Back with a Vengeance: Measles 2025

Dr. Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each episode, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change, how you care for kids.

Welcome to Talking Pediatrics. I’m your host, Dr. Kade Goepferd. In case you have been living under a rock, I want to let you know that measles is back. Texas is currently experiencing its largest measles outbreak in 30 years. Two children have died and several people have been hospitalized by this extremely contagious disease that was once considered eliminated, but has surged again as vaccine hesitancy has spread. Measles has now appeared in 20 states since the start of the year. And while situations like this would typically require a rapid and coordinated public health response, this is unfortunately happening at a time when public health funding is being cut across the country and rampant vaccine misinformation is being spread by high ranking public health officials. Here to talk to us today is one of our favorite kid experts, Patsy Stinchfield, pediatric nurse practitioner. Patsy is the former senior director of infection prevention and control at Children’s Minnesota where she worked with us for 35 years. She’s also the immediate past president of the National Foundation for Infectious Diseases and one of my favorite people. Patsy, thanks for joining us today.

Patsy Stinchfield: Thanks so much for having me.

Dr. Kade Goepferd: Alright, we can’t talk about measles without you. Give us a little update. What is going on? What’s going on in Texas? How did we get here? What’s happening?

Patsy Stinchfield: It’s not good. So here we are, 2025 spring and we are now approaching numbers that’ll be the highest we’ve seen since the 1990 measles outbreak. The outbreak that I cut my clinical teeth on and got into measles and worked on for three decades. So right now there’s 663 cases that were reported. Now think of this, in the end of January in Texas, there were two. And now we’re up to 663 cases. 87 have been hospitalized. There’ve been two deaths, two school age, otherwise healthy kids that were unvaccinated and one adult. And there’ve been 17 new cases just in the last four days and we’re now up to 30 states that have at least one case. And when you think of 17 new cases in the last four days, and you think about how contagious measles is, remember that are not, or that communicability factor. So for every one measles case, they can then expose 18 other people. So we potentially have 306 individuals walking around that have already been exposed and then each of them can go on to in a spiderweb fashion, expose other people. So it’s very hard to get it under control once you get into numbers like this.

Dr. Kade Goepferd: Given those numbers and the rate at which measles can spread, what are we predicting? I mean, what are we facing here?

Patsy Stinchfield: Yeah, so those were just Texas numbers. Nationally we’re up to 884 cases. And when you look at where we’ve been back in the next worst year, was 1992. That was the coming down of our big 1990 measles outbreak and there were 2,200 cases, then we will hit a thousand. No doubt we’re only in the first quarter. This is the time of year where measles really does take off, the spring and early summer. So it’s expected, unless we have a massive national vaccination campaign with clear unequivocal messages, it will continue to spread.

Dr. Kade Goepferd: Why are we so concerned about measles as a virus? Yes, it spreads quickly, but you hear a lot of talk about ‘it’s just a rash’ or back in the day we would just get rashes or even on the Brady Bunch they got measles and it wasn’t, oh, they’re just home from school. That’s a TV show people. So tell us about why we’re so concerned about measles.

Patsy Stinchfield: So from a public health perspective, the big picture why we’re so concerned is that it’s a perfect storm happening right now. Number one, measles is the most contagious virus of any infection we know of. Number two, we have increased cases not only in the United States, but globally. We’re seeing increases in Canada, in Mexico, in Brazil, Europe is getting cases. So we know that most United States cases are international travel related. And so it’s not just cases here, but its cases around the world are increasing. Third, vaccine rates around the world are dropping. Not just in the United States but elsewhere. So you’ve got to keep that immunization rate up in a community being in your school or in your church or in your county, your state, your country, at 95% or higher. Anything less than that, that wily infectious virus finds its way and seeks and finds the unprotected.

