Dr. Travis Engel, Chair of Pediatrics, brings his expertise and compassion to a thoughtful discussion on the current measles situation affecting parts of the United States. With just under 500 cases nationally—concentrated primarily in West Texas and eastern New Mexico—he offers a balanced perspective on what families need to know without creating unnecessary alarm.
Engel offers practical guidance for what to do if measles appears in your community. Rather than rushing to emergency departments, Dr. Engel explains the protocols already in place for testing and treatment, highlighting how calling your doctor first can prevent unnecessary exposures and healthcare system strain.
Whether you're fully committed to vaccination, hesitant, or somewhere in between, this conversation offers valuable insights free from judgment or panic. Join us for this important discussion that prioritizes information, respect, and child health above all else. Have questions about your family's specific situation? Your pediatrician or primary care physician is your best resource for personalized guidance.
Transcript
Cami Smith:
Hi and welcome to, and so Much More. I'm here with. Dr Travis our Chair of Pediatrics and also kind of like our local PSA voice. I love when you reach out about what you really think our community needs to know about and it really does show the level of care that is provided at Centra under your supervision over at VBH and really just across the health system.
Cami Smith:
We're going to talk about today is measles and before anybody you know stops or clicks away or maybe like leans in, oh my gosh, what is happening? It's okay, Everything is okay, but it is an important conversation that we want to have.
Dr. Travis Engel:
And, I think, an important conversation to enter into with a very balanced approach, understanding that there's a lot of feelings with regards to vaccination, vaccine hesitancy and what the right thing to do for your child is, because, at the end of the day, that's what every parent really is trying to figure out, absolutely.
Cami Smith:
So what do we need to know? What is happening nationally? You can also go to cdccom, cdcgov which is it yes, cdcgov. And you can see data. You can look at actual numbers and make informed decisions that way. But let us know high level what is happening.
Dr. Travis Engel:
Really response to information provided to it from local health departments and state health departments.
Dr. Travis Engel:
And right now, the vast majority of the measles cases we're seeing are related to an outbreak in West Texas, eastern New Mexico, that started earlier this year amongst a largely Mennonite community that was unvaccinated.
Dr. Travis Engel:
So, based on their kind of personal beliefs and choices.
Dr. Travis Engel:
So, based on their kind of personal beliefs and choices, right now the total number of cases in the United States is just under 500, as this is being recorded towards the end of March, beginning of April, and 97% of those cases can be directly related or attributed to an individual who is unvaccinated, under vaccinated or we don't know the vaccine status.
Dr. Travis Engel:
So that includes anyone from, you know, the baby who is less than one year old, who maybe wasn't eligible to be vaccinated yet and wouldn't have been vaccinated based on the vaccine schedule, to individuals who are, you know, in their 20s, 30s, 40s, adults, right, who weren't vaccinated as a child and chose not to get vaccinated as an adult too. And then there is a small subset of cases, about two to three percent, that we have seen in individuals who are vaccinated who, for any number of genetic, metabolic, immunologic reasons, do not respond to vaccination, and that actually is in keeping with about the rate that we see when we have studied the vaccine efficacy is that there is a subset of individuals between two and 3% that for some reason just aren't full responders to the vaccine.
Dr. Travis Engel:
The vast majority of individuals do respond appropriately and mount that immune response to vaccination, but two to three percent of the general population will have an underperforming response to that and might be susceptible during outbreak situations to contracting measles, even though they have been vaccinated in the past.
Cami Smith:
Okay, so just under 500 cases nationally. No cases confirmed currently in Virginia.
Dr. Travis Engel:
Yeah, no local cases, and so this gets into a little bit more terminology about what do we consider a case that is attributable to Virginia versus a case that happened to travel through Virginia, etc. There was an individual who traveled through Dulles Airport who was found to be positive for measles. That case doesn't necessarily get attributed to Virginia because that individual started somewhere else with measles and ended. Case doesn't necessarily get attributed to Virginia because that individual started somewhere else with measles and ended up somewhere else with measles, but important to take note.
Dr. Travis Engel:
Important to take note that just because there's zero cases attributed to Virginia doesn't mean that we haven't had cases potentially traveling through and that our exposure risk isn't there.
