Hi everyone. Welcome to Febrile, a cultured podcast about all things infectious disease. We use consult questions to dive into ID clinical reasoning, diagnostics and antimicrobial management. I'm Sara Dong, your host and a Med-Peds ID doc. Today we are joined by Dr. Adam Ratner. He is a Professor of Pediatrics and Microbiology at NYU Grossman School of Medicine and the Director of the Division of Pediatric Infectious Diseases at Hassenfeld Children's Hospital and Bellevue Hospital Center.
He also has recently written a book entitled Booster Shots, the Urgent Lessons of Measles and the Uncertain Future of Children's Health. We are excited to have Adam here. Today, he's sharing his opinions and not those of his institutions. As everyone's favorite cultured podcast, on Febrile, we like to ask our guests to share a little piece of culture. You know, just something that you enjoy or that brings you happiness.
Sure. Um, so my happy place really is, uh, taking my dog for a walk in the park. Um, culture-wise, uh, you know, I, I love writing and I love reading and, and you know, the thing that I read most recently that I thought was fantastic is actually infectious disease related. It's, um, John Green's new book, which is, uh, Everything is Tuberculosis, which was just wonderfully written and, and beautiful and great. I, I even reached out to John Green's publicist.
Just be like, I don't think you'd ever do anything small and ID oriented, but if you did, we would love to have you come talk on Febrile. I got to do an event with him, uh, around the time of his book launch, so I got to interview him about his book. We talked a little bit about my book. It was, it, it was like a dream come true. I mean, I, um, I've been a, a huge fan of his since my daughter and I read, um, uh, The Fault in Our Stars when she was younger. And so it's, it was great.
That's awesome. Yeah, it's perfect. It's always nice when there's a little combo of the culture actually having an ID tie in. Well, I have brought a case to you today that we will talk through and get your thoughts on. So I'll give you a little bit of background. Uh, we have a nine-year-old boy who comes into the emergency room with his parents.
He initially had said he had a little bit of ear ache on the right that started a couple days ago, and his family started to notice increased swelling of his face and jaw. And so the swelling was mostly on the right side.
They feel like at this point though, that maybe his left jaw is a little bit more swollen as well, and so on exam you can see that he has swelling of his parotid gland bilaterally, but the right is certainly more pronounced than the left and kind of obscuring that angle of the mandible. He is otherwise healthy, has had no prior medical problems, has never been on medication.
He received some initial vaccines through about the age of nine months, but he otherwise has not received any additional vaccinations. So, you get called by the emergency room. What's kind of going through your mind as you're thinking about this kid? Sure. So I'm assuming that, that he doesn't have fever or other systemic symptoms that are prominent as, as part of this, just based on the description.
You know, the initial symptoms could be acute otitis media, although then the, the swelling and the parotids would be strange after that. Um, he could have, uh, a dental source for, for an infection. I mean, certainly that can give you ear pain to start with and then, and then pain, you know, in the area of, of the jaw. But again, you wouldn't necessarily expect swelling of the glands. You know, the most likely thing is, uh, parotitis. So, you know, some kind of inflammation of the parotids.
And, you know, things that I'm thinking about are acute suppurative parotitis, which is usually but not always unilateral. It's often polymicrobial. Uh, Staph aureus is most common, but you can have group A strep, Strep pneumo, Haemophilus, like, and, and lots of oral organisms can do it. Um, you can get granulomatous infiltration. Um, if you have, MAI or MTB, which would be rare in this circumstance or Bartonella. Um, so those all kind of go under the heading of acute suppurative parotitis.
And then under non-suppurative parotitis, I would think about, um, still some infectious causes, so mostly viral causes of, of parotitis. Um, first on the list would be mumps, especially because you said that this is a kid who got vaccinated up until nine months and then not since then. So in a child who hasn't received the measles, mumps, rubella vaccine, which we usually give at, at 12 to 15 months, I'm thinking about mumps in this child.
