ADHD and lifespan; preventing measles; eating at parties: Upstate Medical University's HealthLink on Air for Sunday, March 16, 2025

Host Amber Smith: Coming up next on Upstate's "Health Link on Air," a professor discusses why people with attention-deficit/hyperactivity-disorder may have shorter lifespans.

Stephen Faraone, PhD: ... People with ADHD we know are at increased risk for accidents. Kids who are impulsive run into the street, chasing a ball, and maybe get hit by a car. Adults who are driving and have ADHD, not being attentive, can get into an accident. So these accidental causes certainly account for some of these deaths. ...

Host Amber Smith: And an infectious disease doctor reminds us what's important to know about the highly contagious measles virus.

Jana Shaw, MD: ... Measles is one of the most contagious viruses we know. It is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected. ...

Host Amber Smith: All that, plus healthy party foods, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we go over the signs and symptoms of measles and how to prevent the contagious disease. But first, why do people with ADHD have shorter lifespans than the general population?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Adults with attention-deficit/hyperactivity disorder die earlier than their counterparts in the general population, according to a recent study. At the same time, health care providers are diagnosing a growing number of adults with ADHD. For help understanding what's going on, I'm talking with an expert ADHD researcher from Upstate, Dr. Stephen Faraone. He's a Distinguished Professor of psychiatry and behavioral sciences.

Welcome back to "HealthLink on Air," Dr. Faraone.

Stephen Faraone, PhD: Happy to be here, Amber.

Host Amber Smith: This study about life expectancy is from the British Journal of Psychiatry.

Can you tell us about it?

Stephen Faraone, PhD: Yes. It's a study of 3,000 people in the United Kingdom where the researchers had access to their medical record data and their diagnosis of ADHD. And they did what several other researchers have done around the world. They looked at mortality, dying, and they found, as some other people have, that people who have ADHD have an increased risk for dying younger, compared to people who don't.

In the British study, it was about an average, I think, seven years earlier for men, and nine years earlier for women.

Host Amber Smith: So do you think similar results would be found if we looked at this in the U.S. population?

Stephen Faraone, PhD: In fact, similar results have already been found in the U.S. population. There's at least, I think there've been, four studies in the United States that looked at mortality in people with ADHD, and all of them except one found the same thing the British, my group, found: that if you have ADHD you're at higher risk for dying.

And in fact, there've been studies around the world, studies in Denmark, studies in Taiwan, other countries around the world, and these studies were recently pooled together in what's called a meta-analysis, where all the studies got put together in the same paper, to see what they say as a group.

And this meta-analysis concluded that not only was there an increased risk for mortality in ADHD, but it was essentially the same in males and females. So both males and females with ADHD are at increased risk.

Host Amber Smith: Well, let's talk about the possible reasons for that. What are the health risks associated with an ADHD diagnosis?

Stephen Faraone, PhD: So this is really interesting, Amber, because, the first thing I'll tell you is that in the meta-analysis, what they found was that the increased premature deaths in people with ADHD were due to accidental injuries or unnatural causes, not natural causes.

That's pretty interesting. It means that people with ADHD we know are at increased risk for accidents. Kids who are impulsive run into the street, chasing a ball, and maybe get hit by a car. Adults who are driving and have ADHD, not being attentive, can get into an accident. So these accidental causes certainly account for some of these deaths.

We also know there's increased risk for suicide among people with ADHD, and that's another reason for the increased mortality. Now, I was surprised that natural causes of death, meaning people dying from diseases like cardiovascular disease, diabetes, et cetera, were not increased in people with ADHD, because ADHD does carry with it an increased risk for a variety of disorders, including cardiometabolic disorders like diabetes.

Host Amber Smith: But people with ADHD are not dying in higher numbers because of that.

Stephen Faraone, PhD: Correct. They're not dying in higher numbers because of that. And that's good news. It means, probably, that when they occur, their medical disorders are being appropriately treated.

Host Amber Smith: So are there things the health care system could do better that would help lengthen the lifespans of adults with ADHD?

Stephen Faraone, PhD: Essentially, treatment is what is needed. There's at least one study that shows that people with ADHD who are treated for their disorder are less likely to die young than people with ADHD who are not treated, and we know they're less likely to have accidents.

So it's very clear that the No. 1 thing that can be done is that people with ADHD are identified by the health care system, and they're appropriately treated with the current medications and therapies that we have available for them.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Upstate psychologist and ADHD researcher Dr. Stephen Faraone about attention-deficit/hyperactivity disorder.

We've talked about life expectancy with this diagnosis, and now I'd like to ask you about an increase in first-time ADHD diagnoses among adults 30 and older.

