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Welcome to Doc Talk, a weekly podcast featuring Monument Health physicians addressing medical topics. Tune in to your health with Monument Health.
Mark Houston: Hello everyone and welcome to another edition of Doc Talk. My name is Mark Houston and on this episode I am sitting down with Dr. Paula Marsland, who is a pediatrician at Monument Health in Spearfish. Dr. Marsen brings a powerful mix of experience from pediatric training at Seattle's Children's in the Alaskan Native Medical Center to serving in the US Army's 250th Forward Surgical Team. Today we're going to talk about a disease that I never thought we would have to talk about again in this particular context and that is, of course, measles. It's back, it's spreading.
Why now? And what do parents and specifically communities need to know to protect themselves? So, Dr. Marsen, thanks for coming in and doing this. I appreciate it.
Dr. Marsland: Really excited to be here. Thanks for having me.
Mark Houston: Oh, that's great. I know you had a big press conference earlier this morning. So, you've been making the meteor round, so to speak. But it's great to have you here. And you are like we were talking before we turned the mics on here, based in Spearfish. And you're not native to this region, are you?
Dr. Marsland: I'm not.
Mark Houston: Where do you come from, Dr. Marsland?
Dr. Marsland: Yeah. Well, I've lived a few lives.
I grew up in North Central Wisconsin in a very tiny farming community, middle of nowhere. And I ended up going to college and getting my undergraduate degree at West Point, at the United States Military Academy in New York. And, it was an interesting experience. I started at a time when nothing was happening in the world. It was 1999. And while I was there, the attack on September 11th, everything changed.
And literally overnight everything changed. So once I graduated, I did five years active duty Army service. I was stationed in Seoul, South Korea and then at Fort Lewis in Washington. And while I was in Washington, I was part of a couple different medical units that deployed to Iraq during the four years that I was there. Really great experience and I very much appreciate the military, and a huge thank you to all of those out there who have served. It's a big sacrifice and so important to our country. Though it taught me a lot about myself and my values and it was just an experience that I will never forget. I ended up transitioning out of active duty in 2008 and I stayed in Washington.
I actually went to work for Pepsi of all things.
Mark Houston: That is a weird transition right there.
Dr. Marsland: Yep. I was a production manager in a small bottling facility in Seattle making soda. Weirdly enough, after a couple years I realized that wasn't for me.
Mark Houston: Well, why did you decide to do that? I mean, with that training you had, why did you just feel like you needed something else?
Dr. Marsland: It was a couple of factors. I think I would have stayed in the military. It was a really good fit for me. Unfortunately, my family was experiencing some illness and my young nephew, and honestly, I was on the other side of the world every time we got bad news. And it just became really important to me to at least be available to my family.
Mark Houston: Yeah.
Dr. Marsland: And I'm glad I did that. And that was important for my family and myself.
Mark Houston: Oh, absolutely.
Dr. Marsland: And so the reason I chose Pepsi, it was 2008. We were in a recession. I was terrified and wanted a job. And so I went through a recruiter and I met the folks from Pepsi and it actually ended up that the general manager of the group I went to work for was a prior West Point grad and we had a lot in common and so I think that kind of sealed the deal for me. And he had had a really good experience with the company and it was an excellent company. I just realized soda was not my passion. Funny enough though, after I started working there and as I basically made all my plans to leave Pepsi, my now husband came to work for the company.
Mark Houston: So, it's like you weren't going to get out.
Dr. Marsland: Yep. That's how we met. But by the time we started dating, I had actually already been accepted into a program in Wisconsin to get my master's degree in clinical microbiology.
Mark Houston: Okay. Which is basically the lab nerdy side of studying infectious disease, right? Was this—did you have a medical—well, did you have a military background in your family?
Dr. Marsland: My oldest brother was a Marine.
Mark Houston: Okay. Okay. And did you have a medical background in your family at all then?
Dr. Marsland: No, not really. No. I'd actually wanted to do medicine since high school though. Had dreamed of being a doctor.
Mark Houston: Oh, actually.
Dr. Marsland: And like I said, life had kind of taken some turns along the road. And funny enough, when I was looking at going back to school at that time, I thought I was too old to try for medical school. But I found this program in microbiology in La Crosse, Wisconsin, which many folks around here will know and have driven through, of course.
