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New York Public Health Now
s2e08 Measles in New York: NYSDOH Experts Discuss the Importance of Immunization and the Risks of Vaccine Hesitancy
New York's Health Commissioner Dr. Jim McDonald and Executive Deputy Commissioner Johanne Morne sit down with NYSDOH's epidemiology experts Dr. Debra Blog and Travis O'Donnell to discuss the risks of measles and the importance of immunization. Learn about measles transmission, complications, historical and recent outbreaks in New York, and much more.
If you have an idea for topics we should discuss, please let us know: PublicHealthNowPodcast@health.ny.gov
Welcome to New York Public Health now podcast. This is where we talk about the why so you can decide what to do. I'm Dr. Jim McDonald, Commissioner of the New York State Department Health. Again sitting here in the 14th Floor of Corning tower overlooking Empire State Plaza here in downtown Albany. So as we continue in our second season of New York Public Health now, today we have two guests talking about measles. Two of our own in house experts, Dr. Deb Blog, Medical Director of our Division of Vaccine Excellence here at the New York State Department of Health. And Travis O'Donnell, the Director of the Department Center for Community Health, and before welcoming Dr. Blog and Travis, I'd like to introduce my co-host Johanne Morne. Johanne, our Executive Deputy Commissioner, how are you today, Johanne.
Johanne Morne:I am doing great. And I'm really excited about today's guests and the conversation that we're going to have so looking forward to sharing how New Yorkers can protect themselves against measles.
Jim McDonald:Yeah, it's kind of fun for me, we're gonna talk a little bit about the Division of Vaccine Excellence, which is relatively new at the Department Health. I'm going to talk a lot about measles today, too, which I think is a really, really important concept to talk about.
Johanne Morne:So let me introduce our guest, Dr. Debra Blog, began her public health career with the Bureau of immunization at the department and was the Director of the Division of Epidemiology. Before that, she worked for the Centers for Disease Control and Prevention on adult immunization, and as a general pediatrician for 10 years.
Jim McDonald:And Travis O'Donnell is the Director of the Department's Center for Community Health, which is responsible for epidemiology, vaccination, chronic disease, nutrition, and family health activities throughout the state. Before serving this role, Travis worked for 20 years in sexual health and harm reduction first and community based organizations and later for the Department of Health. So welcome, Dr. Blog, and welcome, Travis.
Debra Blog:Hi.
Travis O'Donnell:Thank you very happy to be here.
Jim McDonald:Let's just start off a little bit with you, Dr. Blog. I mean, we did an introduction, but tell us a little bit more about yourself, please.
Debra Blog:Well, as you said, I am a pediatrician, I did my first residency in pediatrics and I worked for about 10 years as a general pediatrician. And I did a second residency in preventive medicine with the New York State Department of Health. And I've worked for the department for over 22 years, with a little bit of time at CDC and I began my career at immunization, and I'm now back in immunization as the medical director. It's my favorite part of public health, and I really enjoy working in it. Sure. Measles is an acute viral infectious disease.
Jim McDonald:Yeah, it's funny, you remind me, I met you when I was doing my preventive medicine residency here at the New York State Department of Health, it's interesting that we both have It's extremely contagious, and it spreads easily through the that in common, we're pediatricians and also specially trained in preventive medicine. I think preventive medicine is probably the least known medical specialty, it's my guess. But perhaps it should be the best known because ounce of prevention is worth a pound of cure, is what the old saying goes here. So anyways, Dr. Blog, let's dive in a little bit to measles. So by late March of this year 2024, 16 of our state's and reported measles cases this year, at least that air when an infected person coughs or sneezes. It can cause state I have from the Centers for Disease Control and Prevention. So Dr. Blog, can you just talk about what is measles and how is it spread? severe disease, complications and even death. It can affect anyone who is not immune, but it's most common in children. It infects the respiratory tract and spreads throughout the body. Symptoms include a high fever, cough, runny nose, and a rash that begins on the face and spreads downward on the body. And the best way to prevent it is through vaccination.
Johanne Morne:Very interesting. I want to talk a bit about you know, you come into the measles are extremely contagious. Before we do that, though, I'm going to turn to you, Travis. I just wanted to take a moment. Tell us a little bit about your background and how you ended up here at the department.
