Ask Dr. Hallberg: What's happening with measles in Minnesota?by Tom Crann, Minnesota Public Radio,
Dr. Jon Hallberg, Minnesota Public Radio
St. Paul, Minn. — The measles is back in Minnesota.
State health department officials have confirmed 15 cases of the contagious disease so far this year.
MPR News spoke with Dr. Jon Hallberg on Wednesday to learn more about measles and what can be done to prevent it.
Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic in Minneapolis.
Tom Crann: Remind us again what happens to you when you get measles.
Dr. Jon Hallberg: First, it incubates for one to two weeks. So you don't even know you have it at first. Then you start getting things like a fever, and people often think of the rash ... but that's one of the last things to appear.
You feel tired. You get conjunctivitis or pink eye, very bad pink eye, a runny nose. ... And then the rash appears, and the rash starts at the hairline and kind of works its way down in a sort of march all the way down to the feet.
Crann: How dangerous is it?
Hallberg: Well, one in 10 kids who get this develop an ear infection. One in 20 develop pneumonia. And they think about one in 1,000 -- maybe even one to two in 1,000 -- actually can die from complications.
And, in fact, in the world there are about 200,000 deaths a year, out of 10 million cases, and half of those deaths occur in India.
Crann: We think of this as a children's disease. Can adults get it?
Hallberg: Sure, if they have not been exposed to it as a child, or they did not receive the immunizations. In fact, it's so contagious that if you have 100 people who have never seen it before -- whether it's through a shot or natural acquisition -- 90 percent of them will get it. Ninety out of 100 people will actually get measles. So it's highly, highly contagious.
Crann: How is it contagious? Through coughing, sneezing?
Hallberg: That's right. It's acquired through respiratory droplets, but the droplets can also land on things. And they suspect that the virus can stay alive for about two hours after it's been coughed or sneezed. So it's very easy to get it and not even be in direct contact with someone with it.
Crann: What is the treatment for it?
Hallberg: There really isn't a treatment for it. It's just what we call supportive care. Once you have it, if you get an ear infection, we can treat that. If you get pneumonia, we can treat that, but otherwise it's just supportive care, making somebody feel better while they have it and it runs its course.
Crann: How common has it been here in the U.S. in recent years?
Hallberg: It's not common. Through immunization efforts in North and South America, [other countries like] Finland -- and this is from the [Centers for Disease Control and Prevention] in research I did today -- there really isn't any endemic measles. It doesn't exist. Some diseases may kind of lay low and emerge once in a while, but it is eradicated from this part of the world. The way that we see it is when people travel, and then they bring it back. And then you have people who have not had the immunization that get sick.
Crann: Since measles is still active in other parts of the world where vaccination hasn't been as strong or universal, what about people who are traveling internationally? Do they have to get any sort of booster shot, or should they worry about this?
Hallberg: Well, people who are of a certain age and they know they've had the immunizations or had it as a child, they don't need to worry about it. Where it gets really tricky, though, is if people travel with a child, an infant who's under the age of 12 months. So if they're less than a year of age, the recommendation is to actually start with one MMR -- measles, mumps, rubella vaccine -- before they travel, to actually get some protection. And this is not the standard of care, but it's for this very reason that they otherwise are a little more vulnerable than they would otherwise be.
Crann: So, Jon, you mentioned there was a time before general vaccines when most kids would get the measles or be exposed to it, right?
Hallberg: Yes, there was a time in the United States where they think that pretty much everybody under the age of 15 had received it. And it almost became just sort of one of many childhood illnesses that you would suffer from.
Crann: Like chicken pox?
Hallberg: That's right, almost as common as chicken pox.
Crann: And is there any indication that the measles today is more virulent or worse than what people would've gotten years ago?
Hallberg: No. I think it's a bad disease now, and it was a bad disease then. And though it's common, it doesn't mean that it's acceptable. I think that people should remember that the reason we have immunizations now that we give infants, and some of us as adults, it's because these are the worst actors. These are the viruses and the bacteria that we can actually prevent from infecting us, and for very good reason.
Crann: Jon, you and I have talked about this before when it comes to especially people in public health, public health professionals. Is this an illustration of what happens when there isn't effective and thorough vaccinations?
Hallberg: Well, right. I think that the efforts are there. It's simply a matter of people wanting to go through with it. It's not like we don't have enough supply. It's not an issue that we've had at times with influenza immunization, for example, where there's not enough. There's plenty of this. So if people are not getting it, it's simply by choice.
Of course, there are access issues, and we're trying to address that, and the state is being very aggressive about that, offering free clinics right now for people who have not been able to receive it to this point. So the vaccination is there. It's simply a matter of getting it.
(Interview edited and transcribed by MPR reporter Madeleine Baran)
Tom Crann is the host of All Things Considered for MPR News.
Assistant professor in family medicine at the University of Minnesota, and medical director at Mill City Clinic.