The Cedars-Sinai Newsroom spoke to two infectious disease specialists—Jonathan Grein, MD, director of Hospital Epidemiology, and Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s—to get the facts about how to protect yourself and your family.

Why is measles so dangerous?

Priya Soni, MD: Many people think that measles is just a rash, but it can be life threatening. One in 5 children who develop measles end up in the hospital. One in 20 children develop pneumonia, and this is the leading cause of measles-related deaths. In addition, 1 in 1,000 children can develop a rare complication of brain swelling—encephalitis—that can cause permanent brain damage.

How does measles spread?

Jonathan Grein, MD: Measles is one of the most infectious diseases that we know of, and it's spread very easily through the air, particularly for people who are not immune or have not received the vaccine. It's so infectious that you don't even need to be in the same room at the same time with someone who has measles to potentially get infected.

What are the telltale signs of measles?

Grein: The symptoms of measles can begin like any other viral illness. You may feel feverish, have muscle aches, headaches, very nonspecific symptoms. Patients may then go on to develop cough, runny nose, sometimes redness of the eyes. That all precedes the classic rash that you may be familiar with that typically starts on the face and spreads throughout the body. I think it’s important to know that it is possible to be infectious several days before that rash begins, which is one of the real challenges with trying to control measles from being spread person to person.

What should you do if you think your child has measles?

Soni: If you think your child has measles, the first thing to do is call your pediatrician, but do not go directly to their offices or the Emergency Department without speaking to someone on the phone first. The virus is extremely contagious, so you want to call ahead to let the healthcare providers know what’s going on. Showing up without calling ahead can cause other children in the waiting room to be infected. In addition, you should immediately isolate your child from other children, especially infants who are less than a year of age, as they may not have protection from the virus. You should also isolate your child from any immunocompromised family members.

How is measles treated?

Grein: The treatment for measles is solely supportive. There is no specific measles treatment, but you want to try to control the fever and make sure the patient is hydrated and resting in isolation.

How do we protect against measles?

Soni: Vaccination is the best protection against measles. The MMR vaccine, which is inclusive of measles, mumps and rubella, is 97% effective after two doses. It's one of the most effective vaccines that we have. And it protects children in outbreak situations and other vulnerable community members as well.

Typically, the first dose of the measles vaccine is given at 12-15 months of age. The second dose is given around 4-6 years of age.

If your child is 6-12 months old, they can receive an early dose of the measles vaccine if they're in a high-risk situation such as an outbreak or if they’ve been exposed to the virus. This additional dose that's given earlier than the recommended schedule does not count toward their two-dose series.

Do adults need to get vaccinated against measles?

Grein: Most adults will not need an additional booster dose if they were previously vaccinated. There is a small number of adults who may have received a different version of the measles vaccine between 1963 and 1967. This vaccine was later found to be less effective, and it doesn't provide as long-lasting immunity as the current vaccine. So if you did receive that vaccine, it is recommended that you receive a booster dose with the current MMR vaccine to achieve appropriate immunity.

Read more on the Cedars-Sinai Blog: Why Some Vaccines Last A Lifetime and Others Don't 

The findings, published in Arteriosclerosis, Thrombosis, and Vascular Biology, suggest that a treatment therapy that inhibits interleukin-1-beta might help patients, including the approximately 20% of children who don’t respond to current therapies.

Kawasaki disease was first described by Japanese pediatrician Tomisaku Kawasaki in 1967, but its cause remains unknown. The condition typically affects children under the age of 5, and patients with the disease usually present with a sudden, high fever; rash; redness of eyes, lips and tongue; and swelling of hands and feet that last for 10 days or longer.

In Japan, Kawasaki disease cases are on the rise after a significant decrease in 2020.

“The disease is treatable in most children if caught early, but some children continue to have fever and become at risk of developing cardiovascular complications, such as coronary artery aneurysms or arrhythmias,” said Moshe Arditi, MD, executive vice chair of the Department of Pediatrics for Research at Cedars-Sinai Guerin Children’s, the GUESS?/Fashion Industries Guild Chair in Community Child Health, and a co-senior author of the study.

