May 2, 2025 • 32 mins
Measles isn't just a childhood rash—it's a potentially devastating illness that can reset your entire immune system. In this eye-opening conversation, our team explores why this ancient virus still demands our attention in 2025.
When we began recording this episode, a troubling measles outbreak was unfolding in Texas, with two unvaccinated children already having lost their lives. We dive into the history of this disease, tracing its evolution from cattle plague to human pathogen and explaining why the World Health Organization classifies it as one of the world's most contagious diseases.
What makes measles particularly dangerous isn't just its extraordinary transmissibility—it's a phenomenon called "immune amnesia." This lesser-known complication can erase your body's hard-earned immunity to other pathogens for up to three years after infection. Dr. Matt Dasco shares his firsthand clinical experiences treating measles patients, painting a vivid picture of why prevention is so crucial.
The good news? We have an exceptionally effective vaccine. The MMR (measles, mumps, rubella) vaccine provides 97% protection after two doses and confers lifetime immunity. Yet despite this medical marvel, vaccine hesitancy fueled by misinformation has allowed measles to stage a comeback after being declared eliminated in the US in 2000.
Our team doesn't shy away from addressing difficult questions about vaccine communication, acknowledging that building trust requires honest conversations about both benefits and risks. We explore why middle and high-income communities often experience higher vaccine hesitancy and how social media amplifies misinformation.
Whether you're concerned about current outbreaks, curious about infectious disease, or simply want to understand how to evaluate health information critically, this episode offers vital insights into protecting our communities from a preventable threat. Subscribe now to join our evidence-based conversation about the health challenges that affect us all.
Thanks for listening to the Infectious Science Podcast. Be sure to visit infectiousscience.org to join the conversation, access the show notes, and don’t forget to sign up for our newsletter to receive our free materials.
We hope you enjoyed this new episode of Infectious Science, and if you did, please leave us a review on Apple Podcasts and Spotify. Please share this episode with others who may be interested in this topic!
Also, please don’t hesitate to ask questions or tell us which topics you want us to cover in future episodes. To get in touch, drop us a line in the comment section or send us a message on social media.
Instagram @Infectscipod
Facebook Infectious Science Podcast
See you next time for a new episode!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:09):
This is a podcast about One Health the idea that
the health of humans, animals,plants and the environment that
we all share are intrinsicallylinked.
Speaker 2 (00:17):
Coming to you from the University of Texas Medical
Branch and the GalvestonNational Laboratory.
Speaker 1 (00:21):
This is Infectious Science.
Where enthusiasm for science?
Speaker 2 (00:25):
is contagious.
Speaker 1 (00:29):
Hello everybody, welcome to the Infectious
Science podcast.
This is Matt Dasho.
It's been a minute.
I'm here with my good friendsDr Dennis Benta, christina Rios
and Dr Camille Ledoux, who hasfinished her PhD since I was
last on the podcast.
So lots of advancements.
Today's topic, I think, isquite relevant.
(00:50):
It's always been relevant.
It's a topic that is onpeople's minds in global health
and public health for decadesand has come back to the news.
So we thought it's a reallygood opportunity for us to talk
a little bit about measles.
So welcome everybody.
Speaker 3 (01:07):
Yeah, thanks so much, welcome back.
Speaker 1 (01:10):
Thanks.
I'm glad you would have me.
I'm glad you let me back intothe club.
It sucks.
We're not in the podcast closet.
I'm here in San Antonio withyou guys and so thank you for
keeping my spot open on thecouch.
I appreciate it.
The virtual couch.
That's good times.
So, Camille, you want to kickus off.
Contextualize us a little bit.
Tell us a little bit aboutmeasles.
Speaker 5 (01:34):
Yeah, let's dive into measles.
Let's start with some history,because I think that's always a
good way to contextualize wherewe're at with infectious
diseases.
So the first written account ofmeasles was published by a
Persian doctor the ninth century, which is a little over a
thousand years ago.
So this is a disease that'sbeen with humanity for a long
time.
But it wasn't until 1954 thatthe causative agent of measles
was found to be a virus, andmeasles is specifically caused
(01:54):
by morbillivirus, and somorbillivirus is from the Latin
morbis, which means littleplague which I feel like is a
pretty cool name, so it's littleplague.
Speaker 3 (02:02):
It's a good nickname for somebody right?
Speaker 5 (02:04):
Yes, yes, I feel like if I was going to get another
cat or something, maybe likeMorbilovirus would be like a
solid name, like Little Plague.
Yes, yes, I agree, I agree.
So what's really interesting isthat Morbiloviruses are
responsible for rinderpest,which affected cattle.
It's one of the only diseaseswe have ever eliminated, which
(02:26):
is really neat.
And morbilloviruses also causedistemper in cats and dogs and
we vaccinate for distemper incats and dogs because it's so
often fatal.
And what's really interestingthat I didn't know when I was
diving into this is that thecurrent measles virus that
infects humans is suspected tohave branched off from the
cattle infecting rinderpestvirus about 1500 years ago.
But now measles is a humanadapted disease and it doesn't
(02:48):
have any known animal reservoirs.
But, as our resident vet on thevirtual couch of the podcast,
dr Bente, could you tell us alittle bit about rinderpest?
Speaker 3 (02:56):
For sure, dr Ledoux.
So rinderpest as a German Ishould say rinderpest, which is
a German word and thentranslated means cattle plague.
It's a highly, or was a highlycontagious viral disease and it
primarily affects hoofed animals, so cattle, buffalo, various
(03:17):
wild ungulates and so on, withfairly high mortality rates,
sometimes approaching 100% innaive populations.
And it was really.
It was a very devastatingdisease that shaped a lot of not
only the animal health andveterinary health, but it also
shaped trade and public health.
You can imagine that if you owna herd and so on, this was
(03:38):
devastating for your income.
So the clinical science ofrenner pest is it's
characterized by fever, oralerosions, nasal and ocular
discharge and severe diarrheaand dehydration, and that's
often leading to the deathwithin 10 to 14 days.
And the transmission occurs andwe'll talk more about the
(03:59):
measles transmission, but herethe transmission occurred
through the secretion ofcontaminated water, or maybe
even contaminated, or secretions, nasal secretions and so on and
maybe to a certain degree, alsothrough the aerosol
transmission.
Yeah, it's thought tooriginated from in Asia and
caused really like huge faminesand economic disruptions, and
(04:23):
has been eradicated.
The last confirmed case was in2001.
And so in 2011 was the seconddisease eradicated worldwide
after smallpox.
This, as Camille said earlier,it's very closely related to
measles and there's somesuggestion that it might have
diverged.
Measles diverged from Rhinopestaround like 600 BC.
(04:46):
That's the idea.
So that's all I got onRhinopest.
Speaker 5 (04:50):
Yeah, it's really interesting.
I always think it's really coolto talk about diseases that we
have eliminated, because that'sa very rare occurrence.
A little bit more on thehistory of it.
It became a notifiable diseasein the United States in 1912.
And that means doctors have toreport cases if they see a
measles case.
In the first decade of thismandatory reporting, around
6,000 measles-related deathswere reported In the decade
(05:13):
before a vaccine was available.
Us reporting suggests thatnearly all children caught the
virus that causes measles by thetime they were 15.
So if you think of somethingthat's really infecting a
population, that's prettysignificant.
Almost all kids by the timethey were 15 got measles before
we had a vaccine available.
So this was very much.
This disease has been with us along time but it's also been
(05:34):
really widely spread in apopulation and on average,
before we had a vaccine, threeto four million people were
infected each year in the UnitedStates, which is a pretty
staggering amount, and two tothree out of every 100 cases of
measles is known to result inbrain damage or death.
So if you start to think ofwhen you have up to three or
four million cases before we hada vaccine, that's potentially a
lot of morbidity and mortality.
(05:56):
But because of a really highlyeffective vaccine program,
measles was actually declaredeliminated in the United States
in 2000 because there was a12-month absence of the disease
spreading.
And this was really because ofherd immunity that occurs when a
sufficient portion of thepopulation is immune to a
disease and it basicallyprotects those who aren't immune
, maybe because they can't bevaccinated or something like
(06:18):
that.
