Talking All Things Cardiopulm
This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences.The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation.
Talking All Things Cardiopulm
Episode 97: Measles Resurgence: The comeback no one needed
I love a good comeback story, and typically cheer for the underdog, but the Measles can go ahead and stay in the past. As cases continue to rise, it’s time to take a look at overall pathophysiology and transmission of this very contagious virus.
Join me as we discuss yet another virus taking the U.S. by storm.
At the time of this recording the data available was as of 2/28/25 with 164 cases of measles, 1 death and 20% hospitalization. 1 week later, as of 3/7/25 cases have increased to 222 cases (94% unvaccinated), 2 deaths, and a 17% hospitalization rate.
In this episode:
- Pathogenesis of measles
- Transmission of measles
- Signs and symptoms of measles
- Benefits of MMR vaccine
- Incidence and history of the measles in the U.S.
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Welcome to Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci, physical therapist and board-certified cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences. The goal is to learn, inspire and bring cardiopalm to the forefront of conversation. Thanks for joining me today and let's get after it. Hello, hello and welcome to another episode of Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci. Before we jump into today's episode, if you are not on my newsletter, click the link in the show notes and join. I'm hoping to be a little bit more active in there. It's been a goal of mine to increase my writing to the audience, but it also helps keep in contact with you and if I have any offerings out, hoping to get maybe some CEUs going this year, so you'd be the first to know if you are there and, in this current state, if we lose Instagram, if podcasting becomes a thing, you have access to me, so just an easy way to kind of keep in touch in that regard and throw a plug in for myself If you are in the acute care setting, if you are wanting to sit for the CCS, if you're prepping the NPTE in the next few months or even within the next year, and you are looking for one-on-one mentoring? I'm your girl. Hit the link in the show notes and you can sign up for one-on-one mentoring, and I do have some programs available for people who are looking to prep over the course of one year. So, if you're interested, contact me. We can chat about it, set up a discovery call and really just kind of get into what you need, because that's most important whenever you're learning.
Rachele Burriesci:All right, so what are we talking about today? Well, today we're going to be talking about the measles, also known as rubeola. I really honestly never thought that this was something that I was going to have to really dive into, because it hasn't been a thing in nearly 25 years. We're going to chat a little bit about history and incidents and why we're talking about it today history and incidents and why we're talking about it today, and then, of course, best ways to prevent and like. What do we need to know, right, because this is honestly a topic that I've never had to dive into. I mean, I know the basics about the measles prior to this, and so I really wanted to have a better understanding, because we are having an outbreak. Our numbers are higher this year, within two months of time, versus the last. You know however many years over the course of a year. So our numbers really are increasing, and so I think it's just, you know, something that we should chat about and educate ourselves on, at least me specifically.
Rachele Burriesci:So the measles have been around since the 7th to 9th century, so we go way back on this one, and in 1757, it was officially characterized as an infectious agent by a Scottish physician named Francis Holmes. So 1757, measles got its name. Basically, starting in 1912 is when the US started to really document the number of cases of measles, the number of deaths per measles and everything that comes along with surveillance, and around that time we can expect around 6,000 deaths per year from measles and with an average of 3 to 4 million people affected by measles per year. From a complications perspective, they averaged around 10,000 cases of encephalopathy and about 48,000 hospitalizations. And so, basically, by the time you were 15, you were likely to have had the measles. Um, once you have the measles, you are immune to getting the measles again. So you're once you have it, you're never going to get it again. But, as you can see, there are some complications and there is a risk of death.
Rachele Burriesci:And it wasn't until 1963 that the first vaccine came out and there was like two vaccines available, a live attenuated and a live killed virus. And over the course of five years they sort of tweaked this virus to make it more effective, because it wasn't very effective at that time. And I think it's been since. 1968 was the date that that vaccine has been the one that we've basically used since. So there's like this time period between 1957 and 1968, where there's like a gray area of are you protected or are you not protected based on the vaccine that you got? So in the current outbreak there's a lot of question we'll get into. This is like who should get vaccinated? Well, that time period seems to be of concern.
