Recent Fox Attacks in Maine May Be Due to New Rabies Strain
Why Are Measles Cases Popping Up Across The United States? Here's What To Know About The Highly Contagious Virus
CNN —
Nearly two dozen cases of measles have been reported since December 1, according to an alert from the US Centers for Disease Control and Prevention. International travel, coupled with declining global vaccination rates, is probably behind this spate of cases, experts say.
The Philadelphia Department of Public Health has confirmed at least nine cases of measles over the past month after a person contracted the highly contagious virus outside the United States and exposed a parent and child at a children's hospital, according to health department spokesperson James Garrow. That exposure then led to a Philadelphia day care outbreak that includes at least five children.
Health officials in Virginia are also warning people who recently traveled out of two D.C.-area airports – Dulles International Airport on January 3 and Reagan Washington National Airport on January 4 – of potential exposure to the virus after someone returning to the US from abroad traveled through Northern Virginia.
Additionally, a single case of measles has been confirmed in "an unvaccinated resident of the metro Atlanta area," the Georgia Department of Public Health announced this month.
"The individual was exposed to measles while traveling out of the country," a news release said. "DPH is working to identify anyone who may have had contact with the individual while they were infectious."
It's not only the United States. In the UK, a measles outbreak continues to widen: As of January 18, there have been 216 confirmed cases and 103 probable cases reported since October. The UK Health Security Agency has declared a national incident to signal the growing public health risk.
"It's always concerning when we have a case of measles because of the probability that it's going to spread to other individuals," said Dr. Thomas Murray, a professor of pediatrics at the Yale School of Medicine who focuses on infectious diseases and global health.
"About 90% of susceptible people who are exposed will come down with signs and symptoms of the disease, so it's very contagious."
Measles was eliminated in the United States in 2000, after zero virus spread for more than a year, largely due to a "highly effective vaccination campaign," according to the US Centers for Disease Control and Prevention.
However, clusters in the US are still possible because the virus is not eliminated worldwide. There are several countries with active outbreaks.
"Many of the diseases for which we have vaccines have virtually disappeared from the United States but certainly not in other places around the world," Murray said.
If an unvaccinated person goes to a country where a disease is still common, becomes infected and brings it back to the US, Murray notes, they can spread the virus to other unvaccinated people.
"There's a lot of travel back and forth," he said. "If there are pockets of unvaccinated individuals that are congregating closely together and that disease gets introduced into that population, you can have large clusters of cases."
Vaccination rates in the US also remain low, particularly among children, according to American Academy of Pediatrics spokesperson Dr. Christina Johns, a Maryland-based pediatric emergency physician at a PM Pediatric Care urgent care.
The CDC noted in its alert that the majority of the measles cases "were among children and adolescents who had not received a measles-containing vaccine (MMR or MMRV), even if age eligible."
About 92% of US children have been vaccinated against measles, mumps and rubella (called the MMR vaccine) by age 2, according to a 2023 report from the CDC – below the federal target of 95%.
The percentage of kindergartners who got their state-required vaccines for measles also remained below the federal target for the 2022-23 school year, according to CDC data. And the rate of vaccine exemptions for children has reached the highest level ever reported in the US.
Children should get two doses of the MMR vaccine, according to the CDC: the first dose at 12 to 15 months of age and the second at 4 to 6 years of age.
Before the nation's measles vaccination program, about 3 million to 4 million people got the virus every year, and about 400 to 500 died.
The last significant measles outbreak in the US was in 2018-19 in Rockland County, New York, focused among unvaccinated children in Orthodox Jewish communities.
Although the CDC reported only 56 measles cases in 2023, Johns says that is too many when a highly effective vaccine exists.
"Most people haven't seen a case of measles," she stressed. "They don't really have an appreciation for the severity of the illness."
The measles virus can spread when an infected person coughs or sneezes, lingering in the air for up to two hours after they leave a room, according to Murray. The virus can also live on surfaces such as doorknobs for about the same amount of time.
When symptoms begin, they're similar to those of many respiratory illnesses – high fever, cough, red eyes, runny nose and congestion – followed by a "fairly characteristic" rash, Murray said.
"You get flat red lesions, flat red spots that typically start on your face and move down across the body across the chest and trunk and extremities," he said. "It can be a total body rash, and it's pretty severe."
The incubation period for measles is very long, Murray adds. It takes about 10 to 12 days for initial symptoms to appear after exposure.
Because of this, most infected people assume their respiratory symptoms are nothing but a cold until the rash appears three to five days after the initial illness begins, according to Murray. Even then, most people – including some doctors – will not recognize a measles rash.