And unfortunately, whilemeasles was declared eliminated
in the United States in 2000,it's no longer considered
declared eliminated, and that'sbecause vaccine hesitancy has
really led to a drop in herdimmunity in certain communities
and in those unvaccinatedpopulations, measles has once
again really arisen as asignificant health concern in
the United States.
(06:38):
So what I think is reallyinteresting about measles is
that, according to the WHO, it'sone of the world's most
contagious diseases, and so Ithink people often think of
contagious diseases as somethingthat we work with.
That's like people, or theythink like that, and we
oftentimes put on the backburner something that has
previously been eliminatedbecause we had a really good
vaccine program.
But I think people cansometimes forget about things
(06:59):
like measles that are socontagious and it's really
contagious because it's a virusthat aerosolizes and it remains
active and contagious in the airor on surfaces that are exposed
to infectious droplets thatsomeone who is sick has exhaled
or coughed out.
And what's really wild, just togive you some numbers on like
how contagious is measles if 10unvaccinated people walked into
(07:21):
a room where someone who hadmeasles was or had been in the
prior two hours, nine of themwould contract measles.
So nine out of 10 people whoare unvaccinated, who are
exposed, will contract.
And so, putting that furtherinto perspective, if you think
about something like COVID-19,which caused a lot of upheaval
and panic, the average number ofpeople that were infected by
(07:43):
someone who was sick with COVIDin a susceptible population was
like two to four other people.
But, in contrast, the averagenumber of people that are
infected by someone with measlesin a susceptible population is
12 to 18, which is much, muchhigher.
And it's really interestingbecause it causes some
unpleasant symptoms, right?
So measles in itself is notpleasant.
You can have fever, cough rash,it can potentially lead to
(08:05):
pneumonia, it can causeencephalitis which is going to
be inflammation of the brain.
But what I found reallyconcerning about measles I was
doing research on it was itsability to cause immune amnesia,
and so it can do that byessentially destroying your
immune memory from previousinfections.
So during infection, measles canreset the immune system, and
(08:28):
some studies that I was readingreally suggest that measles
basically does this by replacingits host old memory cells with
measles-specific white bloodcells known as lymphocytes, and
this results in people who havehad measles gaining a really
strong measles-specific immunity, which they could have gained
with a vaccine, while losingtheir immunity to other
pathogens.
And so this destruction ofimmune memory and replacement
with lymphocytes is unique tomeasles, and this immune amnesia
(08:51):
can last two to three yearsafter infection, which is a
really long time to essentiallybecome naive to other pathogens
that you might have been exposedto before and would not
necessarily have had a problemshaking off.
And so that really means thatpeople who you know get measles,
if and when they recover from ameasles infection, can be
vulnerable to other infectionsthat could result in death that
(09:12):
they might otherwise have beenimmune to.
So I think that that's anaspect that I don't often see
spoken of when we speak aboutmeasles is that it's not just
those clinical effects that yousee, that you'll see like a
fever and a rash, it's alsothere's this potential for you
to become naive on an immunelevel to other pathogens.
Speaker 1 (09:29):
Camille, can I ask you something about that?
I wanted to ask.
You had mentioned earlier thatmeasles has a much higher degree
of infectivity than otherviruses, let's say SARS-CoV-2.
And I remember when we weredealing with the COVID pandemic,
we were all talking aboutwearing masks and distancing and
a lot of that had to do withthere were factors that were
(09:51):
related to the virus, there werefactors that were related to
the environment and then therewere factors that were related
to the host.
So all of these areepidemiologic constructions the
infectivity, or how many peoplecan be infected by one person.
So these are all kind ofepidemiologic calculations that
people make based on all thesefactors.
(10:11):
In your reading did you come upwith what is it about the
measles that makes it so muchmore contagious?
Is it because it lasts longerin the environment?
Is it because it's smaller andcan stay suspended in the air
for longer?
Is it more durable to UVradiation or to wind or to solar
(10:31):
energy, like?
What is it about the measlesvirus that makes it more
transmissible in the samecondition that let's say, if you
had one person with COVID in aroom and you had another person
with measles in another room,that there would be more
infection from the measles?
Speaker 3 (10:47):
Maybe I can take that .
Speaker 5 (10:47):
I don't know, camille , did you want to say something
or did you come across somethingin your I know, anything that
aerosolizes and can hang in theair has the potential to infect
more people than somethingthat's like droplet that's going
to very quickly fall out of theair.
But feel free to.
Speaker 3 (11:01):
Yeah, no, that's absolutely true, right?
What droplet size it attachesto.
Like you said, camille, certainsizes will just fall down,
while others stay in the air fora longer period of time.
It's also how much virus isbeing shed from the body, and
when it's shed, we learnsometimes that certain diseases
are shed even before you havesigns, clinical signs, and
(11:24):
that's another thing.
And then it's also thesusceptibility of the host.
So where in the body can thevirus get in and then
immediately start replicating,and what dose is necessary to
replicate when measles hangingin the air for a long period of
time?
And then it maybe easily bindsto something in your mouth or in
your oropharynx and then isable to immediately infect some
(11:45):
of those cells.
So that's one of the thingsthat come together.
It's an envelope virus, so youwould expect that it's not
easily inactivated, but at thesame time it's just really good
at producing a lot of virusparticles and having them float
around on particles in the air.
Yeah.
Speaker 5 (12:01):
I think that's a great answer for that.
Matt, you have actually treatedpatients with measles, so can
you talk a bit about what doesthat look like in the clinic?
Because this is such acontagious disease?
How are these people treated?
Because from my understandingas I'm reading, there are things
you can do to treat measles,but it's really a lot of.
It is just supportive care.
There's not like a specifictreatment that we have for
(12:22):
measles.
We have a vaccine, but onceyou're infected we don't have
anything.
That's just.
This will help you get overmeasles.
Speaker 1 (12:27):
Yeah, absolutely, and I have treated people with
measles not in the United States, as when I lived in a Southern
African country called Botswanaand we had a measles outbreak
while I was living there.
But there was a period of timewhere I think in many countries
they were just doing single doseof the MMR vaccine and then
there were some catch-ups andthere was a little bit of delays
and so there was a measlesoutbreak and in Botswana it
(12:50):
happened to be paired with alsoa country that also was heavily
affected by the HIV pandemic.
So we saw people who were HIVinfected and non-HIV infected
who were suffering with measles,and we saw adults and children
that had the disease.
I'm not a pediatrician so Ididn't treat the children, but
actually in that setting theadult ward even 13, 14-year-olds
(13:12):
might be hospitalized in anadult ward.
So we did care for teenagerssuffering with measles and what
I can say is that it's a diseasethat I really wouldn't wish on
folks.
I think it's a veryuncomfortable disease if you're
sick enough to be hospitalized.
And again, it's notscaremongering, it's just it's
like any other condition.
If you have a way to prevent it, you'd really love to prevent
it, because once someone'sinfected with measles, there is
(13:34):
risk, as you mentioned, camille,that they progress to
developing pulmonary myelitis orencephalitis.
So it infects the brain tissuesthemselves and causes brain
swelling.
There's the risk of respiratoryfailure themselves and causes
brain swelling.
There's the risk of respiratoryfailure which necessitates
intubation and respiratorysupport, and of course there's
the risk of death right, whichwe would rather avoid if at all
(13:55):
possible.
So usually the incubationperiod from the time that you're
infected is anywhere from sevenup to 21 days, but usually
about two weeks is the rule ofthumb.
That you're exposed, then ittakes about two weeks from then
to develop the symptoms.
There's usually what people calla prodrome of the disease, so
it's the earliest signs beforepeople get the rash.
(14:16):
They get this prodrome, whichused to be called the four C's,
which aren't four C's, there'sactually three C's and a K, but
it's cough chorizaconjunctivitis and coplic spots.
So coplic spots are theselittle lesions that appear
inside the oral mucosa, theinside of the mouth, before the
measles lesions appear, and thenthey get the rash, which
(14:40):
usually looks like reddish spots.
They start as little spots butthen they become more broad and
join with each other.
