Measles is Back: What You Need to Know Now

There are more than 100 confirmed cases of measles in Texas. Measles spreads incredibly fast in children and adults. Ron Cook, D.O., TTUHSC Chief Health Officer, is our guest for this episode. He answers our questions about symptoms, how it spreads, whether or not adults are safe and what we can do to protect ourselves and others from getting sick.

Transcript

Melissa Whitfield  0:09 
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. There is currently an outbreak of measles in West Texas, and what makes this alarming is that measles spreads incredibly fast in children and adults. Dr Ron Cook, TTUHSC Chief Health Officer is our guest for this episode. Dr Cook answers all our questions about symptoms, how it spreads, whether or not adults are safe, and what we can do to protect ourselves and others from getting sick.

Melissa Whitfield  0:52 
Dr Cook, thanks for coming back on our podcast.

Dr. Ron Cook  0:58 
You bet, my pleasure.

Melissa Whitfield  0:59 
Can you remind our listeners a little bit about yourself?

Dr. Ron Cook  1:03 
So I'm Ron Cook. I am the Chief Health Officer for the Health Sciences Center, working with Dr Rice Spearman in the president's office. I'm also the Health Authority for the city of Lubbock, which means anything that's going on down there I'm part of. I'm medical director for the clinic that we have down there. And also the Health Authority, which is all the public health related activities that we do down there.

Melissa Whitfield  1:26 
Well, thanks for coming on our podcast, and you're here today to talk to us about measles. There's an outbreak not very far from here. Can you tell us what? What are measles? What is measles? And why are we talking about it now?

Dr. Ron Cook  1:37 
We're talking about it now because as of yesterday, we have 107 cases, and we're investigating about 50 more of those, so some of those will be positive. So we're concerned. And measles is such an infectious virus, it's of the family called the Morbillivirus, morbidity, mortality, morbidity means illness, and so they call it the Morbillivirus, and that's the scientific name. So it's a very highly infectious virus that was pretty much isolated and removed from patients or people population that we didn't see it anymore, but we'd have one or two that would crop up, usually from international travel. But now we've had an outbreak, it's probably going to be the nation's my prediction will be one of the nation's largest outbreaks in recent history, in the last 20 years.

Melissa Whitfield  2:30 
How does it spread?

Dr. Ron Cook  2:31 
It is spread by respiratory droplet, coughing and being in the same room as somebody coughing and sneezing and blowing their nose. It's respiratory droplet, and it's very infectious, one of the highest. It has the highest infectious rate of any virus that we know. Maybe Polio might be a little higher, and we saw the devastating effects to Polio. But this one is just as high, if not higher, than Polio. We would say, if you come in a room this size, and there's 100 people in this room, 80 to 90% of those individuals could be infected if they've never seen the virus before, or have been treated or have been vaccinated. That's how infectious it is, and it hangs around in that room for a couple of hours. So somebody new coming into that room, even though that person is gone, could still be infected from that virus because it's floating around in the air.

Melissa Whitfield  3:24 
What are the symptoms? And are there any treatments?

Dr. Ron Cook  3:27 
So the symptoms are high fever, and then what we call the three C's, cough, coryza and conjunctivitis. So cough, coryza means runny nose and conjunctivitis, the red, inflamed, runny eyes, conjunctivitis, so those three C's, and then this high fever of really 103 104 fever in some individuals, pretty high. And then you get a rash a few days later, after you start those symptoms. And then that rash usually starts at the head, on top of the face, on top of this gap and works its way down through the body.

Melissa Whitfield  4:04 
How is it prevented? And I know it's controversial, but are vaccines safe? And I know some older people among my age are wondering, is there a booster we should take, and is there anyone who should not get a vaccine?

Dr. Ron Cook  4:16 
So the vaccine is very, very safe. It has been around more than 50 years, and we've given it billions of doses probably. There was two iterations back in the 60s, there was the first iteration of the vaccine, and then in late 60s, another iteration came out, a new iteration, and if you have had two doses of that vaccine, you are considered immunized, and it's a lifelong immunity. But let me add a little caveat here, two things we never say in medicine. We never say never, and we never say always. And so there will be some people's immunity who wanes, but that's usually less than 1% and so if you've had two doses, you're considered you're going to have about a 98% immunity. That leaves 2% but 98% immunity against this virus, and it's usually life long.

Melissa Whitfield  5:12 
Is there anyone who shouldn't get a vaccine?

Dr. Ron Cook  5:15 
Those that are immunocompromised and if you're pregnant, you should not get this vaccine. If you're taking a drug that suppresses your immune system, say you've had a transplant, you've had a liver transplant or a kidney transplant, you need to talk to your transplant person, your transplant team, and ask them if it's safe for you to take this vaccine. And then, if you're pregnant, we wouldn't give you this vaccine. So here's here's something in your favor. If you've been pregnant in the last 30 years at least, we tested you for a different type of measles called Rubella. Now the vaccine that we give is called MMR, measles, mumps and rubella. Measles is Rubeola, the one you don't want to get the measles you don't want to get while you're pregnant, is called Rubella, because it can cause problems with the growing baby inside of you. It causes some birth defects, even death. Now, so there's confusion between Rubeola and Rubella. What we're talking about this outbreak now is Rubeola. So there's two kinds of measles. They sound very close to the same, but if you've been pregnant in the last 30 years, we have checked your level of immunity against Rubella, and if you weren't immune to Rubella, we gave you another vaccine, MMR, another dose of the MMR, upon your discharge from the hospital. So that included another dose of Rubeola, the first m in measles, mumps and rubella. So if you've had a baby in the last 30 years, chances are we've checked your titer to rubella, and if it was not high enough, we gave you another MMR, so you're immune to Rubeola, so you may have had three doses or more. If you've had international travel, most travel physicians or travel clinics would advise you to get an MMR before you go overseas, somewhere, especially into a community that may not have the immune rate that that we have the vaccination rate that we have here in the United States against MMR.

