Q&A: What to know about measles

Van Sickels: So that’s a great question. We’ve had so many questions from people that have tried to figure out if they got vaccinated against measles. It is tough. So, a couple ways you can do it. First, obviously, if you’re able to find your shot records, look for that MMR and then look for the dates. Really, if you’ve got one dose of MMR and you’re not planning travel, you’re not going to a university or some other secondary education, vocational school, something like that, or don’t work in the health care field, that’s probably sufficient for right now. There’s no emergency to do anything different. If you see two doses, then you’re good. 

Another way you can check is, if you grew up in Kentucky and you were vaccinated here, we have a Kentucky Immunization Registry. So, most health care facilities put in vaccines that were given across the Commonwealth of Kentucky, and your health care provider can check those for you. The catch with that is it started in 2015, and it only goes back to 2005. So, if you were born before then, or got the vaccine before then, we don’t always have the records here in Kentucky. 

The last option is to ask your care provider if they can do what’s called a titer or a level. We generally would prefer to vaccinate you instead, but if you’re looking as an adult, it’s a tough conversation because it’s unclear if all insurances will cover the MMR vaccine. It is a live vaccine, so it’s worth asking your health care provider because if you’re pregnant or if you are someone who’s immune compromised, it might not be safe for you.  

So have that conversation. They’ll help you decide if you should get the vaccine. They’ll say, it’s safe, you probably got it, it’s worth just giving it to you, which is always the better choice. Or maybe we should check a titer, which also might be important for your job. 

UKNow: And you’ve mentioned travel several times. That’s the way that measles frequently makes its way back into the U.S. Let’s say you are traveling internationally. What is the best route to figure out if you need to check to see if you’re immune against measles or even other vaccinations? 

Van Sickels: Sure. So, I think the first stop is check with your primary care provider. They can, if you have lived or got your vaccines here in Kentucky, again, they can check that registry. And that’s something you can just do and see if you’ve had it. Check your shot records with your family. If not, call and come see us. We have a Travel Clinic at UK for pre-travel. We’re happy to go through everything with you and that will include measles as well as other things that might help you, such as water safety and other precautions you might recommend for travel. But we can go through that with you here at UK. 

UKNow: I think it’s been about a month or so, but the Department for Public Health had put out a notice that there was a confirmed case of measles in Frankfort and kind of letting people know like, ‘Hey you were exposed.’ So just for future reference, if you think that you’ve been exposed to measles or have learned for sure, getting a notification that you’re exposed, what should you do if you are unvaccinated? 

Van Sickels: Sure, so if you are unvaccinated and you get notified by the health department, they will track you and they will have you check in with them daily to track your symptoms and make sure you don’t develop symptoms. And if you do, they will help direct you. Around this area, it will be to UK and we can help you out. If we catch you within a short window of time, so say you’re unvaccinated and we find out you were exposed to somebody with measles in the last three days, we can give you the vaccine and help prevent you from getting measles.  

Even within six days, the health department will contact us and let us know because there’s another medicine we can give you to help prevent you from getting measles as well. If you get past that six-day window, it’s a little tough, but we’ll watch you and we can still take care of you. So, the important part is to notify the health department and I would say if you haven’t been notified by the health department or if you think you’ve been exposed to somebody with measles, call your primary care doctor and don’t go in, just call them first. 

Exposed people are not infectious, but it’s always better to let them know because a lot of us haven’t seen measles and they might want to do some research before you come in to provide you the best guidance. 

UKNow: And let’s say if you’ve been exposed, should you let other people like in your family, your friends know as well? 

Van Sickels: Sure, so exposed people by definition are not contagious. So, you’re safe to stay in your home environment unless you were to develop symptoms. 

The health department is really good with anyone, especially with measles and other diseases that have high transmission rates of educating you of what you can and cannot do, or should and should not do rather. But you are safe to go around others unless you develop symptoms. I’m a big proponent of full disclosure, so I would always advocate for talk to your family, because it would feel lonely. You might be scared. A lot of people get scared with all these things happening, so I think that would be an advisable thing to do. But you’re not contagious. 

