CEimpact Podcast

Whooping Cough and Measles Are Back

• CEimpact

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Recent years have seen a troubling resurgence of whooping cough and measles — diseases many thought were largely controlled — highlighting the continuing importance of vaccination, surveillance, and community education. This course reviews the latest evidence on global and local trends, explores the factors driving renewed outbreaks, and discusses the key roles of pharmacists in prevention and early detection. You will gain insights to be better prepared to support immunization efforts, patient counseling, and public health awareness in response to this resurgence.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

GUEST
Christina O'Connor, PharmD, BCPS, BCIDP
Clinical Pharmacy Manager
Mayo Clinic


PRACTICE RESOURCE
Purchase this course to receive the exclusive downloadable practice resource handout to use as a reference guide to the podcast

 
CPE REDEMPTION
This course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation:


 CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe recent epidemiologic trends in pertussis and measles resurgence and factors contributing to increased incidence.
2. Identify the pharmacist's responsibilities for promoting vaccination, encouraging timely immunization, supporting outbreak prevention, and providing patient education.

Rachel Maynard and Christina O'Connor have no relevant financial relationships to disclose.

0.075 CEU/0.75 Hr
UAN: 0107-0000-26-038-H01-P
Initial release date: 1/12/2026
Expiration date: 1/12/2027
Additional CPE details can be found here.

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SPEAKER_01:

Here on Game Changers, we're all about helping you stay ahead of pharmacy practice. But why stop at listening? You can earn CE credit for this episode and hundreds more by visiting CEimpact.com and logging into your account or creating a new one. Get credit, get inspired, and make your learning count. Hey CE Impact subscribers, and welcome to the Game Changers Clinical Update Podcast. I'm your host, Rachel Maynard, and today we'll be talking about a topic that's gotten a lot of buzz lately, and that's looking at two infectious diseases that many of us thought were pretty uncommon or even eliminated in the US: whooping cough or pertussis and measles. But what we're seeing is that's not the case anymore, and these two infectious diseases are on the rise again, and they can be potentially serious conditions with severe complications. So we're going to start out with a quick review of what these conditions are, then jump into why we're seeing these increases and what we can do as pharmacists to help address these concerns in practice. And to do all that, I am very pleased to welcome our guest today, Dr. Christina O'Connor. So welcome, Christina. Yeah, thank you for having me. Excellent. Well, Christina, maybe you can share a little bit about your background, your current role, and why you're interested in this topic.

SPEAKER_00:

Yeah, absolutely. So a clinical pharmacy manager for infectious diseases pharmacist at Mayo Clinic. And I have a team that is across the Midwest here. So both Minnesota and in Wisconsin. And I think that this is just really a fascinating topic. I think this is something that is really affecting so many of us and is really spreading across the United States. So I'm excited to be here to talk more about it.

SPEAKER_01:

And what we can do to help help maybe try to limit some of that, those numbers that we're seeing that rise. Absolutely. So just to sort of level set and start things out, I thought it would be helpful to just go through a quick review of these conditions and throughout our discussion to keep things organized. Let's talk about each of these conditions one by one. So pertussis and measles, and sort of follow that flow throughout our discussion. So let's kick off with a brief overview of whooping cough or protussis and what causes it, how it spread, common symptoms, complications, and I'll just kick it over to you if you want to jump into that.

SPEAKER_00:

Yeah, sure. So starting with whooping cough, also known as pertussis, it's a highly contagious respiratory disease. It's caused by Bordatella pertussis. It mainly affects infants and young children. And the reason that it has the name whooping cough is because of a whooping sound that's made, particularly in young children, but also can be in adults when there's like a sharp inhalation of the breath. So there's a cough and then a big whoop when people inhale again. A whooping cough has three distinctive phases to it. The first phase is called a cataral phase, and that lasts about one to two weeks. There's a dry, productive cough, runny nose, and a low-grade fever. It's very similar to like the common cold. Some people describe it as like a cold where you don't have a ton of congestion. Um in children or infants, sometimes the only assign in this phase is apnea. So it can present a little different in children, infants, and that's something to keep in mind. The next phase is the paroxysmal phase, and this can last up to a month or more. And this is what you want to think of as your is kind of like a coughing fit phase. Um these coughing fits can occur frequently, particularly at night, and can be up to 15 attacks in 24 hours. And it increases, particularly over the first couple of weeks. Something that is also very characteristic of whooping cough is it's a cough that's followed by vomiting. So that's something that's definitely different than the common cold. And people can have no fever as well in this phase. Um, in between these coughing fits, people can be kind of like feeling relatively well, other than exhaustion. And then in the babies, there can be even cyanosis or like turning blue. And then the third phase, the last phase, is the convalescent phase. And this is can be two months or more, just like a gradual improvement in weeks to months of that cough. And it's sometimes called the 100-day cough.