The standard of care for children with Kawasaki disease is to administer intravenous immunoglobulin and aspirin to reduce inflammation and fever. But recent clinical trials have found that blocking proteins called inflammatory cytokines, such as tumor necrosis factor alpha or interleukin-1-beta, improves symptoms in children.

Drugs that block tumor necrosis factor alpha are already being used in patients. A potential new therapy currently being investigated, anakinra, suppresses and blocks the function of the interleukin-1 receptor, which binds the inflammatory interleukin-1 cytokines.

This study sought to identify which cytokines might be involved in the biologic processes that cause cardiovascular complications in children with Kawasaki disease.

Arditi, who is also director of the Infectious and Immunological Diseases Research Center in the Department of Biomedical Sciences and a professor of Pediatrics, and Eugenio Cingolani, MD, who is director of Cardiogenetics and Preclinical Research at the Smidt Heart Institute at Cedars-Sinai and an associate professor of Cardiology, brought their labs together to work on the study.

Together, the investigators studied publicly available datasets showing gene expressions in children with Kawasaki disease. They found elevated expression of the genes of cytokines interleukin-1-beta and tumor necrosis factor alpha in patients with the disease.

“We sought to identify whether one protein caused more cardiac dysfunction and arrhythmias in this mouse model of Kawasaki disease,” Cingolani said.

The team performed several experiments in laboratory mice with a disease model resembling Kawasaki disease in humans. The investigators injected mice with drugs that block the expression of interleukin-1-beta or tumor necrosis factor alpha. They found that drugs that blocked interleukin-1-beta signaling but not tumor necrosis factor alpha signaling prevented abnormal changes in how the heart pumps blood and the heart’s rhythm. 

“We need to test whether these observations in an animal disease model remain true in children with Kawasaki disease,” said Thassio Ricard Ribeiro Mesquita, PhD, a research scientist with the Smidt Heart Institute, an assistant professor of Cardiology at Cedars-Sinai and first author of the study. “If so, they would further support the use of therapies that block interleukin-1-beta in patients with Kawasaki disease.”

Based on the experimental studies from the Arditi Laboratory on the role of interleukin-1-beta in Kawasaki disease, anakinra—the drug that blocks the interleukin-1 receptor—is now in Phase III clinical trials in children.

Other Cedars-Sinai investigators who worked on the study include Shuang Chen, Youngho Lee, Rodrigo Miguel-dos-Santos, Asli Atici, Magali Noval Rivas and Yen-Nien Lin.

The study was funded by the National Institutes of Health, the American Heart Association, the California Institute for Regenerative Medicine and the Cedars-Sinai Board of Governors.

Follow Cedars-Sinai Academic Medicine on X for more on the latest basic science and clinical research from Cedars-Sinai.

Globally, measles cases increased by 79% in 2023, according to the World Health Organization. In 2022, WHO estimated that measles killed more than 130,000—most of them children. 

In the U.S., during the first two months of 2024, nearly two dozen cases have been reported in California, Arizona and nine other states.

“Measles is a huge concern and directly related to declining measles vaccination rates,” said Priya Soni, MD, a pediatric infectious disease specialist with Cedars-Sinai Guerin Children’s. “Vaccine hesitancy, fueled during the pandemic by the anti-vaccine movement, has affected vaccination rates nationwide. In addition, because children were quarantined during the pandemic, many missed out on well-child visits and didn’t catch up on their vaccines. That has meant 61 million fewer doses distributed nationwide between 2020 and 2022.”

Measles is a contagious infection—even more infectious than COVID-19. While one person with COVID-19 can infect one to three others, one person with measles can infect as many as 18 other susceptible individuals. This airborne virus remains infectious for up to two hours after an infected individual leaves an area.  

“The big danger with measles is that it is one of the most unpredictable infections,” Soni said. “There is a very real risk of hospitalization, death or serious damage to the immune system. Even after you’ve recovered from measles, your immune system can be altered for up to three years and you become at risk for many other infections.”

Other potential complications include bacterial pneumonia and encephalitis, an inflammation of the brain. Measles carries the highest risk of complications in children 5 and younger and in adults 30 and older.