"Infected people are contagious from 4 days before the rash starts through 4 days afterwards," the CDC says.
"The younger the health care provider, the less likely they are to have seen a case," Murray said. "But certainly, when it's circulating, we do everything we can to get the word out on what to look for."
The CDC advises health-care workers to isolate patients who may have measles in specific isolation rooms or private rooms instead of having them waiting in common areas; to test patients with suspected cases; and promptly alert state and local health departments.
Lower MMR vaccination rates can put unvaccinated and undervaccinated individuals at risk, Johns says, especially children and those with immune system problems.
Measles can lead to serious complications, especially in children under 2, such as blindness, encephalitis or inflammation of the brain, and severe pneumonia, according to Murray.
"Measles is also a virus that knocks down parts of the immune system," he said. "There's recent evidence that having measles increases your susceptibility to other infections."
A rare complication called subacute sclerosing panencephalitis can also happen seven to 10 years after infection and may result in seizures as well as behavioral and mental deterioration.
Additionally, someone who doesn't get the MMR vaccine is at risk of contracting mumps and rubella, which are rare but still in circulation in the US due to international travel.
In 2023, 436 mumps cases were reported by 42 jurisdictions, according to CDC data. Rubella is less common, with fewer than 10 people in the US getting the virus each year.
If you're fully vaccinated against measles, your chance of infection after exposure is very low because the two childhood doses typically confer lifelong immunity, experts say.
"It's not impossible, but it's very, very low," Murray notes.
But for people who aren't unvaccinated or who have weak immune systems, the risk increases – "especially if they know they're in an area where measles has been circulating," he said. "In that case, what you would do is, you would call your health care provider and work with [them] to determine next steps."
If you think you might have been exposed to measles, stay home until a plan is in place, Murray advises.
"Call ahead before you go to any health care facility, because that health care facility can anticipate your arrival and make sure you are placed in the appropriate isolation rooms," Murray said. "The last thing we want to do is have someone with measles sitting in the emergency room waiting room."
Unvaccinated people who know when they were exposed can get the MMR vaccine within 72 hours of exposure to prevent the disease altogether or lessen the severity of the illness, Murray adds.
As for treatment, the virus simply has to run its course, he says. There is no specific antiviral treatment, and medical care is mainly supportive: staying home from school or work to rest and drink plenty of fluids.
If a person infected with measles is showing symptoms of encephalitis, such as a headache, high fever or seizures, they should be taken to a hospital immediately.
"Typically, hospitalization for measles occurs when children are in respiratory distress from lung involvement like pneumonia or are dehydrated and need IV fluids," Johns said.
Severe measles cases among children can also be treated with vitamin A, according to the CDC, to support the immune system.
"Vitamin A should be administered immediately on diagnosis and repeated the next day," the agency said.
Correction: A previous version of this story misstated the year measles was eliminated from the United States.
Is Shingles Contagious? Plus, How It Spreads
Shingles is not contagious, but someone can transmit the virus when the shingles rash is in the blister phase.
Shingles — also known as herpes zoster — is caused by the varicella-zoster virus, the same virus that causes chickenpox.
Shingles itself is not contagious, but the virus is. If you have shingles, you can pass the virus to another person, which could then cause them to develop chickenpox.
The varicella-zoster virus stays in that person's nerve tissue indefinitely. It may be inactive for most of a person's life but can reactivate and cause shingles.
Read on to learn more about shingles and how to prevent the transmission of the varicella-zoster virus.
The varicella-zoster virus can be transmitted through contact with open shingles blisters. It typically passes from someone with shingles to someone who has never had chickenpox. If a person has had chickenpox, they usually have antibodies against the virus in their body.
You cannot contract the virus through contact with the saliva or nasal secretions of someone who has shingles, except in rare cases. That means you usually can't acquire the virus if someone who has it coughs or sneezes on you.
Most people have the varicella-zoster virus in their bodies, but it only reactivates in around one-third of people. Experts do not know why some people develop it and others don't.
The chance of this happening increases as a person gets older. Around half of all cases occur after the age of 60 years, and the risk increases significantly from age 70 onward.
You might also have a higher risk if you:
Even a common cold can affect the immune system and trigger shingles in some people.
The most noticeable symptoms are blisters and pain.
BlistersThe outward symptoms of shingles look similar to chickenpox. Both diseases cause raised blisters that open, ooze fluid, and crust over.
But unlike the chickenpox rash, which can occur on different parts of your body, shingles usually affect one area of your body. Shingles blisters are most prevalent on your torso, which wraps around your waist on one side of your body. In fact, the word "shingles" comes from the Latin word for "belt."