And then we also have a situation where we are still coming out of the pandemic a bit, where we lost immunization rates, not just with MMR vaccine, but all vaccines. We are improving in that area, but even here in Minnesota, our MMR rate is not good and it’s below 90% and we need to be above 95%. And then last and probably most important, is we have mis-info demic as the WHO said, is that we’ve got an endemic epidemic of misinformation that is spreading about vaccines, and now our head of the Health and Human services for the United States is not helping that. It is a person with a history of active misinformation and disinformation about MMR vaccine, about measles. Just read about what happened in Samoa. Read about some of the quotes of things that happened before the election. So now you have someone not as strong perhaps as recently before being in this position, but that to me is even worse. So you’re saying measles, mumps, rubella vaccine is the one thing that will prevent measles, but then he doesn’t say everyone must go get vaccinated. So it’s a mixed message and I think it’s really confusing people even more. So no matter what your role is, whether you are a clinician with a one-on-one conversation or you’re a state epidemiologist or you’re the head of HHS, we need to have one clear message that measles, mumps, rubella is the only thing that will prevent your child getting measles. And measles is a deadly and scary disease and needs to be prevented.

Dr. Kade Goepferd: Yeah, let’s lean into that just a little bit more. I’ve been practicing pediatrics for 20 years and when I entered pediatrics, we were on the verge actually of saying that there was no more measles. We had such a robust vaccination rate at that time, and so many of us who are practicing now haven’t seen measles and I think need to be able to recognize it. One which we will have a follow-up podcast to go into a little bit more of the recognition and the signs and the symptoms and the treatment, but I think also be able to explain to families why we don’t want their kids getting measles. So it is much more than just a rash. And can you talk about some of the big reasons we don’t want people getting measles?

Patsy Stinchfield: Right. I’m going to pick up on what you said that we almost were rid of measles. And it’s true. In 2000, the United States was given a World Health Organization designation that measles was eliminated. That means we didn’t have any natural in our country measles cases spreading. There were no outbreaks. It was not from homegrown within, they were all internationally imported diseases eradicated. And people get these two terms mixed up is only applied to smallpox. That means there’s no smallpox anywhere in the world. There’s a lot of measles left in the world. So our elimination status is at risk, and if these cases continue to climb, we will lose that status. And why do we care about this disease? We care because one, it is so contagious and we always have vulnerable people. So we always have children too young to be immunized. We always have people with immune deficiencies or on medications that suppress their immune system. We always have pregnant women. Those are really high risk populations. If they get measles, they’re going to be in big trouble.

And so what happens with measles? Yes, it’s a rash. It is not like the Brady Bunch though. If you ask any of our children’s ER staff, they’ll tell you, you can spot a child with measles walking in because they’re not kind of running around the lobby or wanting a Popsicle. They are like a rag doll slung over their parents shoulder. They don’t want the lights on. They’re crying, they’re irritable, they’re miserable, and even this is a mild case. And they might get evaluated and say, your lungs unclear. You’re not dehydrated. They may go home. It’s a miserable few weeks for this family. That alone is difficult. The rash itself is unique in that it starts at the hairline and looks like a bucket of rash poured over the face and then down the trunk and then will clear the same way.

It’s not particularly itchy or problematic. What happens though is that one in 20 of those kids coming into our ER, one in 20 of people getting measles, will get pneumonia. And pneumonia is the number one killer of people with measles. It’s either the measles virus itself, but more commonly measles will kind of shred your airways and get into your lungs and then your normal strep and staph that we normally have on our body or in our body then becomes part of the lungs where it’s not supposed to be and you get these terrible bacterial secondary infections, on a ventilator, IV antibiotics, breathing with difficulty. That’s about one in 20, about 10% of them will have bad ear infections, about one in a thousand will have encephalitis. That’s a second related cause of death where you get brain swelling, you can have permanent hearing loss, permanent vision loss. It’s just not something to think of as a mild rash. I think one of the worst things that we haven’t talked enough about is this immune amnesia.

The worst case that you have, the more severe your illness, the worse your immune amnesia will be. But all people who get measles will lose between 11% and 73% of their immune memory. So think of it like this. If you think of all of your vaccines you ever had, all the colds and illnesses you ever had, goes into your body’s immune system like a bank. So those are all your infectious deposits. When you get measles, it’s like it comes in and does an entire withdrawal or will withdraw 50% of those antibody memory or up to 73% if you had a bad case of measles. Those memories are what protect you in the event that front of someone with chicken pox for example, or you get colds. So you can rebuild that, but they have to be revaccinated, they have to re-experience colds and it’ll take another two to three years. So ask yourself, remember that night you were up all night at four in the morning, the kid had 103 temp and you’re scared to death. Do you want to do that again? You don’t want to do that again. And you can prevent that with an MMR vaccine.