UKNow: Let’s talk a little bit more about symptoms. So a lot of them are similar to any respiratory virus, but can you kind of take us through what makes measles a little bit different? 

Van Sickels: Sure, so the big things that we educate people on about measles are obviously the rash, and I’ll talk about that a little bit more in a second, but it has what’s called the three Cs. So it’s cough, coryza — which is a fancy term for runny nose that I think they just use to give another C — and conjunctivitis, which is red eyes. So, you have to have that, fevers, and/or the rash, to really have a probable case of measles.  

So, what happens typically in the first few days is you’ll get the cough or the runny nose or the red eyes or altogether. You’ll get a fever that kind of keeps going and then about day four-ish you’ll start developing the rash. The rash starts around here on your head or behind your ears and then will spread downward.  

The tough part is in somebody that is pale skinned like me, it would be very apparent to see the rash. It’s red, you’ll see bumps, they’ll kind of come together as splotches and maybe have some dots. It doesn’t typically itch too bad. In somebody who is darker skinned or somebody of color, it might be more faint. We have to look very carefully and see if we just see light bumps or darkening of the skin to really see if that rash is there. And that’s usually what tips us off.  

So, it’s good for us to recognize how rashes appear on all skin types and make sure we’re thinking about measles. That being said, there’s a lot of diseases that can cause fevers, cough and rash. We’ve probably all had one in this room. And so, we have to be careful to distinguish those from something else. 

Hand, foot and mouth disease is a good example. It causes rash on the hands and fevers and things like that. There’s a few others. 

UKNow: Are children more susceptible to developing harsher symptoms because of their immune systems? 

Van Sickels: Yeah, that’s a great question with measles specifically, children who do not have adequate nutrition status, and specifically younger children under six months, are at higher risk for complications of measles. So definitely the younger kids, and certainly any child who was born with an immune deficiency or a weakened immune system in some way or has another chronic condition might be at risk for more complications for measles. But as a blanket of all children, not usually, but it depends on the age. 

UKNow: And you mentioned earlier, pregnant women, other adult populations, other specific medical conditions where we’d really be concerned if someone contracted measles? 

Van Sickels: Adults in general, when we look at the data, when you see who gets hospitalized more, it is adults who are unvaccinated over 20. 

Anybody who’s pregnant, anybody who has immune compromise, a lot of people, especially in this day and age, are on medications that alter their immune system for chronic medical conditions. They could be more at risk and we want to make sure we vaccinate them or check their immunity before we start those medications. That’s one of the things that our colleagues in dermatology, rheumatology, and gastroenterology are really good at for people with chronic conditions. 

UKNow: So at what point, if you’re unvaccinated, you think you have the measles, would you maybe call your primary care doctor versus thinking, “Maybe I should go to the emergency room?” 

Van Sickels: Sure, so you know the first step if you think you have the measles and I will say right now if there was a new case, it would be tough. 

Most of the time we find out about measles cases or people think they have measles cases because there’s a known exposure, because really we start looking at outbreak when there’s just one case in a hospital and in a community. We take them very seriously. So usually you get a lot of people notifying you once there’s one known case. But if you weren’t aware of an outbreak and you think you might have measles, the biggest thing I can tell you to do is call ahead.  

Because if you were to go into an emergency room, if you were to go into a clinic, it could infect so many people. So call ahead, they’ll have you discuss your symptoms. We can do so much with telehealth now. That will give your primary care provider a chance to call one of us on UKMDs, talk to us about the case and see what the best guidance is, interface with the health department who are real experts and who we rely on for testing.  

For when you should go to the hospital, I would recommend still calling ahead. If you’re going to go to the ER and you’re sick, you should, and I’ll tell you why. 