The shingles rash may also appear on one side of your face. If this happens, contact a doctor immediately.
Learn more about what shingles looks like on the skin.
PainShingles travels along a nerve path, causing pain and strange sensations. Your skin might tingle or feel like it's burning before the blisters appear. Itching and sensitivity to touch are also symptoms of shingles.
Shingles pain varies in severity. It can be challenging to treat with over-the-counter pain relievers.
Some people experience nerve pain after the visible symptoms of shingles clear. This is known as postherpetic neuralgia. Approximately 10–18% of people with shingles develop postherpetic neuralgia, and the risk increases with age.
Other symptomsThe virus can cause symptoms unrelated to rashes, including:
Learn more about shingles without a rash here.
Shingles is not contagious. But if someone comes into contact with the rash at a certain stage, they may contract the varicella-zoster virus and develop chickenpox. If they have chickenpox, shingles can develop later in life.
To prevent transmitting the virus, keep shingles rashes covered. Cover the rash from when the blisters appear to when they crust and scab over.
This usually takes 7–10 days, and the broader rash will usually clear after 2–4 weeks.
The varicella-zoster virus is typically less likely to be transmitted with shingles than with chickenpox. However, the varicella-zoster virus can be passed on from when your symptoms start until your rash and blisters have crusted dry.
If you have shingles and are otherwise healthy, you can still go out in public or to work. But be sure to follow these tips:
Doctors recommend the chickenpox vaccine for children. Preventing chickenpox will also prevent shingles.
For adults, a different vaccine called Shingrix is available to help prevent shingles. Health experts recommend the vaccine for all healthy adults ages 50 years and older. A healthcare professional will give two doses, 2 to 6 months apart, as an injection in your arm.
A double dose offers over 90% protection. The protection level stays above 85% for at least 4 years.
You can get the vaccine even if you:
The vaccine is not suitable if you are currently experiencing shingles.
A shingles outbreak usually lasts 3–5 weeks. Most people experience pain and discomfort for a short period and then fully recover. People usually only have one episode of shingles in their lifetime.
Shingles outbreaks are temporary, but they can affect your health and well-being.
Shingles nerve pain can linger, lasting for weeks or even months in some cases. Generally, shingles pain is more persistent and longer lasting in older adults. Younger people usually show no signs of the disease once the blisters have cleared up.
Is it OK to be around someone with shingles?You cannot get shingles from someone who has shingles like you can with the flu. But if you've never had chickenpox or haven't been vaccinated against the varicella-zoster virus, you can contract the virus if you come into contact with the liquid inside a shingles blister.
You can develop chickenpox if you contract this virus.
Once you have the varicella-zoster virus in your body, it's possible for the virus to reactivate and for you to develop shingles at some point in your life if you're not vaccinated against shingles.
Since it's very rare to contract the virus through contact with the saliva or nasal secretions of someone who has shingles, if someone with shingles coughs or sneezes on you, you're not likely to get the varicella-zoster virus. However, it can be spread by the liquid inside shingles blisters.
Can I sleep in the same bed as someone with shingles?Maybe. If you have never had the varicella-zoster virus, you are at risk of contracting it if you come into contact with someone's shingles blisters or bedding that has liquid from the blisters on it.
Also, a person with shingles may be in pain or may have pain when touched.
How long does shingles last?A shingles outbreak usually lasts 3–5 weeks.
How long should you stay home with shingles?If you keep your blisters covered, you may not need to stay home at all. But shingles can be very painful, so you may not feel like going to work while you have blisters.
Can I be around my grandchildren if I have shingles?You can't spread shingles to your grandchildren, but if they have not had chickenpox or been vaccinated, they can contract the varicella-zoster virus and develop chickenpox.
Keeping your blisters covered while around your grandchildren (and anyone else) and washing your hands frequently should prevent spread.
Can shingles spread from kissing?It's unlikely you will contract the varicella-zoster virus from kissing since it's rarely spread from contact with saliva or mucous membranes.
However, if someone has a shingles rash with weeping blisters on their face or lips, you could contract the virus from kissing.
Can I touch my baby if I have shingles?Since no baby has been vaccinated for the varicella-zoster virus, they can contract it and may develop chickenpox.
As long as all blisters are well covered and your hands are clean, you should be able to touch your baby. You may need to avoid premature babies or infants with low birth weights.
You also need to be very vigilant about handwashing until all your blisters are fully crusted over.
Shingles is a rash that can affect people who have had chickenpox, even if they had it years ago. The varicella-zoster virus causes it. The virus remains dormant in the body, but in some cases, it can reactivate and cause shingles.