Mark Houston: Yeah. Beautiful area.
Dr. Marsland: It is. And so I went and I did that program and my husband and I continued dating and eventually he proposed. So I moved back to Washington.
Dr. Marsland: But then I took a job at the state department of health in Washington as a molecular microbiologist, meaning I was part of the team that was running tests and samples. And funny enough, we had an M.S. outbreak while I was there that we were running mumps testing on. We had a few pockets of measles in different communities. Nothing that took hold like what we're dealing with now, but certainly familiarity with those infections. I was also part of the team bringing on whole genome sequencing in foodborne outbreak investigations. It was really cool stuff.
Mark Houston: Oh, it would be.
Dr. Marsland: But again, I kind of got the itch after a few years. What I realized then was I missed people. I liked the intellectual stimulation of the lab and the new technologies and what we were doing.
Mark Houston: Yeah.
Dr. Marsland: But I really missed that connection with patients and families that I had gotten during my training. So my husband, he's phenomenal. He looked at me and he's like, "Try for medical school. This is what you've always wanted." And so I did. And thankfully I got in. A lot of doors opened.
Mark Houston: Personally, I feel like that's a God thing.
Dr. Marsland: Sure. And from there I entered medical school at the University of Washington and went on then to residency in pediatrics at Seattle Children's Hospital where I was fortunate enough to join the Alaska track where I got to spend one out of the three years of residency in Alaska.
And that's really where I fell in love with rural-based community medicine, working in Fairbanks as well as in Anchorage. That just struck a piece of me where I loved being that long-term continuity with families. I loved trying to help troubleshoot problems where we don't have all the resources and finding ways to work with what we have and to partner with families who maybe they've traveled two hours to come to that clinic appointment, right? Like that is a different game than an inner urban clinic that's seeing, you know, kids every 15 minutes, right? And so that's really what drove my passion for smaller-town medicine. And so when the job came up in Spearfish, it really felt like a perfect connection of all these things I loved, right? Got me back to the Midwest. Close enough, I guess, to home.
I like the impression I have so far of western South Dakota's topography and the area is more west and mountainish, but the people are Midwest.
Dr. Marsland: Yes, absolutely. For sure. It's been so lovely. I feel totally at home.
Mark Houston: Well, that's great. I mean, we have to claim the whole state, but once we get east of the river, it's, you know, they're on their own. All right. If you don't have the mountains, just we're going to make fun of you. Anyway, well, we're obviously very glad you're here and working in Spearfish. Now, did your husband come? I mean, he's here, too, obviously.
Dr. Marsland: Not yet, actually.
Mark Houston: Oh, really? You guys—
It's been that quick. It was that quick.
Dr. Marsland: Well, we also have two kids. Yes. One who finished high school and actually once we took this job, he decided to enroll at the School of Mines.
Mark Houston: Oh, awesome.
Dr. Marsland: Yes. So, he's out here with me.
Mark Houston: Okay.
Dr. Marsland: And then our daughter is finishing high school.
Mark Houston: Oh, perfect.
Dr. Marsland: So, she's got a year left. So, we do a lot of travel back and forth.
Mark Houston: Well, and that's good. You're not really uprooting them really. I mean, it's a hassle for you guys, of course, but you know, hopefully it'll all be—you'll all come together here shortly.
Dr. Marsland: Exactly. That's the goal. My husband is excited to join me out here. He loves it.
Mark Houston: Are you guys outdoorsy at all? Do you like to do that stuff?
Dr. Marsland: For sure.
Mark Houston: So, at least you'll have very much so a lot of that. Awesome.
Mark Houston: Okay. Absolutely. Well that is a pretty amazing background honestly to get us to what we were going to talk about today for sure. And I guess let's just start very bluntly, doctor. Why are we seeing a resurgence of measles right now when I think a lot of us had thought, oh man, we'll never have to deal with this again. This is finally right, but why? What's happening?