SPEAKER_01:

Oh, yeah. That's a nice way to remember the the duration. And by that point, it's not infectious necessarily, it's just sort of recovery from the acute coughing and potential damage to the lungs. Is that right?

SPEAKER_00:

Or yeah, it can be thought of that way. And some kind of key things to think about that are considered like, here's when I should really be thinking about whooping cough. Is the person has a cough that's been lasting for more than two weeks. And then they also have one of these features, they're they're describing it as a fit of cough. There's that inspiratory whoop sound, or they that they vomit after coughing. And then in infants, it was really looking for that apnea or you know, not breathing. And of course, particularly in people that aren't vaccinated or have had some contact with someone that's known to have whooping cough.

SPEAKER_01:

Okay. Okay, that's great background and overview. And I I like how you summarize some of those key symptoms that we can be listening for, patients reporting. Because as you said, it can often be confused with a common cold. And so some of those differentiators like the whoop, the whooping, the fits, the apnea in infants, those are some really nice, I think, practical takeaways that we can be thinking about. Um, okay, excellent. And in terms of measles, let's move on to measles and do a similar sort of review there, if you can, Christina.

SPEAKER_00:

Yeah, measles is another one highly contagious. It's really one of the most contagious disease, infectious diseases that's out there. Um this one's not bacterial, this one is viral. So that is something that is a little bit of a difference to keep in mind. Um, but it also has like a characteristic presentation that you can look for. So there's like a prodrome phase, and that's two to four days. And that doesn't start until 10 to 14 days, usually after an exposure. And patients, you want to look for the three C's in this phase. It's cough, choriza, which is runny nose, and conjunctivitis. Um, and patients can have a high fever. So you want to think of the three C's for measles, and then as well as can have a very high fever up to 104 degrees. Patients are contagious in this stage. Next comes the rash phase, and this is usually about three to five days after the initial symptoms, and it's a red blotchy rash. It usually starts in the face and the head, and then it spreads to the trunk and the extremities. And patients will stay contagious all the way through up to four days after the rash is gone. The other thing that can be looked for that's path pneumonic for measles is what's called coplic spats. So if you want to look in someone's mouth, but this is where they are on the inside of the mouth, it can be like this little, like a white, bluish black or raised, kind of like a raised lesion in the mouth, and that's in up to 70% of cases. It's within a couple of days before the measles rash. So you could have the coplic spats potentially before you the patient even has the full body rash or the rash even starting. And it's considered early and very specific for measles. Um the other thing too to keep in mind is just really again how infectious this is, that it can just persist in the air for up to two hours in an enclosed space and it will infect 90% of people that are exposed to it. It all can also can live on surfaces. So if someone touches a surface that is contaminated with measles, that's and then they touch their eyes or their nose, that can also lead to to developing measles.

SPEAKER_01:

Yeah. So again, great summary. And that extremely contagious sort of aspect of it, I think is really important, especially as we get into talking about vaccination maybe a little lot a little later on, and how a 95% threshold is sort of the target for herd immunity because of this nature of it being so contagious. Is that right?

SPEAKER_00:

Or yeah, yeah, exactly. So the more contagious it is, it's kind of like goes hand in hand with you needing to have, yeah, 95%, like that's the number that you see that you need to have vaccinated for herd immunity. So a lot of emphasis placed on making sure folks are vaccinated for measles. And then, you know, the complications are if it can be very serious. And there's some other things, you know, you can have more of the garden variety, otitis media and pneumonia, if you will, which are serious in themselves, but blindness can happen from measles as well as encephalitis that leads to permanent brain damage. And then death rate is estimated about one per 1,000. So the complications can be really serious. Um, about 11% of cases in 2025 in the US of measles cases had to be people had to be hospitalized and three people have died in 2025. So the stakes are really high with measles.