There's a long list of other viruses that can give you parotid inflammation. You know, the CMV, EBV, influenza, parainfluenza, some of the enteroviruses including coxsackievirus. Um, there are some herpes viruses that can do it like HSV1 or 2, like HHV six. Uh, there are reports of COVID associated parotitis. Um. Rarely LCMV. HIV uh, untreated HIV can, can be a cause of, of parotitis. Again, I think the many of these are, are much lower on the list.
And then there are non-infectious causes, some of which can cause bilateral parotitis. Um, often they're, uh, unilateral. Um. You know, a sialolithiasis just blockage of a, of a, um, duct can, um, can give you parotid swelling. Chronic recurrent parotitis, which can be due to problems in salivary production or drainage. There's this entity called juvenile recurrent parotitis, which I don't understand well, and I think nobody really understands that well. But that can happen.
Um, and then there are, there are autoimmune things. Sjogren's syndrome, sarcoid. I suppose Kawasaki can be a cause of parotitis. Um, I'm running out of things, but, but I, I think that, you know, based on how he looks at least per the description, I think less likely acute suppurative parotitis, I think more likely a viral cause. Although you, you know, it's hard to rule out one of the autoimmune things at the beginning. Yeah. And you know, that's, we have this big list.
How would you approach at least sort of your first batch of testing? Like, what would you prioritize for this, uh, this child? Yeah, so I mean, I'd wanna take a look in his mouth. I'd, I'd wanna look at the, at, at stenson's duct I could and, and, you know, maybe see if you can either see or feel a stone, because if this is, is truly a mechanical thing than your approach is different. You're, you're calling someone to take a look and, and see if that can be removed. There are sort of basic labs.
I, I would look at, you know, a CBC, a set of electrolytes, you know, with, with mumps you would expect a, uh, a, some leukopenia, but maybe a relative lymphocytosis. Some viral testing and I think we can be a bit judicious at the beginning in terms of, of that. Depending on the season, you might send, you know, influenza testing because that would be actionable if positive. Um, COVID testing. Maybe EBV and CMV and, and certainly a mumps PCR and maybe a, maybe a mumps IGM as well.
The mumps PCR, you, you would try to get some parotid gland secretions for, for that. It's my understanding, I haven't done this in a while, but I think that you have to massage the parotid gland for, uh, for 30 seconds or something before you collect the, the sample to get maximum yield.
And I would call my local public health department at this point, not so much because I wanna report a case of mumps, but if I'm sending mumps testing, I'm calling them because often, and this is true with measles testing, at, at least for us in New York City, they can turn these things around much faster than either our lab or a, uh, a commercial lab can. So they may be helpful in terms of, of diagnostics.
And then the, you know, the other thing that you could think about, depending on how the kid looks, is either a sonogram of the area or I suppose if you want detailed imaging, you could do a CT, but I would probably start with a sono unless Yeah. exam gave you something obvious. Yeah. And you know, we'll say we at least have a CBC back. We just have some mild leukocytosis at the moment.
Um, We're working on sending off some of this additional testing, you mentioned kind of just an intro of like, flu, EBV, CMV, and then we've touched base with, um, our health department and, and infection control. Just to ask the questions about sending off mumps PCR 'cause um. I didn't say it, but that's what the emergency room has called you for. So, you know, while we're waiting for the results, they ask what should we think about? Like say this was mumps, what are complications?
'cause we haven't seen it and we don't really know what to think about. Yeah, we, we, we still do not see it a lot, uh, whi which is good because most people are vaccinated. The, the things that you worry about with mumps infection, so, so kids present like this child usually though, so fever, maybe some headaches and myalgias, parotid swelling. It's often unilateral followed by then swelling of the contralateral gland. But, but sometimes it can only be, you know, it can just be unilateral.
