Tag: public health

A row of clear glass vaccine vials with a syringe resting against them on a grey background

Are You Still Protected From Measles? The 1963 to 1967 Vaccine Gap and What Adults Should Do

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Pennsylvania crossed a thousand measles cases this week. The state is at 1,078 across 41 counties, with 207 hospitalizations and five measles-associated deaths, and Lancaster County alone accounts for 401 of them. Nationally we are at roughly 3,880 cases. That is the highest annual total since 1991.

New York’s governor declared a disaster emergency on Monday so that paramedics, pharmacists and midwives can give vaccines. Florida’s health department held a hearing in Orlando on October 8 on dropping hepatitis B, chickenpox, Hib and pneumococcal from its school and daycare requirements. Measles is not among them. The MMR requirement is written into state statute, so only the legislature can touch it. Comment on the other four closed on October 19 and the rule has not been adopted.

Almost all of the coverage is about children, because that is where the cases are.

I have had one of these myself, by video. An unvaccinated child, high fever, body aches, and a rash whose appearance made me think measles before I thought of anything else. Looking like measles is not the same as being measles. Confirmation takes a swab for PCR and a blood sample for measles IgM, and neither of those travels down a camera, so that visit ended where it had to end, in a referral for testing in person.

That is the honest limit of the work I do. I could recognize it. I could not prove it.

The question I get by video is a different one, and it comes from adults. Some version of: am I still covered?

It is a better question than it sounds, because for a specific group of people the honest answer is no.

The 1963 to 1967 problem

There were two measles vaccines licensed in 1963. One was a live attenuated vaccine, which is the ancestor of the MMR we give now. The other was an inactivated vaccine, a killed-virus product that was pulled from the market in 1967 because it did not work well enough.

It did something worse than not working. Some people who got the killed vaccine and later met the real virus developed atypical measles syndrome, an unusually severe illness with high fever, an odd rash that starts on the extremities, and pneumonia.

So the guidance is specific. Anyone vaccinated before 1968 with killed measles vaccine, or with a vaccine of unknown type, should be revaccinated with at least one dose of live attenuated measles vaccine. If you are in a high-risk group, that becomes two doses.

The number of people affected is small. The CDC puts it at under five percent of adults. Immunize.org estimates fewer than a million Americans.

Here is the practical problem with a small number. Almost nobody born in that window knows which shot they got. The record, if it exists at all, is a line in a pediatrician’s file from sixty years ago, and that pediatrician has been retired for thirty of them. “Measles vaccine, 1965” does not tell you which product it was.

Which is why the rule says unknown type counts the same as known killed. If you cannot establish it was the live vaccine, you are treated as though it was not.

If you were born before 1957

You are presumed immune and you do not need anything.

That cutoff is not a guess about vaccines. It is a statement about how common measles was. Before the vaccine existed, essentially everyone caught it in childhood, so the assumption is that you already did, whether or not you remember it.

One exception, and it is the one that applies to me and to anyone else reading this who works in health care. For healthcare personnel, facilities should consider vaccinating staff born before 1957 who have no laboratory evidence of immunity and no laboratory confirmation of past disease. The presumption is good enough for the general public. It is not good enough for someone standing in a room with a febrile child.

Should you get a titer drawn?

Usually not, and this is where I disagree with how the question is often handled.

The CDC does not recommend routinely screening adults for measles immunity outside an outbreak area, and it does not recommend testing after vaccination to confirm it took. If you have documentation of two MMR doses, you are done. No blood draw adds anything.

A titer is useful in one specific situation, which is when you genuinely do not know your history and the result would change what happens next. Positive measles IgG means immune. Negative or equivocal means treat as non-immune, unless you meet one of the other criteria such as birth before 1957.

But consider the arithmetic before you order it. An MMR dose costs less than the antibody test in most places, takes one visit instead of two, and carries no penalty if you turn out to have been immune all along. An extra dose in someone who is already protected does nothing at all. It does not boost, it does not harm, it simply has no target.

So for most adults who are uncertain, getting the shot is faster and cheaper than proving you do not need it.

The exception worth naming is pregnancy. MMR is a live vaccine and is not given during pregnancy, so a woman who is pregnant and uncertain about her status gets the titer instead, and the vaccine afterward if she needs it.

About the death count, since you will see it argued about

Pennsylvania reports five measles-associated deaths this year. The CDC’s national count is two, and the CDC’s database does not say which states those two are in.

That gap is real and it is worth understanding, because it is being read as evidence of a cover-up in one direction and of inflated numbers in the other.

The mechanism is duller than either. The CDC moved to counting measles deaths from National Center for Health Statistics mortality data, which is built from death certificates and lists an underlying cause, rather than from state health department reports. NCHS data is designed to measure long-term trends across a population. It was not built to adjudicate individual infectious disease cases in the middle of an outbreak, and it runs on a slower clock, which is the substance of what the outside experts objecting to the change have said.

