DEAR DR. ROACH: With the resurgence of measles because of declining vaccination rates, should we be wary of the same happening with smallpox (which was also thought to have been eradicated)? And as an aside, is my ancient smallpox vaccination of 1952 still protecting me? What about my equally ancient (circa 1962) polio vaccine? — C.C.

ANSWER: At the time of this writing, the 2024-2025 measles outbreak is the largest in a few years and the first to include measles deaths in 10 years. Measles was declared eliminated in 2000 from the United States, meaning that cases of measles in the U.S. came from another country. With a high degree of vaccine coverage (95% or greater), measles is unlikely to spread in the U.S.

Unfortunately, the current outbreak is mostly spreading in people who have not been vaccinated. All children and adults who are not vaccinated should get vaccinated unless there is a clear medical reason not to (which is not common).

Smallpox is different. There is no more worldwide wild smallpox since 1977, and as best as we know, the virus only exists in locked containers at the Centers for Disease Control and Prevention in Atlanta and at VECTOR in Koltsovo, Russia. Any case of smallpox at this point would have to be considered as a possible bioterrorism attack.

Unfortunately, your vaccine from the 1950s, like mine from the 1960s, cannot be considered effective. In the unlikely event of a smallpox case being confirmed, a response would need to be coordinated by local and national health authorities, including treatment and vaccination through the Strategic National Stockpile. Smallpox vaccines work very quickly to protect people.

People who received a complete course of poliovirus vaccination (even 70 years or so ago) do not need a booster unless they are traveling to an area with poliovirus transmission.

The management of potential outbreaks requires a dedicated, well-trained and experienced team of clinicians, scientists, and public health experts.

DEAR DR. ROACH: I am a breast cancer survivor whose cancer was 100% estrogen-responsive. I have completed five years of the recommended treatment. My current problem is extreme itching in the vaginal area, which I suspect is a result of the years of estrogen blockers that I had to take.

Is there any topical product that would relieve the discomfort without putting me at risk for a return of the cancer? — Anon.

ANSWER: I recommend you start with a vaginal moisturizer, which is nonhormonal and will not increase your cancer risk at all. There are many different brands, and those that have hyaluronic acid as an ingredient are preferred by many women. But you should try a few different brands to see if one works well for you. One study found improvement with nonhormonal treatment in 90% of women who had treatment-related vaginal discomfort.

If nonhormonal treatment isn’t effective, then low-dose vaginal estrogen is recommended by some oncologists, as there are limited data to support its safety. However, its safety is not guaranteed, and there may be some risk. I never prescribe these without a thorough discussion with the patient and the patient’s oncologist about the potential risk.

Although blood estrogen levels are only minimally higher when using low-dose vaginal estrogen, estrogen levels may be temporarily but significantly higher when first using these products. This is due to the thin lining of the vulva and vagina, and estrogen is better absorbed when there is a healthy lining.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.