A health care data and analytics company reports that the rate of first-time diagnoses rose about 61% among people aged 30 to 44 and 64% among people aged 45 to 64.

This was from a database of 30 health systems that included more than a million people who were diagnosed. Do you think this would hold true across the general population?

Stephen Faraone, PhD: I think it does. In fact, there were data that were published last year by our Centers for Disease Control, and they show the same thing.

There's been over the last number of years, few years, a gradual increase in the diagnosis of ADHD in adults. The good news is that the diagnostic rates are approaching the expected population rate. We know from population studies, where an epidemiologist goes out and knocks on doors and interviews people, that the true prevalence, if you will, of ADHD in the population is roughly 5%-6%.

The CDC rates are now approaching that level. and what's even more interesting is that the greatest increase in diagnoses we're seeing now is for females and not males. And the reason for that is because there is an under-diagnosis of girls at younger ages. Many children, adolescents with ADHD, even in their 20s, you're less likely to be diagnosed with ADHD if you're female than if you're male.

That switches when you're older. When you're older, females are more likely to be diagnosed than males.

Host Amber Smith: Are you seeing more adults asking if they have ADHD, thinking that they've got some symptoms and maybe ought to be diagnosed?

Stephen Faraone, PhD: If we kind of rewind back to the 1990s, when I first started studying adult ADHD, back then, many people believed that ADHD disappeared in adulthood.

In fact, I had to write a paper that basically showed that that was wrong. There was a paper published in the American Journal of Psychiatry that said ADHD disappeared in adulthood. That was wrong. I knew that was wrong from my own clinical experience and research and published a paper that basically showed that it was wrong, that children with ADHD grow up; roughly two-thirds continued to have ADHD into adulthood.

So we know that ADHD in adulthood is real. What's happened is that because many people, including myself, have done lots of work studying adult ADHD from many perspectives, including treatment, genetics, neuroimaging, it's now very clear that it's a valid diagnosis to make in adults.

It takes a long time for that information to seep into the population, and also into the population of health care providers. But now it seems that most, if not many, health care providers know about this, and they're starting to diagnose and treat the disorder.

Host Amber Smith: So these adults that are diagnosed with ADHD now, were they just never diagnosed as children or do these ADHD symptoms just emerge later in life in some people?

Stephen Faraone, PhD: So what happens is that there are different kinds of ADHD in adulthood. There are some adults who have had ADHD since childhood, and it was identified, treated, and so forth, and by adulthood, they continue to be treated.

There's another group of adults that had ADHD in childhood. They clearly had it from taking their history, but they just weren't treated. Those tend to be the females because girls with ADHD are primarily inattentive, whereas boys with ADHD are more likely to be hyperactive, impulsive and very disruptive.

So when you're a child, you get referred to mental health (providers) if you cause problems for other people. If you're an adult, you refer yourself when you're feeling that you have problems. So when the girls grow up, they realize that, "Hey, I've got a problem. I'm going to refer myself for treatment."

Host Amber Smith: So do you think ADHD is overdiagnosed or underdiagnosed?

Stephen Faraone, PhD: I think neither is true. I think that for any medical disorder, sometimes people overdiagnose, certain doctors might overdiagnose it, certain doctors might underdiagnose it. What people need to understand: that ADHD, when you think of it as a disorder, it's very much like hypertension (high blood pressure) or obesity, or hypercholesterolemia, high cholesterol levels.

Everybody has a blood pressure. Everybody has a cholesterol level, and doctors have to decide: Where's that cut point where I decide to treat somebody? And that cut point, we have it clearly defined in our diagnostic manuals, but sometimes somebody comes in, an adult with ADHD, for example, might come in, and they might not quite meet the diagnostic criteria.

It's sort of like someone who has sub-threshold hypertension. They don't really meet the criteria for hypertension, but the doctor might decide to treat the hypertension because of other reasons. And so sometimes when people say there's overdiagnosis, they're referring to people who basically have lots of ADHD symptoms and are impaired. They just don't meet the full diagnostic criteria by the book. I think it's wrong to call it overdiagnosis because in many cases that's simply a physician or a nurse practitioner or a psychologist doing the right thing for the patient.

Host Amber Smith: I see. So what are the most common symptoms for adults? And that's going to differ between women and men, right?

Stephen Faraone, PhD: Well, actually the symptom complex does differ. What happens, though, is that in childhood, the three sets of symptoms for ADHD are inattention, impulsivity and hyperactivity. And they're all very apparent in childhood. Although with girls, they tend to be more, mostly inattentive. As children with ADHD age, what happens is that the symptoms of hyperactivity/impulsivity tend to attenuate.

