Q. Our 18-year-old son is going to the University of Maryland and we're concerned about the outbreaks of measles on college campuses. Are there any steps we should take to ensure his health?
A. Nowadays, most cases of measles occur among young adults in college or traveling abroad. Make sure your son is adequately vaccinated, and he shouldn't have any trouble. However, measles vaccination isn't as simple as it may seem. Several situations may mean your son needs a vaccination now: No prior measles vaccination; Previous vaccination with the inactivated measles vaccine; Vaccination before 12 months of age; Live measles vaccination whose effectiveness has "worn off."
To begin with, check your son's immunization record. If in doubt about whether he was immunized against measles and there has been a measles outbreak on campus, it's best for him to be safe and get a measles shot. People born before 1957, however, are generally immune because of previous infection, which in some cases may not have been apparent and gone unrecognized.
The so-called inactivated vaccine, in general use between 1963 and 1967, didn't produce the same high degree of immunity against measles that the current live vaccine does. In some cases, people who had gotten the inactivated vaccine later came down with a severe form of the disease called atypical measles. So if your son received the inactivated vaccine, he should be vaccinated again.
Until 1977, most children got their measles shot around 12 months of age. Scientists then discovered that the shot's protection was better if given at age 15 months, the currently recommended age for measles immunization. People born after 1956 who were vaccinated before 12 months of age should get another shot.
There's disagreement about whether people who received their measles vaccination between 12 and 15 months should have another one. In most cases, this is unnecessary. But if this applies to your son and he's attending a school where there has been a measles outbreak, you might want to ask your doctor about revaccination.
The current measles vaccine is 95 percent effective, so it's very rare for someone who received live measles vaccination after 15 months of age to come down with the disease. People who fall into this category don't need a booster shot or need to worry much about getting measles.
Q. Every so often I find a tick on my dog after he returns from his romp in the woods. I know ticks can carry disease, and I'm concerned about my family being exposed to them. I've heard of different ways to remove ticks if you ever find one on yourself, but what's the preferred method?
A. Ticks can carry a number of diseases, but it's fairly uncommon for ticks to pass them on to people.
Many health professionals say you should never pull a tick off once it's attached to the skin. A recent study of tick removal techniques published in the June issue of Pediatrics challenges that teaching and some of the popular methods used to coax ticks into letting go.
The idea of pulling ticks off got a bad name because it was thought that the tick's mouth parts -- which the tick uses to attach itself to the skin and feed -- would be left behind and lead to infection. So other methods, designed to make the tick back out on its own, became popular. These include coating the tick with petroleum jelly or nail polish, dousing it with rubbing alcohol, or burning it with a hot match tip or heated tweezers.
At least in this study, these methods didn't work very well. Instead, simple, steady tugging at the tick using tweezers or protected fingers was uniformly successful. It's important, however, not to crush, twist or jerk the tick, or incomplete removal may result.
Other points to keep in mind when removing ticks are: Use tweezers or protect your fingers with rubber gloves, or, at the very least, a paper towel; Grasp the tick as close to the skin surface as possible and pull with a steady force; Dispose of the tick by flushing it down a drain or wadding it in adhesive tape before throwing it in the trash; Wash your hands and the site of the tick bite thoroughly with soap and water; Even if a small remnant is left behind, in most cases there is no cause for alarm; Call your doctor if a rash or fever develops.
Q. I take a diuretic for high blood pressure, which is under good control. I would like to try going without the medication to see if it continues to stay down; however, I've been told that once medication is needed, it will always be needed. Is there any truth to this?
For the most part, you should expect to take high blood pressure medicine for the rest of your life. But I won't deny that some people are able to successfully cut back on their medicine or stop entirely.
You may be able to lower your blood pressure by a low-sodium diet, weight loss and exercise. Even without those techniques, some people who have taken large does of several blood pressure medicines for years have been able to lower the dosage or eliminate one or more of the drugs.
Occasionally, changes in the circulatory system will reduce your blood pressure or the need for medication. In some people, for example, this happens after a heart attack.
If your blood pressure is well below 140/90, you could talk to your doctor about a trial period without medication. But chances are you'll prove to yourself the need for taking your blood pressure medicine.