Pennsylvania uses a different definition: a laboratory-confirmed measles infection and death within thirty days of symptom onset, absent an obvious unrelated cause such as a car crash.

Both definitions are defensible. They will produce different numbers during a fast-moving outbreak, and the federal one will lag.

There is also a political layer, which I will describe rather than referee. The CDC initially included Pennsylvania’s first two deaths and then removed them pending review, after the Health Secretary publicly questioned whether measles had caused them. That detail was first reported by a Substack citing an anonymous CDC employee, so I hold it more loosely than the rest of this. The count later returned to two after NCHS verified one death. Pennsylvania has since conditioned its request for federal Epi-Aid assistance on the CDC publicly recognizing the state’s full count.

What I would say clinically is narrow. Of Pennsylvania’s five, two were unvaccinated adults, aged 18 and 40, and two were infants too young to be vaccinated. That pattern is what measles mortality has always looked like. It kills the unprotected and the too-young-to-protect, and it does so through pneumonia and encephalitis rather than through the rash anyone remembers.

As the infectious disease physician Amesh Adalja put it, to the public a gap like this looks like either incompetence or concealment. Neither is true here, and the fact that neither is true is not doing much to help.

What I would actually do

If you have records showing two MMR doses, nothing. You are protected and the protection does not fade.

If you were born before 1957 and do not work in health care, nothing.

If you were vaccinated between 1963 and 1967, or you have no idea what you got and you were born after 1957, get one dose of MMR. Do not spend three weeks trying to find a sixty-year-old paper record first.

If you are pregnant and uncertain, ask for the titer, and plan the vaccine for after delivery.

And if you have an infant under twelve months in a household traveling to an outbreak area, that is a real conversation with your pediatrician about an early dose, which is a thing that exists and is not widely known.

The Bottom Line

Measles is at a thirty-five year high, and the people getting sick are overwhelmingly children who were never vaccinated. That is a different problem from the one most adults are asking me about.

For adults, the short version is that the vaccine works, it does not wear off, and the only real gap is a four-year window in the sixties when a product that did not work well was in use. If you fall in that window or you simply cannot establish what you got, a single MMR dose closes it, and it is cheaper and faster than proving you were fine all along.

Related Reading

The Plague Death in Irkutsk: What We Know, What Russia Won’t Say, and Whether Americans Should Worry
2026-2027 Flu Shot: When to Get It, Which One, and Is Tamiflu Worth It?
2026 Travel Medicine Guide: Vaccines, Antibiotics, Safety Tips, and What You Don’t Need
H5N1 Bird Flu: What Every Patient Should Know Today
More on Infectious Disease

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

  1. Pennsylvania Department of Health Provides Statewide Update on Measles Outbreak as Cases Reach 1,078 in 41 Counties. Pennsylvania Department of Health, October 7, 2026. https://www.pa.gov/agencies/health/newsroom/pa-department-of-health-provides-statewide-update-on-measles-out9
  2. Measles cases surpass 1,000 in Pennsylvania amid the state’s largest outbreak in decades. ABC News, October 2026. https://abcnews.com/Health/measles-cases-surpass-1000-pennsylvania-outbreak-continues-spread/story?id=137002024
  3. Pennsylvania confirms fifth measles-associated death as US outbreak grows. Al Jazeera, September 30, 2026. https://www.aljazeera.com/news/2026/9/30/pennsylvania-confirms-fifth-measles-associated-death-as-us-outbreak-grows
  4. New York governor declares measles emergency. CT Mirror, October 7, 2026. https://ctmirror.org/2026/10/07/new-york-measles-emergency-hochul
  5. Vaccine change may bring largest measles outbreak ever. WGCU, October 7, 2026. https://wgcu.org/health/2026-10-07/vaccine-change-may-bring-largest-measles-outbreak-ever
  6. Measles Cases and Outbreaks. Centers for Disease Control and Prevention. https://www.cdc.gov/measles/data-research/index.html
  7. Measles Vaccine Recommendations. Centers for Disease Control and Prevention. https://www.cdc.gov/measles/hcp/vaccine-considerations/index.html
  8. Questions About Measles. Centers for Disease Control and Prevention. https://www.cdc.gov/measles/about/questions.html
  9. Ask the Experts: MMR (Measles, Mumps, and Rubella). Immunize.org. https://www.immunize.org/ask-experts/topic/mmr/
  10. Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR. https://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm
  11. CDC’s new tracking method for measles deaths puzzles experts. CIDRAP, University of Minnesota. https://www.cidrap.umn.edu/measles/cdc-s-new-tracking-method-measles-deaths-puzzles-experts
  12. Measles is spreading across the US and officials can’t agree on the death toll. The Conversation, 2026. https://theconversation.com/measles-is-spreading-across-the-us-and-officials-cant-agree-on-the-death-toll-293234
  13. Changes to CDC Vaccine Recommendations in 2025 and 2026. Congressional Research Service, IN12684. https://www.congress.gov/crs-product/IN12684
An empty hospital corridor lit by daylight from a row of windows, with no people present

The Plague Death in Irkutsk: What We Know, What Russia Won’t Say, and Whether Americans Should Worry

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Written October 6, 2026. This story is five days old and still moving. Dates and numbers below are what could be verified as of this morning.

