New data shows a deadly measles complication is more common than thought

New data shows a deadly measles complication is more common than thought

NEW ORLEANS — A complication of measles that kills children years after they have been infected is more common than previously thought, according to disturbing data released Friday.  The complication is a neurological disorder that can lie dormant for years and then is 100 percent fatal. Researchers don't know what causes the virus to reactivate, and there is no cure once it does. The only way to prevent the disorder is by vaccinating everyone possible against measles.  The first MMR dose is typically administered at 12 to 15 months of age. (Babies may be vaccinated at age 6 months or older if they are at risk of exposure to measles, for instance if they are traveling to an area with an outbreak.) Unvaccinated babies can be infected with measles and later develop this complication, which is called subacute sclerosing panencephalitis, or SSPE.  “This is really frightening and we need to see that everyone gets vaccinated,” James Cherry, a study author and expert on pediatrics and infectious diseases at UCLA's medical school, said at a press conference Friday. He said the findings suggest that other cases of SSPE are likely occurring and being missed. Many parents who intentionally refuse to vaccinate their children believe "they are trying to do the right thing," said Gary Marshall, a pediatrics professor at the University of Louisville School of Medicine in Kentucky. "Unfortunately, they're mistaken. The right thing to do to protect their children is to vaccinate them to prevent them from getting measles and getting a horrible complication." In 2014, the United States experienced a record 667 cases of measles, the largest number since the disease's elimination here, according to the Centers for Disease Control and Prevention. One major outbreak occurred primarily among unvaccinated Amish communities in Ohio.   Vaccinating a very high proportion of the population — typically about 90 percent regardless of the disease — ensures herd immunity, which means those who can't be inoculated are still protected because the disease is less likely to spread. The MMR vaccine isn't recommended until after a first birthday because children retain some of their mother's antibodies until that age, making the vaccine less effective, experts say. Others who can't get vaccinated include people with immune system disorders. The researchers analyzed cases of California children who got measles between 1998 and 2015, finding that 1 in 1,387 were younger than 5 when they were infected. They identified 17 cases of SSPE during that period, all of whom had measles before being vaccinated. All but one of those patients have died. A 5-year-old boy, who was infected during travel to Germany, is now in hospice, unable to move or respond to commands, researchers said. The average age of SSPE diagnosis was 12, but the range was from 3 to 35 years. Many of the patients had ongoing cognitive or movement problems before they were definitively diagnosed. SSPE typically progresses in stages. Initially, the signs are subtle, starting with behavioral problems, Cherry said. Then seizures develop until the person becomes comatose. An additional suprising finding is that Asians are disproportionately affected by SSPE, Cherry said. He is not sure why but suspects the disorder could behave like some other diseases, such as influenza, which seem to hit Asians harder and cause higher mortality than other ethnic groups. Measles infection causes fever, runny nose, cough, red eyes, sore throat and rash. The virus spreads throughout the body and is usually cleared within 14 days. In rare cases, the virus spreads to the brain but then becomes dormant. Eventually, that can lead to SSPE and result in death. Among other severe complications of measles, as many as 1 of every 20 children will develop pneumonia — actually the most common cause of death from measles in young children. And about 1 of every 1,000 children will develop encephalitis, or swelling of the brain, that can lead to convulsions and can leave the child deaf or with intellectual disability. Because there is a 5 percent failure rate with the MMR vaccine, a second dose is given to children before they begin school. Measles is so contagious that 95 percent of people need to be vaccinated with two doses to protect those who aren't, experts say. That means all who are eligible, including adults who haven't been previously vaccinated, should receive two doses of the vaccine. Nearly 92 percent of U.S. children 19 to 35 months old have received the MMR vaccine, according to the CDC. Through Oct. 8, 54 people from 16 states were reported to have measles this year.

Why measles could be worse for West Africa than Ebola

As the unprecedented Ebola outbreak slowly fades in West Africa, it has left plenty of other public health worries in its wake. One of the biggest threats: measles. The massive disruptions Ebola caused to the health-care systems in Liberia, Guinea and Sierra Leone led to a significant drop in the number of children getting vaccinated for a range of diseases, including whooping cough and polio. In a study published Thursday in the journal Science, a group of researchers has calculated the potential fallout in the region if there was a measles outbreak. The measles virus is highly contagious and has surfaced in the wake of other humanitarian crises.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico "It's so transmissible, and it's one of the first diseases you often see when there are crises leading to reductions in the vaccination rates," Justin Lessler, an assistant epidemiology professor at the Johns Hopkins Bloomberg School of Public Health and the study's lead author, said in an interview. Lessler and his colleagues used data-backed mathematical models to simulate how quickly a measles outbreak could spread through vulnerable West African populations. Before the Ebola epidemic, they estimated, the region had about 778,000 children between 9 months and 5 years old who had not received a measles vaccine. Eighteen months after the Ebola outbreak began, there could be more than 1.1 million unvaccinated children — an increase of 45 percent. The researchers found that a large measles outbreak could affect 100,000 more people in West Africa than it might have before the Ebola outbreak, or more than 200,000 overall, with most of the victims being young children. They estimated that such a catastrophe could cause 2,000 to 16,000 deaths. By contrast, the Ebola outbreak, which triggered a slow but massive global response last year, officially has led to 24,247 confirmed or suspected cases and 9,961 deaths, according to the latest figures from the World Health Organization.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Lessler acknowledged that the measles estimates in the Science study amount to an educated guess. As with Ebola, it's nearly impossible to predict whether a measles outbreak will happen, whether it would originate in crowded cities or rural countrysides, and how long it might last. In addition, he said researchers initially assumed in their models that 75 percent fewer children in West Africa were receiving vaccines as a result of the Ebola epidemic. That figure was in line with the best information available at the time, he said, but that "new information indicates that was probably a touch pessimistic." The actual drop in vaccination rates appears to be between 25 and 50 percent, Lessler said. But even that less ominous scenario "still translates to tens of thousands of additional cases," he said. The threat isn't merely hypothetical. Lessler noted that a measles outbreak from 2010 to 2013  in the Democratic Republic of Congo — a country long plagued by political instability and civil unrest — led to nearly 300,000 cases and more than 5,000 deaths, many of them children under 5. Measles accounted for scores of childhood deaths during a famine in Ethiopia in 2000.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Mit Philips, a health policy analyst for the international aid group Doctors Without Borders, said Liberia has reported 180 suspected measles cases this year, and it's likely that here are cases that haven't been reported because of overburdened or nonexistent disease surveillance systems in the region. "We don't have a full assessment of the situation," Philips, who recently returned from West Africa, said in an interview from Belgium. "But here's an indication that there's something going on." Beyond the obvious suffering Ebola has inflicted on the region, the epidemic also created a less obvious but no less tragic crisis. The outbreak destroyed the already fragile health-care systems in West Africa, shutting down hospitals and clinics and leaving entire populations without access to routine medical care. The result was people dying of otherwise treatable or preventable conditions such as pneumonia, malaria, diabetes and strokes. Victims of heart attacks or those injured in car or bike accidents often had nowhere to turn. "If you broke a leg and you needed surgery, sorry," Sister Barbara Brillant, national coordinator of the Liberian Catholic Church's health council, told a Post reporter in September. "If you had appendicitis and needed surgery, sorry. It's not available."    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Pregnant women have been particularly vulnerable. Even as more hospitals and clinics have reopened, Philips said she witnessed cases of women not being admitted unless they first tested negative for Ebola. Health workers, traumatized by the risk of infection and the deaths of their colleagues, remain reluctant to participate in procedures involving a lot of blood, such as C-sections and other surgeries. "It's a huge challenge," Philips said. Doctors Without Borders and other aid groups, along with ministries of health in each country and outside agencies such as the WHO and the Centers for Disease Control and Prevention, have been working to help reopen medical facilities and supply them with protective gear, basic medications and trained staff. Officials also are meeting to discuss the feasibility of national vaccination campaigns, something the authors of Thursday's Science paper say is needed as soon as possible to combat a potential measles outbreak. Philips said worries remain about the lack of reliable surveillance efforts for a range of other diseases, including meningitis, cholera, yellow fever and Lassa fever. While cases of those disease likely exist in the region, she said, officials worry they might not be able to spot an outbreak quickly. Lessler, the Hopkins researcher, agreed that Ebola left behind a long list of public health problems. But he said finding a way to vaccinate as many West African children as possible against measles could help prevent one major risk. "Measles is not the only health threat that's been made worse by the Ebola crisis. It may not even be the worst," he said. "But it's certainly one we can do something about."

The Disneyland measles outbreak and the disgraced doctor who whipped up vaccination fear

Officials from Mexico to California are now scrambling to contain an outbreak that began at Disneyland but has now spilled across state lines, infecting dozens, many of whom never received the measles-mumps-rubella vaccine (MMR).         Wakefield had what he needed to publish a study. It was based on 12 kids. And it broadcast concern that MMR could cause a bowel disorder and autism. Nine of the immunized children were found to be autistic. “If there is a causal link between measles, mumps, and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988,” he wrote. The news rocketed across the globe; the media ran hot with the story. “A controversial study has suggested that autism may be a side effect of immunization against measles, mumps and rubella,” New Scientist reported weeks later.     Under such circumstances, most doctors would retreat into obscurity. But not Wakefield. He still believes in the mission, attracting scores of supplicants. Even today, he fiercely defends his campaign against vaccines and has found a sympathetic community in his adopted state of Texas. Asked in 2011 by the New York Times if he still believed MMR had caused the autism in his now discredited paper, he was unequivocal. “Is that a serious question?” he asked. “Yes, I do still think MMR was causing it.”

Here’s how many Americans are actually anti-vaxxers

Polling has suggested as many as three in 10 Americans think that vaccines should not generally be mandatory. And while that's a key political question, it doesn't really get at the heart of the matter: just how many Americans are so-called "anti-vaxxers," i.e. think vaccines are actually harmful.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The answer, at least when it comes to the measles vaccine, is 9 percent, according to a new poll. The survey from the Pew Research Center shows 83 percent of Americans think the measles vaccine is safe, while 9 percent think it's not. Another 7 percent are not sure.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico As with the vaccine choice question, these anti-vaxxers skew toward younger and less-educated Americans, along with racial minorities. Contrary to some conventional wisdom, though, they disproportionately come from places other than the West, where 90 percent see the vaccine as safe. The poll also shows more Democrats (9 percent) and independents (10 percent) say the measles vaccine isn't safe than Republicans who say the same (5 percent). These differences are well within the margin of error, but the aforementioned Pew poll showed Republicans were more likely than Democrats to say vaccines should be a matter of choice. Of course, practically speaking, vaccine skeptics carry more weight than the 9 percent suggests. That's because, among people who are actually parents of minors, the number is slightly higher: 13 percent. In fact, only 80 percent of such parents are sure that the measles vaccine is safe. Which could say a lot about why we find ourselves in the situation we do.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Of course, with all of this, you need to keep in mind that skepticism about other vaccines could be different. The measles vaccine, though, is the one erroneously linked to autism in a now-discredited 1990s study.

Why younger Americans are much more likely to say vaccination should be a choice

Since the measles outbreak in the United States is only getting worse, and since most of the people who get measles have not been vaccinated, much of the discussion surrounding this outbreak has focused on parents who do not vaccinate their children. The argument has been framed as one of parental choice, as New Jersey Gov. Chris Christie (R) put it in comments he quickly walked back on Monday.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico All of which raises the question: How do Americans actually feel about vaccinations and whether parents should have a choice in the matter? The answer, it turns out, is that most Americans believe vaccinations should be mandatory, but you are significantly more likely to feel that way if you actually lived through a time when measles were a widespread danger, rather than a resurgent threat.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico A report from the Pew Research Center last week showed that about seven in 10 Americans feel that parents should have to vaccinate their children. On Monday, Pew released additional figures, showing the breakdown by age group.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It turns out that people between the ages of 18 and 29 are more likely than the American public to think parents should get to decide what to do with vaccinations. Four out of 10 Americans in this age group feel that way (41 percent), compared to three out of 10 Americans nationally (30 percent). This gulf is even more pronounced if you compare it with older generations. Americans older than age 50 are about half as likely as millennials to say that parents should get to decide whether to vaccinate their kids, with just a fifth of those Americans expressing that view (23 percent of those age 50 to 64 and 20 percent of anyone older than that). The likeliest explanation here is simply that people are speaking to their experiences. A 29-year-old would have been entering high school when measles were eliminated in the United States and may have never met anyone who has contracted the disease; a 65-year-old was about to enter high school when the measles vaccination became widespread in 1963. It is also important to remember that until this vaccination became routine that year, between 3 million and 4 million people were infected every year, and between 400 and 500 of those people died, according to the Centers for Disease Control and Prevention. The disease was deemed eliminated in 2000, and since that time most years have seen measles cases that numbered in the dozens (until outbreaks last year and this year).    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Meanwhile, the Pew numbers also helpfully fact-check what seems to have become a misconception surrounding the ongoing anti-vaccination movement — that its proponents are all upper-class, well-off people. Pew reported almost no difference in opinion between people with college degrees and those without, as well as similar viewpoints from those making under $30,000 a year and those making more than $75,000 annually.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The breakdown is below:

Chart: New measles cases skyrocketed in January

Data released Monday from the Centers for Disease Control shows 102 confirmed new measles cases in the month of January this year. That's far and away a monthly record for the years since 2000, when the disease was officially declared eradicated. The majority of cases stem from an outbreak at Disneyland in California.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico To put it another way, we've had about twice as many new measles cases in the past 31 days as we did in all of 2012. Last year was a record year for measles, with 644 new cases confirmed in 2014 \-- the highest in decades. If the California outbreak continues to spread, this year's totals could end up much higher.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico From a public health standpoint, policymakers are in something of a bind. The impulse is to urge parents to vaccinate their children, as President Obama recently did. But when politicians get involved, the danger is that a public health issue becomes a political one. On Monday morning, New Jersey Gov. Chris Christie tried to set himself apart from Obama's position by calling for "balance" on the vaccine debate, only to hastily walk back his statements hours later.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It's nigh impossible to change hearts and minds on vaccines; a recent study found that presenting vaccine skeptics with facts only reinforced their views. Over at The Upshot, political scientist Brendan Nyhan warns that "news articles focusing on an extreme and unrepresentative group of anti-vaccine parents and celebrities may cause others to wrongly infer that their views are mainstream." In reality, their numbers are small -- in California, for instance, only about 2.5 percent of kindergartners hold "personal belief exemptions" that allow them to opt out of state vaccine requirements.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Large outbreaks and big infection numbers, like what we're seeing in California, may scare some skeptical parents into holding their nose and getting their kids the required shots. Reporting out of California from my colleague Todd Frankel suggests this may already be happening.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

There’s a surprisingly simple way to convince vaccine skeptics to reconsider

Here is a depressing fact about facts: In the face of beliefs, they often have little power. Fixing falsehoods — whether it's the closely held conviction of a birther or an anti-vaxxer — doesn't tend to work nearly as well as it seems it should. But maybe we're going about the business of changing people's minds all wrong. A new study found that while it may be tempting to lecture someone that they're just wrong about vaccines and autism, it may be more powerful to simply tell and show them exactly what it's like when a child gets sick from a disease that could have been prevented.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The idea that vaccines are linked to autism risk was born in a study that has been retracted, called "utterly false" by the editor of the journal that published it and refuted many times over by other studies. Nevertheless, the idea continues to seed anxiety among parents. As the number of parents who refuse vaccines has increased, so too have the number of cases of measles. Measles, once declared "eliminated" in the U.S., with 60 cases per year, on average, between 2001 and 2010 has roared back, with 644 cases last year.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In a study published Monday in the Proceedings of the National Academy of Sciences, psychology researchers have found that a more effective way to persuade parents to change their attitudes about vaccinations is not to tell them they're wrong; It's to introduce new facts. A group of 315 people were split into three groups after their baseline feelings about vaccinations were assessed. One group received a parent's description of what it was like to have a child with measles, warnings about the importance of vaccination, and photos of a child covered with measles and rubella rashes, or a young boy's face horribly swollen by mumps. Another group received information about the absence of a link between vaccines and autism. A third group read about an unrelated scientific topic. "It was grounded in an old idea from economics, 'expected utility,' in which you weigh the positive and the negative," said Zach Horne, a graduate student in psychology at the University of Illinois at Urbana-Champaign. "What’s going on with anti-vaccination parents, we think, is because they haven’t seen kids with measles and mumps, those consequences aren’t that real to them. And the other consequence, the purported link between vaccination and autism, is." Horne and colleagues found that trying to tear down the original belief with facts was ineffective. The people who received the latest scientific research about the absence of a link between autism and vaccines changed their attitudes about vaccines about as much as the group that just got some random, unrelated reading material. But those who reviewed the family stories, photos, and a public health warning felt more positive toward vaccines. Those changes were biggest in people that were skeptical of vaccines at the start. That's a hopeful result, because a depressing study published in the journal Pediatrics last year found that none of these individual pieces of information alone worked against closely held beliefs. Giving parents correct information about vaccine risk, showing photos of children sick with preventable diseases, or providing information about what the diseases individually did not work — and even backfired. Those people who were most concerned about the safety of vaccines were less likely to vaccinate their children when given a dose of correct information.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Brendan Nyhan, an assistant professor of government at Dartmouth College, who did the Pediatrics study, said in an e-mail that the new work was encouraging, but that future research should focus on what the differences were between the two studies that led to such different results. Understanding the conflicting findings might help shape an even more effective education campaign for parents making health care decisions for their children. This study alone isn't enough to change policy, but it does suggest that perhaps public health officials may not have been thinking enough about how to present information about disease risks and vaccine risks. Horne said that he began doing Google searches for the images he used in the study to see how easily accessible the information was on the Web site of the Centers for Disease Control and Prevention. It was surprisingly hard to track down, he said, requiring multiple clicks — whereas lists of reasons to refuse vaccines popped up right away. "I think there are immediate steps we could take; we could make it more easy to access this information and put it on a single page that would hopefully become a top hit when you're Googling," Horne said. "The thing with these parents is they are ultimately interested in the health of their child. They just have incorrect beliefs of where the risks are, and their bet is on the wrong horse." Making disease risk information more prominent and accessible might be one way to make the correct information more persuasive.