Cami Smith:
Okay, so I want to talk about that 97%, and I want to do this cautiously because, like you and I were kind of discussing, it is so important for parents, for individuals, to make that decision on whether or not to get vaccinated or vaccinate their family on their own. An informed decision is so vitally important. And so the 97% that we're seeing of those who are not vaccinated, who are contracting measles what does that mean to someone who's watching, who has chosen not to get the vaccination and they're maybe not, you know, second guessing their decision at all. But how would you inform.
Dr. Travis Engel:
Maybe there are questions that arise right Exactly.
Cami Smith:
How can we help inform in a way so that the decision can be something that's made with data and with an open mind?
Dr. Travis Engel:
So I'm glad you brought this up and I'm glad we asked it in that way, Because at the end of the day, whether you make the decision to vaccinate, not to vaccinate or somewhere in between a modified vaccine schedule or something like that vaccinate or somewhere in between a modified vaccine schedule or something like that I truly believe and I work with parents every day that really love their children, who make decisions across the entire spectrum about we are fully vaccinated and we adhere to the schedule and that's what we believe is right for our family and our children.
Dr. Travis Engel:
And then we have parents who have chosen not to get any vaccinations because that's what they believe the information is kind of guided them to do, based on their personal beliefs and the data they see. I don't have any doubt that any of these parents love their children across that whole spectrum. My concern always is whether, regardless of which decision you decided or where you're at on that spectrum, that decision was made with valid, good information, because no parent should go into any decision as important as the health of their child without the right information.
Cami Smith:
Yes, and there's so much information out there. Just doing a quick Google search of vaccination or I mean going on Amazon and searching vaccination, the amount of literature available, right? Now is mind-blowing and it is to to your point across the spectrum. So where do you get the most accurate information?
Dr. Travis Engel:
so the American Academy of Pediatrics, AAP, which is our immunization kind of policy guiding organization, and then there's also various other professional organizations for physicians, like the Society for Infectious Disease and things of that nature.
Dr. Travis Engel:
They really they are. All the data is processed by them and they are able to make really good recommendations on who should get vaccinated, why we get vaccinated, what the vaccine efficacy is, et cetera. That being said, a lot of parents go through cycles where they look at other information too right, and there's certainly no shortage of individuals who can get on TikTok or blogs, things of that nature, and really make specious claims on both sides of the argument, saying whatever they want and attributing it sometimes to the evidence shows us, the science says this or they're making assumptions or conclusions based on data that isn't necessarily there or, I don't believe, has been interpreted correctly. So I think it's important, though, to back up here, because I don't want to be sensational about this at all. Overall, measles, if you go back to the 50s and before, measles is largely survivable. It is Measles is not a death sentence if you get measles. In fact, the vast majority of children who get measles will survive.
Cami Smith:
Yes.
Dr. Travis Engel:
There you were talking earlier. There's an episode of the Brady Bunch where the kids come down with measles and it's treated kind of you know, kind of humorously, like the kids were excited they got a week off school, you know, and they just treated the fever and those kids did well.
Dr. Travis Engel:
So the vast majority of children and adults who get measles do tend to respond favorably to supportive care. There is a small subset of children who get very ill and they can develop something called encephalopathy or really bad pneumonia as well, and those children who get that sick, their mortality rate is much higher. So while that is a minority of children, right, it is still a certain number of children, and I always tell parents, you know it's easy to look at things as a wide spectrum right, and say, well, it's only like 0.3% of children will get severely ill. When it's your child, it's 100%.
Cami Smith:
Yeah.
Dr. Travis Engel:
Right. If it's your child that gets severely ill, it's 100%. Absolutely. You can no longer look at it as. Oh well, it was only 0.3% of the time. It just happened to be my child, I guess, that's okay. The difficult thing for us to have to the difficult. The reason it's difficult to engage in this discussion sometimes is is that it's very tough for parents to sometimes conceptualize that they could be that 0.3%.
Cami Smith:
Yeah, that's tough and there's no way for me to really predict it either.
