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Healthwatch
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Healthwatch
Measles Is Making A Comeback: Can We Stop It?
~6.0 mins read
Seven things to know about the recent measles outbreaks.
brain inflammation (encephalitis), which can lead to seizures, hearing loss, or intellectual disability
pneumonia
eye inflammation (and occasionally, vision loss)
poor pregnancy outcomes, such as miscarriage
subacute sclerosing panencephalitis (SSPE), a rare and lethal disease of the brain that can develop years after the initial measles infection.
Vaccination. Usually, children are given the first dose around age 1 and the second between ages 4 and 6 as part of the Measles-Mumps-Rubella (MMR) vaccine. If a child — or adult — hasn’t been vaccinated, they can have these doses later.
If you were born after 1957 and received a measles vaccination before 1968, consider getting revaccinated or tested for measles antibodies (see below). The vaccine given before 1968 was less effective than later versions. And before 1957, most people became immune after having measles, although this immunity can wane.
Isolation. To limit spread, everyone diagnosed with measles and anyone who might be infected should avoid close contact with others until four days after the rash resolves.
Mask-wearing by people with measles can help prevent spread to others. Household members or other close contacts should also wear a mask to avoid getting it.
Frequent handwashing helps keep the virus from spreading.
Testing. If you aren’t sure about your measles vaccination history or whether you may be vulnerable to infection, consider having a blood test to find out if you’re immune to measles. Memories about past vaccinations can be unreliable, especially if decades have gone by, and immunity can wane.
Pre-travel planning. If you are headed to a place where measles is common, make sure you are up to date with vaccinations.
Has the recent news about measles outbreaks in the US surprised you? Didn’t it seem like we were done with measles?
In the US, widespread vaccination halted the ongoing spread of measles more than 20 years ago, a major public health achievement. Before an effective vaccine was developed in the 1960s, nearly every child in the US got measles. Complications like measles-related pneumonia or hearing loss were common, and 400 to 500 people died each year.
As I write this, there have been 1,227 confirmed cases in 36 states, mostly among children. The biggest outbreak is in west Texas, where 97 people have been hospitalized and two unvaccinated school-age children recently died, the first measles deaths in the US since 2015. Officials in New Mexico have also reported a measles-related death.
Can we prevent these tragedies?
Measles outbreaks are highly preventable. It’s estimated that when 95% of people in a community are vaccinated, both those individuals and others in their community are protected against measles.
But nationally, measles vaccination rates among school-age kids fell from 95% in 2019 to 92% in 2023. Within Texas, the kindergarten vaccination rates have dipped below 95% in about half of all state counties. In the community at the center of the west Texas outbreak, the reported rate is 82%. Declining vaccination rates are common in other parts of the US, too, and that leaves many people vulnerable to measles infections.
Only 3% of the recent cases in the US involved people known to be fully vaccinated. The rest were either unvaccinated or had unknown vaccine status (95%), or they had received only one of the two vaccine doses (2%).
What to know about measles
As measles outbreaks occur within more communities, it’s important to understand why this happens — and how to stop it. Here are seven things to know about measles.
The measles virus is highly contagious
Several communities have suffered outbreaks in recent years. The measles virus readily spreads from person to person through the air we breathe. It can linger in the air for hours after a sneeze or cough. Estimates suggest nine out of 10 nonimmune people exposed to measles will become infected. Measles is far more contagious than the flu, COVID-19, or even Ebola.
Early diagnosis is challenging
It usually takes seven to 14 days for symptoms to show up once a person gets infected. Common early symptoms — fever, cough, runny nose — are similar to other viral infections such as colds or flu. A few days into the illness, painless, tiny white spots in the mouth (called Koplik spots) appear. But they’re easy to miss, and are absent in many cases. A day or two later, a distinctive skin rash develops.
Unfortunately, a person with measles is highly contagious for days before the Koplik spots or skin rash appear. Very often, others have been exposed by the time measles is diagnosed and precautions are taken.
Measles can be serious and even fatal
Measles is not just another cold. A host of complications can develop, including
Complications are most common among children under age 5, adults over age 20, pregnant women, and people with an impaired immune system. Measles is fatal in up to three of every 1,000 cases.