The shingles rash is not contagious. But the virus can be passed on to another person through contact with the rash when blisters are present. Then that person may develop chickenpox.
There is less chance of passing on the virus if the rash is covered, and transmission can only happen from the time blisters form to when they scab over.
Having the shingles vaccine can help protect you from shingles.
What Is Scabies, What Does The Rash Look Like, Is It Caused By Mites And Is It Contagious?
MORE than 200million people around the world suffer from scabies at any one time.
But what exactly is the contagious skin condition and how is it treated? We reveal all.
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Scabies is a contagious skin condition caused by tiny mitesCredit: Alamy What is scabies?Scabies is an itchy rash caused by an infestation of tiny mites.
It is spread through close skin contact.
The NHS says: "Scabies is very common and anyone can get it.
"It should be treated quickly to stop it spreading."
One of the first symptoms of scabies is intense itching, which is often worse at night.
Your entire body can be itchy, even in areas which don't have mites.
A raised rash or spots can then develop.
What does the rash look like?A scabies rash may look red, making it more difficult to see on darker skin.
But you should still be able to feel bumps or lines, which occur when tiny mites lay eggs in the skin.
The rash, which often starts between the fingers but can spread anywhere on the body, can then turn into tiny red or dark spots.
It is most common between the fingers, around the wrists, under the arms, and around the waist, groin and bottom.
It does not usually develop on the head, but in elderly people or those with low immune systems, it can appear on the face, scalp and neck, as well as on their palms and the soles of their feet.
A rash is the most obvious sign of scabies, and usually appears soon after the intense itching begins.
As the mites burrow into the skin, this can cause tunnels to appear on the surface of the skin.
These can be fine, dark or silvery lines of between two to 10mm long.
Scratching can also exacerbate the rash and damage the skin.
This can cause the skin to be inflamed, red and tender.
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The key symptoms of scabies include intense itching and a nasty raised rash or spotsCredit: NHS Is it caused by mites?Yes, scabies is caused by mites.
These are tiny insects called Sarcoptes scabiei var hominis.
They are parasites, meaning they live off their hosts - in this case, humans.
They are invisible to the naked eye, although females are bigger than males, at around 0.4 mm x 0.3 mm compared to 0.2 mm x 0.15 mm.
It is the female which tunnels into the skin and lays eggs.
She will lay between 40 and 50 in her lifetime.
After being laid, the eggs will hatch within three or four days, and the mites take 10 to 15 days to reach adult size.
The symptoms of scabies, such as the rash and itching, is the body's reaction to the mite's saliva, faeces and eggs.
Is it contagious?At least 200million people worldwide suffer from scabies at any one time, according to the World Health Organization.
It is most common in hot, tropical countries and in highly-populated cities, but it can spread anywhere.
It is highly contagious, but it can take up to eight weeks for the rash to appear, meaning people can spread it without realising.
It is passed on via skin-to-skin contact.
Anyone who works, lives or studies together is at risk of catching scabies if one person has it.
When administering treatment, it is important to treat everyone who is or could be affected at the same time.
This prevents it recurring, and people should still be treated even if they show no symptoms.
The NHS says: "Anyone can get scabies – it has nothing to do with poor hygiene.
"People who live or work closely together in nurseries, university halls of residence, or nursing homes are more at risk."
While you don't normally need to see a GP, a pharmacist will be able to prescribe treatment, which is often in the form of a cream or lotion.
You need to wait 24 hours after treatment before returning to school or work.
The NHS recommends those affected wash all the bedding in the house at 60c or higher on the day of treatment.
And any fabrics that can't be washed should be sealed in a bag for three days until the mites die.
People should avoid all physical contact, including sex, until they have completed a full course of treatment.
If you've applied treatment to babies and small children, put socks or gloves on their hands and feet to stop them ingesting the medicated lotion.
For more information visit the NHS website.
Have there been any new cases?At the beginning of 2024, doctors in the UK reported a "nightmare" surge in scabies cases.
They also warned that Britain is facing supply problems to ship drug treatments following the war in Ukraine and rising costs.
As reported by The Guardian, dermatologists and GPs are now scrambling for the medication.
Research from a survey by the British Association of Dermatologists, commissioned by The Guardian, revealed eight of its nine regional representatives reported a rise in scabies in their area last year - with seven out of nine also reporting shortages of treatment drugs.
A concerned dermatologist in the north-east said this would likely result in "increased spread of infection" and "strain on demand".
In December 2023, an outbreak of scabies, believed to have been triggered by an infected roll of fabric, forced a Central Saint Martins art school in north London to close its doors.
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Scabies is caused by Sarcoptes scabiei var hominisCredit: Alamy
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