A patient put it to me plainly on a video visit: do we have to be worried about a new pandemic with the Russia plague that is in the news?

Fair question. I did not give them a clean yes or no, because five days into something like this, anyone offering a clean yes or no is guessing.

Here is what I can tell you, and more usefully, here is what nobody can tell you yet.

A 28-year-old lab tech, four days, and a death certificate that says pneumonia

Darya Shipilova was 28 years old and worked as a laboratory technician at the Irkutsk Anti-Plague Research Institute in Siberia. On September 25, according to Russian media reporting, she broke a test tube of live bacteria while collecting samples. She was admitted to the hospital on September 29 with what her chart called pneumonia of unknown etiology. She died either October 1 or October 2, depending on which outlet you read, and the fact that we cannot pin down the date a woman died is itself a small piece of information about how much is being released.

Four days from the reported accident to the hospital. Two days from the hospital to the morgue.

Then the response. Roughly 197 people who had contact with her were identified, and 189 of them were hospitalized for observation, 114 at one facility, 63 at another, and 12 sent to the anti-plague institute itself. Contacts were isolated in a center that had been used for COVID patients. FSB officers started escorting the ambulances. By October 4 and 5, City Clinical Hospitals No. 1, No. 3 and No. 10, the Ivano-Matreninskaya Children’s Hospital and at least one maternity hospital in Irkutsk were under three-week quarantine.

That is a plague response. Three weeks is not an arbitrary number, it is roughly what you choose when you want to clear the incubation period of something serious and then clear it again.

The part of this that got reported backward

A lot of the coverage I have seen, and the version most people have in their heads, is that Russia said a test tube broke.

Russia said no such thing. Rospotrebnadzor, the state public health agency, has stated there was no accident involving pathogenic microorganisms at the institute, that no microorganisms associated with her professional work were found in her body, and that the epidemiological situation in Irkutsk and Shelekhov is stable. Her cause of death, officially, is pneumonia of unknown cause.

The broken test tube came from her. It is what she reportedly told the medical staff who admitted her, and it reached the public through Russian media rather than through any official channel.

So the official position is not that there was an accident. The official position is that nothing happened. Hold that next to the children’s hospital being closed for three weeks and you have the actual story of the past week. Plague has still never been publicly lab-confirmed in this case. Meanwhile the governor of Irkutsk Oblast, Igor Kobzev, met with Russia’s chief public health officer about “reports of a suspected case of a particularly dangerous infectious disease,” and the head of neighboring Buryatia said out loud that the death was linked to plague before his statement was quietly amended to something softer.

Two different words that look identical

Worth separating, because it explains some of the panic.

“Plague” means a specific bacterium, Yersinia pestis, which causes bubonic, septicemic and pneumonic disease and which has a known treatment. “Plague” also means, in ordinary English, any catastrophe that sweeps through a population. When a headline says plague in Russia, a sizable fraction of readers are not picturing a gram-negative coccobacillus that responds to doxycycline. They are picturing 1348.

Both meanings are legitimate. Only one of them is a diagnosis.

Could a broken tube really do this?

This is the question I find most interesting clinically, and the honest answer is that it is a stretch.

Simon Clarke, a cellular microbiologist at the University of Reading, put it about as well as it can be put: “an awful lot must have gone wrong for a lab worker to be infected by a broken test tube.” Work with a select agent happens inside layered containment. Biosafety cabinets, directional airflow, respiratory protection, procedures that assume breakage will eventually happen because over enough years it does. A tube hitting the floor inside a functioning cabinet is a cleanup problem, not an exposure. For that breakage to seed a fatal pneumonia, she likely had to be outside containment, or the containment had to be failing, or she inhaled a bolus at close range before anything could capture it.

Which brings up the thing I keep coming back to.

If she broke that tube on September 25 and knew it, she should have been on post-exposure prophylaxis within hours. The CDC’s recommendation is seven days of monotherapy: doxycycline 100 mg every 12 hours, or ciprofloxacin 500 to 750 mg every 12 hours, with levofloxacin and moxifloxacin now also first-line. That is it. Oral pills, generic, sitting in any pharmacy in the world including the one inside an anti-plague institute. Given promptly, the odds she ever became symptomatic drop toward nothing.

She presented on September 29.

I do not know whether she was offered prophylaxis and declined it, or reported the break late, or reported it immediately to someone who decided it did not warrant treating, or was treated and failed. Any of those is possible. What I would say plainly is that the four-day gap, not the bacterium, is the most likely reason a healthy 28-year-old died. Untreated pneumonic plague kills most of the people it infects, and it kills them fast. The treatment window is measured in hours after symptoms start, not days. Once you are four days past an inhalational exposure and presenting with pneumonia, antibiotics are being asked to do something they are not very good at.

