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Cancer Answers is hosted by Dr. Anees Chagpar, Associate Professor of Surgical Oncology and Director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven Hospital, and Dr. Francine Foss, Professor of Medical Oncology. The show features a guest cancer specialist who will share the most recent advances in cancer therapy and respond to listeners questions. Myths, facts and advances in cancer diagnosis and treatment are discussed, with a different focus eachweek. Nationally acclaimed specialists in various types of cancer research, diagnosis, and treatment discuss common misconceptions about the disease and respond to questions from the community.Listeners can submit questions to be answered on the program at canceranswers@yale.edu or by leaving a message at (888) 234-4YCC. As a resource, archived programs from 2006 through the present are available in both audio and written versions on the Yale Cancer Center website.

Measles Is Back in Connecticut, New York and Other States


Connecticut's Department of Public Health reported two cases of measles in Fairfield County on Tuesday. This follows several cases in New York City, and a spike in the number of cases last year, even though the disease has already been virtually eliminated from the U.S. since 2000.

So far, 51 cases have been reported in the U.S. this year, and New York City's health department reported 16 cases just last week.

The two cases in Connecticut came from an adult and a baby, said Kathy Kudish, a supervisor of the surveillance unit for vaccine preventable diseases at the Connecticut Department of Public Health's immunization program. She said the adult had no record of being vaccinated, and the baby was seven months old, and thus too young to be vaccinated.

Measles is spread through the air and is highly contagious. The symptoms include a fever, runny nose, cough, and a rash, which usually starts at the hairline and proceeds down the body. It can be a serious disease with possible complications, and even deaths in approximately one case in 1,000 in the U.S.

Kudish said that if someone has a case of measles, you can still vaccinate them immediately, but only for up to 72 hours. There is no specific treatment, but the department recommends contacting a doctor immediately after being exposed to the virus.

Credit Heinz F. Eichenwald, MD / Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The symptoms for measles include a rash, which appears around two weeks after exposure.

The Connecticut Department of Public Health recommends two doses of the vaccine, which will make the vast majority of people immune to the disease. Kudish said, "We need to maintain our high vaccination coverage with MMR vaccine; that's really the key to preventing outbreaks in Connecticut and the U.S."

In Connecticut, school children have to be vaccinated, though parents can claim religious exemptions, or a medical exemption from a physician licensed to practice medicine in the U.S. Kudish said the numbers in this state are relatively low, with just 1.7 percent of kindergarten children being exempt.

The disease was virtually eliminated from the U.S. in 2000, and most cases, can be traced back to infections imported from other countries, according to the Centers for Disease Control and Prevention website. So far, 51 caseshave been reported in the U.S. this year, and New York City's health department reported 16 cases just last week. Cases have also been reported in Massachusetts, California and Canada.

In the past couple of years, the U.S. has seen some spikes in activity.

Graphic by Alan Yu for WNPR. Data from the Centers for Disease Control and Prevention. 

In a report, the CDC attributes the 2008 spike to U.S. residents who weren't vaccinated, or had parents who had religious or philosophical objections to vaccination, and more from imported cases. The report also says the 2011 spike came from a surge in imported cases, primarily from a measles epidemic in western Europe. But it would have been much worse without widespread vaccination, said Amy Parker Fiebelkorn, an epidemiologist at the Centers for Disease Control and Prevention.

"To put this in perspective," Fiebelkorn said, "prior to the vaccine development in 1963, whole cohorts of people became infected with measles. That means that each year, three to four million people would become infected with measles. In the past several years -- 2008, 2011, those were big years in certain respects. ...But when you put it into perspective of the broader context, where we've come from in the pre-vaccine era to now, it's certainly scores of infections lower."

As for why the disease is still around, Fiebelkorn said those outbreaks generally start from people who had not been vaccinated. For example, she pointed to an outbreak in New York Citylast March, the largest the U.S. has seen since 1996, which stemmed from a 17-year-old who had intentionally not gotten vaccinated.

This led to 58 people getting infected, all of them members of the orthodox Jewish community. The CDC notes the disease spread among a few extended families who refused to be vaccinated, and children whose vaccinations had been delayed. The report also notes the high rate of vaccination among the Brooklyn orthodox Jewish community most likely limited the scope of the outbreak.

As another example, she pointed to an outbreak in north Texas, which spread from a vaccine-skepticalmegachurch.

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