They call that becomingconfluent.
It usually spreads down from theface down to the torso but
affects all parts of the body.
It can even infect mucousmembranes, which is very
uncomfortable.
So people can get on top of themeasles lesions they can get
(15:00):
super infections with other skininfections.
So that's never fun to dealwith either, and the
conjunctivitis was somethingthat I saw that was really very
uncomfortable for people.
As people think aboutconjunctivitis, oh, you just get
a little pink eye, but this waspink eye, but painful.
So the folks that were dealingwith conjunctivitis from measles
were really quite uncomfortable.
(15:20):
There's a lot of pus, there's alot of inflammation, it can
decrease the vision, and so itreally for me.
Actually I didn't see so manycases of encephalitis, though we
had maybe one or two, but I didsee a lot of conjunctivitis and
to the point where some ofthose lesions were getting super
infected and they neededantibiotics, and so it's just
one of those things where you'resick enough.
(15:40):
With measles.
It really is quiteuncomfortable, the risk is high,
and so generally it'sconsidered infectious from four
days before the lesions appearuntil four days after they
disappear, and people can have,depending on how their body
responds to it, it can go on forfive days.
Seven days can go up for acouple of weeks.
So it really just depends onhow people respond.
(16:02):
So takeaways on the clinical isthat my heart goes out to
people who are suffering withmeasles or who have been exposed
.
It's again.
It's something that has a verydiverse clinical course.
Some people have no symptoms atall, they just get a little
mild rash, and some people doprogress to having these more
severe manifestations and thoseare the ones that your heart
(16:23):
goes out for and you reallywould love to prevent that,
especially among kids, who wenever want to see our children
suffer, or anybody for thatmatter, but especially children.
I think that's why publichealth community, the medical
community, often really getsbehind vaccines, because that is
certainly the single mosteffective way to reduce
transmission in the community isthe safe and effective vaccine.
(16:44):
I'll say one last comment abouttreatments, one of the issues
we're always looking fortreatments for viruses, and
obviously there's lots ofrepurposed medications that make
the news and have made the newssince the pandemic.
We're always looking for cheapand effective ways to treat
viruses.
Those of us who treated COVID,we had high hopes for things
like ivermectin orhydroxychloroquine.
(17:05):
We would love something cheapthat was effective for treating
those things, and it's justunfortunate that those were
studied and were not shown to beeffective.
One of the things that is verycommonly given to people
infected with measles sufferingwith measles is vitamin A.
It's usually two doses 24 hoursapart, so it's not these
massive quantities of vitamin Athat people may take in
(17:25):
supplements.
It's a very carefullycalculated dose and it's done
because of the effects on theimmune system.
Like Camille mentioned, vitaminA is a fat-soluble vitamin.
It's converted in the body tosome very fundamental substances
that are used for your vision,for eyesight and the protection
of your immune system, so inyour gut wall and other
(17:46):
membranes.
So it's a very importantsubstance and we do give it as a
supplement for people infectedwith measles.
But most of those studies wereon places where vitamin A
deficiency is very common.
If you have vitamin Adeficiency, you have immune
deficiency by default, and sowhen you give vitamin A you make
the immune system stronger,especially in countries like
(18:08):
where I was living, wherepeople's immune systems may have
already been low for variousother reasons.
So in a country like ours,where vitamin A deficiency is
extremely rare, we sometimesstill do give vitamin A in the
clinical setting as part of theprotocol, but it's not nearly to
the doses that sometimes peopleare told to take.
They may read things online orread things in media about
taking a bunch of cod liver oilwhich contains a lot of vitamin
(18:30):
A, unregulated amounts ofvitamin A or vitamin A
supplements and actually vitaminA can induce a pretty severe
toxicity.
If you've ever had a child thattook Accutane or has put retin-A
on their pimples and you seetheir skin start to erupt and
that kind of thing get red andinflamed, that's what vitamin A
is doing.
Those are essentially retinoicacids and it's all to say that
(18:52):
it's a very broad clinicalpresentation.
It can have everything frommild manifestations to severe.
It's preventable by the vaccinewhich I know we're going to
talk about in a little bit, andthat while there's not any
specific anti-measlesanti-virals available, there is
a role for vitamin Asupplementation in small amounts
under a clinician's supervision.
(19:13):
So those are my main takeawaysfrom the clinical side.
Basically, take home is I wouldnot want my child to have a
measles infection.
Even if there's a possibilitythat it's mild, there's the
possibility that it's not and itcan cause severe neurologic
issues that last for a lifetime.
There are people who havepersistent seizures, persistent
respiratory problems because ofmeasles infections.
Speaker 4 (19:33):
Yeah, and I think also, matt, just adding to the
clinical presentation that youmentioned, it's important to
mention that measles issomething that is transmissible
in vitro from mom to baby, andso I think, when a lot of people
talk about infections andinfectivity, we don't tend to
think about congenital diseases,but congenital measles also is
(19:54):
something that's veryproblematic, at least from what
we've learned in class, and so Ithink it's always just
important to reflect on thepopulations that are at risk.
Yes, it's those that are alive,but it's also those with
impaired and weakened immunesystems, and it's also babies
right, neonates, and who don'treally have an immune system
aside from what they've gottenfrom their mom.
And it's just interesting tothink about how one disease can
(20:18):
manifest so differently, to thedegree of severity, in different
populations.
Speaker 5 (20:23):
I think that's an excellent point and I think
everything that you both havesaid it really highlights that
what we really want to do withsomething like measles because
it can be so severe, because itcan be so uncomfortable for
people is prevent it.
So I want to talk a bit aboutthe MMR vaccine.
The measles vaccine becameavailable in 1963.
So it's been with us for a verylong time and today the measles
(20:44):
vaccine is actually combinedwith the mumps and rubella
vaccines.
That's where you get MMR.
So measles, mumps, rubella.
Some people get an MMRV vaccineand that actually protects for
measles, mumps, rubella andvaricella.
So those are the common waysthat you're getting a measles
vaccine nowadays.
I personally had the MMR vaccinewhen I was a kid.
Everyone in my family has alsohad it, and so the CDC
(21:05):
recommends getting the firstdose when you're about 12 months
old, which is when I got mine.
According to my vaccine records.
I looked months old, which iswhen I got mine.
According to my vaccine records.
I looked and my second dose iswhen I was four years old,
before I started school, whichis also what it's recommended.
So what's great about thisvaccine and I can't stress this
enough, what's really cool aboutthis vaccine is that one dose
is 93% effective at preventingmeasles, and two doses is even
(21:27):
better.
It's 97% effective.
That's such a good vaccine andwhat's also really cool about
that is that the immunity issufficient through adulthood, so
once you're vaccinated formeasles, you never have to be
vaccinated for it again, unlikethe flu, which is really unique.
Having a dose of the measlesvaccine when I was 12 months old
and then when I was 4 and nowI'm 25 today it's still
effective and that's pretty coolto think about, because a lot
(21:49):
of vaccines you have to get abooster to think about.
Because a lot of vaccines youhave to get a booster.
You might've gotten COVIDboosters because things are
shifting, so you have to get aflu vaccine or whatever it is.
But to have a lifetime immunityor the potential for lifetime
immunity by getting vaccinated,is really unique.
Speaker 3 (22:01):
Camille, I just wanted to follow up on the
efficacy of the vaccine.
You're absolutely right, like93% for the first shot is really
good, really effective, andthen 97%, as you mentioned,
after the second shot.
But at the same time we alsoneed to mention, because it's so
contagious, right, the R0 is sohigh.
In order to achieve herdimmunity you have to have 95% of
(22:24):
the people vaccinated.
That might be slightlydifferent for other diseases, so
the lower the transmission andif it's less contagious, then
you probably don't need such ahigh vaccination rate or
coverage, but with measles itneeds to be 95, so quite high.
And the other thing that Ifound out when I was researching
this, which I think isinteresting, is that you can
(22:44):
also give the vaccinepost-exposure.
So if you know that somebodywas in the vicinity of somebody
infected, you can then stillvaccinate and reduce the
severity of the disease up to 72hours post exposure.