That is a boring explanation. It is also the one that requires nothing unusual to be true.

Was it resistant? Was it modified?

Here is where I think the public conversation is making an understandable mistake.

You do not need an engineered organism to explain a fast death. You need a late diagnosis, which we appear to have. Adding a modified pathogen to the story explains something that is already explained.

That said, drug-resistant plague is not hypothetical, and this is the fact I would most want people to walk away with. In 1995 a patient in Madagascar with ordinary bubonic plague yielded an isolate called IP275, the first multidrug-resistant Y. pestis ever found. It carried a self-transmissible plasmid, pIP1202, conferring resistance to at least eight drugs used in plague treatment and prophylaxis, streptomycin and tetracycline and chloramphenicol and the sulfonamides among them. Nobody built it. The plasmid backbone turned out to be nearly identical to resistance plasmids from Salmonella Newport and from a fish pathogen, meaning Y. pestis had picked it up from the enormous reservoir of resistance circulating in agricultural bacteria.

Resistant plague already happened, once, by accident, in a patient in 1995. That is a better reason to pay attention than anything anyone has alleged about Irkutsk. We already live with the mature version of this problem in drug-resistant tuberculosis, and nobody had to engineer that either.

As for whether this particular organism was modified: there is no public evidence of it, and there is one piece of evidence against the scenario people fear most. If this were a highly transmissible engineered strain, those 197 contacts would be the first sign. As of the Rospotrebnadzor statements, they were not showing signs of illness. No secondary cases have surfaced publicly. A pathogen built to spread does not stop at one person.

The institute, and the thing that is actually true about it

The Irkutsk Anti-Plague Research Institute of Siberia and the Far East traces to a plague laboratory set up in Irkutsk in 1923 and was formally established in its current form on June 5, 1934. Its job, for ninety years, has been surveillance and containment of plague and other dangerous infections across Siberia and the Russian Far East. Plague is genuinely endemic in Central Asian rodent populations. An institute like this is the reason outbreaks there stay small.

And yes, the Soviet anti-plague network has a documented connection to Biopreparat, the covert Soviet offensive biological weapons program that weaponized plague, anthrax and tularemia. Igor Domaradskiy, one of Biopreparat’s founders, had previously run the anti-plague institutes at Irkutsk and Rostov-on-Don. That is history, not allegation.

What does not exist is any public evidence that the Irkutsk lab is developing plague as a weapon today, or that this death is connected to an offensive program. A facility with a Cold War lineage working on a pathogen endemic to its own region is not, by itself, a weapons story.

Running the conspiracy theories down

These deserve a real answer rather than a wave of the hand, so here they are, from least to most plausible.

It was deliberately released. No. There is no reason to release a weapon into your own closed city, kill one of your own technicians, and quarantine your own children’s hospital.

It is an engineered superbug and the contacts are already dying in secret. This requires 189 hospitalized people, their families and the staff of five medical facilities to all stay silent. Irkutsk has a population over 600,000 and functioning messaging apps. Containment of information at that scale fails, and it fails fast.

It is not plague at all, it is something worse they will not name. Possible in principle, and it is the theory I can least firmly rule out, because no confirmatory testing has been published. But the response fits plague. The duration of the quarantine fits plague. An institute that works with Y. pestis having a Y. pestis accident is the least exotic available explanation.

There is a much bigger outbreak than they are admitting. Partially plausible, and I would not be shocked. Not because of anything specific to Irkutsk, but because this is a system that denied the test tube ever broke while sealing hospitals. Under-reporting is the house tendency.

An ordinary lab-acquired infection, recognized late, in a bureaucracy whose first instinct is denial. This is almost certainly what happened. Every observed fact fits it: the four-day delay, the speed of death, the aggressive contact tracing, the official denial, the walked-back statement from Buryatia, the pneumonia-of-unknown-cause diagnosis that nobody has updated. Boring, tragic, and entirely consistent.

Can we believe them?

On the specifics, no. On the response, mostly yes.

Watch what a government does rather than what it says. Russia’s words say stable and nothing happened. Russia’s actions say particularly dangerous infection, and they committed real resources to a real containment operation. When those two diverge, believe the resources.

The US State Department’s comment struck me as about right: “Many details have not been confirmed. We encourage Russian authorities to share accurate information quickly and openly,” alongside the observation that plague “is a known disease and is treatable with common antibiotics.” The CDC says it is monitoring. President Trump said his administration is looking at it very strongly and that “anybody that has that kind of a problem, we’re always willing to help,” which, whatever else you think of it, is the correct posture toward an outbreak in a country you are not friendly with.

Clarke’s line about what actually controls an outbreak is the one worth keeping: transparency, rapid diagnosis, effective contact tracing. Russia is doing two of the three.

Is this the next COVID?

