1076: Measles, Misinformation, and Modern Supplements: Public Health on the Front Lines

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This is Public Health Review
MORNING edition for Wednesday,

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February 25th, 2026.
I'm John Sheehan with news from

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the Association of State and
Territorial Health Officials.

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Today we hear how a major
measles outbreak is testing

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public health systems.
ASTO member Brandon Traxler,

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deputy director of health
promotion and services and chief

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medical officer for the South
Carolina Department of Public

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Health, shares the latest update
on the state's response.

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Later, we'll hear about the
growing presence of kratom in

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U.S. markets.
Heather Tomlinson, senior

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analyst of environmental health
at ASTO, will explain the

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substances traditional use in
Southeast Asia, how modern

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products differ from natural
leaf preparations, and why

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highly concentrated or synthetic
compounds are raising new health

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concerns.
But let's start with Doctor

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Traxler and the current state of
measles in South Carolina.

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So as of February 17th, we were
reporting 962 cases, confirmed

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cases of measles in the state
during this during this

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outbreak.
So going back to the beginning

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of I guess October of 2025.
So we are seeing some slight

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kind of starting to plateau,
sorry, maybe turn the curve is

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downwards, downward trajectory
the the slope upward is not as

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steep as it was, but still have
a ways to go certainly with that

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still seeing new cases every
day.

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And what's been the playbook for
for responding to it and for

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containing it?
Certainly.

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So first of all, we know that
vaccination is the key to

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getting out of getting out of
the outbreak.

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And so really trying to increase
knowledge, you know, accurate,

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correct information knowledge
and make sure that access was

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present, especially in the
communities that were being hit

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the hardest.
And so, so vaccination, the ease

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of vaccination and then and of
course, trusting the

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vaccination.
And then the other big part was

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those non pharmaceutical
interventions.

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And so quarantine is the early
case identification on contact

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tracing.
We would ask, we were asking

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providers that it when they even
suspected measles, if they were

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going to send a swab, call us.
Don't wait till you get to the

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positive result two or three
days later.

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Call us when you first are going
to send it.

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We're going to get them some
instructions even just right

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there to get the patient when
they send them home and ask you

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to make sure they quarantine or
isolate and what not.

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We also would then start trying
to reach out and do contact

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tracing on those patients,
interview them, see where

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they've been, identify their
contacts and start asking them

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to, to quarantine.
So that by the time we got the

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results back 2-3 days later, we
already were ready to, to, to

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start or had already put in
place, you know, quarantine

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measures.
And we're hopefully stopping the

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spread with it with that early
and aggressive case

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investigation and contact
tracing.

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And do you have some sense of
the factors that have been

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contributing to the increases?
So we certainly know that that

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there's not great vaccination
rates in a lot of these

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communities in this county.
We know that the schools, school

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districts in Spartanburg County
in particular, many of them have

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high exemption rates.
And so have, you know,

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vaccination rates for MMR,
they're well below 95%.

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You know, it's kind of neat.
But at herd immunity, you know,

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one thing we've seen is we're
seeing a lot of, you know, multi

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people, large households with,
with many children, many

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vulnerable or you know, UN
vaccinated people in the same

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household or in the same family
unit, even among several

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households.
And so we're really seeing the

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spread was occurring in in
households, you know, or amongst

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families rather than even more
so and rather than more so than

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in school, for example.
Oh, wow.

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And it's unfortunate that you
you kind of have that metric to

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look at that 95% vaccination
rate and when, when.

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Uptake drops below.
That you kind of you, you kind

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of know what's going to happen.
Exactly.

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You know, we had one of the
first schools and had to, you

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know, I think had a 17%
vaccination rate.

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My goodness.
So there unfortunately you know,

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been a number of kids that have
had to be quarantined, excluded,

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you know, from from exposure at
school when you have that many.

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And certainly we weren't aiming
to minimize the disruptions to

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education.
And and then of course also, so

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for adults, you know the
workforce as much as possible,

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but also knowing how contagious
this is and the need to to stop

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the spread.
Yeah.

