Why Kids Need Vaccinations This Year

It has been a whirlwind year for illnesses. Bird flu outbreaks, a particularly intense influenza season, and measles outbreaks have all made headlines. Each of these stories shares a common thread: a warning about exposure risks and the need for proactive protection. With some of these illnesses now appearing more frequently in our communities, it’s never been more important to make sure children’s immune systems are prepared to face these threats.

A Flu Season Like No Other

This year’s flu season is shaping up to be the deadliest since 2018. In just January and February, nearly 9,800 Americans lost their lives to influenza — almost double the number from the same period last year. In Tennessee alone, flu-related hospitalizations have risen by more than 30% in just the past month.

This is a major risk to children as they enter crowded environments where flu can spread easily. While most children recover from the flu at home, certain symptoms can indicate serious complications that require medical attention. These include:

● Fast or labored breathing

● Persistent high fever (especially over 104°F or lasting more than 3 days)

● Extreme fatigue or trouble waking up

● Bluish lips or face

● Severe muscle pain or complaints of leg pain

● Signs of dehydration (dry mouth, no tears when crying, no urine for 8 hours)

● Seizures or confusion

● A fever that goes away but then returns worse

If your child shows any of these symptoms, it’s important to seek medical attention.

The Return of Measles

While the flu has been in the headlines, measles has also become a serious concern in communities across the U.S., including recent outbreaks in states like Ohio, Florida, and New York. This highly contagious disease was declared eliminated in the U.S. in 2000, but falling vaccination rates are allowing it to creep back into our schools and neighborhoods.

Measles is more contagious than the flu or COVID-19. It can live in the air for up to two hours after an infected person coughs or sneezes, and up to 9 out of 10 unvaccinated people exposed to it will become infected.

Symptoms include:

● High fever

● Cough

● Runny nose

● Red, watery eyes

● A telltale rash that spreads from the face downward

What makes measles especially dangerous is its potential to cause serious complications, including:

● Pneumonia

● Brain swelling (encephalitis)

● Hearing loss

● Death (especially in young children and those with compromised immune systems)

The MMR vaccine (measles, mumps, rubella) is the best tool to fight against measles. Two doses provide about 97% protection. But national coverage is slipping. In 2023, U.S. kindergarten vaccination rates for MMR dropped to their lowest levels in over a decade. This leaves entire communities vulnerable, especially babies too young to be vaccinated and children with medical conditions that prevent immunization.

The Results of Vaccine Hesitancy

Despite these rising threats, fewer Americans are choosing to vaccinate, and kids are caught in the middle. Misinformation has created a dangerous wave of vaccine hesitancy. States are seeing a 16% drop in flu vaccine distribution since 2022, and many have even rolled back school vaccination requirements.

This growing distrust is putting younger people at risk. In communities where fewer children are vaccinated, the flu and measles can easily spread. Getting vaccinated for both remains one of the most effective tools we have to reduce severe illness, hospitalizations, and death.

The Facts: Flu Vaccines Save Lives

There are several common misconceptions about the flu vaccine, such as:

● “The flu shot gave me the flu.” This is not possible. The vaccine contains inactivated virus and cannot cause the illness.

● “I got the shot and still got sick.” Flu vaccines may not prevent every infection, but they significantly reduce the severity and risk of complications.

● “Kids don’t need the flu shot.” In fact, children under 5 — especially under 2 — are at higher risk of serious flu-related complications like pneumonia, dehydration, and, in rare cases, death.

The Facts: Measles Vaccines Are Critical

Measles also comes with a variety of misconceptions, including:

● “Measles isn’t that serious.” Measles can be extremely dangerous to children. It can lead to pneumonia, brain swelling (encephalitis), hearing loss, and even death.

● “We don’t need the measles vaccine anymore — it was eliminated.” While measles was declared eliminated in the U.S. in 2000, outbreaks are on the rise again due to declining vaccination rates. It only takes one case to spread rapidly in an unvaccinated community.

● “My child doesn’t need it yet.” Children should receive their first dose at 12–15 months and a second dose between 4–6 years. Skipping or delaying puts them at risk during outbreaks.

What Parents Can Do Now

It’s not too late to get the protection your child needs. Here’s how you can help reduce the spread and protect your kids:

● Get vaccinated — Scheduling an appointment only takes a few minutes, and there are several resources available to see where vaccines are offered.

● Practice good hygiene — Encourage kids to wash their hands regularly, cover their coughs and sneezes, and stay home when sick.

● Stay informed — Follow updates from the Tennessee Department of Health and the CDC to monitor flu activity and recommendations.

Sources:

CDC: Influenza Vaccine Doses Distributed

CDC: Measles Cases and Outbreaks

National Foundation for Infectious Disease: Myths and Facts About Influenza (Flu)

National Foundation for Infectios Disease: Frequently Asked Questions about Measles

Measles Outbreak 2025: Part II

As promised, here is the second half of my two-part post on the current measles outbreak in the U.S. As I said in my first post, I wanted to cover two aspects of this incredibly important issue. In the first post, I discussed measles, how vaccines changed the game for this highly contagious disease, and how this put the U.S. on the path to declaring measles eliminated in the nation in 2000. However, as sometimes happens, the drastically lowered risk of measles throughout the last decades has brought a somewhat clouded sense of security for many. The feeling that measles poses no threat has made some, perhaps many, less likely to take the preventive action (i.e., measles vaccination) that achieved the disease’s elimination status.

My point last time was that we must remember how we reached minimal threats of measles and so many other diseases. And we must continue these efforts to sustain the progress made and provide the same safety for future generations. As I said before, and stand by, no child or adult should ever die from a vaccine-preventable illness. This is especially true in a country with resources and medical achievements that are as remarkable as ours. Tragically, though, we have seen otherwise in recent weeks, which is what this post will focus on: the current state of the measles outbreaks in the U.S.

