wikidoc - User contributions [en]

Pancreatic cancer epidemiology and demographics

2026-03-03T20:26:21Z

Matt Pijoan: /* Epidemiology and Demographics */

__NOTOC__
{{Pancreatic cancer}}
{{CMG}}; {{AE}}

==Overview==
In the United States, the age-adjusted [[prevalence]] of invasive [[pancreatic cancer]] is 11.7 per 100,000 in 2011. [[Pancreatic cancer|Pancreatic cance]]<nowiki/>r is more prevalent in males than females.
==Epidemiology and Demographics==
===Prevalence===

* In the United States, the age-adjusted [[prevalence]] of invasive [[pancreatic cancer]] is 11.7 per 100,000 in 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>

===Mortality rate===
*As per the ''GLOBOCAN 2012'' estimates, [[pancreatic cancer]] leads to more than 331,000 deaths per year (accounting for 4.0% of all deaths), making it as the seventh leading cause of [[cancer]] death in both males and females. <ref name="pmid27956793">{{cite journal| author=Ilic M, Ilic I| title=Epidemiology of pancreatic cancer. | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 44 | pages= 9694-9705 | pmid=27956793 | doi=10.3748/wjg.v22.i44.9694 | pmc=5124974 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27956793 }} </ref>
*In 2012, about 338,000 suffered from [[pancreatic cancer]], making it the 11th most common [[cancer]].<ref name="pmid27956793">{{cite journal| author=Ilic M, Ilic I| title=Epidemiology of pancreatic cancer. | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 44 | pages= 9694-9705 | pmid=27956793 | doi=10.3748/wjg.v22.i44.9694 | pmc=5124974 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27956793 }} </ref> <ref name="pmid25220842">{{cite journal| author=Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al.| title=Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. | journal=Int J Cancer | year= 2015 | volume= 136 | issue= 5 | pages= E359-86 | pmid=25220842 | doi=10.1002/ijc.29210 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25220842 }} </ref>

===Incidence===
*Estimated new cases and deaths from [[pancreatic cancer]] in the United States in 2015:
:*New cases: 48,960
:*Deaths: 40,560
:*The [[incidence]] of [[Pancreatic cancer|carcinoma of the pancreas]] has markedly increased over the past several decades and ranks as the fourth leading cause of [[cancer]] death in the United States.

*[[Incidence]] rates for [[pancreatic cancer]] in 2012 were: <ref name="pmid27956793">{{cite journal| author=Ilic M, Ilic I| title=Epidemiology of pancreatic cancer. | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 44 | pages= 9694-9705 | pmid=27956793 | doi=10.3748/wjg.v22.i44.9694 | pmc=5124974 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27956793 }} </ref>
**In United States, the highest [[Incidence (epidemiology)|incidence rate]] of 7.4 per 100,000 people
**In Western Europe, 7.3 per 100,000 people
**In Europe and Australia/New Zealand, equally about 6.5 per 100,000 people
**In Middle Africa and South-Central Asia, the lowest [[incidence]] rate of 1.0 per 100,000 people
**In Pakistan, 0.5 per 100,000 people

* The delay-adjusted [[incidence]] of invasive pancreatic cancer in 2011 was estimated to be 12.63 per 100,000 persons in the United States<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>

* In 2011, the age-adjusted [[incidence]] of invasive pancreatic cancer was 12.30 per 100,000 persons in the United States<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>

===Age===

* While the overall age-adjusted [[incidence]] of invasive pancreatic cancer in the United States between 2007 and 2011 is 12.3 per 100,000, the age-adjusted [[incidence]] of invasive pancreatic cancer by age category is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
** Under 65 years: 4 per 100,000
** 65 and over: 69.4 per 100,000

===Gender===

* In the United States, the age-adjusted [[prevalence]] of invasive [[pancreatic cancer]] by gender in 2011 is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
** In males: 12.3 per 100,000
** In females: 11.2 per 100,000

* In the United States, the delay-adjusted [[incidence]] of invasive [[pancreatic cancer]] by gender in 2011 is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
** In males: 14.75 per 100,000 persons
** In females: 10.93 per 100,000 persons

* In the United States, the age-adjusted [[incidence]] of invasive [[pancreatic cancer]] by gender on 2011 is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
** In males: 14.38 per 100,000 persons
** In females: 10.62 per 100,000 persons

Shown below is an image depicting the delay-adjusted [[incidence]] and observed [[incidence]] of invasive [[pancreatic cancer]] by gender and race in the United States between 1975 and 2011. These graphs are adapted from [[SEER]]: ''The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute''.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>

