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Speaker 2:Coming to you from the University of Texas Medical Branch and the Galveston National Laboratory.
Speaker 1:This is Infectious Science. Where enthusiasm for science?
Speaker 2:is contagious.
Speaker 1:Hello everybody, welcome to the Infectious Science podcast. This is Matt Dasho. It's been a minute. I'm here with my good friends Dr Dennis Benta, christina Rios and Dr Camille Ledoux, who has finished her PhD since I was last on the podcast. So lots of advancements. Today's topic, I think, is quite relevant. It's always been relevant. It's a topic that is on people's minds in global health and public health for decades and has come back to the news. So we thought it's a really good opportunity for us to talk a little bit about measles. So welcome everybody.
Speaker 3:Yeah, thanks so much, welcome back.
Speaker 1:Thanks. I'm glad you would have me. I'm glad you let me back into the club. It sucks. We're not in the podcast closet. I'm here in San Antonio with you guys and so thank you for keeping my spot open on the couch. I appreciate it. The virtual couch. That's good times. So, Camille, you want to kick us off. Contextualize us a little bit. Tell us a little bit about measles.
Speaker 5:Yeah, let's dive into measles. Let's start with some history, because I think that's always a good way to contextualize where we're at with infectious diseases. So the first written account of measles was published by a Persian doctor the ninth century, which is a little over a thousand years ago. So this is a disease that's been with humanity for a long time. But it wasn't until 1954 that the causative agent of measles was found to be a virus, and measles is specifically caused by morbillivirus, and so morbillivirus is from the Latin morbis, which means little plague which I feel like is a pretty cool name, so it's little plague.
Speaker 3:It's a good nickname for somebody right?
Speaker 5:Yes, yes, I feel like if I was going to get another cat or something, maybe like Morbilovirus would be like a solid name, like Little Plague. Yes, yes, I agree, I agree. So what's really interesting is that Morbiloviruses are responsible for rinderpest, which affected cattle. It's one of the only diseases we have ever eliminated, which is really neat. And morbilloviruses also cause distemper in cats and dogs and we vaccinate for distemper in cats and dogs because it's so often fatal. And what's really interesting that I didn't know when I was diving into this is that the current measles virus that infects humans is suspected to have branched off from the cattle infecting rinderpest virus about 1500 years ago. But now measles is a human adapted disease and it doesn't have any known animal reservoirs. But, as our resident vet on the virtual couch of the podcast, dr Bente, could you tell us a little bit about rinderpest?
Speaker 3:For sure, dr Ledoux. So rinderpest as a German I should say rinderpest, which is a German word and then translated means cattle plague. It's a highly, or was a highly contagious viral disease and it primarily affects hoofed animals, so cattle, buffalo, various wild ungulates and so on, with fairly high mortality rates, sometimes approaching 100% in naive populations. And it was really. It was a very devastating disease that shaped a lot of not only the animal health and veterinary health, but it also shaped trade and public health. You can imagine that if you own a herd and so on, this was devastating for your income.
Speaker 3:So the clinical science of renner pest is it's characterized by fever, oral erosions, nasal and ocular discharge and severe diarrhea and dehydration, and that's often leading to the death within 10 to 14 days. And the transmission occurs and we'll talk more about the measles transmission, but here the transmission occurred through the secretion of contaminated water, or maybe even contaminated, or secretions, nasal secretions and so on and maybe to a certain degree, also through the aerosol transmission. Yeah, it's thought to originated from in Asia and caused really like huge famines and economic disruptions, and has been eradicated. The last confirmed case was in 2001. And so in 2011 was the second disease eradicated worldwide after smallpox. This, as Camille said earlier, it's very closely related to measles and there's some suggestion that it might have diverged. Measles diverged from Rhinopest around like 600 BC. That's the idea. So that's all I got on Rhinopest.
Speaker 5:Yeah, it's really interesting. I always think it's really cool to talk about diseases that we have eliminated, because that's a very rare occurrence. A little bit more on the history of it. It became a notifiable disease in the United States in 1912. And that means doctors have to report cases if they see a measles case.
