Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilton , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilton .

Speaker 2: 0:19

Hey, everybody, it's Dr. David Hilden , your host of the Healthy Matters podcast. And welcome to episode 23 in which we are gonna talk about measles. Joining me today is Shea Younga Beecher. She is a nurse practitioner in the Department of Pediatrics at Hennepin Healthcare in downtown Minneapolis. And someone who's seen lots of cases in measles and frankly in expert on the subject. Shay , thanks for being on the show.

Speaker 3: 0:41

Hi, nice

Speaker 2: 0:41

To be here. It's great to have you on. First of all, why are we talking about measles at all?

Speaker 3: 0:46

Oh boy. We are in the middle of an outbreak currently. We have 42 confirmed cases of measles here in the Twin Cities. The outbreak started in May of 2024, and because of the way measles is transmitted from person to person and um, how it spreads through communities, here we are about four months later, still talking about it.

Speaker 2: 1:06

We're still talking about measles. So we're, we're broadcasting from Minneapolis, Minnesota. Uh , is this a Minneapolis problem or is this our outbreaks common?

Speaker 3: 1:15

It, it's becoming more common. We thought we got rid of it back in 2000. We actually even say in the United States, measles has been eliminated, but the pandemic really shifted , um, ways kids have gotten their care, in particular pediatric preventative care such as immunizations. And because of that , uh, everyone's behind on their immunizations. What we normally protect against vaccine preventable diseases aren't, and here we have the diseases

Speaker 2: 1:40

And here we are. So I'm an adult medicine physician. I do not see children, and I've been practicing now for well over 20 years, and I can't recall the last case of measles I saw, because for the last 20 years it's been pretty much not a thing, but you are in pediatrics and now it's back to being a thing. So we're gonna delve into that a lot more because this is a relevant topic for our communities and children and, and , uh, the adults that , uh, live with them. So help us to understand measles, if you could. So

Speaker 3: 2:15

Measles is probably one of our most contagious viruses that we know about. Um, it typically presents with a high fever, so 103 to 105 degrees, which if anyone's had a kid, even 101 fever, scary high,

Speaker 2: 2:28

It feels

Speaker 3: 2:28

Warm, right? Yep . Um , in addition to that, you get the runny nose, the cough, sort of the pink eyes, the crusty eyes, and then there's this rash. The rash spreads from head to toe. And , uh, once that rash presents itself and you're like, okay, let's , let's test for measles. So

Speaker 2: 2:44

Everything up to the rash, but maybe even a little bit, the rash parents listening to this right now are going, yeah, my kid gets out all the time. They get fevers, they get runny, snotty nose. And how do , when , when , when should a parent be worried that uhoh , this might be measles?

Speaker 3: 2:59

So for the most part , uh, measles happens if you're unvaccinated. So if your child is unvaccinated, meaning they don't have their completed two doses required to be protected against the disease, then it's important to keep an eye out for high fevers, cough, runny nose, and the rash.

Speaker 2: 3:16

So we work at a , a big hospital in a big city, and every now and then of the past few months, we get these messages from smart people who run things and they say, there's been a case of measles, they were on our campus, and then all these precautions that we needed to take or do something. So what I'm trying to get at is how is this thing transmitted? Why is it so dang contagious? Because that requires a message, a blanket message that goes out to a whole hospital simply because one person was here.

Speaker 3: 3:47

Uh, this is airborne. So this means it spreads in the air, and it's either when someone coughs, sneezes and those drop loads travel, and then you inhale them, or those same infectious droplets land on something. And then you touch that something. And here's the scary part. With measles, it can remain in a room for up to two hours after that person has infected the space. So imagine that you're on a school bus and a bunch of middle schoolers got , got off, completed their route, and now the bus is going around to pick up the kindergartners. It's within that two hour timeframe. So if a seventh grader coughed spread measles, and then your kindergartner comes on the bus, breathes it in two hours later, they can get infected if they're unvaccinated.