No, and I want to be specific about why, because “no” by itself has stopped persuading anyone and I understand why.

A lot of people came out of 2020 believing that COVID began in a laboratory. Whether or not that is what happened, and it remains genuinely unresolved, that belief is the reason a Siberian lab accident in 2026 lands differently than it would have landed in 2015. People are not being irrational. They are pattern-matching to the last five years, and they have been told before that there was nothing to see.

So, the differences that matter.

Yersinia pestis is a bacterium. SARS-CoV-2 is a virus. That distinction is not academic: we have had effective antibiotics against plague since the 1940s, every pharmacy stocks doxycycline, and treatment is cheap and oral. There was no equivalent for COVID in February 2020, which is why the whole fight there moved to vaccination instead of treatment.

Pneumonic plague spreads through respiratory droplets during close, sustained contact. It is not the long-range airborne spreader that COVID turned out to be. It does not do silent asymptomatic transmission for a week before anyone feels sick. It announces itself, violently, within a few days.

And it has never been good at sustained human-to-human chains in the modern era. In the United States, we average about seven plague cases a year, mostly in the rural Southwest from fleas and infected animals. Arizona had a fatal pneumonic case in Coconino County in July 2025, written up in MMWR, the county’s first since 2007. The last documented person-to-person transmission of pneumonic plague in the United States was in 1924, in Los Angeles. A century, with the organism present in our own rodents the entire time.

A pathogen that cannot start a chain cannot start a pandemic.

So should you buy N95s?

No.

Not for this. If you already own a box, you did not waste your money, and if you live where I do, wildfire season is a far better argument for keeping them than Irkutsk is. But buying respirators this week as a response to a plague death 5,000 miles away is spending money and worry on the wrong thing.

If you want a useful response to this story, here is one. Know whether you could get a doctor on the phone within 24 hours of getting sick. That is the variable that killed Darya Shipilova, four days of it, and it is the only variable in this entire story that you personally have any control over. The antibiotics work. Getting to them in time is the whole game.

I say that as someone who practices entirely by video, so treat it as the interested opinion that it is.

The Bottom Line

A 28-year-old technician at a Siberian plague institute broke a tube on September 25, went to the hospital on September 29, and was dead within about two days. Russia says there was no accident and no plague while quarantining five medical facilities and tracking 197 contacts. The most likely explanation needs no engineering and no conspiracy: a laboratory exposure that should have been met with seven days of doxycycline within hours, met instead with four days of delay. Plague remains treatable, remains bad at spreading between people, and has not caused person-to-person transmission in this country since 1924. Watch for confirmatory testing and for secondary cases among the contacts. Those are the two things that would change my read. Skip the N95s.

Related Reading

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2026-2027 Flu Shot: When to Get It, Which One, and Is Tamiflu Worth It?
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More on Infectious Disease

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

  1. Hospitals in Irkutsk impose quarantines after an employee at an anti-plague institute dies. Meduza, October 5, 2026. https://meduza.io/en/feature/2026/10/05/hospitals-in-irkutsk-impose-quarantines-after-an-employee-at-an-anti-plague-institute-dies-russia-s-public-health-agency-says-she-died-of-pneumonia-and-the-epidemiological-situation-remains-stable
  2. Nearly 200 People Under Observation After Irkutsk Lab Worker Dies From Plague. The Moscow Times, October 2, 2026. https://www.themoscowtimes.com/2026/10/02/nearly-200-people-under-observation-after-irkutsk-lab-worker-dies-from-plague-a93857
  3. Siberian Anti-Plague Institute Staff Isolated After Worker’s Death. RFE/RL. https://www.rferl.org/a/russia-plague-warning-siberia-irkutsk-laboratory/33870385.html
  4. Plague outbreak in Russia, expert comment by Dr Simon Clarke. University of Reading, 2026. https://www.reading.ac.uk/news/2026/Expert-Comment/Plague-outbreak-in-Russia-expert-comment
  5. Russia plague: What we know about the suspected case reportedly linked to a lab worker’s death. CNBC, October 5, 2026. https://www.cnbc.com/2026/10/05/russia-plague-suspected-case-irkutsk.html
  6. State Department monitoring reported fatal case of pneumonic plague. ABC News, October 2026. https://abcnews.com/US/state-department-monitoring-reported-fatal-case-pneumonic-plague/story?id=136992734
  7. Russian plague lab researcher dies as nearly 200 monitored: here’s what we know. Forbes, October 5, 2026. https://www.forbes.com/sites/siladityaray/2026/10/05/russian-plague-lab-researcher-dies-as-nearly-200-monitored-heres-what-we-know/
  8. Russian lab worker dies of suspected plague in Siberia; US monitoring case. Al Jazeera, October 5, 2026. https://www.aljazeera.com/news/2026/10/5/russian-lab-worker-dies-of-suspected-plague-in-siberia-us-monitoring-case
  9. Has plague returned to Siberia? Panic in Russia after death of lab worker. Euronews, October 4, 2026. https://www.euronews.com/2026/10/04/has-plague-returned-to-siberia-panic-in-russia-after-death-of-lab-worker
  10. The Siberian lab at the centre of a plague scare: its history, work and what it actually does. ThePrint. https://theprint.in/theprint-essential/the-siberian-lab-at-the-centre-of-a-plague-scare-its-history-work-and-what-it-actually-does/3063082/
  11. Recommended antimicrobial pre- and post-exposure prophylaxis for plague. Centers for Disease Control and Prevention, 2021. https://www.cdc.gov/plague/resources/PlagueProphyTreatmentTable_2021-P.pdf
  12. Nelson CA, et al. Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response. MMWR Recomm Rep, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312557/
  13. Welch TJ, et al. Multiple Antimicrobial Resistance in Plague: An Emerging Public Health Risk. PLoS One, 2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819562/
  14. Notes from the Field: Fatal Pneumonic Plague, Coconino County, Arizona, July 2025. MMWR, volume 75. https://www.cdc.gov/mmwr/volumes/75/wr/mm7538a2.htm
  15. Biopreparat, background on the Soviet biological weapons program. https://en.wikipedia.org/wiki/Biopreparat
Glass of water and digital thermometer on a bedside table