The measles vaccine, given as part of the MMR (measles, mumps and rubella) vaccine, is extremely effective, giving those vaccinated with just one dose up to 93% protection. The second dose confers up to a 97% lifetime protection rate.  

Although the first dose of the MMR vaccine is traditionally given to infants 12-15 months of age, and the second around a child’s fifth or sixth birthday, Soni said infants as young as 6 months can receive the first vaccine if they are traveling to areas where the measles infection rate is high.

For parents worried their child may have been exposed to measles, there are several telltale signs. One of the first is small white spots that appear inside the cheeks. Those spots—called Koplik spots—are unique to measles. Children also can develop a diffuse rash of small, red bumps that erupt on the face but then spread down the rest of the body, along with a high fever.

“Unfortunately, there are no antivirals or treatments for measles other than rest, staying hydrated and fighting the fever with cool baths and fever-reducing medications,” Soni said.

The good news about measles is that it is preventable with the vaccine, Soni said. But when collective MMR vaccination rates drop below 95% in a population, our “herd immunity” diminishes and this can lead to pockets of outbreaks with measles in certain communities and populations.  

“There is no scenario where getting the actual measles infection is somehow better for your child then getting the vaccine,” Soni said. “You are doing an incredible thing for your child and your family by getting them vaccinated.”

Read more on the Cedars-Sinai Blog: COVID-19 and Flu Shots Provide a Double Dose of Protection

“We’ve had patients come into our clinics testing positive for both COVID and flu,” said Caroline Goldzweig, MD, chief medical officer of the Cedars-Sinai Medical Network. “Having one doesn’t protect you from the other.”

Goldzweig said Cedars-Sinai’s primary care and urgent care offices have seen a steady rise in respiratory viruses since November. Their percentage of positive COVID-19 tests has doubled since then, rising to 14% of tested patients by the end of December.

The percentage of positive influenza tests in Los Angeles County more than doubled to almost 23% by the end of December. RSV, which mostly affects younger and older patients, peaked late in November, but 10% of tests for the virus in Los Angeles County are still positive.

Cedars-Sinai Medical Center also has seen a steady rise of COVID-19 patients since Thanksgiving, although these patients still remain a fraction of those cared for in the hospital’s 915 beds. Flu has followed a similar pattern.

Priya Soni, MD, a pediatric infectious disease specialist with Cedars-Sinai Guerin Children’s, has treated many young children and infants who have not yet been vaccinated against COVID-19 and come to the hospital needing oxygen. She recommends that babies get the COVID-19 vaccine when they’re eligible, starting at 6 months of age.

RSV also is dangerous for young infants. Expectant mothers should consider getting not only the updated COVID-19 vaccine but the newly available RSV vaccine as well, Soni said, if they’re going to deliver during respiratory virus season “so that the antibodies can protect your infant during their youngest and most vulnerable few months of life.” This is especially important because a new RSV immunization for infants is in short supply.

Soni added that it’s not too late for people of all ages to get the updated COVID-19 vaccine, especially with the further increase in cases experts are predicting over the next couple of weeks. It’s also not too late to get the flu shot. This year’s formulation is very effective against circulating influenza strains. A new RSV vaccine is also available for adults over 60, with the greatest benefit for those who are at higher risk because of chronic medical conditions.

“Remember to mask,” Soni said. “It’s a really effective way to protect yourself in very crowded situations and when you have a vulnerable family member.”

But Wait, There’s More

If a tripledemic weren’t bad enough, a fourth illness—superimposed bacterial infection—has been exacerbating an already challenging virus season, landing vulnerable patients in the hospital, said Soniya Gandhi, MD, associate chief medical officer at Cedars-Sinai.

“When you have these viral infections, there is a risk of superimposed bacterial infection,” said Gandhi, an infectious disease specialist. “And we have seen a rise in pneumococcal pneumonia as a superimposed bacterial infection on top of the viral illness.” 

Still another culprit has been appearing in Cedars-Sinai’s outpatient clinics. Goldzweig said the staff members have seen many patients with viral gastroenteritis, a stomach bug causing nausea, vomiting and diarrhea. The virus spreads through contact, likely making the rounds at holiday meals. Avoid it by not sharing food and washing hands after eating or visiting the bathroom.