Rachele Burriesci:Once vaccines were in effect, the cases of measles worldwide decreased significantly and in 1971, they actually combined the measles vaccines with mumps and rubella and that's the vaccine that we know, the MMR measles, mumps and rubella and it was pretty effective. The numbers went down pretty significantly. The effectiveness was around 93% effective. And then in 1989, there was an outbreak. And so 1989 and 1990 are the two years that there was quite a big spike in the number of measles cases in 1989 was 17,914, and in 1990, 27,808. And so, because of this spike, they updated the vaccination recommendation, which was two doses of the MMR, and in 2000, basically, measles was considered to be eradicated from the United States. That has since changed. So, just from like a numbers perspective, prior to the vaccine, about two to three million deaths occurred globally and about five to six thousand deaths per year in this country.
Rachele Burriesci:The number of cases went down significantly after vaccines were put into place and, like I said, there was the spike in 1989, 1990. And then after that, 2000, when they considered it to be eradicated, there were 85 cases of measles in the US In 2004, 37 cases right, so like pretty low, insignificant numbers that typically were caused by either travel or, potentially, someone who was unvaccinated became vaccinated, but it was never an outbreak because the vaccination rates were adequate In 2011,. In 2011, we are up to 220 cases. 2014, 667 cases. That seems to be the biggest year actually. Nope, that's a lie. There's one later on that's even higher, and then there's like a downtrend again. It's like, really, you know, like a couple of hundred here and there.
Rachele Burriesci:2016 was In 2019, there were 1,274 active cases of measles. I did go back to see if there was a number of deaths listed, and I could not find that. In 2020, though, right, the world shut down, the cases of measles also shut down, and so in 2020, there were 13 active cases in the US. Now there is some significance around 2020, and that is because of COVID, the global initiative of increasing vaccinations in other countries, also decreased, and so, although we haven't seen a significant rise in measles in this country, the increase across the globe has also increased, as well as a decrease in vaccination rates. But we also know in this country, vaccine rates have decreased and there's a lot of fear around vaccines all of a sudden, or at least in the last maybe 10 years, and so now we're starting to see these things pop up, and so in 2024, there were 285 cases of measles in this country. Of those 285, 89% of them were unvaccinated, and it had a 40% hospitalization rate. 40% hospitalization rate is significant to me. This isn't just you get measles, you're sick for a few days and it's over, right, like 40%, hospitalization is significant 114 out of 285 cases required hospitalization. Same thing I went back to see if there was any deaths recorded, and I did not see any deaths listed. I assume, then, that there were no deaths from this.
Rachele Burriesci:Now the concern starts to rise. Now, right, and I know there's probably again that sense of we're kind of over-exaggerating what's happening. I honestly don't think so. So in 2025, right as of February 28th so on Friday, the CDC typically has these updated cases Now there's a whole bunch of issues that are going on with the CDC right now firing layoffs and all sorts of stuff and there are other organizations trying to help out. And, with that being said, I still am trusting CDC, but I always have a question mark and I've been, like using other sources.
Rachele Burriesci:As well as of February 28th, there have been 164 cases. We are only two months into this year. That seems concerning enough. With that being said, we have a 20% hospitalization rate, so 32 out of 164 cases have been hospitalized, and there has already been one death, and that death was in a child, and I don't know the age range, but I did hear that there was no underlying disease in said child. So that seems pretty concerning to me.
Rachele Burriesci:Same thing this seems to have really spiked in an area that has low vaccination rates. I don't have the percent on that, and Texas has the primary numbers here. But this is where we start to have concern. Measles is highly contagious and we'll get into how it spreads in a minute, but although Texas is kind of the primary source here, it has now moved into New Mexico. There are nine cases in New Mexico. There was a post actually made on Instagram by a physician where there was an announcement that there was someone who had been diagnosed with measles who recently flew in California, and they gave the gate and the time that that person was in that terminal. And so that's a concern, right, because, like I had mentioned in another podcast, that these viruses don't understand boundaries and because we have the ability to travel these diseases, these viruses have the ability to spread, right. And so, as of again February 28th, there were nine cases in New Mexico, three in New Jersey and one in Miami. So we're starting to kind of fan out here.