Measles in the U.S. in 2025 by the Numbers

As of March 14, 2025, the Centers for Disease Control and Prevention (CDC) reported a total of 301 confirmed measles cases in the following locations: Alaska, California, Florida, Georgia, Kentucky, Maryland, New Jersey, New Mexico, New York City, New York State, Pennsylvania, Rhode Island, Texas, Vermont, and Washington. There have been many other likely measles cases that have been reported, as well, but the ones counted at this time are the only ones that have been confirmed by CDC. For comparison, there were 285 cases of measles in the entire year of 2024. We are only in March, and we have already surpassed that.

I will link to the CDC’s full page of statistics and data on the measles cases and outbreaks below (which updates each Friday), but I want to highlight some of that information here. In 2025 (although we are only in mid-March), there have been 3 measles outbreaks reported. The CDC defines an outbreak as three or more related cases. Of the 301 confirmed cases, 280 (93%) have been associated with an outbreak. Measles is the most contagious disease transmitted directly between people and one of the most highly contagious infectious diseases known to science. If just one person has measles, up to 9 out of 10 people nearby will become infected if they are unvaccinated. It is far more contagious than influenza or COVID, which is one of the reasons that vaccination against measles is so essential. Without protection, we are extremely vulnerable to measles.

Think of it this way: until now, the odds of being exposed to a measles outbreak have been low, since the disease was eliminated in the U.S. in 2000. However, if someone does happen to be exposed to the virus and is not vaccinated, they are around 90% likely to be infected.

I don’t want to roll those dice. It is important to remember that measles is spread through the air, even by breathing, and infectious droplets can remain in the air or stay on surfaces for two hours. An infected person might be long gone when you touch the same checkout counter they used an hour before you; we have no way of knowing.

So, I will repeat my broken record warning here. Since we never know what germs might “come to us,” so to speak, despite doing our best to stay away from risk, we have to do everything possible to protect ourselves. Making it even more complicated, in the first 2–4 days an individual has measles, symptoms are often common ones such as cough, congestion, and fever. So, it’s not unusual for individuals with measles to think they have just a simple cold at first, and to go about their lives, exposing others while they are highly contagious. To give you an idea of who has been most affected by the current outbreaks, 34% of cases have been under 5 years old, and 42% have been between 5–19 years old. So, children and adolescents make up over two-thirds of current measles cases. In 2025 measles cases, 95% were unvaccinated or had unknown vaccination status. These statistics relate to recent trends in the U.S., indicating lower vaccination rates among children.

I am including links to articles that discuss these trends in the “Want to Learn More?” section below. Of critical importance is that we are now beyond people “just” (I use that term somewhat sarcastically) getting sick from measles. An unvaccinated six-year-old child died from measles in Gaines County, Texas, in February. Measles is also the suspected cause of death of an unvaccinated adult in New Mexico (awaiting confirmation by CDC). This is now, without exaggeration, a deadly outbreak. The concern is that health officials and experts have not seen signs of the outbreak(s) slowing down. How far the outbreak could spread and how many people could be affected is difficult to predict (and I don’t like uncertainty).

One key variable is where or among whom measles tries to spread. If a population has a high vaccination rate (for example, 95%), an outbreak is very unlikely to occur because it does not have much opportunity to spread. However, there isn’t a lot of hard, accurate data that can tell you vaccination percentage rates for different, especially small, areas. We have to think of the worst-case scenario here, and for measles to spread at this time, it is possible that we could see several thousand cases this year. Only time will tell.

Other Thoughts

Again, getting vaccinated is the best personal protection from measles and the most effective way to keep these outbreaks from spreading. There is a lot of detailed information about the measles vaccine (usually combined with mumps and rubella), the age schedule for vaccination, and the number of doses needed. And, of course, there are exceptions to every rule and “what-ifs” to consider, and plenty of other information regarding immunization. Since this is not a highly technical, clinical post about the ins and outs of that extensive information, I am including a link below to the CDC’s very detailed explanation of that. I encourage you to visit the site and see if, even as an adult, you might benefit from a measles booster vaccine. There are also additional links that can answer other questions about why the vaccine is important, facts about safety and effectiveness, possible side effects, and even how to find where it is offered and assistance with paying for it.

Going forward, I hope you will keep aware of the measles outbreak in the U.S. I will include brief updates in upcoming posts or at least mention when/if something noteworthy happens (hopefully, nothing will). If there seems to be interest, I can also write up a quick post on some of the various “remedies” and suggested home prevention methods you may have seen or read about on the news or social media. There is a lot of clarification needed there.

Some of it stems from some accurate information, but much of it has gotten skewed and/or misconstrued. Many health experts, including my colleagues (and myself), are deeply concerned that as these recommendations continue to lose accuracy, individuals will rely on these, thinking they are as effective as vaccination. So, if you are interested in a “debunking”, please let me know! I hope

this post was informative and not too heavy on data and statistics. I look forward to sharing with you again soon.

Be Well; Be Kind,

Dr. Casey

Want to Learn More?

If you want to keep up with the latest numbers of measles cases, outbreaks, and related information, you can check the CDC’s website here (which is updated every Friday): https://www.cdc.gov/measles/data-research/index.html

Just as another reminder of measles symptoms and possible complications, and things to be aware of, here is some detailed information on what to look for, provided by CDC: https://www.cdc.gov/measles/signs-symptoms/index.html

This is another scientific article, so I will repeat my warning that it may be technical in places, but this publication discusses decreasing vaccination rates among children 24 months old and younger looking at data from 2020–2023. It is an interesting read by authors Hill et al.: https://www.cdc.gov/mmwr/volumes/73/wr/mm7338a3.htm

Here is the detailed information I referenced above about the measles vaccine, recommendations, safety, effectiveness, concerns, how to find a vaccine, and even assistance paying for it if needed (and much more) from the CDC:

https://www.cdc.gov/measles/vaccines/index.html?CDC_AA_refVal=https%3A%2F%2F

www.cdc.gov%2Fvaccines%2Fvpd%2Fmmr%2Fpublic%2Findex.html

In case you do not realize the full extent of possible outcomes of measles — both immediate and long-term (which many do not realize), here is a very impactful article on a physician who had just such an experience with one of his patients from NPR:

https://www.npr.org/sections/shots-health-news/2025/03/17/nx-s1-5328765/measles-Outbreak-health-risk

Why You Need Multiple Doses of a Vaccine

VaIf you look at the list of vaccines children need, you may think it’s long. That’s not the case, though. Each vaccine plays an important role in preparing children’s immune systems to protect them from potentially deadly diseases. This protection typically takes a few weeks to build and, in many cases, can last a lifetime. However, some vaccines, such as those for tetanus or seasonal flu, require occasional booster doses to maintain immunity.