The reason that we worry about mumps is you can get orchitis in about 30% of cases that are unvaccinated. It, it's much lower, but not zero in, in cases that happen in vaccinated people. The orchitis is usually unilateral, but can be bilateral, and so I think it's 90% unilateral and, and in 10% of cases can be bilateral. That's relevant because you can get testicular atrophy after mumps orchitis, and so there can, if you have bilateral orchitis, there can be effects on fertility later.
Uh, oophoritis also happens. Um, it's less frequent than orchitis. Um, but, and it can be harder to, to diagnose, but that, that is also a concern. You get aseptic meningitis in about 1% of kids with mumps. Although my understanding is that if you, if you do taps on a larger number of kids, you find that most of them have a mild lymphocytic pleocytosis, even if they don't have symptoms of aseptic meningitis.
I'm not advocating tapping this well appearing child, but I, but just to throw that out there, um. You know, and then more rarely you can have some important, uh, downstream complications. So hearing loss happens in a small percentage of, of kids, but can be permanent. Some kids get pancreatitis or, um, myocarditis. Older kids and adults really are more likely to have most of these complications, like they happen at higher rates in, in unvaccinated adults.
Um, so I, I think that's where I would start in terms of, of why I, why I worry about kids with mumps. Yeah. Perfect. So I'll kind of speed us along. We did do an ultrasound of the area, didn't really identify an abscess fortunately, or an obvious stone. Wasn't identified on exam or that ultrasound. Um, there was discussion and attempt to look and see if drainage could be sent off of the Stenson duct, but really they weren't expressing anything.
Um, so that wasn't sent off and we ended up getting back an EBV test that was suggestive of acute infection. Um, and fortunately our, our mumps testing, which was sent off is, is negative. So fortunately this is great, right? Our kid doesn't have mumps. They have EBV, which would be a very common explanation for this. Um, but you know, now that you're here with the family, we have this opportunity, uh, to talk a little bit about vaccines.
'cause, you know, lots of people have been going in the room and asking them, Hey, do you remember if he got this MMR vaccine? Um, and we of course that mumps is preventable with immunization.
Everyone who listens to Febrile I'm sure knows that, but, at least my approach, at least to start, is when I encounter patients or families that have not received certain vaccines or have expressed vaccine hesitancy, I ask, you know, what their concerns are, exploring that with, can you tell me a little bit about what worried you about the MMR vaccine, or can you share what you've experienced and so I'll let you know that we started that and the
parents share that they just felt like their son had gotten too many vaccines. All these antigens that they've read about online. They're really worried and they also share that they kind of just felt like, you know, if he got natural infection, that immunity might be better and that everyone that they knew who had chickenpox and mumps when in the past. Everything was fine and that they can be vigilant and try to deal with natural infection if it comes.
And so I will open it up to you on like how, how do you move this conversation forward? What would sort of be your approach? Sure. And, and you've done a lot of the, the heavy lifting at the beginning already. I mean, the, that, and that's, that's how I would open this conversation also. I mean, I'll, I'll start by saying that I'm a, a hospital based ID doctor. I'm not a primary pediatrician, and the primary pediatricians are the superheroes of having these conversations.
And I think that when we have these conversations, ID folks in a, in a hospital setting, it's a different kind of conversation. Like either it's something like this where it's a child where we were worried about a vaccine preventable disease and then it didn't end up being this, or I've had a lot of these conversations with kids who, you know, are hospitalized for measles or hospitalized for flu, and so, they're, they're in a situation where the child is sick.
It, it can be an emotionally fraught situation. I still think it's important to at least begin the, the conversation, but it can be, it can be hard. You have to be careful that the conversation doesn't go off the rails. That, that they don't think that you're blaming them for anything. I mean, thi this is, I, I think probably a more comfortable situation where you say, okay, we were worried about this because of the vaccine status. Now let, let's have a conversation.
Um. And I think figuring out what the concern is is really important because it's a different conversation if there's one vaccine that the parents are, are frightened about and it's because of one thing that they heard online, and you can really zoom in on that.
