Measles Epidemic

The United States is experiencing a multistate outbreak of measles. The Centers for Disease Control and Prevention (CDC) reports that from Jan 1 to Feb 13, 2015 the number of measles cases was 141 and the disease had spread to 17 states and the District of Columbia.   The CDC reported that as of Feb 24 the number of US measles cases had increased to 154 and the cases were linked to “three separate outbreaks” – Disneyland, and unrelated outbreaks in Illinois and Nevada.

The multistate outbreak is believed to have started when a traveler who was infected with measles overseas visited Disneyland, though the specific source isn’t known, according to the CDC. An analysis of the virus causing this outbreak shows it is identical to a virus type that caused a large outbreak in the Philippines last year. But the virus type appears to be common: it has also been identified in 14 other countries and at least six U.S. states with cases that aren’t linked to the Disneyland outbreak.

Also, seven countries in Europe and Central Asia (Kyrgyzstan, Bosnia, Russia, Georgia, Italy, Germany, Kazakhstan) have reported 22 567 cases of measles in 2014 and thus far in 2015.  According to the World Health Organization (WHO), the outbreaks are due to a growing number of parents who either refuse to vaccinate their children or are facing barriers in getting the immunizations they need. 

Before the era of widespread vaccination measles was a disease that affected the overwhelming majority of children.  The symptoms of measles generally appear about 7 to 14 days after a person is infected and typically begin with

•   high fever

•   cough

•   runny nose and

•   red, watery eyes

Two or three days after symptoms begin, tiny white spots may appear inside the mouth and a skin rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may join together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.  After a few days, the fever subsides and the rash fades.

The Persian physician and philosopher Rhazes (860-932) in the 10th century A.D. wrote and described measles as a disease that is “more dreaded than smallpox”.  In 1757, Francis Home a Scottish physician, found that measles is an infectious disease.

In the decade before 1963 when a vaccine became available, nearly all children got measles (Rubeola) by the time they were 15 years of age. It is estimated 3 to 4 million patients in the United States were infected each year and approximately 400 to 500 patients died and 4,000 suffered encephalitis from measles.

In 1954, John F. Enders and Dr. Thomas C. Peebles collected blood samples from several ill students during a measles outbreak in Boston, Massachusetts in an effort to isolate the virus and make measles’ vaccine. They succeeded in isolating the virus in the blood of a 13-year-old boy.  In 1963, John Enders and colleagues transformed their Edmonston-B strain of measles virus into a vaccine. Measles vaccine today is usually combined with mumps, rubella and varicella and given in one or two doses.

According to CDC most of those infected this year were not vaccinated. Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, said, “it is not a problem with the measles vaccine not working. ...It is a problem of the measles vaccine not being used”.

As measles is a viral disease no specific medication is available for its treatment.  However some measures such as acetaminophen for high fever, a humidifier for relief of cough and vitamin A do provide symptomatic relief.

In non-immunized patients, measles vaccination within 72 hours of exposure to the virus may provide protection against the disease.

Pregnant women, infants and patients with weakened immune systems who are exposed to the virus may receive an injection of antibodies called immune serum globulin. When given within six days of exposure, these antibodies can prevent measles or make symptoms less severe.

Vaccination still remains the best way to prevent measles.  One dose of the Measles, Mumps and Rubela vaccine (MMR) is 93% effective while two doses are 97% effective in preventing the disease.  On Feb 21 two California senators introduced legislation that “would permit only medical exemptions as legitimate reasons to sidestep vaccinations,” The WHO has issued a warning and demands that counties control the outbreaks with "no exception" as the epidemic threatens the goal of eliminating measles in the region by the end of 2015.

Obesity

A study by Ng et al reports on the prevalence of obesity in countries around the world.  Their research that was supported by Bill and Melinda Gates Foundation and published in Lancet, reviewed more than 1,700 studies covering 188 countries from 1980 to 2013.

The study found more than 2.1 billion individuals worldwide are overweight or obese, up from 857 million in 1980.  Also, obesity was estimated to have caused 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years worldwide in 2010.

They based their analysis on body-mass index (BMI) a measure of weight and height.  Individuals with a BMI of 30 or more are considered obese, while those a BMI of 25 to 29.9 are considered overweight, according to the U.S. National Institutes of Health.

Worldwide, the proportion of adults with a BMI of 25 or greater increased between 1980 and 2013 from 28·8% to 36·9% in men, and from 29·8% to 38·0% in women. In the US, 87 million individuals or 27.2% were obese according to study conducted in 2013 (Gallup). The prevalence of obesity has increased in children and adolescents worldwide.  In 2013, 23·8% of boys and 22·6% of girls were overweight or obese in developed countries, while in developing countries 12·9% of the boys and 13·4% of the girls were overweight or obese. One of the “most troubling” findings of the study is that the percentage of overweight or obese children and teenagers has increased by nearly 50 percent since 1980.   In the US alone, nearly 30 percent of the children and teens are either obese or overweight, up from 19 percent in 1980.

More than half of the world’s 671 million obese people live in the U.S., China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia.  During the more than three decades studied, the largest increase in obesity rates were in Egypt, Saudi Arabia, Oman, Honduras and Bahrain for women and New Zealand, Bahrain, Kuwait, Saudi Arabia and the U.S. for men.  In adults, the estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa.  Since 2006, the increase in adult obesity in developed countries has slowed down.  

Because obesity can raise the risk of diabetes, osteoarthritis, heart disease and cancer, among other health-threatening conditions, strategies to correct it such increase physical activity, decrease of total caloric intake and selectivity the foods eaten are needed as obesity represents a major global health challenge.

Addendum:  A study based on review of the health records of 65,000 that was published in JAMAPediatrics (9/29/14) suggests infants and young children with repeated exposure to broad-spectrum antibiotics at ages 0-23 months are associated with childhood obesity.