Young Americans are the only Americans who really doubt vaccine safety

The recent debate surrounding vaccinations in the United States has drawn a lot of attention to the people who are against vaccinations. Who are these people, exactly? Well, it turns out they are young Americans who only really know a country where measles almost never occurred (until last year). Americans are largely in agreement that the measles vaccination is safe. The Pew Research Center released numbers  Monday showing that 83 percent of Americans feel this way, with just 9 percent of people saying they felt the vaccination is unsafe. (Another 7 percent said they just don’t know.) When you break it down by age group, though, you find out a little more about who, exactly, makes up the 9 percent category. Pew reported that Americans age 18 to 29 are significantly more likely than their parents and grandparents to say that vaccinations are not safe. Fifteen percent of younger Americans in this age bracket say they think the vaccinations are unsafe, more than double the number of Americans ages 50 or older. This isn’t a galloping shock. As we noted last week (when Pew released different numbers), millennials are also much more likely than older generations to think vaccination should be a choice. This comes from experience, or lack thereof; measles used to be a widespread problem in this country, infecting millions of Americans (between 400 and 500 of whom died) each year until the early 1960s. That is when the vaccination became widespread.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico This vaccine was so successful that by 2000, measles was deemed eliminated in the United States. In the years that followed, measles was barely a blip on the public-health radar; in any given year, there were between 37 and 220 cases, though the number mostly stayed in the double-digits. The situation changed last year, when there were 644 cases.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In other words, if you just turned 65, you reached your teenage years knowing how severe measles could be. If you just turned 29, you became a teenager when the disease was so rare it was declared eliminated. And over the last half- century, older Americans have seen the dramatic shift in measles contraction in this country. They have seen their children and grandchildren get vaccinated, and they have seen the disease recede. Meanwhile, over the last 15 years, younger Americans have heard from celebrities and other voices questioning a vaccination that, to them, attacks a problem they never really had reason to understand.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Meanwhile, the Centers for Disease Control and Prevention reported Monday that the outbreak has now spread to three additional states. There are currently 121 known cases in 17 states and the District of Columbia.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Related:**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Everything you need to know about measles**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Parents skip vaccinations for many reasons**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Five infants in Chicago area diagnosed with measles**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

As measles cases increase, a sharp call for vaccinations

EVEN WHEN there are significant gains against infectious diseases, there can be reversals. In 2000, measles was considered all but eliminated in the United States. For a while, there were only about 60 cases a year, mostly brought in from overseas. Now, the number of cases and outbreaks in the United States is rising again. The Centers for Disease Control and Prevention reported Thursday that there have already been more cases this year, 288, than in any full year this century. Measles is a highly infectious respiratory disease caused by a virus that affects young children, with fever, runny nose, cough and a distinctive rash. Infrequently, it leads to more serious complications. There have been no deaths in the United States for a while, but in 2012 measles caused an estimated 122,000 deaths worldwide. That’s far fewer than in the past, thanks to a global campaign to vaccinate more than a billion children in high-risk countries. In the United States, a vigorous effort at immunization in recent years brought measles almost to a standstill. After an epidemic from 1989 to 1991 resulted in 55,000 cases and more than 100 deaths, largely because of lack of immunization among poor and uninsured children, a federal program approved in 1994, Vaccines for Children, resulted in much wider coverage. More than 90 percent of the children in the United States are immunized. Most of the recent measles cases in the United States arrived with travelers. For example, California reported 58 cases from January through April 18 this year, the highest number for that period in 19 years. According to the CDC, 93 percent of the California cases are linked to importation of the disease. The Philippines has seen an ongoing outbreak. Sometimes a single traveler can ignite a wildfire of infections. In 2013, a 17-year-old who had not been vaccinated returned to an orthodox Jewish community in Brooklyn from the United Kingdom, leading to an outbreak that affected 58 people; most were in three extended families that had declined the measles vaccine. This year, an outbreak in Ohio has reached 68 cases, apparently sparked by Amish missionaries, unvaccinated, who had visited the Philippines. The measles vaccine has been in use for half a century and is safe, inexpensive and effective. Some parents suspicious of vaccines have decided against immunization; in other cases, people are simply ignorant of the risks of inaction. Not all 50 states have the toughest immunization laws and standards. Thus, in some vulnerable pockets of the United States, a single person can touch off an outbreak. A nation’s borders provide no ironclad defense against viruses and bacteria. But measles can be stopped with comprehensive and proper immunization. **Read more about this issue:** Seth Mnookin: An early cure for parents’ vaccine panic Michael Gerson: The enduring benefits of vaccination Michael Gerson: Global vaccine efforts offer hope to millions Alexandra Petri: The one problem with that Jenny McCarthy Twitter backlash

Why measles should be the thing that freaks politicians out

_This post has been updated._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Gov. Chris Christie's (R-N.J.) declaration on Monday that vaccinations against diseases like measles should incorporate a "balance" of parental concerns with public health recommendations met with a quick, often derisive response. It's easy to see why.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico "Not every vaccine is created equal," Christie said, "and not every disease type is as great a public health threat as others." In short order, that comment was contrasted with Christie's forceful response to a possible Ebola case in his state. In that case, Christie mandated that Kaci Hickox be quarantined against her will -- suggesting that Christie feels that Ebola is a greater public health threat than the measles.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In West Africa, that's been true. In the United States, it has not, by a wide margin. According to data from the Centers for Disease Control, there were four cases of Ebola diagnosed in the United States last year. In contrast, there were 644 cases of measles. This year, a measles outbreak at Disneyland has pushed the number of cases in the country up quickly -- but no one else has contracted Ebola.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico We've noted that one of the Ebola cases diagnosed in the U.S. died -- the first man to receive the diagnosis. Measles is less deadly than Ebola, but still deadly. In about two of 1,000 cases among children, the patient dies. Others suffer from less severe complications.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico But the most salient comparison between the two is that measles, unlike Ebola, can largely be prevented through the use of vaccinations. Ebola transmissions can be kept in check through quarantines, yes, but measles was eradicated in the United States in 2000 thanks to the use of vaccinations and education programs. Now, in part thanks to parents opting to ignore public health advice, it's back.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _Update:_ A spokesperson for Christie issued a statement stating, in part, that "with a disease like measles there is no question kids should be vaccinated."    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico We've also updated the graphic to include data from the last three days of January. **RELATED** : **‘Get your kids vaccinated,’ Obama tells parents doubting ‘indisputable’ science**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Amid growing vaccination debate, measles continues to spread and is now in New York state**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **The Disneyland measles outbreak and the disgraced doctor who whipped up vaccination fear**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Anti-vaccine doctor revels in his notoriety**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Why this baby’s mom is so angry at the anti-vaxxers**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

‘No room for doubt’: New science proves Zika causes microcephaly

In a report released Thursday, researchers from Brazil and Britain studied babies born this year in the heart of the epidemic in northeastern Brazil. They compared 32 babies born with microcephaly to 62 babies born around the same time in the same hospitals who did not have the severe birth defect. Compared to babies without microcephaly, a condition characterized by an abnormally small head, the babies with microcephaly were 55 times more likely to have been infected with Zika in utero. The report was published in the journal Lancet Infectious Diseases.  But the latest data come from a case control study, where scientists try to match a baby with an abnormality to a baby with similar characteristics but no abnormality to find the differences that could explain the birth defect. “Although there is a strong scientific consensus that Zika virus is a cause of microcephaly, the early findings from this case control study are the missing pieces in the jigsaw in terms of proving the link,” said Laura Rodrigues, an infectious disease expert at the London School of Hygiene & Tropical Medicine and an author of the study. The report is a preliminary analysis. The full study, which will include 200 babies with microcephaly and 400 without, will help quantify the risk more precisely and provide more information about other potential factors, the researchers said. Still, the early findings are striking, said Andrew Pavia, a pediatric infectious disease specialist at the University of Utah who was not involved in the research. He likened the search for a causal link to hunting a murder suspect. “The evidence was very strong before this, enough to get a conviction out of most juries,” he said about Zika and microcephaly. “Now they have essentially found the gun in the defendant’s glove compartment. There is overwhelming evidence and there is really no room for doubt.” The study included 32 infants born with microcephaly between January and May 2016 at eight hospitals in Recife, Brazil, and 62 babies without microcephaly born the following morning. The mothers in both groups had similar characteristics. Most mothers had Zika virus infections. Although many mothers also had other infections, such as dengue, those infections weren't associated with microcephaly in the study, and there was no significant difference between the mothers of the two groups. Researchers found that about half of the babies with microcephaly had laboratory-confirmed Zika infections in their blood or spinal fluid. By comparison, none of the babies in the healthy control group tested positive for Zika. The study was requested by the Health Ministry in Brazil, which has more than 1,800 confirmed cases of Zika-related microcephaly. As a result of the findings, Zika virus should be officially added to the list of congenital infections alongside others such as syphilis, rubella and cytomegalovirus, said Thália Velho Barreto de Araújo, an expert at the Federal University of Pernambuco in Recife.   In Florida, where local mosquitoes are actively transmitting the virus in an area north of downtown Miami and in Miami Beach, state officials reported seven new cases Thursday, bringing the total in Florida’s outbreak to 87.

‘No room for doubt': New science proves Zika causes microcephaly

Vaccines and what we owe to our neighbors

The measles outbreak that began at California’s Disneyland — and spread like pixie dust — along with several other, smaller flare-ups, has health officials warning of worse to come. Preventable infectious disease is making its return to the developed world, this time by invitation. The scientific consensus on measles is effectively unanimous: 1) It is not trivial. Children with measles can get seriously ill, and there is chance of complications such as middle ear infections, pneumonia and encephalitis. 2) Measles is highly transmissible — one of the easiest viruses to get or give. 3) The measles vaccine is highly effective — one of the most successful against any virus or microbe. I’ll turn “4)” over to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases: “The ‘evidence’ that measles vaccination is associated with serious adverse events such as autism and other afflictions,” Fauci told me, “has been completely discredited by a number of independent scientific bodies.” Yet, a significant minority of parents — often well-educated parents — are opting out of vaccination. Many states (including California) make it relatively easy to refuse vaccination for “philosophic” reasons. This does not, I suspect, mean that people are reading Immanuel Kant or John Stuart Mill; it means they are consuming dodgy sources on the Internet. Resistance to vaccination on the left often reflects an obsession with purity. Vaccines are placed in the same mental category as genetically modified organisms (GMOs), DDT and gluten. But the problem with organic health care is that the “natural” rate of child mortality is unacceptably high. Organically raised children can get some very nasty diseases. Opposition to vaccination on the right often reflects an obsession with liberty — in this case, freedom from intrusive state mandates. It has always struck me as odd that a parent would defend his or her children with a gun but leave them vulnerable to a microbe. Some conservatives get especially exercised when vaccination has anything to do with sex — as with the human papillomavirus (HPV) vaccine — on the questionable theory that teenagers are more likely to fornicate if they have a medical permission slip (or less likely to without it). Whether hipsters or home-schoolers, parents who don’t vaccinate are free riders. Their children benefit from herd immunity without assuming the very small risk of adverse reaction to vaccination. It is a game that works — until too many play it. Herd immunity requires about 90 percent vaccine coverage. Some children with highly vulnerable immune systems — say, those being treated for leukemia — can’t be vaccinated for medical reasons. When the number of non-medical exemptions from vaccination gets large enough, the child with leukemia becomes the most vulnerable to the spread of disease. The government (in this case, state governments) has the responsibility to keep vaccination rates above 90 percent, which benefits everyone. This requires burdening the freedom of parents in a variety of ways — not putting them in jail if they refuse to vaccinate but instead denying them some public good (such as public education) and subjecting them to stigma (which they generally deserve). As the rate of vaccination goes lower, the level of coercion must increase — making exemptions more difficult and burdensome to secure (as California needs to do). This issue is important in itself. It also demonstrates a point that is properly called “philosophic.” Vaccination is communitarianism in its purest, laboratory form. The choices of citizens are restricted for a clearly (even mathematically) defined social good. Things get murkier with other kinds of goods. Does the same coercive power apply to chronic diseases involving lifestyle choices? Government has taken a position against the use of tobacco. What about substances such as sugar, salt and saturated fat? Does the common good extend to the moral and social health of a community? Maybe just to the moral health of people younger than 21 or 18, who can’t buy or consume certain things? How about prostitution, which degrades women and men (even as willing participants) and results in a squalid social atmosphere? How about the legal availability of concentrated forms of tetrahydrocannabinol (THC), the active ingredient in marijuana? In all these matters, there is a balance between individual rights and the common good. This may sound commonplace. But some Americans seem to believe that the mere assertion of a right is sufficient to end a public argument. It is not, when the exercise of that right has unacceptable public consequences, or when the sum of likely choices is dangerous to a community. Sometimes we need 90 percent of the public to make the right choice, or innocent people suffer. _Read more fromMichael Gerson’s archive, follow him on Twitter or subscribe to his updates on Facebook _. **Read more on this topic:** The Post’s View: The measles vaccine is a shot of common sense The Post’s View: As measles cases increase, a sharp call for vaccinations Michael Gerson: The enduring benefits of vaccination Paul Waldman: What Chris Christie gets wrong about vaccine deniers

‘An embarrassment’: U.S. health care far from the top in global study

Americans grumble all the time about the quality of our health-care system, but when we're dealing with serious issues, such as injuries from an auto accident or cancer, we often count our blessings that we live in a wealthy country that has well-trained doctors with access to the latest medical technology. Yet those factors don't always correlate with staying alive. That's the distressing finding from a global study of what researchers call “amenable mortality,” or deaths that theoretically could have been avoided by timely and effective medical care. Christopher Murray, a researcher at the University of Washington, and his collaborators looked at 32 causes of death in 195 countries from 1990 to 2015 to create a health-care quality index they used for rankings. Murray described the findings as “disturbing.” “Having a strong economy does not guarantee good health care,” he said. “Having great medical technology doesn’t, either. We know this because people are not getting the care that should be expected for diseases with established treatments.” The top country on their list is Andorra, the microstate in the Pyrenees mountains with a population of about 85,000 and an economy is based on tourism. The lowest is the Central African Republic, the landlocked country in the middle of the continent where violence by armed groups against the civilian population has broken out in recent days. As might be expected, many highly developed nations, such as Norway, Australia and Canada, scored well. Those in more-remote areas in sub-Saharan Africa, South Asia, Latin America and the Caribbean scored poorly. In the map below, the higher the health-care quality index, or HAQ, the better the level of care, according to the study. The world's superpower doesn't rank where you might expect it to. The United States scores an 80 on the index, which is at the bottom of the second decile and puts it on par with Estonia and Montenegro. The United States measures well for diseases preventable by vaccines, such as diphtheria and measles, but it gets almost failing grades for nine other conditions that can lead to death. These are lower respiratory infections, neonatal disorders, non-melanoma skin cancer, Hodgkin’s lymphoma, ischemic heart disease, hypertensive heart disease, diabetes, chronic kidney disease and the adverse effects of medical treatment itself. “America’s ranking is an embarrassment,” according to Murray, who noted that U.S. health spending per person — $9,000 annually — is more than that of any other country. The study, published in the Lancet on Thursday evening, offers some models that the United States might want to consider to take steps to improve. It highlights a long list of countries, including Peru, South Korea, Niger and Jordan, that have had health-care quality climb since 1990, meeting or surpassing levels of other countries with similar development.

The incredible power of the measles vaccine, in 3 graphics

Sometimes we take the benefits of modern medicine for granted, but a small dose of data and history can easily remedy that. The chart below, created by Valentine Svensson, a PhD student in molecular biology at Cambridge University, shows the dramatic decline in the incidence of measles in 20th century America.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico You can see that the incidence of measles fell sharply after the vaccine was introduced in 1963, only 50 years ago. As the vaccine did its work, the incidence of measles dropped to zero by the end of the century. (The left-hand axis is graphed as a base 10 log, a common technique that statisticians use to bring in spread-out values and illuminate a trend.) Lest we forget where we came from, here's a map that shows how deadly measles was in 1880. The map shows the ratio of deaths from measles to aggregate deaths, based on the tenth census ever conducted in this country. The graph at the lower left hand corner of the page shows how the states compared in terms of deaths by measles, while the key at the bottom right hand corner of the page tells you how many deaths the different shaded areas correspond to. (Click on the map, which is republished courtesy of the David Rumsey Historical Map Collection **,** to enlarge.)    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In most states, fewer than 30 deaths per 1,000 were due to measles, or less than 3 percent of overall deaths. In some parts of Georgia, Nebraska, Colorado and Kansas, however, that proportion reached 3-6 percent of deaths, while in New Mexico it topped 6 percent of all deaths. Finally, here's a graphic showing how measles spreads in an area without a vaccination program, by Bonnie Berkowitz and Lazaro Gamio of The Washington Post. The differently shaded squares represent four generations of infection, from Patient Zero (the darkest red square at the top left) to the people he or she infects (the next 17 reddish squares), the people they infect in turn (the next five lines of peach-colored squares), and the people they infect (the rest of the graphic). The dark squares represent the people who die from measles.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Without vaccinations, each measles case will infect 12 to 18 other people on average every 10 to 14 days. You can see how quickly the disease spreads from the first generation (Patient Zero) to 12 to 18 people in the second generation, 144-324 people in the third generation, and 1728-5832 people in the fourth generation. That adds up to more than 6,000 infections, all within 40 days. In a country with substandard healthcare and malnutrition, up to 28 percent of those infected will die. Now contrast that with a country with full vaccination: In that scenario the disease would spread to 0.8 people every 10 to 14 days, and less than .3 percent will die. In a country like the United States, where most people have been vaccinated but pockets have not, the disease would spread to 1.1 to 2 people every 10-14 days and less than .3 percent would die. **More posts fromKnow More, Wonkblog's social media site: **    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _Where America’s uninsured, untreated, mentally ill live_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _Map: Where Americans are dying before their time_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _The terrifying rise of diabetes, in every corner of the U.S._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Young adults are driving vaccine skepticism in the U.S.

Who are the vaccine skeptics? On the heels of the Disneyland vaccine outbreak, that's what everyone wants to know. As with just about every other major issue facing the country, the temptation is to divide it along familiar left/right political divides. It may seem natural that Republicans, who tend to be skeptical of mandates and government intrusions, would be most opposed to vaccination policies. Or that Democrats, distrustful of big businesses like pharmaceutical companies, would harbor the most skepticism. But as it turns out, we're asking the wrong question. Public opinion polling shows that vaccination attitudes don't differ much by party affiliation. Or by income, or even education. But there is one important demographic factor: age. Millennials -- 18 to 29-year-olds -- are about twice as likely as senior citizens (65+) to say that parents should decide whether their kids get vaccinated, rather than having it mandated by law. Republicans and independents are more likely to say this than Democrats, but here the split is not as stark.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico More strikingly, 21 percent of millennials say it's likely that early childhood vaccinations are linked to autism, compared to only 3 percent of those aged 65+. There's little variation by political party on this question.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The Pew Research Center, which polled the first question, posits that "One possible reason that older groups might be more supportive of mandatory vaccinations is that many among them remember when diseases like measles were common." Having come of age in an era when measles was declared eradicated, millennials have no generational memory of time when hundreds of thousands of Americans were stricken with the disease each year. Not to mention polio, or smallpox.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Vaccines are partially a victim of their own success. They've done such a great job of wiping out deadly diseases that it's easy to become complacent. Largely liberated from having to worry about measles outbreaks, or tetanus, or polio, we're able to fret over whether vaccinations comport with an "all-natural" lifestyle. But we've forgotten that the incredible success of vaccination programs is what afforded us that luxury to begin with. It may take more California-style outbreaks to jolt our memory.

The measles vaccine is a shot of common sense

DR. JAY Gordon, a pediatrician in Santa Monica, Calif., appeared in a “CBS Evening News” broadcast the other day, talking about the measles outbreak that began at Disneyland and now has infected 67 people in 11 states. Dr. Gordon has signed “personal belief exemptions” allowing parents in California to avoid vaccinating their children against the disease. “This measles outbreak does not pose a great risk to a healthy child,” he said. “And quite frankly, I don’t think it poses any risk to a healthy child.” He added that measles “is an almost always benign childhood illness.” This thinking is dangerous. Measles is a highly infectious, acute viral illness that threatens people who are unvaccinated. Dr. Gordon would be right to say it is not a great risk to children who have been inoculated. But he and others who enable people to avoid vaccination are trafficking in poor information that could lead to more cases of a disease that was eliminated in the United States 15 years ago. Is measles “benign”? The Centers for Disease Control and Prevention says measles “can lead to severe complications and death” and “even patients who experience uncomplicated acute measles have a small risk for developing a devastating neurologic illness . . . years after their infection.” Measles is common elsewhere in the world, with about 20 million cases reported each year and 122,000 deaths. Before vaccination began in 1963, about 3 million to 4 million people got the disease each year in the United States, of whom 400 to 500 died, 48,000 were hospitalized and 4,000 developed brain swelling. That does not fit our definition of benign. Last year, the United States experienced 644 cases of measles in 27 states and 23 outbreaks. This is the greatest number since elimination — zero transmissions from one person to another for a whole year — was declared in 2000. What is happening is that unvaccinated Americans and foreigners are bringing the virus to the United States after becoming infected abroad. There are outbreaks in Europe, Africa, Asia and the Pacific; last year most of the cases brought into the United States came from the Philippines, which has been struggling with a large outbreak. While it isn’t certain how the outbreak began at Disneyland, experts say a visitor carried it into the park from overseas between Dec. 15 and Dec. 20. Others were exposed, including at least five Disney employees. Just one infected person can spread the virus to others. According to the Centers for Infectious Disease Research and Policy at the University of Minnesota, the genotype linked to the Disney outbreak is circulating in 14 countries around the world. There is an effective shield in the United States. The measles, mumps and rubella vaccine works and has a 50-year safety record. Certainly there are enough serious public-health threats today in the United States that a new one should not be created out of a virus that was already eliminated. Those who refuse to vaccinate are wrong. They endanger themselves and those around them. **Read more** **on this issue:** The Post’s View: As measles cases increase, a sharp call for vaccinations Letter to the Editor: Not a strong argument for vaccination Michael Gerson: The enduring benefits of vaccination

U.S. measles outbreak sets record for post-elimination era

The ongoing measles outbreak in the United States has reached a record for any year since the disease was eliminated in this country 14 years ago, with 288 cases of the potentially deadly infection reported in 18 states, the Centers for Disease Control and Prevention said Thursday.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday The largest measles clusters are in Ohio (138 confirmed cases), California (60) and New York (26), according to the CDC. Almost all — 97 percent — have been brought into the country by travelers, mainly Americans, who contracted the infection abroad. About half of those were people who picked it up in the Philippines, where a large measles outbreak has affected more than 32,000 people, causing 41 deaths,  since January alone, said Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases. In this country, the biggest outbreak is centered in the Amish community in Ohio, where many of the residents are unvaccinated, the CDC reported. In Virginia, two cases were confirmed earlier this month.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday "This is a wake-up call for travelers and parents to make sure vaccinations are up to date," Schuchat said. "Measles vaccine is very safe and effective and measles can be serious," she added. "It's very infectious." Forty-three of the people in this country who have come down with measles required hospitalization, most often for pneumonia, she said. No deaths have been reported here. Measles is a highly contagious respiratory disease that generally affects young children, causing fever, a runny nose, a cough and a distinctive rash all over the body. This year, however, more than half the people who have come down with it are 20 years old or older, according to CDC data. About one in 10 children also gets an ear infection and one in 20 comes down with pneumonia. A person with measles is contagious as long as four days before the symptoms are apparent. Parents and even physicians who haven't seen measles in years may be unaware of the early warning signs. The largest number of confirmed cases of measles since the infection was eliminated in the United States in 2000 occurred in 2011, when 220 were recorded. The CDC hasn't seen this many cases so early in the year since 1994, when 764 people were infected by this time, Schuchat said. In the past 20 years, a concerted public health campaign, especially among lower-income families, has made measles outbreaks rare in the United States. But an estimated 20 million people are infected in Europe, Asia, Africa and elsewhere each year, and 122,000 of them die. In the United States, the number of people who choose not to be immunized for religious, philosophical or personal reasons has begun to become a public health problem, Schuchat said. Others are unaware of, or unable to get, vaccinations before they arrive in the United States. A small number of adults can lose their immunity over time and may need to be re-vaccinated. Authorities aren't sure how the Amish community in Ohio contracted the disease, but Schuchat said they believe that people traveling to conduct faith-based work abroad are involved. According to the CDC, 40 importations of the infection were attributed to unvaccinated U.S. travelers returning from abroad. Steven Nolt, a history professor at Goshen College in Indiana who has written about the Amish, said some groups do travel to places such as Kenya, Ukraine and Central America to do mission or relief work. He said many Amish do vaccinate themselves and their chidren, but others refuse.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Some, Nolt said, have a "more traditional, conservative, old-fashioned way of life and set of sensibilities that views medicine as something that is used to heal or cure, rather than to prevent" disease. Others have a "theologically informed...sense that we should place our trust in God and not in vaccines." Schuchat urged anyone who isn't sure whether his or her immunizations are up to date to get another dose of the vaccine, especially if traveling to places like the Philippines or doing health care work. Though the vaccine generally isn't given to children before the first birthday, infants traveling abroad can be inoculated with one dose as young as six months, Schuchat said. The vaccine is generally administered in two doses a few years apart. People whose immune systems are suppressed and pregnant women should not receive the vaccine, she said. Adults born before 1957 likely had the measles and should be immune, she added. The vaccine became available in 1963. Related: Potential measles exposure in Fairfax, Loudoun counties    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Va. health officials report second confirmed measles case    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday CDC reports biggest measles outbreak since 1996    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Woman’s cancer killed by measles virus    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday A vaccinated person contracted and passed on the measles    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday

Germany is battling a measles outbreak that is 10 times worse than the one in the U.S.