Melissa Whitfield  7:24 
Well, that's, that's quite a relief to me, but there are some who have not had babies. So can adults get measles? And is it as severe in adults as it is in children?

Dr. Ron Cook  7:34 
Well, it's, it's severe. The only case of measles that I ever saw was in a classmate my first year of medical school, one of my classmates came down with measles. He had not received any doses of the MMR growing up, and so he came down with measles and missed three weeks of medical school because he was that sick. And we have a picture in our medical school yearbook of him at home, laying on his couch recuperating from getting the measles. Guy was pretty sick, and so you're going to feel pretty terrible. Now in children, it's typically worse just because they have smaller airways and inflammation. And smaller airways goes much farther, and you can be much sicker, and you have greater chance of having low oxygen levels, you can get pneumonia, and that's really what we're seeing with those that are hospitalized. I think we've had around 17 hospitalized already sent in our in our community. Now this this outbreak, is not necessarily in our community, but it's in the surrounding community in Gaines County, where those individuals come to Lubbock for their health care. We've had one case in Lubbock from a known ER exposure, and so that person was not part of that community in Gaines County, but this individual was in a waiting room where another individual with measles being seen, and that individual came down with measles. It's very infectious. Very infectious.

Melissa Whitfield  9:03 
So we heard a lot about herd immunity during the COVID 19 pandemic. Is herd immunity applicable to the measles?

Dr. Ron Cook  9:11 
Well, let's define herd immunity. Herd immunity is we'll call it cattle, right? Because it's a herd, and if you have one calf that's born and it doesn't have immunity to everything else around it, those cattle that surround it help protect, gives it a layer of insulation from those individuals that may come in and potentially give the virus. It has to go through several people to get to that calf. That's what I was talking about. How this virus is so infectious, you almost have to have in that room with 100 people 98% immunity. So that one individual that's in the middle of the room doesn't get it. So we don't have that, especially in Gaines County, where it was 40 to 60% vaccination rate. In Lubbock, I think I saw numbers for our our kindergarten classes are around 90% 80 to 90% so that's good, and different different groups in those have varying numbers, but our numbers in our schools are pretty high. And so herd immunity, it takes a lot to get to herd immunity. For measles, for flu, pretty low, but for measles, has to be really high

Melissa Whitfield  10:31 
If someone has chicken pox. Now this is me going back to when I was a child, and I remember my mother warning us around the spring that chicken pox is coming up. But if someone has chicken pox, does that mean that they're safe from measles?

Dr. Ron Cook  10:44 
No, that's a completely different virus. That's Varicella Zoster, and this is the measles virus, Rubeola morbilla virus, and so they don't cross one little caveat. Here's my never say, never, never say, always. There is a measles, mumps, rubella and varicella, MMRV, so if you've had that vaccine, you may be immune to chicken pox. Most adults in my age group have had chicken pox, but we have been giving out varicella vaccine in children for many years. So most kids are immune today to chicken pox. If, if you don't know your immune titer for measles, or immune titer, which is a level of antibody to that disease, you can talk to your primary care physician say, I don't think I've ever had chicken pox. I don't think I've ever had the measles. Talk to your primary care physician or your primary care provider, and talk to them about getting a blood level to see if you have antibodies, that's what your body makes against these viruses, to see if you've had exposure. Have had it. For example, my oldest son came down with chicken pox, and my youngest son only had we can only find one pock mark on his on his body when he was young, and I worried for a long time that he didn't have immunity to chicken box. Well, as as the years went by, there was an opportunity for us to do a blood test on him. I said, can we add a varicella titer? And we did, and he had immunity, so I didn't have to worry about it too much. So you can, you can get a titer for Rubeola. You can get a titer for Rubella. You can get a titer for Varicella too.

Melissa Whitfield  12:28 
Is there anything else you'd like to add?

Dr. Ron Cook  12:30 
Yeah, most adults are worried well, most adults in that in those same scenarios that I painted, if, if you've had a child, if you've had two doses of the vaccine, or if you're a front line in health care, we usually require that you get a third dose just to boost your immunity. But for the most part, most adults born before 1957 have had it. Those born after 1957 probably either had it or had two doses of the MMR. So most people, most adults, don't need a booster, but that's a conversation you should have with your primary care provider.

Melissa Whitfield  13:13 
Well, thank you so much for coming on our podcast.

Dr. Ron Cook  13:15 
My pleasure.

Melissa Whitfield  13:16 
And relieving our anxiety about the measles. Can't wait to have you back on.

Dr. Ron Cook  13:21 
My pleasure, anytime.

Melissa Whitfield  13:24 
Thank you for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.