So far, 2025 has offered no shortage of healthcare challenges, opportunities, and uncertainties. Today I want to start with viruses. Four viruses have attracted attention lately, and I’m going to cover two of them.
The first is measles.
Many folks under 40 have never seen measles. But it’s one of the most contagious viral diseases known. Unimmunized individuals exposed to the virus are at high risk of contracting it – by “exposed,” I mean sharing the same airspace as an infected individual within the past four hours. Historically, 2-3 of every 1,000 infected children die from the disease, and an additional child survives with severe complications, including brain damage. An infected individual will typically infect between 12 and 18 additional individuals.
The last major measles outbreak in the U.S. started in 1989, during the Bush I Administration. During the outbreak there were 123 measles-related deaths. Most were preschool children.
In 2000, the World Health Organization (WHO) declared measles eliminated in the U.S. due largely to vaccination. At that time, continued incidence of measles has largely been attributed to international travelers. A subsequent outbreak in 2019 prompted President Trump to insist that parents must vaccinate their children. The Surgeon General drew a connection between states with vaccine exemptions and higher risks of outbreaks, and advised health officials on ways to encourage vaccination.
Currently, west Texas has a measles outbreak. As of last Friday, there were 198 cases, almost 70 percent from a single county. That’s more than were recorded in any whole year since 1992. Ninety-seven percent of patients were unvaccinated or had unknown vaccination status.
Forty-five percent were between the ages of 5-17. Only 2.5 percent of cases received at least one dose of vaccine. In nearby New Mexico, a measles outbreak has 10 confirmed cases, including six adults and four children. All were either unvaccinated or had unknown vaccination status.
Two deaths have been attributed to measles – both unvaccinated, including a child in Texas and an adult in New Mexico. Texas and New Mexico constitute 94 percent of the total measles cases so far this year.
U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. stated that “we’re delivering vitamin A and ambulance rides” and locals are “seeing very good results with a combination of budesonide, clarithromycin, and cod liver oil.”
HHS has also sent additional doses of vaccine to west Texas – that’s the best option. This is an about-face for the Secretary, who previously stated “measles outbreaks have been fabricated to create fear that in turn forces government officials to ‘do something.’ They then inflict unnecessary and risky vaccines on millions of children.”
Rural Texas, in general, is a healthcare desert. Texas spends less on public health per person than many other states. Texas spent $17 per person on public health in 2023, down from $19 in 2013.
The other virus is the flu, which is coming back with a vengeance in the wake of reduced vaccination rates. Currently, flu has killed 114 children. There are at least nine influenza-associated encephalopathy or encephalitis deaths.
Why is this important? The social determinants of health (SDoH) are more important than ever. They need consideration when patients seek attention, but also as part of preventive care. Achieving good health has never been more difficult – or more dangerous.
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