Um, I've gotten a lot of that with, with flu vaccine discussions where parents are like, well, every year there's a, you know, there's an article that says that the flu vaccine is only 20 or 30% effective, so I just feel like it's not worth it. And they, you know, they've gotten their kid vaccinated against everything else. Totally different conversation than, you know, we, we think that, you know, vaccines are gonna harm our child, or, you know, we think it's too many too soon.
There, there are all of these other things. So, I mean. For, for this family, I might sit and talk to them specifically about mumps a little bit, and because that's, that'll be sort of front of mind for them and what I would worry about and the fertility thing. And then I would talk about, you know, measles and how that can be dangerous as well.
And then, you know, you may not be able to move the needle in terms of, of convincing them that vaccine immunity is, is worth getting and is better than natural immunity if you know, in to use their words. Um, you know, I, I think. We can also bring up, I, I think this resonates with some families, the idea of, you know, vaccines as a way of protecting not just your child and obviously you want to protect your child, but also pitching in to protect the community.
And I'll, you know, I'll talk about kids who can't get vaccinated, you know. Older people who may have been vaccinated and, and had waning immunity and that we try to stop these things from circulating to protect young kids and kids who are getting chemotherapy and, and folks like that. A lot of it depends on kind of the particulars of how the conversation goes and what they seem to respond to. And often the best you can hope for is to start them thinking about it, you know?
Encourage them to have another conversation with their pediatrician when they go back there and maybe, maybe you make some headway. Yeah. And uh, I think the point you made about how so many of these conversations are not happening when we see them as consultants in the hospital is so vital.
And, you know, you made me think about, I had a, I was having a conversation with some other peds peds folks recently about how challenging it is to talk about it in the inpatient setting, especially if perhaps that child has a pretty devastating infection from something that they could have been vaccinated against. And I think everyone who's a pediatrician sees a really bad case of flu, at least a year.
And I was wondering if, you know, with your experience, for example, with the measles outbreak that you talk about in New York, uh. Are there any other sort of tools or, or, or advice that you give to people who are potentially navigating these types of challenging discussions, which at baseline are hard, but even harder when a child already is experiencing some symptoms, some something impacting their, their health already. Yeah, it's, uh, it's not easy.
Um, and, and I think that you need to make sure that everyone is on the same page in terms of the family should understand that I know that they love the, their kid and that they are trying to protect their child and that they want the same thing that I'm trying to do, which is for their kid to grow up and be happy and, and healthy.
And if you can start from that point of alignment where they know, that I'm willing to sit and talk to them and that I'm not judging them and that I really, really do want their kid to get better and, and want their kid to be as, as healthy as they can. And they know that I know that about them. I think that really helps.
You know, am I ever frustrated by the of, of course, like it's, it is enormously frustrating to be in a situation where you're, you're taking care of a sick child and, and it was a preventable disease. I've seen a number of kids over the last couple of years with HiB meningitis, um, which I had never seen for like the prior 30 years, and it's. It's a horrible disease and it was totally preventable and it's, it's unbelievably frustrating.
But that just, even just from a, a totally practical point of view, going in with that message doesn't help.. Like, it's not gonna bring anyone closer to vaccinating. It's, you know, it's gonna make the parents feel attacked. It's going, they're gonna lash out and say, why don't you just focus on, on getting my child better now? And then, you know, you've sort of lost that opportunity to talk. So I, I think spending time on that alignment at the beginning.
And, you know, and then you can take your own feelings later and, and talk about them with someone else. But, uh, but that's, that's really important. Yeah, yeah. And like you were saying. Opening it up so that they have more conversations with perhaps their pediatrician that they trust in the future. Um, and you know, I of course wanna point to your recent book.
I know I have, uh, several colleagues of mine that have really enjoyed Booster Shots and you talk about measles as being this quintessential human pathogen and kind of case example and your experiences, but also historical perspectives. And, we are obviously in a very abnormal year for measles cases in the US and you know, I think naturally many healthcare professionals are struggling and feel like messaging is challenging.