Rachele Burriesci:What's the number one way to prevent measles? Well, that's vaccination. We have the MMR vaccine. It has been around since 1968. It is very effective. One dose of the MMR is said to be 93% effective against measles, 78% effective against mumps and 97% effective against rubella. The second dose is where we really increase our immunity. That recommendation came after there was a spike in 1989. And so two doses of the MMR vaccine you have 97% effectiveness against measles, 88% effective against mumps.
Rachele Burriesci:The timing of these vaccines in this country are the first one should be given to infants at 12 to 15 months, and that seems to be like a sweet spot of increasing immunity. In other countries they'll do it earlier, right around nine months, but the improvement in immunity is less. Improvement in immunity is less. So typically the reason for the 12 to 15 month time is that you should be covered by your mother prior to that and then, once your immunity has worn off from your mom, then you would then get vaccinated. Seems to be the timing of it and that 12 month mark seems to be like a sweet spot. The second MMR vaccine is recommended at four to six years old. So if you've had two doses of MMR you are 97% effective. With that being said, there's still a chance of contracting measles, especially if you're in a highly dense populated area with a measles outbreak. So if you have the two-dose vaccine you should be given lifelong immunity.
Rachele Burriesci:From a recommendation perspective, because people are asking about like should you get vaccinated, should you not get vaccinated, obviously talk with your doctors. People before 1957 should be in the clear due to likely having measles. And then there's some question of well, if you don't know. And then there's this timeframe between 1963 and 1968, where there was that first vaccine that wasn't as effective. So that seems to be a timeframe where they're recommending vaccination. And then another question that has come up in question here is can you get the vaccine if you know you have been exposed? The answer seems to be yes, you can receive the vaccine within 72 hours of exposure to help prevent infection. I do not know the percent that then protects you. My understanding is that you have most protection after two doses and you are given protection around that two-week marker after vaccination. So I'm sure there's some sort of timing issue with that as well.
Rachele Burriesci:Contraindications to the vaccine. It is considered to be safe and effective. There are some contraindications, especially if you have an allergic reaction, especially to the first dose, or if you're allergic to any component of said vaccine. There is a very big contraindication for this vaccine with immunocompromised persons, and the reason is is because this is a live attenuated vaccine. So even though it is a weakened version of the vaccine, it is a live vaccine In that same immunocompromised conversation as if you've been on corticosteroids within 14 days. It is not recommended that a person receive vaccination. Hiv if you have active HIV infection is considered a contraindication. And pregnancy you are not supposed to get this vaccine if you were actively pregnant and there are complications that can occur because of that. So for the most part the vaccine is safe and effective. There are some listed contraindications.
Rachele Burriesci:There are obviously some adverse side effects, including fever. The rate of fever after vaccination seems to be somewhere around 5% to 15%. You can also potentially get a rash and that's again around that 5% marker. My understanding is that even if you have a rash, you are not contagious. You are not going to spread measles by getting the vaccine. There is a risk for fibril seizures, and that is one in 3,000 to one in 4,000. And that can be a scary side effect. For reference, if a person has measles, the risk of fibril seizures is one in 1,000. So less than if you actually get the virus. Anaphylactic reaction is always a concern anytime you're taking a substance of any kind, including vaccines, and the rate seems to be relatively low 8 to 14.4 cases per million. And then arthralgia seems to be a potential side effect, specifically in women who are of adult age, and this can occur in 25% where they have some joint pain. So anytime you take a medicine, a vaccine, yes there are some side effects or concerns. This is a vaccine that has been around for a very long time. This is a vaccine that is very effective in preventing spread. Two doses is the recommendation per CDC, ama, pediatric Association, so quite a few organizations behind said recommendation.