Dr. Travis Engel:
There's no way for me to really give you data-driven guidance on well. For this reason, x, y or z, you're more likely to be in that 0.3%. So vaccination for you is more important. So that's why the recommendation on the whole is is that widespread vaccination for the community is the evidence-based and really clinically guided approach to how we prevent this.
Cami Smith:
Yeah to 95% correct. That's like the goal.
Dr. Travis Engel:
Yeah, so we talk about herd immunity and how we herd immunity is a little bit more of a complex subject to discuss, especially in terms of different illnesses.
Dr. Travis Engel:
But in general, for certain vaccines we kind of establish a rate of what the community vaccination needs to be in order to basically prevent that illness from becoming so widespread that those who are unvaccinated, under vaccinated or non responders won't get the disease.
Dr. Travis Engel:
Which, if you have a group of unimmunized individuals or I shouldn't say just unimmunized but susceptible individuals right in a room of a hundred people and you put one of those individuals in there who has measles right, more than 90 of those people will contract measles. Ultimately it is that contagious right. That is. The big concern with measles is not so much that it is clinically severe for the majority of patients we already said that it really isn't but that it is so contagious that by the time a measles epidemic runs rampant in an unimmunized or susceptible community, the numbers have been driven up so high that that 0.3% of patients with severe illness that number, if you only have 100 patients, 0.3% is pretty small. If you have 1,000 patients, it's an order of magnitude bigger. 10,000 patients, it's two orders of magnitude bigger, 100,000, et cetera. So when these epidemics start and we start seeing that number of total cases rise, we know that the number of patients with severe illness will rise too.
Cami Smith:
Yeah.
Dr. Travis Engel:
So again a lot of technical things to discuss in that conversation. But I think the take home points are measles overall is not particularly severe in the vast majority of patients. In the patients that it does get severe for it can be clinically devastating and the mortality is high. There's no way to predict that and vaccination against measles right will prevent or gives you protection. If you've had your full series in up to 97% of people, you're 97% protected.
Cami Smith:
Yeah.
Dr. Travis Engel:
Which is really close to 100%. Yes, right, yes, so Okay, protected, yeah, which is really close to 100.
Cami Smith:
Yes, right, yes, so okay and I think that's a good message to share is that this is not any kind of time for panic. This is just. This is what you need to know. Being informed is so important, but then also, like this is happening, and because of the level of contagion, I think, washing your hands, the things that we talk about regularly- Trying to isolate when you have a fever, exactly, and that can be so hard to do. I want to recognize that, Like you know, we all have lives.
Cami Smith:
It's hard to put everything on hold when you're sick and stay home or work from home, especially with a family, but prioritizing your health is so important. Work from home, especially with a family, but prioritizing your health is so important. And then having a conversation with your doctor about the level of vaccination that you are concerned about, you have questions about, and then just being open to that information.
Dr. Travis Engel:
So I think it would also be interesting to kind of discuss like well, what would it look like if someone tested positive for measles here in Lynchburg, right? Yeah, I mean, because that's kind of what we deal with on the day-to-day right is what happens Right now. It seems pretty foreign to us. Most of this is in West Texas, eastern New Mexico.
Cami Smith:
It feels very far away, it feels really far away.
Dr. Travis Engel:
What would happen? What happens if someone walks into Lynchburg General Hospital and we have a suspicion for measles and they test positive? And what do families need to know about? Okay, well, what level of concern do I need to have now? Yes, Now it's here.
Cami Smith:
And that feels different.
Dr. Travis Engel:
That hits very different and that kind of makes the hair stand up on end right now when I talk about it. And it is possible, right, we have a large majority of our population that travels quite a bit to and from school. Yes, right, we have people traveling through multiple methods of travel. We have an airport, we have Amtrak, so I mean it's possible that someone gets here with measles. It's possible and that's a fact of life we need to deal with.