And I was wondering for you, as someone, you know, you've written this book, but also as a leader in your division and and with your experience, are there examples of ways that you encourage people to advocate beyond, you know, we all do daily one-on-one or family conversations in clinical practice, but like as a trainee or an early career physician, how, how should we think about advocating for vaccines on a larger scale and or sort of how can we improve the
way we communicate as ID specialists? Yeah, I, I think, you know, if ever there was a time that we needed people to be out there, this is that time. And that can be, you know, finding specific causes that you're, you know, passionate about in contacting your representatives and doing that. Just like any citizen can. Often I have, I have, you know. People who are not in medicine ask me this question.
And I, I say that one thing that that is I think very powerful that doesn't happen a lot is, when you're a parent and you're at the playground or in the store or whatever, like the messages that people hear tend to be anti-vaccine messages. They are much louder than we are. And not that we have to be loud, but I think that conversations where we normalize vaccination because most families still, the vast majority of families get their kids vaccinated on schedule.
And so saying at the playground, Hey, I took my daughter to, you know, to get her MMR today. Not saying anything else, not saying, you know, you should do this or whatever, but like, making that part of the conversation, I think helps a lot. Um. In terms of what physicians can do, have that conversation within your family, even if it's uncomfortable. I mean, I, I do not recommend burning bridges. Uh, I try hard not to burn bridges in my own family.
Um, we all have challenging family members, but like, it's easier to shy away from the conversations. You try not to let them devolve into yelling, but you put good information out there as best you can. It's, uh, it is not easy. Um, I've been lucky in that, you know, this book has come out at a time when we have a large measles outbreak. There's a lot of interest.
I've gotten to do a lot of press and, and have had a, a bigger voice than I've, I've had before and I've been lucky to be able to talk about vaccines and talk about things that are important out there. But, but I think we can all do that. And, and of course like if you want to like write op-eds, write, you know, like, like to the extent that you're comfortable, like get out there and do that kind of thing as well.
Yeah, so , I actually wanted this episode to serve as a really a kickoff for a few episodes related to vaccine preventable illnesses, which are of course on the top of everyone's mind, and, today we've chatted a little bit about mumps. We have two additional episodes that are gonna follow this discussing, um, two other vaccine preventable illnesses. I won't spoil the topics quite yet. Um, for those who haven't listened to it already.
I encourage you to check out our prior episode number 102: Rubeola Response. This shared a measles outbreak response from a team of ID docs, really from the perspective of the hospital epidemiology team. And maybe I'll, um, ask you, Adam, to give a few thoughts on measles, particularly given your new book. Um, and then I can update with the latest case numbers right before we post the episode as well. Yeah, I mean, we are having quite a year for vaccine preventable diseases.
As I'm sure the whole audience knows, there is a large measles outbreak now in Texas and New Mexico and Oklahoma and Kansas. That appears to be one large outbreak. Um, and that, that is now well over 500 cases, it may be over 600 at this point. Um, there are also now outbreaks in Indiana and Ohio. Um, I saw a, an alert just in the past couple of days that there are more cases in Philadelphia. It's not just one place in the US and I think that there are a couple of things going on with that.
I mean, we had nationwide a reasonable kindergarten MMR vaccination coverage rate, prior to the COVID-19 pandemic, it was about 95%, but that nationwide rate masks state to state variability, and then community to community variability within states. The overall rate has dropped. We're below 93% for kindergarten MMR, and and falling for As, as a nationwide rate. And then even in states where you have good coverage across the states.
So the Texas overall rate is about 94%, but the Gaines County rate where the, where the outbreak started and is, is, uh, is concentrated, is about 80%.
And we saw a very similar thing in 20 18, 20 19 in New York City where the citywide rate, um, for MMR vaccination in kindergarten was about 98%, so I wouldn't have thought that we would be at risk, but if you look on a, a zip code level or a neighborhood level, it was more like 80% in, you know, in the specific communities that, that were really involved in the outbreak. And so I, I'm worried about measles in particular because it's so contagious and so dangerous for kids.