SPEAKER_01:

Okay. And you know what you just reminded me, we didn't really talk about the complications of pretussis. So I think there are some similar concerns there. Again, in terms of severity, yes, you know, the the fits and the apnea are obviously concerned, but are there any more severe complications that we could be thinking about and and possibly educating patients about in terms of especially when it comes to vaccination and prevention?

SPEAKER_00:

Yeah, you're right. And there's some overlap there a bit with some of the complications. So pneumonia, seizures, and th encephalopathy as well, all with pertussis, and then the apnea in young infants, and particularly with kids, there can be mortality as well with whooping cough, unfortunately.

SPEAKER_01:

So, yeah, both both with measles and pertosis, especially in infants' children, that those complications can be especially problematic, it sounds like.

SPEAKER_00:

Correct. And the other group to really keep in mind as well, particularly as well for measles, is in pregnancy. So measles can be transmitted to during pregnancy to a fetus and can result in result in congenital measles. And that also can result permanent brain damage, encephalitis. So really some serious potential complications.

SPEAKER_01:

Okay. Well, thank you for laying that groundwork because I think that ties in nicely to then some of the concerns that we think about when we're seeing these cases and reports of measles and whooping cough going up. Um, so again, let's start with protessis and think about some of the recent trends that we've seen here. So, what kinds of statistics are we seeing around protessis? And then what do we think are some of the reasons why we're seeing this rise in cases?

SPEAKER_00:

Yeah, I was even surprised looking at some of the recent data, how much protessis has really gone up in the US, a six-fold increase in protestis cases between 2023 and 2024. That's just really ratching up. And in countries outside the US, 65-fold increase in China, which I thought was just stunning. Yeah. Yeah. So, and it's it's kind of keeps, you know, kind of actually increasing the first three months of 2025. The US has had 6,600 for testosterys cases, which is four times the pace of just last year, 2024, and 25 times the pace of 2023. So it seems like it's like really just like ratcheting up right now. Yeah, more than's been seen in over 50 years, some of the stats are that have been reported.

SPEAKER_01:

Okay. And maybe actually let's let's talk about some of those stats for measles too. Yeah. How does that how does that look too? And I think that one is actually to me, that one is even more astounding. Some of these numbers I've been seeing, especially because it was considered eliminated at one point. So yeah, let's let's talk about that.

SPEAKER_00:

Yeah. So measles was declared eliminated in the United States in 2000, but that is not really the case anymore. So it's currently that the US it may potentially lose its distinction as being considered a place where measles is eliminated, just based on the recent amount of transmission. Um 47 outbreaks in the year of 2025. And of all the cases, the majority are 88% of them are outbreak related. West Texas alone, 700 confirmed cases in January of 2025, and that's where two deaths of children were reported. And then there's kind of like outbreaks popping up in a lot of different places in a lot of different states, like Ohio, South Carolina. We're just really seeing across the US these like kind of 100 to 200 scale cases popping up all across the US.

SPEAKER_01:

And so let's talk about why this is happening. And I think there may be some slight differences between the rise in protestas that we're seeing versus the rise in measles, but and we know there are vaccines for both, but let's let's talk about that. What are some of the potential reasons why we're seeing increases in both of these? What are the similarities, but then maybe some of the differences too, and and why we might be seeing these cases going up?

SPEAKER_00:

Yeah, sure. That's a good question. So I think the main similarity is just drop in vaccination rates, right? Less people are getting vaccinated, and there's different contributing factors, factors to that. There's the fact that a lot of people didn't get vaccinated during COVID, and a lot of these, the non-COVID vaccines sort of fell off radars. So just getting off regular schedules and things like that. So that's that to be part of it. Um, like the social changes just around perceptions of vaccination is also leading to less people getting vaccinated. So I'd say that's like a similarity between the two. Another thing that maybe a similarity is improved diagnostics. So people are more aware, there's more tests for both, particularly or more rapid tests or more available tests as well for protesses and measles. So that's something to consider too, is like we potentially are better at detecting more of them. One of the differences I think would be as far as like whooping cough, is I hear more concerned with just wear-off of the vaccine of the protection and more of a need to get boosters to get a booster. So there's like that that wearing off or waning of immunity, particularly with protussis vaccine, as well as use of acellular protussis vaccine. And there's some thought too kind of ties into waning that it might be not as effective as whole cell protustis vaccines that had been used in the past, but it's better tolerated. So that those are some of the things that I've heard. Was there anything else that you've kind of heard about related to protussis in particular?

