US health officials urge all international travellers to get measles vaccinations amid outbreaks
Health officials in the United States have changed their advice to international travellers about measles, saying people should be vaccinated against the virus no matter where they're going.
US residents are recommended to get measles-mumps-rubella shots, anyway. But the US Centers for Disease Control and Prevention (CDC) previously emphasised the importance of vaccination for travellers going to countries with outbreaks.
Last week, the CDC updated its guidance to call for vaccinations for travellers going to all other countries.
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Ashley Darcy-Mahoney, a researcher at George Washington University's nursing school in the US, called the update significant.
A Colorado outbreak last month stemmed from an international flight that landed in Denver, she noted. The CDC travel notice change reflects a recognition that people are not just being exposed to measles in countries where it's spreading, but also in airplanes and during travel, she added.
"We're seeing a shift from localised outbreaks to transmission in transit," and the CDC seems to be responding to that, Darcy-Mahoney said.
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How to avoid measles, one of the world's most contagious viruses
In line with recommendations in the European Union, the CDC's travel notice advises two doses for all Americans ages 1 and older, and an early dose for travelling infants ages 6 months to 11 months.
Meanwhile, the European Centre for Disease Prevention and Control (ECDC) recommends that travellers ensure they are up-to-date on their vaccinations before going abroad.
So far this year, the US has seen more than 1,000 measles cases, and the EU has reported more than 5,500 cases.
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Yahoo
an hour ago
- Yahoo
Trump's new budget bill hides an assault on hospice
President Trump's 'big beautiful bill,' which passed the House with almost unanimous Republican support on May 22, mandates $500 billion in cuts to Medicare. This is a cruel assault on some of the most vulnerable Americans that will strip them of vital health care services. It will also take an axe to hospice, which relies on Medicare reimbursement to function. Since 1982, when Medicare first began covering hospice, Americans have turned to it for essential end-of-life services that address the specialized needs of the dying and allow for death with dignity. Our current system doesn't always run perfectly and would benefit from greater funding and support. I know this because when my mother was 99.5 years of age and less than six months away from her death, medical staff at our local hospice agency determined she was not, in fact, dying soon enough. Presumably adhering to Medicare guidelines, they callously discontinued our hospice services. The abrupt cessation of care prompted my debilitated mom's eviction from an assisted living facility. The chaotic aftermath necessitated medicine, schedule and equipment adjustments for her and delivered a massive blow to me, her primary caregiver. Fewer resources means this financially draining and emotionally wrenching situation will become more common — perhaps even the norm. The shifting demographics make the picture even bleaker. The U.S. is a rapidly aging population, with the number of Americans ages 65 and older expected to more than double over the next 40 years. At a time when we should be buttressing hospice services, our government is threatening to starve them. According to the Office of the Inspector General, 'About 1.7 million Medicare beneficiaries receive hospice care each year, and Medicare pays about $23 billion annually for this care.' Hospice is an interdisciplinary service that provides everything from pain relief to spiritual support to medication management to dietary consulting to mobility equipment to bereavement counseling. While the price tag may sound hefty and our current administration would like us to believe that public services are an unbearable financial burden, an investigation published in the Journal of American Medical Association Health Forum found that hospice saves Medicare money. Research shows that hospice significantly benefits dementia and cancer patients at the end of their lives. On May 19, 2025, the Journal of the American Geriatrics Society published a study of 51,300 assisted living residents that concluded, 'Higher frequency of hospice staff visits was associated with better perceived hospice quality. Policies supporting greater hospice staff engagement, including nonclinical staff, may enhance end-of-life care experiences for assisted living residents.' The report matters because the findings illuminate the humane need for both clinical and nonclinical treatment that provides for medical and emotional support as life ends. We all heard President Trump campaign on promises to protect Medicare, but Richard Fiesta, executive director of the advocacy group Alliance for Retired Americans, describes the ongoing national budget scene as 'an all-out assault on Medicare and Medicaid that will hurt older Americans in every community across the country.' And Shannon Benton, the executive director of the Senior Citizens League, another advocacy group, now warns that the potential Medicare cuts could lead to lower reimbursement rates. This would