A Minnesota second opinion on measles

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A measles outbreak that began in Texas and has now spread to neighboring states is a grim reminder that this virus not only still circulates but can take advantage of an unfortunate reality: the crack in our collective defense caused by declining vaccination rates.

To those who might scoff at measles' risk, consider something called subacute sclerosing panencephalitis, or SSPE. It’s a rare infection of the central nervous system that can occur years after contracting measles.

“The disease begins, on average, 6–10 years after acute infection with measles (range, 1–24 years) and is characterized with progressive cognitive and motor deterioration leading to severe disability and eventual fatal outcome within months or years of onset," according to a 2019 medical journal article.

This potentially deadly complication thankfully doesn’t occur very often. A 2023 resource for physicians estimates that “4 to 11 per 100,000 cases of measles result in SSPE. This number goes up to 18 per 100,000 cases if the child was less than five years old when primarily infected.”

Some might find comfort in the rarity of SSPE or other potential measles complications, such as pneumonia or brain swelling that can cause hearing loss or intellectual disabilities. Still, they are a possibility, a sobering reality with the outbreak still uncontained, the growing number of unvaccinated kids and dubious recent remarks by Robert F. Kennedy Jr.

Kennedy leads the U.S. Department of Health and Human Services. He’s long been a vaccine skeptic and recently appeared to downplay measles’ risks while advocating for certain treatments, such as steroids, vitamin A and antibiotics.

For a second opinion, I reached out to Dr. Beth Thielen, an M Health Fairview infectious disease physician and a University of Minnesota Medical School assistant professor. Here’s an edited excerpt from our interview. Hopefully, her answers will help Minnesotans make informed decisions about protecting their families:

Q. No measles cases have been reported this year in Minnesota. With the ongoing outbreak centered in Texas and nearby states, does the distance mean Minnesotans shouldn’t worry?

Thielen: No. [Measles] is something that is an ongoing risk. It’s something I hear about maybe once a year in my capacity as an infectious disease doctor because there’s constant reintroductions from other parts of the world. Specifically, here in Minnesota, we have people traveling to warm states. I have no doubt we have members of our community traveling to places like New Mexico and Texas for spring break. There’s also ongoing transmission in many other parts of the world, particularly Africa. Over the last few years, unvaccinated international travelers are getting exposed and then coming back to Minnesota.

Q. What makes measles so dangerous?

Thielen: It’s hard to overstate how exquisitely infectious measles is. It’s documented that when there’s measles virus in the air, people who are susceptible can acquire measles just by going into a room where someone with measles was in the past two hours.

The thing that makes measles different from most respiratory infections is that it has this very pronounced systemic infection phase. Whereas a lot of respiratory viruses sort of stay in the respiratory tract, measles causes a lot more system spread and goes and replicates in the lymph nodes and other parts of the body. So it really is a lot more severe, with a lot more profound systemic effects.

Kids with measles are quite ill. There’s a decent complication rate for causing even fatal complications. It can cause pneumonia. If children or adults die of measles, respiratory complications are one of the big reasons. It has also the capability to go to the brain and cause an infection that can also be fatal.

Q. Are there still risks for those who recover from a measles infection?

Thielen: One of the scariest things is a delayed neurological infection that is typically fatal, described as SSPE. But we also know that measles seems to suppress the immune system for a more prolonged period of time after the infection, so there are risks that you may be more susceptible to other infections in the post-infection period.

Q. How is measles treated? Are there antivirals? Are antibiotics effective?

Thielen: There is one antiviral occasionally used in very severe cases, like immunocompromised people, and that drug is called ribavirin. It generally does not seem to be super effective.

After the initial viral infection, patients may develop a measles complication that could be a bacterial infection. These people would be treated with the antibiotics, but the antibiotics don’t have an effect directly against the measles virus.

Q. Kennedy mentioned steroids as a measles treatment option. Are they effective?

Thielen: Steroids are a very double-edged sword. There are some infections that as a health provider I treat with steroids, and they can be lifesaving. But I would say we don’t have evidence that measles is one of them. And the big problem with steroids is that it can blunt your natural immune response. Because we don’t have an antiviral therapy to treat measles, we are entirely reliant on the body’s own immune system. So, there is potential concern that steroids can make a viral infection worse by blunting the body’s ability to respond to that infection.

Q. What about another Kennedy-recommended treatment: vitamin A?

Thielen: The reason that has come up is based on some grain of truth. Generally speaking, in a developing country where there’s a lot of coexisting malnutrition and micronutrient deficiencies, there is evidence that giving vitamin A to kids after they’ve been infected with measles that they have better outcomes. Our pediatric infectious disease guidebook recommends giving vitamin A to children even in the United States, but in truth we don’t know how important it is when our overall levels of nutrition are much better, and our kids are less likely to be vitamin A deficient at baseline.

The other thing I would point out is that vitamin A can have significant toxicity at high levels. So this is not something I would advise people to be dosing at home without the guidance of a knowledgeable health professional.

Q. Is there any over-the-counter supplement or medication that can prevent measles?

Thielen: No. The best, most effective prevention strategy we have is vaccination, the MMR [measles, mumps, rubella] vaccine.

For more information about the vaccine, at what age it’s given and what to do after a measles exposure, go online to the Minnesota Department of Health’s measles resource center: tinyurl.com/MDHMeaslesInfo. Credible information about vaccine safety is available at tinyurl.com/MMRVaccineSafety.