Rachele Burriesci:All right, so let's talk a little bit about the measles. It is again a single-stranded negative sense RNA. It's considered a paramyxovirus of the genus Morbillivirus and, like we talked with other viruses before, there are proteins that essentially are the cause to actually contract said virus. So we have the F protein and the H protein in the measles virus. The F protein is what is going to actually attach to the host cell membrane, cause viral penetration and also causes hemolysis. The H protein is responsible of binding the virus to the receptors on said host cells and so it is again a respiratory transmiss virus. So the primary site of infection occurs at the alveolar macrophage and so two to three days after replicating in the lung it actually spreads to lymphoid tissues is which is how it becomes um, spread throughout the blood and spread through the whole system, um, so then they have the second, second phase of viremia at five to seven days after the initial infection. After that initial host uh grabs on from the lung. After that initial host grabs on from the lung and then it basically spreads via lymphocytes and then migrates into the subepithelial cell layers, into epithelial cells and endothelial cells, throughout basically all organ systems. So it has this systemic spread and then, from the lung perspective, it basically is shed through damaged epithelium in the lungs, which is how then you, after being exposed and contracting said virus, can spread it to other individuals.
Rachele Burriesci:This is a human to human transmission. There are no ability to spread to animals at this point. So how is this virus spread? It is spread via respiratory droplets, airborne particulates. So if a person has measles and they cough, sneeze, talk, sing into the air, that respiratory particulate goes into the air. So the primary mode of transmission is airborne particulate and the particulate can stay in the air for up to two hours time, as well as large droplets, close talking type of thing. That is the primary mode of transmission. It can also spread via contact. So, again, if I cough onto an inanimate object fomites is the word that we use for that. The virus can last on inanimate objects for also up to two hours time, but the primary mode is airborne and this is and I have read many articles from many different sources seems to be highly contagious and very easy to spread.
Rachele Burriesci:So I was trying to find a time of exposure, because that is an important thing, and I think after COVID that was one of the things I really wanted to kind of like understand is how long do you need to be exposed to someone with said diagnosis that you then have to be worried about contracting said virus, and this seems to be one of the hardest questions to sort of establish, for obvious reasons. Right, you're not just going to put somebody in a room and wait to see if they contract, so the research on that is always questionable. For TB, although it can last for up to 14 hours time, it requires long-term close exposure in order to contract. Measles is not like that. Measles is highly contagious, and so there is some guesstimates about how many people are you likely to infect. So one person with measles is likely to infect at least to 12 to 18 other persons, and it will infect 90% of unvaccinated people that are in close contact with that person. You can spread the disease four days prior to showing symptoms and then four days after the rash starts. So the rash timing seems to be part of that airborne precaution timeframe. Again, unknown duration of exposure, but longer duration and increased face-to-face contact is going to increase your risk of actually getting said virus. There is a chance again for people who are vaccinated to get the measles. But something that was interesting is that persons who are vaccinated who end up contracting the measles have a lower viral load and are less likely to spread the virus than someone who is unvaccinated. So if you're unvaccinated and you get the measles, you have a higher viral load and you have easier spread. So that seems to also be you know, just like an interesting piece of it, that there is still risk that you could get it. That risk is lower. But if you do get the measles then you are less likely to spread it compared to someone who is unvaccinated.
Rachele Burriesci:All right, so primary mode of transmission is via airborne particulate. So precautions, especially in the hospital. Setting is airborne and so it's airborne plus standard, which essentially means we're going to be wearing an N95 or a PAPR. That person is recommended to be in an airborne prepped room, and standard typically includes things like gloves and hand hygiene. I did confirm that from a hand hygiene perspective, both washing hands and using an alcohol sanitizer are effective against the measles. And now this is super important that we are again cleaning surfaces that have been touched and washing hands throughout, because it can be spread from hand to mouth, hand to eye transmission.
Rachele Burriesci:So primary symptoms and I think the biggest one on the list is high fever, typically over 102, and the range is somewhere between 102 to 105. Dry cough is on the list, said to be a potential later symptom Runny nose, watery red eyes and then some quintessential like differentials here are white spots inside of the cheek called colic spots, and then the rash actually occurs seven to 18 days after exposure. So the rash comes second. That's part of that second piece of that pathogenesis that we talked about earlier After exposure. Here's another important piece is that incubation period is a little bit longer. So incubation period of measles after exposure is somewhere between 10 and 12 days. So this isn't one of those diseases or viruses, like the flu, that you're going to start seeing symptoms within three days. This is a longer wait time. This is a longer incubation period. So we have 10 to 12 days after exposure that you are likely to start showing symptoms.