When it comes to protecting children from some of the diseases out there, vaccines are one of the most effective tools available, and understanding the science behind vaccines can help explain why multiple doses are necessary to build long-lasting immunity.

Strengthening the Immune Response

Our immune system learns how to fight infections by encountering germs, either naturally or through vaccination. When a vaccine introduces a weakened or inactive virus or bacteria into the body, the immune system responds by producing antibodies.

For some diseases, one dose isn’t enough to trigger a strong or lasting immune response. Booster shots are needed to reinforce the body’s ability to recognize and fight off the disease if exposed in the future. This is why vaccines, like diphtheria, tetanus, and pertussis (DTaP), require multiple doses over time.

Providing Immunity in Steps

Some vaccines are given in a series because they work best when introduced gradually. For example:

● The hepatitis B vaccine is given in a three-dose schedule because the first dose introduces the virus to the immune system, the second dose boosts response, and the third dose ensures long-term protection.

● The polio vaccine is administered multiple times in early childhood to build a strong defense and prevent outbreaks.

Each dose works strategically for your immune system, strengthening its ability to recognize and eliminate disease-causing agents.

Compensating for Weakened Immunity Over Time

Some vaccines require booster shots because immunity from the first dose weakens over time. The tetanus vaccine needs to be repeated every 10 years to make sure that the immune system remains ready to fight off the bacteria if exposed.

This is the same as the influenza (flu) vaccine, that’s needed annually because flu viruses mutate and change frequently. Each year’s flu shot is formulated to match the most common flu strains circulating at that time.

Increasing Effectiveness with Advancements in Science

Vaccine schedules are based on decades of research and are constantly refined as new data becomes available. Scientists test and study vaccines to determine the best number of doses required for maximum effectiveness. The goal is to minimize risks while ensuring long-term protection.

In the early days of the human papillomavirus (HPV) vaccine, it required three doses, but research showed that two doses were just as effective in younger people. This adjustment reduces the number of shots needed while maintaining the same level of protection against cancers caused by HPV.

Can Too Many Vaccines Overwhelm the Body?

One common concern that often comes up is whether receiving multiple vaccines can overwhelm the immune system. However, scientific research shows that the immune system is equipped to handle multiple vaccines at once. Every day, children encounter thousands of bacteria and viruses in their environment, and the number of antigens (substances that trigger an immune response) in vaccines is small compared to what the body naturally encounters.

The immune system is adaptable and capable of responding to multiple threats simultaneously. Vaccines are carefully tested and scheduled to ensure they don’t overload the immune system.

Skipping vaccines out of concern for “too many shots” can leave a child open to contracting preventable disease, which can be much more dangerous than any temporary side effects of vaccination.

Vaccination Saves Lives

Ensuring that your children stay on track and receive all the necessary vaccines in the outlined schedules is essential for preventing serious diseases. Skipping doses can leave them partially protected, increasing the risk of infection and spread.

Vaccines are safe, thoroughly tested, and continue to be monitored for effectiveness. Completing the full series of vaccine doses strengthens immunity, prevents outbreaks, and protects future generations from diseases, like measles, that were once deadly.

Sources:

CDC: Reasons to Vaccinate

National Foundation for Infectious Diseases: 10 Reasons to Get Vaccinated

U.S. Food and Drug Administration: Vaccines for Children — A Guide for Parents and Caregivers

The Risks and How to Protect Children from Hepatitis A

There are several illnesses and viruses parents need to be on the lookout for, especially with newborns or young children. One illness often overlooked is Hepatitis A, a liver infection caused by the Hepatitis A virus (HAV). While it may not be as widely discussed as other vaccine-preventable diseases, Hepatitis A has the potential to cause serious illness in children.

What is Hepatitis A?

There are five different types of hepatitis: A, B, C, D, and E. Hepatitis A is a highly contagious virus that affects the liver. Unlike Hepatitis B and C, it doesn’t lead to long-term liver damage, but it can still cause severe illness, particularly in young children. The virus spreads easily, especially in areas with poor sanitation or where hygiene practices are not consistently followed.

Although most people recover completely from Hepatitis A, the infection can last for weeks or even months, causing discomfort and disruption to everyday life. In rare cases, it can lead to severe complications, especially for children who may have pre-existing liver conditions.

How Do Kids Get Hepatitis A?

Hepatitis A is primarily spread through the fecal-oral route, meaning it is transmitted when a person unknowingly ingests the virus after coming into contact with contaminated objects, food, water, or an infected person.

Young children are vulnerable because the virus spreads easily through poor hand hygiene. Some of the most common ways children contract Hepatitis A include:

● Eating food that was handled by someone who didn’t wash their hands properly after using the bathroom.

● Drinking water or eating produce contaminated with the virus, which can happen when traveling to certain regions.

● Touching contaminated surfaces, such as toys or shared objects, and then putting their hands in their mouths.

● Having close contact with an infected person, including sharing utensils or personal items.

● Being exposed in daycare or school settings, where outbreaks can spread quickly.

Because the virus can survive on surfaces for long periods, it spreads easily in group settings.

What Happens if a Child Gets Hepatitis A?

Not all children show symptoms when infected with Hepatitis A, but when they do, the illness can last for several weeks or even months. Symptoms can range from mild to severe and may include:

● Fever

● Loss of appetite

● Nausea and vomiting

● Abdominal pain

● Dark urine and pale stools

● Yellowing of the skin or eyes (jaundice)

While most children recover fully without long-term effects, Hepatitis A can sometimes lead to hospitalization, dehydration, and in rare cases, severe liver complications.

When Should Kids Get the Hepatitis A Vaccine?