be disastrous for millions of Americans and would threaten to eradicate end-of-life care as we know common belief, hospices are not run by volunteers. Volunteers might become part-time visitors or assistants for a variety of tasks, but hospice administrations are led by professionals who are evaluated on financial performance and organizational viability. Palliative care is free to recipients and families and available at all income levels, but hospices are businesses, and they must raise sufficient funds through donations, gifts, bequests and reimbursements to compensate employees, repay loans, cover operating costs, and plan for exigencies. Simply put, much of that money comes from Medicare. Specialized care for the dying was introduced to the U.S. in 1963, when Yale University's then dean Florence Wald invited Dame Cicely Saunders of the U.K. to participate in a visiting lecture at Yale. At that time Saunders said, 'We will do all we can not only to help you die peacefully, but also to live until you die.' Four years later, in 1967, Saunders created St. Christopher's Hospice in the U.K. Later, in 1974, Florence Wald founded Connecticut Hospice in Branford, Connecticut — America's first hospice. Within five years and after several national conferences, the U.S. Department of Health, Education and Welfare acknowledged that hospices provided alternative care programs for Americans losing their lives to terminal illnesses. Federal hospice regulations were drafted. In 1982, Medicare added hospice care to its benefits, and in 1985, Medicare hospice coverage became permanent. With that, the U.S. recognized the right of its citizens to die with dignity. Forty years later, our government has signaled that a rollback of that right may be on the horizon. Eventually, my mother died in a highly regarded long-term care complex without hospice support and with no prescribed opioids. It was an unnecessarily excruciating death that exacerbated my and my family's grief. The trauma we suffered was destabilizing and healing from it was slow and difficult. If Trump's Orwellian-named 'big beautiful bill' passes the Senate, I fear our experience will have been an ugly preview of what is to come.
Yahoo
an hour ago
- Yahoo
‘Problematic' MAHA report minimizes success of lifesaving asthma medicines, doctors say
Teens play basketball outside on a hot day in summer 2023 in New York City after the state issued an air quality health advisory recommending active children and those with asthma limit time outside. Experts worry that a new federal report minimizes how millions of kids in the U.S. rely on asthma medications to breathe normally. (Photo by) Medical experts are dismayed over a federal report's claim that kids are overprescribed asthma medications, saying it minimizes how many lives the drugs save. Safe treatment protocols for asthma management have been carefully studied over the years, said Dr. Perry Sheffield, a pediatrician and professor at the Icahn School of Medicine at Mount Sinai. 'The federal government actually has some really beautiful and clear guidelines and strategies, and things that are vetted by and carefully edited by many experts in the field,' said Sheffield, who co-directs a region of the federally funded Pediatric Environmental Health Specialty Units that serves New Jersey, New York, Puerto Rico and the U.S. Virgin Islands. Asthma affects more than 4.6 million American children, according to the federal Centers for Disease Control and Prevention. It's one of the most common long-term diseases in U.S. children. The Make America Healthy Again Commission report released in late May, parts of which have been widely criticized, alleges that American children are on too much medication of various kinds, including asthma treatments. Experts worry that the administration will set policy based on the assessment, dissuading insurers from covering asthma prescriptions. They also say that the report's assertions could worsen disparities that affect children's access to those medications and undermine years of research around the drugs. Blue Cross Blue Shield now requires prior approval for severe asthma drugs in some states The MAHA commission has until August to release a strategy based on the findings in the report. Black and Indigenous children as well as those living in inner cities or in lower-income households are among those with the highest rates of asthma. Pollution disproportionately shrouds communities of color and can be a trigger that exacerbates the disease. The report's message could heighten those disparities, said Dr. Elizabeth Matsui, a University of Texas at Austin professor and a past chair of the American Academy of Pediatrics' Section on Allergy and Immunology. 'One thing that has been very clear is that kids of color are less likely to be appropriately managed in terms of their asthma medication management,' she said. 'So a message of overprescription that is simply not supported by the evidence also could potentially exacerbate already-existing racial and ethnic disparities in asthma that we have really not made much headway on.' The report touches on childhood prediabetes, obesity and mental health. However, firearm injuries — the leading cause of death for children and teens in 2020 and 2021, according to the CDC — weren't mentioned. The 70-page report from the commission, chaired by Secretary of Health and Human Services Robert F. Kennedy Jr., claims four main issues are the drivers behind childhood chronic disease: poor diet, aggregation of environmental chemicals, lack of physical activity and chronic stress, and 'overmedicalization.' Matsui and other experts said the report's use of that word is 'problematic.' 