So for example, a child with ADHD might be running around climbing on furniture, really being super hyperactive and disruptive because of it. Adults with ADHD don't run around and climb on furniture, but they do experience other effects of hyperactivity, such as they don't like sitting still.

So an adult with ADHD, for example, doesn't like to be in a conference room for an hour or two, just sitting still in the chair. And all of us who have been in conferences where we have to sit for a while, there are some people that just get up and pace around. I'm not saying they all have ADHD, but they might because that's a typical response of a person with ADHD.

Now, in adulthood, yes, the women tend to continue to be more attentive, but the men also tend to be more attentive as well. And so some of us have argued that in adulthood, we should also consider other symptoms or other features of ADHD that are not officially diagnostic, such as difficulties with regulating one's emotions.

That's currently under debate. And it may end up being in a future diagnostic manual.

Host Amber Smith: If children are diagnosed with ADHD early, as kids, can they be treated so that they're not experiencing symptoms of ADHD as adults, or is it a lifelong treatment that they are on?

Stephen Faraone, PhD: It differs for different kids. Some children who were treated will continue to have some symptoms, but the treatment will help them. But it won't help them completely. Those are the more severe cases of ADHD, and they will likely need lifelong treatment.

Other children with ADHD will remit their symptoms, and they won't need lifelong treatment.

And that's why sometimes in adolescence and young adulthood, the treatments will stop for a while. The doctor will say, let's stop treatment for a few weeks or a month, see how you're doing. Because the ADHD itself may have remitted.

There's some evidence that the kids who remit their ADHD are more likely to have changes in their brain that make their brains more typical than other kids with ADHD who don't remit, although we're not sure if those brain changes really cause the remission. And there's other evidence that suggests that kids that are treated in childhood and adolescence are more likely to remit their ADHD than others.

Host Amber Smith: How is ADHD typically treated in adults?

Stephen Faraone, PhD: In adults it's treated with, Basically the same medications that kids are treated with, and that's methylphenidate, which most people know as Ritalin or Concerta, and amphetamines, which most people know as Adderall or Vyvanse, although there are many other brand names for those medications. Those are are called the stimulant medications.

There's another set of medications called nonstimulant medications, such as atomoxetine, extended-release fluoxetine, guanfacine and clonidine. These are also used to treat ADHD in adults and children.

Host Amber Smith: Do the ADHD medicines work OK with other medications that adults may be taking? I'm thinking diabetes or heart disease. ...

Stephen Faraone, PhD: It's always important that when one is prescribed a new medication, that the doctor checks to make sure that medication is not going to cause a problem because it may interact in an adverse way with another medication.

It's very medication specific. There's sometimes two medications shouldn't go together. Usually it's not a problem, but people should always either ask their doctor, or actually, the pharmacists know a lot about this, too, and they can always check with their pharmacist to be sure that If they're prescribed a medication for ADHD, it's not going to cause a problem. It typically does not cause problems.

Host Amber Smith: Well, getting back to longevity, if ADHD is properly treated, will that improve a person with ADHD's life expectancy?

Stephen Faraone, PhD: There are some data that suggests that yes, that people with ADHD that have been on medication are less likely to die younger than other people, which makes sense, because we know the medications protect them against accidental injuries, which is one of the major causes of premature death in ADHD.

Host Amber Smith: Well, this has been very interesting. I thank you for your time.

Stephen Faraone, PhD: Happy to be here. Thank you, Amber.

Host Amber Smith: My guest has been Dr. Stephen Faraone. He's a Distinguished Professor of psychiatry and behavioral sciences at Upstate, specializing in ADHD research.I'm Amber Smith for Upstate's "Health Link on Air."

What's important to know about measles? Next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Measles is a highly contagious virus that can have severe complications, including death, but is easily preventable by a childhood vaccine. So why are we seeing clusters of measles cases popping up in schools and communities?

My guest, Dr. Jana Shaw, has the answers. She's a professor of pediatrics and of public health and preventive medicine at Upstate.

Welcome back to "HealthLink on Air," Dr. Shaw.

Jana Shaw, MD: Thank you for having me, Amber,

Host Amber Smith: A measles vaccine was first available in the early '60s. Have we studied what the response was like at that time?

Jana Shaw, MD: Yes, we have some historical and research records that describe the reception of the measles vaccines in the early 1960s. As you and the audience may remember, the first vaccines were available in 1963, and around that time, there was a blend of enthusiasm and skepticism among the public about the vaccine.