But call ahead first and they’ll give you some instructions on what to do for yourself or for a loved one if it’s a child. For a child, signs of dehydration, if they’re not eating, they’re not drinking, they’re not peeing and pooping normally and their cry gets weaker — they need to go to the emergency room and be evaluated. Dehydration is one of the top reasons for hospitalization. Again, call ahead first.  

For adults, dehydration is still there. Pneumonia tends to be one of the reasons that gets us to go to hospital. You’re unable to breathe well, you’re not keeping down fluids, you’re not able to just take care of yourself at home, that’s when you need to go in. But call ahead first.  

If you’re someone that can wear a mask, wear a mask because that just really helps reduce the spread. Obviously little babies, you can’t put a mask on them. 

UKNow: Talk a little bit about, if you’ve been exposed to measles, you’re getting sick, it’s too late to get the vaccine to kind of completely prevent you from getting sick. But what is a treatment like for a non-life-threatening case of measles? Can you treat it at home? 

Van Sickels: Yeah, so unlike for flu or COVID where we have some treatments we can give for people that are not hospitalized, there’s not much we can give other than telling you to do the same old stuff I tell you to do for any other infection. Hydrate, keep eating, watch your symptoms, stay in isolation would be the other one from a public health measure, but really try to keep yourself hydrated, treat your fever symptomatically and rest. You’ll get better in most cases.  

So that’s the good thing. For most people, they will do better. But we want to really try to, on the forefront, prevent any possible illness that becomes severe. But yes, if you get it, the chances are you’re going to do well. Hydrate, medicines for fevers, eat like you normally would, and we want you to stay in isolation for at least four days after the onset of the rash. 

So, when the rash starts, that’s day zero, and then you count one, two, three, four, which I think all of us are used to with COVID isolation stuff. 

We’ve gotten good at counting these days, but that’s when you can come out as the fifth day after. If you’re immune compromised, talk to your health care provider first and they might give you little bit different advice, but that would be the general recommendation. 

UKNow: Be a little more specific for our resources on campus, you know, just thinking about our students and our employees. If you haven’t gotten the vaccine yet and you want to, what are your options? 

Van Sickels: Yeah, so the pharmacies across campus, the Apothecary, the Kentucky Clinic, for example, they have the MMR vaccine. We’re fortunate here at UK to have access to it. Some clinics don’t, especially if they see mainly adults, they don’t stock it always. But at UK, we’re really lucky. Our UK retail pharmacies are amazing and they have the vaccine. They can vaccinate you.  

Talk to your student health provider. If you’re someone here and you go to UHS, University Health Services, they can help guide you on the best path or they can look up and see maybe you did get a vaccine dose and you might not need it or you might need a second dose and then we can help protect you. So, I think having that conversation is the most important.  

If you feel like, especially with lots of people traveling for spring break or even this summer, going to wherever their home is or maybe taking a trip, even people study abroad, things like that, check in with student health before you go, take care of everything pre-travel. We can help you in Travel Clinic if needed. And then if you come home and you feel like you’ve been exposed, call ahead. 

UKNow: And just to kind of finish up, is there anything else that you would want either the campus community to know, our students, or just the community at large about measles? 

Van Sickels: Yeah, I think the take home point of this and what I really want to stress is awareness of how vaccines have really helped our country, helped our children and helped our communities, specifically the MMR vaccine, but really any that we recommend.  

We don’t want to see these cases here. We don’t want to see these cases anywhere. We definitely don’t want to see them here in Kentucky. And I think if people can go out and educate their friends, say, hey, the MMR vaccine is safe.  

It does not have severe side effects. It is a way that we can prevent children from dying and even adults from dying and encourage people to talk to their pediatricians and get their childhood vaccines. We will raise a safer generation going forward. And that’s what I would really like to see out of this measles conversation, not just for measles, but for other vaccine preventable illnesses too, because healthy children lead to a healthier Kentucky, leads to better lives for everyone here and abroad. 

UKNow: Well said. Thank you so much Dr. Van Sickels for joining us today and thank you all for tuning in.