'The implication could be, unfortunately, that when a child has asthma — so, they have coughing, chest tightness, wheezing — that that is not really a disease,' said Matsui. 'We know for a fact that that's a disease, and we know that it is quite treatable, quite controllable, and that it has profound impacts on the child's day-to-day life.' Other scientists have similarly criticized the report, saying it makes sweeping and misleading generalizations about children's health without sufficient evidence. The White House corrected the report after nonprofit news outlet NOTUS found that it cited studies that didn't exist. The implication could be, unfortunately, that when a child has asthma … that that is not really a disease. We know for a fact that that's a disease. – Dr. Elizabeth Matsui, University of Texas at Austin professor When it comes to asthma, the report says, 'Asthma controller prescriptions increased 30% from 1999-2008.' That sentence originally cited a broken link to a study from 2011; the link was later replaced. Controller meds include inhalers. The MAHA report also claims that 'There is evidence of overprescription of oral corticosteroids for mild cases of asthma.' The original version of the report listed estimated percentages of oral corticosteroids overuse, citing a nonexistent study. The wording was changed and the citation was later replaced with a link to a 2017 study by pediatric pulmonologist Dr. Harold Farber. The study was not a randomized controlled trial, which increases reliability. Farber told NOTUS that the report made an 'overgeneralization' of his research. Stateline also reached out to Farber, whose public relations team declined an interview request. Oral corticosteroids are liquid or tablet medications used to reduce inflammation for conditions including allergies, asthma, arthritis and Crohn's disease. For asthma, they're used to treat severe flare-up episodes. The Asthma and Allergy Foundation of America says the medications have been shown to reduce emergency room visits and hospitalizations, and that while they do come with risk of side effects, they're mostly used in acute flare-ups. And while rare, asthma-related deaths in kids do occur, and are often preventable. 'Asthma medications, including oral steroids, are lifesaving,' said Dr. Elizabeth Friedman, a pediatrician at Children's Mercy Kansas City. 'I believe that physicians, not politicians, are best equipped and most effectively trained to make the determination of whether or not these medications are needed for our patients.' Friedman worries that federal characterizations of asthma meds will affect how state Medicaid agencies cover the drugs. When Medicaid coverage changed for a common prescribed inhaler last year, many of her Missouri Medicaid patients were suddenly without the drug. They ended up hospitalized, she said. Friedman directs Region 7 of the Pediatric Environmental Health Specialty Units, a network of experts that works to address reproductive and children's environmental health issues. Region 7 provides outreach and education in Iowa, Kansas, Missouri and Nebraska. She also said she's concerned that the report is 'making a broad, sweeping statement based on one epidemiologic study from one state.' An increase in inhaler prescriptions is not necessarily a bad thing, experts say. It's a sign that kids are getting their medication. There has been an increase in inhaler prescriptions, along with a corresponding decrease in the oral corticosteroids, which is what experts would want to see, said Chelsea Langer, bureau chief of the New Mexico Department of Health's Environmental Health Epidemiology Bureau. She said that means kids are 'following their asthma action plans and taking the controller medications to prevent needing the relief or treatment [oral] meds.' Trump has canceled environmental justice grants. Here's what communities are losing. Asthma prevalence has increased over the years, meaning more people need medication, noted Dr. Alan Baptist, division head of Allergy and Clinical Immunology at Henry Ford Health in Michigan. He said that because steroid tablets come with risk of side effects, it is best to limit them. But for kids without access to a regular pediatric provider or to health insurance that covers an inhaler, cost can be an obstacle, he said. Fluticasone propionate, an FDA-approved medicine for people 4 and older, costs on average $200 or more for one inhaler without insurance. 'What often happens with kids, and especially kids who are in Medicaid, or who are in an underserved or disadvantaged population, they are not given appropriate asthma controller medication,' said Baptist, who helped write federal guidelines for asthma treatment best practices as part of a National Institutes of Health committee. Baptist noted that while he was glad to see pollution mentioned in the report as a danger for kids, it's at odds with the recent cuts to environmental health grants that aimed to address such asthma triggers. 'They're somewhat cherry-picking some of the data that they're putting down,' he said. 