<figure-inline class="mw-default-size"><figure-inline><figure-inline><figure-inline>[[Image:Delay-adjusted incidence and observed incidence of invasive pancreatic cancer by gender and race in the United States.PNG|806x806px]]</figure-inline></figure-inline></figure-inline></figure-inline>

===Race===

* Shown below is a table depicting the age-adjusted [[prevalence]] of invasive pancreatic cancer by race in 2011 in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>

{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''All Races''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''White''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Black''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Asian/Pacific Islander''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Hispanic'''
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Age-adjusted [[prevalence]]'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |11.7 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |11.7 per 100,000 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |13 per 100,000 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |10.4 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |9.6 per 100,000
|}

Shown below is an image depicting the [[incidence]] of invasive pancreatic cancer by race in the United States between 1975 and 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>

<figure-inline class="mw-default-size"><figure-inline><figure-inline><figure-inline>[[Image:Incidence of invasive pancreatic cancer by race in the United States between 1975 and 2011.PNG|473x473px]]</figure-inline></figure-inline></figure-inline></figure-inline>

<small> API: Asian/Pacific Islander; AI/AN: American Indian/ Alaska Native</small>

===Percent Distribution of Invasive Pancreatic Cancer by Histology===
Among patients with [[Histology|histologically]] confirmed cases of invasive [[pancreatic cancer]], the percent distribution of the types of the disease in the United States are:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* [[Carcinoma]]: 97.9%
** Epidermoid [[carcinoma]]: 0.2%
** [[Adenocarcinoma]]: 86%
***[[Adenocarcinoma]] not otherwise specified: 69.9%
***Papillary [[adenocarcinoma]]: 0.1%
***[[Adenocarcinoma|Mucinous adenocarcinoma]]: 2.6%
***Mucin- producing [[adenocarcinoma]]: 1.1%
***Inflitrating duct [[carcinoma]]: 9.8%
***Other [[adenocarcinoma]]: 2.6%
**Other specific [[carcinoma]]: 6.5%
*** Islet cell [[carcinoma]]: 0.9%
*** Other [[carcinoma]]: 5.7%
** [[Carcinoma]] not otherwise specified: 5.2%
* [[Sarcoma]] and other soft tissue tumors: 0.1%
* Other specific types: 0.1%
* Unspecified: 1.9%

===Developed Countries===
*Developed countries have the highest [[incidence]] and [[Mortality rate|mortality rates]] of [[pancreatic cancer]]. <ref name="pmid27956793">{{cite journal| author=Ilic M, Ilic I| title=Epidemiology of pancreatic cancer. | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 44 | pages= 9694-9705 | pmid=27956793 | doi=10.3748/wjg.v22.i44.9694 | pmc=5124974 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27956793 }} </ref>
===Developing Countries===
*[[Pancreatic cancer]] incidence and mortality varies across different countries. The [[incidence]] is considerably lower in developing countries. <ref name="pmid27956793">{{cite journal| author=Ilic M, Ilic I| title=Epidemiology of pancreatic cancer. | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 44 | pages= 9694-9705 | pmid=27956793 | doi=10.3748/wjg.v22.i44.9694 | pmc=5124974 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27956793 }} </ref>

===Awareness===
*November is [[pancreatic cancer]] awareness month.
*Purple is the traditional color chosen to represent [[pancreatic cancer]] awareness.
*The National Cancer Institute’s cancer research budget was $4.824 billion in 2004, an estimated $52.7 million of which was devoted to [[pancreatic cancer]].<ref>http://pancan.org/About/pancreaticCancerStats.html</ref>
*Research spending per [[pancreatic cancer]] patient is $1145, the lowest of any leading [[cancer]].<ref>http://pancan.org/About/pancreaticCancerStats.html</ref>
*The P''ancreatic Cancer Action Network'' (''PanCAN'') was created as an advocacy group for [[pancreatic cancer]].
*The ''National Charity pancreatic cancer UK'' works to raise awareness in the UK.

==References==
{{Reflist|2}}

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[[Category:Disease]]
[[Category:Types of cancer]]
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Intravenous drug use (recreational)

2025-12-15T16:03:05Z

Matt Pijoan: Removed protection from "Intravenous drug use (recreational)"

{{SI}}
{{CMG}}

==Overview==
IV drug use is a relatively recent phenomenon arising from the invention of re-usable [[syringe]]s and the synthesis of chemically pure [[morphine]] and [[cocaine]]. It was noted that administering drugs intravenously strengthened their effect.

