A leading infectious diseases specialist at Jackson Health speaks about measles, how it spreads and what people can do to stay protected after the state's first case of the year was reported last week in Miami-Dade.
“Before 1968, there was an inactive vaccine, which wasn't as effective and people used to just get one dose, but the newer vaccines are very effective,” said Dr. Jyoti Somani, the health system's associate medical director of infection prevention and antimicrobial stewardship.
“This was eradicated in 2000 in the U.S.,” she said. “So it's kind of like we're going back in time, just because people don't want to get the vaccine, which is quite sad.”
However, even post-exposure vaccination can be effective at curbing severe effects from the virus, according to Somani.
“If you get a vaccine within three days of exposure, that actually really reduces your risk of getting measles or at least getting a severe case,” she said. “So that's known as post exposure prophylaxis with the vaccine.”
Health experts across the country agree that the measles, mumps and rubella (MMR) vaccine is the leading preventative measure for measles.
No new cases have been reported at Miami’s Palmetto Senior High School after one student last week was diagnosed with the highly contagious disease.
Miami-Dade County Public Schools Superintendent Jose L. Dotres told reporters last week that Palmetto High had a vaccine rate of 99.7%.
The case, however, drew public and media attention in the wake of an outbreak in rural West Texas that has infected over 200 people and led to a child’s death.
The conversation with Somani was edited for clarity and brevity.
WLRN: What is measles, and how is it spread?
SOMANI: Measles is a virus. Actually, it’s one of our most contagious viruses, and it's spread via respiratory droplets. So, you know, people coughing or if you have a runny nose, it can spread through that through droplets from your nose and also airborne transmission.
The actual droplets that you cough out are super small, so they can travel long distances. So when that's the case, we call it airborne transmission because it can travel more than 6 feet, and the particles can remain suspended in the air for up to two hours.
How many people can one person potentially infect if they do contract the disease?
Right, so people may remember this from the beginning of COVID when everyone talked about the R0, which is sort of like what is the number that one person can spread if they're all unvaccinated. And for measles it's 18. The average is probably about 15, but up to 18 people can be infected from one person.
And what are the symptoms, and what should people look out for?
Often, you just start with non-specific symptoms like a fever; you can have a headache, but often you also get kind of red, watery eyes, a runny nose, a sore throat, a cough. So, those are non-specific symptoms, we call it the prodromal stage. So, those are your first symptoms, and you may not think necessarily about measles because there's no rash at that point.
The rash may start after about three or four days of the fever, and the rash starts usually at the hairline. It's on the face, you may not notice it at the hairline, but certainly by the time you notice it, it would be on the face already; and then it travels downward to your trunk your arms your legs. The rash is usually not itchy and doesn't usually hurt, but it can be kind of sandpaper-like. Those are the main things that you would see or experience.
What are the health risks, and how do they differ in children, teenagers and adults?
So the highest risk of getting sick and getting complications of measles are in children less than the age of 1. They can get pneumonias …. (and) the infection can go into their brain. The other high-risk group is pregnant women, mainly because it can also affect the fetus. And then finally are the immunocompromised patients, which can include the very elderly because the immune system is not strong. So then the virus can also, in those cases, cause pneumonia and cause more severe disease.
So what are some of the preventative measures for the disease?
The biggest prevention is vaccination. Amazingly, the measles vaccine is highly effective. The efficacy from one dose is 93% and two doses is 97%. The problem is they're attenuated live vaccines, meaning they're kind of weakened vaccines, but they're live, so we can't really give them to immunocompromised patients, patients who've had a transplant, who are on lots of medications like steroids or other medicines for autoimmune disease. We can't really give it to those patients. So, usually what we do in those cases is we counsel those high-risk patients who can't get the vaccine or can't get a booster. We counsel them to make sure their family members are vaccinated. And that way they don't bring it home and expose them.
And beyond vaccination, what kinds of steps can students and educators in school settings take to mitigate their risks?
Being in small areas increases the risk. So, if you happen to be in a dorm and then, you know, in a small room and there's a lot of people or in a party indoors, and there's a case of measles, that's pretty high risk. So, it is better to be outside where there's a lot of air exchanges, or not gather in big groups in a closed-in space.
So what's the likelihood of infection in people that do have full immunization?
Very, very, very low. In fact, if we know they're vaccinated, we probably wouldn't even suspect measles or test for it.
The only exception would be if you were vaccinated and now you're on treatment where your immune system is really compromised. You could lose your antibody titers — your protection against the virus.
Information from the Associated Press was used in this report.
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