Rachele Burriesci:Those symptoms again start around two to four days, which include that high fever, potential conjunctivitis we have watery red eyes, but conjunctivitis is also colic spots one to two days before the measles rash. Like there's this like progression right Fever seems to occur first high fever, potential cough, red watery eyes, runny nose. Then you get the white spots one to two days before the measles rash and then the measles rash is a little bit later. In that timeframe, when the measles rash occurs, it actually starts at the hairline and works its way down and out. So it starts at the hairline, starts at the head, works its way down and out the extremities and it also goes away that same way. That same way Again, from a precautions perspective, they tend to take you off of that airborne precautions around four days after the rash starts.
Rachele Burriesci:So starts at the hairline face, neck works its way down the body out to the extremities and hands. Initially those lesions are blanchable, which means if you push them they become white or pale and then three to four days in they're no longer blanchable and the lesions peel off in scales in the more severely affected areas. They are said to not cause scarring, so I didn't go much further into that. But apparently you don't get a ton of scarring from this and the rash itself is not itchy and you cannot spread measles by touching the rash. It's spread by respiratory particulate. Okay, some other symptoms that can occur outside of the primary are loss of appetite and swollen lymph nodes, which is of no surprise because it really is spread through lymph nodes.
Rachele Burriesci:Now there are some complications right. So like this is where the concern comes in. Approximately 30% of measles cases in the US between 1987 to 2000 were reported to have one or more complications. Primary complications is diarrhea and then from that becomes dehydration. Otitis, media ear inflammation or ear infection is also on the higher rate. Pneumonia is a big concern. So one in 20 cases of measles can end up with pneumonia and pneumonia is the most common cause of mortality in measles. It can also cause encephalitis and the rate of complication of that is one in 1,000. It can also cause blindness and then one in five are hospitalized. As we saw, there was a 40% hospitalization rate last year. Currently we're up to 20% and there is risk of death, and the risk of death is one to three in every 1000 cases. With that being said, we already have one death in 167 cases, I believe I said I don't want to misspeak, but I'm pretty sure that's the number I said earlier 164. So there's risk, right, and so long-term complications of measles is also important. I didn't really dig into the encephalitis impact long-term or the number of potential blindness, but that is a risk.
Rachele Burriesci:The other piece of this is immune suppression. So after measles you can have immune suppression for weeks to months, and more recent studies even indicate you can have immune suppression for two to three years post-measle infection. Now, this is important because immune suppression for two to three years post-measle infection Now, this is important because immune suppression increases your risk for a secondary infection, right, which is a very common conversation with all of these viruses, right, mortality typically occurs with that secondary infection. Something really interesting about measles is that it can cause something called immune amnesia, and so immune amnesia basically means that this virus suppresses your immune system so much that it loses the ability to fight off viruses that you were once protected against, so things that you had antigens build up to fight against. You sort of lose that ability, which is a very interesting side effect of getting measles, which just puts you at higher risk overall.
Rachele Burriesci:The complications that we talked about earlier are most commonly occurring in younger children less than five years old and on the older age group of greater than 30 years old. So some consideration there. Also high risk with people who are pregnant. So if you were to contract measles while you're pregnant, there's risk of low birth weight, spontaneous abortion, intrauterine fetal death and potential maternal death. So some concern as well for persons that are pregnant.