== Perceived Advantages ==
There are a variety of reasons why drugs would be injected rather than taken through other methods.

* '''Increased effect''' — Injecting a drug intravenously means that more of the drug will reach the brain quicker. This also means that the drug will have a very strong and rapid onset (or rush).

* '''More efficient usage''' — Injection ensures that all of the drug will be absorbed.

* '''Bypasses the digestive system''' — Some people with sensitive stomachs find it very unpleasant to swallow drugs because of persistent cramps or nausea.

* '''Does not harm the lungs or mucous membranes''' — Unlike the many metres of surface veins, the [[mucous membranes]] occupy a more restricted surface area and can be permanently damaged by habitual [[insufflation]] (snorting).

== Disadvantages ==
In addition to general problems associated with IV drug use (see [[Intravenous therapy#Risks of intravenous therapy]]) there are some specific problems associated with the informal injection of drugs by non-professionals.

* '''Increased chance of blood-borne infection''' — This is generally a twofold problem. One is [[needle sharing]] which transmits [[blood-borne disease]]s between users and the other is secondary infection of injection sites caused by lack of hygiene and failure to rotate the injection site. In addition, the use of cotton to filter some drugs can lead to [[cotton fever]].

* '''Increased chance of overdose''' — Because IV injection delivers a dose of drug straight into the bloodstream it bypasses the body's natural chemical defenses. Taking too much can result in unpleasant side effects or even death

* '''Scarring of the peripheral veins''' — This arises from the use of blunt injecting equipment. This is particularly common with users who have been injecting while in jail and re-use disposable syringes sometimes hundreds of times. IV drug use for an extended period may result in collapsed veins. Though rotating sites and allowing time to heal before reuse may decrease the likelyhood of this occuring, collapse of peripheral veins may still occur with prolonged IV drug use. IV drug users are among the most difficult patient populations to obtain blood-specimens from because of peripheral venous scarring.

* '''Increased chance of addiction''' — It is possible that the heightened effect of administering drugs intravenously can make the chances of addiction more likely but this is not established.

* '''Needle phobia''' — Quite a number of people have an intense aversion to needles which, in extreme cases, is called [[trypanophobia]] and can make them feel nauseous or faint.

* '''Social stigma''' — In many societies there is a social stigma attached to IV drug use. Many people feel that it is somehow "unclean" to take drugs in such a manner, even though they may be perfectly comfortable taking them by another route. It ,however, should be noted, that person taking all precautions will not subject themselves to diseases any more than a non-IV drug user. This may be because of its common use in [[inner city|inner cities]] and with lower-class people.

== Preparation ==
The drug, usually in a powder or crystal form (though not always), is dissolved in water, normally in a spoon. Users draw the required amount of water into a syringe and squirt this over the drugs. The solution is then mixed and heated from below if necessary. Heating is used mainly with [[heroin]],(thought not always, depending on the type of heroin)<ref>http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11419488&dopt=Abstract</ref> but is also used when pharmaceutical drugs such [[Oxycontin]] or [[Dilaudid]] are injected to better separate the drug from the waxy filler; [[amphetamine]]s lose potency when heated and cocaine HCl (powdered cocaine)dissolves quite easily. Heroin prepared for the European market usually requires the addition of a quantity of acidic mixer such as citric acid or ascorbic acid powder to dissolve the drug. Once the drugs are dissolved a small syringe, usually .5 or 1 cc, is used to draw the solution through a filter, usually [[cotton]] from a [[cigarette filter]] or [[cotton swab]] (cotton bud). The preferred injection site is the crook of the elbow (i.e., the [[Cephalic vein|Median Cephalic vein]]), on the user's non-writing hand. Other users opt to use the [[Basilic vein]]; While it may be easier to "hit", caution must be exercised as two nerves run parallel to the vein increasing the chance of nerve damage, as well as the chance of an arterial "nick".<ref>http://www.medscape.com/viewarticle/509098_4</ref>

==References==
{{reflist|1}}

==See also==
*[[Recreational drug use]]

[[Category:Addiction]]
[[Category:Drug culture]]
[[Category:Emergency medicine]]

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Measles

2025-09-18T16:07:23Z

Matt Pijoan:

Measles overview

2025-09-18T16:07:01Z

Matt Pijoan:

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__NOTOC__
{{Measles}}
{{CMG}}

==Overview==
Measles is a highly contagious viral disease caused by the [[Morbillivirus]], a member of the Paramyxoviridae family. The virus is transmitted primarily by respiratory droplets and aerosols from infected individuals.

