Dr. Jana Shaw: Measles
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This year, 607 cases and two deaths, with another under investigation, have been confirmed in the United States, despite the disease having been previously declared eliminated in the country.
On April 17, 2025, SciLine interviewed: Dr. Jana Shaw, a professor of pediatrics, and public health and preventive medicine, at SUNY Upstate Medical University. See the footage and transcript from the interview below, or select ‘Contents’ on the left to skip to specific questions.
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Introduction
[0:00:18]
JANA SHAW: My name is Jana Shaw, and I’m a professor of pediatrics at SUNY Upstate Medical University. I’m a pediatrician and infectious disease specialist, and my area of interest is vaccine hesitancy, and I’m also a clinician, so I take care of children who are admitted with serious infections, including those that are preventable through vaccination.
Interview with SciLine
What are the symptoms of measles?
[0:00:40]
JANA SHAW: It typically infects our noses and lungs, and it can spread and cause these common symptoms that include cough, runny nose, fever, headaches, congestion, red eyes and rash. The illness typically starts with fever first and those cold symptoms and then goes on progressing with rash. The rash is pretty characteristic. It starts along your hairline and will spread down your body all the way through your hands and feet, and it will start fading over several days in the same order it appeared.
How contagious is measles?
[0:01:32]
JANA SHAW: Measles is a very contagious virus. In fact, it’s one of the most contagious viruses we know. Among 10 people who are not immune to measles, for example, they either were not vaccinated or never had measles, nine out of them will become infected, so it’s highly transmissible, very contagious. Nearly everyone will end up getting measles if they are not immune. And the challenge with this virus also is that the virus can linger in the air for up to two hours after the infected person has left the room. As such, the virus can impact you, even if you’re not surrounded by the infected person directly.
How common are complications from measles?
[0:02:22]
JANA SHAW: They are pretty common. In fact, up to a third of people who have measles can go on developing serious infections, requiring hospitalizations. Those would be people who may go on getting dehydrated, meaning they are unable either to keep fluids down or they have diarrhea that prevents them from staying well hydrated. A lot of people can go on developing pneumonia, which is serious. They may need support oxygen to help them breathe and stay well oxygenated. And for some people, they may go on developing seizures and develop infection associated with brain infection, and as such, they end up in the hospital needing further care.
How significant is the current measles situation in the U.S., and how does it compare to 2019?
[0:03:20]
JANA SHAW: In the U.S., we have seen dramatic increase of measles cases this year alone. There have been over 720 cases of measles reported as of April 10 this year, and a measles virus keeps on spreading through states. The infection is of concern because one of the biggest outbreaks we’ve had in the U.S. was back in 2019, when over 1200 cases had been reported. I’m concerned that we will surpass this number this year, since we are somewhat early in the transmission, and it doesn’t appear that efforts to vaccinate exposed populations and those at risk have been carried out consistently. As such, the virus is likely to circulate and infect others.
Given the number of measles-related deaths we’ve seen (two confirmed, with a third under investigation), do you think the actual number of cases is being undercounted?
[0:04:25]
JANA SHAW: I do worry that we are undercounting the cases, because there were three deaths—the two of them are confirmed associated due to measles. It’s quite likely there are a lot more cases, since we know that one to three people will die—out of 1000 will die from measles. As such, the numbers point to a far larger outbreak than has been recognized. It can be challenging at times to diagnose mild cases as not all people who are infected will either seek medical care or be concerned about measles, and as such, they will forego testing. So, it’s quite likely that the 720 cases that have been reported is an undercount, and there are a lot more cases in the U.S.
How well does the MMR (measles, mumps, rubella) vaccine work at preventing measles?
[0:05:20]
JANA SHAW: The MMR vaccine is very effective in protecting vaccinated individuals from the infection, from disease, and from severe complications and death. In children, one dose of the vaccine will protect more than nine children out of 10, and two doses will protect nearly all children from infection. So, vaccination is a single most important and effective strategies that parents can use to protect their children.
How safe is the MMR vaccine, and how do we know?