Dr. Marsland: Yeah. So measles is one of those diseases that its only dominant host is humans. So it has to have a human population to keep propagating. And in the past, we've always had a case or two every year. This is usually somebody who traveled internationally, unvaccinated, coming back into the country, and it just fizzles out. We might have a few cases, but that's about it. Unfortunately, at this point our vaccination rates have dropped and because measles is so contagious, experts estimate we need to keep a 95% vaccination rate or higher to keep measles from taking hold and we have now dropped below that. We're somewhere—the estimates are 91, 93%. It depends, of course, where you are in the country. But that's how it's taken hold. Most likely these cases have started similar to previous with international travel to areas where measles is endemic, meaning they see it all the time, and then came back to the US and it got a foothold.
Yeah. And these communities where vaccination rates are lower, we have lost what we call herd immunity where enough of the population is vaccinated, we protect those who aren't or who can't be vaccinated. We're losing that, right? And that's why we're seeing measles come back in the way it has.
Mark Houston: Okay. Now for parents who are listening right now who think, you know, it's just a rash. It's a fever. What are the dangers of measles? Because I don't think it is just that, is it? I mean, I think it's most—is it mostly survivable, but if we don't have to have that danger, right? I mean, that's the thing. So, how deadly or damaging can it be?
Dr. Marsland: Great question. So, number one, measles is miserable. Yeah, your kids are sick and they're sick for a good amount of time. Measles, I kind of mentioned this before, it's highly contagious. It is three times more contagious than the flu, than COVID. It's way more contagious than Ebola. Measles—if you had a person who had measles and went into an elevator, say, and they left, over the next two hours, if 10 people who are unvaccinated or unprotected went into that elevator, nine to 10 of them would get measles. It's airborne. It stays—those droplets stay in the air and just a tiny amount of that is infectious to cause the disease.
The disease itself often starts out with a fever. It can be a high fever like 103 to 105 Fahrenheit.
Mark Houston: Oh, that's dangerously high.
Dr. Marsland: Yeah. And your kids, like I said, they're sick. Yeah. Runny nose, a cough. Often they'll get conjunctivitis with the bright red eyes. Usually you don't see that discharge like you think of with classic pink eye, right? But their eyes will get real red. You might even see some white spots in their mouth. These are called Koplik spots. Sometimes we see them, sometimes we don't. They're there briefly. Then about two to four days after the fever, the rash comes in—or after the fever starts, excuse me. Then we see the rash. And the rash starts at the head. You'll see red dots right kind of along the scalp line on the face and then they'll get a little bit bigger. You'll feel them and they'll spread from the head down the body. It's almost like somebody dumped a bucket of measles on you and started at the head.
And the rash will blanch, meaning you can touch it and it turns white and then it'll get red again.
Mark Houston: Okay.
Dr. Marsland: And it'll spread across the whole body. The reason we worry, number one, like I said, it's very contagious so people will get sick quick. People feel terrible when they have it. And then there's the complications. Some of the common things we see: pneumonia. It likes to infect the lungs. Ear infections.
Mark Houston: Mhm.
Dr. Marsland: We can see actually a lot of diarrhea comes with measles. And so that brings in the worry about hydration. Are kids able to keep enough fluids in to support themselves while they're sick and feeling miserable? That's a big question. Rarely, but it does happen. About one in a thousand kids will experience encephalitis or inflammation of the brain. It's pretty awful. And then death. There is a possibility of death and we've already seen that in this outbreak. Of the people infected that we know of, we've had three deaths. That's one to three per thousand people, and often it's in kids. Of the current outbreak, 67% of kids are 19 year olds or younger. Of those hospitalized, it's about 133 last I checked. 104 of them are kids less than 19 years old.
Mark Houston: Are you guys getting worried about this at this point? I mean, has it reached that point where now you as doctors and pediatricians are really starting to have the discussion of, yeah, we better get some messages out quickly?
Dr. Marsland: 100%. I'm talking about it on every visit, right? Doesn't matter what you came in for. I want to make sure families are informed. I want to make sure they know what's going on and what their options are.
Mark Houston: Got it. Now the communities that are seeing lower vaccination rates, what do you see are the most common myths or fears that parents have about not just measles but—it comes in the group, it's the MMR is what people should be familiar with—measles, mumps, rubella. And I believe there's two of those you're supposed to get, correct? Is that it? Okay, so what do you hear from people? What are they most worried about, about this vaccination?