The Hepatitis A vaccine is the most effective way to protect children from infection. It is part of the routine childhood vaccination schedule in the United States.

The recommended vaccination schedule includes:

● First dose: Given between 12 and 23 months of age.

● Second dose: Given at least six months after the first dose.

If a child was not vaccinated as a toddler, they can still receive the vaccine at any age. It is recommended for children who are traveling to countries where Hepatitis A is common, attending daycare, or living in communities where outbreaks are known to happen. The vaccine provides long-term protection and is highly effective in preventing infection.

How Can Parents Prevent Hepatitis A?

There are several things parents can do to help protect their children against Hepatitis A. Teaching and encouraging good hygiene habits is always important for reducing the risk of illness transmission. Some key prevention measures include:

● Ensuring children wash their hands thoroughly with soap and water, especially after using the bathroom and before eating.

● Making sure all food is cooked properly and prepared under sanitary conditions.

● Providing only clean, safe drinking water, particularly when traveling.

● Avoiding sharing utensils, cups, or personal items with others.

Hepatitis A is a serious but preventable illness. By ensuring that children receive the recommended vaccinations and practicing good hygiene, parents can significantly reduce the risk of infection. If you are unsure whether your child is vaccinated, speak with your pediatrician about getting them up to date.

Sources:

CDC: Hepatitis A Vaccine Administration

U.S. Department of Health and Human Services: Hepatitis A Basic Information

WHO: Hepatitis A

Measles Parties vs. MMR Vaccine

The spread of measles has not made its way to Tennessee yet; however, with this highly contagious disease, the state could soon see cases appearing, like in Texas and New Mexico.

During times like these, parents need to recognize symptoms and take steps to prevent their children from becoming infected. However, due to a flurry of misinformation that is easily accessible online, a troubling trend is currently emerging. So-called ‘measles parties’ are intentionally exposing children to the virus in hopes of achieving natural immunity. What people fail to understand is that this decision puts their children and others at risk.

Measles Cases

Measles was once considered eliminated in the United States. Now, the country is starting to see outbreaks in several different states. There are currently over 200 cases, with the majority found in individuals aged 5 to 19. The Centers for Disease Control and Prevention (CDC) also shows that most of these cases are in unvaccinated individuals. This trend in declining vaccination rates has been fueled by the anti-vaccine movement seen online, which has allowed the virus to return, spreading rapidly through communities with low immunization coverage.

Measles is one of the most contagious viruses known to us. According to Johns Hopkins University, nine out of ten unvaccinated people who come into contact with an infected individual will catch the virus. It can linger in the air for up to two hours, infecting anyone who passes through the same space. Unlike COVID-19, which has a lower transmission rate, measles spreads with devastating efficiency.

The Concerning Risk of Rising Measles Parties

Those in support of measles parties have argued online that exposing children to the virus will provide them with lifelong immunity, similar to old-fashioned chickenpox parties. What’s not taken into consideration are the severe complications that measles can cause.

While some children recover without issues, many don’t. In the U.S., there have so far been two measles-related deaths this year, something that hasn’t been seen since 2015. When infected with the disease, measles can lead to pneumonia, encephalitis (brain swelling), permanent disabilities, and death. One in every 1,000 children who contract measles will develop encephalitis, potentially resulting in lifelong neurological impairment. Some may suffer from subacute sclerosing panencephalitis (SSPE), a fatal brain disease that appears years after measles infection.

There is no way to predict which children will develop complications. Some might appear healthy but suffer catastrophic consequences. Exposing children to measles is not the solution to fighting the disease; it poses a huge risk to lives.

How Vaccination Works to Protect Everyone

Understandably, people who want to partake in a measles party are looking to develop herd immunity. But it’s not measles parties you need to attend; instead, you should book an appointment for vaccination. When enough people in a community are vaccinated, the spread of a contagious disease is minimized. The measles vaccine, part of the MMR (measles, mumps, rubella) shot, has been proven to be highly effective against the disease. Receiving two doses provides about 97% immunity.

Before vaccines, measles was responsible for taking hundreds of American lives annually. Now, thanks to widespread immunization, those deaths are rare. However, due to a recent drop in vaccination rates, this once-strong shield has been weakened, allowing outbreaks to take place in areas like Texas and New Mexico.

Those who are unvaccinated not only risk themselves but also pose a danger to babies too young for vaccination, immunocompromised individuals, and elderly people with weakened immune responses.

Vaccination Is the Best and Safest Option

The measles vaccine is not experimental or unproven; it has been rigorously tested and safely used for decades. The CDC recommends that children receive their first dose at 12–15 months and a second between ages 4–6. For those who missed vaccination earlier, it is never too late to receive a dose.

The rise of measles in the U.S. is entirely preventable. The best way to stop the spread, prevent illness, and protect lives is to ensure widespread vaccination. Misinformation and fear should not dictate healthcare decisions when it’s clear that the measles vaccine saves lives.

In an age when people are inundated with information online, it’s hard to determine what’s real or fake. It’s important for parents to reject the dangerous myth of measles parties and instead prioritize real protection for their children. If you are unsure whether the medical news you hear online is true or have questions about vaccination and herd immunity, the best course of action is to discuss them with a healthcare provider.

Taking steps to understand how diseases work and how to prevent them are the first steps in ensuring everyone is protected and that we don’t see continued outbreaks of this highly contagious and potentially life-threatening disease.

Sources:

CDC: Measles

CDC: Measles Cases and Outbreaks

John Hopkins Medicine: Measles: What You Should Know

Texas Health and Human Services: Measles FAQ: Should I have a “measles party”

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Dr. Casey

Measles Outbreak 2025: Part I

I’ve never done this before, but this will be Part I of a two-part post. I am dedicating two posts to this for a couple of reasons. First, because it is such an important and timely issue, and second, because I want to cover two different aspects of the topic. To really cover both pieces adequately, I need to devote the appropriate amount of information and time to them, and I don’t think you want to read a 5,000-word post in one sitting; I would not. So, today will be Part I of my post about the current measles outbreaks in the U.S.