SPEAKER_01:

No, no, I was thinking of that weaning immunity difference too with protustis, because I I'm aware of that concern with protustis vaccination versus measles, not so much that being an issue. And even the concept of people born before a certain year, I think it's 1957, who they they are presumed immune simply by the fact that they were born at that time because of measles being more endemic and so not necessarily something they've been exposed to. So yeah.

SPEAKER_00:

Yep, absolutely. Yeah, that would be that that piece with the 1957 is really a good one to keep in mind.

SPEAKER_01:

Yeah.

SPEAKER_00:

And some of those differences there. And then the other thing, too, that I think is seems to be a little bit more of the case with measles is some close-knit communities tend to be some areas where there's outbreaks, but that doesn't seem to be quite the same as what we're seeing in with pertussis.

SPEAKER_01:

Right, right. So yeah, yeah. And also again, sort of that going back to that contagious nature of measles extremely contagious nature. And so when you have outbreaks in a in a community, it can spread like wildfile. Yeah. The I'm curious, Christina, have you seen this in your practice? Have you seen some of these cases coming to your clinic or health center? Um, or is this something happening locally for you? Or if not, have you heard of your colleagues sort of going through this and and what they're seeing firsthand?

SPEAKER_00:

Yeah, there have been um measles cases here that and I I want to say the first one would have been like within the year that we had, and that was a pretty big deal. I'm not we're I'm not really located in a in like a big city or anything. So for us, even having like, you know, one of these come to us in Rochester, Minnesota's is kind of a big deal. So yeah, we've we've we have seen that. I haven't heard as much about the whooping cough, but I I do just kind of wonder about us being a little protected with having so many vaccinated folks that work at Mail where I am. We might have a little bit better herd immunity potentially here. So, but I've definitely been hearing about it, you know, just like in general, the alarm being raised about this through a lot of the infectious diseases channels that that I am in communities that I'm a part of.

SPEAKER_01:

Yeah, absolutely. You know, I think the other thing that you just reminded me of when you were talking about where you are based is international travel too, especially after COVID and that becoming even more common, I think. And that's also increasing the risk of transmission and and I think also potentially contributing to some of this rise that we're seeing.

SPEAKER_00:

Yeah, especially with measles. Right. Yeah, chattel to endemic areas can be a risk and back with measles.

SPEAKER_01:

Yeah, and then exactly, and that that is one of the risk factors, I think, for thinking about vaccination and who we should be looking out for potentially. So we'll get back to that in a minute. But yeah, so it sounds like you know, we have the the decreased rates for various reasons, decreased rates of routine vaccination, vaccination during the pandemic, vaccine hesitancy leading to potential decreased rates as well, and then some of those other factors. So we've sort of skirted around the issue of vaccination in our discussion so far. So let's just dive right into that. And again, let's start with whooping cough protests and talk about what vaccination, when is vaccination recommended and and who, what kinds of patients are we looking for?

SPEAKER_00:

Yeah, absolutely. And I think here the saying an ounce of prevention is a pound of cure, like absolutely the case with whooping cough and measles. Um and I think that's just a good, you know, some of those, you know, kind of colloquialisms, I think can be very powerful to share with people. So yeah, preventing whooping cough is one of the best things you can do through vaccination. And that would be DTAP, and that's for kids, and then TDAP for adults and teens, both highly effective, 80 to 90 percent effective, and significantly can reduce severity and complications. Um, I think one of the really interesting things to two to keep in mind to kind of connect to being on the lookout for symptoms is that people. That are vaccinated because the severity is this, they may not have all of those signs we talked about. So, like that whoop sound may actually be absent if the patient is previously vaccinated. So that's that's something to kind of to keep in mind. The great thing about the DTAP and TTAP is there's also an excellent safety record for those the side effects or mild things like muscle soreness, redness at the injection site, maybe a little low grade fever. So it's generally really well tolerated. The schedule for kids, for children, DTAP series at two, four, six months, and then 15 to 18 months, and then again at four to six years. And then for adolescents and adults, at least one TDAP, and that's preferably around 11 to 12 years of age, and it can replace any TD booster. And I think that is one of the things that I really recommend. And I know that I made sure when I was pregnant that my husband got TDAP. I was like, you need to get the pee. I need you to have the pee. So I think that's something that is really important, and pharmacists can intervene on is that you know, making sure to get the pea part to protect as well against pertussis. And that can be at any time, regardless of whenever if someone got a TD, you can still go ahead and get the TDAP. And then pregnancy is another time. Speaking of pregnancy, so 27 to 36 weeks of gestation, and that's with each pregnancy, too. And that helps to pass immunity to the newborn. So you're you're boosting your immune system, not just to protect yourself, but also to give those good antibodies to baby. Right. So those are the main ones that I think of for whooping cough. Any others that you have, Rachel?