'It says the U.S. government is 'committed to fostering radical transparency and gold-standard science' to better understand the potential cumulative impacts of environmental exposure. If that's what they're saying, then they should be funding even greater studies that look at the effects.' Dr. Priya Bansal, an Illinois pediatrician and past president of the Illinois Society of Allergy, Asthma and Immunology, said she's concerned the report doesn't define mild, moderate or severe asthma to differentiate the different best-practice treatment plans. Bansal also said she worries that federal officials' characterization of an FDA-approved drug will lead to insurance companies refusing to cover inhalers or oral steroids for her patients who rely on them. 'I'm going to be worried about coverage for my asthmatics,' she said. 'The question is, what's the next move that they're going to make? If they think that, are they going to now say, 'Hey, we're not going to cover inhalers for mild asthmatics'?' Stateline reporter Nada Hassanein can be reached at nhassanein@ SUPPORT: YOU MAKE OUR WORK POSSIBLE
Vox
an hour ago
- Vox
Ketamine is suddenly everywhere
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. Ketamine seems to be everywhere — from the nightclub to the psychiatric clinic. Among its growing number of users is Elon Musk, who says he takes ketamine every two weeks for depression as prescribed by a doctor. He's far from alone: More and more Americans are turning to ketamine for relief for their mental health struggles. But the New York Times reported recently that Musk was taking so much ketamine during last year's presidential campaign, sometimes daily, that he reportedly told people it was causing him bladder problems, a known symptom of chronic ketamine use. Musk's reported experience with the drug — from medical to possibly abusive — provides a window into ketamine's growing popularity in the United States, and the paradox that popularity presents. Ketamine, both an anesthetic and a hallucinogen, was first synthesized in the 1960s and has long been used for surgery and veterinary medicine. More recently, it has shown remarkable effectiveness in alleviating symptoms of depression, particularly in treatment-resistant populations. Clinics administering the drug — which legally must be licensed by the government to provide intravenous infusions — are becoming more popular. The Food and Drug Administration approved the first ketamine-derived nasal spray for depression in 2019. On the other hand, as highlighted in the Times' report alleging that Musk was mixing ketamine with other drugs, more Americans appear to be using ketamine recreationally and outside of medical supervision. Chronic misuse can put people at risk of serious physical and mental health consequences, from kidney and liver damage to memory loss and paranoia. 'There is absolutely a role for ketamine to help people with depression and suicidal ideation,' said Dr. Kevin Yang, a resident physician in psychiatry at the University of California-San Diego. 'At the same time, that doesn't mean it's going to be safe and effective for everyone.' According to a study co-authored by Yang and published earlier this year, the percentage of Americans who reported using ketamine within the past year grew by 82 percent from 2015 to 2019, took a brief dip in 2020 — possibly because of the pandemic complicating people's access to the drug — and then rose another 40 percent from 2021 to 2022. The increases were similar for both people with depression and people without, suggesting that the growth is being driven by both more people seeking ketamine for clinical purposes and more people using it recreationally. The overall number of people taking ketamine is still tiny: About 0.28 percent of the population as of 2022, though this might be an undercount, as people don't always tell the truth in surveys about drug use. There is other evidence to suggest more people are taking ketamine recreationally. Yang's study found that ketamine use was rising most among white people and people with college degrees, and users reported taking it more often in combination with other recreational drugs such as ecstasy and cocaine. Ketamine drug seizures nationwide increased from 55 in 2017 to 247 in 2022, according to a 2023 study led by Joseph Palamar at New York University. Experts think most recreational ketamine is produced illicitly, but the number of legitimate ketamine prescriptions that are being diverted — i.e., lost or stolen — has been going up, a 2024 analysis by Palamar and his colleagues found, which is another possible indicator of a blossoming black market. The buzz about ketamine's popularity in Silicon Valley and its persistence in certain club cultures that first emerged in the '80s confirms its place in the counterculture. We can't know the reality behind Musk's public statements and the anonymous reporting about his ketamine use. The Times reports that people close to Musk worried that his therapeutic use of ketamine had become recreational; Musk quickly dismissed the Times's reporting. But the drug does coexist as a therapeutic and a narcotic, and the line between the two can be blurry. People should not try to self-medicate with ketamine, Yang said. Its risks need to be taken seriously. Here's what you need to know. How to think about ketamine as its popularity grows Ketamine is edging into the mainstream after years at its fringes. It has been around for decades, enjoying