On one occasion, as reported by colleague Stanley Holloway, after a show he left the theater and a fan asked for his autograph, a request he rudely refused. The outraged lady struck him with her rolled-up program, whereupon Holloway said it was a rare, but welcome case of “a fan hitting the sh*t!”
As I write this on May 10, 2025, the converse is true, with 1,001 confirmed cases of measles in 31 American jurisdictions this year. Of these, 30% were in those under 5 years of age, 13% were hospitalized and, thus far, there have been at least 3 deaths; from the center of the outbreak in Gaines County, Texas, a 6-year-old girl from Seminole died in February and an 8-year-old girl from the same town succumbed in April.
Measles comes from the Middle Dutch masel, which means “blemish.” It is a highly contagious infectious disease, easily transmitted from person to person from 4 days before to 4 days after the rash appears—more on that below. If 100 people are exposed to measles who are either unvaccinated or who have not had the disease, at least 90 will get sick. Measles is transmitted by cough or sneeze droplets and viable virus can be found in the air two hours after the patient has left the room.
Measles is caused by a virus of the Morbillimus genus, a single strand of genetic material, a fatty envelope, and a few proteins sticking out. The fancy name for the disease is Rubeola—hence my reference to a girl named Ruby—the word means “red.” It was first mentioned as far back as 700 ad and accurately described in the 10th century ad by a Persian doctor, Ibn Razi, who said it was “more dreaded than smallpox.” Other historical references abound, including King Edward VI, who reigned in England and Ireland from 1547 to 1553. He contracted measles in 1552 and subsequently died aged just 15, having progressed to probably develop tuberculosis in his weakened immune state.
Symptoms include a distinctive maculopapular rash, meaning it is red and has both flat and bumpy parts. It can take 7–10 days from first exposure until symptoms start with a worsening and wretched feeling of malaise, typical of many viral diseases. Fever then develops that can reach 105° Fahrenheit, 40.5° Celsius. That’s hot! And the wretched feeling worsens. One then gets the three “C’s,” cough, coryza (runny nose), and conjunctivitis (watering eyes), plus light intolerance, peeling skin, and more feeling wretched.
Early in the sickness, doctors can see a pathognomic sign (meaning it is 100% indicative of measles) called Koplik’s spots, small white/grey spots inside the mouth. Then, within 3–5 days of symptoms, the rash appears, often around the hairline, but until recently many doctors have never seen measles and may be slow to identify and report the case (the law demands this) and ensure the patient is isolated.
Diagnosis is based on reported symptoms and what one sees on examination, and then a laboratory test on nasal or throat swabs to identify the causative virus with polymerase chain reaction (PCR) testing.
Feeling lousy for a week or so, a rash and a fever is just the start of it; sequelae include pneumonia, gastroenteritis, ear infection, and two rare, but very serious brain complications. First, primary measles encephalitis comes on during the initial illness and subacute sclerosing panencephalitis can appear years later. These can cause amnesia, mental retardation, deafness, loss of vision (Rex Harrison lost the sight in his left eye from measles), and death.
For pregnant women, measles can cause miscarriage, stillbirth, premature birth, low birth weight, and respiratory problems. For unvaccinated patients living with cancer, autoimmune diseases like rheumatoid arthritis and psoriasis, or taking steroids, measles is likely to carry much higher risk of serious consequences.
Treatment relies on bed rest, although people feel so ill that’s all they want to do. Medications to lower fever like acetaminophen (Tylenol) and some tender loving care help, but there is no specific antiviral medication that works for measles. Data suggest that measles causes reduced levels of vitamin A, but although taking vitamin A supplements does not prevent measles, it may lessen the severity of an attack.
Incidentally, Rubella, also known as German Measles, is a totally different disease. The “German” part acknowledges that the initial descriptions came from German doctors and that the word germanus means “similar” as in similar to measles.
And now we come to the heart of the matter: Edward Jenner, a cow, and a discussion. In the 18th century Jenner observed that milkmaids who contracted cowpox did not get smallpox, inspiring him to extract pus from a cowpox lesion, introducing it into the arm of young James Phipps. When subsequently exposed multiple times to deadly smallpox, the boy did not get sick and in fact lived to be 65, had children, and attended Jenner’s funeral.
The word vaccination derives from vacca, meaning cow, and ever since the birth of this science there have been doubts, skepticism, and all sorts of denial theories. However, facts reveal that prior to 1963 when the first measles vaccine was introduced in America, measles caused 3–4 million cases, 48,000 hospitalizations, 1,000 cases of brain swelling, and 450 deaths every year. With vaccinations, numbers plummeted and after years of declining cases, in 2000 the disease was considered eliminated. However, that status was rescinded due to an outbreak in 2019; in prior years a small number of people entering America from overseas were infected.
While no medical intervention is risk-free, vaccination has been one of the most successful public health policies together with clean drinking water, safe and sufficient food supply, and effective sewage systems saving millions of lives. However, declining vaccination rates have allowed measles and other infections to return.
Other diseases many of us have forgotten, but which can be prevented by vaccines, include polio and whooping cough, both of which are surging and can be fatal. The latter has caused recent deaths of two babies in Louisiana and one each in Washington state, Idaho, and South Dakota, with Oregon reporting its highest number of cases in 75 years. Last year there were 35,000 cases nationwide and 10 deaths with 2025 set to be worse—we had four times the number of cases in the first 3 months of this year compared to last year.
If one looks at the current measles outbreak, 96% of those infected were either unvaccinated or had unknown vaccination status, 2% had one vaccination dose, and 2% had two doses ((https://www.cdc.gov/measles/data-research/index.html).
This leads me to a very interesting development; science is not static—we know that vaccines work, but how many doses are needed and how long do they last? Enter an American company, Immunoprofile (https://immunoprofile.com/) who, as the name suggests, with a simple finger-prick can inform people whether or not they have antibodies (a means of ascertaining protection) to eleven common vaccine-preventable diseases, including measles, polio, and whooping cough amongst others. People can then decide whether to seek additional vaccines or choose to totally isolate themselves from an outbreak. In the spirit of full disclosure, I own stock in this company because I believe in the value they bring.
John Scott Haldane, a Scottish scientist, invented oxygen therapy, early gas masks during World War I, and diver decompression practices. He also dreamed up the idea of using canaries to detect fatal gases in coal mines, giving rise to the phrase “canary in the coal mine,” an early indicator of a big problem. Measles is the canary in the coal mine, and if we do not act the poison will permeate society and other disease outbreaks will follow. I encourage my readers to learn more, talk to your family and medical advisors, and do what you believe is right to ensure that you, or people you love, do not contract measles.
I started this article referencing the musical My Fair Lady and want to finish with two songs. First, in 1980 The Police recorded “Canary in a Coalmine,” which states, “You get so dizzy even walking in a straight line.” In 1967 The Rolling Stones sang about Ruby Tuesday:
Goodbye, Ruby Tuesday
Who could hang a name on you?
When you change with every new day
Still, I’m gonna miss you
I don’t think any of us would miss Ruby-ola, and walking a straight line is a good thing.
Fly well!
Please subscribe to my podcast at www.jointhedocs.com on either Spotify or Apple podcasts—it’s free! Enjoy our social media videos on:
YouTube: @JoinTheDocs
Instagram: @JoinTheDocs
TikTok: @JoinTheDocs
Facebook: @JoinTheDocs
Twitter: @JoinTheDocs
You can send your questions and comments to Dr. Sackier via email: [email protected]