Dr. Travis Engel:
So, first and foremost, if there's a case of reported measles, a positive case of measles in Lynchburg, the vast majority of people don't need to panic, right? I would say no one needs to panic, right, if you are immunized, even if you've been exposed, your protection is intact from that immunization in the vast majority of people. And there's no reason, if you're asymptomatic, even if you've had a close exposure, that you need to run to the doctor, you need to run to the emergency department just to get checked out, right, that you need to run to the doctor, you need to run to the emergency department just to get checked out, right, especially before any symptoms occur. The potential for us to be able to test and really determine was that exposure meaningful for you? Is it gonna lead to clinical disease Is very small. We're not really able to do it.
Dr. Travis Engel:
So that would be my first bit of advice is, if there is a positive case of measles identified here and you're concerned that you've been exposed, if you're fully protected, don't feel the need, if you have no symptoms, to rush to your doctor or to the emergency department. If you're feeling well If you haven't been vaccinated and you're feeling well and you feel like well, maybe there's the risk that I've been exposed you still probably don't need to run to the doctor, run to the emergency department Okay.
Dr. Travis Engel:
All right. Now then we have kind of the other arm of this, which is well, what if I am starting to get symptoms and I've been exposed, and I would say whether you've been vaccinated or not, because we do have a certain number of individuals who are just non-responders to vaccination. It's very, very small. But if you've been exposed and you have symptoms and your symptoms are mild, right, you can certainly call up your pediatrician's office or your primary care doctor's office.
Cami Smith:
Yeah.
Dr. Travis Engel:
And have that discussion with them and say you know, I've been exposed, I'm worried, I'm having some of the symptoms. They can talk that over with you and say well, does this sound more like flu, covid, measles, etc. Because there still are other viruses, right?
Cami Smith:
Yeah, this isn't the only player out there.
Dr. Travis Engel:
Exactly and common things being common, right, it may be one of those other viruses too and determine what is the right timing and when is and what are the right circumstances for you to have to come into the office. And the reason I'm being so careful about how I discuss this is what we, what we don't want to happen is, out of an abundance of caution, for the emergency department and the primary care clinics to get inundated with people who come in just for concern of exposure.
Cami Smith:
Yeah.
Dr. Travis Engel:
Because that increases the risk of further exposure potentially and it bogs down the system for other individuals who have clinical signs of illness from any number of causes. So we've worked with the local health department and at the state level and we have plans in place to be able to provide testing if we need to. So we actually have a testing algorithm in place and I've worked really diligently with our emergency department and with the local pediatric offices to be able to get samples for the state if the concern exists and the right circumstances are present that we say, hey, this is a possible case of measles based on your exposure, your vaccine history and your symptoms, and we can get the samples. And we can even collect those in the outpatient setting to where you don't have to present to the emergency department Wow so.
Cami Smith:
That's incredible. That's why.
Dr. Travis Engel:
I'm really recommending call your pediatrician's office first and if you are not so severe that you require hospitalization, we would. We would really like to keep those individuals out of the emergency department.
Cami Smith:
Yes.
Dr. Travis Engel:
And out of the pediatrician's waiting room too, and be able to do like drive-by testing, if possible.
Cami Smith:
Well and out of urgent care, out of the place. You know the places where we're like go here for this. This is a case that is different, but I do want to say I find it so encouraging that those conversations have already happened, that those precautions are in place. This isn't something you want to happen and to not be ready, and so for our community to be rest assured that we are and that I think that's very important to know.
Cami Smith:
Yeah, is there anything that we have a discuss that you think is important to really touch on when it comes to this particular I don't want to call it an outbreak, but this particular measles conversation?
Dr. Travis Engel:
Yeah, a few things. So, first and foremost, again, like I try to separate the topic of measles in and of itself from the topic of vaccine hesitancy, vaccine skepticism, things of that nature what's right for my family certainly isn't right for everyone. But I'll give just two anecdotal experiences really quick. I am a pediatrician. I make no money off individuals' vaccine status or any vaccines that I give, and most pediatric offices lose money when they provide vaccines. Really, it costs more to have vaccines on hand and provide those vaccines than it does that we are compensated to give them.