Speaker 2: 4:26

That is , uh, impressive contagion. I mean, yeah , it really, really is. That's, and that is a little scary, you know, and, and frankly, during the covid years, I did a lot of public education Yeah . About covid, and we were wondering, is this thing pet ? Is it like , yeah . Is it ,

Speaker 3: 4:40

It's like measles. Yeah.

Speaker 2: 4:41

Is it like measles? Because if it's like measles, we're in trouble.

Speaker 3: 4:45

That's the standard at which we had measure Yes . Everything else against. And here we have the standard that we're concerned about in our community,

Speaker 2: 4:52

It's actually happening. It is just that contagious. Yeah . One of , I can't think of anything. Actually more contagious. So you're simply in a room where somebody had it within the last few hours. You got it. Right . If you're not, if

Speaker 3: 5:03

You're not vaccinated,

Speaker 2: 5:03

We're gonna talk much more about how to prevent measles for in your child, in your family, in your community, in just a little bit, but a a little bit more about the disease itself. Mm-Hmm . <affirmative> , what can happen? So what my kid got measles. What are some of the things that can happen like that can go wrong or complications or what can happen?

Speaker 3: 5:20

You hope that your kid gets measles and within a week they're back to normal. There are cases that result in complications, or the most common being secondary bacterial infections. So that, that could mean an ear infection, pneumonia, diarrhea. Um, there's a something called acute encephalitis, which is inflammation of the brain that can lead to brain damage. And in fact, one to three of a thousand kids will die due to either breathing or brain complications.

Speaker 2: 5:48

I'm so glad you mentioned that one, because we, in the healthcare profession, we know about all these really potentially life-threatening things that can happen. You can get a brain infection, but the public doesn't always know that. And they go, well , my kid got better. Yeah. Three of a thousand's. A lot. You don't wanna be the parent of that , one of those three.

Speaker 3: 6:05

No. Here's another scary part about measles, and I'm not here to instill here , but you have to keep this on your radar and you're trying to do all that you can do to protect your kids. You're thinking about all those rare situations. That's why you put kids in a seatbelt and that random off chance that you get into a car accident, same way with measles, there's an off chance that you might get that rare illness. And there's one in particular called a subacute sclerosis. And panencephalitis, it's fatal. It's this sort of degenerative behavioral cognitive disease. It can appear seven to 10 years after you're infected. So it's not just a complication that happens, boom, you're sick in one week, you're in the hospital, and then you get sicker. This is boom, you're sick, you get better. You go on with your life. Seven to 10 years later, you get this illness that appears again and it kills you. And in fact, in 2015, there was a woman in the state of Washington that died from this because she got measles 12 years prior.

Speaker 2: 7:01

Wow. Yeah. So it is, yeah. And, and I I appreciate your earlier sentence. You're not here to, to instill fear, but you are here to give solid information. Yes. And and it's really relevant to this particular topic. So do vaccines prevent it?

Speaker 3: 7:17

Yes. And I'm not gonna say a hundred percent, but the rates are pretty good. So we get two doses. The first dose typically occurs by one year of age, one to 15 months. Um, the second dose happens right before kindergarten. So between four and six years of age with that first vaccine, 93%, you can prevent it with that second vaccine, 97 to 98%. That's phenomenal. There's

Speaker 2: 7:40

Almost nothing in medicine that effective. Right . I mean, there really isn't. There's almost nothing that effective. And frankly, we have decades and decades and I mean, we're talking many decades of experience with the measles vaccine and how effective it is. I'm an old cadre and I had it, you know, way back in the sixties, <laugh> . So, so the thing does work. So we will get much more into the vaccines, but I wanna talk a little bit more about, you said earlier that somebody got an illness many years after getting measles. Are what's their immune system's status? Are they protected?

Speaker 3: 8:13

They have some level of protection just because they got the disease. But truthfully, to get the best level, that 97% protection that we're aiming for, you need to get the vaccine even if you had measles.

Speaker 2: 8:25

Can adults get measles?

