Measles: Understanding This New Outbreak in the US and in Israel
Prof. Allon E. Moses, is the head of Hadassah Medical Organization's Department of Clinical Microbiology and Infectious Diseases. He was recently elected president of the Israel Society for Infectious Diseases. After graduating from Ben Gurion University of the Negev, Moses did his residency at Hadassah Hospital Mount Scopus. He was also a clinical fellow at Harvard University. He's been a lecturer and professor at Hadassah for over 20 years and has been Chairman of the Department since 2005.
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Melanie Cole (Host): We're hearing more and more about cases of measles being confirmed both in the states and abroad. Today, we're talking about measles with Professor Allon Moses on this episode of Hadassah On-Call.
Welcome. My guest today is Professor Allon Moses. He's the current Director of the Infectious Disease Center at the Hadassah Medical Organization. Professor Moses, I'm so glad to have you back on the show. We know you have a long illustrious career at Hadassah, tell us a little bit about it before you help us understand the current situation in Israel with measles.
Professor Allon Moses (Guest): Sure Melanie. Thank you for having me here on the program. So, I'm Director of the department which is called the Department of Clinical Microbiology and Infectious Diseases. And we actually have under one department, both infectious disease doctors and the clinical microbiology lab. It's an unusual collaboration in this situation because in most places the two departments are separate. So, infectious diseases are not usually together with the clinical microbiology. We feel that this collaboration brings much better service to our patients because infectious disease doctors and the lab technicians work close by each other.
Host: Let's talk about measles Professor. Tell us about the current state of what's going on with the recent measles outbreak at what's happening around the world and in Israel? How would you characterize this?
Professor Moses: Well there is certainly an ongoing outbreak. As we all remember, measles was a disease which we have not seen for many, many years and now in recent years, it's come back. And this is very frustrating and, in many ways, worrisome. Until about a year and a half ago we hadn't seen measles for a long time and in the past year and a half in Israel, we've seen over 4000 cases. This is highly unusual and as you can understand, the disease has some worrying parts to it and unfortunately, we even had two case fatalities. So, the disease is not a simple disease and patients who are not immunized against measles are prone to disease.
In Israel, we've seen that 90% of patients who had the disease did not receive two vaccinations. So, it's clearly a disease that confronts patients who have not been vaccinated properly.
Host: Four thousand. That's an incredible statistic Professor. Why is measles so dangerous?
Professor Moses: Well first of all, it's one of the most contagious diseases, 90% of prone patients who have not been vaccinated who would be close to a patient with measles will get the disease. So, it's one of the most contagious diseases we know. It spreads by airborne particles. This means that the room a patient — if a patient is in a room with other patients, he can cough, his small measles particles are lighter than air, they stay in the air for awhile for several hours and the patient who has just walked in, if he has not been vaccinated can get the disease through his respiratory tract. So, it's a very contagious disease on the one hand and on the other hand; the particles are in the air. So, it's an airborne spread disease.
Host: How scary Professor. So, who should be vaccinated for measles? When should this happen and if an adult has not been vaccinated; can they still be?
Professor Moses: Sure, this is very important. The vaccination for measles has been around for many, many years. The current vaccine goes with two other vaccinations it's called MMR, measles, mumps, and rubella. These three vaccinations are very effective. Every child should receive the vaccination between 12 and 14 months. It usually depends where he lives. In Israel, we give it at 12 months. That's the first dose. And the second dose needs to be given a few years later and it's given at the age of 4 to six years. we, in Israel, give it in first grade which is at the age of six.
So, to achieve a 97% vaccination level, you need to receive two vaccines. So, it's a highly effective vaccination and anybody who has received two doses is actually very safe. One dose is also effective, and we have seen that 93% of kids or patients who received one dose are immunized. So, it's a very effective vaccine and unfortunately, those who are not vaccinated are at risk. They are the ones who will contract the disease. And when there's enough patients who have the disease, it can spread around.
Now, any patient — you asked me whether adults should receive the vaccine. Any patient, any person who has not received two vaccinations need to be vaccinated. If a person was born before 1957, he's naturally immunized because this was before the vaccine era and we know that patients who were born before 1957 probably had the disease and therefore are naturally immunized. Anybody born after 1957 needs to have two vaccinations.
Host: Then what about children under one year old Professor? People hear this term herd immunity. Does that protect us all even the unvaccinated people? What about our little guys?
Professor Moses: Okay so the vaccine as I said is usually given after 12 months. For the first six months, the baby is usually immune because of antibodies which are transferred from his mother. And so there's a period of time between six and twelve months when the young kid is not immunized and that's certainly a worrisome time and we should try and avoid these small children to come in contact with the patients who have measles. There are solutions for contact for small kids and we usually give either a passive immunization or sometimes even a active immunization is given earlier. But the point is with herd immunity, that when you have over 90% of the population immunized; it sort of gives a guard against the virus, the measle virus penetrating into small pockets of unimmunized persons like the small children. But once you have too many cases, the herd immunity breaks. If you have thousands of cases, it's much easier unfortunately for the measle virus to reach persons who have not been vaccinated.