During the latest outbreaks, 148 cases — about one in eight — have required hospitalization.
Getting measles may suppress your immune system
When you get sick from a viral or bacterial infection, antibodies created by your immune system will later recognize and help mount a defense against these intruders. In 2019, a study at Harvard Medical School (HMS) found that the measles virus may wipe out up to three-quarters of antibodies protecting against viruses or bacteria that a child was previously immune to — anything from strains of the flu to herpesvirus to bacteria that cause pneumonia and skin infections.
“If your child gets the measles and then gets pneumonia two years later, you wouldn’t necessarily tie the two together. The symptoms of measles itself may be only the tip of the iceberg,” said the study’s first author, Dr. Michael Mina, who was a postdoctoral researcher in the laboratory of geneticist Stephen Elledge at HMS and Brigham and Women’s Hospital at the time of the study.
In this video, Mina and Elledge discuss their findings.
Vaccination is highly effective
Two doses of the current vaccine provide 97% protection — much higher than most other vaccines. Rarely, a person gets measles despite being fully vaccinated. When that happens, the disease tends to be milder and less likely to spread to others.
The measles vaccine is safe
The safety profile of the measles vaccine is excellent. Common side effects include temporary soreness in the arm, low-grade fever, and muscle pain, as is true for most vaccinations. A suggestion that measles or other vaccines cause autism has been convincingly discredited. However, this often-repeated misinformation has contributed to significant vaccine hesitancy and falling rates of vaccination.
Ways to protect yourself from measles infection
If you were born after 1957 and received a measles vaccination before 1968, consider getting revaccinated or tested for measles antibodies (see below). The vaccine given before 1968 was less effective than later versions. And before 1957, most people became immune after having measles, although this immunity can wane.
The bottom line
While news about measles in recent months may have been a surprise, it’s also alarming. Experts warn that the number of cases (and possibly deaths) are likely to increase. And due to falling vaccination rates, outbreaks are bound to keep occurring. One study estimates that between nine and 15 million children in the US could be susceptible to measles.
But there’s also good news: we know that measles outbreaks can be contained and the disease itself can be eliminated. Learn how to protect yourself and your family. Engage respectfully with people who are vaccine hesitant: share what you’ve learned from reliable sources about the disease, especially about the well-established safety of vaccination.
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Healthwatch
What Is Prostatitis And How Is It Treated?
~3.5 mins read
Prostatitis can cause painful or uncomfortable symptoms, but various types of treatment can help.
Prostatitis, or inflammation of the prostate, is more common than you might think — it accounts for roughly two million doctor visits every year. The troubling symptoms include burning or painful urination, an urgent need to go (especially at night), painful ejaculations, and also pain in the lower back and perineum (the space between the scrotum and anus).
Prostatitis overview
There are four general categories of prostatitis:
Acute bacterial prostatitis comes on suddenly and is often caused by infections with bacteria such as Escherichia coli that normally live in the colon. Men can suffer muscle aches, fever, and blood in semen or urine, as well as urogenital symptoms. Acute inflammation can cause the prostate to swell and block urinary outflow from the bladder. A complete blockage is a medical emergency that requires immediate treatment. Depending on symptom severity, hospitalization may be necessary.
Chronic bacterial prostatitis results from milder infections that sometimes linger for months. It occurs more often in older men and the symptoms typically wax and wane in severity, sometimes becoming barely noticeable.
Chronic nonbacterial prostatitis, also called chronic pelvic pain syndrome (CPPS), is the most common type. CPPS can be triggered by stress, urinary tract infections, or physical trauma causing inflammation or nerve damage in the genitourinary area. In some men, the cause is never identified. CPPS can affect the entire pelvic floor, meaning all the muscles, nerves, and tissues that support organs involved in bowel, bladder, and sexual functioning.
Asymptomatic inflammatory prostatitis is diagnosed when doctors detect white blood cells in prostate tissues or secretions in men being evaluated for other conditions. It generally requires no treatment.
Both acute and chronic bacterial prostatitis can cause blood levels of prostate-specific antigen (PSA) to spike. This can be alarming, since high PSA is also indicative of prostate cancer. But if a man has prostatitis, then that condition — and not prostate cancer — may very well be the reason for the rise in PSA.
