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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
Stepping Up Activity If Winter Slowed You Down
~4.7 mins read
Better health, better mood, better balance, and a multitude of other benefits await.
heart disease
stroke
diabetes
cancer
brain shrinkage
muscle loss
weight gain
poor posture
poor balance
back pain
and even premature death.
If it's cold outside: It's generally safe to exercise when the mercury is above 32° F and the ground is dry. The right gear for cold doesn't need to be fancy. A warm jacket, a hat, gloves, heavy socks, and nonslip shoes are a great start. Layers of athletic clothing that wick away moisture while keeping you warm can help, too. Consider going for a brisk walk or hike, taking part in an orienteering event, or working out with battle ropes ($25 and up) that you attach to a tree.
If you have mobility issues: Most workouts can be modified. For example, it might be easier to do an aerobics or weights workout in a pool, where buoyancy makes it easier to move and there's little fear of falling. Or try a seated workout at home, such as chair yoga, tai chi, Pilates, or strength training. You'll find an endless array of free seated workout videos on YouTube, but look for those created by a reliable source such as Silver Sneakers, or a physical therapist, certified personal trainer, or certified exercise instructor. Another option is an adaptive sports program in your community, such as adaptive basketball.
If you can't stand formal exercise: Skip a structured workout and just be more active throughout the day. Do some vigorous housework (like scrubbing a bathtub or vacuuming) or yard work, climb stairs, jog to the mailbox, jog from the parking lot to the grocery store, or do any activity that gets your heart and lungs working. Track your activity minutes with a smartphone (most devices come with built-in fitness apps) or wearable fitness tracker ($20 and up).
If you're stuck indoors: The pandemic showed us there are lots of indoor exercise options. If you're looking for free options, do a body-weight workout, with exercises like planks and squats; follow a free exercise video online; practice yoga or tai chi; turn on music and dance; stretch; or do a resistance band workout. Or if it's in the budget, get a treadmill, take an online exercise class, or work online with a personal trainer. The American Council on Exercise has a tool on its website to locate certified trainers in your area.
If you've been cocooning due to winter's cold, who can blame you? But a lack of activity isn't good for body or mind during any season. And whether you're deep in the grip of winter or fortunate to be basking in signs of spring, today is a good day to start exercising. If you're not sure where to start — or why you should — we've shared tips and answers below.
Moving more: What's in it for all of us?
We're all supposed to strengthen our muscles at least twice a week and get a total at least 150 minutes of weekly aerobic activity (the kind that gets your heart and lungs working). But fewer than 18% of U.S. adults meet those weekly recommendations, according to the CDC.
How can choosing to become more active help? A brighter mood is one benefit: physical activity helps ease depression and anxiety, for example. And being sufficiently active — whether in short or longer chunks of time — also lowers your risk for health problems like
What are your exercise obstacles?
Even when we understand these benefits, a range of obstacles may keep us on the couch.
Don't like the cold? Have trouble standing, walking, or moving around easily? Just don't like exercise? Don't let obstacles like these stop you anymore. Try some workarounds.
Is it hard to find time to exercise?
The good news is that any amount of physical activity is great for health. For example, a 2022 study found that racking up 15 to 20 minutes of weekly vigorous exercise (less than three minutes per day) was tied to lower risks of heart disease, cancer, and early death.
"We don't quite understand how it works, but we do know the body's metabolic machinery that imparts health benefits can be turned on by short bouts of movement spread across days or weeks," says Dr. Aaron Baggish, founder of Harvard-affiliated Massachusetts General Hospital's Cardiovascular Performance Program and an associate professor of medicine at Harvard Medical School.
And the more you exercise, Dr. Baggish says, the more benefits you accrue, such as better mood, better balance, and reduced risks of diabetes, high blood pressure, high cholesterol, and cognitive decline.
What's the next step to take?
For most people, increasing activity is doable. If you have a heart condition, poor balance, muscle weakness, or you're easily winded, talk to your doctor or get an evaluation from a physical therapist.
And no matter which activity you select, ease into it. When you've been inactive for a while, your muscles are vulnerable to injury if you do too much too soon.
"Your muscles may be sore initially if they are being asked to do more," says Dr. Sarah Eby, a sports medicine specialist at Harvard-affiliated Spaulding Rehabilitation Hospital. "That's normal. Just be sure to start low, and slowly increase your duration and intensity over time. Pick activities you enjoy and set small, measurable, and attainable goals, even if it's as simple as walking five minutes every day this week."