So that's a neat fact that youcan even use the vaccine not
even prior but also afterexposure, and it will show some
(23:07):
efficacy.
Speaker 5 (23:08):
Yeah, that's really cool.
Speaker 3 (23:09):
That's a really cool vaccine, and if you have so much
efficacy, then you can alsogive it post exposure and it's
got lifetime immunity.
Speaker 5 (23:13):
That's really cool.
That's a really cool vaccine Ifyou have so much efficacy and
then you can also give itpost-exposure and it's got
lifetime immunity.
That's really neat and it'sunique and it's hard to get a
vaccine.
That is that good.
I do want to talk about we'rein Texas.
We always talk about what'sgoing on in Texas or the Texas
connection for what we havegoing on, and so we're talking
about measles today.
I do want to talk about measlesin Texas because there's been
five US measles outbreaks thisyear, so in 2025.
(23:36):
Currently there is a measlesoutbreak in Texas.
It originated in a religiouscommunity that rejects vaccines.
Since the beginning of the yearand at the time of this
recording, which is thebeginning of April, 541 cases
have been identified in Texas.
So nearly all the cases haveoccurred of people who aren't
vaccinated, and it's estimatedthat about one in five people
(23:56):
infected in any outbreak willneed hospitalization and one in
20 will develop pneumonia.
And really sadly is that twofatalities have occurred in
Texas.
One was an unvaccinatedsix-year-old girl and another in
an unvaccinated eight-year-oldgirl.
So two school-aged childrenthat weren't vaccinated
(24:16):
contracted measles and thenpassed away, which is never
something you want to hear aboutin the news or you want to see,
because these things arepreventable, and so I think
that's.
Speaker 4 (24:21):
Yeah, I think it's important to compare those
numbers to what we've had in thepast.
So literally just comparing itto 2024 cases, according to the
CDC, there was a total of 285cases and the majority of those
cases of measles was childrenunder five years old.
So once again looking towardsvaccination status, apparently
89% of the population that didacquire measles last year were
(24:45):
either unvaccinated or theirvaccination status was unknown.
So just comparing, is that forthe whole?
Speaker 1 (24:51):
US.
Speaker 4 (24:52):
Yeah.
So comparing the numbers lastyear to, we're only in month
four of 2025 and we're alreadydoubled, or almost doubled that.
That's a pretty significantjump.
Speaker 5 (25:01):
Yeah for sure, and I think a big contributor to this
is vaccine hesitancy, sosomething I think you see a lot
on in the news.
I was really curious to get tothe bottom of what is
potentially really causing this.
So I think a big reason whywe're seeing the rise that we do
see right now is vaccinehesitancy.
I'm always curious as to what'sdriving something like vaccine
hesitancy as someone who'sinterested in public health and
(25:23):
interested in kind of theinterconnected health of
communities.
So I found a systematic reviewwas published in 2023, and it
suggests that the most citedreason for MMR hesitancy is
based on misinformation.
So parents were afraid thattheir children would be at risk
of autism which is a debunkedmyth if they received the MMR
vaccine.
And, in addition, vaccinehesitancy to MMR and other
(25:45):
childhood vaccines was reallylocalized to middle and high
income areas, in mothers withcollege level or higher
education, who preferred orinternet or social media
narratives over physician-basedvaccine information.
And so I think that's importantto note because, as we
previously discussed in our lastepisode, which was on
misinformation anddisinformation and infodemiology
, social media is used by 90% ofAmericans as a source of health
(26:09):
information.
So how we talk about thesethings matters and I think
having access to what iscurrently going on in the
current outbreaks, without theother kind of feedback that can
cloud those narratives, is alsoreally important, and that's
part of the reason we want tomake this episode.
Speaker 1 (26:22):
I appreciate that, camille, and I think it's good
you touched on it.
I think in science, our echochamber is one in which I think
we don't always fully understandwe have this great, safe and
effective thing, why is it notbeing used?
And then we find out that, okay, it's because of misinformation
, and I do agree.
I think it's very hard.
I've spent a lot of time in thecommunity over the last year
(26:43):
here in South Texas and what Ihear from people in the
community is that it's very hardto decipher what is reliable
information and what ismisleading information or
misinformation, because I thinkin general, we have to start
with the assumption that peoplewant to be healthy and they want
the best possible health forthemselves and for their
community, and one of the issuesis that in science and health,
(27:08):
I think we have historicallyapproached these things as
givens.
Listen, if we recommend avaccine, people should just get
it right, and people have realquestions and some of them have
to do with its associated risksand what they've heard about.
I always tell people when I'mhaving an individual patient
conversation about a vaccine Isay nothing is without a
(27:28):
potential complication, both theones we know and the ones we
don't know.
What we know is that we haveliterally decades of experience
with this one and we can prettysafely say what the risks are.
If we don't tell someone thatthere's a very small risk of
febrile seizures after the MMRvaccine, and then we give them
the MMR vaccine and the kid hasa febrile seizure, they're going
to say I'm never vaccinating mykid against anything again
(27:49):
because you told me that it wasall going to be okay.
So I think we have to be veryclear with both patients and
with communities about the risks, the balance of risks, and I
think there's a lot of work tobe done and I appreciate spaces
like this on the podcast to tryto provide people with
information that they can useand that they can use when
they're trying to sort of reasonthrough these very complicated
(28:12):
decisions.
I think people don't know whatto trust and where to get their
information.
What they get fed to them isactually very scary and I think
if we don't acknowledge howscary it is some of the
information that people getabout even what we now consider
routine vaccines, and we don'tacknowledge and appreciate that
fear, we potentially alienatepeople even more right.
(28:34):
So I think your point is welltaken that hesitancy is playing
a huge role.
We're seeing declining levelsof immunity in the population in
general.
It's been falling for severalyears, but I think the only way
we're going to see a restorationof faith and trust is by deep
engagement with the communityand listening and trying to
understand what the concerns are.
(28:55):
So your points are well taken.
The CDC continues to have good,reliable information.
The World Health Organizationcontinues to have good, reliable
information.
It takes nothing for someone tomake a TikTok or a YouTube or
even a podcast.
It takes two turntables and amicrophone.
That's all it takes.
I'm dating myself, aren't I onthat reference, but it doesn't
take much right.
So I tell people that in sciencewe have to constantly be
(29:19):
questioning and making sure thatwe're making the right
recommendations for people.
So when we come out and we sayman measles vaccine is safe and
effective, it's not becausewe're pushing an agenda.
It's actually because we reallycare and we want to see people
live the most healthy lifepossible.
Speaker 3 (29:32):
Yeah, I absolutely agree, matt, and I think for me
that's the key or the take-homemessage of this episode, right A
?
We as doctors, as physicians,scientists and so on, we need to
do a better job communicatingthis.
What's the risk of a vaccine?
It's not completely without anyrisk, right, but it's way, way,
far less than the disease, andI don't think we often do a good
(29:54):
job explaining that.
So I think we have to tell thepeople there could be a risk of
one in a hundred thousandvaccines.
That might be some side effects, but with a disease it's a
numbers game and when I talk topeople, I feel like it's always
seen as black and white, right,like you take the vaccine and it
always gives you side effects.
And that's not true.
It's much more detailed thanthat and we have to be better at
(30:17):
communicating that.
Speaker 5 (30:18):
I really appreciate both of you saying that.
I think that was really whatdrove me to conceptualize this
episode is I think there's somuch nuance and it's hard to
communicate nuance when thedriving thing is what's going to
give me clicks, and so I thinkthat's a very real thing.
And I also just want to add apersonal note.
I started drafting this episodeafter I had a conversation with
my brother about having my nieceget her second measles vaccine
(30:41):
a little bit early, becausethere was an outbreak nearby
where they lived, and so that'show this started is we're people
and we care about thecommunities that we're in, and
we want people to have access togood information.
So that was really my goal withthis, but it's always such a
pleasure to get to join and sitdown with the podcast team and
just chat about this.
I always learn so much and Ialways feel like it makes me
hopeful for where we're movingforward with health and science,
(31:02):
because there are so many goodpeople working for it and we do
have such brilliant, diversehuman communities.