Dr. Kade Goepferd: Yeah, no, I think absolutely that’s the thing that I tend to lean into with families is that immune amnesia. And we all remember those miserable early daycare years where kids got every ear infection and every cold and every gastroenteritis and everything. And that was all part of, like you said, kind of building up our immune system bank. And to have to start that all over and to have to start it over again at 10 or 14 or whatever age just is not what we want to be doing. So you mentioned vaccination is the way to prevent measles. Talk to us about the MMR vaccine. RFK Junior has called its integrity into question and can you tell us about what we know about the vaccine, how long it lasts, efficacy, things like that?

Patsy Stinchfield: Sure. If you were to take the MMR vaccine to Shark Tank, you would win. You would be given because it meets every mark. Number one, it’s safe. Only about one in a million will have an allergic reaction to the contents of it. Some people may have, about 5%, will have a rash that looks like measles about 10 days after they get their vaccine. That’s your immune system sort of responding to it. So it’s very, very safe. Number two, it’s really effective. With one dose you’ll prevent measles 93%, with two doses, 97%. So okay, it’s not a hundred percent, but 97% chance of this working really well, like that’s a product you want to buy on Shark Tank.

And then the other thing with it is that the effectiveness, the safety, and we have so much experience with it. We’ve been using this vaccine for decades and we know that it’s safe and we know that it works and it is the only thing that will prevent measles. The other Shark Tank thing about MMR vaccine is the financial part. So the cost of it measles, MMR vaccine is what, $29. And so for every $1 spent on an MMR vaccine, we save $3 on the public health outreach of disease and $10 of societal costs. So it is financially a really great deal. Besides the net savings of fully vaccinated community can be up in the upwards of $70 million for societal net savings. And the costs averted, the money that we save directly can be $20 million and indirectly societal costs can be up over $76 million. So it is financially the right thing to do, but of course we talked about that last because it’s medically the right thing to do.

Dr. Kade Goepferd: So speaking of things preventing measles, there’s been a lot out there about vitamin A. Some people are mistakenly using vitamin A to prevent measles. And as you and I know as a fat-soluble vitamin, you can actually take too much vitamin A. So tell me a little bit about vitamin A, Patsy.

Patsy Stinchfield: Yeah, so vitamin A has really been in the news a lot and it’s unfortunately kind of mixed messages. Vitamin A is not to be used to prevent measles. And unfortunately that’s what’s happening in Texas. They’re seeing kids getting admitted with liver toxicity from self prescribing vitamin A to themselves. This has been a suggestion from the kind of anti-vaccine communities, like you don’t need a vaccine, you just take vitamins. That is false. However, there is a role for vitamin A once a person is diagnosed, and this is where the messages need to be really, really clear. It does not work for prevention. It could help for, and it doesn’t cure either, there’s no antiviral medicine for measles like we have for flu or like we have for HIV or like we have for COVID. There’s no medicine. But we have experience in developing parts of the world with vitamin A and severely malnourished children and in looking at measles itself, it can deplete your vitamin A stores regardless of what your nutritional status is. So as part of my work with the National Foundation for Infectious Disease after our 2017 outbreak, Gabi Hester and I did some research on this Vitamin A message is so confusing. We’re hearing different messages from WHO and CDC and AAP. No one’s really using it. If they’re using it, they’re using it at the wrong doses. So we did some studies and looked at children’s hospitals and it was not being used appropriately. And then I convened an expert group at NFID and did a call to action, it’s the NFID measles call to action on the use of vitamin A and some of the world’s most knowledgeable people about this topic were in the room. And we do know that because the virus can deplete some of your vitamin A stores regardless of your nutritional status, that it is effective on diagnosis in the hospital prescribed by a knowledgeable clinician, that is age dose specific, that you give a high dose on day one and a high dose on day two and then you’re done. And that can reduce complications and it can reduce mortality, especially in the very young that kids two and under. So we use it. Children’s has a marvelous clinical guideline that has now been shared across the country through some of the public health associations and I think you’re going to hear more about that on your next podcast.

Dr. Kade Goepferd: So if we know that this is a vaccine preventable disease, the vaccine works really well, it’s going to make us money on Shark Tank, we know all of those things. So the problem seems to be that we’re not vaccinating enough folks. How big of a problem is vaccine hesitancy when it comes to the MMR vaccine and what are we seeing over time? And I’m also a little curious about, are there particular areas of the country, demographics of folks who are under vaccinated?

