Latest / Culture Positive: An Infection Prevention Podcast / Measles: Eliminated Until It Wasn't
Transcript
- Ally: Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each week, We'll dive into healthcare stories, public health conversations, workplace realities, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. I was talking with one of my childhood friends the other day, just checking in on each other and yapping about new stuff we have going on. She has a beautiful baby boy and told me that her pediatrician was recommending early MMR shots since the state she lives in is experiencing an increase in cases of measles. At this time, that really could be any state in the US. We are just over halfway through 2026, and the CDC has reported more cases of measles than any other year since 1991. As of July 23rd, 2026, 2,318 confirmed cases of measles have been reported in the United States with numerous outbreaks recorded. What is measles? How did we get here? And where do we currently stand? Let's get into it. Measles, also called rubiola, is a very contagious viral illness that can affect both children and adults. Measles is known for the distinct rash, coplic spots, and high fevers. Symptoms of measles typically present around 7 to 14 days after the last exposure to the virus. The initial symptoms are high fever, as high as 105, cough. runny nose, and watery eyes. About two to three days after those initial symptoms is when Coplex spots may appear. Coplex spots are small white lesions that appear on the inside of the cheeks. the Coblex spots typically appear two to three days before the body rash develops. The rash typically starts at the hairline and face and then works its way down the entire body, moving from the trunk to the limbs and feet. The rash has raised bumps along with blotchy red skin. A tricky thing about measles is when someone starts to become infectious. A person with measles can spread the virus four days before the rash appears and four days after. For recovery from measles, most children get better with no lasting effects. However, measles can lead to serious complications or even death. Complications of measles are middle ear infection. That may lead to hearing loss, pneumonia, diarrhea, and infection of the brain, also known as encephalitis. Measles is one of the most contagious diseases humans have ever faced. This disease can be traced back to as early as the 9th century. A Persian physician noted the difference between smallpox and measles, and in so many words said, Measles was more dreaded than smallpox. It became more widespread as global movement and trade increased in the sixteenth century. In 1757, Scottish Dr. Francis Holm discovered that measles was caused by a pathogen. Keep in mind, this was the 1700s, so his study probably wouldn't get approved today. Dr. Holm transmitted the disease to healthy individuals using the blood of infected patients. This way he was able to demonstrate that measles was indeed an infectious agent. In 1954, there was a measles outbreak at a boarding school just outside of Boston, Massachusetts. Doctors at Boston Children's Hospital took throat swabs and blood samples from infected students in hopes that they would be able to isolate the virus itself. A culture collected by Dr. Thomas Pebbles on an 11-year-old schoolboy, David Edmondson. led to doctors being able to create the first vaccine against measles. Fun fact the strain that was used to develop the measles vaccine is called the Edmondson B strain, named after that eleven year old schoolboy. The measles vaccine was trialed on thousands of children in New York City and Nigeria. The vaccine was reported to be a hundred percent effective, and in nineteen sixty-three it was licensed for public use. In nineteen seventy one, the MMR vaccine became available, which combines vaccines for measles, mumps, and rubella. In the year 2000, measles was declared eliminated from the United States. Let me say that again. Eliminated from the United States. This means there was no continuous spread of measles for greater than 12 months. The declaration of elimination of measles can be attributed to having such an effective vaccination program at that time. Things are looking very different from where we were in 2000. And a large part of that is vaccine hesitancy. We have seen a steady decrease of vaccine compliance across the United States. Data from CDC found that 92.5% of kindergartners in the US were vaccinated against measles, mumps, and rubella for the 2024-2025 school year. For herd immunity, we need to be at 95% to prevent an outbreak or epidemic. Herd immunity is when enough people in a community become immune to a disease so it can no longer spread quite as easily. This can happen through vaccination or prior infection, but when talking about children and measles, this happens through vaccination. The MMR vaccine is so effective. In fact, it's ninety-seven percent effective in preventing measles when you complete the full schedule of two doses. Herd immunity also protects vulnerable people who are immunocompromised or cannot receive vaccines. When looking at kindergartners for the 2024-2025 school year, we are below the mark of herd immunity by 2.5%. So it's no surprise that we are seeing outbreaks of measles occurring as we speak. The