Prostatitis treatments
Fortunately, research advances are leading to some encouraging developments for men suffering from this condition.
Antibiotics called fluoroquinolones are effective treatments for acute and chronic bacterial prostatitis. A four-to six-week course of the drugs typically does the trick. However, bacterial resistance to fluoroquinolones is a growing problem. An older drug called fosfomycin can help if other drugs stop working. PSA levels will decline with treatment, although that process may take three to six months.
CPPS is treated in other ways. Since it is not caused by a bacterial infection, CPPS will not respond to antibiotics. Medical treatments include nonsteroidal anti-inflammatory drugs such as ibuprofen, alpha blockers including tamsulosin (Flomax) that loosen tight muscles in the prostate and bladder neck, and drugs called PDEF inhibitors such as tadalafil (Cialis) that improve blood flow to the prostate.
Specialized types of physical therapy can provide some relief. One method called trigger point therapy, for instance, targets tender areas in muscles that tighten up and spasm. With another method called myofascial release, physical therapists can reduce tension in the connective tissues surrounding muscles and organs. Men should avoid Kegel exercises, however, which can tighten the pelvic floor and cause worsening symptoms.
Acupuncture has shown promise in clinical trials. One study published in 2023 showed significant improvements in CPPS symptoms lasting up to six months after the acupuncture treatments were finished. Mounting evidence suggest that CPPS should be treated with holistic strategies that also consider psychological factors.
Men with CPPS often suffer from depression, anxiety, and other mental health issues that can exacerbate pain perception. Techniques such as mindfulness and cognitive behavioral therapy for CPPS can help CPPS sufferers develop effective coping strategies.
Comment
"An accurate diagnosis is important given differences in how each of the four categories of prostatitis is treated," said Dr. Boris Gershman, a urologist at Beth Israel Deaconess Medical Center and assistant professor of surgery at Harvard Medical School. PSA should also be retested after treating bacterial forms of prostatitis, Dr. Gershman added, to ensure that the levels go back to normal. If the PSA stays elevated after antibiotic treatment, or if abnormal levels are detected in men with nonbacterial prostatitis, then the PSA "should be evaluated in accordance with standard diagnostic approaches," Dr. Gershman said.
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Healthwatch
Wildfires: How To Cope When Smoke Affects Air Quality And Health
~3.5 mins read
Smoke from regional wildfires endangers health even for those not directly in the path of fire.
Create an evacuation plan for your family before a wildfire occurs.
Make sure that you have several days on hand of medications, water, and food that doesn’t need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
Follow alerts from local officials if you are in the region of an active fire.
Stay aware of air quality.AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It’s also important to know if your system has outdoor air intake vents.
Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
Make a “clean room.” Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn’t need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air.
As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.
How does wildfire smoke affect air quality?
Wildfire smoke contributes greatly to poor air quality. Just like pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.
Smoke carried by weather patterns and jet streams can cross state and national boundaries, traveling to distant regions.
How does wildfire smoke affect our health?
The small particles in wildfire smoke –– known as particulate matter, or PM10, PM2.5, PM0.1 –– are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.
The health effects of wildfire smoke include eye and skin irritation, coughing, wheezing, and difficulty breathing. Other possible serious health effects include heart failure, heart attacks, and strokes.
Who needs to be especially careful?
Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.
If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.
What can you do to prepare for wildfire emergencies?
If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:
What steps can you take to lower health risks during poor air quality days?
These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:
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Healthwatch
Can A Routine Vaccine Prevent Dementia?
~5.0 mins read
Shingles vaccination may come with unexpected benefits.
A study of more than 300,000 adults found that among those 70 and older, dementia was less common among those who had received shingles vaccination than among those who did not.
A study of more than 200,000 older adults compared rates of dementia between those receiving a newer (recombinant) shingles vaccine and those who had an older (live) vaccine that is no longer approved in the US. Researchers found that the risk of dementia was lower six years after receiving either vaccine. But the effect was larger for the newer vaccine: those given the recombinant vaccine spent more time living dementia-free (164 days longer) compared with those given the older vaccine.
Examples of exposures might be an illness (like the COVID pandemic), a policy (like a smoking ban in one state), or a vaccination (like the shingles vaccine).