Speaker 3: 8:26

Yes. In fact, in the current outbreak, one case outta the 42 is in an individual that's older than 20, I believe they're about 30 years old.

Speaker 2: 8:34

I'm gonna shift a little bit now about your practice in your career. You work here in Minneapolis, Minnesota, but you told me , uh, you also have practiced in the African country of Tanzania. Mm-Hmm. <affirmative> . Could you talk about your experience in populations both here in Minneapolis and in Eastern Africa?

Speaker 3: 8:52

The same things that work in East Africa, work here in the Twin Cities. The same things that families are concerned about in East Africa are the same things that families are concerned about here universally. We all , uh, want the best for our children. We wanna do everything that we can to protect them. The same things keep us up at night. And what I'm finding is that we need to make sure that we're getting to sort of the, the best way to promote health. And that's through one-on-one interactions with individuals.

Speaker 2: 9:20

So here in the Twin Cities, you do a mobile van. I I've seen it folks, if you haven't seen the Hennepin Healthcare mobile pediatrics van, it's, it goes out to communities and provide some healthcare . Could you talk about that program?

Speaker 3: 9:32

Yeah. We started this in May of 2020, which is early pandemic. We were at that stage where I think most of us was still watching Tiger King and wiping down our milk cartons with myself .

Speaker 2: 9:41

We were wiping them down. Remember that <laugh> , you stood out on your back of your house and you wiped down your cheer.

Speaker 3: 9:46

Is it Tiger King? I don't

Speaker 2: 9:47

Remember. No, it was, it was that guy who ran the tigers <laugh> . I do remember that . Oh , those were

Speaker 3: 9:52

The , so we , we did not know much about nostalgia

Speaker 2: 9:54

Corona

Speaker 3: 9:55

Virus items . That's the , my weird word . But you can call it, I dunno . Yeah .

Speaker 2: 9:58

But at that time you were wondering how to care for children.

Speaker 3: 10:01

Yes, because we knew that we weren't going out to receive care. I mean, one thing, we were limiting who we would see in clinic. We were prioritizing the youngest of young. Um, and then on the other hand, nobody wanted to leave their house. So we had large communities of children that were not getting their vaccines, and we did not want a measles outbreak on top of a coronavirus outbreak. So we took this van, packed some needles in the back of it, <laugh> , and went house to house, giving kids their shots. It sounds a little sketchy, but <laugh> No, it was,

Speaker 2: 10:29

It was totally on the up . I've seen it. You painted the logo on the side of it . Oh ,

Speaker 3: 10:34

Back in the day. It was a really sketchy mic ,

Speaker 2: 10:36

<laugh> . Oh , okay. So you didn't have the sweet band you have today? We didn't ,

Speaker 3: 10:38

Yeah. Uh , now it's a lot better. Super adorable. It is , uh, superhero graphics all over it and

Speaker 2: 10:44

Kid friendly and cri And

Speaker 3: 10:45

Then we have some street cred too. People know what it is. Know the entity, know us, and it's a very welcomed presence. And we earned our way to get to that point. But the point was to bring kids their healthcare when they couldn't come into clinic or they didn't want to, for whatever reasons, we went to them and met them where they were.

Speaker 2: 11:03

Do you know, I just absolutely love whenever I hear of a healthcare system that is meeting people where they are, whether that be in Tanzania or whether it be in Minneapolis, Minnesota. And that program is simply amazing for getting vaccines and other healthcare to families in our communities. We're gonna take a short break. We're talking to Shea Beecher . She is a nurse practitioner and has a master of public health. So she has experience in population health as well. She practices here in Minneapolis, Minnesota at Hennepin Healthcare. And we are talking about measles when we come back. She's gonna talk about preventive health measures and the vaccine. Stay with us. We'll be right back

Speaker 4: 11:44

When he up in healthcare says, we are here for life. They mean here for you, your life and all that it brings. He up in healthcare has a hospital HCMC and a network of clinics both downtown and across the west Metro. They provide all the primary care and specialty care you would expect to find. But did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 12:21

And we're back talking to Shea Beecher about the measles. So you gave us some good foundational information in the first half. Now I want to turn to the vaccine. The vaccine works. You said that it is exceptionally effective in many of us. I would say most of the population has been vaccinated, but not all. So what concerns are you hearing about in the communities, especially those who are, who have questions about the vaccine?