Before the vaccine's advent, measles posed a prevalent and serious threat to childhood health, prompting anticipation for a solution among parents and health care providers. However, there existed also a perception of measles as a benign, essentially not serious, infection that offered a lifelong immunity, and that has complicated the public's understanding of vaccination benefits.

In contrast to diseases like smallpox, for example, and polio and diphtheria, which instill fear and were nearly eradicated in the U.S. through vaccination efforts, measles appears to be a more manageable target due to its lack of chronic carriers and nonhuman reservoirs. So initially the immunization campaign was challenged by this lack of perception that measles is a serious infection in children and that vaccine may not be needed.

In addition, the initial vaccination campaigns in 1967 yielded promising results, and there was a significant reduction in measles cases. However, this sense of progress was sort of short-lived, as cases resurged in subsequent years. It became evident that while vaccination protected certain communities, disparities persisted, with measles disproportionately affecting marginalized populations.

So similarly to today, we still see, for different types of vaccines, that some populations are more or less protected against vaccine-preventable diseases. And some of the concerns are due to access to vaccination or perceived lack of safety or efficacy of vaccination. So those sentiments were not all that different.

Host Amber Smith: What was the death rate for measles like before the vaccine became available?

Jana Shaw, MD: Before the widespread availability of the measles vaccine in the early '60s, the death rate from measles in the United States was notable and varied. The historical data suggests that the mortality rate ranged from approximately 0.2% of reported cases. In other words, that means that for every thousand reported cases of measles, approximately two to three individuals would die from the disease.

However, it's also important to recognize that these statistics may fluctuate based on factors such as access to care and demographic disparities and the presence of concurrent health issues.

In addition, death is only one of the outcomes of measles. But measles can also lead to a number of complications, and in roughly 30% of cases, children or adult can develop diarrhea. It's one of the most common complications, and most of the deaths will primarily occur from infection of the respiratory tract or brain swelling.

And the complications are more common, also, of course, in low-income countries, where the fatality rate can be as high as 4% to 10%.

Host Amber Smith: So were parents back then eager, or were they skeptical, about getting their kids vaccinated?

Jana Shaw, MD: So initially, parents were open to vaccination, with some of the hesitation that I have shared about the need for the vaccine, because in those years, measles was perceived as an infection of childhood that led to lifelong immunity.

And by some parents, it was actually celebrated, compared to smallpox and other serious infections like polio -- those were feared by parents. Measles was less feared, hence the public health officials really had a challenge to help parents understand that measles, although it's perceived as not particularly severe, can have serious complications and can lead to death.

Host Amber Smith: So something must have worked because vaccination pretty much eradicated measles, right? A few years ago, we were talking about it being eradicated.

Jana Shaw, MD: Yes, measles was eliminated, rather than eradicated, in the U.S. in 2000. And in fact, before the initiation of the measles vaccination program in 1963, there were an estimated 3 million to 4 million individuals who contracted measles annually in the United States, and that is essentially the U.S. birth cohort.

Among the reported cases, and, typically, there would be 500,000 cases officially reported, which was a severe underestimation of the burden of the infection, 500 of those would result in death, and 50,000 would lead to hospitalization, and 1,000 individuals, on average, would develop brain swelling due to measles.

So prior to the vaccination program, we had seen a large burden of serious infection and complications from measles, which has led to substantial decline, when in 2000 in the U.S., measles was declared to be eliminated, which essentially means that there is an absence of continuous disease transmission for more than 12 months.

Host Amber Smith: So why are we hearing about outbreaks of measles now?

Jana Shaw, MD: Well, I think the answer will be self-evident as I sort of walk through some of the numbers and the reasons that led to the emergence of measles outbreaks.

For example, in 2009, the United States experienced one of the largest numbers of measles cases since 1992.

There were over 1,200 cases reported, and these outbreaks were sparked by the international importation of the virus by unvaccinated individuals, mostly Americans, and the majority of those cases in the U.S. occurred among individuals who deliberately chose not to receive the vaccine.

So those were cases among individuals who were intentionally unvaccinated. And because measles is so contagious, it facilitates its rapid spread, and it leads to outbreaks in communities that are under-vaccinated.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking about measles with pediatric infectious disease specialist Dr. Jana Shaw.

So let's talk about how contagious measles is. Just for example, if one kid who's infected in a class of say, 20 students, how many other kids might become infected?

Jana Shaw, MD: That's an important question, because measles is one of the most contagious viruses we know. It is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.

Infected people can spread measles to others from four days before, through four days after, the rash appears. And the risk of transmission is highest when the symptoms may be similar to other respiratory infections, cough, runny nose, fever and sore throat and pink eye. And those are difficult to pinpoint as measles, so at times when people are infected, they may not know they have measles because the symptoms are similar to other respiratory tract infections.