The incubation period is typically 10–14 days (range, 7–23), during which patients are asymptomatic. Illness begins with a prodrome of fever plus [[cough]], [[coryza]], or [[conjunctivitis]] (the “three Cs”). [[Koplik spots]] on the buccal mucosa may appear 1–2 days before rash onset. The rash is an erythematous [[Maculopapular rash|maculopapular]] exanthem that starts on the face and spreads to the trunk and extremities<ref name=":1">(No date) ''Iris home''. Available at: <nowiki>https://iris.who.int/handle/10665/365133</nowiki> (Accessed: 17 September 2025).</ref>.

Infected persons are contagious from approximately 4 days before rash onset until 4 days after<ref name=":1" />.

Measles remains a major global health concern. Since 2024, all WHO regions have reported rising numbers of measles cases. In 2024, there were 395,521 laboratory-confirmed cases worldwide, and in just the first two months of 2025, 16,147 cases were reported. Hospitalization occurred in more than half of reported cases, suggesting the true burden is much higher<ref name=":2">World Health Organization. Immunization data: provisional measles and rubella data. 2024 (<nowiki>https://immunizationdata</nowiki> .who.int/global?topic=Provisional</ref>.

==Historical Perspective==
The measles virus was first isolated in cell culture in 1954 by John F. Enders and Thomas C. Peebles, leading to the development of measles-containing vaccines. The '''first vaccine was licensed in 1963''', based on the Edmonston prototype strain. An inactivated (killed) vaccine, used between 1963 and 1967, was later withdrawn because it predisposed recipients to a severe form of disease called ''atypical measles syndrome'' when they were exposed to wild-type measles virus<ref>Polack, F.P. (2007) ‘Atypical measles and enhanced respiratory syncytial virus disease (ERD) made simple’, ''Pediatric Research'', 62(1), pp. 111–115. doi:10.1203/pdr.0b013e3180686ce0.</ref>.

Subsequent development of live attenuated vaccine strains, including Edmonston B, Edmonston-Enders, and Moraten strains, provided effective durable protection. The '''first combined [[MMR vaccine|measles-mumps-rubella (MMR) vaccine]]''' was licensed in 1971<ref name=":0">Do, L.A. and Mulholland, K. (2025) ‘Measles 2025’, ''New England Journal of Medicine'' [Preprint]. doi:10.1056/nejmra2504516.</ref>.

In 1977, the [https://en.wikipedia.org/wiki/World_Health_Organization World Health Organization (WHO)] introduced the Expanded Programme on Immunization, initially recommending a one-dose measles schedule. By 2000, WHO and [https://en.wikipedia.org/wiki/UNICEF UNICEF] endorsed a '''two-dose schedule''' globally<ref>''MMR vaccine vis'' (no date) ''Centers for Disease Control and Prevention''. Available at: <nowiki>https://www.cdc.gov/vaccines/hcp/current-vis/mmr.html</nowiki> (Accessed: 17 September 2025).</ref>.

Despite large gains, measles resurgence has been a recurring theme. In 2019, global cases surged to 869,770, driven by outbreaks in the Democratic Republic of Congo, Madagascar, Samoa, Ukraine, and Brazil, largely due to vaccine hesitancy<ref name=":3">Patel, M.K. ''et al.'' (2020) ‘Progress toward regional measles elimination — worldwide, 2000–2019’, ''MMWR. Morbidity and Mortality Weekly Report'', 69(45), pp. 1700–1705. doi:10.15585/mmwr.mm6945a6.</ref>. This factor also contributed to the more than 100,00 measles cases in Europe in 2019 and the increased number of measles cases in the United States almost 20 years after the declaration that the disease head been eliminated in 2000<ref>Hotez, P.J., Nuzhath, T. and Colwell, B. (2020) ‘Combating vaccine hesitancy and other 21st century social determinants in the global fight against measles’, ''Current Opinion in Virology'', 41, pp. 1–7. doi:10.1016/j.coviro.2020.01.001.</ref>.

Since 2024, measles cases have been rising sharply again, with major outbreaks in Europe and the United States. If the United States experiences uninterrupted transmission for more than 12 months, it risks losing its measles elimination status<ref name=":0" />.