Speaker 3: 12:45

I think in general, vaccines give families a pause. Like with anything that you're gonna do to your kid, you wanna make sure that it is safe and that it promotes the health of your child. One thing that we hear about is that vaccines make my child sick. In general, you get a vaccine, your arm hurts. My gosh, you get a fever, you get aches, you get chills. Why would you put your child through that? And the truth is, the vaccines are sort of intended to trigger your immune response as if there was an actual infection. And so they sort of give you this fake response, right? We don't know the difference. We still feel crummy, but we can treat that with some Tylenol ibuprofen. Compare that to example, with actually getting a virus. You might take some ibuprofen Tylenol and that fever is gonna keep coming back and there could be complications. So we expect that when you get a vaccine, yes, you will get the arm soreness. Yes, you'll get fever aches, but that goes away. The second thing that I hear from families is that, my goodness, my kid gets so many shots all at once. And the truth is, kids are the most vulnerable for infectious diseases. A couple of reasons why they're young and have never been exposed to it. We wanna sort of expose them in this controlled setting that we can prime their immune system and that they're ready to fight it when they really do come across as infection.

Speaker 2: 14:05

Yeah . Their , their bodies are practicing.

Speaker 3: 14:06

Bodies are practicing. Yeah. Um , the second thing about kids is that they are in cesspools every single day. If you have a kid in preschool, you know that they're constantly snot nosed, coughing in your face, in each other's faces ,

Speaker 2: 14:18

Licking each other,

Speaker 3: 14:19

Licking everything,

Speaker 2: 14:20

Licking everything matter .

Speaker 3: 14:21

So you wanna make sure that when they're in their congregated spaces with other snot nose kids, that they have the best protection that they can. So that's why we have to unfortunately give kids a series of vaccines pretty close to each other when they're young. And then the other , uh, concern that I hear as it relates specifically to the MMR vaccine is that it causes autism. At the end of the day, this theory that MMR causes autism was actually published in a scientific journal. And it spurred this community, including scientists and doctors and nurses and families to think, oh my gosh, what are we doing with this vaccine? At the end of it, it was peer reviewed, again with other scientists and doctors and nurses, and they realized the study was flawed. It didn't make sense, and there was actually no truth to it. But that wasn't enough. People went forth and looked at MMR Vaccines autism and try to find a link between the two. And there's now been incredible amounts of data and studies and there has been conclusively no link between MMR and autism. Unfortunately, one sold that cat out the bag, the cat's out there, and it's hard to pull it back in. And we, especially in this age of social media and Google searching and podcast, we can find whatever information we want to support our worst concerns or fears. And so it's been hard to address that fear of autism linked to MMR . There is no link. However, we do not know what causes autism. And for that reason, it's hard to say, well, but get the vaccine anyways.

Speaker 2: 15:55

Right. Right. A lot to unpack there, but I so appreciate what you just said because the, the MMR measles, mumps rubella , um, vaccine is so much, it's like the index case of misinformation. I remember when that thing was published, it was discredited. It was not actually scientifically sound. It is just not supported by any facts that there's a link between the vaccine and autism. And yet because of the reasons you said, it just flourishes out there. Once that gets out there, it's difficult to shake it. So in your practice, how do you address that? Because it's easy to blame people, but they've been exposed to information that sounds reasonable. This guy's gotta doctor, you know , sounds reasonable. How do you combat that when you see families who, it's not their fault, but they've been fed wrong information,

Speaker 3: 16:51

Or they might have a cousin or a neighbor that has autism Mm-Hmm. <affirmative> and they understand , um, how challenging having such a diagnosis can be in social interactions or on daily family life. And so they're concerned about whether that will affect their child. It's really hard. And the, the fear is quite intense. I've had families where I've counseled one-on-one up to 45 minutes about how the vaccine is beneficial, how it will not cause autism. And we will go up to the point where we draw up the vaccine and are seconds away and the family will say, no, let's just pause and I'll come back and think about it at another time.