So, the herd immunity and in Israel, we know that over 95% of the population received the proper immunization, but even though this number is really fantastic and very high; we find populations especially the orthodox who have not been vaccinated and they form pockets of susceptible persons and once a single person is infected, it easily spreads between the other person who have not been vaccinated. So, the big issue here is populations who are hesitant or don't agree to be vaccinated.
Host: Well, we've heard so many theories about the MMR vaccine Professor. Please clear this up. People have fears of autism and weakening a child's immune system causing asthma or even being attributed to food allergies. Please, for the listeners, clear this up. You are an expert, one of the world's great experts in this field. Please clear this up for the listeners.
Professor Moses: This has been indisputably proven. The MMR vaccine is safe. Not only is it very effective, it's very, very safe. Autism is not in any way connected to the measles vaccine. This has been proved over and over again. I have no doubt in recommending my patients, anyone to receive the vaccine.
Now there are persons who cannot receive it. Since it's a live attenuated virus, anyone who is very immune compromised needs to ask his physician whether he can receive it or not. But the majority of the population not only can receive, must receive the vaccine. And if you look at the dangers of this disease; they are much more than the dangers of the vaccine. I said the mortality is about one to a thousand. But there are other complications and even late complications. We know that there are severe neurologic sequelae, although rare, but they can occur in patients who've had measles at childhood.
So, I have no hesitation in recommending this very effective and nontoxic vaccine.
Host: Thank you so much Professor, for making that so clear. The CDC has recently issued a health warning in Israel for measles as it relates to travelers. What do you want travelers to know or to do to protect themselves and are the vaccine recommendations different in Israel than they are here?
Professor Moses: Well, I must tell you that in Europe there's also an outbreak so, the Israeli Health Ministry has also put out a warning for Israeli going to Europe. Yes, we have a measles outbreak and anybody who comes to Israel should have two vaccines. Once you have received two doses of the vaccine, you are completely safe and should not worry. So, anybody who receives the vaccine, who is able to receive two doses is safe. The smaller children will receive one dose are — the vaccination rate is a little lower. So, they should consider if they are especially if they come from Jewish Orthodox community, they should consider twice if they come to families where there is danger for an outbreak. But for the regular tourists who visit the country, the danger is minimal. Certainly if you have two doses of vaccination.
Host: As we wrap up Professor, tell us a bit about Hadassah's new infectious disease center. What are some other infectious diseases that are just as prominent as measles right now that you are seeing in patients there?
Professor Moses: Thank you for this very important question. We have just opened two weeks ago, the new ambulatory infectious disease clinic at Hadassah. And our clinic sees a variety of patients. We have our everyday infectious disease patients who come in after they've been hospitalized. We also have the AIDS medicine center of Hadassah. We provide care for the AIDS patients of the greater Jerusalem area. And we are also in charge of the Hanson Center which is the center for leprosy in Israel. It's the national center. In Israel, there are some patients with leprosy as not everybody knows, and we encounter between one and five new leprosy patients in Israel usually those who come from — it's foreign workers or new immigrants from Africa. So, it's a rare disease but we see it and we see our patients in the new ambulatory care.
And now we have a new plan to see and we've begun seeing patients who need multidisciplinary care. I'll give you an example. We have a clinic for orthopedic infections. So, a patient who had an orthopedic surgery, hip prosthesis and unfortunately had an infection, instead of seeing an orthopedic surgeon separately and infectious disease surgeon separately and the radiologist separately; we provide the multidisciplinary service so the two or three experts who will see the patient at what time. We think that in this way, we can provide much, much better care for our patients.
A similar clinic is opening for patients with diabetic foot infections. There they need the multidisciplinary care and we bring the experts to the patient instead of the patients going around and searching for opinions from three or four different disciplines. This is something very, very good for our patients.
Host: What wonderful comprehensive care and so important for patients. Professor, give us your best advice about this outbreak of measles, what you would like travelers to know in Israel and abroad. People wonder if they should even be wearing masks on airplanes because it is an airborne disease. Please wrap this up with your very best advice as the expert that you are.
Professor Moses: You know I think that we can not underscore the importance of receiving two doses of vaccination. At this point, it's up to our ministry of health, the health officials to be sure that all populations receive the vaccinations. For the first time in Israel, the medical staff has been forced to receive vaccinations and medical personnel cannot come to the hospital if he has not received two doses of vaccine. The same should be in the schools. I know there is debate about this but if we have everybody vaccinated, we will be able to stop this outbreak since we have a very, very effective vaccine.
Host: Thank you so much Professor for sharing your incredible expertise with us. It's a bit of an unsettling time when we hear about the recent outbreaks, so thank you for all the great advice. Thank you again for joining us. And that wraps up another episode of Hadassah On-Call: New Frontiers in Medicine brought to you by Hadassah, the Women's Zionist Organization of America. The largest Jewish Women's organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please head over to our website www.hadassh.org, and to hear more episodes in this podcast series please visit www.hadassah.org/podcasts. If you found this podcast informative, as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. Until next time, this is Melanie Cole.
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