Get Tested, Get Treatment

Flu, RSV and COVID-19 all share similar cold-like symptoms—nasal congestion, headaches, fatigue—plus muscle aches and fever. But it’s important to get tested to determine which virus, or viruses, might be causing symptoms.

“There's no way to tell specifically what you have without getting tested, so it's incredibly important to get tested early on during your illness because there may be specific treatment options depending on what you have, as well as specific recommendations regarding isolation and keeping you and your loved ones safe,” Gandhi said.

Gandhi said patients with COVID-19 may qualify for Paxlovid, which needs to be taken within five days of symptom onset or as soon as possible to be effective. Similarly, those with the flu might be prescribed Tamiflu, which must be taken within 72 hours of diagnosis to be effective.

For those who don’t know whether their sniffles or sore throat require a trip to the doctor, a virtual appointment can be a convenient first step. Adult patients in California can use Cedars-Sinai Connect, a new mobile app that provides quick access to Cedars-Sinai experts, who are available 24/7 for urgent issues. Same-day appointments also are available on the platform for primary care 

Mild symptoms can be managed virtually, Goldzweig said. Providers might recommend using a self-testing kit for COVID-19 or refer a patient for in-person testing or labs. Or they can follow up with a prescription if needed or advise on supportive care (fluids, Tylenol) to help patients manage symptoms at home. Goldzweig said patients with more serious symptoms—ongoing inability to tolerate food or fluids or prolonged dizziness—should visit urgent care.

For parents who want to prepare ahead of time for the possibility of a sick child, Soni recommends keeping a few things on hand: a humidifier to ease congestion and cold-like symptoms and a nasal suction device and saline solution to help clear mucus from a viral infection.

And all season long, she says, we should all “hydrate, hydrate, hydrate.”

Read more on the Cedars-Sinai Blog: COVID-19 and Flu Shots Provide a Double Dose of Protection

Flu season started early in the Southern Hemisphere, which typically gives experts some clues as to what we’ll experience here in the U.S. To avoid getting caught off guard, it’s important to get the flu shot in September or October, said infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai.

“Even a typical flu season can be deadly and can cause significant hospitalization,” Gandhi said, pointing to 58,000 deaths in the U.S. and more than half a million hospitalizations—all caused by last year’s flu. “We should do what we can to protect ourselves—and others—with the best tool we have: the flu vaccine.”

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during regularly scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment online through My CS-Link at clinics in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

In addition to the flu, COVID-19 and the respiratory syncytial virus (RSV) could again spike at the same time, triggering a “tripledemic,” Gandhi said. Last year, that same triple punch filled emergency departments across the country and strained children’s hospitals with young patients, who are vulnerable to RSV—a virus that can be serious, if not deadly, for infants and older adults.

But there’s a silver lining this year. In addition to the flu vaccine, new RSV shots are available for babies and adults over 60, and a new COVID-19 booster is coming this fall.

“These new shots and vaccines could really help protect us and our community during the upcoming season,” Gandhi said. “We need to preserve capacity in hospitals for those patients who really need that care.”

Help for Youngest and Oldest

RSV causes mild cold-like symptoms in most people, but it’s the leading cause for hospitalization among infants in the U.S. In babies, the virus can cause mild illness or it can cause dangerous inflammation in a child’s tiny airways.

“There's really no way to predict how your child would do even if they're completely healthy,” said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s. “If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures.”

Most children in the U.S. will be infected with RSV within the first year of their life, and almost all infants will have been exposed to the virus by the time they're 2 years old.

But parents of infants have a new way to protect their children. The U.S. Food and Drug Administration (FDA) recently approved an immunization—a monoclonal antibody treatment called nirsevimab-alip (Beyfortus)—that can be given as a single-dose shot to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season also can get the shot.

Soni said she “100%” recommends the immunization because of strong clinical trials that yielded positive results.

The FDA also recently approved a Pfizer RSV vaccine for women who are 32-36 weeks pregnant to protect their infants at birth. The same vaccine also was approved for adults 60 and older, as was another vaccine from pharmaceutical company GSK.