Measles Is Back: What Urgent Care and Telemedicine Clinicians Need to Watch For

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Measles is back in our daily practice in a way many of us have never seen in our careers. In just the first weeks of 2026, the United States has already recorded more than 900 confirmed measles cases, with most linked to active outbreaks rather than isolated travel related infections. Those numbers are not abstract. They reflect real patients who often first appear with what looks like an ordinary viral upper respiratory infection.

In Virginia, where some of my colleagues practice, the health department has already confirmed 10 measles cases this year, the majority in young children in the Northern region. Public exposure sites in that region now include grocery stores, urgent care centers, emergency departments, churches, and big box retailers, with symptom watch dates stretching into early March. That list reads like a map of daily life, which is exactly the point. Measles is circulating in the same spaces our patients and our own families move through every day.

Clinically, we know this pattern. Early measles often looks like influenza or another common respiratory virus, with fever, cough, coryza, and conjunctivitis. The rash, when it appears, typically starts on the face or hairline and then spreads down the body over several days. The catch is timing. Patients are contagious for about four days before the rash and about four days after it appears, which means they have already spent several days at work, school, religious services, or stores while shedding virus. On a virtual visit, we are often meeting them right in the middle of that window.

On a 24/7 virtual care platform, measles usually does not present with a red flag label in the chief complaint. Instead, it shows up as “fever and cough,” “pink eye,” or “rash on face” typed into a symptom field at 10 p.m. A typical encounter might start with a parent worried about a toddler who has had three days of high fever, a worsening dry cough, a streaming nose, and eyes that are red and watery. The parent may have tried acetaminophen and fluids at home and is now concerned because the child just looks wiped out. At that point there may be no rash, or the parent might mention a few faint spots on the forehead that they are not sure about.

The current outbreaks highlight just how contagious measles is. The virus lives in the nose and throat and is released into the air when an infected person breathes, coughs, or sneezes. It can remain viable in the air or on surfaces for up to two hours after the person leaves. This is why unannounced walk ins to clinics or emergency departments are so risky and why strict infection control and coordination with public health are not optional. One infectious patient who sits in a crowded waiting room can trigger a long chain of secondary cases.

From an epidemiologic standpoint, the current U.S. numbers are sobering. As of mid to late February 2026, national case counts have passed 900 and are now over 1,100, with infections documented in more than two dozen states. A large share of these cases are tied to ongoing outbreaks that began in 2025 and spilled into this year. The vast majority of patients are unvaccinated or have unknown vaccination status, often children and adolescents. Hospitalization rates vary by age, but recent CDC data show that even in 2024, several percent of cases required inpatient care, with higher risk among young children and adults. Measles can lead to pneumonia, encephalitis, and death, even in high resource settings.

On the Virginia Department of Health dashboard, six of the ten cases reported in 2026 have occurred in children under five years old, a group that cannot always be fully immunized yet and that we worry about the most. That number is the one I keep coming back to. Exposure notifications list locations like a grocery store in Lorton, multiple retail sites and restaurants in Manassas, a church, and an office building in Alexandria, each with specific time windows and follow up symptom watch dates 21 days out. It is easy to imagine the scenarios. A preschooler with early measles sitting in a shopping cart. A young adult with mild symptoms walking into an urgent care center after work. These are ordinary moments that turn into public health events.

For virtual care clinicians, the practical question is what to do when that next “simple viral illness” consult pops up in the queue. First, we cannot afford to ignore vaccination status. Every patient with upper respiratory symptoms, especially in outbreak regions, should be asked directly about MMR doses and prior measles infection. This includes adults who vaguely recall “getting shots as a kid” but are not sure which ones. Second, we need to look closely at risk factors: unvaccinated or incompletely vaccinated patients, infants who are too young for full immunization, immunocompromised individuals, pregnant patients, and anyone with recent travel to areas with known outbreaks or exposure to crowded settings.