[0:06:06]
JANA SHAW: MMR vaccination is very safe. We know because the vaccine has been extensively studied in clinical trials, and after the vaccine has been licensed in 60s and then 70s, ongoing post-licensure vaccine safety monitoring continues. That’s how we know that vaccines are safe in general, and we know that MMR vaccination is safe. However, there are side effects related to vaccination and MMR vaccine as well, and those are common side effects that people experience, such as swelling, redness, pain at the site of injection, children may go on developing fever as well. If you are concerned about vaccine safety, talk to your providers so your questions can be answered, because everybody may have different concerns about the vaccine safety, but it’s clear that vaccination is the safest mode of prevention, and that certainly that vaccination is the safer choice for parents or for adults than taking on the risks of being exposed and infected with this virus. We also know that the vaccine is safe because multiple different studies have looked at different concerns and associations, including now debunked information about autism and MMR vaccination that has been studied extensively. We know the vaccine is safe. We know it doesn’t cause autism, and as such, parents should strongly consider getting their children vaccinated if they are not.
Why do doctors recommend that children receive two doses of the MMR vaccine—one at 12 to 15 months old and another at 4 to 6 years old?
[0:08:01]
JANA SHAW: Initially, there was a one dose recommended for children ages 12 to 15 months, and because the vaccine worked really well, we thought we would not need another dose. However, in the 80s, we have seen school-aged children contracting measles at schools, and what has been recognized that there’s still an opportunity to protect all children, and maybe for children who are at the high-risk settings where the virus can spread very easily, the best policy and strategies really to include a second dose, because that will protect nearly all children. So, that was the main reason for recommending two doses, because with one dose, we have still seen outbreaks at school settings where the virus was widely circulating. And as such, after the second dose has been recommended, the outbreaks have subsided. And in fact, MMR vaccination has been so successful that in 2000 the U.S. was able to declare the virus eliminated, which means that we have no longer seen transmission of the virus in the community. There was no locally acquired measles. Majority of the measles cases since 2000s were imported from abroad.
Should parents of children who are too young to be fully vaccinated take special precautions?
[0:09:30]
JANA SHAW: Yes, if you live in an area where the virus is now circulating, or you plan on traveling to areas where measles virus is circulating, you should talk to your child’s pediatrician and ask whether the child can be safely vaccinated. We typically vaccinate children at 12 to 15 months of age against measles. However, children who travel to areas with ongoing transmission can be vaccinated a little sooner. So it’s important to remember, if your child does receive MMR vaccine before one year of age, that those will not count in the future, since some of the virus or the effect of the vaccine can be decreased through pre-existing protection that a baby might have acquired from mother. As such, the child will need additional two doses after one year of age. But there are things parents can do. They can talk to the provider, vaccinate the child early, and then avoid public settings and avoid areas where there is a known transmission of this virus.
Do you have any other advice on preventing measles when traveling to areas where it’s spreading?
[0:10:51]
JANA SHAW: Outside of really getting vaccinated—because that’s your safest choice, the vaccine works very well and is very safe—there is not much one can do except of being cognizant of your risk trying to avoid public settings. Maybe wear a tight-fitting, high-grade mask if you have to go to places, or if you travel, if you’re on a public transportation or a plane wearing a mask. And if you do develop symptoms or think you were exposed, is to talk to your provider, alert them about your exposure. So next steps that can keep you safe can be taken. For people who are exposed, they can safely be vaccinated if they are in the window where the vaccine can still mitigate the severity of the disease, or there are other measures that can take place to ensure that you don’t go on developing severe disease.
Should adults who were vaccinated as children get boosters now?
[0:12:05]
Yes, so some adults may need to be vaccinated against measles. Those who were vaccinated before 1968, they should talk to their provider to learn a little bit more about the vaccine they have received and also should discuss their risk for measles because for some adults who might have acquired conditions that suppress their immune system, if they lost the protection against measles, they may be a candidate for additional vaccination. And further, it’s important to remember, if you were born before 1957, you were likely naturally exposed to this virus, and you may not need additional vaccine doses. So, the best way to address this question is really for each individual to reach out to their provider or local health department if you don’t have a healthcare provider to discuss with them whether you should receive additional doses of the vaccine.