==Pathophysiology==
Measles is caused by a nonsegmented, negative-stranded [[RNA virus]] of the [[Paramyxoviridae]] family, genus [[Morbillivirus]]. The virus initially infects the [[respiratory epithelium]] of the [[nasopharynx]] and then spreads systemically.

Cellular receptors:

* CD46 – used primarily by vaccine strains<ref>Dorig RE, Marcil A, Chopra A, Richardson CD. The human CD46 molecule is a receptor for measles virus (Edmonston strain). Cell. 1993;75(2):295-305</ref><ref>Naniche D, Varior-Krishnan G, Cervoni F, Wild TF, Rossi B, Rabourdin-Combe C, et al. Human membrane cofactor protein (CD46) acts as a cellular receptor for measles virus. J Virol. 1993;67(10):6025-32</ref>.
* SLAM (CD150⁺) – expressed on B and T [[lymphocytes]], the main receptor for wild-type measles virus<ref>Tatsuo H, Ono N, Tanaka K, Yanagi Y. SLAM (CDw150) is a cellular receptor for measles virus. Nature. 2000;406(6798):893-7</ref>.
* Nectin-4 – an epithelial cell receptor identified in 2010-2011<ref>Muhlebach MD, Mateo M, Sinn PL, Prufer S, Uhlig KM, Leonard VH, et al. Adherens junction protein nectin-4 is the epithelial receptor for measles virus. Nature. 2011;480(7378):530-3</ref>.

The Virus induces a viremia that disseminates widely, causing systemic infection involving the skin, eyes, respiratory tract, and gastrointestinal tract<ref>World Health Organization. Immunization data: provisional measles and rubella data. 2024 (<nowiki>https://immunizationdata.who.int/global?topic=Provisional-measles-and-rubella-data&location=</nowiki>)</ref>.

A central feature of measles pathogenesis is immune amnesia. The virus depletes memory B and T lymphocytes (CD150⁺ cells), leading to loss of preexisting immunity to other pathogens. This results in increased susceptibility to secondary infections, particularly bacterial [[pneumonia]], for up to a year after recovery<ref>Mina MJ, Kula T, Leng Y, Li M, de Vries RD, Knip M, et al. Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens. Science. 2019;366(6465):599- 606</ref><ref>Petrova VN, Sawatsky B, Han AX, Laksono BM, Walz L, Parker E, et al. Incomplete genetic reconstitution of B cell pools contributes to prolonged immunosuppression after measles. Sci Immunol. 2019;4(41)</ref>.

Severe disease is more likely in malnourished children, immunocompromised patients (including those with [[Human Immunodeficiency Virus (HIV)|HIV]] or undergoing [[cancer]] treatment), and [[Pregnancy|pregnant]] women<ref>''Routine MMR vaccination recommendations: For Providers'' (2021) ''Centers for Disease Control and Prevention''. Available at: <nowiki>https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html</nowiki> (Accessed: 17 September 2025).</ref><ref>e Y-L, Zhai X-W, Zhu Y-F, et al. Mea�sles outbreak in pediatric hematology and oncology patients in Shanghai, 2015. Chin Med J (Engl) 2017;130:1320-6</ref><ref>Khalil A, Samara A, Campbell C, Lad�hani SN. Pregnant women and measles: we need to be vigilant during outbreaks. EClinicalMedicine 2024;72:102594</ref>.

==Differentiating Measles from other Diseases==
The clinical features of [[measles]], fever, cough, coryza, conjunctivitis, and a maculopapular rash, can overlap with several other infectious exanthems.

Conditions that may resemble measles include<ref>Brown DW, Warrener L, Scobie HM, Donadel M, Waku-Kouomou D, Mulders MN, et al. Rapid diagnostic tests to address challenges for global measles surveillance. Curr Opin Virol. 2020;41:77-84</ref>:

* Dengue fever
* Zika virus infection
* Parvovirus infection

Therefore, because of this overlap, laboratory confirmation is essential, particularly in the early stages of an outbreak or in areas with low measles incidence. Confirmation relies on<ref>Warrener L, Andrews N, Koroma H, Alessandrini I, Haque M, Garcia CC, et al. Evaluation of a rapid diagnostic test for measles IgM detection; accuracy and the reliability of visual reading using sera from the measles surveillance programme in Brazil, 2015. Epidemiol Infect. 2023;151:e151.</ref>:

* Detection of measles-specific IgM antibodies (enzyme immunoassays).
* Detection of measles RNA by real-time reverse transcriptase polymerase chain reaction (RT-PCR).

