Adults and Measles

Although vaccination discussions are typically most focused around children due to the dramatic lifelong benefits of childhood immunization, I have had many recent inquiries from adults about Measles vaccination due to the recent outbreaks. Below is some information that should be most helpful for my adult patients based on these inquiries. The majority of this information is directly from the Centers for Disease Control (CDC) as they have the experts dedicated to continually researching and updating the information. If you want further detail you can access much more at

Up to 90% of unvaccinated individuals exposed to measles will get it compared to only about 3% of those who have had the standard 2 dose vaccination.

Recent Data:
From January 1 to April 19, 2019, 626** individual cases of measles have been confirmed in 22 states. This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000, second only to the 667 cases reported during all of 2014. In the coming weeks, 2019 confirmed case numbers will likely surpass 2014 levels.


*Cases as of December 29, 2018. Case count is preliminary and subject to change.
**Cases as of April 19, 2019. Case count is preliminary and subject to change. Data are updated every Monday.

Recent areas of Measles outbreaks in the US include New York State, Rockland County, New York City, Washington, New Jersey, California, Butte County, and Michigan. These are linked to travelers who brought measles back from other countries where large measles outbreaks are occurring. A significant outbreak can occur when a traveler bringing measles into the country then exposes a pocket of unvaccinated people.

Complications of Measles:
It is important to consider the potentially severe complications of measles infection. Awareness has faded due to successful immunization campaigns over the years leading to most people fortunately not having to experience themselves or a loved one suffering or dying from this.
● Ear infections,
● Permanent hearing loss,
● Pneumonia,
● Encephalitis (brain swelling),
● Brain damage,
● Death.

What Adults Can Do:
1. Make sure your children obtain immunizations at the optimal recommended schedule.
2. Generally if you received your childhood immunizations appropriately you would NOT need additional immunization or testing for immunity. But, there are a couple of special considerations:
a. Birth before 1957 provides only presumptive evidence for measles, mumps, and rubella. Before vaccines were available, nearly everyone was infected with measles, mumps, and rubella viruses during childhood. The majority of people born before 1957 are likely to have been infected naturally and therefore are presumed to be protected against measles, mumps, and rubella. Healthcare personnel born before 1957 without laboratory evidence of immunity or disease should consider getting two doses of MMR vaccine.
b. If you were vaccinated between 1963 and 1968 you may have received a “killed measles vaccine” which was an earlier formulation that is no longer used and was not as effective as the current MMR vaccine. Fortunately, this involves a relatively small number of people.
c. If you have direct, close contact (sharing sport equipment, drinks, kissing, living in close quarters) with someone diagnosed with measles.
d. International travelers without evidence of measles immunity.
3. If you have concern for any of the above circumstances or otherwise then you can schedule an appointment with us to discuss the best preventive measures for you. If appropriate you can have a blood test to determine if you are immune or to get a dose of the MMR vaccination. There is no specific additional harm in getting another dose of the MMR vaccine if you may already be immune to measles, mumps, or rubella. You should check with your insurance to understand your coverage for testing or immunization so there is no surprise if insurance passes the cost directly to you.
4. If you do not have immunity and are exposed to measles you may get some protection if you get the MMR vaccine within 72 hours of your exposure. Clearly this is a last resort.
5. There are some individuals who should not get the MMR vaccine and it is important to discuss preventive measures with your doctor.
6. If you think you have the measles then contact your doctor’s office with your concern PRIOR to going to the office. Most offices have extremely cautious protocols to minimize risk of spreading this highly contagious infection while still evaluating and treating you appropriately.
7. For more information:


Happy Holidays!

If you blinked, you may have missed it, but we are already well into the month of December. The holidays are upon us. ‘Tis the season for family, festivities, and FOOD!holiday blog Here at Cedar Park Pediatric & Family Medicine, we want you to enjoy every moment of the holidays, while also maintaining a high level of health. So as the holidays draw near, let us take a moment to outline a few strategies to prepare you for your family, friend, and work-related get-togethers.

Game Plan

Close your eyes and think for a second about your favorite holiday dish. What are you picturing? Sweet potato casserole with a mountain of gooey, lightly browned marshmallows on top? A golden-brown turkey baked to perfection with just the right flavor? A juice prime rib or ham? Or is it the classic pumpkin pie, made from a recipe that has been passed down for generations? And, what about holiday cookies? I for one am a fan of all! But before those dishes are in front of us, mentally preparing and having a game plan will help make dinner more enjoyable with no regrets! A game plan could be as simple as deciding now what you really want to enjoy instead of piling on every dish in the line.