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In light of that, and in light
of how serious this disease

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really is, what how do you get
that message out to the

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community?
You know, I think some of it is

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that they have had to, they have
had to see it to believe it, you

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know, in terms of, you know,
having your child excluded for

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the 2nd 21 day period or
something from an exposure.

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I mean that that is pretty eye
opening, you know, as there have

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been cases that the community's
become aware of or is more

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serious where somebody was
hospitalized.

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You know, I do think and hope
that that is impacted them and

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really made them re evaluate,
you know, getting their children

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vaccinated.
Is there anything else that you

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feel like?
Public health officials.

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Or community members should be
hearing right now.

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You know, we've been working
also with faith-based groups,

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you know, in South Carolina and
church and other faith-based

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organizations are very, very
central and very critical part

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of many people's lives.
And so that is the other thing

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that we've been trying to do in
that area is work with church

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and faith-based group leaders to
make sure that they have the

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accurate information and that
they're not, you know, helping

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to spread misinformation, that
they know what the right

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information is to give their
their members.

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And, you know, even asking them
to say, Hey, can you encourage,

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you know, can you use your
position, you know, as this

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respected, you know, person in
the community to really

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encourage vaccination, you know,
and help spread true information

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that's, that's accurate.
And so, you know, it's been,

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it's been slow, some with some
others have been, have embraced

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it.
But I think even with the slow

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ones, it's we have been building
relationships which is key, you

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know, for not just this outbreak
but long term.

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So, Doctor Traxler, are you
finding that certain communities

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just have more resistance?
To say.

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Government messaging or to sort
of.

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Trusting health officials just.
You know, because of the world

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right now.
Well, we certainly are seeing

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groups of people that that are
believing a lot more of the

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misinformation and and they just
don't have much trust of the

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government.
Yeah, for various reasons, but

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especially coming out of the
pandemic.

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But, you know, we also see
groups and we've seen some, you

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know, immigrant, legal immigrant
communities, for example, in

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this, in this situation, you
know, Eastern European, where

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that are very close knit
communities and very strong,

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great members of, of the Society
of the state, but have very,

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very valid reasons for not
trusting the government.

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You know, if they came about, if
they came of age as the, as the

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Soviet Union was falling apart,
you know, and we're being

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potentially even given vaccines
or placebos because the

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government didn't have enough,
you know, or, you know, we're

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being lied to by the government.
I mean, there, there's a lot of

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history with some of these
communities that is very real.

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And you cannot fault them then
for not trusting us, you know,

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And so it's going to take time
and relationships for us to help

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them see that that we're not the
same as, as what they

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experienced, you know, 30-40
years ago and, and that we

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really do want to help and, you
know, provide accurate

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information.
Doctor Brandon Traxler is an

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Askedo member and deputy
director of health promotion and

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services and chief medical
officer of the South Carolina

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Department of Public Health.
Happy 125th anniversary to the

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New York State Department of
Health.

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The department's milestones of
success began early by

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pioneering food and drink
sanitation standards in 19-O2.

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The department's commissioner is
ASTO member James McDonald.

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You can hear his message
celebrating the success in New

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York State through the link in
our show notes.

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Now let's hear about a
relatively new substance to U.S.

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markets, kratom.
Heather Tomlinson, Senior

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Analyst of Environmental Health
at ASTO, will tell us what

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kratom is, how it's been used
historically, and how today's

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products differ from traditional
leaf based preparations.

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It's from Southeast Asia and
it's actually derived from the

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leaves of the kratom tree native
to that area.

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Historically, it's been used by
chewing the leaves or creating a

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tea, which has helped with
fatigue, pain relief and

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treating withdrawal symptoms.
And it's very commonly part of

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socio religious ceremonies in
the US.

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We've been seeing a shift where
these new kratom products kind

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of range from a variety of forms
from powders, gummy and

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beverages, but the chemical
composition of these products

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has also significantly changed
from the traditional usage.

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Yeah, it's been sneaking into
the marketplaces along the lines

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of, you know, an ingredient
that's in energy drinks or

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supplements, that kind of thing.
Yeah, we are seeing it in a lot

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of different formats.
And a lot of the a lot of those

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kratom ingredients.
Stateside around here.

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Use synthetic compounds,
correct?