Measles. What about them? I wrote about the disease way back in April (almost a full year ago!), citing the disease as one that has had “eliminated” status in the United States. The U.S. achieved that elimination status when Dr. John Enders and colleagues developed the first measles vaccine licensed for public use in 1963. Even in the decade before the vaccine became available, almost all children got measles by the time they reached 15 years old and an estimated 3–4 million Americans were infected every year. And of those millions infected every year, there were hundreds of deaths, nearly 50,000 hospitalizations, and approximately 1,000 patients developed encephalitis — swelling of the brain. But after the measles vaccine was introduced, reported measles cases in the U.S. dropped by 97% in only three years. An improved measles vaccine was introduced in 1968, which is the one still used today (developed by Dr. Maurice Hilleman and colleagues). Seeing the remarkable effects of vaccination against measles, the U.S. set a goal in 1978 to eliminate measles from the country by 1982. The rest is very interesting, including expanding that goal to worldwide elimination, but that isn’t the purpose of today’s post (however, I am including links below that you can visit to read more about this fascinating mission and achievement). To spoil the ending of our mission in the U.S., measles was declared eliminated in the nation in 2000. Elimination, in this context, was defined as the absence of continuous spread of disease beyond 12 months. The credit for this remarkable and historic accomplishment was given to the U.S.’s highly effective vaccination program.

Wouldn’t it great if that were the end of the story? But, it’s not.

In my post from last April, I discussed that this amazing achievement — measles elimination in the U.S. — unfortunately came as a double-edged sword. Now, we are unfortunately seeing the sharp, unforgiving side of that sword. The risk of measles has become so low (the good side) that people are less likely to understand how severe the disease can be, and thus don’t feel as threatened, and therefore are less likely to take preventive actions — like getting vaccinated. It is easy and perhaps admirable to strive for an “organic, all-natural” approach to life when you haven’t faced the horrors of a society without proper sanitation, hygiene, medical care, etc. But many people have forgotten, or perhaps do not realize, that we are only able to enjoy the luxuries of our lifestyles because of the tireless efforts and struggles of so many who blazed a trail before us to give us such an opportunity.

An example my colleagues and I frequently use to try to explain the short (or no) memory issue that spurs major health issues is the following, and is based on countless real-life experiences with patients. We often see patients suffering from, for example, high blood pressure. They experience negative symptoms, their quality of life lowers, they know something is wrong, and they come see their healthcare provider. Their provider recommends lifestyle changes (healthier diet, more physical activity, no smoking, etc.) and prescribes medicine to manage the patient’s blood pressure. The patient goes home, starts taking the blood pressure medication (and hopefully starts making the lifestyle improvements), and within weeks — they feel great! In fact, all of the negative symptoms they were experiencing from the high blood pressure might even be gone and they feel as good as new. Well, they are feeling good now. So…they stop taking the medicine. They aren’t having those problems like before, so “obviously” (in their minds) they must not need the medicine anymore. But a few more weeks go by, off of the medication, and all of the negative symptoms return, and they end up back at their healthcare provider trying to figure out what happened?? (But something tells me that you know what happened…)

They were feeling better because of the medicine. It was treating their condition. So, stop taking it, and consequently stop feeling better. It seems so simple when we talk about it like this, but I cannot tell you the hundreds of patients who have this exact experience. Their symptoms are out of sight, so they are out of mind, and may as well not exist. It can be difficult to think you need to take medication if you aren’t feeling unwell. But there is a similar effect with vaccine-preventable diseases.

When is the last time that someone you know had smallpox? Or even polio (in your lifetime)? My medical students actually have difficulty diagnosing chickenpox. That absolutely blew my mind the first time I heard a student say that, but I realized it’s because their generation has had a vaccine for that, whereas chickenpox was practically a rite of passage when I was growing up. For some people, is difficult to think about needing medication (such as a vaccine) when you feel in great health, especially if you don’t even have a tangible idea of what that medicine/vaccine is for. I don’t know anyone who ever spent time in an iron lung. Those are just pictures in books. Examples of other real things that, maybe to someone not unlike myself, are just pictures in books: guillotine executions, leper colonies, the destruction of Pompeii, and dinosaurs.

Am I very concerned about or taking any imminent preventive measures to protect against crossing paths with a velociraptor (that is my youngest’s current favorite kind of dinosaur)? Not especially. I’ve never seen one in “real life.” No one I know has ever seen a living dinosaur. I know they are a real thing but from a long time ago. I have seen illustrations of dinosaurs. Having a young dinosaur aficionado in my house, I have read more than my fair share about them. I’ve seen fossils and even full skeletons with my own eyes, so I know they did exist at one time and some were huge, and likely absolutely terrifying and life-threatening. But I have no real concept or firsthand understanding of these creatures in reality; for me, they are more of an idea. Therefore, I don’t have any real fear of dinosaurs. I have a lot going on, and frankly I don’t spend a lot of time thinking, much less worrying, about them. If the news reported that we were having a dinosaur outbreak, I would be completely unprepared. I am not really sure what I could do to prepare for that, anyway — and am going to try very hard not to go down that mental rabbit hole. But I also know that the odds of such a thing are essentially zero (although anything can happen, right). Ultimately, I feel quite comfortable that I am safe from a dinosaur attack.

Although that is obviously an extreme example, the same sort of thing frequently happens when it comes to diseases we think of as a thing of the past. How worried are you about catching the Black Death (bubonic plague), for example? My guess is probably not very. My long-winded point is that — humans are forgetful creatures; our memories are very limited. That saying, “out of sight, out of mind,” is true. While we are extremely fortunate to live in a time and place without daily fear of countless diseases, we can’t let ourselves become complacent. We have to remember how we got here.

Huge advancements and improvements in sanitation and hygiene have made a world of difference for diseases like cholera, dysentery, typhus, and plague (among others). And for other diseases that used to carry a huge death toll, vaccines have saved millions of lives and prevented sickness and other negative health outcomes for even more.