Our body has numerous ways of telling us that we are full. One of them is by signaling to our brain that we have eaten enough food to satiate us, or satisfy us. For example, when you fill your car with gas, the pump shuts off when the optimal amount is in the tank. The more common way our body tells us to stop eating, eyesbiggerthanstomachspicespecially at a big holiday meal, is when the stomach stretches because it is too full, it tells the brain to stop eating because there is no more room. Think about how much you usually fill up your plate the first time through the line. Remember that we can always go back for more if we are still hungry. This is one of the times where quantity is not necessarily better than quality. Let’s not let our eyes be bigger than our stomachs!


As you sit down to eat, look around and savor the time you have with your family. As you chew, savor each bite because it may be a whole year before you have that favorite dish again. Slowing down while you eat also gives your body time to tell you if you are satiated, or satisfied, rather than full to the brim.


Get moving! The weather, especially here in Texas, is usually still really nice through December. So get outside and throw around the football or basketball, or sign up for a festive run or take your family to walk through local light displays.


As wonderful as holiday food is, not all of it would be considered healthy. Take some time to look on Pinterest or your favorite search engine for healthy alternatives to traditional dishes. To get you started, here is a healthier pumpkin pie recipe, and here is a pumpkin spice latte recipe. If you’re craving peppermint, try this Skinny Peppermint Mocha.

Andrew Kester FNP Portrait Main web version


About the Author

Andrew Kester, FNP-C, is a certified Nurse Practitioner on the Family Medicine team at Cedar Park Pediatric & Family Medicine.

Happy Diabetes Awareness Month!


November is national diabetes awareness month, so now is a great time to ask why this matters and why screening is important.

So, why the awareness, and what exactly is diabetes?

In 2015, over 30 million American’s were living with diabetes, which was also the 7th leading cause of death in the United States [4,2]. The number of people diagnosed with diabetes is anticipated to continue growing, so providing awareness helps to shed light on the disease and the importance of screening.

Before we can understand the disease, let’s talk about blood sugar (also called blood glucose) and insulin. Every time you eat you are giving your body fuel so that it can perform all your favorite daily activities, just as filling your car with gas allows you to drive around to your favorite places. As your food gets broken down in your stomach, one of the important byproducts is blood sugar. Blood sugar is a vital component of energy for your body, but too much can cause major problems. This leads us to insulin. Insulin is a hormone made by the pancreas that helps to lower our blood sugar when it gets too high.

There are two types of diabetes, and we will talk briefly about each. In short, type 1 diabetes is caused because the pancreas can’t make any insulin, which results in high blood sugar. Type 2 diabetes, however, is caused because the body is not sensitive to the effects of insulin anymore, which results in high blood sugar. The overwhelming majority of American’s have type II diabetes.

What are some of the risk factors for diabetes?

The following are some of the things that may put you at risk for developing diabetes [3]

  • Having a family history of diabetes
  • Being overweight or obese
  • Being age 45 years or older
  • Being of African American, Native Alaskan, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
  • Having high blood pressure
  • Having high cholesterol
  • Having a history of gestational diabetes
  • Sedentary lifestyle
  • Having polycystic ovary syndrome

What kinds of problems can diabetes cause?

The following are some of the problems that uncontrolled diabetes can cause [1]:

  • Blindness
  • Limb Amputation
  • Kidney Failure
  • Vascular and Heart Disease
  • Nerve Problems
  • Delayed Wound Healing

So, diabetes can cause some major problems. Is it treatable? And what can I do to see if I am at risk?

The great news is YES! Diabetes can be treated and well controlled! The easiest and most important way to know if you are at risk for diabetes is to talk with your healthcare provider here at Cedar Park Pediatric and Family Medicine. As part of your annual wellness visit, we will look at your whole picture of health and screen you for diabetes by checking your fasting blood sugar. If you haven’t yet, take a moment today to advocate for your health by scheduling your annual wellness visit!

About the Author

Andrew Kester FNP Portrait Main web version


Andrew Kester, FNP-C, is a certified Nurse Practitioner on the Family Medicine team at Cedar Park Pediatric & Family Medicine.