The United States has been shocked by a surge in measles cases with more than 100 incidents in January alone.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico This, however, is much less worrisome than a current outbreak in Germany. While authorities there had hoped to completely eliminate the disease this year, 254 new cases emerged in January, primarily in Berlin. If we consider that the German population is only one fourth of the United States', the German measles surge was about 10 times worse than the one in the United States in January, relative to the total population.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico There is one significant difference, though: The outbreak has raised little attention in Germany. Whereas measles has been high on the news agenda for weeks in the United States, in Germany, it has neither caused a debate about the alleged risks of vaccines nor has the outbreak been featured on front pages. The reason is simple: Germany has had even worse outbreaks over the past years. Experts, however, say that the risks of ignoring the upsurge would be significant. "The outbreak in Berlin is a sobering setback. In general, Germany's immunization rate is too low," Anette Siedler, the director of Germany's renowned Robert Koch Institute, was quoted as saying by German media.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico But according to the World Health Organization, Germany already has one of the world's highest immunization rates among 1-year-olds with 97 percent -- compared to the United States with 91 percent. So where do all the new cases come from? German experts say that one third of all vaccinated German children either lack a sufficient immunization (which usually requires a second dose), or are vaccinated too late. **How could the recent outbreak spread so quickly?**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In fact, most of those who caught the virus were adults -- whereas official statistics only take into account children. Similar patterns have been observed in California, where the majority of those who caught the virus were adults as well. Particularly those born between 1970 and 1990 might have missed vaccination doses, due to a lack of stringent recommendations by public health officials at that time. What is worrisome is that the course of the disease is particularly serious for adults, although children are usually more likely to get infected.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The reasons for the lack of vaccinations in Germany are similar to the ones that are often mentioned in the United States: In both countries, **** measles seemed to have been "eliminated," and subsequently people started to "relax" about immunization. Contrary to developing countries, where the terrifying repercussions of measles outbreaks are still too visible to ignore, many in the United States or Germany have never been confronted with the disease. This makes them more susceptible for the ongoing debates about the safety of vaccinations that have prevented some parents from becoming vaccinated or ensuring that their children receive the necessary doses.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico What is different in Germany is that the cases have so far been limited to Berlin and Brandenburg, which is the state that surrounds Germany's capital. **Why the 1990s Yugoslav civil war might be to blame**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Local authorities in Germany first noticed a surge in infections last October among asylum seekers from Serbia as well as Bosnia and Herzegovina. One potential reason for the increase in cases could be the fact that the Yugoslav civil war in the 1990s interrupted vaccination programs in the areas from where the refugees have now fled. Overall, nearly all of those who got infected said they had not been vaccinated. Space to accommodate Germany's asylum seekers is rare and immigrants have complained that they are forced to live on little space -- a significant factor, considering that 90 percent of those without vaccination who come in contact with measles patients will catch the virus. Hence, the Robert Koch Institute has now recommended authorities to put a special emphasis on the vaccination of refugees who have fled Bosnia and Herzegovina.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Justin Lessler, an Assistant Epidemiology Professor at the Bloomberg School of Public Health, thinks that U.S. outbreaks could have similar origins. "There are several communities in the United States with close ties to countries with circulating measles and low vaccination rates, and these are certainly at risk. Since 2001, outbreaks in the US have been sparked by disease acquired in Romania, Kenya, Switzerland, and many more," Lessler told The Washington Post. To generally blame immigrants for the surge in measles cases would be misleading, though. Contrary to Germany and the United States, many countries in Africa or Latin America claim to have already successfully eliminated the virus. **RELATED:**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Map: 113 countries have higher measles immunization rates than the U.S. for 1-year-olds    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

The disturbing racial bias in who we help when they need it most

In many ways, a new study, published in the American Journal of Public Health, further confirms the phenomenon. Using data from the National Emergency Management Information System (NEMSIS), which tracks the details associated with millions of emergency calls from around the United States, researchers at Cornell University found that only 1 in 39 people (or roughly 2.57 percent of people) who suffered a medical emergency in public received any help beyond a call for an ambulance. And that number is probably kinder than it seems, since it doesn't discount support by family members and friends. But the study also reveals a nefarious side to our collective tendency toward inaction. While the phenomenon is a troubling one for society as a whole, it appears to have a disproportionate effect on some. Black patients, the NEMSIS data show, are significantly less likely than their white counterparts to receive help of any form before paramedics arrive. "There is a huge racial disparity in terms of who gets help during public emergencies," said Erin York Cornwell, an assistant professor of sociology at Cornell University, and the study's lead author. "It's really very concerning. It's what's most troubling." The chart below, plucked from the study, shows just how great that disparity is. The likelihood of someone receiving support from a bystander is so minuscule, the researchers had to zoom into the very bottom spectrum of probabilities (that's what second chart, magnified on the top right, is). And when they zoomed in, it was clear that black people received help far less often, even after adjusting for population (that's what the low, mid, and high density indicators mean). Overall, white people were more than twice as likely to receive help than black patients (the probabilities were 4.5 percent and 1.8 percent, respectively). There are several reasons why people are reluctant to lend a hand in these situations. The bystander effect certainly appears to take its toll. There are few places better fit to show the phenomenon, after all, than out in the streets when unexpected emergencies bubble up, confronting crowds of complete strangers with the chance to help. It's no coincidence that the rate of support was highest in low density (i.e. less populate) areas. There is also possibility that helping might undermine the efforts of paramedics, especially if one misdiagnoses the problem. The risk of helping, in other words, might appear to outweigh the risk of not helping. But even still, Cornwell says she expected the rates at which people receive this kind of support to be much higher. "In many cases, it's as simple as giving someone a blanket, a bottle of water, some juice, or a little food, " she said. "We're talking about things like holding someone's head, keeping someone still, or helping someone take medication—things that require no training at all."   Socioeconomic circumstances, however, likely only tell part of the story. While the researchers don't know the race of the bystanders who did and did not help those suffering from medical emergencies, they believe a certain level of racial bias may be at play as well. "The difference is just too significant," said Cornwell. The data do show at least one anomaly, which could support that hypothesis. For whites, the bystander effect appears to have an enormous impact. Whites patients in the less populated areas are much more likely to receive support than those in more populated ones. For black patients, the difference isn't nearly as significant, suggesting that it could have more to do with the individual than with the environment.

Michael Gerson: The enduring benefits of vaccination

Recently I wrote about a type of scientific denialism — often practiced by religious people — that cheats children out of the wonders of modern cosmology and encourages unnecessary religious doubt. But there is another sort of scientific skepticism — often displayed by affluent and educated parents — that withholds routine childhood vaccinations and encourages unnecessary disease. These should be kept in proportion. The belief that human beings walked with dinosaurs is wrong. The belief that vaccinations cause autism or brain damage is wrong and dangerous. In the latter case (as in the former), the scientific argument is not merely lopsided but single-sided. Like any medicine, vaccines have a very small risk of serious side effects, which doctors are trained to identify. But the association of the measles vaccination with autism has been entirely discredited. Childhood vaccinations do not involve dangerous levels of toxins and do not compromise the immune system. And vaccinations prevent a range of diseases — chickenpox, diphtheria, measles, mumps, pertussis, polio, rotavirus, rubella, tetanus — that used to routinely hospitalize, disable or kill children. In most health matters, defying medical authority mainly has individual consequences. Those who believe that cancer can be treated with coffee enemas are only killing themselves. But communicable diseases are different. Some people can’t be immunized for medical reasons, or their protective response to a vaccine is weak. They depend on the immunity of others to avoid infection. Immunization rates north of 90 percent are usually required to protect the whole herd. This means that if even a small portion of the herd refuses vaccination, the risks rise for everyone. Epidemiology grants marginal groups the power to do great harm. The United States generally has rates of immunization in the high 80s or low 90s. In some places, however, the rate dips lower, making it easier for an infected traveler (for example) to cause an outbreak. Recent examples can be found in Orange County, Calif., and New York City. The problem is even worse in Britain (where the immunization rate for measles is only about 80 percent) and in other parts of Europe. Those who resist vaccination are a varied group. The parents of autistic children seek and deserve an explanation. Unfortunately, vaccination is not the answer. Other “non-conformists” are a subset of home-schoolers, distrustful of government mandates and intent on the right to keep and bear viruses. A larger number of resisters are committed to an organic, chemical-free, natural lifestyle. This is attractive, except in the case of diseases in which the “natural” state — through most of history and still in much of the world — has been massive infant and child suffering and death. The achievements of science in this area are highly artificial — and thank goodness. The ability to opt out of vaccinations (other than for diagnosed medical problems) is often miscast as a matter of parental choice, leading to a proliferation of state exemptions for vague religious and philosophic reasons. What could be wrong with choice? A lot, when you are choosing to endanger your neighbors. Vaccination — in a little-used but useful term — is a social responsibility. It is a duty we owe each other as members of a community. Opting out should be difficult and burdensome. And there is no parental right to send a purposely unvaccinated child to public school, exposing other children to unnecessary risk. Resistance to immunization is not new. In the late 1700s, some believed that the smallpox vaccine could turn people into cows. Today, however, there would be 1,000 Web sites alleging a sinister connection between Big Pharma and Big Dairy. The problem of vaccine denialism is closely tied to the problem of information and authority in the digital age. People prone to skepticism can cover themselves with layers of pseudo-science and conspiracy theories that thicken and harden like papier mache. On medical issues, the United States needs not more sources of questionable information but more trust in knowledgeable authority. The Centers for Disease Control and Prevention, the American Academy of Pediatrics and your local pediatrician are not lying about immunization. Many Web sites are. The seriousness of this discussion must somehow reflect the seriousness of the stakes. Vaccine denialism is not the equivalent of advocating for diaper-free children or sleeping in the family bed. During the lifetimes of American children born from 1994 to 2013, according to the CDC, childhood vaccinations will prevent an estimated 21 million hospitalizations and 732,000 deaths. This is miraculous but not natural. _Read more fromMichael Gerson’s archive, follow him on Twitter or subscribe to his updates on Facebook _. **Read more about this issue:** Alexandra Petri: The one problem with that Jenny McCarthy Twitter backlash Seth Mnookin: An early cure for parents’ vaccine panic Sandra G. Boodman: Inside the vaccine-autism scare

In 2013, measles killed more kids than car accidents or AIDS

Measles killed 82,100 children under age 5 in 2013, ranking the disease at No. 7 on the list of the top causes of child death, according to recent statistics from the Global Burden of Disease study published in the Lancet. Lower respiratory infections like pneumonia were the number one killer, followed by malaria, diarrhea, nutritional deficiencies, congenital defects and meningitis. More small children died from measles in 2013 than died from drowning, road injuries or aids.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Here in the United States, we have the luxury of signing up for "personal belief exemptions" from vaccine requirements and indulging vaccine skeptics in their unfounded beliefs about the "dangers" posed by measles vaccines. Currently there are 113 countries that can boast better measles vaccination rates than the United States. The only reason this is possible, of course, is the incredible effectiveness of vaccines at eradicating diseases like measles.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico But these numbers serve as a stark reminder that in the developing world, where measles kills roughly 225 children each day, the situation is quite different. Children under 5 make up more than half of the 145,000 deaths attributed to the disease annually. In some particularly impoverished and malnourished areas, the disease has a fatality rate of 10 percent.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico According to the World Health Organization, it costs about a dollar to immunize a child against measles. But a single case of the disease here in the United States costs about $11,000 to treat. Not a bad return on investment.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

‘The world is becoming a safer place to live in.’

You might not guess it from the constant headlines about war, terrorism and mass shootings, but researchers say the world is actually becoming a less perilous place for many people. New findings published this week detail how the global toll of injuries -- including everything from car crashes to poisonings to natural disasters -- has fallen by nearly a third over the past quarter-century. Researchers dug into the latest data from the Global Burden of Diseases and Injuries, an effort that began in 1990 and now encompasses information from 188 countries in 21 distinct regions of the world. They wanted to examine whether dozens of types of injuries had become more or less frequent over time and whether fewer people were dying from them. For 2013, the most recent year for which data are available, the researchers calculated that nearly a billion people worldwide suffered injuries that required medical attention, according to results published in the journal Injury Prevention. The major causes of death were not surprising: Road-related accidents claimed more lives than any other type of injury, followed by self- harm, falls and interpersonal violence.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Despite those numbers, the researchers found that a measure known as "disability-adjusted life years" -- calculated by adding years of life lost to death and years of life lived with disability -- had fallen by 31 percent between 1990 and 2013. The rate of decline was "significant" for 22 of 26 injury categories. Such decreases, the researchers write, "warrant a general statement that the world is becoming a safer place to live in." That said, the findings make clear that it isn't necessarily a safer world for everyone, at least not in equal measure. Women in South Asian had high rates of fire-related injuries. Eastern Europe and Central Asia reported high rates of drowning and self-harm, while Latin America recorded high rates of homicide, even in children. In almost every region, injury rates remained higher in men than in women, with the exception of those 80 years and older, for whom gender differences virtually disappeared. And among people ages 15 to 49, there was an eight-fold difference in road traffic injuries between the high-income Asia Pacific region and poorer areas of western Sub-Saharan Africa.

People on the autism spectrum live an average of 18 years less than everyone else, study finds

Researchers looking into mortality trends and autism have made a troubling discovery: People on the autism spectrum are dying young — some 12 to 30 years earlier than might otherwise be expected.  The data, which includes information on 27,000 people with the social-communication disorder and about 2.5 million who do not have the diagnosis from Sweden's national registries, found that, on average, autistic adults die 18 years younger than their non-autistic counterparts. An autistic person's age at death also appeared to be impacted by cognitive ability. Those with autism and a learning disability died 30 years earlier on average while those without intellectual impairment died 12 years earlier. Individuals considered to be on the "high-functioning" end of the spectrum with strong language skills — those who might have been diagnosed with Asperger's before the diagnostic criteria changed — still had double the risk of dying young as those without the condition. The overall trends were similar for both genders, but autistic women with learning disabilities had the highest risk of premature death of any of the subgroups. "This new research confirms the true scale of the hidden mortality crisis in autism," said Jon Spiers, chief executive of Autistica, an autism charity in Britain. "The inequality in outcomes for autistic people shown in this data is shameful. We cannot accept a situation where many autistic people will never see their 40th birthday." Experts theorized that both biological and social factors may be contributing to the higher risk of premature death. Some studies have suggested a link between the genes leading to autism and those related to epilepsy, mood disorder and anxiety disorder. Indeed, the Swedish analysis found that up to 40 percent of people with autism also suffer from epilepsy. People with autism may also differ from those in the general population by having a more restricted diet, limited access to exercise and increased use of medication.  The data shows that adults with autism and no additional learning disability are over nine times more likely to commit suicide. The rate is shockingly high, but not inconsistent with previous research that estimates that 30 to 50 percent of autistic people have considered committing suicide. There's evidence that diminished sense of self-worth begins in childhood. One study found that while only 0.5 percent of typically developing children experienced suicidal thoughts, 14 percent of those with autism had. Calling the problem a "hidden crisis," Spiers announced at a briefing in London this week that the organization is seeking to raise funds to launch a five-year, $14.5-million research program to investigate why autistic adults are dying so young. In the United States, the prevalence of autism has been growing in recent decades. The Centers for Disease Control and Prevention estimated in 2014 that 1 in 68 children have the condition.

Measles cases are spreading, despite high vaccination rates. What’s going on?