When clinical suspicion is high, escalation needs to happen quickly and in a structured way. Patients should be referred for immediate in person evaluation and diagnostic testing in a setting that is prepared to implement airborne precautions. Instead of showing up unannounced at a clinic or emergency department, patients should call ahead, so infection prevention teams can arrange safe arrival and isolation. Coordination with local health departments is key. I haven’t hit real friction getting a family to follow that plan, since I haven’t had a suspected measles case reach that point yet. What I do run into, often, is patients, mostly kids, who are unvaccinated because a parent made that choice on purpose and says so plainly when I ask. On the Virginia site, there is even a specific survey link for people who may have been exposed, which triggers public health follow up. Similar mechanisms exist in other states and are often underused.

Virtual clinicians also have a clear boundary here. On the Teladoc platform, for example, management of suspected or confirmed measles is explicitly prohibited, and all such cases must be referred to in-person care. That restriction exists because measles care and infection control require physical assessment, access to testing, immunoglobulin and vaccine for post-exposure prophylaxis, and the ability to initiate supportive treatment for complications, none of which can be delivered over video.

Vaccination remains the core prevention strategy. Two doses of MMR vaccine provide about 97 percent protection against measles. Breakthrough infections can occur, but they are uncommon, and most cases in the current outbreaks are in people who are unvaccinated or not fully vaccinated. The Virginia data show that over 90 percent of the state’s population, and roughly 95 percent of kindergarteners, are vaccinated against measles, yet small pockets of under vaccination have still allowed the virus to spread. In every virtual encounter, we have a chance to answer questions, correct misinformation, and nudge patients toward getting up to date on their shots.

I haven’t personally managed a confirmed measles case over telemedicine. But here’s the kind of scenario clinicians in virtual care should be watching for, a hypothetical built from the pattern these outbreaks produce, not a real patient of mine: A college student logs on late at night with a fever, sore throat, and mild cough after returning from a service trip where they worked in crowded community settings. They mention that their university recently sent out an email about a measles exposure but they “think” they had all their vaccines as a child. As the clinician, you dig a little deeper, learn there is no documentation of a second MMR dose, and find that the student has started to notice a faint rash near the hairline. In that moment, treating this as a routine viral upper respiratory infection would be a miss. Instead, you walk the student through the concern for measles, arrange urgent in person evaluation, instruct them to call ahead before arrival, and notify your internal public health liaison to coordinate with the local health department. That single decision can prevent dozens of secondary cases in a dormitory and on campus.

The current surge of measles cases is a reminder that this disease remains an ongoing threat, one that follows gaps in vaccination and public health infrastructure. For those of us working in virtual care, our role is to keep it on the differential, ask the extra questions, recognize the pattern a day or two earlier, and move swiftly when suspicion is high. The work can feel routine until it is not. Two years ago I wasn’t asking about immunization status at every visit. I do now, at any health-related visit, and especially with kids. I’ve also changed how I handle a rash over video, because video alone is generally not as good quality as a high-resolution photo. Getting a usable photo takes some coaching. The patient needs to stand back far enough, get the angle right, and hold the phone steady so it isn’t blurry. I like a distance shot to see the whole pattern and a macro shot up close if the patient can manage it.

Centers for Disease Control and Prevention. Measles Cases and Outbreaks. Updated February 26, 2026. Available at: https://www.cdc.gov/measles/data-research/index.html. Accessed February 27, 2026.

Centers for Disease Control and Prevention. Measles Vaccination. Updated December 29, 2025. Available at: https://www.cdc.gov/measles/vaccines/index.html. Accessed February 27, 2026.

Centers for Disease Control and Prevention. Measles, Mumps, and Rubella (MMR) Vaccination: Information for Healthcare Professionals. Updated January 25, 2026. Available at: https://www.cdc.gov/vaccines/hcp/by-disease/mmr.html. Accessed February 27, 2026.

Virginia Department of Health. Measles. 2026. Available at: https://www.vdh.virginia.gov/measles/. Accessed February 27, 2026.

Virginia Department of Health, Office of Emergency Preparedness. VDH OEP Weekly Situation Update. Published February 19, 2026. Available at: https://www.vdh.virginia.gov/emergency-preparedness/2026/02/20/vdh-oep-weekly-situation-update-137/. Accessed February 27, 2026.

Virginia Department of Health. Virginia Health Officials Investigating Two Confirmed Measles Cases in Northern Virginia. News release, February 18, 2026. Available at: https://www.vdh.virginia.gov/news/public-relations-contacts/2026-regional-news-releases/virginia-health-officials-investigating-two-confirmed-measles-cases-in-northern-virginia/. Accessed February 27, 2026.

