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Tag: encephalitis

  • Parents’ guide to measles: How to prevent infection

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    After being eliminated from the United States in 2000, measles is making a comeback — and not only in Season 1 of HBO’s popular drama, “The Pitt.” The cases are now numerous enough that the U.S. is on track to lose its measles-free status. 

    In 2025, the Centers for Disease Control and Prevention reported 2,267 confirmed measles cases, the most since 1991. So far this year, 588 cases have been confirmed, many stemming from a large, ongoing outbreak in South Carolina. But other states, including Florida, North Carolina and Utah, had also reported cases by late January. 

    For many parents of young kids, who are especially vulnerable to the virus, measles is a disease of the past — widespread vaccination made infections rare. It’s even new for some doctors, many of whom are encountering the first infections of their careers.

    But as cases pop up in communities nationwide, we thought it was time for a crash course on the virus and how to protect your family. 

    What are the symptoms of measles? 

    Measles is a highly contagious respiratory virus that causes a rash. Even milder cases that don’t require hospitalization are miserable, doctors told us.

    “This is not a trivial virus,” said Dr. William Schaffner, an infectious disease doctor at Vanderbilt University. “I would not wish measles on any child.”

    Symptoms typically appear one to two weeks after exposure. The first symptoms aren’t unusual — a cough, runny nose, fever, and red watery eyes. 

    A few days after symptoms start, tiny white spots, called Koplik spots, may appear on the inside of the mouth. Three to five days in, the measles rash’s flat, red spots will appear, starting on the face and moving down the body to the trunk and limbs. On darker skin tones, the spots can appear purple-ish or dark brown.  

    “The measles rash can look like other childhood rashes like scarlet fever, roseola and rubella,” said Dr. Peter Chin-Hong, an infectious disease doctor at the University of California, San Francisco. But the combination of cough, runny nose, and red eyes amid an outbreak of the disease “is kind of a clincher for measles.”

    Measles can cause high fevers, over 104 degrees Fahrenheit. Most people recover in around 10 days, but complications are possible. 

    A sign warning of measles is posted on a glass door as a patients wait in the family medicine wing of at the Texas Tech Physicians of the Permian Basin Monday, Feb. 24, 2025, in Odessa, Texas. (AP)

    What are complications from the measles?

    Beyond feeling sick and miserable, the most common complications are ear infections and diarrhea, which can lead to dehydration. 

    More severe complications are possible. According to the CDC, about 1 in 5 unvaccinated people who get measles in the U.S. requires hospitalization.

    Among children, about 1 in 20 who are infected will develop pneumonia, and about 1 in 1,000 experience swelling of the brain that can cause deafness and permanent disability. 

    Tragically, as many as 3 in 1,000 children will die from complications of the disease.

    An even rarer fatal complication is subacute sclerosing panencephalitis, which doesn’t appear until around 7 to 10 years after infection. This has no cure and causes a slow, progressive cognitive decline into a vegetative state and then death. 

    Certain groups are at especially high risk for complications: children under 5, adults older than 20, pregnant women, and people who have compromised immune systems. Most people fall into one of those groups.

    How is the measles spread? 

    Like many other respiratory viruses, measles is spread through coughing or sneezing. But it’s highly infectious. Of people who aren’t vaccinated or who haven’t had a previous infection, up to 90% will get sick after being exposed to someone with measles.

    And you can get it from someone you’ve never even met or seen. If a person with measles has been in a room, someone else can get infected from breathing the same air, up to two hours after the infected person has left.

    A person with measles is infectious four days before the rash appears and four days afterward, according to the CDC.

    Face masks and regular hand washing may provide some limited protection. Given how infectious measles is, “I would not want to rely on a mask or hand washing alone in order to reduce my chance of getting measles,” Schaffner said. 

    But you don’t need to lock yourself in the house. If you are living in an area with no reported cases of measles, “the likelihood of you having measles is close to zero,” said Dr. Aaron Milstone, a pediatric infectious disease doctor at Johns Hopkins University. The probability is even lower if you are vaccinated. 

    How is measles treated?

    There is no cure for measles. Doctors can provide supportive care and try to manage the symptoms — reduce fever, prevent dehydration, treat secondary bacterial infections — until the disease has run its course, but there is no treatment.

    For people who are deficient in vitamin A, taking supplements can reduce the risk of serious complications once they are sick. But there is no evidence that vitamin A prevents infection.