Dr. Marsland: Yeah, I hear a couple of things. Okay, so unfortunately in recent years, vaccines have gotten a bad rep and there's a lot of information out there and I do not blame parents for having questions, for being worried because at the end of the day, we all have the same goal. We want to keep kids safe, right? You as a parent are doing that in the best way you know how, taking in all the information available to you, taking in your family and friends' experiences, their wisdom, and I'm bringing to you the medical piece and what we know from the evidence and the studies that we have done.
Commonly, I hear things that families are worried that the vaccine has changed and that it's something new that we're doing. When it comes to MMR, we aren't. We're using the same vaccine that we started using in 1971, over 50 years ago.
Mark Houston: Well, that must mean it is effective and it works.
Dr. Marsland: Exactly. One dose, 93% effective in preventing measles. That second dose, 97% effective. It's awesome. It's one of our best. Especially for something that's so contagious. It's safe. Of course, there are always risks with any vaccination. Common things we see: redness, soreness at the injection site. Occasionally, kids will get a low-grade fever. You know, that 99, 100. They might feel a little punky for a day or two. Rarely do we see anything beyond that.
There is some worry that the vaccine itself can cause measles. We do see in one to 5% of kids that they'll develop a rash after getting the vaccine. This is not a contagious measles infection. Our studies show that none of the outbreaks are from the vaccine strain. We do sometimes see this rash pop up though. I can totally get why as a parent, if you heard your neighbor's kid got the measles vaccine and then developed a rash, that you'd be worried about that. It's not contagious. It is not what we're worried about. The vaccine is safe. And when you compare the risks of the vaccine itself and those things I've just talked about, the risk of the infection and what it can cause—much, much worse.
And there are some longer-term complications that we worry about years down the road that we haven't even talked about yet and we can certainly get to that. But kind of coming back to the vaccine question, I hear: is it new? Has it changed? I also hear a lot about worries that we give it too young. For that, I would argue our children, especially as infants and toddlers, their bodies are exposed to tens of hundreds of new things every day. You think about your kid that, you know, out in the yard eating dirt and the whole thing.
Mark Houston: Exactly.
Dr. Marsland: Licks the bus seat and you're like, "Oh, no." Their immune systems can handle it. They are totally ready for this. And we've done the studies to prove these are the best ages. These get us the best response, etc. So that's one question.
And then with MMR specifically, unfortunately, a number of years ago, a gentleman published a study that linked MMR with autism. And that was tragic.
Mark Houston: That study was falsified. It has been totally debunked. Totally.
Dr. Marsland: Absolutely. At least 18 studies have been done since then, have proven there is no link. That doctor has been banned from medicine. He is no longer allowed to practice. But unfortunately, his legacy is one of doubt and mistrust. And that's part of the conversation that I always want to have with families. Like, what are your worries, right? Please talk to me. Tell me because I will gladly give you information. I understand that you're not doing this from a place of wanting to be difficult. You want your child protected. And how we do that is the partnership that I hope you all have with your pediatrician and your family medicine clinics, that we can talk through these things and you have the best information in your hands.
Absolutely. I want to go back to—you had mentioned about giving it too young and I had been reading, I saw a study or a case study of one kid that ended up with it. He was 16 or 17 years old, ended up with measles, ended up passing away from it. But they said that he wasn't vaccinated, but it had been in his system since he was two months old and that it can reoccur that far. Is that true? Is that something that can happen?
Dr. Marsland: What the condition you're talking about is called subacute sclerosing panencephalitis, or SSPE.
Mark Houston: Okay.
Dr. Marsland: This is a rare complication of measles, but we know it is from measles. And the average time for this to present is 10 years after the original infection.
Mark Houston: I was so stunned to learn that it can stay in your body like that.
Dr. Marsland: It can. And this causes effect on the nervous system, on the brain, ultimately leading to coma and death. It is almost universally fatal. And it is not every child that will develop SSPE, of course, but of those that do, it's deadly.