Zika Prevention in Children

zika_mosquito-335x189Everywhere you turn these days, the spread of the Zika virus is talked about in the media.  Recently it has even been identified in Texas, primarily in the Rio Grande Valley region. With it encroaching so close to home, we thought it wise to review how it spreads, what the symptoms are and what can be done to prevent it.

As most of you probably know, Zika is contracted when humans are infected by mosquitoes. Humans can then spread it from person to person through blood transfusion, mother to baby in utero and sexual contact.

Symptoms associated with a Zika viral infection are relatively mild, and in fact, many experience no symptoms at all. For those that do show signs, the illness may entail a fever, rash, joint pain and red eyes which lasts approximately 3-7 days. The scare associated with Zika stems around an increase of newborn microcephaly believed to be associated with a Zika virus outbreak in Brazil starting in 2015.

To prevent the contraction of Zika virus, the CDC recommendations taking steps to prevent mosquito bites by following these recommendations:

  • Wear protective clothing including long sleeve shirts, pants, socks and hats to create a physical barrier from mosquitoes.
  • Use mosquito-repellent clothing treated with permethrin which lasts for 6 washes.
  • Avoid being outside during sunrise and sunset when the insects are most active.
  • The current AAP and CDC recommendation for children older than 2 months of age is to use 10% to 30% DEET. DEET should not be used on children younger than 2 months of age.
  • The effectiveness is similar for 10% DEET and 30% DEET but the duration of effect varies. Ten percent DEET provides protection for about 2 hours, and 30% protects for about 5 hours. Choose the lowest concentration that will provide the required length of coverage.
  • The concentration of DEET varies significantly from product to product, so read the label of any product you purchase.
  • As an alternative to DEET, Picaridin has become available in the U.S. in concentrations of 7% to 20%. Concentration of 7% Picardin provides protection for about 1-2 hours and 20% Picaridin provides 4-5 hours of protection. Picaridin is a synthetic compound developed from a plant extract from the genus Piper, the same genus that produces table pepper. Picaridin has been available since 1998 in Europe but was approved for sale in the U.S.A. only in 2005. AS with DEET, the EPA has concluded that the normal use of picaridin does not present a health concern. Picaridin is sometimes preferred over DEET because it is odorless, non-greasy, and does not dissolve plastics or other synthetics. Repellents that include picaridin include Cutter Advanced, Sawyer Premium and Repel Smart Spray.
  • With any type of insect repellent, remember not to apply to a child’s hands, eyes, mouth, or cut or irritated skin.
  • And finally, children should wash off repellents when they return indoors.

For further questions/concerns regarding Zika and its prevention, please do not hesitate to consult your pediatrician.


What’s that rash? Have you had your shingles vaccine?

shingles vaccineHerpes zoster, or more commonly known as “Shingles” affects almost 1 in every 3 people in the United States in their lifetime.  Anyone who has ever recovered from the chickenpox may develop shingles, even children. However, the risk of shingles increases with age.  Almost half of cases are seen in individuals 60 years and older.  Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from VZV the virus stays inactive or dormant in the body and the virus can reactivate years later.

Symptoms of shingles include a very painful rash that develops on one side of the face or body. The rash forms blisters which may burst, and scab over in 7-10 days and clears up within 4 weeks. Before the rash develops you may have pain, itching, burning, or tingling to the area. This can happen anywhere between 1-5 days prior to the rash occurring. Most commonly, the rash occurs in a stripe pattern on one side of the body. It can also cause fever, headaches, chills, upset stomach, and fatigue.

Shingles cannot be passed on from one person to another. HOWEVER – the virus that causes shingles, VZV, can spread to another person with active shingles who has never had chickenpox. In this case, the person may develop chickenpox, but not shingles. The virus is spread through direct contact with fluid from the blisters. A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear and once the rash has developed crusts. Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

  • Avoid touching or scratching the rash
  • Wash your hands often to prevent the spread of VZV
  • Until the rash has developed crusts, avoid contact with those who:
    • Are pregnant who have never had chickenpox or the vaccine,
    • Premature or low birth weight infants,
    • Have weakened immune systems (chemotherapy, immunosuppressant medications, HIV)

Treatment for shingles includes antiviral medications, which shorten the length and severity of the illness. Medication must be started as soon as possible after the rash appears. If you, or someone you know thinks they have shingles, contact our office for an evaluation appointment as soon as possible.