These methods are especially important in immunocompromised patients, who may not mount a detectable antibody response.

==Epidemiology and Demographics==
Measles is one of the most contagious infectious diseases, with a primary case reproduction number (R₀) of '''12 to 18'''<ref>Larson, H.J., Gakidou, E. and Murray, C.J.L. (2022) ‘The vaccine-hesitant moment’, ''New England Journal of Medicine'', 387(1), pp. 58–65. doi:10.1056/nejmra2106441.</ref>. According to the WHO, it remains a leading cause of vaccine-preventable childhood mortality worldwide.

=== Global Trends ===
According to the World Health Organization (WHO), measles deaths had fallen substantially with the expansion of immunization programs. Between 1999 and 2005, global measles deaths decreased by approximately '''60%''', from an estimated '''873,000 deaths''' to '''345,000 deaths''', with Africa experiencing a '''75% reduction''' (from 506,000 to 126,000 deaths). This progress was largely driven by international partnerships such as the Measles Initiative (American Red Cross, CDC, UNICEF, UN Foundation, and WHO).

However, these gains have been eroded in recent years

* '''2019''': Global cases rose to '''869,770''', the highest number in decades, with large outbreaks in the Democratic Republic of Congo, Madagascar, Samoa, Ukraine, and Brazil<ref name=":3" />.
* '''Covid-19 pandemic (2020)''': Caused major disruptions in routine immunization and catch-up campaigns. Global coverage with the first measles vaccine dose fell to '''81% — the lowest since 2008''' — before recovering slightly to '''83% in 2022–2023'''<ref name=":4">Minta, A.A. ''et al.'' (2023) ‘Progress toward measles elimination — worldwide, 2000–2022’, ''MMWR. Morbidity and Mortality Weekly Report'', 72(46), pp. 1262–1268. doi:10.15585/mmwr.mm7246a3.</ref>.
* '''2024''': WHO regions reported widespread resurgence, with '''395,521 laboratory-confirmed measles cases''' worldwide<ref name=":2" />.
* '''Early 2025''': In just the first two months, '''16,147 cases''' were reported globally. More than half of confirmed cases required hospitalization, indicating that the true burden is likely higher<ref name=":2" />.

=== Regional Burden ===

* '''Low- and middle-income countries (LMICs):''' Account for the vast majority of measles cases. In 2023–2024, more than '''90% of global cases''' occurred in LMICs, mostly in children under 5 years of age. Mortality is highest in infants younger than 1 year<ref name=":4" />.
* '''Vietnam (2025):''' Among the top 10 countries for reported measles cases; children '''6–8 months old''' accounted for up to '''25% of cases''' in some areas<ref>ProMed. Measles — Viet Nam (03): WHO assessment, alert 2025 (https:// promedmail.org/promed-post/?id=8721943)\</ref>.
* '''Europe:''' In 2024, Europe reported its highest number of measles cases in more than 25 years, representing '''20% of global cases'''<ref name=":2" />.

* '''United States:''' By May 30, 2025, there were '''1,088 confirmed measles cases and 3 deaths'''. About '''96%''' of these cases were in unvaccinated persons or those with unknown vaccination status, and '''12%''' required hospitalization. This represents nearly '''four times the total reported in 2024'''. If uninterrupted transmission continues for 12 months, the United States will lose its elimination status<ref>Centers for Disease Control and Prevention. Measles cases and outbreaks. June 6, 2025 (<nowiki>https://www.cdc.gov/measles/</nowiki> data-research/index.html)</ref>.

=== Drivers of the resurgence ===

* '''Vaccine hesitancy''', fueled by misinformation (e.g., false claims linking MMR vaccine to autism, unfounded belief that vitamin A prevents measles)<ref>DeStefano, F. and Shimabukuro, T.T. (2019) ‘The MMR vaccine and autism’, ''Annual Review of Virology'', 6(1), pp. 585–600. doi:10.1146/annurev-virology-092818-015515.</ref>.
* '''Disruptions during Covid-19''', which delayed or canceled mass immunization campaigns<ref>Centers for Disease Control and Prevention. ACIP recommendations: measles, mumps and rubella (MMR) vaccine. July 29, 2024 (<nowiki>https://www.cdc.gov/acip</nowiki> -recs/hcp/vaccine-specific/mmr.html)</ref>.

* '''Political and funding changes''', including U.S. withdrawal of support from WHO and [https://en.wikipedia.org/wiki/GAVI Gavi, the Vaccine Alliance], reducing resources for global measles control<ref name=":0" />.

