the measles vaccine 100% effective? Can you still get measles even if you’ve been vaccinated? Tell us a little bit about any dangers or side effects. People have so many questions about this particular vaccine.

Dr. Elward: Oh, absolutely. Yes. There is a very small chance that you could still get the measles even if you have been vaccinated. So even if I, who have been vaccinated, am taking care of somebody who might have the measles, I do take special precautions with wearing a special mask. So there is about a 3% chance that you might not be protected. Other than that, the vaccine is very, very effective. It is a very safe vaccine. There are some side effects that you might see. The most common things are that you would have a fever greater than 103 degrees Fahrenheit. That does happen in between 5 and 15 people out of every 100 people who get the vaccine. That might happen a little time after that you’ve had the vaccine, maybe 6 to 12 days after you’ve had the vaccine.

About 5 out of every 100 people get a rash that will just come and go. It will not last for very long. There are a very, very small number of people, about 1 in every 3,000 people, who might have a very, very high fever 5 to 12 days after that, and might have a seizure with a fever. These are very scary to watch, but do not cause any long term damage and are typically very short lived. That is a very, very small chance of having a side effect like that. Compared to if you get the measles, you have about a 25% chance of actually being in the hospital. You have a much higher chance of getting the brain swelling or dying from the measles than you would of having this very rare side effect of getting the vaccine of having what’s called a febrile seizure.

Then there’s a small number of people who can have a very low platelet count within a couple of months. Platelets are a factor in the blood that’s important for clotting. That risk is about 1 in 40,000 people. So that’s even a tinier, tinier risk. That has never been associated with a big bleeding problem. That side effect has never, ever been associated with death. There’s no evidence that getting the vaccine again actually increases your risk of any of these side effects of having the vaccine. So this is a very safe vaccine. The tiny chances of even these side effects are much, much smaller than first of all your chance of getting that measles if you're exposed to it, or of having a serious complication or even death from measles if you get the disease.

Host: Dr. Elward, as a part myself, do we let our vaccinated child play with kids who haven’t gotten the vaccine? What do we do about that? The fear that right now people are wandering around unvaccinated. We have questions about herd immunity. What should we be doing and thinking as parents?

Dr. Elward: Well, I think we always want to rely on our public health and our infectious diseases teams to give up to date guidance in the moment. In general, I would say that we wouldn’t advise people to not play with unvaccinated children. I think you do want to be very, very careful just in general if children are sick in thinking about having them stay home until they're resting and they're feeling better. Most schools and daycares have regulations about children with fevers staying home until they’ve been fever free for 24 hours. So if everyone follows those general guidelines, that will help to keep all of our children safe.

There may be special circumstances, like in cities where they are having lots of cases of measles. In New York and Los Angles for example where the public health authorities might give us additional guidance, and actually may ask certain people to stay home if they are thought to have the measles, to get vaccinated if they haven’t been vaccinated. So the public health team would communicate through the media and through other channels if we need to do anything differently. Right now, in this area, there are no specific recommendations for any special populations to stay home or to be quarantined or to be excluded from any normal activities.

Host: So then what should we do if we believe that our child has the measles? If we suspect some of the symptoms or we’re afraid that they were around somebody who was unvaccinated or who had the measles. How does St. Louis Children’s Hospital treat patients with measles, and what should we do?

Dr. Elward: So the first thing we would a parent to do would be to contact their pediatrician for specific advice. We are very closely connected with our pediatrician, and we would usually be talking with them from the infectious diseases side of things. We would recommend that if we’re highly suspicious for measles that we would evaluate that child. There are some specific tests that can be done. There are lots of viruses, lots of viruses that are circulating right now that can cause fever, cough, runny nose, red eyes, and rashes. Odds are still right now that the cause of those symptoms would be a different virus other than measles. But if you have had a known exposure and you have symptoms like that, we want you to call your doctor. Your doctor is likely to recommend that you might come in and get some blood tests and potentially a swab of the nose to try to confirm that it’s either a different virus or the measles virus.

If somebody has the measles virus, there’s no specific medicine that we can give to kill the virus. What we do is give supportive care so kids can have ear infections or pneumonia when they have measles. We would treat those with antibiotics because you can have infection with another germ on top of the virus that would be killed by antibiotics. The antibiotics don’t kill the virus itself. Then we would be monitoring the children very, very closely. Supporting their hydration potentially with a tube in their arm to give them IV fluids. We would be monitoring them for any signs of encephalitis or brain swelling. So it’s possible that the child might be hospitalized so that we could watch very closely and try to make sure that we support them through the illness.

Host: What great and such important information. Dr. Elward, wrap it up for us. What would you like the parents listening, the other moms and parents to know about this recent outbreak, the fear of this particular disease coming back, and what you want us to know about the vaccine? And how important sticking to that vaccination schedule really is.

Dr. Elward: Measles can be serious. This is not just another viral infection. This one is associated with a higher risk of death, especially in very young kids less than five years of age and in kids who have cancer, adults who have cancer. So that’s point number one. Measles is very serious. Number two, measles is very, very contagious. If you have not been vaccinated, then nine out of ten people who come in contact with somebody with measles will contract measles.

The third thing is that you can still get measles in the United States. We do have a record number of cases right now. The fourth this is that we have the power to do something about this. We can protect our children against measles. We have a very safe and very, very effective vaccine. So I would encourage people to get their children vaccinated according to the routine schedule. Also to make sure that if you are seeing your pediatrician or planning to travel with your child who is six months and older and you are going out of the country, please talk with your doctor about that. Because that would be a time when we would give your baby the measles vaccine earlier than we typically would.

Host: Thank you so much for joining us and filling us in on really what’s going on today with the measles. If you found this podcast enlightening, please share on your social media and be sure to check out all the other helpful podcasts in our library. Head on over to the website at stlouischildrens.org to get connected with one of our providers. I'm Melanie Cole. Thanks so much for tuning in.