SPEAKER_01:

Yeah, no, I think you summarized it really well. I think the reminder about each pregnancy is so important. And and in that sort of third trimester time frame, the weeks that you said, what are those weeks again? Maybe just restate those.

SPEAKER_00:

Sure. 27 to 36 weeks gestation.

SPEAKER_01:

Yep, perfect. And so again, the idea of passing it on to the newborn because then they aren't vaccinated until that two-month time frame, right? When they start their childhood vaccination series. So protecting them in that interim time, I think is a good reminder. And then, you know, I often think about I think what we get a lot of questions around is for someone who's pregnant, and then like you mentioned your spouse and making sure he was vaccinated. What about grandparents or any other people who might be coming in contact with the baby after it's born? Is that I I feel like that's an opportunity to be having some of those conversations, especially if that person who's going to be in contact hasn't had a TD or TDAP recently. So are we looking for people who maybe haven't had a tetanus booster, but also that pertussis booster in the last 10 years? Is that sort of the time frame we're thinking about? Or just in general, would these people be benefiting from vaccination if you know your grandparent is going to be visiting the child after after the birth?

SPEAKER_00:

Yeah, I think there's a good there's a good indication for that. I what I've read is too is like cocooning someone isn't as much strongly recommended as it had been in the past. But I still think that, you know, getting everybody vaccinated is just good practice, um, especially around those times when you're going to be around susceptible individuals like babies.

SPEAKER_01:

Yeah, yeah, you're right. It's not like grandparents need, it's not like in pregnancy where it's recommended each pregnancy. Grandparents aren't recommended to be vaccinated each pregnancy. You're absolutely right. So yeah, there is a differentiation there. But I do think a lot of people may not remember when their last booster was. And so even having that conversation and just having them be aware, I really loved how you said you need the pea, add the pee. That's a good, good, good takeaway, I think. Yeah, so then that's prevention of protestis, but what about management? And so if you had a patient who is say they they're reporting that they have these fits or this whooping, where do you start in terms of thinking about managing that patient?

SPEAKER_00:

Yes, absolutely. I think this one to me has a really nice bread and butter pharmacy one, like one that we're real like super, I feel super comfortable with. So I think, well, the first thing too is like, do you think about like, do I need to have like a diagnosis, like a like a test positive to start treatment? And the answer is no. If the patient has a clinical diagnosis, like they have the signs and symptoms, you don't have to wait for like a lab test to treat protussis. And that is gonna be our good old friendly ZPAC. It still is a thromycin, 500 milligrams on the first day and 250 days, two to five. So I think that's a real nice one, easy to remember. I think one thing that too that is I was kind of re-reviewing about pertussis that that I refreshed on as well can be some expectation setting. And I think it's something that can be, we don't want to scare people away from not wanting to be treated, but people may not have a super improvement necessarily in their symptoms with azithromycin. But what it's really good at is it's really good at decreasing transmission or protossis. So patients may or may not have a shorter course of their disease or super improvement in their symptoms that they feel, but it is going to help to decrease their ability to transmit. So I think that's something just to kind of keep in mind that to kind of understand what the context of the reason for the main reason for treating is. And then it's most effective in the first one to two weeks. So the sooner you can catch it, again, not having to wait on like a micro lab test, the sooner you can get somebody started on that ZPAC, the better it is, the more helpful it is going to be for them. If it's gone too long and they're not considered contagious anymore, generally three weeks after the coughing starts, they don't necessarily need antibiotics. There's some exceptions, like pregnancy, lots of comorbidities, very old or very young. But generally, if they're way far out and they're not even considered symptomatic anymore, then they may not even need an antibiotic. So those are some of the things. And then if somebody has a reason they can't have azithromycin, then there's alternatives. So self-trim, trimethoprim, sulfamethoxazole is one of the alternatives, and that's a double strength two times a day for two weeks. And then in the very last line, there's other some other alternatives that you could get into fluoroquinolones, tetracyclines, but the thing to keep in mind is those are kind of like lab-only data. Those you really kind of really want to try to stick to the azithromycin and self-trim if you can. And then people do have options, kind of a last line thing. One to keep in mind is but not amoxicillin. So amoxicillin doesn't clear the borditella from the nasopharynx. So that would be one you wouldn't want to recommend based on what I've read, into what the alternatives are, as you get down into the rabbit hole of allergies and intolerances that some folks have.