It’s now official: Measles cases in the United States are at their  highest level  since 2000, when the disease was  declared eliminated — meaning that regular, year-round transmission had been interrupted.  Five hundred fourteen cases have been reported this year — more than double the previous high, in 2011 — and the number is expected to continue to climb. The measles vaccine is among the most effective, and the vast majority of Americans have either had the measles (and are therefore immune to a second case) or have been vaccinated against it. So why are so many people being infected? One big reason is vaccine refusals: The overwhelming majority of current infections occur in unvaccinated people, most of whom declined the injections for religious, philosophical or personal reasons, according to the Centers for Disease Control and Prevention. But 10 percent of the cases occurred in vaccinated individuals. Even worse, a case study published in February about a woman dubbed “Measles Mary” described a scenario that scientists had not known was possible: In 2011, the 22-year- old New York theater worker, who had been vaccinated, not only contracted the disease but also passed it along to four others, two of whom had also been vaccinated. While this was very rare — it was the first documented case of a vaccinated person passing measles along to others — the case illustrates how the disease can pose a threat even to those who have had their measles vaccine. What’s going on? Briefly, there are two ways vaccines can fail. To understand them, it helps first to understand how vaccines work. Vaccines are made from a deactivated or weakened piece of a   disease-causing pathogen — a virus or bacterium. When the vaccine is introduced into your body, it tricks your immune system into thinking it’s the real deal. The immune system ramps up and creates antibodies, which remain in your system until the day the real pathogen arrives . . . and then BAM! The disease is dead on arrival. That process — the body’s generating antibodies in response to a vaccine — is called seroconversion. But sometimes the person getting the vaccine does not seroconvert: Antibodies are not created, and the person is not protected. This is the first way vaccines can fail, and it happens about 5 percent of the time with the MMR (measles, mumps and rubella) vaccine. That’s the reason for the second shot in the MMR series: After getting it, an additional 3 to 4 percent of people seroconvert, leaving 1 to 2 percent unprotected. Parents who don’t want to vaccinate their kids may ask, “Why does it matter to you that my kids aren’t vaccinated if yours are?” The reason is that an unvaccinated child is more likely to catch a disease and then pass it on to others, including to someone who has been vaccinated but — because of failed seroconversion — is not fully protected. So if vaccines can fail right off the bat, why bother with them? Well, they fail in only a small percentage of the population. Seat belts don’t prevent death 100 percent of the time, and life jackets don’t prevent drowning 100 percent of the time, but they do reduce the risk of death; that’s why we use vaccines — for risk reduction, not risk elimination. But if a person seroconverts after the first MMR shot, does he need the second? The short answer is yes: Most of the time, it’s a good idea. For one thing, a person may seroconvert for the measles but not the mumps or rubella after the first MMR dose. Even if a blood draw to check antibody concentration after the first shot reveals the person has high enough levels to protect against measles, mumps and rubella, the second dose may further increase those concentrations, acting like a booster. And having high concentrations may be good later on because of the second way vaccines can fail: the passage of time. As a successfully vaccinated person ages, the concentration of antibodies decreases, causing immunity to wane. The best known recent example of this is the pertussis vaccine introduced in the 1990s, which waned more quickly than its predecessor vaccine and is partly responsible for the increase in U.S. cases of pertussis, or whooping cough, over the past decade. Waning immunity is the reason for vaccine boosters. (The immunity provided by having caught an infection can also decrease over time.) The initial series of vaccine shots, such as the five on the childhood immunization schedule for DTaP (diphtheria, tetanus and pertussis), provide initial immunity at the highest efficacy possible. Then boosters, such as the Tdap (the adult version of DTaP), are given to strengthen a person’s immunity after it has probably waned. In the case of Measles Mary, the vaccine failure was a result of waning. Researchers already knew that some people don’t seroconvert after contracting measles, but Mary had evidence of antibodies, so failed seroconversion wasn’t the problem. The problem was that her antibodies had waned, making her both susceptible to catching the disease and, apparently, capable of passing it on. This finding is important, but it’s also notable that this occurrence is so rare — so far — that it merited a case study in the medical literature. It’s not the waning antibodies to measles that caught scientists off guard; it’s the fact that she was able to pass on the infection despite having antibodies. It’s the first time since the measles vaccine became available in 1963 that this process has been documented. What this finding means remains to be seen. Because the measles vaccine has been around only about 50 years, scientists don’t know if it can last a lifetime. The Measles Mary case implies not. In fact, since this woman was so young, it implies the vaccine’s effectiveness may wear off in some rare cases in just a couple of decades. Until about six or seven years ago, waning immunity to measles would not have been a major concern. That’s because the United States had high levels of what is called herd immunity —  meaning so many people are vaccinated that a disease has trouble spreading because there are few unprotected people left to pass it along. Not only does herd immunity protect those who are too young, too sick or too immuno-compromised to be vaccinated, it also protects those who have been vaccinated and think they’re protected but actually aren’t. Herd immunity meant that even the measles cases introduced into the United States from abroad wouldn’t travel far. But the recent string of outbreaks spans the country — New York City,  California, Seattle, Massachusetts, Dallas — and they will continue if immunization levels remain low enough to let the disease spread. If the case of Measles Mary indicates that waning immunity from the vaccine is more widespread, the situation may become even more dangerous unless vaccination rates pick up again. Haelle is a freelance science writer. Related: U.S. measles outbreak sets record Potential measles exposure in Virginia, Maryland and D.C.

CDC reports biggest measles outbreak since 1996

Measles have infected 129 people in 13 states in 2014, the most in the first four months of any year since 1996, officials from the Centers for Disease Control and Prevention reported Thursday as they warned clinicians, parents and others to watch for the potentially deadly virus. Thirty-four of the cases were imported via travel to other countries, including 17 from the Philippines, where a huge outbreak has affected 20,000 people and caused 69 deaths, said Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases. There have been no measles deaths reported from the outbreak in the United States, and none since 2003. But Schuchat acknowledged that "it's probably just a numbers game, probably just a matter of time until we have more." One or two of every 1,000 cases of measles are fatal, according to the CDC.    *[WSU]: Wayne State University California, with 58 cases, has been hit hardest by one of the 13 separate outbreaks of measles in the United States. New York has seen 24 infections and Washington state has had 13. Measles is a highly contagious respiratory disease that generally affects young children, causing fever, a runny nose, a cough and a distinctive rash all over the body. About one in 10 children also gets an ear infection and one in 20 comes down with pneumonia. A person with measles is contagious as long as four days before the symptoms are apparent, Schuchat said. Parents and even physicians who haven't seen measles in years may be unaware of the early warning signs, she said. In the past 20 years, a concerted public health campaign, especially among lower-income families, has made measles outbreaks rare. The disease has been considered eradicated since 2000. But today, the number of unvaccinated children has begun to become a problem, Schuchat said. Some people are choosing not to have their children immunized for personal reasons and others are unaware of, or unable to get, vaccinations, before they arrive in the U.S. She said the CDC is also seeing growth in the disease pertussis, also known as whooping cough. Before vaccinations were available, about 500,000 people were infected with measles annually in the U.S., a number that fell to about 60 after the disease was all but eliminated in 2000. Since 2010, it has increased to an average of 155 cases per year. Still, she said, fewer than one percent of the toddlers in the United States have received no vaccines at all. "Vaccinating your children is still a social norm in this country," she said. In a telephone news conference Thursday, CDC Director Thomas Frieden lauded the Vaccines For Children program started in 1994, after a measles outbreak from 1989-1991 resulted in 55,000 cases, primarily because poor and uninsured children had not been immunized. Among children born in the following two decades, the CDC estimated, vaccinations prevented an estimated 322 million illnesses and 732,000 deaths, saving about $295 billion. The program provides free vaccinations for measles and 13 other diseases.    *[WSU]: Wayne State University But "we can’t let our successes result in complacency," Frieden said. "In fact measles, is very common in some parts of the world...An it travels fast." He said 20 million people across the globe get the disease annually, and 122,000 of them die. In a separate commentary Thursday in the Annals of Internal Medicine, epidemiologist Julia Shaklee Sammons warned that "as more parents decline to vaccinate their children, measles incidence is increasing—a fact that alarms me both as a hospital epidemiologist and as a parent of a vulnerable infant too young to receive the measles vaccine." When infected patients seek medical care, she noted, "hospitals and clinics may inadvertently fuel transmission if those with measles are not rapidly triaged and isolated."    *[WSU]: Wayne State University The proportion of vaccinated children varies by state, depending on the toughness of their immunization laws, Sammons said. Nationally the measles, mumps, rubella vaccination rate is over 90 percent, but in 15 states it is below that standard, she wrote. New York magazine reported last month on schools in California and New York with low immunization rates among students, in part because parents are choosing not to vaccinate them. The CDC said that 54 of this year's 58 California cases were in some way associated with importation of the virus from abroad. Twenty-five of the people infected were not immunized--19 of them because of philosophical objections--and 18 more had no documentation of vaccinations. Three were too young for routine vaccination and three others were not vaccinated for unknown reasons. Eleven had received two or more doses of vaccine that did not protect them. The vaccine is about 97 percent effective, said CDC official Gregory S. Wallace, so about three in 100 people who are vaccinated and exposed to the infection will contract it.

Insecticide blamed for Indian school deaths kills 200,000 every year, is related to sarin

The tainted school lunches that killed 23 children and sickened many more in India this week are thought to have been contaminated with an insecticide called Organophosphorous. It's a nasty substance, so hazardous that its use in the United States declined by 55 percent between 1997 and 2007 but so common that, in 2001, Americans used 73 million pounds just that year. And it's especially common in India.    *[WSU]: Wayne State University Bloomberg's Jason Gale and Ketaki Gokhale looked into the medical research around Organophosphorous, which turns out to have a record of killing more than just insects. Here are a few facts about the substance:    *[WSU]: Wayne State University • It kills 200,000 people around the world every year • It's closely related to sarin, a chemical weapon made famous by Saddam Hussein.    *[WSU]: Wayne State University • More than 15 percent of cases of ingestion lead to death • People who survive ingestion will sometimes develop paralysis later or neuropsychological problems, as the chemical is absorbed into the body's fat. • Organophosphorous poisoning can be treated with atropine or other medicines, but only if it's administered at the exact right moment. Otherwise, it can worsen the effects. No one can agree when the right moment is. • This is really tragic: Organophosphorous can produce a "peripheral respiratory failure." This means that, even after a patient has been treated and appears to be improving, a second round of respiratory symptoms will suddenly set in, sometimes fatally.

A toolbox for building effective vaccination laws

OVER THE past decade, it has become easier for parents to exempt their children from vaccination requirements. It’s no coincidence that it has also become easier to catch a preventable disease. Scientists have long stressed the importance of vaccines in public health, but a study released this summer provides the most rigorous overview to date of what rules and regulations promote the highest immunization rates and how those rates thwart outbreaks. The study’s review of individual policies gives local legislators a toolbox for building effective vaccination laws. The Health Affairs report, conducted by health policy experts at the University of Georgia, lends additional legitimacy to a view most sensible people already hold — that vaccines, and the laws that enforce them, save lives. According to the study, the states with the weakest rules and lowest rates experience the highest incidence of preventable diseases such as measles and whooping cough. Tough laws, on the other hand, lead to more vaccinations and less illness. This confirms what health officials have said for decades, yet the study also does something new and useful: It untangles the web of state vaccine policies and measures exactly what effect each component of each law has on rate reduction. What policies work best? Some are obvious. Banning philosophical exemptions, whereby parents can claim that their personal but not necessarily religious views bar them from allowing their children to be immunized, raises vaccination rates by 0.1 percent. Others are subtler, smaller tweaks that can have a surprisingly large impact. Requiring a state health department official to sign off on a nonmedical exemption, for example, pushes immunization rates up 1.12 percent. This modest change helps guarantee that the quickest and easiest route to enrolling a child in school is to get him or her vaccinated — not to fill out and file an exemption form. But only four states have the policy in place. From 2002 to 2012, the study shows, the occurrence of whooping cough was twice as high in states with the loosest laws as in states with the strictest laws. That is no surprise, when too-low levels of vaccination threaten the collective immunity that keeps infants and sick people safe. But legislators should take note that even a percentage-point decrease in the vaccination rate can transform a community into a breeding ground for disease for children and the infirm. It is up to these lawmakers to enact policies ensuring a healthful environment. In many ways, the study’s authors have completed the bulk of the lawmakers’ work for them. Now, they just have to do the right thing. **Read more on this topic:** Michael Gerson: Vaccines and what we owe to our neighbors The Post’s View: The measles vaccine is a shot of common sense Kathleen Parker: Seeking a vaccine for ignorance

Seeking a vaccine for ignorance

Flashback: Galileo is under house arrest pondering the unyielding ignorance of The Church for refusing to consider his heliocentric proposition that the Earth circled the sun. We find this historical anecdote preposterous today, but people were persecuted for lesser heresies in Galileo’s time. Though we are now centuries removed from such dim-wittery, we find ourselves in a not-dissimilar pickle. After decades free of many crippling and deadly diseases thanks to the miracle of vaccines, some people are skeptical. Parents fearful of side effects, often on account of anecdotal evidence or discredited studies, are reluctant to vaccinate their children. Marin County, Calif., a liberal enclave famous for its beauty and wealth, seems to be the epicenter of the debate. Many have opted out of vaccinations as part of their evolution into honeybees. Some see vaccines as a conspiracy of Big Pharma. Elsewhere, especially in the South, people are simply distrustful of authority, especially government. The latter group is familiarly known as the GOP base. They tend to be litmus-test conservatives on social issues and place Scripture above science. On the bright side, the far left and the far right finally have found common ground. They’d rather let their children risk illness — and their country an epidemic — than contaminate their offspring’s pristine bodies with antibodies. Oh, to be a fly at that picnic! One wonders what public tortures Jonas Salk might have encountered had he presented his polio vaccine today rather than in the 1950s. One crucial difference is that polio left visual reminders of its assault on the human body. The 1952 epidemic affected nearly 58,000 people, more than 3,100 of whom died and some 21,000 were left disabled. Most Americans under the age of 50, including doctors, have never seen measles. Now, after decades of being a virtually measles-free nation, we have 100 cases spread across at least 14 states and the potential for more as stubborn purists resist common sense. Science and experience overwhelmingly support vaccines, and the single study to the contrary, suggesting a connection to autism, has been thoroughly discredited. Naturally, into this tar pit, the GOP presidential field has fallen. Or rather, been pushed. Asked about the vaccine controversy, both New Jersey Gov. Chris Christie and Kentucky Sen. Rand Paul have handed the media a fresh bone to gnaw. Christie initially said that parents “need to have some measure of choice,” though he later clarified by saying that children should be vaccinated against measles. Paul told radio host Laura Ingraham, “While I think it’s a good idea to take the vaccine, I think that’s a personal decision for individuals.” Neither comment standing alone is objectionable. Barring a time-release patch from God, vaccines are the best we’ve got. Eventually, most parents come around to this conclusion, despite reluctance to inject their children with a tiny dose of the virus. They do it because the alternative is unthinkable. While parents’ rights should always be protected in the absence of harm to their children, the public health of the nation also has to be protected. Individual rights are justifiably modified when the exercise of those rights adversely affects others. Smoking is a textbook example of this premise. Preserving individual freedom is one of the compelling forces of modern conservatism and remains its most attractive feature. Thus, Republican candidates are faced with a daunting balancing act of confirming to primary voters their allegiance to the principle while also signaling to the rest of the country that they’re not _that_ foolish. These conundrums are not new. The conflict between individual rights and the greater good is the fundamental argument in a democracy, the success of which relies upon an educated rather than only radio-informed citizenry, as well as leaders willing to defend science over ideology. Aspiring presidents would do well to articulate these conflicts with compassion, without condescension or pandering — while explaining why, in this case, vaccines are the right choice. For starters they might quote Thomas Frieden, director of the Centers for Disease Control and Prevention: “Study after study has shown that there are no negative long-term consequences. . . . And the more kids who are not vaccinated, the more they’re at risk and the more they put their neighbors’ kids at risk as well.” There. That didn’t hurt much, did it? _Read more fromKathleen Parker’s archive, follow her on Twitter or find her on Facebook._ **Read more about this topic:** Michael Gerson: Vaccines and what we owe to our neighbors The Post’s View: The measles vaccine is a shot of common sense Michael Gerson: The enduring benefits of vaccination The Post’s View: As measles cases increase, a sharp call for vaccinations

A new threat appears along the U.S.-Mexico border: Americans with measles

As Republican lawmakers suggest that undocumented immigrants crossing the southern border may be responsible for bringing measles and other diseases into the country, Mexican health authorities are warning people traveling to the United States about the risk of infection here following an outbreak of measles at Disneyland last month that has sickened dozens of people in several states.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It's a remarkable reversal that demonstrates how far public health in Latin America has advanced in the past few decades -- especially in contrast to measles's alarming return in the United States. Health officials in the Mexican state of Chihuahua, which borders Texas and New Mexico, are distributing pamphlets with information about measles at airports, bus stations and border crossings. They're urging anyone with plans to travel to U.S. states where the outbreak has spread to immunize themselves, if they haven't already.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico These actions follow the arrival of two people with measles in Mexico from the United States last month, one of them an infant nearing her second birthday. Measles poses grave risks to small children, including permanent deafness, brain damage and death.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico "The U.S. exported [the] measles virus to Mexico,” Anne Schuchat, an official at the Centers for Disease Control and Prevention, has said.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico She told U.S. lawmakers at a hearing this month that in years past, travelers and immigrants from Mexico and Latin America brought measles and other diseases into the United States. Yet immunization rates in Latin American countries have improved, and the rate in Mexico has been higher than the U.S. rate for most of the past 20 years, according to the World Health Organization.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Now, although vaccination rates in the United States remain above 90 percent, sentiment has turned against vaccines in a few communities.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The country had 644 cases last year, by far the most in at least decades, and the recent outbreak, which has already infected at least 123 people and likely more, has spread south to Mexico.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico "We see the virus unfortunately going the other direction," Schuchat said later. Measles's new reality is at odds with the warnings given by some G.O.P. lawmakers, such as Rep. Mo Brooks (R-Ala.), who recently suggested that the southern border was a risk to public health in the United States. "I don’t think there is any health care professional who has examined the facts who can honestly say that Americans have not died because the diseases brought into America by illegal aliens who are not properly health care screened as lawful immigrants are," he said.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Schuchat told lawmakers that most measles strains are now brought into the United States by unvaccinated Americans traveling abroad, who probably enter the country without being screened in any way when they return home. Meanwhile, Americans who are worried about any public health risk from illegal immigration can still protect themselves through vaccinations for most diseases.

More people died taking selfies in India than anywhere in world, study says. Way more.

Selfies and scholarship have finally intersected. And it was not good news for India.  The analysis — provocatively titled “Me, Myself and My Killfie: Characterizing and Preventing Selfie Deaths" — found that of 127 reported selfie deaths from March 2014 to September,"a whopping 76 deaths occurred in India alone!”   Researchers analyzed thousands of selfies posted on Twitter and found that men were far more likely than women to take dangerous selfies. It found 13 percent were taken in what could be dangerous circumstances, and the majority of victims were under the age of 24. The most common cause of death worldwide was “falling off a building or mountain,” which was responsible for 29 deaths. The second most second-most common being hit by a train, responsible for 11 deaths. “This trend caters to the belief that posting on or next to train tracks with their best friend is regarded as romantic and a sign of never- ending friendship,” the study noted. Most of the Indian deaths were water-related. The authors hope the study will serve as a warning of the hazards and inspire new mobile phone technology that can warn photo-takers if they are in a danger zone.

The Ebola outbreak may have been bigger than believed, with ‘invisible’ infection

A new study raises the terrifying possibility that the Ebola virus outbreak in West Africa may have been larger than anyone realized. During the height of the crisis, the military quarantined whole villages, and so many people were dying very painful and very visible deaths that there wasn't enough time to bury them. At the time, the idea that there might be a significant number of people infected with the virus but with minimal or even no symptoms was not something that public health officials had much time to think about. This may have been an important oversight.  Their work focused on one village in the diamond-rich district of Kono in eastern Sierra Leone. From October 2015 to January 2016, they collected blood samples from 187 people from homes that had been quarantined because of possible exposure to an Ebola patient. The scientists found that 14 individuals who had not been previously identified as having Ebola were infected. Only two of them said they had had a fever during the time when the virus was spreading, but the other 12 said they didn't notice any signs or symptoms. While this study is very small relative to the 28,000 cases of Ebola that have been reported during the outbreak, it raises important questions about how the virus is transmitted and about what defines a survivor, and it may influence how vaccines should be developed and tested. “The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection,” Eugene Richardson from Stanford University and his colleagues wrote. “These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak.”

A new study raises the terrifying possibility that the Ebola virus outbreak in West Africa may have been larger than anyone realized. During the height of the crisis, the military quarantined whole villages, and so many people were dying very painful and very visible deaths that there wasn't enough time to bury them. At the time, the idea that there might be a significant number of people infected with the virus but with minimal or even no symptoms was not something that public health officials had much time to think about. This may have been an important oversight.  Their work focused on one village in the diamond-rich district of Kono in eastern Sierra Leone. From October 2015 to January 2016, they collected blood samples from 187 people from homes that had been quarantined because of possible exposure to an Ebola patient. The scientists found that 14 individuals who had not been previously identified as having Ebola were infected. Only two of them said they had had a fever during the time when the virus was spreading, but the other 12 days they didn't notice any signs or symptoms. While this study is very small relative to the 28,000 cases of Ebola that have been reported during the outbreak, it raises important questions about how the virus is transmitted and about what defines a survivor, and it may influence how vaccines should be developed and tested. “The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection,” Eugene Richardson from Stanford University and his colleagues wrote. “These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak.”

Study: People make a staggering number of mistakes when giving medicine to children

There’s been a lot of publicity about errors hospitals make when administering medication. But a new study shows there’s a big problem at home too: One child every eight minutes is improperly medicated. The most common error: double-dosing, or inadvertently giving a child the same medicine twice, which strongly suggests parents should make a note every time they administer a dose. Fortunately, only rarely are the consequences of error deadly. These are among the findings of a large new study published in the journal Pediatrics. It’s based on data from the National Poison Database System covering the years 2002 to 2012 — which makes it conservative, since not everyone winds up reporting an error or even knows they’ve made an error and thinks to call a poison control center.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Here are the numbers: The study said 696,937 children younger than six experienced out-of-hospital medication errors. That averages to 63,358 episodes per year, the study said, or one every eight minutes. The average annual rate of medication error was 26.4 per 10,000 people. The younger the child, the more likely there is to be an error — in part, the study suggests, because older kids can tell someone that they’ve already taken their dose. Analgesics — pain relievers — were the medication most commonly involved in errors, followed by cough and cold preparations. Twenty-seven percent of the errors involved double-dosing. Other mistakes include other incorrect dosages, confused units of measure and giving the wrong medicine. According to the study, 93.5 percent of the errors could be managed without going to a health facility. Only 5.1 percent required admission to a health-care facility. A total of 25 children died.