Speaker 5:In the first decade of this mandatory reporting, around 6,000 measles-related deaths were reported In the decade before a vaccine was available. Us reporting suggests that nearly all children caught the virus that causes measles by the time they were 15. So if you think of something that's really infecting a population, that's pretty significant. Almost all kids by the time they were 15 got measles before we had a vaccine available. So this was very much. This disease has been with us a long time but it's also been really widely spread in a population and on average, before we had a vaccine, three to four million people were infected each year in the United States, which is a pretty staggering amount, and two to three out of every 100 cases of measles is known to result in brain damage or death. So if you start to think of when you have up to three or four million cases before we had a vaccine, that's potentially a lot of morbidity and mortality. But because of a really highly effective vaccine program, measles was actually declared eliminated in the United States in 2000 because there was a 12-month absence of the disease spreading. And this was really because of herd immunity that occurs when a sufficient portion of the population is immune to a disease and it basically protects those who aren't immune, maybe because they can't be vaccinated or something like that. And unfortunately, while measles was declared eliminated in the United States in 2000, it's no longer considered declared eliminated, and that's because vaccine hesitancy has really led to a drop in herd immunity in certain communities and in those unvaccinated populations, measles has once again really arisen as a significant health concern in the United States.
Speaker 5:So what I think is really interesting about measles is that, according to the WHO, it's one of the world's most contagious diseases, and so I think people often think of contagious diseases as something that we work with. That's like people, or they think like that, and we oftentimes put on the back burner something that has previously been eliminated because we had a really good vaccine program. But I think people can sometimes forget about things like measles that are so contagious and it's really contagious because it's a virus that aerosolizes and it remains active and contagious in the air or on surfaces that are exposed to infectious droplets that someone who is sick has exhaled or coughed out. And what's really wild, just to give you some numbers on like how contagious is measles if 10 unvaccinated people walked into a room where someone who had measles was or had been in the prior two hours, nine of them would contract measles. So nine out of 10 people who are unvaccinated, who are exposed, will contract.
Speaker 5:And so, putting that further into perspective, if you think about something like COVID-19, which caused a lot of upheaval and panic, the average number of people that were infected by someone who was sick with COVID in a susceptible population was like two to four other people. But, in contrast, the average number of people that are infected by someone with measles in a susceptible population is 12 to 18, which is much, much higher. And it's really interesting because it causes some unpleasant symptoms, right? So measles in itself is not pleasant. You can have fever, cough rash, it can potentially lead to pneumonia, it can cause encephalitis which is going to be inflammation of the brain.
Speaker 5:But what I found really concerning about measles I was doing research on it was its ability to cause immune amnesia, and so it can do that by essentially destroying your immune memory from previous infections.
Speaker 5:So during infection, measles can reset the immune system, and some studies that I was reading really suggest that measles basically does this by replacing its host old memory cells with measles-specific white blood cells known as lymphocytes, and this results in people who have had measles gaining a really strong measles-specific immunity, which they could have gained with a vaccine, while losing their immunity to other pathogens.
Speaker 5:And so this destruction of immune memory and replacement with lymphocytes is unique to measles, and this immune amnesia can last two to three years after infection, which is a really long time to essentially become naive to other pathogens that you might have been exposed to before and would not necessarily have had a problem shaking off. And so that really means that people who you know get measles, if and when they recover from a measles infection, can be vulnerable to other infections that could result in death that they might otherwise have been immune to. So I think that that's an aspect that I don't often see spoken of when we speak about measles is that it's not just those clinical effects that you see, that you'll see like a fever and a rash, it's also there's this potential for you to become naive on an immune level to other pathogens.
Speaker 1:Camille, can I ask you something about that?
Speaker 1:I wanted to ask. You had mentioned earlier that measles has a much higher degree of infectivity than other viruses, let's say SARS-CoV-2. And I remember when we were dealing with the COVID pandemic, we were all talking about wearing masks and distancing and a lot of that had to do with there were factors that were related to the virus, there were factors that were related to the environment and then there were factors that were related to the host. So all of these are epidemiologic constructions the infectivity, or how many people can be infected by one person. So these are all kind of epidemiologic calculations that people make based on all these factors.
Speaker 1:In your reading did you come up with what is it about the measles that makes it so much more contagious? Is it because it lasts longer in the environment? Is it because it's smaller and can stay suspended in the air for longer? Is it more durable to UV radiation or to wind or to solar energy, like? What is it about the measles virus that makes it more transmissible in the same condition that let's say, if you had one person with COVID in a room and you had another person with measles in another room, that there would be more infection from the measles?
Speaker 3:Maybe I can take that.
Speaker 5:I don't know, camille, did you want to say something or did you come across something in your I know, anything that aerosolizes and can hang in the air has the potential to infect more people than something that's like droplet that's going to very quickly fall out of the air. But feel free to.
