Talk:Measles

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Former good articleMeasles was one of the Natural sciences good articles, but it has been removed from the list. There are suggestions below for improving the article to meet the good article criteria. Once these issues have been addressed, the article can be renominated. Editors may also seek a reassessment of the decision if they believe there was a mistake.
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DateProcessResult
March 10, 2006Good article nomineeListed
June 9, 2009Good article reassessmentDelisted
Current status: Delisted good article
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--Akrasia25 (talk) 12:31, 7 March 2019 (UTC)

Historical data not supported by source[edit]

In article: "In 1980, 2.6 million people died of it,[6]"

In source: "Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year." 1980 does not appear anywhere in the source. Please edit. — Preceding unsigned comment added by 184.74.151.135 (talk) 15:13, 5 April 2019 (UTC)

You are correct. thank you for catching that error. MartinezMD (talk) 19:25, 5 April 2019 (UTC)
User:MartinezMD ref states 1980 here https://web.archive.org/web/20150203144905/http://www.who.int/mediacentre/factsheets/fs286/en/
Doc James (talk · contribs · email) 19:49, 5 April 2019 (UTC)
User:Doc James thank you. The IP editor was correct however that it wasn't in the tagged source. Would you be kind enough to add this or substitute it? MartinezMD (talk) 19:56, 5 April 2019 (UTC)

Semi-protected edit request on April 2019[edit]

Regarding the last confirmed measles death in the US, the source that is cited to claim that the 29 year old woman that died was vaccinated actually does not support that claim.

"First Measles Death in US Since 2003 Highlights the Unknown Vulnerables – Phenomena: Germination". 2015-07-02. Archived from the original on 2015-07-03. Retrieved 2015-07-03."

All that it says is that "According to investigative work by the state department, the woman had been vaccinated, though spokesperson Donn Moyer told me her mother was not able to locate a vaccination record. " But the referenced article it self does not point to a source with the "investigative work by the state department". I recommend either supporting the claim with an actually reference to the investigative work, or simply write that "it is unclear if she was vaccinated or not". The following article seems to have a more factual assessment of her status. I recommend citing this one instead.

https://www.seattletimes.com/seattle-news/health/fatal-measles-case-linked-to-exposure-at-tribal-clinic-records-show/

Furthermore, the link to the reference provided in the current wiki page is actually not working, only an archived version of it exists. The link I provide above, does work. — Preceding unsigned comment added by 73.61.19.49 (talk) 15:19, 17 April 2019 (UTC)

Read the archived source more carefully. It says "Update: According to further state info, the woman learned she might have been exposed to measles; had her degree of immune protection checked, and discovered she would have had enough immunity to protect against measles if she had not been taking the immune-suppressing drugs." MartinezMD (talk) 16:26, 17 April 2019 (UTC)
My point is exactly that. It says " According to further state info" without citing any sources. Anyone can write an article that says "according to state info, XYZ is true". Unless someone can provide with a source for the said state info, this should be removed and not trusted. Facts, not fiction. — Preceding unsigned comment added by 193.137.158.241 (talk) 14:14, 22 April 2019 (UTC)
The news reports are summaries, not primary sources. From the article you cite - "That’s according to emails and documents from Washington State Department of Health (DOH) officials released in response to a Seattle Times Public Records Act request." So they don't publish the verbatim report. Since we consider reliable sources accurate, that's what we use. We also can't help when websites trim their pages; the archived copy is considered valid. Also, you don't have to change the "question answered" parameter to "no". You're getting a reply and there is a conversation thread now. MartinezMD (talk) 14:29, 22 April 2019 (UTC)
The Reliable source page that you sent me says, regarding news stories sources, that "Whether a specific news story is reliable for a fact or statement should be examined on a case-by-case basis", which implies that Wiki should be open to verifying the validity of a statement, and not just accept it at face value. Several news agencies seem to agree on the fact that the woman died, that she was taking suppressive drugs, what her age was, and that her mother did not know her vaccination status. It is indeed a bit hard to find the original WA state DOH report. So I think it is honest to go with the consensus. Furthermore, after some investigation, I found some interview that relates to an interview with a spokesman from the DOH that seems to give some detail about the vaccination status issue (https://www.npr.org/2015/07/06/420594973/first-measles-death-in-12-years-renews-vaccination-concerns). It seems like the vaccination status is indeed unknown, but that, they did some blood tests, and they found that she had antibodies of a kind that could have fought measles. Now, this does not necessarily imply that she had been vaccinated. She could have had those antibodies naturally, or via some other (but not measles) vaccine. So, I suggest that we replace the current source with the one I provided, and that we write that, "it is unclear if the woman had been vaccinated against measles, and her official vaccination status is "unknown", although, according the WA DOH department, blood tests reveled that she had antibodies that, if not under suppressive drugs, would have been able to fight of the disease". Not sure I agree with you regarding the yes/no status. If there are unanswered issues, the status should be "no", even though I really appreciate you having answered some of my posts. Cheers ! — Preceding unsigned comment added by 193.137.158.164 (talk) 17:06, 23 April 2019 (UTC)
I honestly don't understand your issue. You've now found yet another reliable source, NPR,(which I'm now adding to the article) that reports the mother's statement she was vaccinated, and also the statement that she had antibodies. If you tried finding my vaccine record you wouldn't find it either as it was 50 years ago. How would that invalidate the fact that I was vaccinated for example? Also, no, you don't get antibodies without the vaccine or having the illness previously. Antibody formation requires a specific exposure. I disagree with your proposal for these reasons, and unless editors have another opinion, the question is answered.MartinezMD (talk) 17:26, 23 April 2019 (UTC)
Agree with User:MartinezMD. Here is the full quote,