And I think disease is always apart of that, but so is the
support and the resources andthe people coming out of the
woodwork to try and help, and soI think that's also part of
what the study of infectiousdiseases looks like.
That's what health care lookslike.
So thanks for sitting down withus and thanks for listening to
(31:24):
this episode.
We really appreciate it.
Speaker 2 (31:27):
Thanks for listening to the Infectious Science
podcast.
Be sure to hit subscribe andvisit infectiousscienceorg to
join the conversation, accessthe show notes and to sign up
for our newsletter and receiveour free materials.
Speaker 1 (31:38):
If you enjoyed this new episode of Infectious
Science, please leave us areview on Apple Podcasts and
Spotify, and go ahead and sharethis episode with some of your
friends.
Speaker 2 (31:47):
Also, don't hesitate to ask questions and tell us
what topics you'd like us tocover for future episodes.
To get in touch, drop a line inthe comments section or send us
a message on social media.
Speaker 1 (31:56):
So we'll see you next time for a new episode, and in
the meantime, stay happy stayhealthy, stay interested.
Thank you.
This is a podcast about One Health the idea that
the health of humans, animals,plants and the environment that
we all share are intrinsicallylinked.
Speaker 2 (00:17):
Coming to you from the University of Texas Medical
Branch and the GalvestonNational Laboratory.
Speaker 1 (00:21):
This is Infectious Science.
Where enthusiasm for science?
Speaker 2 (00:25):
is contagious.
Speaker 1 (00:29):
Hello everybody, welcome to the Infectious
Science podcast.
This is Matt Dasho.
It's been a minute.
I'm here with my good friendsDr Dennis Benta, christina Rios
and Dr Camille Ledoux, who hasfinished her PhD since I was
last on the podcast.
So lots of advancements.
Today's topic, I think, isquite relevant.
(00:50):
It's always been relevant.
It's a topic that is onpeople's minds in global health
and public health for decadesand has come back to the news.
So we thought it's a reallygood opportunity for us to talk
a little bit about measles.
So welcome everybody.
Speaker 3 (01:07):
Yeah, thanks so much, welcome back.
Speaker 1 (01:10):
Thanks.
I'm glad you would have me.
I'm glad you let me back intothe club.
It sucks.
We're not in the podcast closet.
I'm here in San Antonio withyou guys and so thank you for
keeping my spot open on thecouch.
I appreciate it.
The virtual couch.
That's good times.
So, Camille, you want to kickus off.
Contextualize us a little bit.
Tell us a little bit aboutmeasles.
Speaker 5 (01:34):
Yeah, let's dive into measles.
Let's start with some history,because I think that's always a
good way to contextualize wherewe're at with infectious
diseases.
So the first written account ofmeasles was published by a
Persian doctor the ninth century, which is a little over a
thousand years ago.
So this is a disease that'sbeen with humanity for a long
time.
But it wasn't until 1954 thatthe causative agent of measles
was found to be a virus, andmeasles is specifically caused
(01:54):
by morbillivirus, and somorbillivirus is from the Latin
morbis, which means littleplague which I feel like is a
pretty cool name, so it's littleplague.
Speaker 3 (02:02):
It's a good nickname for somebody right?
Speaker 5 (02:04):
Yes, yes, I feel like if I was going to get another
cat or something, maybe likeMorbilovirus would be like a
solid name, like Little Plague.
Yes, yes, I agree, I agree.
So what's really interesting isthat Morbiloviruses are
responsible for rinderpest,which affected cattle.
It's one of the only diseaseswe have ever eliminated, which
(02:26):
is really neat.
And morbilloviruses also causedistemper in cats and dogs and
we vaccinate for distemper incats and dogs because it's so
often fatal.
And what's really interestingthat I didn't know when I was
diving into this is that thecurrent measles virus that
infects humans is suspected tohave branched off from the
cattle infecting rinderpestvirus about 1500 years ago.
But now measles is a humanadapted disease and it doesn't
(02:48):
have any known animal reservoirs.
But, as our resident vet on thevirtual couch of the podcast,
dr Bente, could you tell us alittle bit about rinderpest?
Speaker 3 (02:56):
For sure, dr Ledoux.
So rinderpest as a German Ishould say rinderpest, which is
a German word and thentranslated means cattle plague.
It's a highly, or was a highlycontagious viral disease and it
primarily affects hoofed animals, so cattle, buffalo, various
(03:17):
wild ungulates and so on, withfairly high mortality rates,
sometimes approaching 100% innaive populations.
And it was really.
It was a very devastatingdisease that shaped a lot of not
only the animal health andveterinary health, but it also
shaped trade and public health.
You can imagine that if you owna herd and so on, this was
(03:38):
devastating for your income.
So the clinical science ofrenner pest is it's
characterized by fever, oralerosions, nasal and ocular
discharge and severe diarrheaand dehydration, and that's
often leading to the deathwithin 10 to 14 days.
And the transmission occurs andwe'll talk more about the
(03:59):
measles transmission, but herethe transmission occurred
through the secretion ofcontaminated water, or maybe
even contaminated, or secretions, nasal secretions and so on and
maybe to a certain degree, alsothrough the aerosol
transmission.
Yeah, it's thought tooriginated from in Asia and
caused really like huge faminesand economic disruptions, and
(04:23):
has been eradicated.
The last confirmed case was in2001.
And so in 2011 was the seconddisease eradicated worldwide
after smallpox.
This, as Camille said earlier,it's very closely related to
measles and there's somesuggestion that it might have
diverged.
Measles diverged from Rhinopestaround like 600 BC.
(04:46):
That's the idea.
So that's all I got onRhinopest.
Speaker 5 (04:50):
Yeah, it's really interesting.
I always think it's really coolto talk about diseases that we
have eliminated, because that'sa very rare occurrence.
A little bit more on thehistory of it.
It became a notifiable diseasein the United States in 1912.
And that means doctors have toreport cases if they see a
measles case.
In the first decade of thismandatory reporting, around
6,000 measles-related deathswere reported In the decade
(05:13):
before a vaccine was available.
Us reporting suggests thatnearly all children caught the
virus that causes measles by thetime they were 15.
So if you think of somethingthat's really infecting a
population, that's prettysignificant.
Almost all kids by the timethey were 15 got measles before
we had a vaccine available.
So this was very much.
This disease has been with us along time but it's also been
(05:34):
really widely spread in apopulation and on average,
before we had a vaccine, threeto four million people were
infected each year in the UnitedStates, which is a pretty
staggering amount, and two tothree out of every 100 cases of
measles is known to result inbrain damage or death.
So if you start to think ofwhen you have up to three or
four million cases before we hada vaccine, that's potentially a
lot of morbidity and mortality.
(05:56):
But because of a really highlyeffective vaccine program,
measles was actually declaredeliminated in the United States
in 2000 because there was a12-month absence of the disease
spreading.
And this was really because ofherd immunity that occurs when a
sufficient portion of thepopulation is immune to a
disease and it basicallyprotects those who aren't immune
, maybe because they can't bevaccinated or something like
(06:18):
that.
And unfortunately, whilemeasles was declared eliminated
in the United States in 2000,it's no longer considered
declared eliminated, and that'sbecause vaccine hesitancy has
really led to a drop in herdimmunity in certain communities
and in those unvaccinatedpopulations, measles has once
again really arisen as asignificant health concern in
the United States.
(06:38):
So what I think is reallyinteresting about measles is
that, according to the WHO, it'sone of the world's most
contagious diseases, and so Ithink people often think of
contagious diseases as somethingthat we work with.
That's like people, or theythink like that, and we
oftentimes put on the backburner something that has
previously been eliminatedbecause we had a really good
vaccine program.
But I think people cansometimes forget about things
(06:59):
like measles that are socontagious and it's really
contagious because it's a virusthat aerosolizes and it remains
active and contagious in the airor on surfaces that are exposed
to infectious droplets thatsomeone who is sick has exhaled
or coughed out.
And what's really wild, just togive you some numbers on like
how contagious is measles if 10unvaccinated people walked into
(07:21):
a room where someone who hadmeasles was or had been in the
prior two hours, nine of themwould contract measles.