Odds are you won’t get Zika. But it’s only human to worry that you might.

There is a serious disease outbreak in Brazil right now. And then there is the Great Zika Freakout, the part of this outbreak that is offering some interesting lessons about the emotional nature of risk perception and how our fears so often don’t match the facts. You wouldn’t know it from the World Health Organization’s declaration of a global public health emergency, or all the dramatic news coverage, but while the microcephaly risk from Zika is real, at this point it’s lower than you might expect, given the alarms. The rate of confirmed microcephaly cases (641) out of total births in Brazil (roughly 3 million) is about 2 in 10,000. While that does make it a real public health concern, it’s hardly the imminent danger many might assume. But as the West Nile virus scare reminded us in 1999-2000, even when the probabilities are low, new risks scare us more than those that have been around a while. As the excessive fears of childhood vaccines illustrate, we are super-sensitive to any risk to kids. And as countless examples teach, when we can’t escape 24/7 alarmist news coverage of the risk du jour (shark attacks, childhood abductions, rare but frightening mass shootings), that elevated awareness magnifies our sense of danger, too. The Zika Freakout may not match the numbers, but psychologically it makes sense.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It’s also demonstrating how readily we abandon critical thinking and believe even the wildest claims when those claims fit our values and beliefs. One example: On a Reddit board devoted to conspiracy theories, someone suggested that genetically modified mosquitoes being tested in Brazil to control mosquito populations caused the Zika/microcephaly outbreak. (The modified bugs breed offspring that die, so the population crashes.) Despite such an overtly questionable source, and numerous glaring inaccuracies that were quickly reported by responsible journalists, the “genetic modifications cause Zika” notion quickly spread. Within days of that Reddit post, the theory was repeated by the environmental journal the Ecologist, London’s Daily Mail newspaper, the anti-GM and anti-West Russian government (they also blamed Bill Gates directly) and anti-GM websites.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The viral spread of the theory demonstrates how readily our fears are informed more by underlying emotions and values than careful evidence-based thinking. Those underlying values in this case are clear. A link between Zika and genetic modification taps a widely held sentiment that human technology and behavior are fouling up the natural world (a view I generally share). Some who feel this value most passionately blame humans for almost anything that goes amiss in nature, concocting a set of facts that fit those beliefs. It’s automatic, the environmentalist version of, “If you only have a hammer, everything looks like a nail.” A new theory of what caused the Zika outbreak also rises from those beliefs. Anti-GM advocates in Argentina now blame an industrial pesticide used to control mosquito populations, despite the fact that this particular chemical has been globally approved by health agencies and has been safely used for decades in areas infected by Zika, with no microcephaly outbreak. Along with this claim, advocates warn that “chemical control is contaminating the environment as well as people,” that the use of larvacide to control mosquitoes “is in fact a commercial maneuver from the chemical poisons industry,” and to top it all off, that the larvacide is manufactured by a subsidiary of Monsanto (which is incorrect). Like the purported link between genetic modifications and Zika, such allegations resonate with the values of environmentalists, who accept and spread the claim without skepticism or critical thinking despite the overt bias of the source.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Research suggests that we do this sort of thing — motivated reasoning based more on how we feel than simply what the facts say — for profound reasons. It helps us survive _._ We uncritically accept claims that support our values because such claims provide evidence of the truth of our beliefs. That helps us argue that our values are the ones that everybody should hold, that society should operate along our guidelines, not according to the values and beliefs of other groups or tribes. We prefer, and feel safer, in a society operating by our rules. And adopting values-based views that are shared by those in the groups we most closely identify with establishes us as loyal members of the group, worthy of the group’s support and protection, a vital goal for social animals like us. These are powerful subconscious influences on cognition, motivations way more powerful than the goal of just objectively figuring stuff out.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico This motivated reasoning shapes our views on politics or religion or economics or, well, on pretty much anything, not just how we feel about Zika or other risks. But with risk, this feelings-based system — what researchers Paul Slovic and Melissa Finucane call the Affect Heuristic — has consequences. Some areas in Brazil, threatened not only by Zika but dengue and Chikungunya viruses spread by the same species of mosquito, are holding back on using that larvacide. Many places around the world facing mosquito-born diseases that sicken and kill millions are fighting the use of the genetically modified mosquito that could help protect public health. The values-based fear of these technologies, in denial of robust evidence of their safety and efficacy, is blocking their use. People are getting sick and dying as a result.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico We can’t entirely overcome the innately subjective nature of human cognition and become perfectly objective, fact-based, critical thinkers. But we can recognize the dangers from affective thinking that cause us to worry about some things more than we need to, and worry about some things less than we should. We can recognize and take more seriously the risks that these risk _mis_ perceptions can create. We can realize that a little more careful thinking, and just a touch of skepticism about the latest scary claim, even if that means letting the evidence push back against our own values just a bit, could help keep us safer. It’s one of the lessons the Zika panic is offering us — if we’re smart enough to listen.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Ebola vaccine shown to be ‘highly protective’ against deadly virus in major trial

Although the current outbreak has been contained, health officials fear the deadly pathogen could come back and have been racing to develop new ways to stop it should that scenario unfold. The new study, led by the World Health Organization, was based in a coastal region of Guinea known as Basse-Guinee. The vaccine showed 100 percent efficacy in protecting those who got it. More than 11,800 people participated in the trial. “While these compelling results come too late for those who lost their lives during West Africa’s Ebola epidemic, they show that when the next Ebola outbreak hits, we will not be defenseless,” Marie-Paule Kieny, the study's lead author and WHO assistant director general for health systems, said in announcing the results. When preliminary findings were unveiled in July 2015, WHO Director General Margaret Chan called the vaccine a potential “game-changer.” Guinea was one of three West African nations hit hardest by Ebola beginning in 2014. Researchers are running two parallel studies of the same vaccine in Sierra Leone and Liberia, the other epicenter countries. The vaccine used in the study, known as rVSV-ZEBOV and licensed by Merck, involves just a single shot. Both the U.S. Food and Drug Administration and the European Medicines Agency have designated it for streamlined regulatory approval. A number of other vaccines — developed by GlaxoSmithKline and the Beijing Institute of Biotechnology, among other groups — also have shown promise and are advancing in human trials.   At the beginning of the trial, which took place in 2015 when the virus was still actively spreading in the region, the rings were randomly divided into two groups. One was to get the vaccine immediately and the other after a three-week delay. When the first results showed that the vaccine was working, everyone was offered it immediately. Those 18 and older got it initially, then children older than 6. The results were striking: In the group of 5,837 people who received the vaccine immediately, there were zero Ebola cases. In the other group, which included those who got a delayed vaccination as well as those who were never vaccinated, there were 23 cases. Kieny and research team members from Guinea’s Health Ministry and other international partners also noted that vaccination appeared to create a type of “herd immunity” that indirectly protected people who had not been vaccinated. But more research will be needed to confirm this theory, they said. Two serious adverse events were reported after vaccination, with one participant spiking a fever and another suffering an allergic reaction. Everyone else either reported no side effects or very mild ones such as headache, fatigue and muscle pain. No effects were long term. Despite researchers' caution that more studies are needed to confirm the vaccine's safety for children and other vulnerable groups, such as individuals with HIV, they already are making plans to accelerate its rollout should future trials further confirm safety and effectiveness. Merck has committed to having 300,000 emergency doses available soon and to submit the licensing application to regulatory authorities by the end of 2017. In a commentary piece — optimistically titled “First Ebola virus vaccine to protect human beings?" — virologist Thomas Geisbert of the University of Texas wrote that the study data were so strong that it seemed likely that the vaccine “probably contributed to controlling the 2013–16 outbreak of Ebola virus disease in Guinea." As encouraged as he seemed by the study, Geisbert also raised a number of questions. Researchers still don't know whether the vaccine is long-lasting, he said, asking, “Is it still protective, for example, 2-3 years after the vaccination?” He also noted that safety questions came up in the early testing. Still, he wrote, “After 40 years we appear to now have an effective vaccine for Ebola virus disease to build upon.”

Genetic tests could explain why some children and teens die unexpectedly

By the time I first heard his name last summer, while working at my pediatric cardiology clinic at the University of Massachusetts Medical School, his face was all over the local television broadcasts. Josh Thibodeau, an active 12-year-old attending his first day of soccer camp in the town of Holden, had suddenly collapsed during a low-   intensity passing drill. His younger brother Adam looked on in horror as emergency crews started chest compressions and tried to revive Josh with a defibrillator before rushing him to the hospital. Josh’s parents, Deb and Ralph, arrived in the emergency room quickly, but they were too late. “The doctor came in to talk to me,” Deb told me recently. “It was very scripted, like on ‘E.R.’: ‘We have the best people.’ ‘We did all we could.’ ” Josh’s death plunged the Thibodeaus into what Deb called “a state of nonreality.” It was hard for them to fathom what had happened. Until the sunny July day when he died, Josh had been the picture of health: a goofy, messy kid with a dry sense of humor, a great concern for fairness, a smile that lit up a room. The family’s grief, Deb wrote me, was “almost unimaginable.” Every year, researchers estimate, several thousand apparently healthy infants and children in the United States die suddenly and unexpectedly. Unlike with deaths in older people, there often is no obvious cause, such as violence or overdose. Sometimes an autopsy detects an unsuspected condition such as brain bleeding, poisoning or infection. But otherwise, the fatality is labeled a case of sudden unexplained death. (In children up to age 1, the term is sudden infant death syndrome, or SIDS.) It defies obvious solution. Observational studies from the 1980s showed that sudden deaths seemed more common in babies placed on their bellies. A national “back to sleep” campaign begun in 1994 led to an initial decline in infant deaths — perhaps in the fraction of fatalities caused by accidental suffocation — but for more than a decade now rates of unexplained sudden demise in infants and kids haven’t budged. Without a clear diagnosis, families such as the Thibodeaus worry that another relative could drop dead at any minute. Compounding the problem is that few of the thousands of medical examiners and coroners across the country are accredited, according to Andrew Baker, president of the National Association of Medical Examiners. Some of these examiners — their ranks can include elected officials without formal training — never look at the child’s heart or brain in detail. Some perform X-rays and full toxicology tests in children who die suddenly; others check only for alcohol. Nationwide, there is no consensus or regulatory guidance on how to do autopsies on kids such as Josh, which makes it difficult for researchers to examine the phenomena of sudden unexplained death. “Our extended families lived in fear,” said Josh’s mother, who has four other children and more than a dozen nieces and nephews. In 1998, Michael Ackerman, a researcher at the Mayo Clinic in Minnesota, heard about a 19-year-old athlete who had died after nearly drowning in only four feet of water while swimming at a fitness club in Iowa. At the time, Ackerman and several colleagues were studying a genetic disease called long QT syndrome. Characterized by a hidden defect in certain cardiac cells, the syndrome had several bizarre variants. One type results in cardiac arrest when patients hear sudden noises, like ringing from alarm clocks. Another caused a fatal rhythm problem when someone jumps into water. Suspecting that the Iowa victim had had that condition, Ackerman performed the world’s first “genetic autopsy,” using DNA extracted from her heart at autopsy, to show that she had long QT syndrome. He published the results in the New England Journal of Medicine and then determined that the woman’s surviving sister also had the problem, which was treatable. Thinking he was on to something, Ackerman got dozens of medical examiners in Minnesota to send him blood samples from sudden-death autopsies in young adults and children. He found that one-third had long QT syndrome or similar treatable genetic mutations affecting the heart. Roughly one-fifth of all SIDS cases in particular also showed it. In another study, 30 percent of victims of unexplained drowning tested positive for similar heart problems. (In Southeast Asia, researchers have found that another genetic cardiac condition, Brugada syndrome, causes many cases of sudden death.) A 2007 editorial in the Journal of the American College of Cardiology commented that genetic autopsy should “become part of the routine post-mortem study” in sudden unexplained deaths — not just to offer closure to families, but to save relatives from the same fate. Though not directly involved in Josh Thibodeau’s care, I was aware of Ackerman’s research and asked the medical examiner handling his case to save blood for a genetic autopsy after I saw television reports about Josh’s sudden death. Ultimately, Josh’s body was taken to Boston for autopsy, and several tubes of blood were saved. After receiving consent from the Thibodeaus, our medical team helped the family send the tubes for DNA analysis. A few weeks passed before the results were faxed to our office. The genetic autopsy showed a mutation causing excessive heart muscle growth and rhythm disturbances — a disorder called hypertrophic cardiomyopathy. Microscopic testing of Josh’s heart confirmed the diagnosis, and, reassuringly, additional genetic testing showed that none of his relatives carried the mutation. (Amazingly, however, testing showed that Josh’s brother Adam has long QT syndrome, which was entirely unrelated to Josh’s problem. Adam is now on a daily medication to prevent sudden death. He still plays competitive soccer.) Because of the testing, Deb and her husband now know that they and their surviving children are safe. “Genetic autopsies aren’t about the children who have died,” Deb observes. “They’re about those who were left behind.” Given how helpful such autopsies can be, why aren’t more done? A large reason is the cost. In Josh’s case, our team found a sympathetic claims reviewer at Blue Cross Blue Shield, who approved a genetic autopsy despite having no obligation to pay. But in most cases, once someone dies, health insurance does not pay for any further diagnostic testing. Labs charge $2,500 to $5,000 for the analysis, which the medical examiner’s office must pay, roughly doubling or tripling the cost of an autopsy. As a result, none do the testing routinely in cases of sudden unexplained death and many never inform people of its availability. I recently asked Henry Nields, the chief medical examiner for Massachusetts, how many genetic autopsies were performed among the dozens of children with unexplained sudden death in the preceding 12 months. To his knowledge, Josh Thibodeau’s was the only one. Lisa Salberg, who runs the nonprofit Hypertrophic Cardiomyopathy Association, regularly scans news wires for stories of sudden unexplained death, and she calls medical examiners out of the blue to suggest genetic autopsies. In 2009, a 14-year-old named Ian Artola was bare-knuckle sparring with a friend — one bystander called it “a little fight club” — at a New Jersey park when he collapsed and died. On rare occasions, a blow to the chest from a karate kick or a baseball at precisely the wrong moment can disrupt the heart, causing sudden death. If that’s what killed Ian, his friend would live with lifelong guilt. Hearing the story, Salberg called the county’s medical examiner, and her group offered to fund a genetic autopsy on the teen. “I know I sound like a stalker,” Salberg tells me. “I’m calling them saying, ‘I know you’ve got this body.’ ” Ian’s family consented to the test, and the results vindicated Salberg’s hunch: The teen had the same problem as Josh Thibodeau. Further testing showed that his sister was fine but that his mother carried the gene. She is now monitored regularly. No doctor or medical examiner or public health authority saved that mother’s life. Instead, a determined stranger made a phone call. The problem, though, is that someone such as Salberg may not hear about the next case. Sanghavi is chief of pediatric cardiology at the University of Massachusetts Medical School. He writes widely on medical issues and is the author of “A Map of the Child: A Pediatrician’s Tour of the Body.”

Outbreaks of disease may not boost vaccination rates. Here’s why.

When an outbreak of a vaccine-preventable infectious disease hits, how might people in the affected area respond? You might think once parents become aware of vaccination's benefits, they would choose to get their children fully immunized. As it turns out, at least in one case, that conventional wisdom didn't hold. Washington state's 2011-2012 whooping-cough outbreak didn't increase the number of infants who were fully up-to-date with their whooping cough immunizations, a new study suggests. In recent years the U.S. has experienced a number of outbreaks of vaccine-preventable infectious diseases such as pertussis (whooping cough) and measles, both previously rare in the United States. Vaccination rates have actually grown nationally over the past couple of decades. But health officials in recent years have reported increases in the fraction of parents who don't have their children fully vaccinated or who seek vaccination exemptions for their children. Often, large numbers of non-vaccinated or under-vaccinated children are clustered together, particularly in areas or states where it's easier for parents to get exemptions from school vaccination requirements. The rareness of such diseases might have reduced public awareness of the benefits of the vaccinations that are so crucial to preventing their spread. But it's also clear that the anti-vaccine movement has gained more traction.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday And rising proportions of non-vaccinated or under-vaccinated children very likely played at least some role in past whooping-cough outbreaks. Research has linked clusters of non-medical exemptions in California to the state's whooping cough outbreaks in 2010.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday With whooping cough, another factor may be at play. For reasons researchers still are trying to understand, a relatively new formulation of the children's whooping-cough vaccine doesn't appear to work as well as its predecessor. Although the vaccine still protects most people who get it, that protection may wane faster than before. That doesn't mean we should stop administering the vaccine; rather, it means that the public-health risks of _not_ vaccinating become magnified.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday But Washington state has had a strong anti-vaccine movement, and it shows in how many parents received non-medical vaccination exemptions for their kids in recent years. In the late 2000s, the percentage of kindergarteners who received at least one exemption from a vaccination surged, peaking at a whopping 7.6 percent in the 2008-2009 school year.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday The state went on to suffer an epidemic of whooping cough in 2011 and 2012 that made national headlines. Since then, the state's recently toughened requirements to receive an exemption have helped cut exemption rates, but the damage may have already been done.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday In the epidemic's immediate aftermath, did vaccination rates rise for whooping cough? To answer this question, Elizabeth Wolf of the University of Washington-affiliated Seattle Children's Research Institute and her colleagues assessed state immunization records from September 2011, before the epidemic, and September 2012, after it had started, and they determined whether Washington infants (3 to 8 months old) were up-to-date on their diphtheria, tetanus and pertussis (DTaP) vaccine. Infants were considered up-to-date if they had received one dose of the DTaP vaccine by 3 months old, another dose second by 5 months old and a third dose by 7 months old. Wolf and colleagues had predicted that a lot more infants statewide would be up-to-date after the outbreak. But to their surprise, the proportion of infants who were up-to-date increased only 2.1 percentage points, from 67.4 to 69.5 percent. That change, the researchers said, was too small from a statistical standpoint for them to conclude that more infants were up-to-date post-epidemic. What do the findings tell us? "This finding may challenge the assumption that vaccine acceptance uniformly increases when risk of disease is high," Wolf said in a statement. She and her colleagues presented the findings at a recent scientific meeting in Vancouver, British Columbia.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday It's only one study of one outbreak, so in that regard we should be cautious in how we apply these findings to other outbreaks. But the findings should give pause to public-health officials, who are already having to combat strong anti-vaccine sentiment as they try to encourage parents to keep their children up-to-date on their vaccinations. If an epidemic isn't enough to boost vaccination rates, one might wonder: What is? "Our results support the idea that there is likely not one issue or strategy that will convince all hesitant parents," Wolf told me in an email. Researchers will have to figure out which combinations of approaches work best on specific groups of hesitant parents, she suggested.

Why are mass shootings becoming more common?

The news on Friday was horrific. A man shot and killed 27 people, including 20 children, at an elementary school in Newtown, Connecticut. Yet these sorts of headlines are also becoming eerily familiar. Of the 12 deadliest shootings in U.S. history, six have taken place since 2007. (The Newton school shooting will likely rank second on that list.) Mass shootings appear to be on the upswing — even as other types of homicides and violent crimes are becoming less frequent. David Brooks highlighted this discrepancy back in July. For much of the 20th century there were, on average, a handful of mass killings per decade. But that number spiked in 1980, and kept rising thereafter. In the United States, there have now been at least 62 mass shootings in the past three decades, with 24 in the last seven years alone, according to a recent Mother Jones survey. This has happened even as the nation's overall violent crime and homicide rates have been dropping. So what explains the apparent rise in mass shootings? One theory is that certain types of killing sprees are somehow contagious. Back in 1999, four public health researchers published a famous study titled "Media and Mass Homicides" in the Archives of Suicide Research. They studied a series of mass homicides in Australia, New Zealand, and Britain in the 1980s and 1990s and found that different incidents appeared to be influenced by each other in a number of ways, often spanning many years and across continents. The idea that one violent rampage might inspire another has given rise to plenty of articles and papers about whether the press should be more conscientious in the way it reports on these events. Giving a murderer too much publicity might be a bad idea. A great deal of research, however, suggests that behavioral scientists just don't have a strong grasp on what drives mass shootings and violent rampages, or why they've increased in recent decades. Here's how a 2010 article in the Journal of Police and Criminal Psychology sums it up: And here's a 2012 article from the American Journal of Public Health, coming to a similar conclusion: Mental illness is one likely factor — a survey by Mother Jones found that at least 38 of the 61 mass shooters in the past three decades "displayed signs of mental health problems prior to the killings." Yet the studies above note that researchers still have a ways to go before they understand the exact connection between the two. And what about the availability of guns as a factor? Researchers have found a connection between guns and homicide — more guns tend to lead to more murder. And guns will obviously make any mass attack far deadlier. Note that there was also an attack on 22 students in a Chinese elementary school on Friday. But there was a key difference: The man only had a knife, and there were zero fatalities. Again, though, overall gun violence in the United States has been declining in recent years while mass shootings appear to have become more commonplace. It's not entirely clear why that is. And it's an increasingly important question. ** _Update_ :** It's also possible that mass shootings simply _aren't_ on the upswing at all. See this newer post for data suggesting that these shootings have remained constant since 1980, and haven't increased at all.