Patsy Stinchfield: Yes. So we know that MMR vaccine, it probably is one of the leading vaccines that parents have had hesitancy about since the early nineties when the ill fated paper came out about is MMR vaccine related to autism? It is not.

Dozens of studies since then has shown with millions of subjects that there is no relationship whatsoever. However, that is ingrained in a lot of people’s minds and it’s hard to overcome that. And then it’s been spreading to other vaccines too. Well, maybe I should pick and choose and I don’t know. I’m definitely not doing a flu shot. I don’t need to do that. It’s just the flu. Again, healthy people die of that regularly. So that misinformation is like that’s where you start. And I think as clinicians, what we have to do is find where our Venn diagrams overlap. So you as a parent are concerned about your child’s safety. I’m concerned about your child’s safety. Help me understand what your concerns are around MMR, and listen. Then just be quiet. Look ’em in the eye and listen. And sometimes you’ll be surprised at what they’re saying, well, I really want to do it. I’m in this kind of crunchy moms group and nobody does it and I might lose my social status or I might be kicked out of this group. There’s sort of societal reasons people skip it. It’s like your number one job and my number one job is the safety of your child. Forget your friends, forget your groups. It’s how do we protect your child in this world? And I think that doing that listening first and then talking about what we just talked about, some of the severity of the disease, that really understanding what we’re up against to sort of say, I’m going to skip that sort of died by measles vaccine omission. We don’t want that as part of our family story, but I would say one of the most important things is parents vaccinate their kids. The majority of kindergartners are fully vaccinated. Where are those parents? We really need them to speak up and to say, I gave my kid the MMR and it was no big deal. I think it seems so normal to most parents that’s like, oxygen is important. I should talk more about oxygen. Like vaccines are lifesaving. Why wouldn’t you do this?

But that voice is really, really absent right now and such a critical voice. So having parents speak up and speak out on social media, TikTok, that’s where parents are getting their information in a lot of ways. I think clinicians being like you, being part and active in social media and then just being prepared for those one-on-one conversations in a encouraging and listening kind of mode.

Dr. Kade Goepferd: Something you said really struck me when you said this kind of offhand comment of, I’m just going to skip that one. And I’ve been there. I’ve been sitting in a primary care office and the subject of the child’s vaccines will come up and the parents will say, well, I’m just going to skip this one, or I’m not going to do MMR or I don’t want the MMR. The easy thing for me to do is say, okay, cut my losses and give them the rest of the vaccines. The hard thing to do is to have that conversation that none of us want to have.

To say, can you tell me more about what you’re concerned about? We have a shared interest in protecting the health of your child. Those kinds of things. Any tips for us to help us with that conversation? So one of the things that I’ll just admit that I struggled with is that a parent will say, well, I’m concerned about autism. And then I might say, well, I can understand why you would be concerned about that because there was false information published about that. We’ve done subsequent studies, as you mentioned, there is absolutely no connection between the MMR vaccine and autism. They don’t believe me. I am now an untrustworthy source because I’m associated with medicine or in their minds, pharmaceutical companies or whatever. Any tips for us about how we can rebuild that trust with our patients so they believe us?

Patsy Stinchfield: Yes. Number one is remember that we work for the child. If they say, I’m going to skip that one today, and we just go, okay, and we move on, then the child is like, hold on, hold on. I don’t want to go to the ICU. I don’t want measles. So try to hear the voice of the child in the room and know that that’s who we work for and that’ll help you. I do feel for clinicians, I know how hard it is to go patient after patient. Having these conversations is really difficult. We need more time in those visits too. I think the other thing is just to say, I understand you have concerns. Make sure they feel heard. And then the next time they come have the same conversation again and like, oh, they’ll say she’s really serious. He’s really serious. They’re really serious. And the conversation will be able to come up again, hopefully with trust. Don’t give up just because they say one time, I don’t want to do that and put it in their jar. They’re not going to do that. People change their minds. And so the trust is built by being compassionate and understanding, can I give you some resources? Can I direct you to some other things? Here’s a video. And then setting up maybe some unique classes on a Saturday afternoon just like, let’s have a listening session. Come on in. Because you can’t do all that in a well child check.