So nine out of 10 people whoare unvaccinated, who are
exposed, will contract.
And so, putting that furtherinto perspective, if you think
about something like COVID-19,which caused a lot of upheaval
and panic, the average number ofpeople that were infected by
(07:43):
someone who was sick with COVIDin a susceptible population was
like two to four other people.
But, in contrast, the averagenumber of people that are
infected by someone with measlesin a susceptible population is
12 to 18, which is much, muchhigher.
And it's really interestingbecause it causes some
unpleasant symptoms, right?
So measles in itself is notpleasant.
You can have fever, cough rash,it can potentially lead to
(08:05):
pneumonia, it can causeencephalitis which is going to
be inflammation of the brain.
But what I found reallyconcerning about measles I was
doing research on it was itsability to cause immune amnesia,
and so it can do that byessentially destroying your
immune memory from previousinfections.
So during infection, measles canreset the immune system, and
(08:28):
some studies that I was readingreally suggest that measles
basically does this by replacingits host old memory cells with
measles-specific white bloodcells known as lymphocytes, and
this results in people who havehad measles gaining a really
strong measles-specific immunity, which they could have gained
with a vaccine, while losingtheir immunity to other
pathogens.
And so this destruction ofimmune memory and replacement
with lymphocytes is unique tomeasles, and this immune amnesia
(08:51):
can last two to three yearsafter infection, which is a
really long time to essentiallybecome naive to other pathogens
that you might have been exposedto before and would not
necessarily have had a problemshaking off.
And so that really means thatpeople who you know get measles,
if and when they recover from ameasles infection, can be
vulnerable to other infectionsthat could result in death that
(09:12):
they might otherwise have beenimmune to.
So I think that that's anaspect that I don't often see
spoken of when we speak aboutmeasles is that it's not just
those clinical effects that yousee, that you'll see like a
fever and a rash, it's alsothere's this potential for you
to become naive on an immunelevel to other pathogens.
Speaker 1 (09:29):
Camille, can I ask you something about that?
I wanted to ask.
You had mentioned earlier thatmeasles has a much higher degree
of infectivity than otherviruses, let's say SARS-CoV-2.
And I remember when we weredealing with the COVID pandemic,
we were all talking aboutwearing masks and distancing and
a lot of that had to do withthere were factors that were
(09:51):
related to the virus, there werefactors that were related to
the environment and then therewere factors that were related
to the host.
So all of these areepidemiologic constructions the
infectivity, or how many peoplecan be infected by one person.
So these are all kind ofepidemiologic calculations that
people make based on all thesefactors.
(10:11):
In your reading did you come upwith what is it about the
measles that makes it so muchmore contagious?
Is it because it lasts longerin the environment?
Is it because it's smaller andcan stay suspended in the air
for longer?
Is it more durable to UVradiation or to wind or to solar
(10:31):
energy, like?
What is it about the measlesvirus that makes it more
transmissible in the samecondition that let's say, if you
had one person with COVID in aroom and you had another person
with measles in another room,that there would be more
infection from the measles?
Speaker 3 (10:47):
Maybe I can take that .
Speaker 5 (10:47):
I don't know, camille , did you want to say something
or did you come across somethingin your I know, anything that
aerosolizes and can hang in theair has the potential to infect
more people than somethingthat's like droplet that's going
to very quickly fall out of theair.
But feel free to.
Speaker 3 (11:01):
Yeah, no, that's absolutely true, right?
What droplet size it attachesto.
Like you said, camille, certainsizes will just fall down,
while others stay in the air fora longer period of time.
It's also how much virus isbeing shed from the body, and
when it's shed, we learnsometimes that certain diseases
are shed even before you havesigns, clinical signs, and
(11:24):
that's another thing.
And then it's also thesusceptibility of the host.
So where in the body can thevirus get in and then
immediately start replicating,and what dose is necessary to
replicate when measles hangingin the air for a long period of
time?
And then it maybe easily bindsto something in your mouth or in
your oropharynx and then isable to immediately infect some
(11:45):
of those cells.
So that's one of the thingsthat come together.
It's an envelope virus, so youwould expect that it's not
easily inactivated, but at thesame time it's just really good
at producing a lot of virusparticles and having them float
around on particles in the air.
Yeah.
Speaker 5 (12:01):
I think that's a great answer for that.
Matt, you have actually treatedpatients with measles, so can
you talk a bit about what doesthat look like in the clinic?
Because this is such acontagious disease?
How are these people treated?
Because from my understandingas I'm reading, there are things
you can do to treat measles,but it's really a lot of.
It is just supportive care.
There's not like a specifictreatment that we have for
(12:22):
measles.
We have a vaccine, but onceyou're infected we don't have
anything.
That's just.
This will help you get overmeasles.
Speaker 1 (12:27):
Yeah, absolutely, and I have treated people with
measles not in the United States, as when I lived in a Southern
African country called Botswanaand we had a measles outbreak
while I was living there.
But there was a period of timewhere I think in many countries
they were just doing single doseof the MMR vaccine and then
there were some catch-ups andthere was a little bit of delays
and so there was a measlesoutbreak and in Botswana it
(12:50):
happened to be paired with alsoa country that also was heavily
affected by the HIV pandemic.
So we saw people who were HIVinfected and non-HIV infected
who were suffering with measles,and we saw adults and children
that had the disease.
I'm not a pediatrician so Ididn't treat the children, but
actually in that setting theadult ward even 13, 14-year-olds
(13:12):
might be hospitalized in anadult ward.
So we did care for teenagerssuffering with measles and what
I can say is that it's a diseasethat I really wouldn't wish on
folks.
I think it's a veryuncomfortable disease if you're
sick enough to be hospitalized.
And again, it's notscaremongering, it's just it's
like any other condition.
If you have a way to prevent it, you'd really love to prevent
it, because once someone'sinfected with measles, there is
(13:34):
risk, as you mentioned, camille,that they progress to
developing pulmonary myelitis orencephalitis.
So it infects the brain tissuesthemselves and causes brain
swelling.
There's the risk of respiratoryfailure themselves and causes
brain swelling.
There's the risk of respiratoryfailure which necessitates
intubation and respiratorysupport, and of course there's
the risk of death right, whichwe would rather avoid if at all
(13:55):
possible.
So usually the incubationperiod from the time that you're
infected is anywhere from sevenup to 21 days, but usually
about two weeks is the rule ofthumb.
That you're exposed, then ittakes about two weeks from then
to develop the symptoms.
There's usually what people calla prodrome of the disease, so
it's the earliest signs beforepeople get the rash.
(14:16):
They get this prodrome, whichused to be called the four C's,
which aren't four C's, there'sactually three C's and a K, but
it's cough chorizaconjunctivitis and coplic spots.
So coplic spots are theselittle lesions that appear
inside the oral mucosa, theinside of the mouth, before the
measles lesions appear, and thenthey get the rash, which
(14:40):
usually looks like reddish spots.
They start as little spots butthen they become more broad and
join with each other.
They call that becomingconfluent.
It usually spreads down from theface down to the torso but
affects all parts of the body.
It can even infect mucousmembranes, which is very
uncomfortable.
So people can get on top of themeasles lesions they can get
(15:00):
super infections with other skininfections.
So that's never fun to dealwith either, and the
conjunctivitis was somethingthat I saw that was really very
uncomfortable for people.
As people think aboutconjunctivitis, oh, you just get
a little pink eye, but this waspink eye, but painful.
So the folks that were dealingwith conjunctivitis from measles
were really quite uncomfortable.
(15:20):
There's a lot of pus, there's alot of inflammation, it can
decrease the vision, and so itreally for me.
Actually I didn't see so manycases of encephalitis, though we
had maybe one or two, but I didsee a lot of conjunctivitis and
to the point where some ofthose lesions were getting super
infected and they neededantibiotics, and so it's just
one of those things where you'resick enough.
(15:40):
With measles.
It really is quiteuncomfortable, the risk is high,
and so generally it'sconsidered infectious from four
days before the lesions appearuntil four days after they
disappear, and people can have,depending on how their body
responds to it, it can go on forfive days.