Remember: the aim is simply exercising more than you have been. And the more you move, the better.
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Healthwatch
Celiac Disease: Exploring Four Myths
~4.2 mins read
An expert shines light on common misconceptions about this genetic autoimmune disease triggered by gluten.
Celiac disease is diagnosed with blood tests that look for specific antibodies. If antibodies are present, a definitive diagnosis requires an intestinal biopsy to look for signs of damage that characterize the condition.
Non-celiac gluten sensitivity does not trigger antibodies or cause intestinal damage. Yet some people with this problem say they also experience brain fog, trouble concentrating, muscle aches and pain, and fatigue after eating gluten-containing foods.
One possibility is sugarlike molecules known as FODMAPs, which are found in many foods — including wheat. Short for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, gas and bloating can occur when gut bacteria feed on FODMAPs.
Another possibility is an allergy to wheat, which can cause symptoms such as swelling, itching, or irritation of the mouth and throat after eating wheat. Other symptoms include a skin rash, stuffy nose, and headache, as well as cramps, nausea, and vomiting. Some people may develop a life-threating allergic reaction known as anaphylaxis.
Enzymes that break down gluten, which people could take alongside gluten-containing foods. "It's a similar concept to the lactase pills taken by people who are lactose intolerant to help them digest dairy products," says Dr. Kelly.
Dampening the immune response to gluten by inhibiting an enzyme called tissue transglutaminase that makes gluten more potent as an antigen.
Reprogramming the immune response to prevent the body from reacting to gluten.
Celiac disease is a digestive and immune disorder that can keep the body from absorbing necessary nutrients. "Our conception and awareness of celiac disease has evolved over the past few decades, but there are still aspects that remain poorly understood," says Dr. Ciaran Kelly, medical director of the Celiac Center at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.
Perhaps not surprisingly, misconceptions are widespread among the general public. One example? Many people assume that everyone who has celiac disease is plagued by abdominal pain, bloating, or diarrhea. But actually, many adults newly diagnosed with this inherited gluten intolerance don't have these symptoms.
What's more, gluten — the sticky protein found in grains such as wheat, barley, and rye — can cause gastrointestinal distress and other symptoms in people who don't have celiac disease. Read on for a deeper dive into four myths and facts about celiac disease and related digestive conditions.
Myth # 1: Celiac disease is usually diagnosed at a young age
Not typically. While celiac disease can develop any time after a baby's first exposure to gluten, it's usually diagnosed much later in life. According to the National Celiac Association, the average age of diagnosis is between 46 and 56. Around 25% of people are diagnosed after age 60.
Celiac disease is slightly more common in women and among people with other autoimmune conditions, including type 1 diabetes, Hashimoto's thyroiditis (a common cause of low thyroid levels), and dermatitis herpetiformis (a rare condition marked by an itchy, blistering rash).
"We don't know why some people go from being susceptible to actually having celiac disease," says Dr. Kelly. The prevailing theory is that some sort of physical or emotional stress — such as a viral infection, surgery, or anxiety from a stressful life event — may "flip the switch" and cause the disease to appear, he says. "Increasing numbers of people are being diagnosed at midlife and older, often after they're found to have conditions such as anemia or osteoporosis caused by nutrient deficiencies," says Dr. Kelly.
Myth #2: Celiac disease only affects the gut
When people have celiac disease, eating gluten triggers an immune system attack that can ravage the lining of the small intestine. A healthy small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed — and thus unable to adequately absorb nutrients.
While gastrointestinal problems can occur, they aren't always present. In fact, celiac disease can present with many different symptoms that affect the nervous, endocrine, and skeletal systems. A few examples are brain fog, changes in menstrual periods, or muscle and joint pain.
Myth # 3: Celiac disease versus gluten intolerance
If you feel sick after eating gluten, you probably have celiac disease, right? Actually, that may not be true. Some people have non-celiac gluten sensitivity (also called gluten intolerance), which can cause uncomfortable digestive symptoms after eating gluten. But gluten intolerance differs from celiac disease.