MCEVERS: And had she been vaccinated for measles? ALECCIA: You know, her vaccination status is uncertain. Her mother tells health officials that she was vaccinated as a child, but they don't have any of the documentation that proves it. And so she's technically classified as kind of an unknown vaccination status. But just after she was exposed, the young woman was tested, and she was found to have antibodies against measles, enough that would've protected a healthy person. But she also had multiple underlying health conditions. And so her immune system was suppressed, and she was vulnerable to the infection anyway.

There is two full sentences explaining the situation for a single death. My opinion is that is sufficient. Ian Furst (talk) 00:37, 24 April 2019 (UTC)
Hello, I disagree that there is proof that she was vaccinated. If there was proof, her status would not be "uncertain". I cannot force the edit, but clearly the current article inaccurately gives a certainty where there is none. Furthermore, if having antibodies was irrefutable proof of vaccination, her record would be "vaccinated". The fact that the doctors left her status as "uncertain" means that she might have gotten the antibodies from something other than the vaccine. For example, babies get antibodies from the mother when breastfeeding (I am not saying this is the case here, what I am saying is that biology is complicated and uncertain. There are many mechanisms by which something can come about). I think it would be fair to change "she had been vaccinated" to "her official vaccination status is uncertain, although she was found to have antibodies against measles". — Preceding unsigned comment added by 194.210.209.83 (talk) 17:14, 26 April 2019 (UTC)
You can disagree. You're welcome to do that, but you've received an answer. Please stop changing the question being answered to No if you don't like the answer you get. Secondly, an adult does not have maternal IgA antibodies. Antibodies to the measles (adult IgG - which are the levels that are measured) are either vaccine or viral induced. So either she previously had the disease or previously was vaccinated.MartinezMD (talk) 17:45, 26 April 2019 (UTC)
I disagree, and I believe that I am correct in saying that it is fair, for truth sake, for the official government status to be reported in the wiki page. I do not understand why the wiki should state something that *might* not be true, and if it is irrefutable proof, why the government won't change the status? Furthermore, I believe that we all agree on the facts. (1) She has the antibodies, (2) she might have been vaccinated, but it is (3) not 100% certain she has been vaccinated against measles specifically, (4) the official status is uncertain. I do not understand why you do not want to report the truth in the wiki. Sorry, this issue has not been addressed. — Preceding unsigned comment added by 136.167.207.15 (talk) 17:25, 14 May 2019 (UTC)
 Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. There is clearly no consensus right now. MrClog (talk) 17:56, 5 June 2019 (UTC)

Are those of us who have had measles immune?[edit]

The second last sentence in the 2nd para says this: Most people do not get the disease more than once.[6] However, the WHO fact sheet cited in [6] above doesn't say anything about this: [1]

Changed the reference to the CDC Pink book Ch 13, p. 212. They discuss that the IgG response is similar to either vaccine or wild-type virus, and that it persists for years. Ian Furst (talk) 20:41, 20 April 2019 (UTC)
You don't even need a biological explanation, just epidemiology. We typically do not see repeat cases of measles, regardless of the reason. MartinezMD (talk) 17:48, 26 April 2019 (UTC)
This isn't really the place, because this isn't about the article, but you should not assume you are immune if you have had it before. Last month, a man who thought he was immune because he had it as a child infected 38 people.[2] I'm not saying you wouldn't be, but it isn't safe to assume that. Natureium (talk) 17:50, 26 April 2019 (UTC)
That's why I said typically ;) In cases like the one you cite, it's possible he had measles before. It's also possible he was misdiagnosed and had another illness as a child. MartinezMD (talk) 21:04, 26 April 2019 (UTC)