Dr. Travis Engel:
So I want to remove this idea that there's a financial incentive or any other incentive for any of us to promote what we feel like is evidence-based, which is getting your vaccines. I will also say all three of my children are fully vaccinated, and I did that without any hesitation, and they all three are thriving and doing well. We'll also say that one of my very good friends is a pediatric infectious disease specialist. That's her. That is her job. She is a physician and she went through three additional years of training, in addition to three years of PEDS residency, to become a PEDS infectious disease doctor. All of her children are fully vaccinated too that's how much she believes in in vaccination
Dr. Travis Engel:
so if there was, I would never recommend something for my family or do anything for my family and recommend it for your family that I didn't feel was safe. Um, now, when it comes to personal belief and the autonomy to do what you feel like is right for your children, I also respect that too, and I think that parents who have chosen that for their family, vaccination is not the path they want to pursue. There's no judgment from me. There certainly isn't, and I don't want anyone to ever feel like they're going to be compelled to engage in care that they're not comfortable with if they come to the ER, just because what I chose for my family is something different than what they chose for their family.
Dr. Travis Engel:
And I care for those children just as much as I care for any other child as well. Now, when it comes to treatment for life-threatening illness and stuff, well, that conversation gets in some ways a little bit more simple, right? Because when a child's not breathing in front of you, we know that we need to help them breathe, and sometimes that requires advanced airway management and stuff like that. But I certainly don't want any parent to ever feel like there's going to be some guilt trip or some sort of judgment leveled at them because they chose a path for their family that was different than mine.
Cami Smith:
Yeah, and that's important to hear, um, so I appreciate that All right.
Dr. Travis Engel:
Symptoms of measles, um, what they call cough choriza, coplic spots like the the seas of measles, and then, um, you end up with a rash too.
Dr. Travis Engel:
So bad cough, bad fever, um, really inflamed red, beefy kind of mucous membranes, and then sometimes the eyes get really injected and then, of course, what we call the morbilliform rash or the measles-like rash that can erupt sometimes in proximity to that fever. Those will be the major signs. And when we see that set of symptoms in association with a patient who, for any number of reasons whether it be travel, vaccine status, immunocompromised state, etc. Then we make the decision that we need to evaluate them for measles potentially.
Cami Smith:
Yeah.
Dr. Travis Engel:
So that's going to be the conversation that would be had. If you're concerned that you were exposed, or you bring your child in for just any general illness and the doctor elicits that history, then they say, okay, well, maybe this is measles and they might have more of a conversation with you about it. And then, last but not least, again, just to kind of reground this conversation in the fact that I fully appreciate and understand and I don't want to be sensational about the severity of measles. The vast majority of patients who contract measles do quite well.
Cami Smith:
Yeah, all right.
Dr. Travis Engel:
But I also don't want to understate the importance of in a pandemic state. If measles were to run rampant, there would be children and adults who would become severely ill and some who would die.
Cami Smith:
Yeah.
Dr. Travis Engel:
Right and I, as a pediatrician, think that even one child who dies from a preventable illness is too much, absolutely, and I can only imagine if that was my child and the grief that I would have. So if I have the chance to prevent any parents from having to feel that grief, or help any family.
Cami Smith:
Yeah that the percentage doesn't matter at that point Exactly.
Dr. Travis Engel:
So again, I just wanted to reground the conversation and the idea, Because a lot of times, people who maybe have some questions in their head about whether they want to get vaccinated or not, they say, well, everyone's just fear-mongering and telling me that this is going to be the worst thing ever. And so I want to recognize that Measles used to be a common occurrence and kids did okay with it that you know measles used to be a common occurrence and kids, kids did okay with it.
Dr. Travis Engel:
But again, if it's your child who gets severely ill and becomes encephalopathic or gets bad pneumonia, the numbers don't matter anymore.
Cami Smith:
You know it's a hundred percent for you. Yeah, thank you. I feel like this is an important conversation and to your point. You know we definitely don't want to stir up any kind of panic, but being informed on the front end can make such a huge difference, and so do the homework. If you feel like you need to see these numbers for yourself, like we said, cdcgov and talk to your pediatrician, talk to your primary care physician, and we hope that you remain well and things stay, as you know, kind of top down as they are now, but we hope that you guys can walk away feeling a little bit more informed. Thank you so much for joining in on and so Much More.