Host Amber Smith: So does this spread through the air when someone coughs or sneezes?

Jana Shaw, MD: Yes, measles spreads through the air. It's called airborne virus, and it spreads through coughing and sneezing.

For example, if other people breathe the contaminated air or touch the infected surfaces and then touch their eyes and noses or mouths, they can become infected. Measles virus can also live up to two hours in an airspace after an infected person leaves an area.

Measles virus is a human species virus, and animals do not spread the measles virus. It's one of the important distinctions from other viruses.

Host Amber Smith: So in that classroom with 20 students, if one is infected, if the rest of them are vaccinated, are they safe from contracting this?

Jana Shaw, MD: Most children who have received two doses of measles, mumps, rubella vaccine would be protected against measles even if the infected individual will enter the classroom. However, it's really important to remember that although measles vaccine works really well, it also is not 100% protective.

In addition, in a classroom, we typically do have some children who either cannot be safely vaccinated or have received maybe measles vaccines but have subsequently developed a condition that sort of weakens their immune system, and, as such, those children will be vulnerable to measles.

So it's really important to remember that the measles immunization program that was rolled out in the '60s in the United States, along with the immunization vaccine requirements, has strengthened the program, but there are still children who are vulnerable to measles, either because they could not be safely vaccinated, or they might have lost protection due to their condition, and therefore it's really important that all who can be safely vaccinated receive the vaccine.

Host Amber Smith: Let me ask you, what happens if there's a measles outbreak in a school and a parent decides to send an unvaccinated child to school anyway?

What is likely to happen in that scenario?

Jana Shaw, MD: The child will contract measles. measles is so contagious, that unless you have an immunity against the virus, you will develop an infection, and hopefully you will not go on developing complications, but you will end up infected.

I should also mention that vaccination alone, for some individuals, if it does not protect them from infection, it will lessen the severity of your disease, so there is additional benefit of vaccination. Not only you are most likely to be protected from infection, but for those with immunity that may not be as strong after vaccination, they are unlikely to develop serious disease.

I should also mention that most schools, and immunization laws for school entry, differ by state, most schools will not allow an unvaccinated child to be at school when there is an ongoing measles outbreak. In fact, it's one of the clauses in immunization law for schools, where children will have to be excluded from school if they are not vaccinated and there is an outbreak.

Host Amber Smith: So if an unvaccinated child, or I guess any child, is exposed to measles and contracts measles, are they likely to spread it to other people as well?

Jana Shaw, MD: Absolutely. Yeah, measles is so contagious that the virus can be easily spread to others. And the question is, how many other people can contract virus from that child?

And that will very much depend on the community immunity, or what we used to refer to as herd immunity, right? If a child lives in a community where a lot of children are unvaccinated, essentially there are pockets of unvaccinated individuals that child will spread the infection to all those who are unvaccinated and the child comes into contact with, and in addition to adults who might have lost protection over time or might have chronic conditions that weaken their immune system, such as adults living with cancer or receiving medications for the rheumatological conditions that weaken their immune system.

Host Amber Smith: Well, let's talk about the measles vaccine that's available today, that's on the market today.

How do we know that it's safe?

Jana Shaw, MD: We know the vaccine is very safe because we have ongoing vaccine safety surveillance systems in the United States. The vaccine safety surveillance continues even after vaccine is licensed, so that doesn't mean we stop looking for safety, especially because clinical trials may not be large enough to account for very rare complications.

As such, we know that the measles vaccine is very safe because we continue to look for serious adverse events following vaccination. So as such, we have data that points to the safety of the vaccine. So it's not that we relied on the clinical trial alone. We continue to monitor and look for signals or concerns that could be associated with vaccination. And those signals or events are carefully evaluated by experts in public health, in pediatrics, in infectious diseases, and those who understand how to establish causality.

Host Amber Smith: So I think the measles vaccine is part of MMR: measles, mumps, rubella. But isn't there a version that also protects against the chickenpox?

Jana Shaw, MD: Yes, you are right. There are two different types of vaccines, MMR and MMRV. The MMR stands for measles, mumps, rubella, while MMRV adds protection against varicella, commonly known as chickenpox. Both vaccines are typically administered at ages 12 to 15 months and 4 to 6 years of age.

In certain cases, Amber, the child's health care provider may choose to delay MMRV vaccination to a later appointment or recommend separate MMR and varicella vaccines instead of using MMRV unless there is a specific preference for the MMRV vaccine expressed by the parent or caregiver.