==Risk Factors==
Measles is a disease with very low incidence in the developed world. Lack of vaccination against measles is one of the biggest risk factors that predisposes measles spread. In developed countries like USA, most cases are attributed to unvaccinated or incompletely vaccinated travelers from other parts of the world. Primary vaccine failure occurs in approximately 5% of individuals vaccinated with a single dose of vaccine at 12 months of age or older and also predisposes an individual to the risk of developing measles.

==Natural History, Complications and Prognosis==
Measles spreads through the air by breathing, coughing or sneezing. It is so contagious that any child who is exposed to it and is not [[immune]] will probably get the disease. The virus lives in the mucus in the nose and throat of the infected person. When that person sneezes or coughs, droplets spray into the air. The virus can live on infected surfaces for up to 2 hours and spreads so easily that people who are not immune will probably get it when they come close to someone who is infected. Measles is a disease of humans.

Complications with measles are relatively common, ranging from relatively mild and less serious [[diarrhea]], to [[pneumonia]] and [[encephalitis]] ([[subacute sclerosing panencephalitis]] - SSPE). Complications are usually more severe amongst adults who catch the virus.

Measles itself is unpleasant, but the complications are dangerous. Six to 20 percent of the people who get the disease will get an [[ear infection]], [[diarrhea]], or even [[pneumonia]]. One out of 1000 people with measles will develop inflammation of the [[brain]], and about one out of 1000 will die.

==Diagnosis==
===Diagnostic Criteria===
A [[measles]] case is confirmed in a person with [[febrile]] [[rash]] illness and laboratory confirmation or a direct epidemiologic link to a confirmed case.

===History and Symptoms===
The symptoms of measles generally begin about 7-14 days after a person has been infected. Clinical diagnosis of [[measles]] requires a history of [[fever]] of at least three days together with at least one of the three ''C''s —[[cough]], [[coryza]] (runny nose) and [[conjunctivitis]] (red eyes). Observation of [[Koplik's spots]] is also a characteristic finding in measles. The fever may reach up to 104° [[Fahrenheit|F]]/ 40° [[Celsius|C]].

===Physical Examination===
Measles is a condition, that is best diagnosed clinically based on a constellation of signs and symptoms. [[Fever]], [[rash]] and [[conjunctivitis]] are 3 major physical findings that must be looked out for, while making the diagnosis of [[measles]].<ref name="CDC"> {{ cite web| title= CDC Measles | url=http://www.cdc.gov/measles/hcp/index.html}} </ref><ref name="WHO"> {{ cite web| title=WHO GUIDELINES FOR EPIDEMIC PREPAREDNESS AND RESPONSE TO MEASLES OUTBREAKS | url=http://www.who.int/csr/resources/publications/measles/WHO_CDS_CSR_ISR_99_1/en/}} </ref>

===Laboratory Findings===
Laboratory confirmation is essential for all sporadic measles cases and all outbreaks. Detection of measles-specific [[IgM]] antibody and measles [[RNA]] by [[real-time polymerase chain reaction]] ([[Real-time polymerase chain reaction|RT–PCR]]) are the most common methods for confirming measles infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have measles at first contact with them. Urine samples may also contain [[virus]], and when feasible to do so, collecting both respiratory and urine samples can increase the likelihood of detecting [[measles virus]]. <ref name="CDC"> {{ cite web| title= CDC Measles Laboratory Findings | url=http://www.cdc.gov/measles/lab-tools/index.html}} </ref>

===Chest X Ray===
A chest X-ray can be used to diagnose [[pneumonia]], which is one of the complications of measles. <ref name="CDC"> {{ cite web| title= CDC Measles Complications | url=http://www.cdc.gov/measles/hcp/index.html#complications }} </ref> The chest x-ray findings in patient with [[measles]] will be a patchy consolidation of lung lobes and poorly define nodules. <ref name="KimLee2002">{{cite journal|last1=Kim|first1=Eun A|last2=Lee|first2=Kyung Soo|last3=Primack|first3=Steven L.|last4=Yoon|first4=Hye Kyung|last5=Byun|first5=Hong Sik|last6=Kim|first6=Tae Sung|last7=Suh|first7=Gee Young|last8=Kwon|first8=O Jung|last9=Han|first9=Joungho|title=Viral Pneumonias in Adults: Radiologic and Pathologic Findings1|journal=RadioGraphics|volume=22|issue=suppl_1|year=2002|pages=S137–S149|issn=0271-5333|doi=10.1148/radiographics.22.suppl_1.g02oc15s137}}</ref>

===Other Diagnostic Studies===
Other diagnostic tests include Vero/hSLAM cells for isolation of [[measles virus]] and genetic and sequencing analysis.