U.S. has experienced several major measles outbreaks under Health Secretary Robert F. Kennedy Jr., who has zero experience and background in public health and healthcare, and also actively promotes conspiracy theories. Not only has his promotion of false claims that measles vaccines are linked to autism, Side note, there is no scientific evidence to prove that vaccines are linked to autism. And the very organization that he oversees in his position, the CDC has the following on their website There is no link between MMR vaccine and autism. Scientists in the United States and other countries have carefully studied the MMR vaccine. None have found a link between autism and the MMR vaccine. I will make sure to include that link in our show notes. Aside from the current Health Secretary's misinformation, he has also cut $500 million in vaccine studies and shut down the centers for research in emerging infectious disease, which aims to prevent future pandemics. With all of this change and upheaval in public health and vaccine work, It is no surprise that we have had several measle outbreaks in the past two years alone. Some of the largest outbreaks in 2025 include an outbreak that began in West Texas and spread into neighboring New Mexico, as well as a large South Carolina outbreak. The outbreak in South Carolina began in October of 2025 and was declared over in April of 2026. During that six month window, close to a thousand people contracted measles. This was the largest single location outbreak in the US since measles was declared eliminated in 2000. do measles outbreaks look like in 2026? As I said at the top of the episode, as of July 23rd, 2026, there are 2,318 confirmed cases of measles. In terms of outbreaks, there are 35 new outbreaks that have been reported so far in 2026. And just a reminder: an outbreak for measles is defined as three or more cases. 93% of the confirmed cases are outbreak-associated, meaning the infection, measles in this case, can be traced back to the same exposure setting. Examples of that could be a school, place of worship, community event, or even a household. This alone shows how rapidly measles can spread through a vulnerable population. When thinking about vulnerable populations when it comes to measles, we think of immunocompromised individuals and the unvaccinated. For all of the cases reported in 2026, 93% have vaccination status of unknown or unvaccinated. 93%. With the increase in measles cases being reported, healthcare settings are having to prepare for the possibility of a positive measles patient coming to their facility. If you were able to check out the last episode, Paging Infection Prevention, I talked a little about isolations and what kind of protocols are put in place to not spread various infections in the hospital. Isolation needed for measles is airborne. Patients need to be on airborne isolation due to how the virus itself can transmit between individuals. The virus can actually float in air and stay infectious for up to two hours after an infected individual has left a room. Absolutely wild. Do keep this in mind when we do a brief exercise on what work can look like for an infection preventionist if they get a call about possible measles. If you breathe the same airspace as someone with measles, you can become infected. With airborne isolation, you also have to think about the ventilation system in your facility. Since measles can float in the air, we do not want an infected person's room air ventilating to another patient's room or into a public space. This is when we utilize negative pressure rooms. Essentially the negative pressure allows for air to flow into the room, but air must exhaust directly outside or filter through a HEPA filter before recirculating. A HEPA filter does not kill the virus, but it does capture the particles that float in the air. So spread does not occur. PPE needed to protect staff and visitors include gowns, gloves, and an N95 mask or papper. A papper, also known as Powered Air Purifying Respirator, is sometimes referred by staff or recommended to wear due to facial hair to ensure. Proper seal. Alright, let's pretend you're at work, minding your business as usual, when you get a call from one of your clinics saying they had a parent call in about their three-month-old baby with concerns of a high fever. They also report there are red spots on the baby's face, but they're not sure if that's due to having some dry skin. The clinic thought to call infection prevention because the parents of the baby also reported. They were at a kid's birthday party about a week ago, and one of the kids at the party just came back positive for measles. The parents also state that at this time the baby is too young to have received the MMR vaccine, so the baby is unvaccinated. The family has not come to the clinic yet, and clinic staff is looking for guidance on how to safely see this patient. Some information on the clinic building itself. The clinic does not have any negative pressure rooms, and the clinic is also located on the fourth floor of a building. We've got this. The Brain Trust can figure this out. At this point, we should treat the patient as a suspect measles and use all mitigation tactics as if this patient is positive for measles. Remember when I told you to keep