No child or adult should ever die from a vaccine-preventable illness. Full stop. Modern sanitation measures such as using clean water and disposing waste into sewer or septic systems are precautions similar to being vaccinated. Both are examples of taking precautions to protect one’s health and the health of others. I don’t know anyone who would choose to drink dirty pond or lake water over a glass of water that has gone through standard filtration from a kitchen sink. So, we should ask ourselves why we would not also utilize the remarkable achievements of vaccines to protect ourselves and others from preventable diseases.

If we want future generations to enjoy the same luxuries of health protection that we currently do, then we have a responsibility to carry that torch forward by vaccinating ourselves, our children, and by engaging in healthy behaviors. If we take progress for granted, then the amazing achievements in health and medicine that we have experienced in our lifetimes die out with us. And that’s not what any parent wants for their child, or anyone wants for another person.

Other Thoughts

Apologies for this lengthy post (just think if I hadn’t broken this up into a two-parter!). But I really wanted to emphasize where some of the misconceptions around vaccination come from, and what we should remind ourselves and others in order to keep ourselves, our loved ones, our communities, and our societies healthy long-term. In Part II, I am going to cover more of the hard facts and latest information about the current measles epidemic in the U.S. Who has been affected, and where? How many outbreaks are there? What do we mean by “outbreak”? What can you do to protect yourself? I promise it will be back to the more typical information-based post, and less…slightly philosophical, I guess. But I hope you made it to the end of this post and that you take some time to really think about what I discussed here. If you are like me, you probably feel a sense of responsibility for future generations. I always strive to leave a place a little better than I found it; I hope you do, too. I know that there are widely differing opinions on vaccination, believe me, so feel free to send me your thoughts, comments, questions, or concerns. Please remember that this is an open space for respectful discussion; that is encouraged! I’m looking forward to the next post with some hard data and information about what we are currently dealing with in U.S. It is upsetting, but it is important to be informed.

Be Well; Be Kind,

Dr. Casey

Want to Learn More?

As promised, you can read more about the timeline of measles, before and after vaccines, at this site, aptly titled, “History of Vaccines,” which has a lot of other interesting content, as well: https://historyofvaccines.org/history/measles/timeline

For more detail on the history of measles, particularly progression in the U.S., I recommend this page by the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/measles/about/history.html

Although this is a scientific article, so it gets technical in some places, I am going to include this link, as well, which provides information about the progression toward worldwide measles elimination from 2000–2022 by authors Minta et al.: https://www.cdc.gov/mmwr/volumes/72/wr/mm7246a3.htm

Want some general information about measles? The National Foundation for Infectious Diseases (NFID) can help you with that: https://www.nfid.org/infectious-disease/measles/

Just for some levity — I did start thinking more about a possible dinosaur invasion, and found this fun little blurb with some tips on how to survive a dinosaur attack (even with some specifics for velociraptors!): https://workrightnw.com/how-to-survive-a-dinosaur-attack/

Here is a great article by the U.S. Office of Health and Human Services (HHS) that discusses the many benefits of good sanitation and hygiene, but explains why these alone are not enough to protect against infectious diseases: https://www.hhs.gov/letsgetreal/learn-about-childrens-vaccines/questions-about-vaccines/are-good-sanitation-and-hygiene-practices-enough-to-protect-against-infectious-diseases

The Need to Get Vaccinated During the Recent Rise in Measles

With spring break approaching and families preparing for trips to other states, parents and children need to be cautious, as the number of measles cases in the United States has grown significantly. So far in 2025, 164 cases have been reported, including a major outbreak in Texas that has resulted in a child’s death. This is particularly concerning given that the last measles-related death occurred around 2015, and just 15 years before that, the disease had been classified as “eradicated” in the U.S.

How Did We Get Here?

Thanks to widespread vaccination programs, measles was largely eliminated. However, declining vaccination rates in recent years have led to a resurgence. Texas, for example, has some of the highest vaccine exemption rates in the U.S., particularly in Gaines County, where nearly 14% of school-age children have opted out of at least one required vaccine. Similar trends are occurring in other states facing outbreaks. These gaps in immunization have contributed to the current measles outbreaks in the U.S.

The Reality of Measles

Measles is one of the most contagious diseases known. If ten unvaccinated children are exposed to someone infected, nine will contract the disease. It spreads through airborne droplets, making it extremely difficult to contain once an outbreak starts.

While some infected individuals may recover without complications, measles can cause severe, long-lasting health issues. The Centers for Disease Control and Prevention (CDC) reports that about 1 in 5 unvaccinated people who contract measles require hospitalization, and about 1 in 1,000 children develop brain swelling, which can lead to permanent brain damage or death.

The Scars Left by Measles

Measles symptoms progress over two to three weeks. The illness begins with a cough or runny nose, followed by fever and a distinctive red rash. It doesn’t stop there, though. In some cases, secondary bacterial infections develop, leading to severe skin complications, open wounds, and long-term scarring.

Beyond its skin-related effects, measles can also cause lasting damage to internal organs. Pneumonia is a common complication, and in rare cases, the virus attacks the brain, leading to subacute sclerosing panencephalitis (SSPE), a fatal neurological disorder that develops years after infection.

Why Vaccination Is a Must

The measles vaccine, administered as part of the Measles-Mumps-Rubella (MMR) vaccine, is one of the safest and most effective vaccines available. Since its development in 1971, it has prevented tens of millions of deaths globally. Before the vaccine, measles caused 2.6 million deaths annually.

To be fully vaccinated, young children require two doses:

● First dose: Given at 12–15 months, providing immunity to about 85% of children.

● Second dose: Given at 4–6 years, increasing protection to 95–98%.

● Lifelong protection: Once fully vaccinated, individuals remain protected for life.

What Parents Need to Do

If you and your family are planning to travel during spring break, there are a couple of things to keep in mind:

● Check your child’s immunization records to ensure they have received both doses of the MMR vaccine.

● If your child has not been vaccinated, schedule an appointment with a healthcare provider immediately.

● If you’re traveling, be extra cautious. Measles outbreaks have been reported in Texas, New Mexico, and California.

Key Takeaways

Measles is not a harmless childhood disease. It can cause lifelong consequences, including permanent scarring, brain damage, and death. The good news is that it is entirely preventable with vaccination. With the recent rise in cases, it is important to stay informed about how these diseases spread and what you can do to prevent outbreaks in your household and community.

