Measles and Vexing Vaccines (Including COVID)

Vaccines are considered by more than a few scientific experts to be among the most significant developments in modern medicine. Now, it’s hard to know what to believe about vaccinations. The resurgence of measles, effectively eradicated in the U.S. 25 years ago, is one indication that in some pockets of our country, is one indication of doubt in vaccines’ effectiveness. Meanwhile, the federal government is pulling back on its recommendations about who should take the COVID-19 vaccine.

Dr. Melissa Held, professor of pediatric infectious diseases and senior associate dean of medical student education at the UConn School of Medicine, and Dr. David Banach, associate professor of medicine, infectious diseases physician and UConn Health’s hospital epidemiologist, join us to help separate facts from myths.

(Dr. Melissa Held, Dr. David Banach, Carolyn Pennington, Chris DeFrancesco, May 2025, studio and production support by Ethan Giorgetti and Ryan Bernat)

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Transcript

Chris: Why has measles been making a comeback? What’s the deal with the COVID shot? Today on the Pulse, we look into some public health matters related to vaccinations.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and ideally leave you with some health information you’ll find useful.

With Carolyn Pennington, I’m Chris DeFrancesco. Are we losing our faith in vaccines?

Carolyn: Many diseases have essentially been eradicated thanks to vaccinations, but some, like measles, are resurfacing. And what about the changing recommendations for the COVID vaccine? We’ve brought in Dr. Melissa Held, professor of pediatric infectious diseases and senior associate dean of medical student education at the UConn School of Medicine, and Dr. David Banach, infectious disease physician and UConn Health’s hospital epidemiologist, to help us sort through it all. Thank you both for being here today.

Dr. Held: Thank you for having us.

Carolyn: So let’s start with measles. Dr. Held, as of this recording, the CDC reports more than a thousand measle cases in the U.S., though none in Connecticut [yay, Connecticut!]. Didn’t we eliminate measles in this country 25 years ago? And why is Connecticut, why no cases here? What are we doing differently?

Dr. Held: Well, so I think there’s a few things. We did declare measles to be at least endemically eradicated in 2000. There’s always been a few small pockets of measles outbreaks over the years. In the most recent years, in 2019, there was a fairly large number of patients with measles. It reached really in the 1,200 range. So we do a very good job in Connecticut, mainly because we have very high rates of vaccinations, specifically the measles-mumps-rubella, or MMR, vaccine. So our vaccine rates of that particular vaccine in Connecticut really are close to 98%.

Carolyn: Wow. That’s  great.

Dr. Held: Which is very high, yes. You want to be able to have as many people vaccinated in a community as possible in order to create what we call herd immunity. Herd immunity means that you need to reach a certain percentage of the population to be vaccinated in order to protect those who can’t be vaccinated for either medical reasons or health reasons, et cetera. So you wanna get at least 95% coverage for measles in particular, because it’s such a highly contagious disease. So we’ve been able to exceed that in Connecticut for many, many years, which is why we often do not really see any cases from Connecticut. If we do, it’s usually an imported case, from someone else who’s come into the state.

Carolyn: So the cases like in Texas that we’ve been hearing about, those are children that have not been vaccinated?

Dr. Held: The vast majority, yes, have been unvaccinated or have what’s called an unknown vaccine status. So the way the Texas registry works is, you have to opt in to have your vaccine records tracked. So some of them don’t have known vaccine records available, but, but it was felt to have started by someone who came into the state of Texas with measles, who then was in a community where there were very low vaccine rates.

Chris: When do you generally take the MMR vaccine, and if you didn’t take it during the original recommendation, is there a window where it still will be effective in a child?

Dr. Held: Right now the recommendation is your first dose is at 12 to 15 months of age, and the second dose is somewhere at the four-to-six-year mark. So most of us have either gotten both of those doses or at least one dose, or who, if you’re an older individual, you probably were, if you were born prior to 1957, immune just by either having had it or probably been exposed to it at that point. For anyone who’s unsure, usually the first thing is, can you track down your own vaccine records? But there’s also a blood test that can be taken to see if you’re immune.

Carolyn: So other than the vaccine, is there anything else you can do to help prevent the measles?

Dr. Held: So really, vaccination is key in prevention of measles. There’s a lot out in the media right now about therapies that are being put forward as being helpful or, or preventing measles. One of which has really made the news is vitamin A or cod liver oil, which contains a lot of vitamin A, and that is not going to prevent measles. I think in countries where there’s a lot of malnutrition and measles is very prevalent, they have found that many of those children, in particular, may be somewhat vitamin A deficient. However, in the United States where that’s really not a problem, giving someone lots of vitamin A or giving them cod liver oil is not going to be helpful in preventing the measles disease.

