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.

The Mediterranean Diet

The Mediterranean diet is derived from the traditional diets of Greece, southern Italy and Spain.  Its uniqueness relates to the use of olive oil instead of butter and the daily consumption of nuts, legumes, fruits and vegetables.  People in the Mediterranean countries depending on their local (island, valleys or mountains) eat moderate amount of fish, or meat such as poultry and/or dairy products (mostly as cheese and yogurt).  They also drink a low amount of wine and/or spirits.  According to the American Heart Association, there's no one "Mediterranean" diet but a dietary pattern that includes the above-mentioned foodstuff and the use of olive oil a monounsaturated fat that does not raise blood cholesterol.

The incidence of heart disease and death rates in Mediterranean countries is lower than in the United States.  Although diet appears to have a role, other factors such as genetic, lifestyle, physical activity and extended social and family support systems may also play a part.

Before advising people to adhere to a strict Mediterranean diet, well designed and controlled studies are needed to determine whether the diet itself or other factors (genes, lifestyle, social) account for the lower deaths from cardiovascular disease among humans.  The findings from the following two studies are supportive of the beneficial effect the Mediterranean diet and the consumption of nuts has in our health. 

An important multi-center study that was conducted in Spain was published in the New EnglandJournal of Medicine.  The authors evaluated the effect of the Mediterranean diet in the prevention of cardiovascular disease in individuals who were at high risk for cardiovascular events, but with no apparent cardiovascular disease. A total of 7447 persons were enrolled whose age ranged from 55 to 80 years; with a male to female ratio 43 to 57 percent were randomly assigned, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). The end point was the rate of major cardiovascular events such as myocardial infarction, stroke, or death from cardiovascular causes. A primary end-point event occurred in 288 participants.  The group assigned to a Mediterranean diet with extra-virgin olive oil experienced 96 events while and the group assigned to a Mediterranean diet with nuts experienced 83 events, respectively, versus 109 events in the control group. On the basis of these results, the trial was stopped after a median follow-up of 4.8 years as the authors concluded that among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.

According to a study from the USA that was also published in the New England Journal of Medicine, people who ate a daily handful of nuts were less likely to die from any cause over a 30-year period and were more slender than those who didn’t consume nuts.  For their research, the authors analyzed information from the Nurses’ Health Study that provided data on 76,464 women, and the Health Professionals’ Follow-Up Study that provided data on 42,498 men. The researchers report a 29% reduction in deaths from heart disease and an 11% reduction in death rate from cancer.  It appeared that the protective effect was similar to all types of nuts.  Those who ate nuts less than once a week had a 7 percent reduction in mortality; once a week, 11 percent reduction; two to four times per week, 13 percent reduction; five to six times per week, 15 percent reduction; and seven or more times a week, a 20 percent reduction in death rate. 

Based on this and other smaller studies, the U.S. Food and Drug Administration concluded that eating 1½ ounce per day of most nuts “may reduce the risk of heart disease.”