    “There’s nothing to do for kids with measles,” said Milstone. “It’s ‘cross your fingers and hope for the best.’ And, as a parent, that scares me.” 

    To prevent further spread, public health departments place unvaccinated people who have come into contact with an infected person under quarantine. Home quarantine lasts around three weeks. 

    Hundreds are currently quarantined in South Carolina thanks to the outbreak there. 

    Should I get vaccinated? 

    Doctors say yes. 

    Vaccination is the best way to protect yourself and your children from measles. 

    In the U.S., it is recommended that all children be vaccinated against measles with the MMR vaccine that also protects against mumps and rubella. The first dose is recommended at 12 to 15 months, and the second dose between 4 and 6 years. This recommendation didn’t change with the CDC’s recent updates to the childhood vaccine schedule. 

    Older children and adults who were not vaccinated as children can still get vaccinated with two doses at least 28 days apart. 

    Two doses of the MMR vaccine are about 97% effective at preventing measles, meaning if you are vaccinated, you are highly unlikely to be infected. Protection is usually lifelong.  

    Last year, 93% of all measles cases were among people who were unvaccinated or whose vaccination status was unknown. 

    Breakthrough infections among those who are fully vaccinated are still possible, and accounted for 4% of cases in 2025.

    Milstone advised adults to double-check what their vaccine status is, in case they only received one dose as a child. But for people who got two doses as a child, there is no need to get another shot as an adult, even if you are living in an area with an outbreak. 


    A vial of the measles, mumps and rubella vaccine is on display at the Lubbock Health Department, Feb. 26, 2025, in Lubbock, Texas. (AP)

    Does the vaccine have side effects? 

    The MMR vaccine uses a live but weakened version of the measles virus.

    There is a small risk of a slight fever and mild rash following vaccination. 

    “It’s not measles, but you know, this is a tamed virus, so on occasion, it can produce a very mild version of the illness,” said Schaffner.

    The MMR vaccine has long been a target of claims linking the vaccine to autism.

    Decades of epidemiological research have not demonstrated a link between autism and the MMR vaccine.

    The claim traces back to a 1998 paper by a British doctor who lost his medical license after his study was found to be — in the British medical journal BMJ’s words — an “elaborate fraud.”  

    Because it is a live virus, it cannot be administered to pregnant women or people who have compromised immune systems. 

    That means that kids who are already at the greatest risk of getting sick are those who can’t get protection. Schaffner said he believes healthy people have an obligation to their neighbors who cannot be immunized and are at risk of severe disease.

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  • Links Found That Tie Encephalitis to Potential Suicide Risks

    Links Found That Tie Encephalitis to Potential Suicide Risks

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    Feb. 23, 2023 – In 2017, during a year of study abroad in Paris, Michelle Cano Bravo began to have hallucinations, insomnia, and paranoia. She also had problems with her thinking skills – she would get lost frequently, even in places she knew. 

    “I had no idea what was happening,” the 25-year-old says. “I was like a dying dog under a house and just looked for solitude.” 

    During that period, Bravo, who today is a law student based in New York, tried to take her life twice. 

    After she returned to the U.S. in early 2018, she began to have more disturbing symptoms. Once, when visiting Times Square, “I thought the people on the big screens were talking to me,” she says.

    She panicked and couldn’t find her way to the subway. She doesn’t remember how she got home. But when she did, she collapsed, screaming that she was dying. She was rushed to the hospital, where she was admitted to the psychiatric unit.

    Days later, she was getting worse. She became unresponsive and comatose. Finally, she was diagnosed with encephalitis and multi-organ system failure. 

    Unfortunately, people with Bravo’s symptoms often are regarded as having a psychiatric illness rather than encephalitis, says Jesús Ramirez-Bermúdez, MD, PhD, of the National Institute of Neurology and Neurosurgery in Mexico City.

    Caring for patients with encephalitis, he says, is “challenging,” because the patients can have sudden and severe mental health disturbances. 

    “They are often misdiagnosed as having a primary psychiatric disorder, for instance schizophrenia or bipolar disorder, but they do not improve with the use of psychiatric medication or psychotherapy,” Ramirez-Bermudez says. Rather, the disease requires “specific treatments,” such as antiviral medications or immunotherapy. 

    What Is Encephalitis?

    Encephalitis is an inflammation of the brain caused either by an infection invading the brain (infectious encephalitis) or through the immune system attacking the brain in error (post-infectious or autoimmune encephalitis). 