CDC (Centers for Disease Control and Prevention) recommends that we administer MMR vaccine and varicella vaccine separately for the first dose, in the 12 to 15 months of age. And that is because compared to the use of separate MMR and varicella vaccines at the same time, administering the MMRV vaccine resulted in one fewer injection, but it was also associated with a slightly higher risk of fever and febrile seizures. And, therefore, the use of separate MMR and varicella vaccines is recommended for those children 12 to 15 months of age to reduce that risk. However, for the older children, at 4 years of age, the use of MMRV vaccine is generally preferred over the separate injections because it's one less shot, essentially.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned for more about measles with Dr. Jana Shaw.

Welcome back to Upstate's "HealthLink on Air." This is your host, Amber Smith.

My guest is pediatric infectious disease specialist Dr. Jana Shaw. We're talking about measles.

So do we know if these childhood vaccines confer immunity lifelong?

Jana Shaw, MD: Yes. The measles vaccines typically provide a long-lasting immunity for the majority of individuals who receive it during childhood. And studies have shown that the measles vaccine induces a strong and durable immune response in most people, and it leads to 99% immunity among those receiving two doses.

There are some exceptions, though. A small percentage of individuals may experience waning immunity over time, especially as they age, and additionally, in rare cases, vaccine failure can occur, meaning that some individuals may not develop sufficient immunity after vaccination.

In addition, while antibody titers may decrease over time, studies also indicate that most individuals with waning titers also have what we call anamnestic response to revaccination, suggesting sustained immunity. So that essentially suggests that even if you receive two doses of MMR vaccine, and maybe you lost titers over time, when you're exposed to the virus or to a booster dose, you would develop heightened immunity, suggesting that those cells that are responsible for immune memory are there lifelong.

Host Amber Smith: You use the phrase " titers." What is that?

Jana Shaw, MD: Titers stands for, essentially, a level of antibodies. Antibodies are molecules that protect us from infection. The antibodies differ by the type of infection. For measles, for example, after infection or vaccination, our immune system responds by releasing antibodies that then serve to neutralize the virus on exposure.

Host Amber Smith: Now, these are vaccines that are meant to be given in childhood, but if there's somebody who wasn't vaccinated as a child, can they still be vaccinated against measles as an adult?

Jana Shaw, MD: Yes, adults can be safely vaccinated against measles as well. And, in fact, adults who have not either had measles or have not been vaccinated should be vaccinated against measles, because, as we know, even in the U.S., even if you don't travel anywhere, it's possible that you may be exposed to someone who has traveled and has brought measles to the country and your community, and you would be at risk for the infection. So it would be best if those individuals talk to their health care providers and seek their guidance on measles vaccination.

Host Amber Smith: You mentioned how contagious measles is. I've read that it has an incubation period of seven to 14 days. So is that when a person is infected, and they can spread it?

Jana Shaw, MD: Yes. The average incubation period for measles is somewhere from 10 to 14 days, which is a period when individuals may not show symptoms yet but can still spread the virus to others.

This also contributes to the prolonged period of infectivity, because people are infected, and they are not aware and, hence, may not take precautions needed to protect those around them.

Host Amber Smith: So compared with other contagious diseases, is this much more contagious because of that? Because people are infectious longer?

Jana Shaw, MD: There are numerous reasons why measles is so contagious. One of them is the incubation period, as you asked. The other is also the airborne spread and the fact that the small droplets, those small infected particles, can remain suspended in the air for several hours, allowing the virus to infect individuals who inhale them.

In addition, infected individuals often have a high concentration of the measles virus in their respiratory secretions, especially during the early stages of illness, and this high viral load then makes them more contagious and makes the transmission more efficient.

The other factor also that's not unique to measles, but contributes to its contagiousness, is that people are contagious even before symptoms appear. So the infected individuals can spread the virus to others during what we call prodromal stages or prodromal phase -- essentially, the phase where you will have fevers and cough and runny nose and maybe red eyes, essentially symptoms that are common for a lot of other respiratory viruses, and you may not know that.

And this early contagiousness makes it challenging to identify and isolate infected individuals before they can transmit the virus. So those are factors why measles is so contagious.

Host Amber Smith: So what are the first symptoms of this disease?

Jana Shaw, MD: Some of the first symptoms of the disease include typical respiratory symptoms that you would see with other viruses. So for example, after your infection or first exposure, then infection and following the incubation period, which is the time where people do not show any symptoms, but the virus replicates within the body without causing symptoms, individuals will go on developing runny nose, fever, cold or flu-like symptoms, red and watery eyes. And they also may develop small white spots inside their mouth.