==Treatment==
===Medical Therapy===
Despite the efforts made in the past years to develop a treatment regimen for [[measles]], there is still no specific [[Antiviral Therapy|antiviral therapy]] for uncomplicated cases of [[measles]], however, some [[drugs]] such as [[ribavirin]] and [[interferon-α]] have been used in the more severe cases of the condition, notably for cases of [[infection]] of the [[CNS]] by the [[virus]]. Yet, there is evidence that the administration of two doses of [[vitamin A]] in children, under the age of two, was associated with a reduced risk of [[morbidity]] and [[mortality]] from the disease. For most patients with [[measles]], the standard treatment is focused on supportive care.<ref name="MossGriffin2012">{{cite journal|last1=Moss|first1=William J|last2=Griffin|first2=Diane E|title=Measles|journal=The Lancet|volume=379|issue=9811|year=2012|pages=153–164|issn=01406736|doi=10.1016/S0140-6736(10)62352-5}}</ref><ref name="pmid16235283">{{cite journal| author=Huiming Y, Chaomin W, Meng M| title=Vitamin A for treating measles in children. | journal=Cochrane Database Syst Rev | year= 2005 | volume= | issue= 4 | pages= CD001479 | pmid=16235283 | doi=10.1002/14651858.CD001479.pub3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16235283 }} </ref><ref name="pmid20390298">{{cite journal| author=Reuter D, Schneider-Schaulies J| title=Measles virus infection of the CNS: human disease, animal models, and approaches to therapy. | journal=Med Microbiol Immunol | year= 2010 | volume= 199 | issue= 3 | pages= 261-71 | pmid=20390298 | doi=10.1007/s00430-010-0153-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390298 }} </ref>

===Primary Prevention===
Ever since the introduction of the [[measles]] [[vaccine]], there has been a marked reduction of the [[incidence]] of this disease in the [[population]]. The widespread use of [[measles]] [[vaccine]] has led to a greater than 99% reduction in [[measles]] cases in the United States, when compared with the non [[vaccine]] era. Therefore the most effective way of preventing [[measles]] is with [[active immunization]] provided by this [[vaccine]], which is often incorporated with the [[rubella]] and/or [[mumps]] [[vaccines]], in the [[MMR vaccine]], in countries where these illnesses represent a problem. Unfortunately, [[measles]] is still a common disease in developing countries, where the [[virus]] is highly [[contagious]] and is able to spread across large areas, where [[vaccination]] is not common.<ref name=WHO>{{cite web | title = Measles | url = http://www.who.int/mediacentre/factsheets/fs286/en/ }}</ref><ref name="MossGriffin2012">{{cite journal|last1=Moss|first1=William J|last2=Griffin|first2=Diane E|title=Measles|journal=The Lancet|volume=379|issue=9811|year=2012|pages=153–164|issn=01406736|doi=10.1016/S0140-6736(10)62352-5}}</ref><ref name=CDC>{{cite web | title = Measles vaccination | url = http://www.cdc.gov/measles/vaccination.html }}</ref>

===Cost-Effectiveness of Therapy===
Although there is still no specific [[Antiviral Therapy|antiviral treatment]] for [[measles]], attending to the considerable decrease in [[morbidity]] and [[mortality]] of [[measles]] in the United States, with the introduction of [[MMR vaccine|measles vaccine]], it may be considered that [[prevention]] of measles by [[vaccination]] shows cost-effectiveness.

===Future or Investigational Therapies===
Despite the impact of [[primary prevention]] with [[vaccination]] in the [[incidence]] of [[measles]] there is still no specific [[Antiviral Therapy|antiviral treatment]] for the disease once it develops. Most developing countries are still severely affected by the high [[incidence]] of this conditions, in part due to the absence of an adequate [[vaccination]] system. Therefore, it is essential the role of [[research]] in developing a more adequate approach to the disease, once it is established. Also, the development of easier and less expensive ways of bringing the [[vaccine]] to populations in developing countries would greatly contribute to a potential eradication of [[measles]].

==References==
{{reflist|2}}
{{WH}}
{{WS}}

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User:Matt Pijoan

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User:Matt Pijoan

2021-05-24T17:01:34Z

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