So I think it’s just important, some people have said, “Well, there’s antibiotics that you can use.” And I think clarithromycin was one I heard about in the news recently, and that’s actually not even — Measles is a virus, so you’re not gonna be able to use antibiotics to treat measles. So I do think there is a lot of misleading information out there right now that I want to caution people to be very wary of.

Carolyn: So, Dr. Banach, why are some people not following the vaccine recommendations as much over the years, in recent years?

Dr. Banach: I think in the last few years we’ve seen a lot of different information that’s come out regarding vaccination. I mean, we know that for decades, we’ve had great herd immunity that’s really helped protect against large-scale outbreaks here in the U.S. for the most part. But there’s been a lot of different information that’s come out and people are getting information from different sources that’s leading them to make decisions about vaccination.

Right now we’re specifically talking about measles-mumps-rubella, but this does apply to other vaccinations as well. So I think that’s actually probably played a big part in our lower rates of vaccine, particularly in certain parts of the country and certain communities.

Chris: A lot of mixed messages about vaccinations from all kinds of sources, including our own federal government these days, which I think brings us to the COVID vaccine. Now, I remember in this room with you, Dr. Banach, talking about when we first got it here at UConn Health, And the recommendations on why everybody should take it and those kinds of things. So that was what, four years ago or so? What have we learned in the last four years about the COVID vaccine?

Dr. Banach: I think, gosh, I remember those early days. It was crazy times. But I think we’ve learned a lot about the COVID vaccines and COVID in general over the last four years, and I think some of that has contributed to an evolution in terms of some of the newer recommendations that we’re seeing.

So I think when it comes to COVID at the population level, at this point, most or nearly all of the population has been exposed, or probably had COVID, or at least a COVID vaccine at some point. It’d be pretty rare to find someone who doesn’t fall in either of those categories. So that provides some level of protection against COVID infections in the future. Not to say that people can’t get infected with COVID, because they can, and some populations can get really severe infections. And I think that’s led to some of the changing federal guidance that for some populations, particularly those at high risk for severe infections, older individuals, individuals with medical comorbidities, that’s really, now we’re shifting to really focusing in on those populations for vaccination.

And I think the federal government now is looking at sort of supporting vaccine in those higher-risk groups, and for other groups, favoring more of like a sort of less strict recommendation for vaccination, and a sort of a different approach, but really kind of a risk-based approach when it comes to the COVID vaccine.

This has been done in other countries. I think the U.S. and many other countries have been strong proponents of widespread vaccination, and I think now we’re seeing a different approach that’s been more focused on the higher-risk populations in terms of encouraging and supporting vaccination.

Carolyn: It seems especially confusing for pregnant women or women with small children whether to get them vaccinated with the COVID vaccine, again, because of all the differing information. Now, Dr. Held, so when parents come in and they ask you, what should I do? What kind of advice do you give them?

Dr. Held: I mean, so the American Academy of Pediatrics is really a great source of information for parents, so that’s one website I always say is a great place to look for up-to-date and accurate information. So I think that’s important. And the vaccine schedule for children is done in a very thoughtful way, and it’s looked at really every year by a very expert group of vaccinologists and, and physicians. And so the schedule is set up in such a way to maximize the protection of children against diseases. A lot of times they outgrow a lot of those diseases and they don’t need updated vaccines at that point. So everyone thinks of their babies coming in and getting three, four vaccines at once, but there is a reason for that, because after a certain age they don’t need to be vaccinated against some of those diseases anymore.

Having conversations about vaccines is so important, and I think talking to your child’s pediatrician or family doctor, or whoever the health care provider is, it’s always an opportunity to share your concerns, share your fears, share what great grandma or great aunt whomever has told you what or what not to do, because there is a lot of differing information out there, especially on the internet, and so it is hard to decide what is the right information to hear, hear the truth from, really. And so, I always tell parents, if you have concerns, if you want to talk about this, if you’re worried about the vaccines, sitting down with your child’s doctor and having that conversation is so critical. And it may take more than one conversation. Certainly I’ve had conversations with parents that we didn’t come to conclusions in that first time and it took another visit to really tease out all the information.

Chris: So talk to the doctor, not just go online and decide for yourself based on the echo chamber that you’re following.

Dr. Held: Yeah. Dr. Google may or may not be correct.