Viewpoint[edit]

This is a viewpoint not a review aricle:

Sundaram, ME; Guterman, LB; Omer, SB (March 2019). "The True Cost of Measles Outbreaks During the Postelimination Era". JAMA. doi:10.1001/jama.2019.1506. PMID 30844023.

Could use a better ref Doc James (talk · contribs · email) 22:36, 2 May 2019 (UTC)

Replaced with a better ref Doc James (talk · contribs · email) 22:43, 2 May 2019 (UTC)
Doc, can you be clear about what was wrong with it? Yes, it's not technically classified as a review but functionally it acts as one. I don't see the issue. It's clearly a secondary source from JAMA reviewing the literature (albeit on a focused topic). It's not a systematic review by any means but it more than suffices for the claim that measles infection causes immunosuppression. I don't have an issue with the Nature Disease Primer review being used but I think it's important to clarify the issue at hand. TylerDurden8823 (talk) 02:58, 3 May 2019 (UTC)
It is labelled as a "viewpoint".
It is not clear what percentage of the complications are due to the immunosuppression. Many may occur for other reasons. Ie the measles infection itself with respect to viral pneumonia.
We state the number of deaths measles causes already and thus we do not need to list death a second time in the infobox.
This source lists the common complications.[3] Doc James (talk · contribs · email) 04:50, 3 May 2019 (UTC)
"It's labeled as a viewpoint." So? This doesn't elaborate on why this source would be problematic. The article is sourced stating that the immunosuppression is the reason for these secondary complications. Obviously, viral pneumonia is a direction manifestation but this isn't what's being referred to. The CDC link indeed lists those common complications but makes no mention whether immunosuppression from measles virus infection is linked to these complications. The other source clearly linked the two. Here are a few more sources that explicitly state the MV infection-related immunosuppression is responsible for these consequences (some may be exacerbated by malnutrition in the developing world as well (e.g., diarrhea): [4], [5] (per the abstract for this one, I don't have access to the full article), and [6]. TylerDurden8823 (talk) 07:35, 3 May 2019 (UTC)
Also, this is already in the text of the Measles article: "[1]

"However, infection is also associated with several weeks of immune suppression with the consequence that the primary causes of measles deaths are secondary infections." TylerDurden8823 (talk) 07:41, 3 May 2019 (UTC)

Our article actually says "In addition, measles can suppress the immune system for weeks to months, and this can contribute to bacterial superinfections such as otitis media and bacterial pneumonia"
Yes the immunosupporession increases the risk of bacterial infection but I am not seeing the source claim that all the bacterial infections related to measles are due to immunosuppression and that there is no other mechanism. Doc James (talk · contribs · email) 22:36, 3 May 2019 (UTC)
We don't necessarily have to say all but these sources make it clear that the immunosuppression is, at the very least, largely responsible for the secondary infections that occur following the primary measles virus infection. I'm not saying it's the only mechanism, but that it is an established mechanism. As the article currently stands, it does not make that connection and it should. TylerDurden8823 (talk) 23:21, 3 May 2019 (UTC)

Does this not sum it up?:

  • "Common complications include diarrhea (in 8% of cases), middle ear infection (7%), pneumonia (6%), and immunosuppression."
  • We could also go with "Common complications include diarrhea (in 8% of cases), middle ear infection (7%), and pneumonia (6%). These occur in part due to measles induced immunosuppression."

Doc James (talk · contribs · email) 22:40, 3 May 2019 (UTC)

No, the first version you have there isn't sufficient. . It doesn't explain to the reader that some of those complications are due to the immunosuppression. That's an important concept. I think the second version would be fine. Also, I would still like to know what the specific objection(s) were to the JAMA Viewpoint article as I asked earlier. TylerDurden8823 (talk) 23:19, 3 May 2019 (UTC)
Have placed the refs by the text it supports.
Yah the viewpoint is published by JAMA. I would prefer a proper review article, which I added, but I guess we could also use the viewpoint. Doc James (talk · contribs · email) 02:12, 5 May 2019 (UTC)

References

  1. ^ Griffin DE (July 2010). "Measles virus-induced suppression of immune responses". Immunological Reviews. 236: 176–89. doi:10.1111/j.1600-065X.2010.00925.x. PMC 2908915. PMID 20636817.