SPEAKER_01:

So okay. Yeah, so a few things that you called out that I think are really important. The the idea of treating within the first couple of weeks, one to two weeks, because afterwards it's you mentioned the hundred-day cough before. So going back to that concept, we don't want to be treating someone even though they're symptomatic of day 50 and you know, not feeling 100%, it doesn't mean they need an antibiotic at that point. But also clarifying that prevention of transmission is an important feature and consideration with the antibiotic use, too, and even, you know, sort of the concept of post-exposure prophylaxis, also like being aware of patients once they are diagnosed, and that can be clinically, as you said, that is a potential reason for them to be getting an antibiotic so that they're not spreading it to others and contributing to these drives in cases that we're seeing across the country. So really important point there too. You know, one other interesting thing I saw just looking into this was the well, I think we're seeing more macrolyte resistance in general in the US too, but also cisromycin specifically and in some countries too, where macrolyte resistance is becoming more prominent. And so that was something that I wasn't really aware of. And again, thinking about international travel and people who may have been exposed to a resistant bug, you know, that's a good reason to be aware of trimethabrom supplementhoxazol as an alternative in some cases when it's necessary.

SPEAKER_00:

Yeah, and the one that I read up to 95% resistance in China for macrolides. So, like basically, if somebody traveled to some different countries depending on the resistance rates there, it you basically would consider the protector the Bordital to be resistant. Um, you can just assume that. So then, yeah, you have some of those alternatives and that you can reach for in those cases. Yeah, yep.

SPEAKER_01:

And then outside of antibiotics, you know, of course, the sort of standard non-pharmacological measures like minifiers and fluids, and you mentioned the vomiting can be a it can be an issue with the swooping cough. So, what other sort of home symptomatic measures can we support with?

SPEAKER_00:

Yeah, I think you mentioned a lot of them. One other that I ran across was cough suppressant could be helpful. So, some especially if someone helps, you could direct them to a dextromethylorphan, should be safe choice. So that could be something else that's tried.

SPEAKER_01:

Um but symptomatic. I mean, it's symptomatic, other than the antibiotics, you know, helping with the uh managing some of those symptoms. And I think, yeah, like you say, with that cough, and especially if it's impacting sleep, you know, that can be a sort of a vicious cycle turn into. All right, so great review of protestis management. How about measles now? And let's start with vaccination again, there, because as you said, prevention is the best medicine, right? And so again, that's gonna be the truth here with vaccination for measles too. So let's talk about that a little bit.

SPEAKER_00:

Yeah, and essentially you can almost think that like vaccination here really is the right aside from one option we'll talk about. It kind of is the treatment. So it's generally considered supportive. There aren't any antivirals that can treat measles, and there's like small case reports with ribovirum, but nothing that's really endorsed. And so post-exposure prophylaxis is the MMR vaccine. And given that within 72 hours of exposure, if a person doesn't have a contraindication, it is a live vaccine. So you do want to think about folks that would have contraindic indications to live vaccines. Um, but especially for those if not immune or they haven't completed the series. And then immunoglobulin is another option within six days of exposure, and that can be used for those with contraindications to the MMR. So there's some really nice tables out there too that can kind of get into like if it's this age and if they're immunocompromised, pregnant or not, and then use either MMR or the immunoglobulin. But those are really the two options that can be looked at. And then there's also vitamin A supplementation for infants and children, and really considering this is supportive and not something that should be done at home. This is something that needs to be done in with guidance from a healthcare professional or even is used in the hospital. Um, it's not, it's not a substitute for the vaccine either. So that's something else that you can really kind of gently emphasize with patients that are looking into vitamin A in the context of measles, but it can be given to infants and children under the supervision of a healthcare provider as part of their supportive management. Um, and but and there's some different dosing schemes kind of based on the age of the patient. So I think that's kind of like a general overview. Anything else for details to get into further on that, Rachel?