Speaker 3:Yeah, no, that's absolutely true, right? What droplet size it attaches to. Like you said, camille, certain sizes will just fall down, while others stay in the air for a longer period of time. It's also how much virus is being shed from the body, and when it's shed, we learn sometimes that certain diseases are shed even before you have signs, clinical signs, and that's another thing. And then it's also the susceptibility of the host. So where in the body can the virus get in and then immediately start replicating, and what dose is necessary to replicate when measles hanging in the air for a long period of time? And then it maybe easily binds to something in your mouth or in your oropharynx and then is able to immediately infect some of those cells. So that's one of the things that come together. It's an envelope virus, so you would expect that it's not easily inactivated, but at the same time it's just really good at producing a lot of virus particles and having them float around on particles in the air. Yeah.
Speaker 5:I think that's a great answer for that. Matt, you have actually treated patients with measles, so can you talk a bit about what does that look like in the clinic? Because this is such a contagious disease? How are these people treated? Because from my understanding as I'm reading, there are things you can do to treat measles, but it's really a lot of. It is just supportive care. There's not like a specific treatment that we have for measles. We have a vaccine, but once you're infected we don't have anything. That's just. This will help you get over measles.
Speaker 1:Yeah, absolutely, and I have treated people with measles not in the United States, as when I lived in a Southern African country called Botswana and we had a measles outbreak while I was living there. But there was a period of time where I think in many countries they were just doing single dose of the MMR vaccine and then there were some catch-ups and there was a little bit of delays and so there was a measles outbreak and in Botswana it happened to be paired with also a country that also was heavily affected by the HIV pandemic. So we saw people who were HIV infected and non-HIV infected who were suffering with measles, and we saw adults and children that had the disease. I'm not a pediatrician so I didn't treat the children, but actually in that setting the adult ward even 13, 14-year-olds might be hospitalized in an adult ward. So we did care for teenagers suffering with measles and what I can say is that it's a disease that I really wouldn't wish on folks. I think it's a very uncomfortable disease if you're sick enough to be hospitalized. And again, it's not scaremongering, it's just it's like any other condition. If you have a way to prevent it, you'd really love to prevent it, because once someone's infected with measles, there is risk, as you mentioned, camille, that they progress to developing pulmonary myelitis or encephalitis. So it infects the brain tissues themselves and causes brain swelling. There's the risk of respiratory failure themselves and causes brain swelling. There's the risk of respiratory failure which necessitates intubation and respiratory support, and of course there's the risk of death right, which we would rather avoid if at all possible. So usually the incubation period from the time that you're infected is anywhere from seven up to 21 days, but usually about two weeks is the rule of thumb. That you're exposed, then it takes about two weeks from then to develop the symptoms.
Speaker 1:There's usually what people call a prodrome of the disease, so it's the earliest signs before people get the rash. They get this prodrome, which used to be called the four C's, which aren't four C's, there's actually three C's and a K, but it's cough choriza conjunctivitis and coplic spots. So coplic spots are these little lesions that appear inside the oral mucosa, the inside of the mouth, before the measles lesions appear, and then they get the rash, which usually looks like reddish spots. They start as little spots but then they become more broad and join with each other. They call that becoming confluent.
Speaker 1:It usually spreads down from the face down to the torso but affects all parts of the body. It can even infect mucous membranes, which is very uncomfortable. So people can get on top of the measles lesions they can get super infections with other skin infections. So that's never fun to deal with either, and the conjunctivitis was something that I saw that was really very uncomfortable for people. As people think about conjunctivitis, oh, you just get a little pink eye, but this was pink eye, but painful. So the folks that were dealing with conjunctivitis from measles were really quite uncomfortable. There's a lot of pus, there's a lot of inflammation, it can decrease the vision, and so it really for me. Actually I didn't see so many cases of encephalitis, though we had maybe one or two, but I did see a lot of conjunctivitis and to the point where some of those lesions were getting super infected and they needed antibiotics, and so it's just one of those things where you're sick enough.