Cause of increase in measles between 2017 to 2019[edit]

The direct cause is a decrease in immunization. This has occurred due to a number of reasons and IMO just listing one in the lead is undue weight. Thus this belongs " and a spike in the "Anti-Vax" movement" in the body not the lead. Doc James (talk · contribs · email) 17:34, 17 June 2019 (UTC)

What are the other reasons (and relative percentage to the effect if available)? I think that would make a difference in whether it should be in the lead or the body. MartinezMD (talk) 21:01, 17 June 2019 (UTC)

Semi-protected edit request on 2 September 2019[edit]

In the epidemiology section for Europe there is an incorrect use of there:

Currently it reads: "In 2019 the United Kingdom, Albania, Czechia, and Greece lost there measles free status due to ongoing and prolonged spread of the disease in these countries.[93]"

It should read "In 2019 the United Kingdom, Albania, Czechia, and Greece lost their measles free status due to ongoing and prolonged spread of the disease in these countries.[93]"

Please change there to their.

Thanks

Ash Singalash (talk) 20:35, 2 September 2019 (UTC)

Thank you for spotting the error. Graham Beards (talk) 21:37, 2 September 2019 (UTC)

Immunosupression more damaging than believed[edit]

Queen's University Medical Student Editing Initiative[edit]

Hello! We are a group of medical students from Queen's University in Kingston, Ontario. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. Thank you in advance for your assistance and feedback! — Preceding unsigned comment added by Miriammaes (talkcontribs) 20:18, 11 November 2019 (UTC)

Queen's University Medical Student Editing Initiative[edit]

Hello! We are a group of medical students from Queen's University in Kingston, Ontario. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. Thank you in advance for your assistance and feedback! — Preceding unsigned comment added by Miriammaes (talkcontribs) 20:18, 11 November 2019 (UTC) Here's the proposed changes we plan on doing to the measles article:

1- Current article under the "Diagnosis" section: “Laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens.” We would add some details about the PCR viral detection with this: “Laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from throat, nasal or urine specimen by using the polymerase chain reaction method (PCR). This method is particularly useful to confirm cases when the IgM antibodies results are inconclusives.”[1]

2- Current article under the "Diagnosis" section: "For people unable to have their blood drawn, saliva can be collected for salivary measles-specific IgA testing". This sentiment will be expanded by adding information about using salivary tests to diagnose measles in order to make the "Diagnosis" section of the Wikipedia article more robust. We propose adding in the following sentences: "Salivary tests used to diagnose measles involve collecting a saliva sample and testing for the presence of measles antibodies. This method is not ideal, as saliva contains many other fluids and proteins which may make it difficult to collect samples and detect measles antibodies. Saliva also contains 800 times fewer antibodies than blood samples do, which makes salivary testing additionally difficult." [2]

3- Current article under the "Diagnosis" section: "Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the following symptoms: cough, coryza, or conjunctivitis. Observation of Koplik's spots is also diagnostic. Laboratory confirmation is however strongly recommended." The proposed addition would include a differential diagnosis as follows: "Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the following symptoms: cough, coryza, or conjunctivitis. Observation of Koplik's spots is also diagnostic. It is important to consider and rule out other possible diagnoses that include parvovirus, dengue fever, Kawasaki disease, and scarlet fever. Laboratory confirmation is however strongly recommended."[citation needed]

4- Current article under "Treatment" section: “A systematic review of trials into its use found no reduction in overall mortality, but it did reduce mortality in children aged under two years.” This sentence will be modified to substantiate the existing information on Vitamin A under the subheading Medications in the “Treatment” portion of the article. This will be done by providing more details on the exact dosage of Vitamin A found to have reduced mortality in the pediatric population. We propose the following change: “A systematic review of trials into its use found no reduction in overall mortality, but two doses (200 000 IU) of Vitamin A was shown to reduce mortality for measles in children younger than two years of age.” Current article: “Some groups, like young children and the severely malnourished, are also given vitamin A, which act as an immunomodulator that boosts the antibody responses to measles and decreases the risk of serious complications.” This sentence will be modified to improve clarity and flow by specifying the indications for appropriate Vitamin A treatment. We propose the following change: “Diet deficiency is a common indication for Vitamin A treatment, and may be appropriate in populations such as young children and the severely malnourished.[citation needed] Vitamin A acts as an immunomodulator that boosts the antibody responses to measles and decreases the risk of serious complications.[citation needed]