a boom as a party drug in the '80s and '90s. For the most part, ketamine had been viewed warily by mainstream scientists. But in 2000, the first major research was published demonstrating its value in treating depression. And increasingly over the past decade, however, ketamine has started to gain more acceptance because of its consistently impressive study results. Studies have found that for some patients, ketamine can begin to relieve their depression symptoms in a matter of hours after therapy and other medications have failed. The testimonials of patients whose depression improved quickly, such as this one published in Vox, are convincing. The benefits identified in clinical research have opened up a larger market for the substance. Johnson & Johnson developed its own ketamine-derived treatment for depression (esketamine, sold as a nasal spray called Spravato) that received FDA approval in 2019, the first of its kind. The number of monthly prescriptions for Spravato doubled from the beginning of 2023 to October 2024. People can also visit clinics to receive an IV of conventional ketamine for treatment, and that business is booming too: In 2015, there were about 60 clinics in the US dedicated to administering ketamine; today, there are between 1,200 and 1,500. For the 21 million Americans who experience major depression, this widening access could help: ketamine and esketamine do appear to have strong anti-depressive effects — as long as it is used in consultation with a doctor and under their supervision. A 2023 meta-analysis of the relevant studies found that across many clinical trials, most patients reported significant improvements in their symptoms within 24 hours. It is recommended primarily for people whose depression has not gotten better after trying other treatments or for people with severe suicide ideation, who need a rapid improvement in their symptoms to avoid a life-threatening emergency. But providers also screen potential patients for any current substance use problems for a very important reason: The risks for ketamine abuse are real. When taken outside of a clinical setting, ketamine is often consumed as a pill or a powder, either snorted or mixed with a drink, and it's easy to take too much. One recent survey found that more than half of patients who attempted to take ketamine at home for depression either intentionally or accidentally took more than the prescribed amount. Users can also develop a tolerance over time, which raises the risk that people will take stronger and stronger doses to feel the same effects. Packs of illegal ketamine are seen before a destruction ceremony to mark the 'International Day against Drug Abuse and Illicit Trafficking' in Yangon on June 26, 2023. Sai Aung Main/AFP via Getty Images Scientists have found that people who use ketamine can develop a dependency on it, especially with frequent and high-dosage use. They become irritable or anxious without the drug and experience other withdrawal symptoms. Its addictive quality, while less potent than that of nicotine or opioids, is an important difference from some other hallucinogens, such as psilocybin, that are also being used in experimental settings for mental health needs and are less likely to be habit-forming. Maintenance doses can also be necessary for ketamine therapy, and regulating any long-term use to prevent dependency is another reason medical supervision is so crucial. There is limited evidence that most people who use ketamine in a clinical setting do not end up abusing it, which is a promising sign that properly managing its use reduces the risk of therapeutic use turning into a disorder. But because ketamine's use for depression is still so new and still growing, it's an important risk to watch out for. Johnson & Johnson urges patients to be mindful of Spravato's potential for misuse. The line between genuine therapeutic use and abuse becomes clearer when a biweekly treatment at a clinic turns into a regular at-home habit, especially if that involves obtaining the drug from illicit sources whose purity is not guaranteed. Street ketamine is typically just the drug itself, produced and sold illegally. But Dr. Nabarun Dasgupta, who oversees the University of North Carolina's Street Drug Analysis Lab, told me they've noticed a recent rise in samples where ketamine is combined with other substances. On its own, ketamine overuse in the short term can cause nausea and high blood pressure, with all of the attendant risks, as well as hallucinations and 'bad trips.' Longer-term abuse can lead to problems with a person's bladder and urinary tract, which can create difficulty urinating — the kind of issues Musk described to people in private, according to the Times. People who chronically abuse ketamine can also experience paranoia, memory loss, and a shortened attention span. The potential for ketamine in a clinical environment is exciting. But its use does come with risks, and not enough people are aware of them: A recent survey from the United Kingdom found that many people there who were taking ketamine did not know that it could be addictive. It can be. Ketamine is not something to experiment with on your own. Clinics have all sorts of safety checks for their patients, Yang told me. Ketamine 'absolutely has been shown to be very effective,' he said, before adding the all-important qualifier: 'under the supervision of a clinical physician.'