Speaker 2: 17:29

Well , that's dramatic. I've, I've often heard of that Thing is , it's the act of commission versus the act of omission. It's easier to not do something and just hope for the best than to actively do something. The act of commission. Well, I am, I am doing something to my child here. What you're doing is protecting them, but it doesn't feel that way in the moment.

Speaker 3: 17:50

Right. Yeah. I was in travel clinic, I'm also , uh, see patients prior to their international travel and we provide counseling about how to mitigate your risks while you're overseas. One of them is through vaccines. People think yellow fever vaccine type food vaccine. The biggest one I'm trying to promote is your MMR vaccine. Measles is not only blowing up here in the United States, it's blowing up globally. And now where do you think Italy, Mexico, Europe, Europe, I just pulled this up recently. They've had a 42 fold increase in measles in 2022. They had 914 cases in 2023 42,000 cases. Good

Speaker 2: 18:27

Grief.

Speaker 3: 18:27

So it is blowing up everywhere. So getting your measles moms or Bella vaccine before you travel is really important. And I had a family that we were discussing this, they were concerned about autism. And the father even said, you know what? Um , actually this is really good because my cousin's wife's mother visited my mother's house two weeks ago and they had measles and here they were about to get onto their plane with their unvaccinated child and travel to the same village where there was measles. And that it was hard to do it. And so I understand how challenging it is to be faced with all this information. And at the end of the day, science doesn't always matter. <laugh> , you wanna do what's best for your child. And so you lead with your gut. And I appreciate how much consideration families do give to the vaccine, but sometimes I think we as providers and public health officials and community leaders can do more to embrace that sort of space, that uncertainty, sit in it for a little bit and then reach out and help them navigate through a tough situation.

Speaker 2: 19:30

I think you're so wise, Shay , um, and what you just said there, because we, it's , it's pretty easy to preach to people, you gotta do this because I said so you gotta do this 'cause I know it's better for your child. That probably doesn't work so well with a parent. So I really appreciate that. Is that working with families and working with parents and recognizing that that tension that people are having, could you touch briefly on public health campaigns? Do they work or what should we be doing as a society to get the word out about measles?

Speaker 3: 20:01

So public health campaigns, there is one going on right now because of our measles outbreak. The Minnesota Department of Health, or MDH has been spending a lot of time speaking with families at those that are infected as well as those that have been exposed. They spend time , uh, meeting with schools, childcare centers, community organizations. They're working with us. We're a part of their team as a mobile vaccinator, able to get two areas of risk, meaning that there's least amount of immune kids or haven't been vaccinated pockets around the Twin cities. And making sure that we do the community education and we do the outreach. And then we also vaccinate, there's multiple efforts across the Twin Cities trying to control Liz Measles outbreak, whether it's the provider and the patient, having that one-on-one counseling in the clinic, visit the community leaders posting on their social media platforms or speaking out at their place of serve our faith or the public health officials knocking on doors trying to see if they can connect with families. There's a lot of things going on. And I think thinking about this current outbreak and then coming out of this ginormous global pandemic, wouldn't it be great if we as a society could spend more effort on the prevention as opposed to their reaction when something goes south ?