Seven days can go up for acouple of weeks.
So it really just depends onhow people respond.
(16:02):
So takeaways on the clinical isthat my heart goes out to
people who are suffering withmeasles or who have been exposed
.
It's again.
It's something that has a verydiverse clinical course.
Some people have no symptoms atall, they just get a little
mild rash, and some people doprogress to having these more
severe manifestations and thoseare the ones that your heart
(16:23):
goes out for and you reallywould love to prevent that,
especially among kids, who wenever want to see our children
suffer, or anybody for thatmatter, but especially children.
I think that's why publichealth community, the medical
community, often really getsbehind vaccines, because that is
certainly the single mosteffective way to reduce
transmission in the community isthe safe and effective vaccine.
(16:44):
I'll say one last comment abouttreatments, one of the issues
we're always looking fortreatments for viruses, and
obviously there's lots ofrepurposed medications that make
the news and have made the newssince the pandemic.
We're always looking for cheapand effective ways to treat
viruses.
Those of us who treated COVID,we had high hopes for things
like ivermectin orhydroxychloroquine.
(17:05):
We would love something cheapthat was effective for treating
those things, and it's justunfortunate that those were
studied and were not shown to beeffective.
One of the things that is verycommonly given to people
infected with measles sufferingwith measles is vitamin A.
It's usually two doses 24 hoursapart, so it's not these
massive quantities of vitamin Athat people may take in
(17:25):
supplements.
It's a very carefullycalculated dose and it's done
because of the effects on theimmune system.
Like Camille mentioned, vitaminA is a fat-soluble vitamin.
It's converted in the body tosome very fundamental substances
that are used for your vision,for eyesight and the protection
of your immune system, so inyour gut wall and other
(17:46):
membranes.
So it's a very importantsubstance and we do give it as a
supplement for people infectedwith measles.
But most of those studies wereon places where vitamin A
deficiency is very common.
If you have vitamin Adeficiency, you have immune
deficiency by default, and sowhen you give vitamin A you make
the immune system stronger,especially in countries like
(18:08):
where I was living, wherepeople's immune systems may have
already been low for variousother reasons.
So in a country like ours,where vitamin A deficiency is
extremely rare, we sometimesstill do give vitamin A in the
clinical setting as part of theprotocol, but it's not nearly to
the doses that sometimes peopleare told to take.
They may read things online orread things in media about
taking a bunch of cod liver oilwhich contains a lot of vitamin
(18:30):
A, unregulated amounts ofvitamin A or vitamin A
supplements and actually vitaminA can induce a pretty severe
toxicity.
If you've ever had a child thattook Accutane or has put retin-A
on their pimples and you seetheir skin start to erupt and
that kind of thing get red andinflamed, that's what vitamin A
is doing.
Those are essentially retinoicacids and it's all to say that
(18:52):
it's a very broad clinicalpresentation.
It can have everything frommild manifestations to severe.
It's preventable by the vaccinewhich I know we're going to
talk about in a little bit, andthat while there's not any
specific anti-measlesanti-virals available, there is
a role for vitamin Asupplementation in small amounts
under a clinician's supervision.
(19:13):
So those are my main takeawaysfrom the clinical side.
Basically, take home is I wouldnot want my child to have a
measles infection.
Even if there's a possibilitythat it's mild, there's the
possibility that it's not and itcan cause severe neurologic
issues that last for a lifetime.
There are people who havepersistent seizures, persistent
respiratory problems because ofmeasles infections.
Speaker 4 (19:33):
Yeah, and I think also, matt, just adding to the
clinical presentation that youmentioned, it's important to
mention that measles issomething that is transmissible
in vitro from mom to baby, andso I think, when a lot of people
talk about infections andinfectivity, we don't tend to
think about congenital diseases,but congenital measles also is
(19:54):
something that's veryproblematic, at least from what
we've learned in class, and so Ithink it's always just
important to reflect on thepopulations that are at risk.
Yes, it's those that are alive,but it's also those with
impaired and weakened immunesystems, and it's also babies
right, neonates, and who don'treally have an immune system
aside from what they've gottenfrom their mom.
And it's just interesting tothink about how one disease can
(20:18):
manifest so differently, to thedegree of severity, in different
populations.
Speaker 5 (20:23):
I think that's an excellent point and I think
everything that you both havesaid it really highlights that
what we really want to do withsomething like measles because
it can be so severe, because itcan be so uncomfortable for
people is prevent it.
So I want to talk a bit aboutthe MMR vaccine.
The measles vaccine becameavailable in 1963.
So it's been with us for a verylong time and today the measles
(20:44):
vaccine is actually combinedwith the mumps and rubella
vaccines.
That's where you get MMR.
So measles, mumps, rubella.
Some people get an MMRV vaccineand that actually protects for
measles, mumps, rubella andvaricella.
So those are the common waysthat you're getting a measles
vaccine nowadays.
I personally had the MMR vaccinewhen I was a kid.
Everyone in my family has alsohad it, and so the CDC
(21:05):
recommends getting the firstdose when you're about 12 months
old, which is when I got mine.
According to my vaccine records.
I looked months old, which iswhen I got mine.
According to my vaccine records.
I looked and my second dose iswhen I was four years old,
before I started school, whichis also what it's recommended.
So what's great about thisvaccine and I can't stress this
enough, what's really cool aboutthis vaccine is that one dose
is 93% effective at preventingmeasles, and two doses is even
(21:27):
better.
It's 97% effective.
That's such a good vaccine andwhat's also really cool about
that is that the immunity issufficient through adulthood, so
once you're vaccinated formeasles, you never have to be
vaccinated for it again, unlikethe flu, which is really unique.
Having a dose of the measlesvaccine when I was 12 months old
and then when I was 4 and nowI'm 25 today it's still
effective and that's pretty coolto think about, because a lot
(21:49):
of vaccines you have to get abooster to think about.
Because a lot of vaccines youhave to get a booster.
You might've gotten COVIDboosters because things are
shifting, so you have to get aflu vaccine or whatever it is.
But to have a lifetime immunityor the potential for lifetime
immunity by getting vaccinated,is really unique.
Speaker 3 (22:01):
Camille, I just wanted to follow up on the
efficacy of the vaccine.
You're absolutely right, like93% for the first shot is really
good, really effective, andthen 97%, as you mentioned,
after the second shot.
But at the same time we alsoneed to mention, because it's so
contagious, right, the R0 is sohigh.
In order to achieve herdimmunity you have to have 95% of
(22:24):
the people vaccinated.
That might be slightlydifferent for other diseases, so
the lower the transmission andif it's less contagious, then
you probably don't need such ahigh vaccination rate or
coverage, but with measles itneeds to be 95, so quite high.
And the other thing that Ifound out when I was researching
this, which I think isinteresting, is that you can
(22:44):
also give the vaccinepost-exposure.
So if you know that somebodywas in the vicinity of somebody
infected, you can then stillvaccinate and reduce the
severity of the disease up to 72hours post exposure.
So that's a neat fact that youcan even use the vaccine not
even prior but also afterexposure, and it will show some
(23:07):
efficacy.
Speaker 5 (23:08):
Yeah, that's really cool.
Speaker 3 (23:09):
That's a really cool vaccine, and if you have so much
efficacy, then you can alsogive it post exposure and it's
got lifetime immunity.
Speaker 5 (23:13):
That's really cool.
That's a really cool vaccine Ifyou have so much efficacy and
then you can also give itpost-exposure and it's got
lifetime immunity.
That's really neat and it'sunique and it's hard to get a
vaccine.
That is that good.
I do want to talk about we'rein Texas.
We always talk about what'sgoing on in Texas or the Texas
connection for what we havegoing on, and so we're talking
about measles today.
I do want to talk about measlesin Texas because there's been
five US measles outbreaks thisyear, so in 2025.
(23:36):
Currently there is a measlesoutbreak in Texas.
It originated in a religiouscommunity that rejects vaccines.
Since the beginning of the yearand at the time of this
recording, which is thebeginning of April, 541 cases
have been identified in Texas.