Sources:

CDC: Measles Cases and Outbreaks

CDC: Clinical Overview of Measles

Who: Measles

Texas Health and Human Services: Annual Reports of Immunization Status

Polio’s Lasting Effect: The Physical and Emotional Impact on Survivors

Polio was a devastating disease in the 20th century, leaving millions of children with lifelong physical disabilities. While vaccines have nearly eradicated polio in many parts of the world, surviving the disease left many with lasting effects. Approximately 1 in 200 cases resulted in irreversible paralysis, usually in the legs, and among those paralyzed, 5–10% died when their breathing muscles became immobilized. Beyond paralysis, polio survivors often faced long-term health challenges, including mobility issues and a reduced quality of life.

The Scars of Polio

One of the most common aftereffects of polio is muscle atrophy, where muscles shrink and weaken due to nerve damage. This can lead to limb deformities, especially in the legs, making walking difficult or impossible without braces or crutches. Many polio survivors developed:

● Flaccid paralysis: The affected muscles remain weak and cannot support movement.

● Leg length discrepancies: One limb may be shorter than the other, causing an uneven gait and leading to hip and spine deformities over time.

● Contractures: Stiffening of joints due to prolonged muscle weakness, leading to permanent bending of the knees or elbows.

To address muscle atrophy, many survivors undergo corrective surgeries to regain some mobility, including tendon transfers, joint fusions, and bone lengthening. These surgeries often leave visible scars on the legs, arms, and back. In some cases, survivors require multiple operations throughout their lives to improve mobility.

The Role of Vaccination in Preventing Polio

Before the introduction of vaccines, polio was a major cause of disability in children. In the early 1950s, the United States experienced about 16,000 cases of paralytic polio annually. The development and widespread use of polio vaccines have led to a dramatic decline in cases worldwide, with a reduction of over 99% since 1988.

For parents today, ensuring that children receive their polio vaccinations is crucial to preventing the disease from spreading. Polio still exists in some parts of the world, and while it is rare in countries with immunization programs, the risk of outbreaks remains if vaccination rates decline. Parents play a crucial role in preventing polio by:

● Following the recommended vaccination schedule — The polio vaccine is typically given in multiple doses throughout early childhood.

● Understanding the continued need for vaccination — Even though polio is nearly eradicated, global travel and outbreaks in under-vaccinated communities make it necessary to keep vaccination rates high.

● Staying informed — Misinformation about vaccines can cause unnecessary fear and hesitation. Parents should rely on trusted medical sources and healthcare professionals for accurate information about the safety and necessity of polio immunization.

Aiming for a Future Without Polio

Polio was a disease that had a devastating impact on children, leaving them with mobility issues that often required surgical treatment. Today, thanks to vaccines, parents no longer have to fear polio’s effects on their children. However, protection only lasts if vaccination rates remain high. Polio hasn’t been officially eradicated everywhere, and a single case can spread quickly in communities where immunization levels have dropped. That’s why ensuring children receive their full polio vaccine series is crucial.

If you have questions, ask your doctor so they can provide you with the most up-to-date information regarding vaccines.

Sources:

CDC: Polio Vaccination

CDC: About Polio in the United States

Mayo Clinic: Post-polio syndrome

Tennessee Faces High Flu Activity: What Parents Need to Know

Tennessee is being hit hard by a surge in flu cases, with the Centers for Disease Control and Prevention (CDC) reporting the state’s activity as “very high.” The Tennessee Department of Health has reported the first flu-related child death of the season, and school districts, including McMinn, Polk, and Rhea Counties, have had to close temporarily because of widespread illness. As a parent, this can be concerning. That’s why it’s important to stay informed about the tools and steps available to help protect your child from the flu.

Understanding the Flu and How It Spreads

The flu can easily spread from one person to another and usually spreads through coughing, sneezing, and close contact with people who are already infected. In most cases, you get a headache, fever, and overall feel pretty bad. But it can get even worse than that. If not treated properly, it can lead to severe illness, especially in young children.

One challenge in preventing the flu is that people can spread the virus before they realize they are sick. This means schools, workplaces, and crowded public areas can quickly become hotspots for flu transmission. As we’re seeing, cases in schools can spread rapidly, depending on whether students have been vaccinated.

Preventing the Spread of the Flu

The best thing to do to help prevent the spread of the flu is to get vaccinated. No amount of hand soap — though still important — can match the effectiveness of a flu shot, which not only lowers your risk of illness but also helps stop it from spreading to others you have close contact with. Additional preventive measures include:

● Frequent handwashing with soap and water

● Covering coughs and sneezes with a tissue or elbow

● Wearing a mask if you feel like you’re experiencing symptoms

● Staying home when feeling unwell to prevent the spread of illness

Most kids with the flu recover at home, but in rare cases, the illness can become serious enough to require a hospital stay. When that happens, it’s usually because of severe symptoms like trouble breathing, dehydration, or complications like pneumonia. For adults, especially older adults and those with existing health conditions, the risk of flu-related complications is even higher. A severe case can lead to prolonged hospital stays, intensive care, or the need for oxygen support.

The Importance of Flu Vaccination

There has been hesitation to get the flu shot due to misconceptions, but experts in the health industry emphasize that vaccination is the best way to reduce flu spread and protect people.

Each year, the flu vaccine is developed through global surveillance, strain selection, production, and distribution. The CDC, FDA, and WHO analyze flu activity worldwide, selecting the most likely strains for the upcoming season. Vaccine production begins using egg-based, cell-based, or recombinant technology, followed by FDA approval before distribution.

The CDC recommends getting vaccinated by late September or October for the best protection. Regardless of the time, it’s always best to get your flu shot when you can.

Act Now and Protect Yourself

The best time to get the flu shot is right now. And with the season in full swing, and Tennessee remaining one of the hardest-hit states, it’s the best option parents have to ensure their children stay safe.

Don’t wait until the flu catches you off guard — talk to your doctor today about getting vaccinated.