Following that stage, the characteristic measles rash emerges. It starts on the face, and it gradually spreads downward to the trunk, arms and legs over several days. The rash consists of red flat spots that may merge together, forming larger blotchy areas, and also during that time, the individuals may experience high fever and other symptoms. And as the rash peaks, the individuals may experience heightened illness symptoms and severe cough. Some of them may have diarrhea, and that period typically lasts for several days. And after seven to 10 days, the fever goes away, and the rash gradually disappears. So those are the characteristic features of measles.

Host Amber Smith: Are children or adults more likely to develop complications from measles?

Jana Shaw, MD: It depends.

So for children, usually those who are under the age of 5, and especially those who are younger than 2 years of age, they're more susceptible to severe complications from measles. And that's primarily due to their immature immune system.

For adults, pregnant women are particularly susceptible to serious disease. The measles can cause premature labor, low birthweight and also maternal complications, such as pneumonia. For adults, also, those with weakened immune systems, such as those who are on chemotherapy or receive transplants, they are at higher risk for severe measles complication.

In low-income countries, malnutrition can weaken the immune system, and those individuals are prone to serious measles complication.

So the risk groups for measles and for complications sort of differ by age and underlying medical condition.

Host Amber Smith: So people who have compromised immune systems now, they may have had the measles vaccine as children, but with their compromised immune system, are they no longer safe?

Can they no longer rely on the childhood vaccine?

Jana Shaw, MD: Correct. I would encourage all those listeners who may have compromised immune systems that they do talk to their provider about their measles immunity, because they might have lost the protection, either due to the use of chemotherapy or use of steroids or other agents that we use to help, maybe down-regulate, immune systems.

Host Amber Smith: So when we hear about these measles outbreaks in cities far away from Syracuse, is there a concern? Is there a nationwide risk to this localized outbreak?

Jana Shaw, MD: Usually we think of measles, and the risk for measles and transmission, as a local problem because it's important that we remind ourselves that even though the vaccination coverage on a national level for two doses is about, let's say, 93%, to some listeners, that sounds like a great number. It is still below the target of 95%, because we want community protection at at least 95% through vaccination, because measles is so contagious.

But we need to realize that the population immunity can differ greatly between different communities. We have schools where a large number of children might be exempted from vaccination for personal or religious or other reasons. And those schools or school districts would be at greater risk for measles spread and complications from measles infection.

And then there might be school districts where a large number, over 95%, of children are fully vaccinated, and those communities would be at low risk for spread of measles.

So really, I think what we need to look at is at the community-level protection to assess the risk of spread of measles virus.

Host Amber Smith: What should a person do if they're exposed to measles? And would that differ depending on whether they're vaccinated or unvaccinated?

Jana Shaw, MD: The risk differs. If you are fully vaccinated, and you have a healthy immune system, you're probably at low risk for measles to start with. One probably should still contact their health care provider and have that conversation because it may mean that you may have to take certain precautions.

However, if you are not vaccinated, you're at great risk of contracting the infection. And you should certainly contact your health care provider as soon as possible, so not only you can self-isolate, but also have a conversation with your provider in terms of what signs and symptoms to look for and whether there are any interventions that should be done to keep you safe.

Host Amber Smith: How is measles treated these days?

Jana Shaw, MD: Unfortunately, we don't have good treatment for measles. It's one of those infections where we offer what we call supportive care. Essentially, when you end up sick and if you have diarrhea, we'll provide you with hydration. If you develop a pneumonia, which is common, we will support your respiratory system by providing oxygen and making sure you stay well hydrated.

So we don't have any specific antiviral medication to fight this and treat this infection. Vitamin A has been used in low-income countries where malnutrition is common to help to curb the infection, but it's all mostly supportive.

Host Amber Smith: Do you think the youngest doctors today are prepared to care for people who are sick with measles?

Jana Shaw, MD: It's true that many young doctors today may not have encountered patients with measles during their medical training, especially in the regions where vaccination programs have been successful in reducing measles incidence.

However, medical education typically includes comprehensive training in infectious diseases, including the recognition and diagnosis and management of measles and its complications.

Although the clinical experience with measles might be limited, we still provide training and education for medical students and trainees and residents -- those are the doctors in training -- to ensure that they keep measles on their mind, especially in children who are presenting with respiratory symptoms and rash and who may not be vaccinated or have traveled to areas where measles transmission occurs.

And to support my point, the New York State Department of Health has recently issued a health advisory providing details about measles symptoms to increase awareness about the disease because we don't want to miss it when we see it because it spreads so easily.

Host Amber Smith: Is this something where if a child is exposed to measles, do they need to go to the emergency room, or do they call their pediatrician, or how do they handle this?