So nearly all the cases haveoccurred of people who aren't
vaccinated, and it's estimatedthat about one in five people
(23:56):
infected in any outbreak willneed hospitalization and one in
20 will develop pneumonia.
And really sadly is that twofatalities have occurred in
Texas.
One was an unvaccinatedsix-year-old girl and another in
an unvaccinated eight-year-oldgirl.
So two school-aged childrenthat weren't vaccinated
(24:16):
contracted measles and thenpassed away, which is never
something you want to hear aboutin the news or you want to see,
because these things arepreventable, and so I think
that's.
Speaker 4 (24:21):
Yeah, I think it's important to compare those
numbers to what we've had in thepast.
So literally just comparing itto 2024 cases, according to the
CDC, there was a total of 285cases and the majority of those
cases of measles was childrenunder five years old.
So once again looking towardsvaccination status, apparently
89% of the population that didacquire measles last year were
(24:45):
either unvaccinated or theirvaccination status was unknown.
So just comparing, is that forthe whole?
Speaker 1 (24:51):
US.
Speaker 4 (24:52):
Yeah.
So comparing the numbers lastyear to, we're only in month
four of 2025 and we're alreadydoubled, or almost doubled that.
That's a pretty significantjump.
Speaker 5 (25:01):
Yeah for sure, and I think a big contributor to this
is vaccine hesitancy, sosomething I think you see a lot
on in the news.
I was really curious to get tothe bottom of what is
potentially really causing this.
So I think a big reason whywe're seeing the rise that we do
see right now is vaccinehesitancy.
I'm always curious as to what'sdriving something like vaccine
hesitancy as someone who'sinterested in public health and
(25:23):
interested in kind of theinterconnected health of
communities.
So I found a systematic reviewwas published in 2023, and it
suggests that the most citedreason for MMR hesitancy is
based on misinformation.
So parents were afraid thattheir children would be at risk
of autism which is a debunkedmyth if they received the MMR
vaccine.
And, in addition, vaccinehesitancy to MMR and other
(25:45):
childhood vaccines was reallylocalized to middle and high
income areas, in mothers withcollege level or higher
education, who preferred orinternet or social media
narratives over physician-basedvaccine information.
And so I think that's importantto note because, as we
previously discussed in our lastepisode, which was on
misinformation anddisinformation and infodemiology
, social media is used by 90% ofAmericans as a source of health
(26:09):
information.
So how we talk about thesethings matters and I think
having access to what iscurrently going on in the
current outbreaks, without theother kind of feedback that can
cloud those narratives, is alsoreally important, and that's
part of the reason we want tomake this episode.
Speaker 1 (26:22):
I appreciate that, camille, and I think it's good
you touched on it.
I think in science, our echochamber is one in which I think
we don't always fully understandwe have this great, safe and
effective thing, why is it notbeing used?
And then we find out that, okay, it's because of misinformation
, and I do agree.
I think it's very hard.
I've spent a lot of time in thecommunity over the last year
(26:43):
here in South Texas and what Ihear from people in the
community is that it's very hardto decipher what is reliable
information and what ismisleading information or
misinformation, because I thinkin general, we have to start
with the assumption that peoplewant to be healthy and they want
the best possible health forthemselves and for their
community, and one of the issuesis that in science and health,
(27:08):
I think we have historicallyapproached these things as
givens.
Listen, if we recommend avaccine, people should just get
it right, and people have realquestions and some of them have
to do with its associated risksand what they've heard about.
I always tell people when I'mhaving an individual patient
conversation about a vaccine Isay nothing is without a
(27:28):
potential complication, both theones we know and the ones we
don't know.
What we know is that we haveliterally decades of experience
with this one and we can prettysafely say what the risks are.
If we don't tell someone thatthere's a very small risk of
febrile seizures after the MMRvaccine, and then we give them
the MMR vaccine and the kid hasa febrile seizure, they're going
to say I'm never vaccinating mykid against anything again
(27:49):
because you told me that it wasall going to be okay.
So I think we have to be veryclear with both patients and
with communities about the risks, the balance of risks, and I
think there's a lot of work tobe done and I appreciate spaces
like this on the podcast to tryto provide people with
information that they can useand that they can use when
they're trying to sort of reasonthrough these very complicated
(28:12):
decisions.
I think people don't know whatto trust and where to get their
information.
What they get fed to them isactually very scary and I think
if we don't acknowledge howscary it is some of the
information that people getabout even what we now consider
routine vaccines, and we don'tacknowledge and appreciate that
fear, we potentially alienatepeople even more right.
(28:34):
So I think your point is welltaken that hesitancy is playing
a huge role.
We're seeing declining levelsof immunity in the population in
general.
It's been falling for severalyears, but I think the only way
we're going to see a restorationof faith and trust is by deep
engagement with the communityand listening and trying to
understand what the concerns are.
(28:55):
So your points are well taken.
The CDC continues to have good,reliable information.
The World Health Organizationcontinues to have good, reliable
information.
It takes nothing for someone tomake a TikTok or a YouTube or
even a podcast.
It takes two turntables and amicrophone.
That's all it takes.
I'm dating myself, aren't I onthat reference, but it doesn't
take much right.
So I tell people that in sciencewe have to constantly be
(29:19):
questioning and making sure thatwe're making the right
recommendations for people.
So when we come out and we sayman measles vaccine is safe and
effective, it's not becausewe're pushing an agenda.
It's actually because we reallycare and we want to see people
live the most healthy lifepossible.
Speaker 3 (29:32):
Yeah, I absolutely agree, matt, and I think for me
that's the key or the take-homemessage of this episode, right A
?
We as doctors, as physicians,scientists and so on, we need to
do a better job communicatingthis.
What's the risk of a vaccine?
It's not completely without anyrisk, right, but it's way, way,
far less than the disease, andI don't think we often do a good
(29:54):
job explaining that.
So I think we have to tell thepeople there could be a risk of
one in a hundred thousandvaccines.
That might be some side effects, but with a disease it's a
numbers game and when I talk topeople, I feel like it's always
seen as black and white, right,like you take the vaccine and it
always gives you side effects.
And that's not true.
It's much more detailed thanthat and we have to be better at
(30:17):
communicating that.
Speaker 5 (30:18):
I really appreciate both of you saying that.
I think that was really whatdrove me to conceptualize this
episode is I think there's somuch nuance and it's hard to
communicate nuance when thedriving thing is what's going to
give me clicks, and so I thinkthat's a very real thing.
And I also just want to add apersonal note.
I started drafting this episodeafter I had a conversation with
my brother about having my nieceget her second measles vaccine
(30:41):
a little bit early, becausethere was an outbreak nearby
where they lived, and so that'show this started is we're people
and we care about thecommunities that we're in, and
we want people to have access togood information.
So that was really my goal withthis, but it's always such a
pleasure to get to join and sitdown with the podcast team and
just chat about this.
I always learn so much and Ialways feel like it makes me
hopeful for where we're movingforward with health and science,
(31:02):
because there are so many goodpeople working for it and we do
have such brilliant, diversehuman communities.
And I think disease is always apart of that, but so is the
support and the resources andthe people coming out of the
woodwork to try and help, and soI think that's also part of
what the study of infectiousdiseases looks like.
That's what health care lookslike.
So thanks for sitting down withus and thanks for listening to
(31:24):
this episode.
We really appreciate it.
Speaker 2 (31:27):
Thanks for listening to the Infectious Science
podcast.
Be sure to hit subscribe andvisit infectiousscienceorg to
join the conversation, accessthe show notes and to sign up
for our newsletter and receiveour free materials.
Speaker 1 (31:38):
If you enjoyed this new episode of Infectious
Science, please leave us areview on Apple Podcasts and
Spotify, and go ahead and sharethis episode with some of your
friends.
Speaker 2 (31:47):
Also, don't hesitate to ask questions and tell us
what topics you'd like us tocover for future episodes.
To get in touch, drop a line inthe comments section or send us
a message on social media.
Speaker 1 (31:56):
So we'll see you next time for a new episode, and in
the meantime, stay happy stayhealthy, stay interested.
Thank you.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.