As public health officials have been working to curb the measles outbreak that began last month at Disneyland, they have run into an unexpected challenge: Because measles was all but eliminated in the United States about 15 years ago, most younger physicians have never seen it.
So now a generation of doctors is getting a crash course via a combination of methods, including informal workshops, emails, fliers and old college textbooks.
On a recent morning, Dr. Greg Moran, interim chief of emergency medicine at Olive View-UCLA Medical Center in Sylmar, gave a quick seminar to a handful of residents, interns and other doctors during their daily huddle in the ER.
"Probably most of you young whippersnappers here have never seen a case of measles," he says, going on to explain when a rash might appear on a person with measles.
In fact, none of the students in the ad hoc workshop had ever seen a case. Before the development of a vaccine in the 1960s, hundreds of thousands of Americans got measles, and about 500 kids died every year, says Moran.
After the advent of the vaccine, the disease was eventually eliminated from the U.S. in 2000. Since then there have been only a relative handful of cases each year, when foreign tourists or traveling Americans bring the disease here.
Public health officials believe a foreign tourist or tourists started the measles outbreak that began at the Disney theme parks last month.
Moran says the daily huddle always focuses on something doctors don't often see. And with the current outbreak, he says, it’s critical that younger staff get a quick refresher on measles.
"None of us are going to see [measles] very commonly, but part of our training is looking for those things we don’t see very often," Moran tells the other doctors. "You have to think of the zebras every once in a while."
"The most important thing we need to know in the emergency department is ... you need to get [a measles patient] in isolation quickly," he tells the group. "Because measles is one of the most contagious viruses ever in the history of humanity, and it spreads very quickly, and it only takes a very brief contact to spread it."
Alexandra Dyer, a 29-year-old first-year resident at Olive View, appreciates this and other educational efforts.
"The attending [doctors] have put together mini-lectures for us, showed us pictures of the rashes. It’s hard to really understand the rashes that you’re looking for until you see them in real life," she says.
Besides re-educating physicians, the goal is to remind them to keep measles in mind as a possible diagnosis when assessing a patient.
To reinforce that message, Olive View has posted signs, and other hospitals have handed out instructional fliers to their staff.
Hospitals and county public health departments are also sending out emails with detailed information about how to identify and treat measles. At Kaiser Permanente, officials pulled together multiple sources to create a comprehensive email that includes links, photos, symptoms, protocols and other guidance, says Dr. Margaret Stone, who works at the Woodland Hills facility and is a member of Kaiser's Southern California infectious disease committee.
"Some of the younger physicians have never seen [measles]," she says. "Doctors are talking about it and sharing their knowledge."
The measles is not difficult to spot if you are looking for it, says Stone. Patients start out with a high fever, runny nose and signs of conjunctivitis (red eyes), and then develop a rash that starts in the face and moves down the body. The trick is to be on the lookout for it, experts say.
Dr. Melissa Orkin, a pediatrician at Kaiser Woodland Hills, says the outreach has been a big help.
"It is scary, since we've never seen it before," says the 32-year-old Orkin, adding that measles will now "be on the top of my list when I see a kid with a rash. Knowing to look for it now is important."
Dr. Danelle Fisher, immediate past president of the Los Angeles Pediatric Society, says members are brushing up on the measles, and the Society will highlight it in its upcoming quarterly newsletter.
Fisher, 43, says she's also cracked open her old medical textbooks and read up on measles in dermatology books and the journal Pediatrics.
"I've never seen measles; I've seen plenty of cases in textbooks, and I remember the Brady Bunch episode when they all had measles," says Fisher, who runs Westchester Pediatrics. "Every physician I know is consulting multiple sources to make sure the immediate info is correct and to remind ourselves what the symptoms are."
Fisher says during her rounds at Providence St. John’s and UCLA Medical Center, Santa Monica doctors are having informal discussions about measles, sharing pictures of the infection and getting up to speed, just like Moran and his crew at Olive View-UCLA Medical Center.
Olive View and other hospitals hope their impromptu classes will not only educate their staffs but will lead to better informed patients, especially when it comes to the decision to vaccinate their kids.