Mississippi – yes, Mississippi – has the nation’s best child vaccination rate. Here’s why.

But there is one notable exception to these dour health stats: Mississippi has the highest vaccination rate for school-age children. It’s not even close. Last year, 99.7 percent of the state’s kindergartners were fully vaccinated. Just 140 students in Mississippi entered school without all of their required shots.  “It’s nice not having measles in Mississippi,” said Mary Currier, Mississippi state health officer. The secret of Mississippi’s success stems from a strong public health program and — most importantly — a strict mandatory vaccination law that lacks the loopholes found in almost every other state. In the Magnolia state, public health trumps parental choice. In other states, parents have increasingly used exemptions to avoid immunization mandates amid fears that the shots are harmful or unnecessary. Medical authorities have discredited these safety concerns. But a broad scientific consensus on the safety of vaccinations has not slowed exemption demand. Today, Mississippi and West Virginia are the only states that don’t allow parents to claim religious or philosophical exemptions to the rules for vaccinating children before they enroll in school. Only medical exemptions are allowed in Mississippi and West Virginia, as they are in every state. But medical exemptions — which might include a child with a weakened immune system — remain rare. They accounted for only 11 percent of exemptions last year, according to the Centers for Disease Control and Prevention. The rest were religious or philosophical exemptions. Last year, more than 91,600 U.S. kindergartners had one — creating a sizable group of potentially unvaccinated or under-vaccinated children.  But, Salmon said, he doesn’t oppose all nonmedical exemptions. The exemptions just needed to be narrow, and parents should be educated about the risks of not vaccinating. “This is a balancing act,” Salmon said. “There are important policy implications [to allowing parents to make decisions about their children’s health]. But it shouldn’t be easy — the path of least resistance.” Along with religious exemptions, 19 states also allow parents to claim philosophical exemptions. Together, these personal belief waivers — some requiring nothing more than checking a box of a health form — have surged in popularity. Arkansas and Texas added them in 2003. But four other states recently introduced rules aimed at making them slightly harder to obtain. California last year began requiring a health-care worker to at least sign off. In the early 1970s, the CDC found that states with school vaccine mandates had about half the measles rate of states without the laws. By 1980, every state had a law on its books. But over the years, more and more states added exemptions. The lack of a religious exemption in Mississippi — where lawmakers recently passed a bill allowing prayer at some school functions — might be surprising. But attempts to add a religious excuse there have failed. In 1979, the Mississippi Supreme Court wrote a strongly worded defense of the state program, “Is it mandated by the First Amendment to the United States Constitution that innocent children, too young to decide for themselves, are to be denied the protection against crippling and death that immunization provides because of a religious belief adhered to by a parent or parents?”  “We’re hopeful,” said Mary Jo Perry, co-director of the vaccine rights group. “I think what we’re asking is reasonable.” Perry, who lives outside Jackson, Miss., is not the stereotypical anti-vaccine activist. All three of her children are completely immunized. But her youngest child suffered seizures after a whooping cough vaccine when he was young. She wished she could have delayed or skipped the shot. In other states, she might have had that right. “I think Mississippi has been exploited by its reputation for ignorance,” she said. But Currier, who runs the state health department, said the lack of exemptions is important. Mississippi faces enough health challenges without worrying about measles or whooping cough. “What we really don’t need is another area we do poorly in and hurt our children,” Currier said. Still, the state public health officials responded to the pressure to change. In 2009, the state relaxed its requirements for medical exemptions. Parents used to need a doctor to submit paperwork to a county health official, who would evaluate whether the exemption was warranted. Medical exemptions were difficult to obtain. But, Currier said, the state now approves all medical exemptions it receives from doctors. Last year, all 130 requests were approved. “We saw the need for a pop-off valve” for the building anger about the strict state mandate, Currier said. Public health officials also are worried about proposals to change the vaccination laws in West Virginia, the only other state without personal belief exemptions. “Our position is we have some of the best immunization laws in the country,” said Rahul Gupta, West Virginia state health officer.  The face of the United States looks like it’s suffering from a severe case of chicken pox. But the complexions of Mississippi and West Virginia are clear. The colored dots stop at the states’ borders. Gupta pointed out that a measles epidemic last year in Columbus, Ohio, which infected 377 people not far from West Virginia, never made it into the Mountaineer state. “Immunizations work,” Gupta said. “It’s not rocket science.”

More parents believe vaccines are ‘unnecessary,’ while a mumps outbreak grows

The AAP study involves a random sampling of about 630 members in 2006 and again in 2013. They found that in 2006, 75 percent of pediatricians who responded had encountered parents who refused vaccines. By 2013, it was up to 87 percent. That’s a big change, but the more interesting part of the survey is why. In 2006, the No. 1 reason parents were refusing vaccines was because of concerns about the ingredient thimerosal causing autism. In 2006, 74 said it was about autism. In 2013, that number had declined to 64 percent. Now, more parents are refusing the vaccine on the grounds that they are “unnecessary” — 73.1 percent in 2013 vs. 63.4 percent in 2006. Moreover, even parents who believe in vaccines appear to be delaying the shots that are supposed to be given on a strict schedule to maximize their effectiveness. Seventy-five percent of pediatricians said that parents asked for delays because of worries about their child's "discomfort" and 72.5 percent because of a concern "for immune system burden."  The rapid speed at which a modern outbreak can spread was underscored in 2014-2015 when a single unvaccinated child with measles at Disneyland in California started an outbreak that spread to 146 people, many of whom were also unvaccinated. There were no deaths, but many became so seriously ill that they had to be hospitalized.  The AAP paper’s publication coincidentally comes during a week when there’s yet another outbreak in the United States of an infectious disease we can prevent through immunizations. In recent months, at least 36 people have contracted mumps — whose symptoms include puffy cheeks and possibly serious respiratory symptoms — in one Long Island town.  The AAP expressed alarm about the findings of the study, stating that "parental noncompliance" with the recommended schedule of the Centers for Disease Control and Prevention "is an increasing public health concern." If the AAP’s urging and the description of some of these outbreaks isn’t enough to persuade you to get yourself or your kids vaccinated, there’s also this. The pediatrician survey also showed that more doctors are pushing back at parents who refuse vaccines for their children. In 2006, only 6.1 percent said they “always” dismiss patients for this. In 2014, 11.7 percent said they always dismiss patients. So if you continue to refuse vaccines, it’s your right — but it may be harder to find a pediatrician willing to support that choice than before.

Measles outbreak in Minnesota surpasses last year’s total for the entire country

Minnesota’s measles outbreak has exceeded the total number of cases reported in the entire United States last year, with no sign of slowing. Health officials worry that the holy month of Ramadan, which began Friday night and brings Muslims together in prayer and festivities, will accelerate the spread of the highly infectious and potentially deadly disease, which is plaguing the close-knit Somali American community. Minnesota health officials are working closely with faith leaders in an unprecedented effort to spread the message that parents should get their children vaccinated and keep them home if they show symptoms of the disease. It’s the first time imams in the United States have taken such an active role in a public health crisis, health officials and Somali Americans said. The imams are up against the anti-vaccine movement, which in recent years has targeted the Somali American community with misinformation linking the measles-mumps-rubella vaccine to autism, a claim that extensive research has disproved. Somali American children in Minnesota had a vaccination rate of 92 percent in 2004, higher than the state average, but that rate has dropped to 42 percent, leaving children vulnerable to disease. Faith leaders and health professionals need to work side by side, said Sharif Mohamed, who has been the imam of his mosque in Minneapolis for nearly 20 years. “The imams emphasize the role of the parent and the role of faith to keep people safe from any disease — not just yourself, but the entire community and also the state — so people have to be responsible citizens and do their part,” he said. “Health professionals can focus on the linkage between the vaccine and the measles. I think we can win the battle.” Health officials say there have been at least 8,250 exposures in day-care centers, schools, hospitals and clinics. As of June 1, there were 73 confirmed cases, the Minnesota department of health announced, most of them in unvaccinated preschool children. A significant number have been hospitalized. Last year, the United States recorded 70 measles cases. Although the largest number of cases are in the Somali American community, the disease has begun to spread to the broader community through the Minneapolis public school system, infecting six white children. Unfounded fears about vaccines have circulated among some in the white community for decades. “It’s white, middle-class parents who have made a decision not to vaccinate and feel very strongly about that choice,” said Kris Ehresmann, director of infectious disease epidemiology at the Minnesota Department of Health. The outbreak in Minnesota has been fueled by local and national anti-vaccine groups that organized meetings in the Somali community. Andrew Wakefield, the founder of the modern anti-vaccine movement, visited Minneapolis at least three times in recent years to talk to parents. At one meeting, during a smaller measles outbreak in 2011 that also affected Somali children, he downplayed the severity of measles, according to a health official. In an interview, Wakefield, whose falsified 1998 study purported to link vaccines to autism, has said he feels no responsibility for the current measles outbreak. At least 50 children have been treated at Children’s Hospitals and Clinics of Minnesota, and 20 have been hospitalized, staying an average of five days, said Patsy Stinchfield, who oversees infection control at Children’s. Some of the children are suffering severe dehydration because their mouths are so sore that they can’t drink or swallow, she said. One child was hospitalized for 17 days. Some children who were discharged had to return to the hospital because of continuing respiratory problems. “We don’t see a plateauing,” Stinchfield said. “We’ve geared up for working on this through the summer.” But there have been some encouraging signs. Since the outbreak began in early April, there has been a surge in vaccinations as parents have seen firsthand the severity of the disease. Statewide, the number of measles-mumps-rubella vaccine doses given before the outbreak was about 2,700 per week. Since the outbreak started, the health department has seen as many as 9,700 doses given in a week. For ethnic Somali children between 2 and 13 years old, the department typically administered about 30 doses a week before the outbreak. That number began to rise after the outbreak started and reached more than 500 doses a week at the end of April and early May, Ehresmann said. Despite the worst measles outbreak in the state in nearly 30 years, anti- vaccine groups have stepped up efforts to spread their message there. At a recent community forum in Minneapolis about the MMR vaccine, an anti-vaccine advocate handed out printouts that claimed the vaccine can cause permanent brain damage and death, according to a Public Radio International report. “When you have an open community meeting, that does allow a forum for the anti-vaccine groups to come and continue to present their misinformation,” Ehresmann said. Health department officials in Columbus, Ohio, and Seattle, home to other large Somali American communities, worry that the disease or misinformation or both could spread to their areas. They have increased outreach, adding education forums and programs to air on Somali-language television. “There is a strong oral tradition in the Somali community, and Somalis in Minnesota have shared the message from the anti-vaccine groups with the community in the Seattle area, so there has been indirect influence from these groups,” said Libby Page, who manages the immunization program for Seattle and King County. According to the Washington State Department of Health, only 65 percent of infants born to Somali families in 2013 had received one or more doses of MMR by 23 months, even though federal guidelines recommend that vaccinations begin at 12 to 18 months. Columbus’s Somali community of 50,000 to 60,000 people is second only to that concentrated in Minneapolis, with about 90,000. There is much travel between the two communities for family gatherings, such as weddings and graduations, as well as for Ramadan. The most important message will come from imams, the most trusted community leaders, health officials say. Clinicians from Children’s Minnesota and Hennepin County Medical Center are working with a group of 30 imams and mosque executive directors who are eager to participate. During the group’s monthly dinner meeting in late May at the Dar Al-Farooq mosque in suburban Minneapolis, faith leaders sat at tables covered in white tablecloths and listened intently as clinicians explained that there is no medicine for measles. They showed photos of Somali children covered in rashes, as well as a chart illustrating the drop in MMR immunization rates. Clinicians also described the characteristics of autism. The condition is often recognized at the age of 12 to 18 months — around the time the first dose of MMR is recommended. The timing is coincidental, but still makes some families incorrectly assume the vaccine caused autism. (In fact, brain abnormalities associated with autism have been detected much earlier and may emerge during fetal development.) “They were really listening,” said Stinchfield, who led the presentation. “You could hear a pin drop.” Several imams stood up to talk. Some spoke with great passion about their responsibility to make sure children in their community and the broader one do not die of a preventable disease. “They very much shared our sense of urgency about this topic,” Stinchfield said. “They very much confirmed they are allies with us. We are going to work together.” Some of the actions under consideration include suggestions for messaging during each night of Ramadan, immunization clinics at individual mosques, education forums to explain how the measles virus spreads, and sessions about autism. For imams such as Mohamed, who is partnering with the Minnesota health department, that additional information will give faith leaders a stronger voice to battle falsehoods. “I think we will at least reduce the attack from the groups with anti-vaccine message,” he said. “They had a very loud voice. But they didn’t get a group of strong imams. We will have impact.”

More pandemics are inevitable, and the U.S. is grossly underprepared

WHILE IT has not gained much attention in the United States, Brazil has been struck in recent months with an outbreak of Zika virus that has infected hundreds of thousands of people. Most of the time the symptoms are mild and flu-like, but in some cases health officials say the virus has led to birth defects in babies born to women who were infected in pregnancy. The virus is spread by small insects such as mosquitoes or fleas, and there is no known vaccine to prevent infection. The Zika story might seem easy to dismiss if one is not living in Brazil. Is this just another unpleasant headline about misery far away? Not quite. In the aftermath of the mishandled and tardy reaction to the Ebola epidemic in West Africa in which more than 11,000 people died, an independent and authoritative commission was set up in the United States to look ahead and draw lessons from this and other recent waves of infectious disease. The 17-member Commission on a Global Health Risk Framework for the Future issued its final report on Jan. 13, and the panel’s conclusions are a wake-up call about the threat of pandemic disease that could originate almost anywhere and spread everywhere. Despite all the advances of science, “the global community has massively underestimated the risks that pandemics present to human life and livelihoods,” the group declared. “There are very few risks facing humankind that threaten loss of life on the scale of pandemics.” The 1918 influenza pandemic killed anywhere from 50 million to 100 million people; in catastrophic mortality events since 1900, only World War II caused more deaths. Since it first appeared, HIV/AIDS has killed more than 35 million. Although the tolls have been far lower, five outbreaks in the past 15 years have been worrying: severe acute respiratory syndrome, or SARS; two influenza waves, H5N1 and H1N1; Ebola; and Middle East respiratory syndrome, or MERS. As the world becomes more globalized with the movement of goods and people, as climate change disrupts the environment, and as pathogens move between humans and animals, cocktails of infectious disease will form, spread and sicken. Already a dozen cases of Zika virus have been reported in the United States, so far only among people who had traveled outside the country. “The threat from infectious diseases is growing,” the panel warns, adding that “the conditions for infectious disease emergence and contagion are more dangerous than ever.” Moreover, “further outbreaks of new, dormant, or even well-known diseases are a certainty.” The commission insists that pandemic risks must be treated not as distant, unavoidable possibilities but as real national security threats. Just as nations invest in military preparedness, the panel says, so should they confront disease. In fact, this has been long neglected in many places. The panel calls for measures to bolster public health systems in individual countries; creating a rapid-response capability; strengthening the World Health Organization; and funding research and development of new therapies, all for about $4.5 billion a year. That’s the equivalent of three Powerball drawings like the one on the day of the panel’s report. **Read more about this topic:** The Post’s View: Everything went wrong in the Ebola outbreak. We’re still not ready if it happens again. Anthony S. Fauci: No more excuses. We have the tools to end the HIV/AIDS pandemic. Lawrence Summers: The world can’t hide from pandemics

Counting the young victims of firearm violence

LOBBYISTS FOR the National Rifle Association (NRA) have spent considerable time and money to discourage the collection and sharing of information related to guns and gun violence. Keeping the public in the dark about the facts is helpful in advancing an extreme agenda. In particular, the gun lobby has used the under-counting of gun accidents involving children to oppose reasonable policies that could help prevent deaths and injuries caused by the careless handling and storage of firearms. An investigative report by the New York Times has presented powerful evidence that federal statistics are incomplete on the number of children killed when a firearm is accidentally discharged. The Times’ Michael Luo and Mike McIntire reviewed hundreds of firearm deaths of children, going as far back as 1999, and — in four of five states examined — found twice as many accidental shootings as were tallied in federal statistics because of reporting peculiarities by medical examiners. By calling into question statistics that show children are more likely to die in falls or by drowning than from the accidental discharge of a firearm, the Times’ report undermined a key argument of the NRA in opposing sensible laws about safe storage of guns and the need to develop technology to make weapons childproof. The madness of opposition to common-sense safeguards was underscored by the heartbreaking stories of a baby fatally shot in his crib by his 2-year-old brother; a 3-year-old who killed himself with a pistol temporarily hidden under a couch by his father; and the 12-year-old girl killed by her brother whose finger slipped on a shotgun. “There are no accidents. There are simply irresponsible, stubborn, cowardly adults unwilling to stand up against the gun lobby and those who support it,” said Jodi Sandoval, whose 14-year-old son was killed in 2012 by a friend who didn’t think the gun he pointed at his friend was loaded. As troubling as the Times’ findings is what’s not known because of the NRA’s successful efforts to stamp out scientific research related to guns. The group successfully lobbied Congress in 1996 for an amendment that was widely interpreted as a ban on gun violence research at the U.S. Centers for Disease Control and Prevention. Only 18 states receive funding to participate in the CDC’s violent-death-reporting system. Scientific research, so critical in improving people’s lives and health, is virtually missing when it comes to guns and the violence that kills and injures tens of thousands of people each year. President Obama, in the aftermath of the Newtown, Conn., shooting and the horror of its 20 little victims, signed an executive order requiring more research on gun violence by the CDC and other federal agencies. But funding from Congress is questionable. It should not be too much to expect that this country gets an accurate count of how many of its children die each year in accidents involving guns and then uses that information to help devise solutions that can spare families such anguish. **Read more about this topic:** Eugene Robinson: The NRA’s tone-deaf rhetoric Aaron Kupchik: The flaws in the NRA’s school-security proposal Philip Caputo: Guns do kill people

Drowning, the silent epidemic

IN AN AGE of ethnic conflict, fatal disease and chronic malnutrition, it seems strange to stumble across figures such as this: 388,000 peopledie every year from drowning, according to the World Health Organization. To put this number in perspective, drowning accounts for nearly 1 in 14 injury-related deaths worldwide. It is the third-leading cause of unintentional death. It is also the greatest cause of injury and unintentional death among children younger than 5 in both the United States and Asia. This is a problem that traverses the developed and developing worlds. Predictably, however, those from poorer countries are at higher risk: The rate of death by drowning in Asia is 30 times higher than in the United States. In Bangladesh, Cambodia, Vietnam and Thailand, drowning is responsible for 1 in 4 child deaths — more than the number who die from measles, polio, whooping cough, tetanus, diphtheria and tuberculosis combined. What makes this public health crisis particularly problematic is that, unlike fatal disease and chronic malnutrition, drowning is not an issue at the forefront of humanitarian aid efforts. Drowning has gone largely unnoticed as a serious health matter because death counts, which rely primarily on hospital reports, fail to take drowning into account. Michael Linnan, technical director at the Alliance for Safe Children, told the Integrated Regional Information Networks that “the child drowning epidemic has been invisible.” The Alliance for Safe Children and UNICEF’s Office of Research released a report in May that found that nearly all drowning-induced deaths are preventable. Instead of allowing this problem to languish unaddressed, governments should mobilize support for demonstrably effective and low-cost prevention strategies. The report emphasized the long-term value of teaching children over the age of 4 SwimSafe techniques — swimming and rescue training — a program that reduced drowning rates by 90 percent in a research program in Bangladesh. Building low-cost bridges and other barriers is also an effective way to protect unsupervised children from water hazards. Gordon Alexander, director of UNICEF’s Office of Research, said that such “affordable interventions” could “save hundreds of thousands of children’s lives.” When the data are so clear and the solutions so straightforward, it is time to address what Mr. Alexander correctly termed this “hidden killer.” ****

CRS Report of the Week: ‘The Measles: Background and Federal Role in Vaccine Policy’

With measles cases popping up around the country, CNN/ORC surveyed Americans on whether vaccinations should be mandatory. Nearly 80 percent said yes, parents should be required to vaccinate their children. And nearly 60 percent said children who are not shouldn’t be allowed to attend public school. Other public polls have shown similar findings.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Whether vaccinating kids should be up to their parents or the government was a hot political topic early this month with probable presidential candidates weighing in. This week’s Loop Congressional Research Service Report pick looks at the federal government’s role in immunization policy. The federal government can buy and distribute vaccines, as well as keep data and funding research, but is “constrained in its ability to mandate the use of specific vaccines by individuals,” the report says. Requiring immunizations is a states issue. Our colleague Todd Frankel wrote last month that Mississippi (yes, Mississippi) has the lowest number of unvaccinated children in the country because it has “a strict mandatory vaccination law that lacks the loopholes found in almost every other state.”    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico States require children enrolling in public schools to be vaccinated, but there are exemptions for any number of reasons, including some states that allow parents to opt out for religious or philosophical reasons. Gov. Chris Christie (R-N.J.) and Sen. Rand Paul (R-Ky.) made headlines for wavering on whether vaccinations should be mandatory in early February, but in the heated aftermath, most politicians quickly asserted that they should be. The debate has resurfaced with the resurgence of measles in the United States. Last year, there were more than 600 reported U.S. cases — the highest by far in 20 years. In the first month of 2015 there were 102 cases. As of this week it’s up to 154 cases. While the annual rate of children getting their measles shots remains above 90 percent, “the increased number of imported measles cases, combined with pockets of unvaccinated individuals, has resulted in a larger number of outbreaks in recent years,” the CRS report says. Even though the federal government can’t force anyone to vaccinate their kids, it can keep urging folks to do so. U.S. Surgeon General Vivek Murthy, on the White House blog this week, noted the measles outbreak is a serious concern and said: “The most important thing people can do to protect themselves against measles is to get vaccinated.” The Measles Background and Federal Role in Vaccine Policy    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico  **Previous Loop CRS Reports of the Week:**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico 1. State of the Union facts    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico 2. Immigration Executive Action   *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico 3\. Obamacare and small business impact    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico 4. In-progress and lapsed monuments and memorials   *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico 5\. Cuba sanctions    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico 6\. ISIS    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Arguing with anti-vaxers: Maybe not a good idea

"These results suggest that correcting vaccine myths may not be an effective approach to promoting vaccination," the authors concluded. How to explain this seeming paradox? "Our explanation is that when you're challenged, you often try to defend the underlying belief or attitude that's come into question," said Nyhan, an assistant professor of government at Dartmouth. That's especially true when the issue is something a person cares deeply about. Anyone who has followed the vaccinate-or-don't-vaccinate debate knows that it qualifies. "If misperceptions are the expression of a more generalized antipathy toward vaccines," the study notes, "then addressing these myths piecemeal is unlikely to be effective. A more comprehensive strategy is likely to be required."  Currently, there is little evidence-based research on vaccine messaging, Nyhan said. In the end, public health advocates may have to accept that while the vast majority of people in this country still vaccinate, some never will, Nyhan said. "We have to be realistic," he said. "It doesn't mean we should give up hope."