Robinson A. VDH: Measles outbreak not likely in Northern Virginia despite uptick in cases. ALXnow. Published February 22, 2026. Available at: https://www.alxnow.com/2026/02/23/vdh-measles-outbreak-not-likely-in-n-va-despite-uptick-in-cases/. Accessed February 27, 2026.

WSBT / Sinclair Broadcast Group. Measles cases surpass 1,100 so far in 2026 as outbreaks continue to spread. Published February 26, 2026. Available at: https://wsbt.com/news/nation-world/us-measles-cases-surpass-1100-so-far-in-2026-health-experts-warn-centers-for-disease-control-and-prevention. Accessed February 27, 2026.

Related Reading

Measles in 2025: What Patients and Providers Need to Know The Viral Rash: Exanthem Is Pertussis Contagious? Symptoms and Treatment Explained Can Telemedicine Diagnose Strep Throat and Ear Infections?

Scott Rennie, D.O.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Tuberculosis in 2025: Kansas Outbreak, Vaccines, and Staying Safe

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Tuberculosis is still very much with us. Kansas dealt with a large outbreak in 2025, a reminder of how persistent this disease can be. As of January 2025, more than 67 active cases had been confirmed, mostly in Wyandotte and Johnson counties. There were fatalities, and the number of latent infections was rising at the time. Public health teams worked hard to contain it. It’s a reminder that TB remains a threat in both high-risk groups and the general population.

What TB Is

TB is caused by Mycobacterium tuberculosis. It usually attacks the lungs, but it doesn’t stop there: it can affect the brain, kidneys, spine, and other organs. It spreads through the air when someone with active TB coughs, sneezes, or even talks, and people nearby can breathe in the bacteria without realizing it.

Symptoms and Progression

The first signs can be subtle. A cough that won’t go away, maybe three weeks or more. Some patients cough up blood or sputum. Chest pain, fatigue, fever, night sweats, loss of appetite, and unexplained weight loss are common. Left untreated, TB can destroy lung tissue and spread further, causing meningitis, bone infection, or failure of multiple organs.

Latent vs Active

It’s important to separate latent TB from active disease. Latent TB means the bacteria are present but not causing illness. The person has no symptoms and is not contagious. But the bacteria can “wake up,” especially if the immune system gets weaker, and turn into active TB.

Active TB means the bacteria are multiplying, symptoms are present, and the patient can spread it to others. That’s the form that requires urgent treatment.

How It’s Detected

Testing matters. The skin test (the PPD or tuberculin test) is still used. A small injection under the skin, and the site is checked in 48 to 72 hours. Blood tests like QuantiFERON-TB Gold or T-SPOT.TB are often preferred, especially for people who got the BCG vaccine, since it can interfere with skin test results.

If TB is suspected, chest imaging can show lung changes, and sputum culture confirms the presence of M. tuberculosis. That culture is the gold standard for diagnosis in someone with symptoms.

The Role of the BCG Vaccine

The only vaccine we have is BCG. It’s mostly given to infants in countries where TB is widespread. It helps protect children from the most severe forms of TB, like meningitis, but it’s less effective at preventing pulmonary TB in adults. In the United States, it’s not routinely used because of its limited impact on adult disease and the way it interferes with skin testing.

Some healthcare workers in high-risk settings or people with repeated exposure may still receive it.

Protecting Against TB

Vaccination isn’t the whole answer for TB. Early detection and treatment carry just as much weight, maybe more. People at higher risk should be screened regularly, and treating latent TB is critical, because it stops progression to active disease.

Simple steps help too: masks in healthcare settings, good airflow in crowded places, covering your mouth when you cough, washing your hands regularly. During outbreaks, N95 or P100 respirators are the masks that actually filter TB bacteria from the air. Surgical masks don’t provide the same protection.

Treatment and Why It Has to Be Completed

TB can be treated, but it takes time. Standard therapy is multiple antibiotics for six to nine months. Isoniazid, rifampin, ethambutol, and pyrazinamide are the most commonly used.

Stopping treatment too soon is dangerous, because that’s exactly how drug-resistant TB develops, and multidrug-resistant TB is much harder to treat, far more expensive, and comes with worse outcomes across the board. An incompletely treated patient is also still contagious. Public health departments often use directly observed therapy, or DOT, where someone watches patients take their medications. It might sound strict, but it works. It prevents resistance and saves lives.

Public Health and What’s Next

TB is a problem here at home, and the outbreak in Kansas proves it. It spreads any time we let our guard down. Healthcare providers need to push for routine testing in high-risk groups, make sure patients complete treatment, and support public health efforts.

Patients and communities have a role too: stay informed, recognize symptoms, seek evaluation early. And we need continued research into better vaccines and treatments.

Related Reading

Tuberculosis: A Growing Problem in the Seattle Area Antibiotic Resistance Could End Modern Medicine, WHO Warns Is Pertussis Contagious? Symptoms and Treatment Explained Pneumonia: Viral, Bacterial or Walking? Am I at Risk?

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

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