SPEAKER_01:

No, I mean I think you summarized it well. I think I've also heard quite a bit about vitamin A, and because it's available over the counter, people may be thinking of it, you know, they've heard about it somehow, you know, in terms of managing measles, because as you said, it could be used in patients with measles under professional guidance, but that doesn't mean that patients at home who either are in a situation where there's an outbreak in their community or if they're trying to use that as an alternative to vaccination, that's where, as you say, redirecting, educating, providing some guidance on that. And there are risks with vitamin A too. It is, you know, fat soluble and so can lead to toxicity, especially if used, especially in high doses, which is you know where it's recommended for hospitalized patients or or those at risk. So clarifying some of that is super important. So, yeah, it that's I I like what you said about how vaccination is also the treatment potentially. And so if we think about vaccination as prevention and not even having to think about the management, what what are the recommendations as they stand currently for vaccination to prevent measles in the first place? Where what can because it's I think you know there's maybe some confusion around that because of the outbreaks, and does that change the standard recommendations? So what let's just review those and get on the same page there too.

SPEAKER_00:

Yeah, absolutely. And MMR I'd say is even simpler. Well, so basically it's MMR and it's even kind of a simpler schedule than DTAP. It's two doses. Yep. Really routine schedule, first dose at 12 to 15 months, second dose at four to six years, and then there's some other indications for adults. So it two doses for healthcare workers, students, and international travel travelers can also be used in an outbreak setting down to as young as six months, then if there's an outbreak, and then as well as international travelers. So if somebody doesn't have evidence of immunity already, then they should have an MMR vaccine before they would depart to that endemic country. Um, the thing to keep in mind is here, you know, pregnant women would not get the vaccine since it's live. So that's another differentiator between measles and whooping cough, whereas we're giving it to women that are pregnant for whooping cough. So that's one thing to keep in mind. But it's highly effective, 93% effective against measles and the with one dose. And then two doses are 97% effective. Um, so and it's another one where it's gonna temper if someone is exposed to meesles, the symptoms. So it maybe it can really decrease those, and it's just really effective at preventing overall.

SPEAKER_01:

And you know, we touched a little bit before about vaccine hesitancy, and I'm sure that's something you are faced with often in in your practice and and when talking with colleagues or or patients. And so how you mentioned the efficacy, you mentioned the schedule, but what what are some just general strategies that we can follow for having those conversations with patients, especially if they are hesitant? I'm thinking that maybe some of these headlines and and you know, sort of this concern that we're seeing with the rising cases could be an opportunity to re-engage in some of those conversations, but I would love to know, you know, your real experience with managing some of that.

SPEAKER_00:

Yeah, I think step on is kind of being familiar with with the indications and being able to know somebody may be a candidate for the vaccine. And then I, you know, I think that what it is is just being very factual, being very straightforward with folks. You don't need to engage in a philosophical debate with anybody. It's just showing what you know in a very simple statement. The statements like vaccines provide the safest way to achieve immunity, or natural infection has serious risks. Um, if someone's worried about vaccines causing immune system overload, we can say that vaccines only use a small portion of the immune system. And as antigen loan actually decreases, decreases we need despite more vaccines, or that there aren't studies, you know, multiple high-quality studies have shown that there's not a link between autism and MMR. So it's just simple statements, just stick into the facts, and there may be some people that never change their mind, and that's okay. Um, you're really looking to engage with the people that are open to listen and hear, and I think that's that's the way to approach it.

SPEAKER_01:

And for those of us who are working in a pharmacy or interacting with patients, you know, I think a few things, you know, if the uh we know that immunization rates went down during the pandemic, so people may have missed the opportunity to vaccinate or have forgotten, you know, in the course of all of the COVID vaccinations and everything else. As you said, routine vaccinations sort of dropped. So just an opportunity to ask, have you had it? And and you know, if not, this is a time to do that. It's never too late. That sort of concept might be, you know, a way to re-engage. Also, you know, going back to school, that's a time when often people are thinking about all kinds of things with back to school and vaccinations can be an opportunity there. But any other sort of tips or tricks in terms of just even when to have these conversations? What are sort of those prime opportunities that you would think of when patients might be receptive?

