Florida Measles - Dr Juan Dumois JHACH

At least ten cases of measles have been reported around Florida since the beginning of the year. We speak with Dr. Juan Dumois, a pediatric infectious disease specialist at Johns Hopkins All Children's Hospital in St. Petesburg, about what's driving these cases and how to respond.

Episode Transcript

(00:00):
Gordon Bird herewith Beyond the News.We're dealing with an outbreak of measles in
Florida. As we're recording this,about nine cases have been reported in Broward
County, most tied to an elementaryschool. One case reported involving an adult
in Polk County. Doctor Jue duMois is an infectious disease specialist at Johns
Hopkins All Children's Hospital in Saint Petersburgand joins us now and Beyond the News,

(00:23):
doctor Doumis, Good day to you, sir. Hello. Well.
Now, of course, measles atone point in say the mid twentieth century
was fairly commonplace, before vaccines becamecommonplace, and then it seemed not to
be. So are we seeing anincrease in cases now and if so,
what are the factors? Well,this cluster of cases that have appeared in

(00:45):
Florida, Florida is definitely an increase, and it does count as an outbreak
of measles right now. The mainfactor is people in the community who have
not been vaccinated. So it usedto be in the fifties and nineteen fifties,
and before that measles was so calmonalmost everybody got it in childhood,

(01:08):
it was just a rite of passage. And then the vaccine was introduced in
the late sixties because even though mostkids recovered from measles fine, some didn't,
and about one in a thousand childrenwould develop a brain infection with permanent
neurologic side effects, and about onein a thousand children died. And when

(01:30):
many thousands of children got measles everyyear in the United States, lots of
them died. So the vaccine wascreated, and it is so effective that
most doctors under sixty years of agein the United States have never seen a
case of measles, so they don'teven recognize how to diagnose it. So

(01:51):
then the outbreak then is a factordriven by people not getting their kids vaccinated
right, And some of those peoplehave not been vaccinated for decades, so
now they've reached adulthood unvaccinated. Thenthey travel overseas and in many other countries
where they don't have opportunities for vaccinationlike we do, there's much more measles

(02:14):
rampant, so a US traveler goingto another country can get infected and come
back and start to get sick,and as they're sick, they're spreading the
virus to others in the community whohaven't been vaccinated or have only been partially
vaccinated. At this point, thestate Department of Health, under the guidance
of Surgeon General Joseph Latipoe, saysthey've been allowing parents and guardians to decide

(02:38):
whether they want to send their childrento school if they come down with measles
because of the high rate of immunityin the community. And their words,
and can you address what the immunityrate would be right now in the state
or the nation or the area,and is it a level where it would

(03:00):
be characterized as a kind of aherd immunity. Yeah. Yeah, you
can say in general terms that mostpeople are immune to measles in Florida,
most meaning fifty one percent or higher. But measles is so contagious, it

(03:20):
is one of the most contagious thingswe know on the planet Earth that in
order to prevent spread in a community, you need to have at least ninety
five percent of the population with immunity, so that you can spread it to
one person, but then the nextperson's immune and they won't get it.
We estimate that the immunity in childrenunder five against measles is less than ninety

(03:49):
five percent currently in Florida due tofamilies who have decided not to vaccinate their
children now, and that can vary. It's not all of Florida, but
there can be small communities like churchcommunities or other communities of people who talk
and convince each other not to vaccinatetheir kids. Where within a town there

(04:14):
may be a neighborhood of unvaccinated kidsthat's not seen in other areas of the
town. Now, with vaccinated versusunvaccinated, is there a difference in terms
of they don't get measles or ifthey get measles, the manifestations are much
milder. How does that work inpeople who've been vaccinated. Either of those

(04:36):
scenarios could happen. The majority ofpeople who get exposed to measles and they've
been fully vaccinated, they don't getsick at all. They have no clue
that they were even exposed. Somemay develop a case of measles that's so
mild that they don't even have thetypical rash and it's just dismissed as another

(04:57):
viral illness. And so then thereare some people who've been vaccinated but their
health has been affected in a wayto weaken their immune system. So like
someone who's had a heart transplant ison medications to prevent rejecting the heart that
also weaken their immune system. Soeven if they had immunity to measles from

(05:20):
childhood, that immunity may be lessthan it was before, and so they
now may develop measles if they getexposed. If you were advising a parent
whose child had come down with measles, would you recommend to them that they
take their children out of school fora time. Oh? Yes, yeah.
Children with measles are so contagious thata child with measles in a classroom

(05:45):
and the door open can be infectingpeople who are walking in the hallway outside
the classroom. So there, andthey're contagious for several days before the rash
begins, and for about four daysafter the rash begins. So they need
to be out of school for thatwhole period of time over a week,
in order to minimize the spread ofmeasles virus to other unvaccinated persons in the

(06:08):
school. We have most of thosecases that have been reported in the Florida
outbreaker. In Broward County. Therewas one reported in Polk County involving a
young adult. What are the differencesin the dangers or effects of coming down
with measles for children versus adults.So either children or adults who are infected

(06:30):
with measles can have some of thecomplications. We know that in older adults,
once they get beyond fifty years ofage, then they may have a
higher risk of complications. Overall,the complication rate of measles, it's not
really high, but maybe at onein a thousand people will develop a brain

(06:53):
infection with permanent neurologic problems afterward,and about one in a thousand people with
measles die of it. And soyou can't predict who is going to die
and who's going to develop the encephalitestbrain infection from measles. It just happens
sporadically. A lot of ground tocover, and we appreciate your input in

(07:14):
this and feel free if you'd liketo throw in any other message before we
wrap it up here about measles andvaccinations and you know public health, you
know, trying to control a measlesoutbreak is a bit complicated because by the
time you know a child has measles, they've already exposed a bunch of people

(07:34):
for several days, because measle's illnessstarts off with three days of coughing,
congestion and maybe some conjunctivideds redness ofthe eyes, which looks like a bunch
of other viral infections, and it'son the fourth day that they start to
develop the typical measles rash on theirface. So it's not until then that

(07:58):
they are likely to get diagnosed anyclinician. But they've already been exposing people
for days before the onset of therash. So then once that child is
diagnosed with measles, then you haveto backtrack and see who were they around
for the last four days and putthem in quarantine for three weeks, because

(08:20):
it can take up to three weeksfor the measles to develop in those people
who are exposed to the initial case. So you could see bunches of kids
being recommended to stay home for threeweeks, which is a big inconvenience to
their families. Mainly though that's goingto happen to kids who have not been
vaccinated, whereas the long quarantine willnot be recommended for fully vaccinated children.

(08:45):
Get a lot to cover and weappreciate your helping us to do that.
Doctor Juan Dumis is an infective infectant. Let me take that again, A
lot to cover and we thank youvery much for helping us cover it.
Doctor Juan du Mois, infectious diseasesspecialist at John's Hopkins All Children's Hospital in
Saint Petersburg, thank you very muchfor joining us on beyond the News.

(09:05):
You're very welcome.