5- Current Article under the "Epidemiology" section: "Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region." Suggested Changes: "In 2000, the WHO established the Global Measles and Rubella Laboratory Network (GMRLN) to provide laboratory surveillance for measles, rubella, and congenital rubella syndrome. Data from 2016-2018 show that the most frequently detected measles virus genotypes are decreasing, suggesting that increasing global population immunity has decreased the number of chains of transmission."[3]

6- We want to add two sentences under the section titled “society and culture” about the recent outbreaks in America that have resulted from the under-vaccination. These are the following sentences I would like to add: “Measles outbreaks have been on the rise in America, especially in communities with lower rates of vaccination. It is often introduced to a region by travelers from other countries and it typically spreads to those without who have not received their vaccination.”[4]

7-Current article under the "History" section: “To date, 21 strains of the measles virus have been identified.” The source that accompanies this statistic is a peer-reviewed article from May 1995. When referring to more recent, reliable sources, it has come to our attention that the World Health Organization in fact recognizes 23 measles genotypes. Therefore, the proposed change is oriented around rectifying this mistake. We also believe that there is value in elaborating on the various clades the World Health Organization recognizes. As a result, we propose adding the following sentences: “To date, the World Health Organization recognizes eight clades named A, B, C, D, E, F, G, and H. There have been 23 strains of the measles virus that have been identified and designated within these clades.”[citation needed]

  1. ^ "Surveillance Manual | Measles | Vaccine Preventable Diseases | CDC". www.cdc.gov. 23 May 2019.
  2. ^ Dimech, W; Mulders, MN (29 July 2016). "A review of testing used in seroprevalence studies on measles and rubella". Vaccine. 34 (35): 4119–4122. doi:10.1016/j.vaccine.2016.06.006. PMID 27340096.
  3. ^ Brown, KE; Rota, PA; Goodson, JL; Williams, D; Abernathy, E; Takeda, M; Mulders, MN (2019). "Genetic Characterization of Measles and Rubella Viruses Detected Through Global Measles and Rubella Elimination Surveillance, 2016–2018". MMWR Morb Mortal Wkly Rep (68): 587–591. doi:10.15585/mmwr.mm6826a3.
  4. ^ "Measles Cases and Outbreaks". Centers for Disease Control and Prevention. 12 November 2019.

IANOZORZ (talkcontribs) 02:04, 19 November 2019 (UTC)

Thank you for sharing all these improvements @IANOZORZ:@Miriammaes, Gracelin97, Raahulan05, Arushidotcom, GursharanS041, and Aburrows077: To help Wikipedians review these ideas to improve the article, can you please add in citations, preferably after every sentence you add. I added [citation needed] tags above as examples. Please feel free to delete them as you go! You can paste your PMIDS/DOIs into the citation tool as we did in class on the 11th to auto-populate the citation Wikipedia style. I am happy to help with this as well on the 25th in class. Thank you again! JenOttawa (talk) 02:12, 19 November 2019 (UTC)

Source for hospitalization rate[edit]

Under "prognosis" (first paragraph), the page says "About 1 in 4 individuals will be hospitalized and 1–2 in 1000 will die." I would be interested in a source on the hospitalization number, as it does not match what I am familiar with myself (which, to be honest, is just a single outbreak of several dozen cases). As the page is semi-protected, I can't add the [citation needed] myself, hence this comment. 2001:67C:2564:331:F9AB:882A:951C:8667 (talk) 21:02, 21 March 2020 (UTC)

E: And just after posting, I realized that the "1-2 in 1000 will die" does not match up with the stated frequency and death in the... what's it called, the info card at the top of the page, which gives a case fatality rate of about .36% if you simply divide the numbers by one another. So I suppose another [citation needed] there. 2001:67C:2564:331:F9AB:882A:951C:8667 (talk) 21:04, 21 March 2020 (UTC)

I updated the numbers regarding child deaths. The CDC summary was updated in 2018 and 2019 and now says one to three children will die. We'll have to review the others. MartinezMD (talk) 22:53, 21 March 2020 (UTC)

Europe[edit]

Why are there so much cases in europe in recent years? Are they imported with foreigners trying to get illegal into europe? — Preceding unsigned comment added by 88.72.81.251 (talk) 09:41, 30 March 2020 (UTC)