Speaker 1:With measles. It really is quite uncomfortable, the risk is high, and so generally it's considered infectious from four days before the lesions appear until four days after they disappear, and people can have, depending on how their body responds to it, it can go on for five days. Seven days can go up for a couple of weeks. So it really just depends on how people respond. So takeaways on the clinical is that my heart goes out to people who are suffering with measles or who have been exposed. It's again. It's something that has a very diverse clinical course. Some people have no symptoms at all, they just get a little mild rash, and some people do progress to having these more severe manifestations and those are the ones that your heart goes out for and you really would love to prevent that, especially among kids, who we never want to see our children suffer, or anybody for that matter, but especially children. I think that's why public health community, the medical community, often really gets behind vaccines, because that is certainly the single most effective way to reduce transmission in the community is the safe and effective vaccine.
Speaker 1:I'll say one last comment about treatments, one of the issues we're always looking for treatments for viruses, and obviously there's lots of repurposed medications that make the news and have made the news since the pandemic. We're always looking for cheap and effective ways to treat viruses. Those of us who treated COVID, we had high hopes for things like ivermectin or hydroxychloroquine. We would love something cheap that was effective for treating those things, and it's just unfortunate that those were studied and were not shown to be effective.
Speaker 1:One of the things that is very commonly given to people infected with measles suffering with measles is vitamin A. It's usually two doses 24 hours apart, so it's not these massive quantities of vitamin A that people may take in supplements. It's a very carefully calculated dose and it's done because of the effects on the immune system. Like Camille mentioned, vitamin A is a fat-soluble vitamin. It's converted in the body to some very fundamental substances that are used for your vision, for eyesight and the protection of your immune system, so in your gut wall and other membranes. So it's a very important substance and we do give it as a supplement for people infected with measles.
Speaker 1:But most of those studies were on places where vitamin A deficiency is very common. If you have vitamin A deficiency, you have immune deficiency by default, and so when you give vitamin A you make the immune system stronger, especially in countries like where I was living, where people's immune systems may have already been low for various other reasons. So in a country like ours, where vitamin A deficiency is extremely rare, we sometimes still do give vitamin A in the clinical setting as part of the protocol, but it's not nearly to the doses that sometimes people are told to take. They may read things online or read things in media about taking a bunch of cod liver oil which contains a lot of vitamin A, unregulated amounts of vitamin A or vitamin A supplements and actually vitamin A can induce a pretty severe toxicity.
Speaker 1:If you've ever had a child that took Accutane or has put retin-A on their pimples and you see their skin start to erupt and that kind of thing get red and inflamed, that's what vitamin A is doing. Those are essentially retinoic acids and it's all to say that it's a very broad clinical presentation. It can have everything from mild manifestations to severe. It's preventable by the vaccine which I know we're going to talk about in a little bit, and that while there's not any specific anti-measles anti-virals available, there is a role for vitamin A supplementation in small amounts under a clinician's supervision. So those are my main takeaways from the clinical side. Basically, take home is I would not want my child to have a measles infection. Even if there's a possibility that it's mild, there's the possibility that it's not and it can cause severe neurologic issues that last for a lifetime. There are people who have persistent seizures, persistent respiratory problems because of measles infections.
Speaker 4:Yeah, and I think also, matt, just adding to the clinical presentation that you mentioned, it's important to mention that measles is something that is transmissible in vitro from mom to baby, and so I think, when a lot of people talk about infections and infectivity, we don't tend to think about congenital diseases, but congenital measles also is something that's very problematic, at least from what we've learned in class, and so I think it's always just important to reflect on the populations that are at risk. Yes, it's those that are alive, but it's also those with impaired and weakened immune systems, and it's also babies right, neonates, and who don't really have an immune system aside from what they've gotten from their mom. And it's just interesting to think about how one disease can manifest so differently, to the degree of severity, in different populations.
Speaker 5:I think that's an excellent point and I think everything that you both have said it really highlights that what we really want to do with something like measles because it can be so severe, because it can be so uncomfortable for people is prevent it. So I want to talk a bit about the MMR vaccine. The measles vaccine became available in 1963. So it's been with us for a very long time and today the measles vaccine is actually combined with the mumps and rubella vaccines. That's where you get MMR. So measles, mumps, rubella. Some people get an MMRV vaccine and that actually protects for measles, mumps, rubella and varicella. So those are the common ways that you're getting a measles vaccine nowadays.
Speaker 5:I personally had the MMR vaccine when I was a kid. Everyone in my family has also had it, and so the CDC recommends getting the first dose when you're about 12 months old, which is when I got mine. According to my vaccine records. I looked months old, which is when I got mine. According to my vaccine records. I looked and my second dose is when I was four years old, before I started school, which is also what it's recommended.