SPEAKER_00:

You know, I think there's a lot of opportunity for pharmacists because we have a lot of organic conversations with people. And I think it's sort of in that case of your normal relationship with someone, I think it really does come best whenever it's from someone the recommendation comes from somebody that you that you know and that you trust. And I think pharmacists are still one of the highest rated trusted professions of all the professions out there, not just healthcare. So we really have an opportunity to do that. And I think that is kind of when it is probably well received versus coming out of nowhere and you know, someone that you don't have a relationship with that can be a little bit more jar jarring for folks. So I know a lot of pharmacists have a lot of things on their plate. So I respect that too. Of course, um, that we that we all have this balance that that we need to meet. But I think there's a lot of natural times in conversation, especially around flu in vaccination series. When you're just kind of talking about vaccines in general, that you can kind of to kind of probe a little bit more, ask a little bit more.

SPEAKER_01:

I think that's just a great takeaway, the idea that these sorts of conversations can happen naturally. It doesn't have to it's a matter of just staying alert and being aware of that potential opportunity as it comes up in those routine conversations, because we are seeing patients on these sort of regular touch points often and using leveraging that. Um, but you know, in terms of thinking about you know, patients also who are reporting symptoms or if you're sort of those red flags are going off that you're thinking, oh, maybe this is could be protestis, could be measles. Are there certain actions? What what side sort of actions should a pharmacist take if they are talking to a patient and thinking about measles or protests in the back of their mind? Those symptoms are being discussed.

SPEAKER_00:

Yeah, immediate referral for suspected cases. So refer people to get tested and potentially in a case of protestis treated. And then also thinking about calling ahead to wherever you're referring them to to alert them. Because you know, you're probably sent potentially sending them to an emergency department or a primary care office, probably more likely an emergency department, potentially. And so they would walk into a room with a bunch of other people that are patients. So you could call ahead and say, hey, I'm sending someone in. I suspect that they may have protests remeasals. So some preventative measures can be taken there as well. And then they're both reportable diseases. So cases can be reported to both state and local health departments. Uh, and that should take place immediately as well.

SPEAKER_01:

Yeah, absolutely. I I'm really glad you called that out. The referral, prompt referral, and that they need to be reported. And as you say, this is something that's managed with measles at least in the hospital, setting isolation and you know, all kinds of additional steps need to be taken. So great point about not just sending them to the emergency room and having them be in the public and potentially introducing others to that risk too. And do you have any advice or best practices for how pharmacists can keep up with what's going on in their community or or like is it are there usually health department sort of listservs or even social media? What are the what are the ways that you sort of stay up with what's going on in your community?

SPEAKER_00:

Yeah, I'm on health department listservs. That's like the way that I kind of keep up with things. IDSA, also if someone's like super interested in the topic, they also have like a newsletter that goes out. But I think like public health is really a place where you can kind of learn more, especially about like what case rates or outbreaks may be out there. So I sign up for those and they just come in through my email. And that's really kind of how I stay up to date. But I know that people can get information from a lot of different places. In Minnesota, the public health department as well also has a social media channel. So those are other things that you can kind of find and our trusted sources where you could get information.

SPEAKER_01:

Excellent. Well, any other sort of takeaways or key points? We'll we'll wrap up with our you know, our game changer and what you think is the main message that we as pharmacists should be thinking about when it comes to this rise in measles and and protesters. So, what is our game changer for our discussion today, Christina? What should people walk away with as the main message and what to be aware of?

SPEAKER_00:

Think about it. What I would say is that whooping cough and measles are back. Think about them, screen for them, encourage a vaccination for them, and if you suspect it, get them to emergency health care.

SPEAKER_01:

So excellent. Well, I think those were very straightforward, nice key points, clear. Thank you so much for your expertise on this topic. It's been really valuable. I think we've all learned a lot from your experience and and your shared shared learning here. So thank you so much for your time. Appreciate it.

SPEAKER_00:

Yeah, thanks, Rachel. That's been fun. I appreciate being on here.

SPEAKER_01:

Thank you, Christina. Excellent. So, listeners, be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.