Mark Houston: Okay. I mean, in reading that, it was a very eye-opening study that I saw because I think a lot of people will compare measles to chickenpox. They think it's a little similar, isn't it, in a way? But obviously it's much more serious. You know, and that's why we were hoping to get rid of it.
So, let's say those of us, or whoever, as kids were vaccinated for measles. Are there boosters needed for this down the road?
Dr. Marsland: Great question. Actually, no.
Mark Houston: Really?
Dr. Marsland: Yep. So, anybody who was born prior to 1957, we consider immune. 1967.
57, I'm sorry.
Dr. Marsland: Yep. Those who are vaccinated between 63 and 67, they should go get an additional dose if they haven't already. And the reason for that is during those years, we had a different vaccine, okay, that we found was less effective. And if you have any questions, talk to your doctor. 63 to 67, you should go get an additional MMR shot. Okay? 68 or later, as long as you got those standard two doses, you've got that 97% protection.
And when it comes to kids, couple of things there. Our standard schedule is to give the first dose between 12 and 15 months and that second dose between four and six years. You can get it earlier than that. If you got your dose at 12 to 15 months and your kiddo's two and you're traveling this summer, absolutely go get that second dose. It is just as effective. You are protected. The child does not need a third dose.
The only range that we're talking about where some things are a little different is the 6- to 11-months. And I'll tell you why. Up until 6 months, we assume babies are protected from mom's antibodies. Those pass through the placenta when they're pregnant. And so we find that those last a good six months and then they start to wane after that. Between six and 12 months—and in some studies in some countries around the world, they vaccinate as early as nine months. So 9 months to 12 months, effective. Again, if you're traveling, you got a 10-month-old, especially if you tell me you need to go anywhere that measles has a high community prevalence, I want to give that 10-month-old an MMR. And that child, though, will need the additional two doses.
Mark Houston: Okay? As long as you got your two doses after 12 months old with at least 28 days between the two doses, you're good. You don't need anymore. If it's an infant who gets it in that 6- to 12-month range, they're going to need those two additional doses when they're older.
Dr. Marsland: The 6- to 9-month range, I want to talk about that a little bit. Totally safe. And again, if you are traveling and you're going to an area where you're worried about it or you're traveling internationally, I absolutely want to give your baby that MMR vaccine. It will protect them in the here and now. What studies have shown is there's some decreased amount of antibody production when we do it that early, meaning there is a theoretical risk that later on they wouldn't be able to mount as robust of a response. However, the risk of measles now is still way higher than that potential risk in the future that we would still recommend you get the vaccine early for your baby. Now, if you can wait until they're 9 months or older, best world. We know they're going to get that really robust protection. But again, if you need to travel, I'd way rather have you protected in this time of outbreak in our country than have you wait and perhaps be exposed.
Mark Houston: So, as you get older, let's say you've had the vaccine in the early 70s or mid-70s or whatever, and you're in your 40s and 50s now, does the protection wane as you get older?
Dr. Marsland: I mean, typically not.
Mark Houston: Okay.
Dr. Marsland: There are a small amount of the population—and we find this with most vaccines—there's a small amount of the population that just doesn't mount a great response regardless of when they got it. And those are the folks that typically this is discovered when they're somebody going into health care and we get titers or serologies, meaning we look at your antibody production and we just see that it's not that strong.
Mark Houston: Right.
Dr. Marsland: Those are the folks who their doctor may tell them, okay, you need an additional dose. So you can get one if you're older. I mean, if you need one, you can get one.
Mark Houston: Absolutely. Fine. Okay.
Dr. Marsland: It's more one of those that if you didn't mount a great response to begin with, you may not mount one now. Again though, rather have you be safe than sorry.
Mark Houston: Yes.
Dr. Marsland: But if you have a normal immune system and you got those standard two doses, we consider you protected.
Mark Houston: Okay. Now let's say somebody—because we've had, I know recently here a couple days ago, from the time we're recording this podcast, that there was a case in Meade County of someone that had measles and it was all over the news. People are like, if you were at this urgent care from here to here because like you said, they can breathe it out and it can hang on for a couple hours in a place even after they leave.
Dr. Marsland: Yep.