Sources:

Tennessee Department of Health: Tennessee’s Weekly Flu Reports

CDC: Weekly US Map: Influenza Summary Update

CDC: Signs and Symptoms of Flu

Categories
Dr. Casey

Virus Spotlight: Influenza A

In one of my most recent posts, I talked about the differences between the major viruses that have been affecting the U.S. this season (the “quademic,” as some have dubbed it): influenza, COVID-19, RSV, and norovirus. Today, though, I want to focus special attention on one of these that has had a particularly notable surge across the country lately, reaching some of the highest levels we use to measure activity. I do not think it will come as a surprise that I am talking about the influenza A virus. I have received several questions and comments about influenza A recently, likely due to these increased levels, so I will answer as many of those as I can (and more) in today’s post.

Some basics about influenza viruses

Just for some background, I will give you a little information about types of influenza, so you can get a better understanding of influenza A. There are four types of influenza viruses: A, B, C, D. Influenzas A, B, and C can affect humans, while influenza D mainly affects animals (such as cattle). Even though influenza C can infect humans, it is much less common and typically causes milder illnesses than A and B. The ones we are most interested in, because they affect us most significantly, are types A and B.

Influenza A and B are the most common, and are the types of influenza that cause “flu season” almost every winter in the U.S. “Flu season” is actually a seasonal epidemic of disease. Influenza A is the only type of influenza known to cause flu pandemics. Influenza A viruses are classified into different types based on two proteins found on the virus’s surface. The first is hemagglutinin (H) and the other is neuraminidase (N). Each of these has multiple subtypes, and that is how different types of influenza A are named, as we sometimes read and hear about (for example, H1N1). These subtypes can be broken down even further, becoming even more detailed and specific, but instead of getting into Virology 101, I will post a resource below if you are interested in getting into the more intricate processes of this.

Why are we concerned right now in the U.S.?

The flu continues to surge all over the U.S., and the majority of these flu cases are influenza A. Another concern is that influenza A usually causes worse symptoms compared to influenza B, and patients with influenza A are more likely to get hospitalized. Influenza B can definitely be severe, too, but right now, influenza A is what is sweeping the nation. In fact, of all the flu tests that have been reported to the Centers for Disease Control and Prevention (CDC) since flu season started last fall, approximately 97% have been positive for influenza A.

This year’s flu season has reached unusually high levels compared to recent years. Currently, we are in what is considered a “second wave” of flu, which is common after the holidays when many people gather in small settings, frequently offering the opportunity for greater viral spread. Figures from the CDC show that national levels of influenza are currently the highest they have been since the peak of the 2009 swine flu pandemic (link below to the website with the figures and other data you can look at). However, the high rates this season are not from a new strain like in 2009. Rather, these high rates seem to be from the usual seasonal types of the influenza virus.

According to the CDC (and a helpful map to which I will also post a link below), most states are at “high” or “very high” levels of influenza. This is based on the most recent data which is from the week ending February 1, 2025. While some states may have reached their peak of flu, others are still growing, and unfortunately, there is not much we can do in the way of predicting how these trends with go.

Why are flu levels so high this year?

Many things can influence overall high levels of flu. One major contributor is that the CDC reports that flu vaccination rates among children are the lowest they have been in six years. Children, particularly, with more vulnerable immune systems, are often infected more easily than adults, and then attend schools which are a prime breeding ground to share germs and spread viruses. In fact, many schools throughout the country have briefly closed to try to stop the cycle of viral spreading among students, faculty/staff, and families. Also, this year, less than half of American adults have received a flu vaccination, making these individuals more susceptible to being infected by flu viruses and for those flu viruses to be more severe.

For example, as time has passed since the COVID-19 pandemic, many people have become more relaxed in their prevention practices. Far fewer people are wearing masks; quarantining or even just staying home from work or school when feeling sick has become an outdated idea for many people, and fewer people are as vigilant about washing their hands, using hand sanitizer, and disinfecting surfaces regularly. People also feel much more comfortable being in large crowds again, as well as in enclosed spaces lacking much ventilation. Many of us feel like life is, “back to normal,” meaning — like it was before COVID-19. But we need to remember that while we no longer have to live in the strict conditions of the pandemic, we need to adopt a new normal, in which we find a balance or compromise between our old ways and the rigid pandemic standards.

Other Questions?

I hope this helps with understanding more about the major flu surges going on around the U.S. right now, and gives you some ways to protect yourself from these viruses. Even if you have had the flu once this season, you can get it again, so do not think you are in the clear. And it is important to take all the prevention steps we can to protect both ourselves and all of those around us. If you can, try to spend some time thinking about the middle ground of the new normal I mentioned above. Maybe even talk about it with others. It is going to be very important going forward to keeping all of us safe and healthy. As always, your questions and comments are welcome, as well as topic suggestions if you have anything in particular you would like to read more about. I am particularly excited about my next piece, so stay tuned! Thank you all, and take care.

Be Well; Be Kind,

Dr. Casey

Want to Learn More?

Can’t get enough about how influenza viruses are broken down into even more detailed subtypes, lineages, and more? Learn more at this CDC site:

https://www.cdc.gov/flu/about/viruses-types.html

The CDC posts a Weekly Influenza Surveillance Report, and one part of it is a Weekly US Map of an Influenza Summary Update. This shows “Influenza Like Illness” Activity Level per state and tracks how it changes by week:

https://www.cdc.gov/fluview/surveillance/usmap.html

The CDC also posts Weekly Influenza Surveillance Report “Key Updates” each week, with the most recent report from the week ending February 1, 2025 (it takes a while to collect and process data from the entire nation so there is a lag time). You can look at these key updates here:

https://www.cdc.gov/fluview/surveillance/2025-week-05.html

Here is a great article that talks about this year’s intense flu season and the impact it has had on many states and communities:

https://www.pbs.org/newshour/health/u-s-facing-most-intense-flu-season-in-at-least-15-years

In case anyone needs a refresher on what symptoms to be on the lookout for when it comes to the flu, here is a tidy list to refer to:

https://www.cdc.gov/flu/signs-symptoms/index.html