For older adults, the Centers for Disease Control and Prevention (CDC) recommended these new vaccines only for those who are at highest risk of severe RSV, such as patients with asthma, diabetes or heart failure. Although both vaccines are considered safe, a very small number of cases of Guillain-Barre syndrome—a condition in which a person’s immune system attacks their peripheral nerves—were reported after vaccination.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC. But the significant risk RSV poses to some older adults could outweigh the very low risk of developing potential side effects.

Sonja Rosen, MD, section chief of Geriatric Medicine at Cedars-Sinai, said that for now,  she recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness. “Patients should speak with their physician and make an informed decision about whether this shot is right for them,” Rosen said.

New Twist on the COVID-19 Booster

The new COVID-19 booster has been updated to include a sub-variant of Omicron called XBB, which was the predominant strain at the time the shot was approved by the FDA this summer.  The vaccine should provide protection from all the strains circulating in the U.S. right now, Gandhi said.

Thanks to the new booster, antiviral medications like Paxlovid and at-home tests, Gandhi is grateful that “we're in a very different position in 2023.” She encouraged the public to take advantage of the booster when it becomes available this fall, to keep themselves and their loved ones safe, especially when gathering throughout the fall and winter holidays.

“We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time,” Gandhi said. “I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion.”

She said it’s safe to get the COVID-19 and flu vaccines together. For older adults who determine with their physician that the RSV shot is right for them, they should get that immunization alone and two weeks apart from the other vaccines, if possible, Gandhi said. 

Read more on the Cedars-Sinai Blog: Flu—When to Go to the ER

What can you do to prevent ticks bites?

"There are several precautions to take before you hit the trails that can prevent bites, such as:

• Wear long-sleeved shirts and long pants. 
• Tuck the bottom of your pants into your boots or socks.  
• Apply tick repellent to clothing. Products with DEET will repel ticks and products with permethrin will kill ticks on contact.
• Avoid hiking in tall grass or heavily wooded areas because ticks tend to live and thrive in those areas.
• Try to hike in the center of the trail to reduce contact with ticks.

How do you check for ticks when you get home?

“The best place to inspect for ticks is in the shower. When you are inspecting your child check around the ears, near the hair line, under the arms, behind the legs and even inside the belly button because ticks like those crevices.”

How do you remove a tick?

“To remove a tick use a tweezer, and you want to apply the force of the tweezer at the base of the tick and  pull up. You don’t want to twist the tick off because you can leave parts of the tick inside embedded in the skin. If a tick is noticed within 24-hours of the hike or bite, and you are able to successfully remove it, the risk of transmission of any tickborne disease is very, very low.”  

What is the risk of Lyme disease?

“Thankfully, in Southern California, the risk of Lyme disease is much, much less than in other parts of the country, particularly in the Northeast. Most of the Lyme disease that we see here in Southern California actually comes from when a child or patient has traveled from the East Coast and they've been hiking there or have been in a summer camp, and they come back and they contracted Lyme disease from their exposure from these Lyme-endemic states in the Northeast.

“Ticks that carry the bacteria that cause Lyme disease can also carry other bacteria and cause infections known as Anaplasmosis and Ehrlichiosis. Symptoms of both can include fever, muscle aches, weakness and headache. Unlike Lyme disease, a rash is not as common. Symptoms usually occur one to two weeks after a bite from an infected tick. In both cases, they can be treated with proper antibiotics. Not every bite from an infected tick however, results in an infection.” 

What other bites do hikers need to watch out for?

"It's very important for parents to also understand that ticks are not the only thing that can bite you when you're out hiking in Southern California. We also often see infections that are caused by fleas. We call this "flea-borne typhus” and it is caused by a Rickettsial bacteria causing infection.  Animals that can carry these infected fleas include cats, wild possums, rats and mice. The infection is usually characterized by high grade fever, a rash as well as a bad headache. It's very important for parents to be aware that if their child goes hiking and has these symptoms, that could be from exposure to an infected flea.

Overall, the best advice is prevention, by wearing the right clothing and using repellents. But if you suspect someone in your family has a flea or tick infection, it’s important to let your doctor know you’ve been hiking to get the proper diagnosis."

Read more on the Cedars-Sinai Blog: Should You Exercise on the Beach?