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Yeah.
So some of those changes in the

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new forms that we're seeing are
with Metro Dining and 70 and

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these two chemicals are normally
found in just trace amounts in

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the natural kratom leaf product
and they can produce this

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response similar to opioids in
their traditional state.

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But in these new products,
westernized products that we're

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seeing on the market, they're
using a synthetic version of

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seven OH, which can be
concentrated to much higher

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levels than what we see
naturally.

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And this is concerning because
we've seen higher levels have

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been associated with significant
health risk such as rapid heart

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rate, high blood pressure and
seizures.

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And these products currently
aren't being regulated at the

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federal level, which has caused
a wide variation of product

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composition and packaging and
has led the FDA to classify

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kratom as an unsafe food
additive.

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And they've recommended 7 OH
products to be classified as a

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controlled substance.
And so because there is sort of

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little federal guidance, what
are states doing in terms of

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regulation?
Yeah.

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So without the stricter federal
regulation or guidance around

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these products, we've seen
states kind of creating a

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patchwork of different
regulations and taking very

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different stances on how they're
regulating these products.

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So we've seen some states that
have actually allowed the sale

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of these products and created
new sales taxes to help support

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the product regulation and
licensing.

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At the same time, we've also
seen several states consider

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creative as a controlled
substance.

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And then we've had 18 states
that have actually regulated the

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possession, distribution, sale
and or manufacturing of the

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products, including age
restrictions on who can buy

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these types of products and then
also some labeling requirements.

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OK.
And.

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This.
Is hardly the 1st substance to

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to make its way into the
marketplace of, of supplements

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and and sort of new beverages,
energy drinks, that kind of

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thing, not to mention beverages
and supplements that have things

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like THC and psilocybin and huge
amounts of caffeine.

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Can you sort of place it?
In the pantheon of these sort of

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new ingredients that that are,
they're creeping up seemingly

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everywhere.
Yeah.

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So we've definitely seen an
expansion of food freedom

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movement and people consuming
new types of products or new

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ways of consuming products.
Some of this has been clearly

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stated by the FDA that they're
not supplements or approved food

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additives.
But often times with these

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quickly changing trends, we
often see that regulations lag

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behind the emergence of these
new products.

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So it's really important that
the public follows public health

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guidance when consuming these,
whether that's the approved

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format or if the product should
be consumed at all.

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Yeah.
How should consumers kind of

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navigate this stuff?
As we've described, this is not

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a leaf from Southeast Asia.
It is a compound that's being

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manufactured.
What kind of considerations

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should consumers be making?
Yeah.

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And as more novel and
psychoactive additives are added

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to the food supply, it's really
important to follow the federal

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guidance and research around
these products.

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We are seeing states take a lot
of lessons learned from cannabis

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regulation on how to make sure
these products are reaching the

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public safely.
And I think it's important for

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states to try to stay aware of
these new trends and new

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products that are coming into
the market and reach out for

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federal guidance on how to
respond to these.

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We also recommend states to
connect with their peers if

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other states have regulated
these products or manage the

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sales to see what they've done
and what's been successful.

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Heather Tomlinson is a senior
analyst of environmental health

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at ASTO.
Earlier we heard from Doctor

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Brandon Traxler, an ASTO member
and deputy director of health

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promotion and services and chief
medical officer of the South

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00:14:18,400 --> 00:14:20,160
Carolina Department of Public
Health.

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Want more public health insights
beyond the podcast?

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00:14:24,760 --> 00:14:28,240
Follow ASTO on social media for
the latest news, resources and

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00:14:28,240 --> 00:14:31,360
conversations shaping state and
territorial public health.

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00:14:31,920 --> 00:14:35,360
You can find us on Instagram,
Facebook X, LinkedIn and Blue

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00:14:35,360 --> 00:14:39,480
Sky, where we share updates from
the field, new tools, policy

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00:14:39,480 --> 00:14:42,400
developments and stories from
health leaders across the

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country.
Follow ASTO wherever you scroll

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and find those links in the show
notes.

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00:14:48,080 --> 00:14:50,040
This has been Public Health
review morning edition.

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00:14:50,120 --> 00:14:52,680
I'm John Sheehan for the
Association of State and

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Territorial Health Officials.