Measles (rubeola) is a highly contagious viral illness that was eliminated in the U.S. in the year 2000. However, due in part to some people becoming wary of vaccines, more Americans now lack immunity.
Recently, the CDC has identified outbreaks in 15 states. Worldwide, in 2023 there was a 79% increase in measles cases that resulted in over 130,000 deaths, mainly in children.
Why does this matter? Measles can cause complications including middle ear infections, pneumonia, brain swelling from inflammation (may cause vision or hearing loss, seizures, learning disabilities, and other neurological problems), and even death.
Measles is spread mainly through droplets in the air from infected people. It can spread before the person has symptoms.
One characteristic feature is a red rash beginning on the skin of the head and traveling down to the feet. This usually starts 3-5 days after onset of illness.
If someone has not been vaccinated and they are exposed to measles, it is recommended that they get vaccinated within 3 days after exposure. Also, unvaccinated people who are exposed are recommended to be quarantined for 21 days to limit community spread.
The measles vaccine is highly effective. Receiving two separate vaccinations prevents measles in 97% of exposed individuals.
I highly recommend that people take this risk seriously. If you have not had two measles vaccinations, talk to your doctor for advice.
COVID is still with us. Currently, there are more Americans hospitalized for COVID than for the flu.
Is there a way to improve this? Yes, there is. People with mild to moderate COVID who are at risk of getting sicker and requiring hospitalization can take Paxlovid and significantly reduce the risk of hospitalization and death.
Who is at risk? Anyone age 50 or older (especially if age 65 or older), or not up to date on COVID vaccination, or have an illness such as diabetes, cancer, heart disease, chronic lung disease, being pregnant or were recently pregnant, or taking immunosuppressive medication.
To be clear, Paxlovid does not prevent you from getting COVID. What it does do is prevent a mild or moderate case progressing to severe COVID requiring hospitalization or even death.
To be effective Paxlovid must be taken within 5 days of symptom onset. The sooner, the better.
What about rebound in people who used Paxlovid? Rebound means that there is a return of symptoms a few days after finishing treatment, and the patient had appeared to have recovered.
This happens in a minority of patients, and the symptoms are brief and mild. In one major study, there were no hospitalizations or deaths among patients with rebound.
Also, rebound is seen in people with COVID who have not taken Paxlovid. So, we don’t know for sure if Paxlovid increases the risk of rebound or not.
There is no data to support restarting Paxlovid if you have rebound symptoms. In any case, it seems unnecessary since the symptoms are mild and short-lived.
What is the bottom line? If you develop COVID and are in a high risk group for progression to severe disease, it would be wise for you to start Paxlovid within 5 days of symptom onset.
The information for this blog comes from an excellent article by Rita Rubin, MA in JAMA.2024; 331(7): 548-551.
Researchers found that being bullied often leads to not trusting other people. In turn, that can lead to poorer mental health.
A study of 10,000 youth in the United Kingdom revealed that those who were bullied had more “mental health problems in late adolescence, and this effect was partially mediated by interpersonal distrust during middle adolescence.”
Those adolescents with high levels of distrust “were approximately 3.5 times more likely to subsequently experience clinically significant mental health problems than those who developed less distrust.”
The researchers concluded that bullied kids would likely have fewer mental health problems if they received counseling that included strengthening their trust in others.
Many people get most of their health information from social media. Alas, it is not always correct information.
According to ML Wang and K Togher in JAMA PEDIATRICS this year, health misinformation ”is extremely prevalent” (see reference at the end).
The article goes on to say, “Due to targeted marketing, health misinformation on social media also disproportionately harms female adolescents, racial and ethnic minority youth, LGBQT+ youth, and other marginalized groups.”
Misinformation may lead to “distorted perceptions of body image and healthy behaviors.” For example, youth may engage in unhealthy, even dangerous, eating behaviors such as forced vomiting after meals.