Chris: So this is why I could never be a physician, I could never do what you do. Because if someone would come into my office and I had to try to convince them to get vaccinated, just in general, I would have a hard time restraining myself from saying, ‘This is one of the great, m odern developments in medicine that has probably saved God knows how many lives over God knows how many years.’ And I would lose my patience with that person and probably wouldn’t be a doctor very much longer. So how do you handle that?

Dr. Banach: I think a lot of the points that Dr. Held brought up about really understanding concerns. I see patients in front of me that have a lot of questions, now patients that have more questions based on what they’re reading, they have information that they’ve obtained from whatever source, and really making sure that I have a good understanding as to where my patient’s coming from with regard to their information, their background, their own personal experiences with health and vaccination. I think that really helps me provide more guided, more specific guidance as far as how to best help that patient with making decisions about vaccination. So I think the overarching kind of very paternalistic approach of “everyone needs to get vaccinated. no questions asked,” I think we really have to move away from that and really address our patients’ concerns, like we do for any other medical care. I think we have to be receptive to that, recognize that patients have questions, and we’re responsible for answering them.

Carolyn: And I think it’s a little more complicated too with like the, if you’re caregiving, if you’ve got elderly parents and you’ve got young children, it’s like the decision whether to vaccinate, to protect your elderly parents. So it seems like it’s a very complicated issue and I do respect you guys for being able to give advice and know what to say to them.

Dr. Held: I always try to remember that really in almost every case, the family wants to do the right thing, they believe they’re doing the right thing, they want to do the right thing. They’re trying to get information to make an informed decision. And so spending the time, as Dr. Banach said, what are their beliefs, what have they heard, what stories have they heard, what’s been their personal experience, can really reshape the conversation into something much more fruitful.

Chris: I think it’s important, in the couple minutes we have left to just go back to kind of the public health aspect. Like, I used to never get the flu shot until I started working here, and it was just because “I’m young, I’m tough, I don’t need it.” But then I realized, well, I could walk down this hallway and get someone else sick. It’s not for me, it’s for the people around me. So like that public health mentality around vaccinations. Why is that so important?

Dr. Held: It’s such a hard concept, I think, for a lot of people in the general population to kind of wrap your head around. Measles, I think in particular, is the most, probably one of the most contagious infectious diseases out there. It is more contagious than the flu. It is more contagious than Ebola, which we always used to worry so much about a number of years ago. So it is really important that we realize how contagious measles is, and that is why you need such a high rate of of coverage.

Dr. Banach: When I think about medical interventions, there’s very few that have that applicability not just to the individual but to the public health. When I prescribe a medication to a patient, with the possible exception of antibiotics, it’s really just for that patient. No one else around them is going to be impacted by that medication. But vaccines are different, and I think weighing sort of the individual versus the public health benefit is a challenge.

We saw that during the COVID pandemic, when we had to make individual decisions that affected us, but also those around us, and vaccinations are part of that as well. And I think individuals want to do the right thing for themselves, but also for those around them. So I think being able to kind of appeal to that, like Dr. Held was saying, is important, and trying to understand how individuals perceive their own personal risk benefit versus the benefit to the public as well. I think that’s the kind of conversations that we have to have with our patients and that make the best decisions with them.

Carolyn: Well, since we have a couple of infectious disease specialists, is there anything else? And again, with all the changes happening in the federal government — and you do hear that they’re cutting back on a lot of the public health initiatives and the research and whatever — is there anything we need to be prepared for?

Dr. Banach: I think we always need to be mindful of what’s out there and what we’re learning about as it happens. We have great public health infrastructure and surveillance available to us to be able to detect early epidemics, early clusters of infection, and react to them, and the H5N1 situation, the avian flu was, was a big part of that. That was detected pretty readily through our public health infrastructure and we were able to identify both humans and animals that were affected and respond accordingly.

So I think it’s really, it’s still critical that we support those kinds of infrastructures from a public health perspective. We have that surveillance out there and if we no longer support that surveillance, we’re going to miss things, and that’s gonna have big implications for public health in terms of causing illness to humans. I think we just need to be of the mindset that even though there’s a lot of competing priorities at the local, state and national level, public health disease surveillance is a big part of that, and we really need to do what we can to support it.

Chris: I will put in the show notes the link to the American Academy of Pediatrics and any other resources that we decide would be helpful to pass along. So those will be in the show notes as you listen to this.

Dr. Melissa Held and Dr. David Banach from UConn Health and the UConn School of Medicine, thank you for being here.

Dr. Held: Thank you.

Dr. Banach: Thank you.

Chris: That is our time for today. Thank you to Ethan Georgetti for his studio support. For Dr. Held, Dr. Banach and Carolyn Pennington, this is Chris DeFrancesco thanking you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.