番茄社区

In part 1 of this Instagram Live discussion, 番茄社区 editor-in-chief Jeremy Faust, MD, Katelyn Jetelina, PhD, MPH, and Katrine Wallace, PhD, talk about the recent rise in measles cases in the U.S.

Jetelina is the author of "Your Local Epidemiologist" newsletter. Wallace is with the School of Public Health at the University of Illinois at Chicago.

The following is a transcript of their remarks:

Faust: Let's start with measles because the title says "Measles, H5N1, and COVID, Oh My!"

In the 1950s and '60s, we would routinely have 500,000 cases of measles per year in the United States. That was one of these [viruses] where [rates were] high and then the vaccine came and it plummeted down to like tens of thousands of cases. And then when they added the second dose in the late 80s or early '90, I believe it went from having thousands of cases a year to just a few. We're talking to the point hundreds, maybe thousands, and then really zero for a while.

Now we're back where we saw before the pandemic with a couple hundred cases a year, a couple years we had in the thousands. Now it's sort of creeping back; we're having outbreaks. We thought we may be able to eradicate this thing, but we can't. That's where we're at.

Let me start with Dr. Wallace. People come to you and ask you questions; you're a science communicator and expert. What's the big thing that people ask you about this?

Wallace: So there's a few things going on, right? We've seen data showing that vaccination rates across the board globally have dropped. We know that measles is, we call it 'the canary in the coal mine' because it's so contagious that it's sort of a preceptor for other vaccine-preventable illnesses coming back and now we're seeing that.

The question I mostly get now is, do we need another dose of measles vaccine? People are nervous that they themselves are going to get measles. So that's mostly been the question that I'm getting, just around whether people need another vaccine as adults.

Faust: Let me ask you, why do you say that measles is a canary in the coal mine for vaccine hesitancy? Because the pediatric vaccine series, the sort that everyone should get, has gone from nothing to lots.

Wallace: Yeah.

Faust: And that's a wonderful thing. I mean, think about the preventable illnesses that we've prevented with this. But some parents are on the vaccine hesitant side of things. They say 'Oh, it's too much. I don't want to do all these.' Why do you think that measles is the canary in the coal mine?

Wallace: Oh, it has more to do with the fact that measles is so contagious that that's the first one that's going to show up when vaccination rates go down. That's the first one, so we call it the canary in the coal mine just because it's an indicator of vaccine rates dropping before we start to see the other ones that are less contagious.

Faust: Ah, I see what you mean.

Jetelina: It's the first building block to fall.

Faust: Right. So in other words, it's the one that's the easiest to spread.

I mean, the reproduction number of measles is like in the double digits. Meaning that every single person who gets it -- obviously these numbers are depending on society and how many people you interact with -- but routinely a kid might give it to more than 10 kids in their classroom if they got it.

Jetelina: If they're unvaccinated.

Wallace: Yeah. It's like 90% of unvaccinated contacts will get measles from the one person.

Faust: Which is interesting because -- we'll come to COVID -- it's different from COVID in the sense of its incubation period being longer. So in that way you have an opportunity to maybe stop an outbreak. On the other hand, it's just an explosion of virus when it happens.

Dr. Jetelina, what are people coming to you with? I know you have a very active comment section on your newsletter.

Jetelina: I do, it's fun. I get so many more emails too.

I agree with Kat, everyone's kind of wondering -- those that are paying attention -- if they need a new booster. We're not seeing that that's the case.

Interestingly, I think after the emergency I've been seeing questions like 'Is measles getting worse or are we just more hyper-aware now about infectious diseases?' In 2024, measles is coming in hot and it is increasing. We're seeing a lot more sparks than we have seen before, which is concerning because it just takes one spark to find an unvaccinated pocket and spread like wildfire.

Unfortunately -- or I don't know if it's unfortunate -- but I'm getting a lot of questions around politics and measles. So for example, 'Where is measles coming from? Is it coming from the border?' That kind of stuff. Which are great questions. I think we just need to answer them because a lot of people are curious, and unfortunately these are talking points of politicians. I think that kind of wraps up the measles questions that I've been getting a lot of.

Wallace: I was just going to completely agree with what she's saying about the origin being migrants. That's what I've been hearing [people say].

We actually had an outbreak here in Chicago at a couple of migrant shelters. Measles was already in Chicago when people came, and nobody arrived here with measles. This is an unvaccinated, vulnerable population. Like we were saying, when we have those sparks it'll find these vulnerable pockets of the community. And in fact, the CDC came to Chicago and vaccinated like a thousand people in one weekend, and we haven't had any problems since.

So that's exactly right, what Katelyn was saying, that it is not a problem with migrants bringing it, it was already here.

Jetelina: It's already here.

Then also what we're seeing, Dr. Wallace, is that it's actually U.S. citizens going abroad, getting it, and bringing it back. The majority is from travel, from unvaccinated kids and adults going somewhere, because in the globe we have huge measles outbreaks. They get it and then they bring it back. So I think that distinction is really important when we talk about equity and access and getting all the facts straight.

Faust: Yeah. And I also think that it's really important for people to realize that when you think about people coming to this country -- I've seen this as a frontline clinician -- people come here whether by official means or unofficial means, but especially people who are here extra-legally or outside the process, they're afraid to interact with the healthcare complex because they're worried that even a city hospital, which is supposed to be serving everybody, is going to call up immigration and say 'Oh, I found someone who's not supposed to be here.'

What I've often seen is that people who came here, maybe they're dreamers or maybe they came here out of desperate need, don't then interact in a way that would really help them and everyone else. No one wants to spread measles, right?

And so I always tell patients 'Look, I work for you. That's [immigration] not my job. I'm not going to call anyone and tell them.' And I wish we were much more progressive on that issue. Not to like hijack this, but I've seen this across the board in healthcare -- like people who can't get dialysis because they're not documented.

This is crazy. We want to help everyone and health is not the place to work out our xenophobia. Let's please take care of each other and who's here.

Jetelina: And viruses don't care. I mean, population health doesn't care. When we treat populations at a time, it's all a team. It's a team effort. It's a team, it's teamwork or measles is going to spread. So I think that you're very right. That's really important.

Faust: Can we talk a little bit about specific things about measles that I think people don't get, which is this immune amnesia? I know that Dr. Jetelina has talked about this a little bit.

I think people are worried that, for example, COVID makes us more susceptible to other illnesses. And I'm not sure that's true. I think that COVID is a very bad disease to get, but it doesn't really attack the immune system's memory the way that measles does.

Jetelina: Yeah. COVID doesn't attack the immune system -- only a very, very small amount. I'll just say that; there's always a nuance there. And I feel like I'm talking too much. Dr. Wallace, you jump in...

Wallace: Oh, no it's alright.

Jetelina: But yeah, measles does. What happens is you get a measles infection, it wipes your immunity to, for example, flu or to other vaccine-preventable diseases. And a lot of people don't realize that. And so yeah, you may survive that measles infection, but we see higher mortality after measles infections to other things because of that reason.

Wallace: Yeah, I agree.

Dr. Faust, you said that people have been saying that COVID then destroys your immune system. I think we have data to support that in long COVID, and we have data to support that in certain special populations that there's some immune kind of deficiencies afterward, but the general public walking around that have had a mild case of COVID -- I don't know that we have data to support that there's immune dysregulation in the general population.

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