Mark Houston: What do parents need to look for that you feel is okay, they have enough of this now that it's urgent, they need to go to the ER or to an urgent care, what signs do they need to look for?
Dr. Marsland: Yeah, absolutely. Well, number one, if you hear on the news that you were in a building where there was a positive measles case, please call your clinic. Call your doctor. Absolutely. We want to have that conversation, even if you have no symptoms and regardless of your age, we want to talk about it. So that's number one.
Number two, for parents, what signs or symptoms? If your kiddo develops a fever with cough, runny nose, and red eyes, please call your doctor's office. Even if they're just getting a fever and you think there's a potential that they were exposed, call. We'd so much rather have that conversation. If your child is starting to get sick, let us know right away, right? Because the sooner we know, the sooner we can treat. There are post-exposure prophylaxis or PEP. We have treatments and I can talk about that here in a second.
Mark Houston: Let us know those.
Dr. Marsland: Yep. For sure. Yep. But the first step is letting us know.
Mark Houston: Okay.
Dr. Marsland: And the next step is when you show up, put a mask on. We want to protect all those other kids in that waiting room. We want to protect everybody else in that clinic. Put on a mask. Call from your car that you're here and let us know. Most clinics are going to have a separate entrance. At least they're going to have a plan.
Mark Houston: Yeah.
Dr. Marsland: They're going to get you in and get you into a room right away to decrease that exposure to others and we can get you treatment and we can get you that evaluation as fast as possible.
Mark Houston: Right. Okay. So, let's talk post-exposure prophylaxis. I'd love to know the treatments, I guess, if you come across it for sure.
Dr. Marsland: Yeah. Yeah. Exactly. So, post-exposure prophylaxis, or PEP, because that is quite a mouthful, PEP is really going to determine—depend, excuse me—on a lot of things. It's going to depend on your age and your vaccination status and how long since the exposure. And so if you find out two days afterwards that you were in that same clinic where a positive patient was, we still want to know about it. And we have these guidelines and certainly your clinic, your doctors will talk you through this, but for example, let's say my nine-month-old was with me and we walked through and it's been two days. First thing we're going to do is recommend that MMR vaccine is our best prophylactic treatment.
Mark Houston: Okay.
Dr. Marsland: Yep. Now, if it's been five days, we have a different recommendation for that. We're going to recommend intramuscular immunoglobulin or IMIG.
Mark Houston: Also a mouthful.
Dr. Marsland: Have a lot of those. Yes. Yes. This is basically we are giving your child antibodies to fight the virus. This is a treatment. But that means coming into the hospital, that means an infusion, that means close monitoring. If we can catch it early and just give the vaccine, that's what I want to do. And so, like I said, we have different recommendations depending on age and vaccine status.
Now, if you're over 12 months old and you already got your two doses and you say, "Hey, I've got signs and symptoms but I had my vaccines," we're going to bring you in. We're going to test you, but the treatment at that point is wait for the results. If the result is positive, then we're going to recommend vitamin A.
I'll get into that in a second.
Yeah. Oh, boy.
Mark Houston: Yep. All right. So many things.
Dr. Marsland: There is, I mean, but it's awesome to know this. I think this information isn't easily accessible. I mean, what you're saying, just these quick breakdowns of things, I mean, I thought I'd looked into this quite a bit and I didn't hear anything about the vitamin A. So, this is great.
Dr. Marsland: Yes. And the—before I kind of dive into vitamin A, what I want to say very clearly is vitamin A is not prophylactic, right? We have very, very low rates of vitamin A deficiency in our country and too much vitamin A is toxic. So please, please do not start out vitamin A.
Mark Houston: Okay, good.
Dr. Marsland: Yep. Too high of levels are toxic. Pregnant women should not get treatment-level vitamin A. It is toxic to the baby.
Mark Houston: Got it.
Dr. Marsland: Yep. So the vitamin A, what we have found—we have found that kiddos who get measles, some studies have actually shown that they may have normal levels before they get the infection, but something about the infection itself either uses our vitamin A or releases it from our body stores, those levels start to drop. If we give vitamin A, it tends to, at least on a population level, decrease the severity of symptoms and the mortality.