    The disease can strike anyone at any age, and more than 250,000 people in the U.S. were diagnosed with it during the past decade. Worldwide, 500,000 people are affected by it annually.

    Unfortunately, about 77% of people don’t know what encephalitis is, and even some health care professionals don’t recognize that psychiatric symptoms can be signs of acute illness in encephalitis.

    Along with psychiatric symptoms, encephalitis can also include flu-like symptoms, fever, headache, sensitivity to light and/or sound, neck stiffness, weakness or partial paralysis in the limbs, double vision, and impaired speech or hearing.

    Suicidality in People With Encephalitis

    Between 2014 and 2021, Ramirez-Bermúdez and his colleagues studied 120 patients hospitalized in a neurologic treatment center in Mexico with anti-NMDA receptor encephalitis – a condition in which the antibodies produced by the person’s own body attack a receptor in the brain.

    This receptor is particularly important as part of the way the body signals itself and is required in several processes that lead to complex behaviors, he explains. Dysfunction in this receptor may lead to times when these processes are disturbed, which may result in psychosis.

    “In the last years, we observed that some patients with autoimmune encephalitis … had suicidal behavior, and a previous study conducted in China suggested that the problem of suicidal behavior is not infrequent in this population,” he says. 

    Ramirez-Bermúdez and his colleagues wanted to investigate how often patients have suicidal thoughts and behaviors, what neurological and psychiatric features might have to be related to suicidality, and what the outcome would be after receiving treatment for the encephalitis.

    All of the patients had brain imaging with an MRI, a lumbar puncture (spinal tap) to check for signs of infection in the brain or spinal cord, an electroencephalogram (EEG) to detect possible seizures or abnormal electrical brain activity, as well as interviews with the patient and family members to look at mental skills, mood, and suicidal thoughts. 

    Of the 120 patients, 15 had suicidal thoughts and/or behaviors. These patients had symptoms including delusions (for example, of being persecuted or of grandiosity), hallucinations, delirium, and being catatonic.

    After medical treatment that included immunotherapy, neurologic and psychiatric medications, rehabilitation, and psychotherapy, 14 of the 15 patients had remission from suicidal thoughts and behaviors. 

    Patients were followed after discharge from the hospital between 1 year and almost 9 years, and remained free of suicidality.

    “The good news is that, in most cases, the suicidal thoughts and behaviors, as well as the features of psychotic depression, improve significantly with the specific immunological therapy,” Ramirez-Bermúdez says. .

    Fighting Stigma, Breaking the Taboo

    Study co-author Ava Easton, PhD, chief executive of the Encephalitis Society, says that encephalitis-related mental health issues, thoughts of self-injury, and suicidal behaviors “may occur for a number of reasons. And stigma around talking about mental health can be a real barrier to speaking up about symptoms – but it is an important barrier to overcome.”

    Easton, an honorary fellow at the University of Liverpool in the United Kingdom, says their study “provides a platform on which to break the taboo, show tangible links which are based on data between suicide and encephalitis, and call for more awareness of the risk of mental health issues during and after encephalitis.”

    Ramirez-Bermúdez agrees. There are “many cultural problems in the conventional approach to mental health problems, including prejudices, fear, myths, stigma, and discrimination,” he says. “This is present in popular culture but also within the culture of medicine and psychology.”

    Bravo, the law student who dealt with encephalitis and its mental effects, told no one about her thoughts of suicide.

     “It was cultural,” she says. 

    Even though her mother is a doctor, she was afraid to share her suicidality with her. In her South American family, “the subject of mental illness isn’t a fun topic to talk about. And the message is, ‘if you’re thinking about killing yourself, you’ll end up in an asylum.’”

    Unfortunately, these attitudes add to a “delay in the recognition” of the diagnosis, Ramirez-Bermúdez says.  

    After treatment and as the acute disease lifted, Bravo slowly regained day-to-day function. But even now, more than 5 years later, she continues to struggle with some symptoms related to her mental skills, as well as depression – although she’s in law school and managing to keep up with her assignments. She’s not actively suicidal but continues to have fleeting moments of feeling it would be preferable not to live anymore. 

    On the other hand, Bravo sees a psychotherapist and finds therapy to be helpful, because “therapy refocuses and recontextualizes everything.” Her therapist reminds her that things could be a lot worse. “And she reminds me that just my being here is a testament to the will to live.” 

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