Dr. Kade Goepferd: No, absolutely not. To your point about reaching different sectors of the community or setting up a listening session, are there demographics of parents or people who are tending not to vaccinate? Are they more rural? Are they suburban who are folks who are not vaccinated?

Patsy Stinchfield: Yeah. Well, I mean, we can look at the COVID vaccine as a good example, that red states Republican voting leaning states had much greater COVID incidence and death. People that live in rural higher red states have a 38% higher mortality from vaccine preventable diseases than states who are higher vaccinated. So rural tends to be an area that we need to pay more attention to, more conservative leaning families. And when you think about all the outbreaks we’ve had, it sort of starts with a very close knit community. In our case in Minnesota, the Somali community, what’s happening right now in the Mennonite community. We can’t just say, oh, they’re Mennonite. They don’t vaccinate. Many Mennonites vaccinate. So again, we have to listen first. This particular group in Gaines County, Texas does not vaccinate. And so that’s where it takes that. There were two international cases that came in from Houston to this Gaines County spread within a very poorly vaccinated community. And now that same strain is in four or five different states and in Mexico. So knowing that that particular group may have unique concerns about vaccines and really trying to listen and understand that, but don’t judge the entire group.

Dr. Kade Goepferd: Yeah. You mentioned crunchy moms. Do we have a crunchy mom problem with vaccine hesitancy?

Patsy Stinchfield: Yes, we do. And I think so. There’s some people that just don’t want to vaccinate because they just don’t like vaccines. So that’s about between 1 and 3%. And there’s, as I said, about 95% are fully vaccinated. It’s that middle group that tend to be a little hesitant that we need more time with and listen. But there definitely are some, that one to 3% are absolutely no way, never, never vaccinate my child. That is not a homogeneous group. It’s a heterogeneous group, and you have to, again, listen first. And there are some moms that are, I only do natural everything, soaps and clothing, and I don’t do vaccines. There’s too many things in it, things like that. It’s just such a fallacy. Most things are, nature has mercury and aluminum and things that they are afraid of that are in vaccines, but that’s even more so in nature, even more so in things like breast milk. But there is a subpopulation that is more on the well-educated, liberal leaning, but are more anti-vaccine from the natural perspective, which is really not a good way to look at vaccines.

Dr. Kade Goepferd: We could, and maybe we should just have a whole podcast about vaccine hesitancy, because I feel like we could talk about this for a long time. But in addition to having these important conversations in the exam room with our families, particularly right now about measles vaccine. But in general, how else can we as pediatricians help to stem this outbreak? I’m very worried about our public health infrastructure right now, not just in the state of Minnesota, but across the country. We’re seeing severe funding cuts, multiple layoffs. How can we join the fight as pediatricians to really help stem this outbreak?

Patsy Stinchfield: Yes. I think extraordinary times require extraordinary measures, and I think just like having appointments in your clinic is not enough, I think we have to look at data, be data-driven and say, well, where are our pockets of under immunized in Minnesota? MDH has that data. Minnesota Department of Health. And then what is the uniqueness about that community? And then work with that community. In Minnesota, it is the Somali community still that is under vaccinated quite substantially. Who are the Somali leaders we should be partnering with? How do we get out to the communities? How do we go out and do education and listen, and then set up some vaccination outreach? And so I think in states where this has potential to explode, it is much better to put the time and energy and resources now in the prevention stage than trying to catch it up later because of that contagiousness of it.

Dr. Kade Goepferd: Well, I really appreciate you coming in to talk with us today about this. I consider you the measles expert, and so when I knew we had to talk about measles, I knew I had to get you back onto the podcast. Thank you for your work. Thanks for joining us, and we really appreciate your time.

Patsy Stinchfield: It’s great to be with you, my friend.

Dr. Kade Goepferd: Thank you for listening to Talking Pediatrics. Come back next time for a new episode with our caregivers and experts in pediatric health. Our showrunner is Cora Nelson. Episodes are produced, engineered and edited by Jake Beaver and Patrick Bixler. Our marketing representatives are Amie Juba and Krithika Devanathan. For information and additional episodes, check us out on your favorite podcast platform or go to childrensmn.org/talkingpediatrics.