The dosing for that again depends on age and it's two doses, one each day for those first two days after we know that you're positive. You'll get this either from your pharmacy or your doctor's office. It's not something that we want you to be administering yourself. Certainly, you're going to give it to your kid, but as far as getting the dose ready for you, I'd really rather we do it because of that risk of toxicity if you did too much too often.
Mark Houston: That's so good to know.
Dr. Marsland: Yeah, there's other things out there, some other recommendations or things you might hear on the internet. Like I said, the vitamin A, cod liver oil is one I've heard about. Very high in vitamin A. Please don't start dosing your kid with a ton of cod liver oil.
Mark Houston: That's the takeaway here.
Dr. Marsland: Okay, take that away. We're just saying this works, but not just every day, twice a day, right? Don't take it, please.
Mark Houston: Bless your—I can't imagine a child who's excited to take—
Isn't that what people used to give kids to make them throw up, too? Is that what it was?
It was something like that. Something like that. Exactly.
Dr. Marsland: All right. So, that's one. So please know. A couple other ones that I've heard of. Budesonide. This is an inhaled steroid. We use this all the time. I use this often in my kiddos with asthma who get sick and need that help or as a controller to help those sick lungs. And that's exactly what it is. It is a treatment for a particular complication or symptom. It's not preventative. We do not have an antiviral that eradicates measles. Not like we have antibiotics that treat bacterial infections. We don't have anything like that for measles. Right? So, we are treating the symptoms. We've got vitamin A in our back pocket that we think helps. And so, we're going to give that to confirmed measles cases, kids only.
Budesonide, that's something that unless you need it already or we are treating you for those lung complications, you might see it, but please don't try to start that prophylactically. And really anything else that you hear, I would strongly encourage that conversation with your doctor, right? Like, great to give your kids some vitamin D. We love vitamin D just as a general healthy vitamin.
100%, right.
That standard multivitamin, awesome. But if you're going to try anything that you've read about or you've heard about, please talk to your doctor first, right? Because some of these things are not benign and we really want to keep kids safe and not create another problem, right, in our efforts to be proactive.
Dr. Marsland: Yeah. You know what I'm hearing through this whole podcast right now is that we seem to understand this particular disease incredibly well. It doesn't seem like there's a lot of surprises. It doesn't seem like there's a lot of misunderstanding. It seems like doctors, especially pediatricians and people that are in your position, understand it and get it. And I guess just from my personal view, that's why this is so frustrating that this outbreak is occurring right now, is because we have the knowledge and we know what works and we're positive that it works and now people are suffering just because we're not listening. And I wish we would be listening more to the people that, like I said, understand this the best. Is that frustrating for you as a doctor? I mean, do you get—I mean I know you want all the kids to be safe but you're also a parent and so you understand what parents feel for their kids and you understand why there's concern, right?
Mark Houston: Absolutely.
But still, at the end of the day, you must just think too, like, oh boy, what else could I have said to make them—
Dr. Marsland: Right. No, that honestly that's where my thoughts go, is I more reflect on it that we as a medical community, that we have let down the families and the worried parents because I think we've done a poor job of listening. We haven't heard people's concerns. We haven't given space for those personal experiences and allowed time to address those things to the best of our ability and recognize that parents are still going to make the decisions that they make. I would so much rather have a conversation and continue that therapeutic relationship because that's ultimately what's going to help your kid the most. And so when I have a family who expresses concerns about vaccines, I am all ears because sometimes I hear things that I didn't realize were circulating.
Mark Houston: Sure. Absolutely.
Dr. Marsland: And that's back on me to educate myself and to provide the studies, the evidence, the data that I can to answer those questions. And so I think it's on us as a medical community to meet families where they are. And it is also I'm really hopeful from a circumstance like this that families are more receptive to hearing what the science says, what the evidence promotes, and again that we can have that open communication because at the end of the day, if you were struggling with the decision to vaccinate, I really hope you do. And if you're worried your kid might have been exposed, I really want to know because I want to take care of them right now.
Mark Houston: There's going to be people—because I remember when I was a kid—they had chickenpox parties where the infected kid would go to all the other kids and infect them all. And there's been whispers of this with the measles.
What's your takeaway on hearing things like that?