Jana Shaw, MD: So this would be an example of condition where you probably don't want to go to the emergency room because this is a highly contagious disease. So if you already have symptoms, you probably want to call your health care provider, so your health care provider can guide you in terms of what is the best next step.

If the child or the person is not moderately or severely sick, it's possible they can just be observed at home. However, for those who may have symptoms that require medical attention, they may have to be brought to ED (emergency department). But it would be important that that health care provider notifies ED, so the patient can be quickly isolated, so others in the hospital are not exposed and are safe.

Host Amber Smith: Well, Dr. Shaw, thank you so much for making time to tell us about measles.

Jana Shaw, MD: Oh, thank you for having me, Amber.

Host Amber Smith: My guest has been Dr. Jana Shaw. She's a professor of pediatrics and of public health and preventive medicine at Upstate, specializing in pediatric infectious disease.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from registered dietitian Heather Dorsey from Upstate Medical University. What's the healthy food option for a party?

Heather Dorsey, RD: When you're thinking about having to go over to a friend's or a family member's house or just going to a gathering, and you want to make sure that there are things that you can eat, a great veggie tray or a great fruit tray, and utilizing that Greek yogurt for a base for a dip.

So a really quick veggie dip based with Greek yogurt is a cup of Greek yogurt, a tablespoon of olive oil, a tablespoon of lemon, a little clove of garlic, a teaspoon of dried dill and a little bit of parsley. And then if you want to add a little heat to that dip, you can put a pinch of pepper flakes in it.

And likewise with the fruit tray. You can pair it with a delicious Greek yogurt-based dip. Again, start with a cup of Greek yogurt, two tablespoons of honey, a teaspoon of vanilla and a half a teaspoon of cinnamon. And those additives actually really have some deep health benefits with antioxidants and helping with blood sugar control. So that makes it a really healthy dip.

Two of my other favorites to bring that has a little bit more substance to it, is something called cowboy caviar. This is basically a black bean-based dip that you can use with tortilla chips, which are whole-grain corn. You get a can of no-salt black beans, a can of no-salt corn, a nice red pepper, one onion, one tomato, one avocado and a little bit of cilantro. Mix it all together, and you've got this really nice, almost like a high-fiber, vegetable-based dip that's going to keep you satisfied, but very low in calories and healthy for you. You can add some heat with a jalapeño if you want.

And then my go-to is always bringing some guacamole. Avocados are a really good rich source of omega 3's and a healthy fat. They definitely fill you up. So it would be just a couple avocados, a red onion, a couple cloves of garlic, a little bit of tomato, squeeze a lime, some cilantro. And again, if you want to add some heat, you can throw a jalapeño in there.

But just some quick and easy things that you can take to a gathering that you can have and take the pressure off of having maybe some of the more decadent things that the host might be serving. So it's just you're kind of putting yourself in the control seat of, OK, if I bring something that's healthy, I know that that's my go-to that I can go and have, andI won't feel guilty later on for overindulging.

Host Amber Smith: You've been listening to registered dietitian Heather Dorsey from Upstate Medical university.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Maggie Bowyer is a poet and author of the poetry collection "Ungodly." Her poem "Funeral Juxtaposition" shows us a young daughter's perspective on her mother's untimely death.

We stand far too close,

Baby hairs on forearms brushing,

Breath-mint clouds

Leaving prickles on our necks.

Everyone leans in,

Feasting on the words

Of a preacher who'd

Never even met her.

The pews weren't as stiff

As my words were

Reciting the Lord's Prayer

In my mother's name.

There was no burial,

As the only wish honored

Was her incineration.

After hugs full of

Too much perfume,

Stiff, freshly pressed suits,

And tears from relatives

Who meant relatively nothing to me,

We went home.

Laid out on the counters

Were ham biscuits

And cold cuts.

The room was filled

With the smell of meat

I refused to eat,

And the chatter of wrinkled lips

"Catching up"

Between bites of

Too sweet brownies.

No one noticed

Me slip off my heels

And out the door.

I couldn't be there,

Where no one seemed to recall

How we just stared at

A seemingly plastic corpse,

My mom's hair completely wrong,

In her least favorite outfit.

And so I sat outside,

In the grass,

Feeling the sting

Of a late December rain.

I bet I ruined that dress,

The black one with

Small purple flowers,

The one I was supposed to

Wear to her wedding.

The rain seemed fitting;

She only liked to leave the beach

On rainy days.

My grandparents sat inside,

Forgetting storms of their own,

While I shared malice

With the clouds above.

I don't know how

You end a poem

About your mother's death

This quick,

Much like I don't know how God

Ends a mother's life

When she was only 36.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

This is your host, Amber Smith, thanking you for listening.