Minnesota public health expert explains measles symptoms and prevention

NINA MOINI: It's been 25 years since the US declared it eliminated measles. But one of the worst outbreaks since then is spreading through rural Texas and New Mexico this month. For now, it isn't a threat to most Americans, but public health experts are alarmed at the outbreak. Measles is very contagious and can cause death or long term effects like brain damage.

So what's causing measles to come back with such force? Dr. Alison Galdys is here to explain. She's a professor at the University of Minnesota Medical School and infectious disease physician with M Health Fairview. Thanks so much for your time today, doctor.

ALISON GALDYS: Thanks so much for having me to talk about this important topic.

NINA MOINI: Absolutely. So this outbreak in Texas and New Mexico right now, and Minnesota had seen a smaller outbreak last fall. It was understood that measles was basically gone from the US at the turn of this century. What happened?

ALISON GALDYS: I think a lot of factors converged to land us at the position we're at now. Chiefly in the last five years there has been ripples of effects due to the COVID pandemic. COVID really changed how we deliver health care and delayed health care for a lot of individuals.

And one of the delays that we saw was in children staying up to date on their vaccine series. So both in the US, in other continents, Europe, for example, is reporting unprecedented numbers of measles cases this year. A lot of that recent increase is attributed to delayed or absent vaccination in our children, who are the primary targets of our vaccine series.

In addition, there's just been an unfortunate wave of vaccine hesitancy that predates the COVID pandemic, and we're seeing rates of full vaccine receipt fall. Meaning in our children and adults, we're seeing fewer and fewer numbers of people being fully up to date on their vaccine series.

We have many infections that are vaccine preventable and measles is a key infection that is vaccine preventable. We have a very effective vaccine that works against measles. So really the numbers that we're seeing are definitely attributable to the lack of vaccine coverage in our health population.

NINA MOINI: And why is measles so particularly concerning? It's very contagious, can you tell us a little bit about it?

ALISON GALDYS: It's extremely contagious. It is regarded as probably the most, if not one of the most contagious pathogens that affects humans. It is a high number of exposed individuals will develop illness. Usually that number is regarded as potentially 5, 10, 15 people, if they're in a crowded area, will develop measles infection if they're exposed.

The other important thing about measles virus is that it can linger in the environment. So sometimes in order for a pathogen to be transmitted from one person to another, direct contact is necessary. But the measles virus can actually linger in the environment, and there have been studies documenting acquisition of measles virus from someone who vacated a room within the previous two hours.

So it's a hearty virus that's highly transmissible and it causes a lot of symptoms. Cough, eye symptoms, and those symptoms are in part what enable the virus to transmit itself.

NINA MOINI: And what are some of the longer term effects that you've seen result from measles?

ALISON GALDYS: I am fortunate, I've been in practice for about 15 years. And as you alluded to previously, we did not see measles infections until the more recent years. So I'm fortunate that I have not seen long term sequelae. It is important to know that particularly neurologic side effects can be observed even months to years after initial infection.

These are not benign, progressive neurologic decline such that individuals are no longer to live independently. Those are more rare, but an important outcome to consider. It is also worth mentioning that the acute phase of measles, anyone who's infected with the measles virus feels miserable. They have high fever.

Many will develop pneumonia, 10% to 20% will require hospitalization due to the severity of their symptoms. And in the acute phase of measles, actually individuals who become infected become more prone to infections with other germs. So an individual with measles might subsequently develop pneumonia from a different germ like a bacteria. So it is a highly impactive virus.

NINA MOINI: Is that part of the challenge, doctor, that when something hasn't been around for a while, trying to convey to people just how serious it can be?

ALISON GALDYS: That really is a challenge. Many providers who are currently in practice have seen measles only seldom in their career or perhaps have never seen acute measles. The other thing that's challenging is the symptoms are fever, cough, eye symptoms, oftentimes a rash, although not all patients with measles will get a rash.

So measles really can mimic a lot of the other infections that present particularly during our winter respiratory seasons, but really all season long.

NINA MOINI: How long does the vaccine protect someone? Are you concerned about different age groups, perhaps older people who were vaccinated long ago, or are you mainly concerned with children?

ALISON GALDYS: Really, children are the key focus of our vaccine campaign. Really the epidemiology, particularly in Texas, demonstrates that children are at highest risk for acquiring infection. As I mentioned previously, the measles vaccine is extremely effective.

There are a subset of adults who may have received a prior version when the measles vaccine was released in the 1960s. The current vaccine product that we utilize is slightly different from that product that we utilized in the '60s. But really since that time, the vaccine has remained effective.

NINA MOINI: Doctor, what's your concern level with this Texas and New Mexico outbreak in terms of it's spreading beyond, their state borders? Because you did mention, children and perhaps because they're at school, they're at such a high risk but we know that things can spread. We saw during the COVID pandemic and with COVID even now, how things can continue to spread, what's your concern level right now?

ALISON GALDYS: That's a great question. So I really have to take my hat off to our public health authorities, particularly state-based. Last year our measles outbreak in Minnesota was sizable. But I think the response was really impressive in containing that outbreak to a level that really it could have grown much further.

Similar public health interventions are underway in both Texas and New Mexico. So I feel that the risk to the general public related to those particular outbreaks is low at this time. However, there are daily reports of individuals, particularly returned travelers.

There are recent reports from Pennsylvania, Michigan, that imported cases from areas where measles is even more active or will be in an ongoing way for measles to spread in the US.

NINA MOINI: Before we let you go, doctor, what do you think should be done or what are you seeing done by perhaps public health experts or individual doctors and providers to do anything differently to communicate to the public about vaccines and the effectiveness in the current climate that we're in for measles and other things?

ALISON GALDYS: First I think is just awareness, making patients, children, and their families aware of vaccine recommendations. Families are busy, reaching out to families who have family members who are not up to date on their measles vaccines. And then really delving into questions that relate to concerns about the measles vaccine.

The measles vaccine is extremely safe. It's extremely effective. Understandably, sometimes families may have questions about the safety of the measles vaccine for themselves or their family members. I think those concerns are important to address.

Because it's been in the media of late, there was a previous link between measles vaccine and autism. And it's worth noting that the scientist who raised that concern actually had all of his science basically rejected from the journal which it was published in. And subsequent studies have not found any linkage between measles vaccine and autism.

In fact, measles virus infection is much more associated with rare neurologic events. So I think it is important when there are safety concerns to ask and then discuss and then present the evidence that really confirms the safety and efficacy of the measles vaccine.

NINA MOINI: Dr. Galdys, thanks so much for your time. I really appreciate it.

ALISON GALDYS: Thank you very much.

NINA MOINI: That was doctor Alison Galdys, professor at the University of Minnesota Medical School and infectious disease physician with M Health Fairview.