in mind that measles can actually float in the air and stay infectious for up to two hours after an infected individual has left a space? We need to remember this when thinking about how a patient will be seen. In a situation like this, it would be best practice for a suspected measles patient to be seen at the end of the day when there are no more patients left in the clinic. We would want to have the child and parent enter the building through a back door, and not the front, to eliminate any possible interactions in a main public space, like a building lobby. Since the clinic is on the fourth floor, We would see if the building had a service elevator that the family could use, but the elevator would need to be shut down for two hours after the suspect measles case had last used it. A service elevator would be ideal since it is not open for public use and would hopefully not affect any patient care in other areas of the building. Okay. We now know how the patient is entering the building and getting up to the clinic. Since the clinic does not have any negative pressure rooms, we would recommend utilizing a HEPA vacuum. Similar to the HEPA filter but a mobile form, it purifies the air and captures any airborne virus particles, including measles. This will keep the other rooms and spaces in the clinic and the entire building safe from having the airborne particles floating outside of the patient room. We confirm that staff has access to proper PPE to wear during interactions with the suspect measles case, and ask the child and parents leave the clinic in the same way they came in, down the service elevator and out the back door. This plan allows for patients to be seen, receive the care they need, and also keeps staff members and occupants of the entire building safe. Unfortunately, not every situation works out like this. Sometimes frontline healthcare workers are not called ahead of time. Sometimes people just think they have a common cold before the rash appears. If an individual is in a public space and they are unaware that they are infectious, this will lead to extensive and exhaustive contact tracing work. Let's say a child presented to an ED waiting room with complaints of high fever, cough, along with watery eyes. The ED intake nurse is trained to perform a patient assessment in real time and determine how urgent the needs are for the patient they are speaking to. In this case, hearing a child report these symptoms, one of the first questions the ED intake nurse may ask would be if the patient is vaccinated against measles or if they have any recent known exposure to a measles case. This eight-year-old kiddo is unvaccinated but does not know of any recent exposures to measles cases. However, looking at this patient's address, the nurse knows the community this patient lives in is experiencing an outbreak. The ED intake nurse would immediately take the child out of the waiting room, have the child wear a surgical mask, and lead them to a negative pressure room with a route that would minimize exposure to others as much as possible. From there, the patient can be properly assessed and tested for rollout measles. Let's say the child does come back positive for measles. Contact tracing will need to be done. The contact tracing process includes identifying, notifying, and monitoring individuals who have been in close contact with an infected person. Remember measles can actually float in the air and stay infectious for up to two hours after an infected individual has left a room. All individuals, staff members, patients, and visitors who were in the ED waiting room at the same time as the positive case and two hours after the case left are considered exposed, And contact tracing work would need to be done for them. Depending on the size of a hospital's emergency department, that could be hundreds of people. Contact tracing for measles is no small feat, but it is a tool used to help stop the spread of infectious diseases. For our huddle corner, a section for some takeaways before signing off, I just want to highlight how hard it is to watch the state of measles in the United States, especially with the US eliminating measles in two thousand. Measles cases have been reported in 45 US jurisdictions with more than 2,000 cases nationwide this year. Approximately 93 of these cases are linked to outbreaks within the United States, and overwhelmingly, majority of those outbreaks have occurred among unvaccinated individuals. I believe in the power of choice when it comes to your own health and body, and I encourage everyone to do their own research. But as a professional in public health and healthcare who is trained in infectious disease, vaccines save lives. Science has already shown us that it is possible. Measles was declared eliminated, not because measles went away, but Because of reaching herd immunity through vaccination. The question isn't whether vaccines work. The question is if we choose science and utilize one of the most effective public health tools we've ever had. Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at CulturePositivePod at gmail.com. References for the episode can be found in the show notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious, stay compassionate, and keep building a culture that's truly positive.