You can reduce your risk for developing shingles and long term pain from shingles by vaccination. The Center for Disease Control recommends that individuals age 60 and over get one dose of the shingles vaccination. If you, or someone you know is interested in the shingles vaccination contact our office at 512-336-2777 to schedule a wellness visit so we can discuss the vaccine, along with other vaccinations and screening measures for your age.  Here is more information on the vaccination. (

Center for Disease Control. Shingles (Herpes Zoster). (2016).

National Foundation for Infectious Diseases. Shingles (Herpes Zoster). (2016)



What you need to know about Zika virus:

Zika virus is spread to people primarily through mosquito bites. The most common symptoms of Zika virus disease are:zika

  • Fever
  • Rash
  • Joint pain
  • Conjunctivitis (red eyes)

The illness is usually mild with symptoms lasting from several days to a week and can generally be managed at home with symptomatic treatment alone, similar to the common cold.  Antibiotics do not treat Zika.  Severe disease requiring hospitalization is uncommon.  If you feel your symptoms are severe, we are available with same day appointments to see you and provide guidance.  For an appointment with one of our Family Medicine providers, call 512-336-2777, option 1.

Other online resources on Zika virus:

Author: Cameron T. King, MD


Can Electronic Cigarettes, “E-Cigs”, Really Help Me Quit Smoking?


Are you looking to quit smoking? That’s great news! Giving up smoking is an extremely tough decision to make (and keep), but one that has incomparable health benefits for the short and long term.

There are many ways you can quit smoking that range anywhere from quitting cold turkey, weaning yourself via nicotine patches and gum, to medications prescribed from your family provider. One speculated way of quitting that has gained popularity over the past few years is the use of electronic cigarettes or “e-cigs”. I would like to clear some misconceptions about the use of these products and hopefully provide good information that helps consumers make educated and accurate decisions about their quitting tools.

What are e-cigs?
E-cigs are battery operated, hand held devices that vaporize nicotine and other chemicals for inhalation. They were first introduced into the U.S. market in 2006 and have been gaining acceptance over the past few years. When exhaled, the vapor looks similar to smoke and has gained the nickname of “vaping”.

What is the controversy behind e-cigs?
You may have heard the many arguments behind whether e-cigs can truly help people quit smoking, or whether that is simply a marketing ploy. The producers of e-cigs and those that provide accessories to the product hold fast to the claims that they are “healthier” than traditional cigarettes because “[they] deliver nicotine without the thousands of known and unknown toxicants in tobacco smoke” (Cahn & Siegel, para. 3, 2011). However, a 2014 study revealed higher voltage e-cigs have higher levels of formaldehyde and other toxic carcinogens (American Lung Association (ALA), 2015).

E-cigs are currently not regulated by the Food and Drug Administration (FDA), which means it is unknown how much nicotine or other harmful chemicals are being ingested during use (FDA, 2014). This means e-cig vapor contents can vary across manufacturers, who are not required to disclose what exactly is in the vapor being sold. These chemicals are the same as those found in traditional cigarettes and have been known to be the cause of cancer related to tobacco smoking.

What are my other options then?

Thankfully, there are many other FDA regulated and medically approved options available for smoking cessation. First, talk with your family provider about your intentions. They will be able to discuss with you various alternatives that range from over the counter tools to prescribed medications. is an excellent website full of information from reputable sources that includes tips on how to adjust to life without smoking and how to manage withdrawal symptoms.

The first step is making the commitment and the second is making an informed plan of action!

Meredith Long is a Board Certified Family Medicine Nurse Practitioner at Cedar Park Pediatric & Family Medicine. She is currently accepting new patients.

At Cedar Park Pediatric & Family Medicine one of our goals is to provide relevant and accurate medical information for our patients and their families.
Cahn, Z. & Siegel, M. (2011). Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? Journal of Public Health Policy, 32, 16-31. doi: 10.1057/jphp.2010.41.Food and Drug Administration. (2014). Electronic cigarettes. Retrieved from .

Food and Drug Administration. (n.d.) Ecigarettes. Retrieved from

American Lung Association. (2015). American Lung Association Statement on E-Cigarettes. Retrieved from