We've, you know, at the time we're recording this, there've been two pediatric deaths, one adult death in the measles outbreak. But I'm also worried because measles is the canary in the coal mine. It's the bellwether because it's so contagious and it, it means that there's likely to be much more than just measles going on soon. And we're, we're seeing that already. Like there have been a ton of pertussis cases.
Um, there were two deaths of, of infants in Louisiana from pertussis just in the, in recent weeks or months, and, that I, I fear will also become a, a nationwide trend. So there's, you know, there, there's the worry that we're not gonna get this measles outbreak under control.
But even if we get this specific one out under control, I'm worried with falling vaccination rates that more frequent and larger outbreaks of measles are gonna be common, and that more frequent and larger outbreaks of other vaccine preventable diseases are coming. And so just to give a quick update, as of May 11th, 2025, the United States has a total of over a thousand confirmed measles cases reported from 31 jurisdictions.
These cases have been in about 30% with children under five years of age, 38% of those who are five to 19 years old, and the remaining in adults 20 and older or unknown. 96% were unvaccinated. 13% of measles cases have been hospitalized , and there have been three confirmed deaths. Back to the episode. Yeah, and this que question isn't probably totally fair, but if you had the opportunity to make a couple decisions, that, like, let's say it's, it's totally up to you.
What would be the things that you would be most focused on for us to support the kids that we take care of, um, and sort of getting through these outbreaks? I mean, there, there is so much that I would change about what's going on now. I mean, and it, it goes way beyond vaccines as you might imagine. Like I am from a, a, a children's health overall point of view, I am really, really worried about Medicaid.
I mean, so many of our patients are dependent on Medicaid for their coverage, for their ability to get care. Um, I'm, I'm worried about the vaccines for children program. I'm worried about state and local health departments being able to provide even basic functions. And just in the last couple of days, um, CDC, it appears, has been unable to respond to a request for help from I think it was Wisconsin that was asking for help with an issue with lead contamination.
And CDC did not have the manpower to do it. There is so much that we need to fix. So much that has gone wrong just in the last couple of months. Um, and I mean, like I, I'm an ID person, I'm a vaccine per, like, that's the stuff I think about most. But it, it's, in terms of child health, it just goes way beyond that. Yeah. Yeah. And I feel like we're feeling it in our, our patients too.
I had, I spent a really long time talking to someone about measles vaccination yesterday because she has young kids. And, she had perceived from the news like, well, how would I know if there's measles in my community? What if there aren't people who are surveilling and, and communicating that there's a case and that I should be worried? And, um, it, it really is causing everyone across the board so much anxiety.
Yeah. And I, I think there's worry about that even in Texas now, with the cuts to local health departments, they've had to scale back on vaccination clinics. I don't know the state of surveillance there. I mean, we're still getting updates from them, but I, I hope that robust testing is still available. I, I think we all think that the case numbers that are being reported are, are a vast underestimate. That's my understanding. Um, and so I, I worry about our ability to get good data.
Yeah. And so usually at the end I open it up to see if there are additional points, but maybe today we can pivot and, and focus a little bit on just asking if you wanted to share something that you love about ID. You know, we focused a little bit on, on things that have felt like setbacks and things that we wanna improve, but I thought it would be nice to sort of reorient as we close out on a, on a positive note.
Yeah, I mean, I, I still, there are challenges, but I still love taking care of patients. I love being on service. I love the puzzles of ID, I love getting to work with trainees. Um, I feel very, very lucky to still have a career where I get to combine research and teaching and seeing patients and, uh, you know, I write on the side.
And so it's been, you know, it, it's all around the theme of, of infectious diseases, but I've just, I feel very lucky to have been able to be part of that and to still be able to be part of that. Yeah, I guess I should ask, any tips for folks to be more active writers, you know, you wrote this, this book, and we often talk about struggling to, to fit writing into our academic life, but you know, it tips that you've used. Yeah, if I, I, not easy.