Travis O'Donnell:Sure, thanks, Johanne. So I'm Travis. I'm the Director of the Center for Community Health at the New York State Department of Health. I've been in this position for about a year and my path in public health unlike Dr. Blog's took a slightly more winding route. My educational background is in the liberal arts. I have a bachelor's degree in English. And I like to think my analytical skills are sort of given me that gives me a springboard against which I can navigate large, complex systems and problems. I've got three kids 9, 11, and 13, and been with the department for about 10 years and it's just such an honor to come to work every day and work with such amazing, passionate, talented and educated experts like Dr. Blog and everyone else in the Center for Community Health.
Johanne Morne:Yeah, agreed, absolutely. So Let's go back to the conversation as it relates to some of the really prioritized work that you're both doing right now. I want to go back to this idea that measles are extremely contagious. So how do we compare the likelihood of infection to flu or COVID-19?
Debra Blog:Yeah, thanks for that. According to the Centers for Disease Control and Prevention, or the CDC, measles is so contagious that if one person has measles, up to about 90% of the people who are not immune, and who come in contact with that person will become infected. As I said, you can get measles through the air just by being in a room where a person infected with measles has been, or on an elevator for example, even up to two hours after that person has left. Infected people can spread measles to others from four days before the rash, so before they even know they have it, perhaps, to three or four days after the rash appears. Compared to say flu or COVID, measles is much more infectious, about four to six times more infectious than flu or COVID. It's one of the most contagious diseases that we know of.
Jim McDonald:You know, Dr. Blog, you remind me: Measles used to be a common childhood disease. You know, it doesn't have to be one again. You know, I think in the year 2000, measles was eliminated in the United States, but it's back here, and I was just thinking a little bit about how common it used to be and how rare it used to be and how we got rid of it and now it's back. But can you tell us when was measles vaccine made available, and how effective is it measles vaccine? Why don't we just talk a little bit about that?
Debra Blog:Well, the measles vaccine was developed in 1963, and by the late 1960s, there were also vaccines available to protect against mumps and rubella. And these three vaccines were combined into the MMR vaccine in 1971.
Jim McDonald:It's been around a long time, haven't they? Really, these vaccines have been around for a long, long time, really.
Debra Blog:Yeah, they've been around for quite a while. Before that, almost everybody got measles at one time in their life for another. One measles vaccine is about 93% effective against measles, and two are about 97% effective against measles.
Jim McDonald:Measles used to be a common childhood disease. So like pediatricians in the 40s, and 50s, would have all seen measles all the time. You know, I can tell you I've been a pediatrician for 34 years. I've seen one case of measles in my career, and that was in medical school and it was an adult before the second MMR vaccine was given. And I think the vast majority of physicians now actually don't have clinical experience and haven't seen a case of measles because it just became so rare.
Johanne Morne:So I'm just thinking, you know, before the measles vaccine was introduced, how frequently did major epidemics occur? And what were the consequences of that? I asked, because it seems as though years ago, it was more commonplace to be diagnosed with measles.
Debra Blog:That is correct. As I said, almost everybody got it in the pre-vaccine era. But there were also major epidemics that occurred about every two to three years. And there was an estimated 2.6 million deaths in the world each year. So very common, and very dangerous.
Jim McDonald:Yeah, that 2.6 million deaths per year is stunning. You know, that old expression, if you don't learn from the past are doomed to repeat it.
Debra Blog:Yes.
Jim McDonald:I do worry about that, and I will tell you, like being a pediatrician, you know, I have attended, regrettably, the death of patients rarely in my career. But it's just an awful, awful experience to be there when one of your patients passes away. It really is just awful. I want to shift our conversation a little bit to vaccine coverage. In New York, it's quite frankly, not what it should be. But is this a problem just in New York? Or is it a problem in the United States or even around the planet? What are your thoughts on that, Dr. Blog?