Speaker 2: 21:19

Yeah, that , yeah. Yeah, that makes perfect sense. You know, and it's much harder to deal with it when the outbreak has occurred. I, I alluded to it earlier here in this hospital, if we have a single patient in our emergency department, we have to go through very complex protocols of not only making that place safe for the next patient, but also monitoring for transmission of new cases for weeks to come every time a single person comes in. And that single person deserves our care. But it does get a whole public health apparatus rolling and it's sometimes hard to break that cycle. So it clearly, we , we need to move way further upstream, upstream and work on immunizations. So we're talking about measles because we're currently in a several month outbreak of measles right here in Minnesota. But that's not the only illness that's frankly preventable in children. So what other illnesses should families know about and what can they do about it

Speaker 3: 22:18

Because of these gaps in vaccination rates, possibly due to the pandemic, possibly due to misinformation or vaccine hesitancy. We now see new old diseases cropping up, for example. Uh , we know that there's been a couple of cases and outbreaks that pertussis are whooping cough , uh, and various school districts across the Twin cities. We also know that there's varicella or chickenpox cases that are cropping up. And these are because we haven't been up to date with our immunizations to the best that we possibly can as a a community.

Speaker 2: 22:49

Yeah. Things that, that folks of a certain age listening to this maybe you were well familiar with whooping cough and all these things that are vaccine preventable. Even polio. Even polio. Um, you'll hear about it here and there. Polio is not gone from the world, although it is nearly gone from the world and it's essentially gone from , uh, the United States. But this is because of vaccines and most of us don't have personal knowledge of some of these illnesses. So you said bringing out some of the oldies. It is, it's like we're going into the archive and pulling out diseases that should be gone. So , um, I appreciate you bringing those up. These are great things for families to know to keep your children safe. Before I let you go, if you could give advice to our listeners, what would it be?

Speaker 3: 23:40

At the end of the day, I think , uh, we as providers, public health officials and families are trying to do the best that we can for each other. We wanna make sure that everybody is safe and healthy, and sometimes we have questions about how to best get to that point. The best way in terms of providing care to your child is to talk to people and get that research from credible sources. And this sounds silly to compare it to buying a toaster, but if you're gonna buy a toaster, you are gonna figure out, you know, who sells the best toaster? Looking up online, what other people are saying about that toaster. Maybe go to the source of where the toasters were made and figuring out, all right , I did my research, I collected the data. This is a toaster I'm gonna go with.

Speaker 2: 24:24

I think it's a pretty good analogy to be honest.

Speaker 3: 24:26

Know if that's the best example. But I think with kids, you're gonna do your research the same way that you wanna figure out what is the best baby high chair , or what is the best brand of clothing or the best diapers. You're gonna figure out, are these vaccines the way to go? And in your research, you might talk to your provider, you might talk to your community leader, your faith leader, your neighbor. You might do your research online, and then you are gonna make that decision and we're all gonna understand that's the best decision that you know you made with the available resources that you did. It's our job as providers and public health professionals to make sure that information is available for you to make those choices.

Speaker 2: 25:05

So I vouch for this podcast as being , uh, solid information and I would say that with 100% certainty on this episode as on the other ones. But where else do you think people can go to get more information?

Speaker 3: 25:19

I'm a big fan of one-on-one conversations with people you trust. Um, sometimes that can be your provider and if you are a person of color or speak a different language, finding a provider that's of color or speaks your language is even better because there is that level of trust that can be established through your conversations. If it's your community faith leader , uh, if it's your school health nurse or your childcare center's community health worker, having a discussion and ongoing dialogue about what is the available information, the reputation of that information, and whether it makes sense for you and your child.

Speaker 2: 25:52

We've been talking to Chang Beecher. She is a certified pediatric nurse practitioner and a public health professional here in downtown Minneapolis, and a colleague of mine here at Hennepin Healthcare Shea . This has been an incredibly valuable conversation to so many people. So thank you. Thank

Speaker 3: 26:08

You for having me. Appreciate it.

Speaker 2: 26:09

It's been great having you here. So we're talking about measles because we're in the middle of an outbreak, but the best way to get through an outbreak is to stay informed. So I appreciate you listening and on our next episode, we're gonna be talking about insomnia. So you are not gonna wanna snooze on that one. I hope you'll join us. In the meantime, be healthy and be well.

Speaker 1: 26:29

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.