Um, it, it's, you know, I started writing this book in 2019. Um, you know, at the, at sort of the tail end of the, the New York City outbreak before anyone had ever heard of, of Covid, I decided I wanted to write a book about measles because I'd learned so much in the outbreak, and it, you know, it, it changed the way I thought about measles. It changed the way I thought about vaccines and the anti-vaccine lobby.
And I, I thought it was this great metaphor for, you know, many things that were going on in children's health. And I, you know, I, I told my wife, who's also a physician that I, I, I think I'm gonna write a book about measles. And she was like, that's great. Why would anyone read a book about measles? And I was like, okay, fair enough.
Um, and like I started working on it and, and then we had covid and it's that, once again changed how I thought about ID and, you know, everything really, you know, it, it changed the way that we worked. It changed the way that I thought about public health and I, you know, it also changed how I was thinking about this book and about measles, and I tried to incorporate what I thought that measles could have taught us that would've been useful in in the setting of the Covid pandemic and.
You know how to fit writing it. It took me years to write this, but it took four years, give or take to to write the book. I am so lucky that I had this project though during Covid because I feel like everyone needed something that wasn't just taking care of patients and going to work and coming home from work and worrying about my family and, and you know, all the other things that we were all doing. And this was my project.
Um, and it's a little weird that my project to take me away from a pandemic was reading about old pandemics. But, but it was, but it worked. Um, and I, it took me longer than I thought to write, in part because I kept getting pulled into more and more covid things. Um, but it also helped me get through the challenges of Covid to have that project. There were points along the way. It, it was a small number.
It was probably two or three points along the way where I really needed to push to get, you know, a final draft done or to get final edits done or something. And my dog and I left and we went somewhere together and it was the two of us. And we worked on the book for a few days, and then we came home. Um, and Nice. because my, my, you know, my child is an adult now, and I could do the, you know, I had the privilege of being able to, to do that, but that. You know, that helped me a lot.
What I learned about myself as, as a writer, was that I could fit doing background research and, and drafting some things into my schedule, because those were things that I could do with 15 minutes here or half hour there if I had it. Um, but that there were times when I really needed to, to sit and focus, and I, I was lucky that I was able to do that. Yeah. And it's true.
I feel like it's, some people are really good at scheduling, you know, times that fit into other things, but sometimes I'm the same way. I often need kind of a dedicated chunk, um, to, I think mostly for me to sort through my own thoughts. Yeah, it's, it's very hard because there, there will never be a time when my to-do list gets to zero, as I imagine is true for everyone listening to this.
You know, like, I'm never gonna clear the decks and, and be like, okay, now I can finally sit down and write. Like, it has to be something that makes it onto that list where, you know, yes. I mean, some people say, you know. Make sure you have 15 minutes, 30 minutes every single day. That didn't happen for me. Um, but, you know, if I'm on service, I'm not sitting and doing 30 minutes of writing a day. I'm, I'm on service all the time.
But I, you know, during times when I wasn't, during times when I could carve out little pieces, I, I did. Well thank you so much for coming today and, uh, talking to the Febrile audience. No, I'm just really grateful to have the chance to to be here. Thank you for inviting me and this was super So a big thanks to Adam for joining Febrile Today. Be sure to check out his book, booster Shots, the Urgent Lessons of Measles and the Uncertain Future of Children's Health, available now.
As we mentioned earlier, you can check out our prior episode on measles called Rubeola Response, episode number 1 0 2 of Febrile. And then stay tuned for two more episodes related to Vaccine preventable diseases. Please check out the website febrile podcast.com, where you'll find the consult notes, which are written supplements to the episodes with links to references, our library of ID infographics, and a link to our merch store.
PEP is produced with support from the Infectious Diseases Society of America. Please reach out if you have any suggestions for future shows or wanna be more involved with febrile. Thanks for listening. Stay safe and I'll see you next time.