Debra Blog:Yeah, it isn't as high as it should be, and that's not just a problem in New York. It's a problem all throughout the globe. In fact, the WHO recognized vaccine hesitancy as a major public health issue. People might not get vaccinated for a variety of reasons it might be lack of access to health care. But increasingly, it's misinformation or disinformation about the vaccine safety, or complacency from not having seen measles, or a lack of knowledge about disease risks. Low vaccination coverage can lead to outbreaks of disease like measles and other vaccine preventable disease. So it's a global concern, because diseases can easily spread across borders, especially in our connected world. And in addition, the COVID 19 pandemic increased the risk of measles outbreaks because, again, according to the CDC, over 61 million doses of measles containing vaccines were postponed during the pandemic due to COVID-19 related delays in supplementary immunization activities in several countries, and this increases the risk of bigger outbreaks across the world, including in the United States.
Johanne Morne:Recognizing that Travis, I have a question for you, how do we distribute the vaccine statewide? Is cost a barrier as far as getting access or coverage?
Travis O'Donnell:Sure, so there's actually a couple parts to this question, and we can approach it from whether you're insured or not insured, and for people who are insured in general, your health care provider will commercially purchase the vaccine, administer it, and submit for reimbursement from the health insurance company. But we recognize that that doesn't work for everybody, and so the state has initiatives called vaccines for adults or VFA, and Vaccines for Children or VFC, and the way that these programs work, they're targeted for people who are uninsured or underinsured, and we have staff who work to enroll providers in the VFC or VFA programs, meaning they agree to all of our rules and will follow all storage requirements, and importantly, that they will serve people who are uninsured or underinsured. We will purchase the vaccine doses and we'll obtain the vaccine doses that we've purchased specifically for the program, and then the enrolled providers will order the vaccine through a centralized distributor and then the doses will go to the health care provider. So our networks for these VFA VFC programs are fairly robust, but there's always room for improvement, recognizing that we need to do everything we can to expand these programs so that nobody goes without. As far as your question about costs, costs should never be a barrier. In the Department of Health, and CCH, health equity really is our lodestar, and so we work to make sure that these options are available for people who can't afford to pay out of pocket for a vaccine. Most local health departments as well as over 80 federally qualified health centers or FQHCs are enrolled in the vaccines for adults program. You know, but I recognize that this really just sort of covers the out of pocket cost of the vaccine itself. I think, as a society, we need to do more to ensure that people have access to transportation, have access to child care, recognizing that there is an impact on somebody's bottom line beyond just paying for the cost of the dose itself.
Jim McDonald:Yeah, thanks, Travis. That was great. So So Dr. Blog, why don't we talk a bit about vaccine hesitancy. You know, this was something that was on the rise even before the pandemic. But can you just talk a little bit about the mission of the Division of Vaccine Excellence, [it's] relatively new here at the Department of Health and and how do we plan to address vaccine hesitancy here at the Department Health? What is our strategy for that?
Debra Blog:The mission of the Division of Vaccine Excellence or DOVE is the promotion of vaccine throughout the lifespan, and we have what we consider more routine activities like the Vaccines for Children program, the vaccines for adults program, vaccine preventable disease surveillance, school vaccine issues. A major part of our mission now is addressing vaccine hesitancy, and we plan to form a bureau that is dedicated to vaccine education and addressing hesitancy we plan to use the latest in research methods. We plan to involve behavioral scientists and others who can help us and support us in this to address vaccine hesitancy in New York State. I think it's extremely important that we do so, it's extremely timely, and we can't afford to not address it and be left behind in that regard.