Rachele Burriesci:Okay, so let's talk a little bit about treatment. There's not a ton of information here, but there's some. So primary things are like correcting and preventing dehydration, and part of that is due to the risk of diarrhea. There are no specific antivirals for measles, so the primary treatment is actually the use of vitamin A, and that is to help prevent eye damage, blindness and potential death. Prevent eye damage, blindness and potential death. So the use of vitamin A the recommendation is two doses as per CDC and they give some recommendations on amount has significantly impacted or decreased the rate of death from measles and, again, blindness. The caveat here is that vitamin A supplementation in these people is more beneficial for people who are vitamin A deficient, people who are typically malnourished and get the measles. So it can still help, right, but it's most effective when there is a vitamin A deficiency. The other piece of this is also understanding that vitamin A is a fat soluble vitamin and so you don't just pass it like a water soluble, like you can't overtake a water soluble vitamin, you just kind of pee it out. Fat soluble is different, so you can have too much of it and it can also cause side effects. So not a ton of treatment available.
Rachele Burriesci:The primary recommendation to prevent measles is vaccination and we have seen in our country over a great number of years. We basically eradicated measles as of the year 2000 by the use of vaccinations via nasopharyngeal or throat swabs and then also to obtain a certain serum blood test which can be relayed over to CDC and state organizations like that. So that's really all I have. From a PT perspective I don't have a lot of information. I have literally never seen a person with measles. From a look at the big picture of how this affects a person, if we're affecting the alveoli on auscultation you might hear something like crackles. In some studies that I read they can have normal auscultation and normal chest x-ray, sometimes not. So not a ton of information there.
Rachele Burriesci:If you have a secondary infection and contract pneumonia, whether it's viral or bacterial, then you follow the viral bacterial rules. So if you have bacterial pneumonia you're more likely to have mucus as part of the problem and so that dry cough could then change to a wet productive cough and then you would hear bronchi or coarse wheezes on auscultation and have a wet productive cough and can do all of the things to help with airway clearance. If you have a more viral pneumonia, you tend to have more fluid and so the fluid typically is in the alveoli and again you would hear crackles and you might have a wet cough, but it should be nonproductive. So that's when you start to get into the secondary infection piece.
Rachele Burriesci:I would be curious from a chest wall perspective, with the rash, if there's any decrease in chest wall mobility, because there seems to not be any scarring. I would assume that long-term we shouldn't have any changes from a chest wall movement perspective. But again, if we have the pneumonia aspect, we might. So bacterial pneumonia is usually very located so to a specific lobe or segment. So you would expect chest wall mobility to be decreased in the area that you have said bacterial pneumonia, for instance right lower lobe, you might see right lower decreased Viral, tends to be more diffused, so scattered throughout, and so it doesn't have a specific side that it affects.
Rachele Burriesci:So that would be the big picture lookout. But I have no experience in treating said person. So if I find out any other information from a cardiopulmonary perspective things to look out for, I will definitely add to this in the future. Hopefully we don't have to and this stays contained and doesn't turn into a big mess. But big picture measles is highly contagious.
Rachele Burriesci:It is spread via respiratory particulate, primarily airborne droplets that can last in the air for up to two hours. It is very likely that if you are unvaccinated and you're in close contact area in the same room as someone who has the measles, that you are likely, you have a 90% chance of becoming infected as well. So high, high rate of transmission spread through respiratory particulate via airborne droplets or close contact large droplets. We are wearing N95 to protect ourselves from getting said measles if we're in contact with droplets. We are wearing N95 to protect ourselves from getting said measles If we're in contact with someone cleaning surfaces, washing hands, you can help prevent spread if someone with known exposure you knowingly had exposure to someone with measles, that if you wear a mask will decrease potential exposure and risk If you know that you've been exposed. If you are actively having symptoms, recommendation is for isolation.
Rachele Burriesci:Right, we're not going out into the community and spreading the love. That is not the goal here. Okay, at least in my opinion, that is not the goal. All right, I think that is all I have for you. In my opinion, that is not the goal. All right, I think that is all I have for you. If we need to dive further into this topic, I certainly will. I'm hoping that we won't have to. I'll probably be looking further into bird flu in the upcoming weeks, but hopefully we can go back to some of the other stuff, maybe talk more about breathing exercises and respiratory muscle training, and you know standard diagnoses that we are seeing Too many viruses at this point that we need to be covering. But, like I said, I'm always going to do my due diligence and staying educated and helping others to stay educated as well. All right, I hope you all have a wonderful day and, whatever you have to do, get after it.