"Non-celiac gluten sensitivity appears to be a real phenomenon, but it's not well defined," says Dr. Kelly. It's unclear whether people experiencing it are intolerant to gluten or to something else in gluten-containing foods.
Myth #4: A gluten-free diet always relieves the symptoms and signs of celiac disease
The sole treatment for celiac disease — adopting a diet that avoids all gluten-containing foods — doesn't always help. This problem is known as nonresponsive celiac disease.
"About 20% of people with celiac disease have ongoing symptoms, despite their best efforts to stick to a gluten-free diet," says Dr. Kelly. Others have intermittent signs and symptoms, particularly when they are accidentally exposed to gluten. Accidental exposures often happen when people eat prepared or restaurant foods that claim to be gluten-free but are not. Cross contamination with gluten-containing foods is another potential route.
Potential solutions to nonresponsive celiac disease are being studied. Three promising approaches are:
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Healthwatch
Can Saw Palmetto Treat An Enlarged Prostate?
~3.3 mins read
Scientific evidence shows little or no benefit.
Marketed as a natural remedy for an enlarged prostate, saw palmetto is a top-selling dietary supplement. It's extracted from berries that grow on saw palmetto palm trees, which are native to the southeastern United States.
By one estimate, more than a third of all US adults who take supplements use saw palmetto specifically. Some evidence suggests that saw palmetto has anti-inflammatory properties, and its use as folk medicine dates back over a century.
But experts at Harvard say men should view its supposed benefits for prostate health skeptically. "Saw palmetto is unlikely to harm you, but it probably won't provide any major benefits either," says Dr. Heidi Rayala, an assistant professor of urology at Harvard Medical School and Beth Israel Deaconess Medical Center.
BPH and the potential effect of saw palmetto
It's common for men to develop an enlarged prostate, or benign prostatic hyperplasia (BPH), when they get older. BPH impedes urinary flow through the urethra, causing obstructive symptoms that can worsen with time.
Just how saw palmetto might act on the prostate to improve symptoms isn't entirely clear, however. Some evidence suggest it mimics the effects of certain drugs used for treating BPH, including 5-alpha reductase inhibitors such as finasteride (Proscar), which shrink the prostate gland.
In the US, no herbal supplement is approved as BPH treatment. The American Urological Association cautions that studies backing saw palmetto for treating enlarged prostates have numerous flaws, including short durations and a lack of placebo controls. Most of the supporting evidence comes from small studies paid for by companies that sell dietary supplements.
What do randomized clinical trials show?
The best-conducted research shows no benefits from saw palmetto for BPH. During one study, 225 men with moderate to severe BPH were treated with either a placebo or 160 milligrams (mg) of saw palmetto, taken twice daily for a year. The investigators detected no difference in outcomes, but they also acknowledged that doses tested in the study may have been too low to produce measurable effects.
So, during a larger subsequent study, researchers tested higher doses of saw palmetto ranging up to 320 mg given three times a day. Nearly 370 men ages 45 and older were randomized to treatment or placebo groups. After year and a half, men in both groups reported feeling either no worse or a little better. Remarkably, 40% of the placebo-treated men said symptoms had improved, suggesting the simple act of taking a pill could have something to do with the supplement's perceived benefits.
Dr. Michael Barry, a professor of medicine at Harvard Medical School, led the study. He urges men to consult with their doctors before trying saw palmetto, mainly to rule out other potential causes of urinary obstruction, which can include bladder or prostate cancer. And saw palmetto may interfere with the blood's clotting ability, making it risky for men who take blood thinners.
Recent results and comments
The latest evidence on saw palmetto and BPH comes from a Cochrane Review of 27 placebo-controlled studies enrolling a combined 4,656 participants. Results published in 2024 showed no improvement in urinary symptoms or quality of life from taking saw palmetto (alone or with other herbal supplements) over durations ranging up to 17 months.
"If the ingredients in these herbal products worked well for urinary symptoms, drug companies would have already had them approved by the FDA as a medicine that insurance companies would have to cover," Dr. Rayala said. "It's okay to take them, but just be cautious about spending too much of your own money on these alternatives."
"It is easy to understand why so many find taking a naturally occurring supplement for treating urinary difficulties in middle age appealing," said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. "However, evidence of effectiveness with saw palmetto is lacking, and its use for BPH and other common urinary symptoms without a full evaluation of the potential cause should be discouraged."
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