Jim McDonald:Yeah, and let me just follow up on that. You
Debra Blog:Yeah, I think that misconception has been around know, it's interesting, the measles, mumps and rubella for a long time. I think it took off when Dr. Andrew Wakefield vaccine, as you said before, it's been around a long time. I can't tell you how many kids in my career I've given the vaccine to, it's many. It's a really safe vaccine. I mean, the most common side effect I saw from the measles vaccine, in particular was made about one out of 20 kids will get a fever and a rash, you know, three, five days later, and that fever and rash is just because it's a live vaccine. But there's a lot of myths about the measles, mumps and rubella vaccine. You know, autism is one of those things where it's an issue, it's near and dear to my heart, because I have three kids, two of them have different forms of autism. And by the way, I think one of the things about being a parent of two kids with autism and a pediatrician who's taken care of and how many kids with autism is, every kid I've taken care of with autism is a little bit different. They're all very different. But there's really no evidence that links any vaccine to autism in the scientific community, but it's part of the the lay understanding a little bit. Do you want to talk a little bit about that, if you don't mind? Like what what is that connection all about? And any ideas and how to dispel people that? published a study about connecting autism and the MMR vaccine. His study was disproven and the journal that published it, retracted it, he lost his license in England, and has not been able to practice in this country either. And there's been large-scale, randomized controlled studies that have looked at children who have autism versus those who do not and the incidence of obtaining MMR vaccine. And it's been shown that there is no difference, and there's just there is no connection between the MMR vaccine and autism, but yet it persists, and it's very hard to fight those notions.
Johanne Morne:Travis, I have a question for you. So we know that New York State had a measles outbreak that was in 2018 and 2019. What are the lessons that we've learned from that experience that, you know, we're looking to apply? Should we find ourselves in this situation again, and what are some of the challenges that the department faces as we navigate a potential measles outbreak?
Travis O'Donnell:Sure, I think first and foremost, as Dr. Blog just alluded to, you know, the low vaccination rates still persist here in the country, as well as here in New York State in several communities. These low vaccination rates really make people vulnerable to vaccine preventable diseases such as measles. I think Furthermore, working with our local health department partners, and directly with the communities most impacted is really important. It's truly a team effort to lead a measles response, or a response to any any outbreak. I think that as we saw in the COVID pandemic, as well, you know, working with communities is truly a year long process as well. We hear all the time that we can't just show up when we need something from community, we have to we have to form strategies and resource those strategies, such that we're able to engage in meaningful ongoing dialogue with the communities most impacted. I think also we have an upward battle, as far as combating anti-vaccine messages goes. They have a real documented detrimental effect on vaccine rates, and right now, when you look at vaccine uptake over time, you note a consistent downward trend, and we are going to need to take real meaningful action over an extended period of time to climb back to where we were, so that we can talk about measles elimination. Once again.
Jim McDonald:Travis, you talked earlier about the vaccine for children program. What is the vaccine for Children Program?
Travis O'Donnell:It is a program that is funded by federal and state dollars that supports uninsured or underinsured children to make sure that they can get any vaccine recommended by ACIP to ensure that cost is never a barrier for any child to get their vaccines.
Jim McDonald:Travis you mentioned ACIP, who is ACIP?
Travis O'Donnell:ACIP is the Advisory Committee on Immunization Practices, and it is a panel of subject matter experts and physicians who on an ongoing basis evaluates all the evidence about vaccine efficacy and vaccine safety, and they set the bar for what immunizations should be recommended for all children based on that evidence.
Johanne Morne:Dr. Blog, I have another question. So as we see measles cases starting to climb or increased in the United States and around the world, how common is it for an individual who is infected with measles to actually require hospitalization?
Debra Blog:Well, the complications of measles including otitis media or ear infections, pneumonia and diarrhea occur commonly in young children, pregnant women and adults over 20 years of age, and also in immunocompromised hosts. In general, about one in four people who get measles will be hospitalized. Acute encephalitis or inflammation of the brain, which often results in permanent brain damage occurs in approximately one in every 1000 cases, and one or two people out of 1000 will die even with the best care. Another scary sequela of measles is something called subacute sclerosing pan encephalitis which is long name for a rare neurodegenerative disease that occurs seven to 10 years after the measles infection. So it can be a very serious disease.
Jim McDonald:You know, Dr. Blog, I think about the subacute sclerosing pan encephalitis, it's really really rare but it you know, it occurs seven to 10 years afters and there's really no treatment for that. But when someone has measles, can you talk a little bit about how their immune system works after they have measles? Like, in other words, when you have measles, do you just get better or is there any consequences for your immune system in the short term?
Debra Blog:Well, it's interesting there is an increasing evidence that the immune system does not function normally after measles infections, and I think we are learning more and more about that. But children who get measles may be more vulnerable to other infectious diseases for a period after having measles.