Outcomes might include virtual versus in-person learning during the pandemic, smoking-related illnesses in a state with a smoking ban compared to a state without that ban, or dementia rates among people who did or didn't receive a vaccine.
developed shingles less often
were 3.5% less likely to develop dementia over seven years (a 20% reduction)
were more likely to be protected from dementia if female.
Reduced inflammation: Preventing shingles may prevent harmful inflammation in the body, especially in the nervous system.
Impact on immune function: Vaccination might alter immune function in a way that protects against dementia.
Reducing stroke risk: Some evidence shows that shingles may increase the risk of stroke. A stroke can contribute to or cause dementia, so perhaps vaccination leads to less dementia by reducing shingles-related strokes.
It's fairly common for a medical treatment to cause side effects: think headache, upset stomach, sleepiness, and occasionally more severe side effects. Far more rarely, a side effect provides an unexpected benefit. This might be the case for the shingles vaccine.
Shingles is a painful, blistering skin rash caused by the varicella zoster virus responsible for chickenpox. The virus lies dormant in nerve tissue and can reactivate to cause shingles in anyone who has had chickenpox in the past. A vaccine to prevent shingles is recommended for adults ages 50 and older, and for people 19 and older who have an impaired immune system.
While we know the shingles vaccine is effective at preventing shingles, evidence is mounting that it might also reduce the risk of dementia. Yes, a vaccination to prevent shingles may lessen your risk of dementia.
Dementia is on the rise
Dementia is a devastating condition for those affected and their families. Currently, an estimated nine million people in the US have dementia. The number is expected to double by 2060, primarily because of the aging population. In most cases, no highly effective treatments are available. An effective preventive measure could have an enormous impact, especially if it's safe, inexpensive, and already available.
Can shingles vaccination prevent dementia?
Some (though not all) studies have found that having shingles increases your risk of dementia in the future. And that's led researchers to explore the possibility that preventing shingles through vaccination might reduce dementia risk.
Several studies suggest this is true. For example:
What is a natural experiment?
Perhaps the best evidence suggesting that shingles vaccination prevents dementia comes from a natural experiment recently published in the journal Nature.
A natural experiment takes advantage of real-world circumstances by dividing people into an exposed group and an unexposed group and then comparing specific outcomes.
Natural experiment studies bypass the challenges of having to recruit hundreds or thousands of study subjects who might differ from one another in important ways, or who might alter their behavior because they know they're in a study. The results can be even more valuable than — and as credible as — standard randomized trials.
What did this natural experiment study look at?
In 2013, Wales made the shingles vaccination available to individuals based on their date of birth: anyone born after September 2, 1933, was eligible, while anyone born before that date was not. Researchers took this opportunity to analyze health records of nearly 300,000 people: half were two weeks older than the cutoff date and half were two weeks younger. The study looked at whether people developed dementia over a seven-year period.
Researchers found that compared to those who didn't get the shingles vaccination, those who received it
A study of this type cannot prove that shingles vaccination prevents dementia. But along with the studies cited above, there's a strong suggestion that it does. We'll need additional studies to confirm the benefit. We also want to understand other details of the vaccine's effect, such as whether protection applies more to some types of dementia (such as Alzheimer's disease) than others, and whether the effect of vaccination changes over time.
Why might the shingles vaccine prevent dementia?
With any unexpected finding in science, it's a good idea to ask whether there is a reasonable explanation behind it. Scientists call this biologic plausibility. In general, the more plausible a result is, the more likely it is to hold up in later research.
In this case, several lines of reasoning explain how a shingles vaccine might reduce the risk of dementia, including:
The observation that women had more protection from dementia than men after shingles vaccination is unexplained. It's possible that the immune response to vaccination is different in women, or that dementia develops differently in women compared with men.
The bottom line
All of us can take steps to lower dementia risk, mostly through healthy behaviors such as being active regularly and choosing a healthy diet. Evidence is mounting that shingles vaccination should be added to the list. It's a story worth following. Future studies of the shingles vaccine could even provide insights into how dementia develops, and how to better prevent and treat it.
Until then, get your shingles vaccination if you're eligible for it. It can prevent painful episodes of shingles — and may do much more.
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