“The constant comparison to unattainable body standards on social media also contributes to body dissatisfaction, low self-esteem, and increased anxiety and depression.”
The authors recommend combatting health misinformation by encouraging adolescents to learn to “use fact-checking websites and tools to help verify information accuracy, understand algorithmic biases, recognize click-bait tactics, critically analyze content, and identify reputable sources.”
Two helpful tools to assess health information accuracy are “Take Two Media Initiatives” and “Media Literacy Now.”
[Wang ML & Togher K. JAMA Pediatrics 2024; 178(2): 178-110]
How can you optimize the immune response to a second COVID vaccination? It turns out that it is easy.
Researchers at the Oregon Health and Science University tested the immune response after research subjects received their second COVID vaccine. Half of them got the shot in the same arm as the first vaccination; the other half got it in the other arm.
The anti-COVID immune response was measured at various times after the second shot. At 3 weeks after the second shot the subjects who SWITCHED ARMS HAD UP TO 4 TIMES the response than those using the same arm.
The higher immune response persisted for at least 13 months. It is surmised that the higher immune response was a result of it being initiated in different lymph nodes (i.e., nodes draining different arms).
The research was published by Fazli and colleagues in the Journal of Clinical Investigation January 16, 2024. The article can be found by typing the following in a search bar:
Insufficient iron in your body causes anemia. Iron is needed to make hemoglobin, which carries oxygen in red blood cells. Hemoglobin also is necessary for energy and proper function of the immune system.
What causes lack of iron? This topic was addressed in a helpful article by Sara Berg, MS who interviewed two blood specialists, Drs. Richard Eisenstaedt and Amar Kelkar.
The interview was published in JAMA News Wire in January 2024. Their answers form the basis of this blog post.
Anemia is the lack of an adequate number of red blood cells. Symptoms may include fatigue, dizziness, brittle nails, pale skin and eyes, headaches, feeling cold, shortness of breath or exercise intolerance.
One uncommon symptom is pica, which involves chewing lots of ice and/or eating starch or other unusual foods.
We lose iron every day from the normal shedding of intestinal cells (about 1 milligram per day).
Menstruating women lose an average of 30 milligrams each month (more or less depending on how heavy their menses are).
Typically, we eat food with iron that provides us with about 20 milligrams per day, but we only absorb about 10% of that.
So, the average menstruating woman takes in just enough iron in her diet to compensate for the loss of iron from menstrual bleeding and shedding of intestinal cells.
It should be no surprise that the most common cause of anemia in menstruating women is inadequate intake of iron.
In men and non-menstruating women, the most common cause of iron deficiency anemia is disease in the intestinal tract. Colon cancer would be an example.
Thus, iron deficiency anemia in these individuals should include an evaluation of their GI tract by a colonoscopy and other tests.
Iron deficiency is easily identified by a blood test, a ferritin level. It indicates the total amount of iron the body has stored. If it is low, the person has iron deficiency.
The underlying cause must be treated. In addition, additional iron needs to be provided. Taking iron pills twice a day between meals is often prescribed.
Do not take iron with antacids or food, including milk or black tea, because they can reduce the absorption of the iron.
On the other hand, iron should be given with vitamin C from supplements or orange juice. It enhances the absorption of iron.
Iron is also present in many foods. Good examples include meat, seafood, beans, legumes, dark leafy greens like spinach, raisins, apricots, and some cereals, breads and pastas (read the labels).
Do not take more iron than recommended by your doctor because too much iron can cause liver or heart damage in susceptible people.
Some people experience vague abdominal symptoms such as cramps or constipation when taking iron. Temporarily reducing the dose until your intestines acclimate to the dose may resolve the problem.
Always communicate with your doctor if you have any problems taking recommended iron.
Sometimes iron deficiency is discovered when someone tries to donate blood and is told their red blood cell count is too low. They should see their doctor who can order appropriate tests to find the cause.
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