Speaker 5:So what's great about this vaccine and I can't stress this enough, what's really cool about this vaccine is that one dose is 93% effective at preventing measles, and two doses is even better. It's 97% effective. That's such a good vaccine and what's also really cool about that is that the immunity is sufficient through adulthood, so once you're vaccinated for measles, you never have to be vaccinated for it again, unlike the flu, which is really unique. Having a dose of the measles vaccine when I was 12 months old and then when I was 4 and now I'm 25 today it's still effective and that's pretty cool to think about, because a lot of vaccines you have to get a booster to think about. Because a lot of vaccines you have to get a booster. You might've gotten COVID boosters because things are shifting, so you have to get a flu vaccine or whatever it is. But to have a lifetime immunity or the potential for lifetime immunity by getting vaccinated, is really unique.
Speaker 3:Camille, I just wanted to follow up on the efficacy of the vaccine. You're absolutely right, like 93% for the first shot is really good, really effective, and then 97%, as you mentioned, after the second shot. But at the same time we also need to mention, because it's so contagious, right, the R0 is so high. In order to achieve herd immunity you have to have 95% of the people vaccinated. That might be slightly different for other diseases, so the lower the transmission and if it's less contagious, then you probably don't need such a high vaccination rate or coverage, but with measles it needs to be 95, so quite high. And the other thing that I found out when I was researching this, which I think is interesting, is that you can also give the vaccine post-exposure. So if you know that somebody was in the vicinity of somebody infected, you can then still vaccinate and reduce the severity of the disease up to 72 hours post exposure. So that's a neat fact that you can even use the vaccine not even prior but also after exposure, and it will show some efficacy.
Speaker 5:Yeah, that's really cool.
Speaker 3:That's a really cool vaccine, and if you have so much efficacy, then you can also give it post exposure and it's got lifetime immunity.
Speaker 5:That's really cool. That's a really cool vaccine If you have so much efficacy and then you can also give it post-exposure and it's got lifetime immunity. That's really neat and it's unique and it's hard to get a vaccine. That is that good. I do want to talk about we're in Texas. We always talk about what's going on in Texas or the Texas connection for what we have going on, and so we're talking about measles today. I do want to talk about measles in Texas because there's been five US measles outbreaks this year, so in 2025.
Speaker 5:Currently there is a measles outbreak in Texas. It originated in a religious community that rejects vaccines. Since the beginning of the year and at the time of this recording, which is the beginning of April, 541 cases have been identified in Texas. So nearly all the cases have occurred of people who aren't vaccinated, and it's estimated that about one in five people infected in any outbreak will need hospitalization and one in 20 will develop pneumonia. And really sadly is that two fatalities have occurred in Texas. One was an unvaccinated six-year-old girl and another in an unvaccinated eight-year-old girl. So two school-aged children that weren't vaccinated contracted measles and then passed away, which is never something you want to hear about in the news or you want to see, because these things are preventable, and so I think that's.
Speaker 4:Yeah, I think it's important to compare those numbers to what we've had in the past. So literally just comparing it to 2024 cases, according to the CDC, there was a total of 285 cases and the majority of those cases of measles was children under five years old. So once again looking towards vaccination status, apparently 89% of the population that did acquire measles last year were either unvaccinated or their vaccination status was unknown. So just comparing, is that for the whole?
Speaker 1:US.
Speaker 4:Yeah. So comparing the numbers last year to, we're only in month four of 2025 and we're already doubled, or almost doubled that. That's a pretty significant jump.
Speaker 5:Yeah for sure, and I think a big contributor to this is vaccine hesitancy, so something I think you see a lot on in the news. I was really curious to get to the bottom of what is potentially really causing this. So I think a big reason why we're seeing the rise that we do see right now is vaccine hesitancy. I'm always curious as to what's driving something like vaccine hesitancy as someone who's interested in public health and interested in kind of the interconnected health of communities. So I found a systematic review was published in 2023, and it suggests that the most cited reason for MMR hesitancy is based on misinformation. So parents were afraid that their children would be at risk of autism which is a debunked myth if they received the MMR vaccine.
Speaker 5:And, in addition, vaccine hesitancy to MMR and other childhood vaccines was really localized to middle and high income areas, in mothers with college level or higher education, who preferred or internet or social media narratives over physician-based vaccine information. And so I think that's important to note because, as we previously discussed in our last episode, which was on misinformation and disinformation and infodemiology, social media is used by 90% of Americans as a source of health information. So how we talk about these things matters and I think having access to what is currently going on in the current outbreaks, without the other kind of feedback that can cloud those narratives, is also really important, and that's part of the reason we want to make this episode.