Dr. Marsland: Please don't. I get the idea, right? And I think people probably did that with measles before the vaccine, right?
Mark Houston: You're exactly right.
Dr. Marsland: But we didn't know about the long-term consequences. We didn't know about things like SSPE. We didn't realize the effectiveness of our vaccines until we started getting the data and saw those measles rates drop so dramatically.
There's another condition that can happen with kids who get measles that we haven't talked about yet that I also think may influence families' decision-making, but again, I just want to make sure they have all the information. There is this condition that we term immune amnesia. This doesn't happen to every kid who gets measles, but it happens to enough that we should talk about it. It's basically—what we're meaning by that is the immune system forgets how to fight things it already knew how to fight. And I'll talk you through this. So, when we get a vaccine or we get an infection, our white blood cells, our immune cells mount a response. And part of that long-term response is the making of memory cells. I'm going to call these our special forces cells.
Mark Houston: Okay, perfect.
All right. You've got the background to call that. So, yes, please do.
Dr. Marsland: Our special forces cells produce antibodies and mount a response that is specific to a singular target. They are the seek and destroy.
So if I got vaccinated for chickenpox and that virus shows up in my body, those special forces cells attack and I probably don't even know that I was exposed because it already clears it from our system.
Measles is sneaky. It infects those memory cells, those special forces cells. And so then as part of our body getting rid of the measles virus, we often have to kill those cells and we've lost that memory. And so it means that if your kid got exposed to a particular cold or ear infection kind of thing, they may have lost immunity to that infection and they could get it again. I heard one infectious disease doctor describe it like starting daycare all over again.
And you know exactly what I mean. Do I?
Dr. Marsland: That year of back-to-back-to-back infections, the runny nose that never goes away, the constant ear infections, like your child could be at risk for that. And it, like I said, it's not everybody. We see it more in kids with severe measles infections than anybody else. But man, if I could prevent that, I sure would want to.
Mark Houston: Is there—are we missing anything, doctor? I don't want to miss anything on this because again this is every—well, it's soon to be everywhere if people don't—excuse me—I think start paying attention and taking the advice of people like you who have studied this and who understand it and know it inside and out really. I just want to make sure I've covered everything so we don't miss anything for sure.
No, I think I think we've touched on everything.
Oh, I—nope, I'm gonna—
Dr. Marsland: Okay, one more thing.
Mark Houston: Yes. No, go ahead.
Dr. Marsland: One more thing. I don't think we talked about this. And you correct me if I'm wrong. The period of which somebody is contagious.
Mark Houston: Yes, that— No, that we did not.
Dr. Marsland: Okay, perfect. Yes, perfect. So, from time of exposure, the incubation time frame for measles is anywhere from 6 to 21 days. Jeepers, this is a sneaky virus. Three weeks later, you could show symptoms. And again, this isn't somebody who is unprotected, unvaccinated that we're talking about here, but up to three weeks. And then once you start symptoms, you are infectious from about four or five days before the rash starts to four days after the rash starts. It's like eight or nine days that you are infectious to those around you.
Mark Houston: That is awful.
Dr. Marsland: And again, depending on kiddos' ages, when we find out that they were either exposed or potentially came in contact with a measles case, that's going to dictate how long we ask families to quarantine. We might be telling you we're going to ask you to quarantine for 21 days. That's three weeks. I mean, just imagine, parents, you have to be in the house now with your kids for 21 days. All right? I don't know how else—if that gets the point across, we'll do it that way, too, I suppose.
Mark Houston: That's this has all been—I mean, I'm so glad you came in and did this and talked about it and your knowledge of it and the fact that you genuinely want to take care of this and take care of the people that might come in contact with it because it is in our area now. You know, we've had the news stories that it is here. And again, is it something that's going to seriously affect you? Maybe not. Mostly not. But why take the chance? It's all too short. We're too—we're not here long enough to begin with. Don't take the chance.
Dr. Paula Marsland, pediatrician at Monument Health in Spearfish. Thank you for coming in and doing this.
Thank you so much for having me. Anytime you want to come in and talk about viruses, let's do it because I'm fascinated by them.
Mark Houston: All right, thank you.
That sounds great. Thank you so much.