Johanne Morne:You both given us a tremendous amount of information in the last few minutes that we've been together, but what haven't we asked? What else would you like to tell us and make sure that others who are listening to our podcast know?
Travis O'Donnell:The one thing I would share is, you know, right now, I feel like the department has been on sort of tenterhooks with respect to the potential for another measles outbreak. We lived through on not too long ago, in 2019, Dr. Blog was at the forefront of that, so the memory is fresh in her mind. Right now, we have fewer than 10 cases in the state, which is good news, and the majority of those have been travel related meeting. Somebody has sort of brought measles into the country. We do have one case outside of New York City and the local health department, in this case Nassau, has done a tremendous response. And, you know, I do think that we have, we have painted a somewhat gloomy picture of measles here for understandable reasons. But the good news is, we really do have the best team here at the State Department of Health and with the local health department. We have dubbed the Division of Vaccine Excellence, we didn't have that last time we went through this. And I really think that you know, I've been with the department 10 years and we are not an ivory tower Health Department. We are people who have had boots on the ground who survived the COVID pandemic, survived the measles pandemic, and if there's one thing this department does, well, it's really come together in in order to mount an effective public health response, and that's what we're seeing right now with measles in New York State.
Jim McDonald:Yeah, thanks, Travis. And Dr. Blog just to kind of end on this note, a little bit like the vaccines we we give as pediatricians are approved by the Food and Drug Administration, and many of them have been around for a very long time, as you mentioned with the measles vaccine in particular, it's been around as long as I have. But can you talk a little bit What is the approval process look like to get a vaccine approved? Can you talk a little bit about that please?
Debra Blog:Yeagh, sure. There is an extensive process involved with vaccine trials that go through the phases that were we may or may not be familiar with. There's phase one, phase two, and phase three. And it even starts before that in the lab, looking at vaccine use in animals. But when we get to phase one is a small trial, then they get bigger, in phase two, and phase three. And even beyond that, there is an extensive monitoring system for vaccine safety. It's something that is taken extremely seriously. And there's a number of systems that look at vaccine safety in certain populations. There is the ability to report vaccine associated events so that they can be investigated. I honestly think there is not a medical intervention that is as carefully studied as vaccines are.
Jim McDonald:Yeah, it is interesting. Even the post marketing surveillance continues every single day.
Debra Blog:It sure does.
Jim McDonald:Well, thank you both for joining us. You know, we talked about the why, to help people decide what to do. When I think about the why of measles is why is it still a disease we're dealing with? It was eliminated. And I think it's why because it's a really contagious disease, [and] until it's eliminated, globally, we're going to be dealing with it. Best way to eliminate globally is just eliminate the spread, and that's done through immunizations with FDA approved vaccines. So really fun to have you both Travis and Dr. Blog, Dr. Blog, thank you very much.
Debra Blog:Thank you. This is fun.
Jim McDonald:Travis, it was good to have you. Thank you for joining us as well.
Travis O'Donnell:Pleasure to be here. Thank you.
Jim McDonald:So that's gonna do it for today's episode of New York Public Health Now podcast. As always, if there's a topic of interest you'd like to hear us talk about, let us know by email at PublicNealthNowPodcast@health.ny.gov- Please keep an eye out for the latest New York Public Health now episode on your favorite podcast player like Apple Podcasts, Overcast Spotify, YouTube and Google podcasts. Search for our podcast by title" New York Public Health now or by keyword NYSDOH, then tap the follow or subscribe button to be notified when we release a new episode which is about every other week.. For New York Public Health Now podcast I'm Dr. Jim McDonald.
Johanne Morne:I'm Johanne Morne.
Travis O'Donnell:I'm Travis O'Donnell.
Debra Blog:I'm Debra Blog.
Jim McDonald:Thank you for listening.
Monica Pomeroy:New York Public Health now is a production of New York State Department of Health's public affairs group. Michael Wren is the executive producer and engineer with additional production support provided by Sarah Snyder, Genine Babakian, Barbara Stubblebine, Alicia Biggs. Monica Pomeroy and Kyle Kotary. Copyright 2024, All rights reserved. We welcome your feedback. Please email us at PublicHealthNowPodcast@health.ny.gov
