Updates With The Experts

A vital part of our wellness is caring for and optimizing our own health which often means staying informed about things that can negatively impact our health and interventions for prevention of injury and disease. As they arise, THE WELL, will reach out to local experts to provide updates on current events and topics that can affect our health and well-being.

This month we interview Dr. Meghan Brett, UNMH's very own epidemiologist and infectious disease expert about the return of measles.

For those of us who haven’t dusted off our infectious disease notes in a few years, can you give us a quick refresher on measles as a pathogen? What is it? How is it spread?

"Measles is caused by the rubeola virus. It causes an acute respiratory viral illness which can be difficult to distinguish from others early on in its disease course. It has a typical incubation period of 7 to 10 days. Most often it starts with a high fever, malaise, cough, and runny nose. Two early clinical findings that can help distinguish it from other respirator viral infections is that people can have conjunctivitis and an enanthem (rash on mucous membranes which show up as gray spots on buccal mucosa). The early symptoms are then followed by a maculopapular rash. People are infectious from 4 days before the rash starts to 4 days after the rash starts."

To give people some perspective, how does the R0 for measles compare to things we are more familiar with like covid or flu?

"The R0 for viral infections indicates how many people a single person can infect. A person with influenza typically infects between 2 to 3 other people. A person with COVID-19 infection (omicron variant) can infect up to 6 other people. Measles is the most infectious virus with one person leading to 16 to 18 other infections."

Does measles still infect and cause symptoms in vaccinated persons?

"Measles can rarely cause infections in patients fully vaccinated against measles. High intensity exposure to a person with measles and longer time since last vaccine often play a role in breakthrough cases. For these breakthrough cases of measles, the infection most often is milder making it more difficult to identify. However, 9 out of 10 unvaccinated people who are exposed to measles go on to develop infection."

Do we know the current vaccination rate in Albuquerque? In New Mexico? Do we still have heard immunity levels sufficient to contain spread?

"As of 2021, 73% of New Mexico children from ages 19 to 35 months were up to date with expected vaccinations (including measles vaccination). This was on par with the U.S. national average. However, this can vary greatly by county. This vaccination rate has improved over time; however, 95% of the population needs to have immunity to stop the spread of measles."

At what age can people be vaccinated and how long after vaccination is it protective?

"Right now, the vaccination schedule for children includes 2 vaccines with the first at age 12 to 15 months of age and the second at 4 to 6 years old. Vaccination with 2 vaccines is 97% effective in preventing infection over a person’s lifetime."

Do we ever need our titers checked or need a booster?

"It depends upon if you work in healthcare or not. If you do not work in healthcare, then those adults born before 1957 are considered immune because measles infections were common. Anyone who works in healthcare, there are stricter criteria for determining if you’re immune or not: 1) written documentation of 2 doses of vaccine 2) laboratory evidence for immunity 3) previous documented history of measles infection. So, for those of us who work in healthcare, it’s important to know if you meet one of these criteria for measles immunity. Otherwise, no boosters are generally recommended."

Not to be a fear-mongerer, but what are the potential sequelae of measles that make prevention such a priority?

"Before vaccines were widely available, approximately 500,000 people developed measles annually in the US with 500 deaths and 48,000 hospitalizations; another 1,000 had brain damage from measles encephalitis (at a rate of 1 in 1,000 measles infections). Other concurrent symptoms include otitis media, bronchopneumonia, and diarrhea. Complications from measles include respiratory and other neurologic complications in about 1 to 3 out of 1,000 children. A rare (4 to 11 cases per 100,000 measles cases), but fatal degenerative disease of the CNS called subacute sclerosing panencephalitis (SSPE) can occur 7 to 10 years after infection."

With the ever changing state of our federal health agencies, what places should we turn to for up to date reliable information and updates on things like measles and bird flu?

"CDC still has reliable information about measles and measles vaccination. Another great resource is immunize.org that has answers to more specific questions related to vaccines. The New Mexico Department of Health continues to update information about the outbreak in southeastern New Mexico at least weekly and is heavily involved in responding to the outbreak with testing, contact tracing and offering vaccination."

Any take-away message that you would like to put across to the members of our department reading this about vaccines?

"Currently, Employee Occupational Health (EOHS) is making sure that faculty in highest risk departments (Emergency Medicine, Internal Medicine, Pediatrics and Family Medicine) have documented immunity to measles. This will likely expand over time so if you receive an email to clarify if you’re immune to measles, please respond. Otherwise, if you happen to suspect that a patient has measles based on clinical presentation and exposure risk, please see the resources that we have developed on Infection Prevention and Control’s website (accessed via the UNMH Intranet: either via the link in the “Clinical Toolbox” or under “Spotlights” >> Infection Prevention and Control >> Measles Resources (red button at top of the page). This includes a checklist for how to manage patients, who to contact and how to test for measles."

Thank you again to the marvelous Dr. Brett for her time!