Speaker 1:I appreciate that, camille, and I think it's good you touched on it. I think in science, our echo chamber is one in which I think we don't always fully understand we have this great, safe and effective thing, why is it not being used? And then we find out that, okay, it's because of misinformation, and I do agree. I think it's very hard. I've spent a lot of time in the community over the last year here in South Texas and what I hear from people in the community is that it's very hard to decipher what is reliable information and what is misleading information or misinformation, because I think in general, we have to start with the assumption that people want to be healthy and they want the best possible health for themselves and for their community, and one of the issues is that in science and health, I think we have historically approached these things as givens. Listen, if we recommend a vaccine, people should just get it right, and people have real questions and some of them have to do with its associated risks and what they've heard about. I always tell people when I'm having an individual patient conversation about a vaccine I say nothing is without a potential complication, both the ones we know and the ones we don't know. What we know is that we have literally decades of experience with this one and we can pretty safely say what the risks are. If we don't tell someone that there's a very small risk of febrile seizures after the MMR vaccine, and then we give them the MMR vaccine and the kid has a febrile seizure, they're going to say I'm never vaccinating my kid against anything again because you told me that it was all going to be okay. So I think we have to be very clear with both patients and with communities about the risks, the balance of risks, and I think there's a lot of work to be done and I appreciate spaces like this on the podcast to try to provide people with information that they can use and that they can use when they're trying to sort of reason through these very complicated decisions.
Speaker 1:I think people don't know what to trust and where to get their information. What they get fed to them is actually very scary and I think if we don't acknowledge how scary it is some of the information that people get about even what we now consider routine vaccines, and we don't acknowledge and appreciate that fear, we potentially alienate people even more right. So I think your point is well taken that hesitancy is playing a huge role. We're seeing declining levels of immunity in the population in general. It's been falling for several years, but I think the only way we're going to see a restoration of faith and trust is by deep engagement with the community and listening and trying to understand what the concerns are. So your points are well taken. The CDC continues to have good, reliable information. The World Health Organization continues to have good, reliable information. It takes nothing for someone to make a TikTok or a YouTube or even a podcast. It takes two turntables and a microphone. That's all it takes. I'm dating myself, aren't I on that reference, but it doesn't take much right.
Speaker 1:So I tell people that in science we have to constantly be questioning and making sure that we're making the right recommendations for people. So when we come out and we say man measles vaccine is safe and effective, it's not because we're pushing an agenda. It's actually because we really care and we want to see people live the most healthy life possible.
Speaker 3:Yeah, I absolutely agree, matt, and I think for me that's the key or the take-home message of this episode, right A? We as doctors, as physicians, scientists and so on, we need to do a better job communicating this. What's the risk of a vaccine? It's not completely without any risk, right, but it's way, way, far less than the disease, and I don't think we often do a good job explaining that. So I think we have to tell the people there could be a risk of one in a hundred thousand vaccines. That might be some side effects, but with a disease it's a numbers game and when I talk to people, I feel like it's always seen as black and white, right, like you take the vaccine and it always gives you side effects. And that's not true. It's much more detailed than that and we have to be better at communicating that.
Speaker 5:I really appreciate both of you saying that. I think that was really what drove me to conceptualize this episode is I think there's so much nuance and it's hard to communicate nuance when the driving thing is what's going to give me clicks, and so I think that's a very real thing. And I also just want to add a personal note.
Speaker 5:I started drafting this episode after I had a conversation with my brother about having my niece get her second measles vaccine a little bit early, because there was an outbreak nearby where they lived, and so that's how this started is we're people and we care about the communities that we're in, and we want people to have access to good information.
Speaker 5:So that was really my goal with this, but it's always such a pleasure to get to join and sit down with the podcast team and just chat about this. I always learn so much and I always feel like it makes me hopeful for where we're moving forward with health and science, because there are so many good people working for it and we do have such brilliant, diverse human communities. And I think disease is always a part of that, but so is the support and the resources and the people coming out of the woodwork to try and help, and so I think that's also part of what the study of infectious diseases looks like. That's what health care looks like. So thanks for sitting down with us and thanks for listening to this episode. We really appreciate it.
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