How should we count the war dead in Syria?

In February, John McCain denounced on the Senate floor what he called an “apocalyptic disaster” in Syria, citing “more than 130,000 people dead” there. The number he cited came from just one of the jumble of NGOs tabulating casualties in Syria.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Counting the dead during war has always been an inexact science. There are obvious methodological hurdles verifying the data in a conflict setting like Syria, with poor security and few impartial witnesses. There are also potential biases among the organizations doing the counting, which are frequently human rights groups loosely aligned with the opposition. Recent civil wars have occurred in places that have not seen a census in decades. And in situations where territory changes hands and citizens find it difficult to predict whether the government or rebels will ultimately prevail, many refuse to report casualties for fear of repercussions. Nor does it help that the U.S. government and UN have basically thrown in the towel on publicizing such data.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Micah Zenko and Amelia Wolf of the Council on Foreign Relations recently blogged that the actual number of people killed in Syria is vastly different from what is portrayed in the media. They suggest the level of civilian fatalities is in fact lower than what is being reported, and that pro-regime forces are dying in greater numbers than civilians. Their claims are not merely speculative, but based on data released by the Syrian Observatory on Human Rights (SOHR).    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday At first glance, the data indeed paint a puzzling depiction of violence. How can it be safer to be an unarmed civilian caught in the middle than a trained soldier behind fortified walls? After all, according to SOHR, the number of civilians killed (51,212) is lower than pro-regime forces, including both soldiers and militia members (57,511). Herein lies the problem with counting the dead in Syria’s civil war: different methods to identifying casualties, different standards, and different agendas can lead to starkly contrasting interpretations of the violence on the ground. Consider just the conflicting enumerations of fatalities in Syria. SOHR claims to be able to account for 99% of all violence in Syria and provides video or photographic evidence in 70% of its cases. No death gets recorded unless there is an accompanying name. Its 150,000-plus-casualty figure is the one most often cited by the international media and NGO community, even though the number could be well above 220,000, SOHR’s director Rami Abdel-Rahman told Lebanon’s _Daily Star._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday By contrast, the Violations Documentation Center in Syria (VDC) relies on a loose network of a few dozen reporters and activists located abroad and on the ground in Syria. Its data, which is periodically audited, is vastly different from the SOHR’s and presents a much more one-sided picture of the violence. VDC claims to be able to document 60% of the instances of violence comprising its data. (Moreover, in light of the escalating number of foreign extremist fighters being killed on the rebel side, it is reportedly going to be doing away with the culturally loaded term “martyr”). A few patterns jump out: First, VDC numbers are _much_ lower than SOHR’s. Given that the SOHR does not collaborate or share its documentation with the other groups, which it accuses of being financed by Gulf donors and therefore lacking credibility, it is difficult to verify its data or explain the discrepancy.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Second, the number of pro-regime fighters killed is far lower than SOHR’s estimates (57,511 in SOHR vs. 10,755 in VDC), while the tally of pro-rebel fighters is roughly the same (24,275 in SOHR vs. 20,365 in VDC). Finally, the number of civilians killed is more lopsided in VDC (57,690) than in SOHR (51,212), though probably more accurate, based on what we know about violence trends in Syria. But the SOHR’s figure excludes rebel fighters. If we add the 18,000 civilians unaccounted for but believed to be either in prison or killed, then the number soars to nearly 70,000 dead. Again, that is not including 24,275 rebel fighters, the 2,286 dissident fighters, and the 11,220 foreign fighters. Presumably, then, the total dead on the rebel side eclipses 100,000. Zenko and Wolf also challenge an assumption that 90 percent of those killed in civil wars tend to be civilians. But this claim does not correspond to the empirical regularity that civilians are often much more targeted than combatants in civil wars. In the case of Syria, it is erroneous to suggest that pro-regime fighters are dying in greater numbers than civilians. Violence is not only targeting the frontlines. The use of car bombs, airstrikes, and barrel bombs often target civilian locations, and they fall disproportionately in pro-rebel strongholds near major population centers like Aleppo and Homs. Again, based on qualitative evidence from the conflict, and from what we know of past civil wars, the distinction between a civilian and a rebel is often murky at best, which makes tabulating civilian casualties so controversial. Recall the confusion in counting the war dead during the height of the Iraq War. The common practice among policymakers was to rely on independent monitors like IraqBodyCount and compare its numbers with those of the Iraqi government and United Nations, which relied on figures from hospitals, morgues and municipalities. A controversial 2006 _Lancet_ study that relied on cluster sampling estimated that over 600,000 Iraqis had been killed in postwar violence.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday The U.S. government and UN still reportedly keep data on civilian casualties in Syria, presumably which is audited and verified regularly, but does not release it to the public or to the academic community. This means we are reliant on third-party sources like SOHR and VDC for our data and documentation. Oxford Research Group is reportedly working on a project to document and name every war-related casualty, not just in Syria but across the globe. Moreover, the Human Rights Data Analysis Group has shown in settings ranging from Guatemala to Kosovo that multiple systems estimation, a statistical technique that exploits overlap between multiple lists of fatalities, can generate more comprehensive estimates of total deaths than simply enumerating the _known_ dead.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Zenko and Wolf’s larger point that we should be suspicious of the casualty reports, given the hostility between the groups collecting the information, is a valid one. The danger is that somebody who knows little about the complexities of Syria – say, an American lawmaker voting on whether to authorize the provision of aid or arms there – might presume based on the SOHR data that the violence in Syria is one-sided, but _inflicted primarily against the regime_. Yes, the number of pro-regime casualties is probably higher than what outside media report. But we need sanguine analysis of what existing data actually show us about the war, and to strive to advance credible and systematic ways of counting the dead in Syria, not just for academic purposes but also for the sake of transitional justice. If we cannot accurately establish the patterns of violence in Syria, we cannot hope to craft smart policies, whether to advance U.S. strategic interests in a narrow sense, or to stem the bloody tide of this wrenching civil war.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday _Laia Balcells is an assistant professor of political science at Duke University. __Lionel Beehner is a PhD Candidate in political science at Yale University. __Jonah Schulhofer-Wohl is an assistant professor of politics at the University of Virginia._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday _Correction:_ “The original post misstated the basis of multiple systems estimation. Multiple systems estimation can be used whether data samples are random or non-random. Its key features are that it uses multiple lists and exploits the overlap between them to model the process by which deaths are included in the lists, therefore accounting for unreported deaths.”    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday

Americans are terrified of Ebola. Which could make it harder to stop Ebola.

Congratulations, media: Americans are thoroughly freaked out about Ebola. A new Washington Post poll shows that fully 43 percent of Americans say they’re worried that they or someone in their immediate family is going to get the disease, a number that was eleven points lower when the Pew Research Center asked the question just a week ago. Thirty-one percent say they’re very concerned that there will be a “widespread Ebola epidemic” in the U.S., and another 34 percent are somewhat concerned.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico We’re scared, and getting more scared all the time. And it may be time to wonder whether the combination of fear and politics could hinder the effective decision-making needed to keep the virus from harming Americans. Yes, Ebola is a terrible infectious disease, one that kills most of the people who catch it. And in parts of west Africa, there is a genuine outbreak that has already killed thousands of people. If you were in Liberia right now, you’d have good reason to be afraid. But you’re not. Here in this country, exactly two people out of 316 million of us have gotten the disease: a man who contracted it in Liberia when he came in contact with a person who was already gravely ill, and a nurse who treated that man. As a point of comparison, twenty-four Americans have been killed so far this year in lightning strikes.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Obviously, our fears have little to do with the things that might actually kill us. We spend time and money worrying about the dramatic, unusual events like terrorism or infectious diseases, but don’t think about things like car accidents (not to mention heart disease) that are much more likely to strike. And Ebola is a natural for cable news, where fear means viewers and it’s easy to tap into narratives we’ve seen play out in a dozen movies and television shows. You don’t even have to go to Fox News, where deranged contributors claim that President Obama wants Americans to get Ebola so we can “suffer along with less fortunate nations.” There is sensationalist coverage everywhere, in which networks with time to fill spend hours on baseless speculation and nightmare scenarios.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In the Post poll, 67 percent of respondents supported restrictions on travel to and from the affected countries. Some lawmakers have begun calling for such restrictions. But experts say that could make the situation worse, by preventing the movement of supplies and personnel needed to contain the outbreak in west Africa. And containing the outbreak at its source will have more of an impact on whether any more Americans become affected than anything else we can do.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico That’s just one example of how political pressure fed by fear could end up resulting in bad decision-making, but there may well be others soon enough. So there are a few things to keep in mind as we think about this disease. The first is that politicians have almost nothing to contribute when it comes to keeping us safe. If you hear a candidate for office talking about it, and he says much beyond, “Let’s just make sure the CDC has the resources it needs,” he’s probably just trying to frighten you. The second is that the actual risk to you and your family is incredibly low. And the third is that if you find yourself with symptoms including anxiety, sweating, and a clutching in your chest, you’ve probably been watching too much television.

California’s epidemic of vaccine denial, mapped

The Disneyland measles outbreak has shined a harsh spotlight on anti-vaccine communities in California and around the country. Dozens of people have fallen ill with the disease, the vast majority of whom are unvaccinated. The year 2014 was already a banner year for measles in the U.S., with preliminary data from the Centers for Disease Control and Prevention showing the highest number of cases in over two decades.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico My colleague Jason Millman reported last week on the results of a study showing that vaccine skeptics tend to cluster together in like-minded, often wealthy communities. Since the study focused on just a handful of northern California counties, I'd like to extend that analysis by looking at vaccine refusal across the entire state of California **** \-- as a result both of vaccine denial and religious objections.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The map below is a first crack at that. Using data from the California Department of Public Health, it divides the state into equal-area grids, and within each area it counts the number of public school kindergartners with what's known as a "personal belief exemption" (PBE) to state vaccine requirements. The hexagon markers are sized by the total number of kindergartners in the area, and colored according to the percent of them with PBEs.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It's important to note a couple things. First, the actual number of kindergartners entering school without their full slate of vaccines is considerably higher than this map suggests. This map only represents kids whose parents have taken a stance against vaccines by applying for a PBE. Statewide about 2.5 percent of kindergartners fall into this category. Overall nearly 10 percent of California kindergartners don't start school fully vaccinated. Most of these kids are "conditional entrants," who, for whatever reasons, are behind in their vaccines but plan to get them.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It's also worth noting that the map only shows public school kids, as geographic data for private schools wasn't available. Kindergartners in private school are more than twice as likely (5.3 percent) to have a PBE than public school kids (2.5 percent). Still, the map provides a useful barometer of the level of principled opposition to vaccines in the state, and that's how I'll be discussing it. Orange County, home to Disneyland, stands out as a cluster of dark red, as do parts of coastal San Diego county. The wealthy southern California coast from Malibu up to San Luis Obispo also stands out. Farther north, Santa Cruz, Marin and Sonoma counties are dark red. Inland there's a belt of anti-vaccine intensity from about Fresno, up through Sacramento and into Yuba county. Pockets of high PBE rates dot most of the northern California landscape. On the other hand, the Los Angeles area is generally vaccine-friendly, as are much of the San Francisco and Silicon Valley regions. The relatively low-income areas in the central valley also have low rates of vaccine opposition. Since California provides district-level vaccination data going back to 2000, it's also possible to map the spread of anti-vaccine sentiment over time. Check out the three maps below.  Back in 2000, only 0.77 percent of California kindergartners had personal belief exemptions from vaccines. By 2013, that percentage had more than quadrupled to 3.15 percent. The scale on these maps tops off at 5 percent. But in some individual school districts, the actual PBE rate is much, much higher. At River Springs Charter School in Temecula, California, nearly a quarter of the 556 kindergartners had personal belief exemptions this year. A third of the kindergartners at the Visions in Education public school in Carmichael hold PBEs, as do 51 percent of kindergartners at Ocean Grove Charter School in Boulder Creek. At a handful of private schools, the PBE rate is 75 percent or more. It goes without saying that a measles outbreak in these communities could be devastating. These parents are gambling with the lives not only of their children, but of other kids in their communities as well -- especially of young children and toddlers who aren't old enough to get all their vaccines yet. According to USA Today, six of the Disneyland measles cases were among infants too young to be vaccinated.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico We need what's known as "herd immunity" to keep these most vulnerable populations safe from infectious diseases. For measles, that immunity kicks in with vaccination rates somewhere between 83 and 94 percent, according to the CDC. So even letting five percent of the kids in your community skip the vaccine is inviting trouble.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Fortunately, the news out of California isn't all bad. Starting with the current school year, California parents are required to consult a health care professional before being certified for a PBE. That's resulted in a drop in the PBE rate from 3.2 percent last year to 2.5 percent this year -- a welcome trend. The Disneyland outbreak also seems to be giving the issue enough visibility that some Californians previously on the fence are willing to change their minds.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico I'm also singling out California simply because it does such a great job of making these numbers publicly available -- as far as the states go, it's far from the bottom of the pack on vaccination rates. According to numbers compiled by the Bloomberg Data team, California is ranked 39th in the nation on overall vaccination rates, with 65.3 percent of its children receiving all seven CDC-recommended shots. By contrast the bottom-ranked state, Alaska, only has a 59.1 percent vaccination rate, while the top, Mississippi, has a rate of 76 percent.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico With any luck, in the aftermath of the California measles outbreak we'll see these number climb.

How the anti-vaccine movement is endangering lives

Infectious diseases that we normally think of as rare in the United States are making a comeback. In recent years, pertussis -- also known as whooping cough -- has returned to the headlines. A measles outbreak that struck a Texas megachurch community late last summer sickened 21 people. And just recently, at least 16 people got sick during a measles outbreak in Ohio. In fact, the Centers for Disease Control and Prevention recently reported 13 measles outbreaks so far in 2014 \-- the most since 1996.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday The diseases are highly contagious, but they are also preventable; two of the many recommended childhood vaccinations protect against measles and pertussis. And measles had been considered effectively eliminated in the United States. What's going on, exactly? Here are some answers.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **Why are so many outbreaks happening?** Although it's a complex problem, health officials say one key culprit is that more and more people are choosing not to get their kids vaccinated against these diseases. For instance, in California parents are increasingly seeking personal or religious exemptions from vaccination requirements for their kids to attend schools. Substandard vaccination rates create an opening for outbreaks, which often start when an unvaccinated person catches the disease while traveling abroad and spreads the illness to friends and family upon returning.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **But aren't overall vaccination rates really high?** Nationally, yes, though it wasn't always this way. Before the 1990s, rates languished below 80 percent for most childhood vaccines at the time. In 1993, after the 1989-1991 measles outbreak, Congress enacted the Vaccines for Children (VFC) program to promote childhood vaccinations.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday CDC data show that vaccination rates are now above 90 percent range for several routine vaccines, including the measles-mumps-rubella (MMR) and whooping cough vaccines. Public health officials target a 90 percent vaccination rate for most routine childhood vaccines. Experts say that a population has "herd immunity" when enough people are vaccinated to prevent a disease from taking hold. This chart shows how vaccination rates climbed after VFC's enactment:    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **If vaccination rates are high, why are we seeing so many outbreaks?** That's because vaccination rates aren't geographically uniform. Public-health experts say that high non-vaccination or exemption rates can occur among pockets of people, particularly at the county or city level. And some research has found that outbreaks are far more likely to happen in these areas, such as during the recent whooping cough outbreaks in California.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **Why are people not vaccinating their kids?** There are a number of factors at play. Many of the diseases we vaccinate against are so rare here now that the public's awareness of vaccination might have decreased. But the one reason that has most alarmed public-health experts lately has been the rise of the anti-vaccine movement. Groups and activists such as celebrity Jenny McCarthy have repeatedly claimed that vaccines cause autism. This vaccine-autism concern may be causing a drop in childhood vaccination rates in many communities, including in affluent, well-educated ones.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **Do vaccines cause autism? Science gives a resounding no.** Anti-vaccine activists often hang their case on a study published in the British journal The Lancet in 1998. This study, which posited a link between the MMR vaccine and autism, was widely discredited by the scientific community and eventually retracted. But the anti-vaccine movement has still gained steam.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Anti-vaccine activists have also raised concerns about vaccines made with the mercury-based preservative known as thimerosal, which they worry could cause brain damage in developing kids. It's true that vaccines once routinely contained thimerosal, which government officials recognized as generally safe. But this preservative has been phased out of nearly all vaccines as a precautionary measure.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Anti-vaccine activists also worry that the CDC's recommended vaccination schedule could overwhelm infants' immune systems by packing too many doses into a short period of time. Although the number of vaccinations that kids receive now is higher than it used to be, the main ingredients in the vaccines have actually decreased in amount. Even if these ingredient amounts hadn't decreased, research has found no relationship between those amounts and autism risk.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday Vaccines do carry a risk of side effects, but they are usually minor. The CDC has concluded from reviewing the scientific evidence that there's no causal link between childhood vaccinations and autism. **Routine vaccines save lives, says science.** A new study from CDC researchers led by Anne Schuchat analyzed what happened to disease rates as childhood vaccination rates increased starting in the early 1990s. The researchers used these findings to model the resulting effect over the kids' lifetimes. In the analysis, the researchers factored in most routine vaccines recommended for children below age 6 (among them the MMR and whooping cough vaccines). Their findings: Routine childhood vaccinations given between 1994 and 2013 will save 732,000 lives and prevent 322 million cases of illness and 21 million hospitalizations over the course of the children's lifetimes.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **Vaccines provide high public-health bang for the buck.** The CDC researchers also weighed the benefits of the vaccinations ("savings in direct and indirect costs that accrued from averting illnesses, hospitalizations, and deaths") against costs ("program costs included vaccine, administration, vaccine adverse events, and parent travel and work time lost"). In 2009 alone, the researchers determined, each $1 spent on vaccines and their administration yielded $10 in benefits to society. And the vaccinations from 1994-2013, the researchers found, will save society a net $1.38 trillion, both directly (by reducing health expenses) and indirectly (via the economic activity that is saved from avoided illnesses). That's almost 10 percent of the U.S. economy's gross domestic product.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **The CDC study may actually underestimate some benefits. Here's why.** It doesn't account for cost savings to society brought on by preventing the diseases' spread to unvaccinated populations, "a powerful driver of cost- effectiveness" in the researchers' view. The study also excludes the influenza and hepatitis A vaccines, and thus fails to capture their benefits.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday **What's the bottom line?** Vaccines may not be perfect. But the science suggests that they are effective -- especially when enough people are receiving them -- and there's still no evidence that they cause autism.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday

What a measles outbreak looks like when no one is vaccinated

_This post comes via Know More, Wonkblog's social media site._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The graphic below, by Bonnie Berkowitz and Lazaro Gamio of The Washington Post, illustrates how measles spreads in an area without a vaccination program. The differently shaded squares represent four generations of infection, from Patient Zero (the darkest red square at the top left) to the people he or she infects, the people they infect in turn, and so on. The dark squares represent people who die from the disease.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Without vaccinations, each measles case will infect 12 to 18 other people on average every 10 to 14 days. You can see how quickly the disease spreads from the first generation (Patient Zero) to 12 to 18 people in the second generation, 144-324 people in the third generation, and 1728-5832 people in the fourth generation. That adds up to more than 6,000 infections, all within 40 days. In a country with substandard healthcare and malnutrition, up to 28 percent of those infected will die. Now contrast that with a country with full vaccination: In that scenario the disease would spread to 0.8 people every 10 to 14 days, and less than .3 percent will die. In a country like the U.S., where most people have been vaccinated but pockets have not, the disease would spread to 1.1 to 2 people every 10-14 days and less than .3 percent would die. It's a great reminder not to take vaccinations for granted. _Check out Know More'shome page, Twitter or Facebook for the best and most interesting visuals, videos and data hits from around the Web._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Where it’s most dangerous to be an aid worker

This month, militants in Pakistan tracked down and killed nine vaccination workers engaged in a three-day immunization campaign, the first time vaccinators have been targeted there in such large numbers. Although thousands of Pakistani health workers are pressing on with the effort, with the help of police protection, the United Nations has suspended its vaccination program in the country. Polio kills about 200 Pakistanis a year, down from 1,500 in the mid-1990s, but the halting of the U.N. campaign means the country is even farther from eradicating the disease, as all but three other nations have managed to do. Beyond the humanitarian repercussions, meanwhile, the attacks on aid workers are also an example of why Pakistan has earned the dubious distinction of being ranked as one of top five least safe countries for aid workers, according to a new report from the group Humanitarian Outcomes. After two years of decline, attacks on aid workers worldwide ticked up to 150 last year from 129 in 2010, and the number of victims of the attacks -- 308 -- was the highest ever recorded. But the vast majority of the attacks, 72 percent, occur in just five countries: Afghanistan, Somalia, Sudan, South Sudan and Pakistan. The causes of the risks to aid workers are what you'd expect: The attacks correlate strongly with political instability and conflict intensity, but overall high levels of domestic homicide do not have much to do with the aid worker murder rate: The organization counts 12 incidents in Pakistan last year and 15 this year, but before 2009, there were only three or fewer attacks annually. Meanwhile, Sudan and Afghanistan have been consistently dangerous for aid workers throughout the past decade. Pakistan's inclusion on the list this year is interesting because there is no intense conflict underway or brewing there. Instead, rule of law has been undermined by the increased influence of the Taliban and other militant groups since 2008. Although wariness of vaccination programs first arose in Pakistan several years ago when radical clerics such as Maulana Fazlullah "warned" parishioners that polio vaccines cause infertility, more recently the Taliban has been responsible for much of the country's anti-vaccine sentiment. The Islamist group denied responsibility for the recent aid worker attacks, but earlier this year, Taliban commanders in Pakistan’s northwestern tribal region said vaccinations could not proceed until the United States stopped drone strikes in the country. In July, the World Health Organization estimated that a polio vaccine ban could affect about 280,000 children living in tribal areas of northwestern Pakistan. The tensions over vaccines were exacerbated by the killing in Pakistan of Osama bin Laden, whose hideout was discovered in part through a CIA spy operation masquerading as a hepatitis vaccination program. What's more, most of the vaccine workers who were gunned down were women, in line with Pakistani militants' apparent penchant for attacking female workers and advocates, including Malala Yousafzai, the school-age education reformer who was shot on a school bus in October for her widely publicized opinions on female education. Unfortunately, the Pakistani government hasn't done much to improve the climate for health and other humanitarian workers. According to a recent Economist report, government officials there have restricted aid workers' movements and visas. Armed escorts for aid operations in Pakistan became mandatory for international staff in some provinces after a string of kidnappings earlier this year, but according to Humanitarian Outcomes, such security measures can undermine the aid workers' independence. As one worker told the group: "It is presented as necessary for our own protection. Any incident will be bad PR for the government, and we’re at their invitation and they feel an obligation to protect us."

These 3 things help make sense of the dangerous Minnesota measles outbreak

It’s extremely contagious, and can lead to hospitalization, pneumonia, deafness and death. And though it was eradicated in the United States in 2000, it’s back with an increasing number of virulent outbreaks — most recently in Minnesota, where the number of documented cases recently rose to 69 and spread to a fourth Minnesota county.  That’s a public health problem, and not just for the unvaccinated. When a critical percentage of the community has been vaccinated, everyone’s more protected from that disease.        According to the 2016 ANES data, nearly 88 percent of people with a graduate degree support school vaccination requirements. That figure was 81 percent for people with bachelor’s degrees, 73 percent for people with some college, and 73 percent among those with only a high school degree or who did not graduate from high school.  And yet a significant proportion of Americans remain skeptical about vaccines. Consider the responses to this question: Do the health benefits of vaccinations generally outweigh the risks; do the risks outweigh the benefits; or is there no difference? Nearly a third of respondents answered skeptically. Fully 12 percent said that the risks of vaccinations outweigh the benefits. And 17 percent said that the risks and benefits are equal. Among these vaccine skeptics, only 48 percent favored vaccination requirements for school attendance. Even more remarkable, this skepticism changes the relationship between someone’s level of education and their support for vaccination requirements.     Among vaccine supporters — those who say the health benefits outweigh the risks — more education increases the likelihood of favoring school vaccination requirements. But among vaccine skeptics, that pattern reverses. In this group, the most highly educated are most opposed to school vaccine requirements. Consider that, among those skeptics who have a high school diploma or less, 58 percent favor vaccine school requirements — but among the skeptics with graduate degrees, that figure drops to 38 percent.    People often resist information that challenges their beliefs. Ironically, when it comes to vaccines, education can bolster false beliefs. All of which suggests that the United States can expect more dangerous outbreaks of measles, the preventable disease that hasn’t been eradicated after all.

Data: The vaccine issue is nowhere near as polarizing as climate change

As the vaccine issue has been thrust into mainstream politics, there has been intense focus — and frantic poll-crawling — to try to find out who thinks what about it. So let’s play along. It turns out there’s revealing new data on this front this morning from Yale researcher Dan Kahan — who finds that members of the tea party are _slightly_ more skeptical of vaccines than Democrats or mainstream Republicans. But he also finds that this is absolutely nothing like the gap between the tea party and the other groups on climate change.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Here’s the first chart that Kahan provides, examining Democrat, mainline conservative Republican, and tea party beliefs on whether vaccines are worth the risk. Both the central and right column depict the views of conservative Republicans, but they are separated by whether they self identified as members of the tea party (on the far right) or not (in the center): Kahan does not think this signals a very partisan issue. I think most informed observers would agree. However, it is nonetheless noteworthy that tea partiers are 10 percent less supportive than Democrats (84 percent to 74 percent). This certainly undermines further the myth that vaccine skepticism is a left wing phenomenon.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico But now look at the same breakdown on climate change: Here, political polarization is just off the charts. So I think there is a complex message here, overall. It may be that on the right, there is slightly _more_ vaccine hesitancy than on the left. But this fact must be considered in a key context: In all political groups, more than 70 percent of people believe that the benefits that come from vaccinating outweigh any purported health risks.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico With data like these, we can therefore explain two things: 1) why conservative politicians seem to be the ones saying things that appear to at least partly question mandatory vaccinations lately; but why 2) the issue still shouldn’t be taken as partisan,  or polarizing — and why we should keep it that way.

CDC confirms Zika virus causes microcephaly, other birth defects

Federal health officials confirmed Wednesday that the Zika virus causes a rare birth defect and other severe fetal abnormalities, marking a turning point in an epidemic that has spread to more than 40 countries and territories in the Americas and elsewhere. Scientists at the Centers for Disease Control and Prevention conducted a careful review of existing research and agreed that the evidence was conclusive, Director Thomas Frieden said. It is the first time a mosquito-borne virus has been linked to congenital brain defects. "It is now clear, and CDC has concluded, that the virus causes microcephaly," Frieden said. CDC is launching more studies to determine whether children with that rare condition, which is characterized at birth by an abnormally small head, represent the "tip of the iceberg of what we could see in damaging effects on the brain and other developmental problems."  Global health officials had already assumed the virus was to blame for the problems being seen in various countries. Since January, many have advised women who were pregnant or hoping to become so to avoid travel to Zika-affected areas or to take steps to avoid Zika infection. That medical advice expanded over time to include women's partners, especially as it became clear sexual transmission of the virus was more common than had been known. The research released Wednesday won't change that advice, officials said. But they are hoping it will help educate the public about the virus and its potential for harm -- particularly in the United States.   "We do know that a lot of people aren't concerned about Zika infection in the United States, and they don't know a lot about it," said Sonja Rasmussen, director of CDC's division of public health information. "It's my hope that we can be more convincing that Zika does cause these severe birth defects in babies and hope that people will focus on prevention more carefully." The research is likely to help scientists developing a vaccine for Zika, she said. Researchers said there was no "smoking gun" or single definitive piece of evidence that confirmed the virus as causing microcephaly, calcifications within the fetal brain and vision problems in newborns. Rather, the findings of recently published studies and a thorough evaluation by CDC researchers using established scientific criteria led them to the conclusion. Frieden likened the process to putting together pieces of a puzzle. The World Health Organization had said in recent weeks that there was scientific consensus about the virus and microcephaly as well as Guillain-Barré syndrome, a neurological condition that can lead to paralysis. Researchers in Brazil, the hardest-hit country, said this week that Zika also may be associated with a second serious condition similar to multiple sclerosis. In a few cases with adults, they found swelling of the brain and spinal cord involving the coating around nerve fibers. CDC officials said they worked independently of the WHO. The U.S. agency is conducting studies on Guillain-Barré syndrome, and officials said they are also likely to make a conclusive link between that condition and Zika. "I think we're on the same page as the WHO," Rasmussen said. There are still many outstanding questions about the risk facing pregnant women infected with Zika. A limited number of studies show the risk ranges from about 1 percent chance of having a baby with microcephaly to almost 30 percent of pregnant women having fetal abnormalities. A study in Brazil identified that upper range, with pregnant women having "grave outcomes," Rasmussen said. Scientists also don't know whether miscarriages and stillbirths are the result of an infection. Nor do they know at what stage of pregnancy is risk the greatest, or whether another infection that occurred at the same time might affect the risk of birth defects, she said. CDC's assessment of the evidence began last October but included Zika studies that were published as recently as last weekend, Rasmussen said. The detailed clinical information shows the most severe forms of microcephaly, also known as fetal brain disruption sequence. In some instances, the babies' heads are much smaller than what clinicians would normally see in microcephaly cases, she said. Among the evidence the report cited to support the causal relationship between Zika and these serious birth defects: • Zika infection during critical periods of early pregnancy, usually the first trimester or early second trimester; • specific, rare patterns of birth defects in fetuses or infants with presumed or confirmed congenital Zika infection; • biological evidence, including the presence of Zika virus in the brain tissue of fetuses and babies with severe microcephaly who had died; • rare exposure to the virus and a rare birth defect.  Brazil normally has an average of 163 cases of microcephaly each year. But since October, officials have confirmed at least 944 cases of microcephaly or other neurological problems, according to the WHO. After a Zika outbreak in French Polynesia, that island also had an increase in microcephaly cases. It normally has no more than two cases a year, but it saw eight cases during a four-month period in 2014. A recently published study using data from the island estimated the risk for the rare birth condition to be 95 cases of microcephaly for each 10,000 pregnant women infected in the first trimester.

Autism Speaks, leading autism advocate, urges vaccination

A leading autism advocacy organization, Autism Speaks, is urging parents to vaccinate their children amid a measles outbreak that has swept 14 states. As some continue to cite unfounded fears that vaccinations can lead to autism, Autism Speaks chief science officer Rob Ring has released a statement saying vaccinations cannot cause the disorder — and telling parents to vaccinate their children. “Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism,” he said late last week in a brief statement. “The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated.”    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Autism Speaks, a nonprofit organization that promotes autism awareness and sponsors research in the field, has stated its policy on vaccinations before, but perhaps never so plainly as now. In the past, the organization, which funded research into possible connections between immunizations and autism, has said it is possible that, in rare cases, “immunization may trigger the onset of autism symptoms in a child with an underlying medical or genetic condition” — while pointing out that “studies have not found a link between vaccines and autism.”    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Fears about vaccination were bolstered by a bogus study that claimed to show a link between the measles, mumps and rubella (MMR) vaccine and autism. The now- discredited study was published in 1998 by British doctor Andrew Wakefield in an esteemed medical journal, the Lancet. The journal later retracted the study, and Wakefield lost his medical license. But his research is still touted as true by some who refuse to vaccinate.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In 2011, Autism Speaks was one of the sponsors of a National Autism Association event at which Wakefield was a speaker. Nevertheless, over the years, the organization has made its policy on the immunization issue clear: Vaccinate your kids. For example, in May 2014, Autism Speaks linked to a report on its Web site that showed vaccinations do not cause autism.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico “This analysis provides further confirmation for a lack of association between vaccines and autism that the broader health-care community has understood and embraced for some time,” Ring said last year about the findings. “Autism Speaks’ own policy on vaccines echoes those of other credible health-care organizations like the American Academy of Pediatrics and the World Health Organization. We strongly encourage parents to work with their physician to ensure their children receive the full benefits immunization offers in protecting their loved ones against a variety of preventable childhood diseases.”    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The organization was not immediately available for comment. All states permit parents to choose not to vaccinate children for legitimate medical reasons such as anaphylactic allergic response, a life-threatening reaction. And many allow them to opt-out for religious or personal beliefs. But non-medical exemptions have come under scrutiny since a measles outbreak in California’s Disneyland swept the country. Last month, 102 people from 14 states were reported to be infected, according to the Centers for Disease Control and Prevention.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Since then, doctors have spoken out about the anti-vaccine movement. Some have refused to see patients who refuse their immunizations. Los Angeles pediatrician Charles Goodman posted a notice in his waiting room last month: He would no longer treat children whose parents won’t get them vaccinated. “Parents who choose not to give measles shots, they’re not just putting their kids at risk, but they’re also putting other kids at risk — especially kids in my waiting room,” he said, according to the Associated Press.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Medical experts have said those who are not vaccinated pose a risk to those who cannot be vaccinated because they have legitimate medical reasons or because they are too young. Children cannot get their MMR vaccine until they are 12 months old. Harry Gewanter, a doctor in Richmond, said it’s parents’ responsibility to vaccinate. “I’ve seen the horror stories of what happens from these diseases and now this generation of doctors have never seen them because of immunization practices,” he said, according to WWBT-TV. “One out of a thousand people infected with measles dies. And just because we haven’t seen it doesn’t mean it’s not coming.”    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **RELATED:Why this baby’s mom is so angry at the anti-vaxxers**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **RELATED:Amid measles outbreak, anti-vaccine doctor revels in his notoriety**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **RELATED:The Disneyland measles outbreak and the disgraced doctor who whipped up vaccination fear**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **RELATED:Parents with doubts about vaccinations face backlash from pediatricians, peers**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Mystery Zika case in Utah was likely spread through sweat or tears

Instead, he had remained at his father's side in the hospital.  The son had contact with his father's skin and wiped his eyes, "both without gloves," said Sankar Swaminathan, an infectious disease specialist at the University of Utah's School of Medicine who treated the two patients. No other family members or health care workers who had contact with the 73-year-old man reported a Zika infection. Swaminathan said the case offers critical new information for health care providers and researchers. In rare cases, when patients have severe Zika infections, "the levels of virus may very well be unprecedented, and the implication is that such cases may present increased risk for transmission through bodily fluids," he said. There only have been nine other Zika-related adult deaths in the Americas that have not been linked to Guillain-Barré syndrome, a rare nervous system illness that causes muscle weakness and sometimes paralysis. Some of those nine individuals had serious underlying medical conditions or very weak immune systems, Swaminathan said. But that was not the case for the Utah man. The father had been treated for prostate cancer but did not have a severely weakened immune system when he became ill with Zika. However, he had previously been infected with dengue, a related virus. Some research in animals has suggested that previous dengue infections may worsen a subsequent Zika infection. It's possible that could have happened in this patient's case, triggering his severe infection, Swaminathan said. The father had traveled to the southwest coast of Mexico, where he got bitten by mosquitoes. After returning home, he became sick and was admitted to the hospital in shock, respiratory distress, a sore throat and conjunctivitis, or inflammation of the eyes. Swaminathan said most doctors treating someone with those symptoms might suspect illnesses such as pneumonia or sepsis, a complication from a life-threatening response to infection. But not Zika. "What this case tells me is that doctors should think about Zika when they see someone who is severely ill and might have been exposed," he said. "It now expands the spectrum of illness." ------------------------------------------------------------------------------------------------------------    The son recovered fully. Health officials are recommending that family contacts and close friends caring for Zika patients who are very sick avoid contact with the patient’s bodily fluids and use good hand hygiene, said Angela Dunn, deputy state epidemiologist in Utah. Health-care workers are urged to continue to apply standard precautions while caring for all patients, including those who might have Zika virus disease. Such measures include wearing gloves, masks and other personal protective equipment.  Although local, state and federal officials cannot say definitively how the son became sick, the Utah case suggests that the way the virus was transmitted “doesn’t appear to be one of the modes we’ve seen before,” said Alexander Kallen, a CDC medical officer. “It does raise the possibility that there was potential exposure to the blood and bodily fluids of the index patient, and that could have led to transmission of the second case,” Kallen said.  As part of the investigation in Utah, health officials interviewed and tested 18 other family members, and none were positive for the virus. They also identified medical workers who cared for the elderly man and surveyed 238 households living within a 200-meter radius of the two homes in which the father lived before becoming hospitalized. Eighty-six medical workers and the community residents who agreed to provide blood or urine specimens were tested. No one else has tested positive. Nor have officials found any evidence of either mosquito species that transmit the virus, Dunn said. Dunn said investigators don’t know which bodily fluid could be the culprit. Zika has been detected in blood, urine, semen, saliva and breast milk. It has also been found in genital-tract swabs and fluid inside the eye. Most people who get Zika infections show no symptoms or have only mild illnesses. But in some cases when patients are very sick, “they often have a lot of diarrhea” and the virus could have spread through that exposure, Dunn said. The son reported hugging and kissing his father and helped hospital personnel hold him while he was being cleaned, the report said. Although it’s perplexing that no one else developed an infection, officials say, it’s hard for a retrospective investigation to fully capture all aspects of the son’s exposure. “We don’t know if there may have been some unrecognized contact with mucous membranes, or whether it was just bad luck that he came in contact with infected fluid,” Kallen said. Because the father had such a high level of the virus in his body — one of the highest scientists have seen — it’s also likely that the virus showed up in more places in his body, increasing the risk of transmission.

The record-breaking measles outbreak summed up in one chart

The measles outbreak in the United States achieved a particular milestone this month. Health officials said they had seen 288 cases of the disease between Jan. 1 and May 23 of this year, the most in any year since the disease was declared eliminated in 2000. That’s also the first time the Centers for Disease Control and Prevention has seen this many cases this early in a year since 1994 (when 764 people were infected over the same span). Nearly every measles case involved an unvaccinated person traveling outside the U.S.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday This chart from the CDC outlines just how severe this year’s outbreak has been, particularly so early in the year: Lenny Bernstein has much, much more on the outbreak over at To Your Health, including details on the latest numbers and more about the dangers for unvaccinated children.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday

The political vaccine debate, explained (Video)

The recent spike in measles cases nationwide has everyone talking about vaccinations. And now the debate has spilled over into the realm of politics, as potential 2016-ers are weighing in.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico According to the Pew Research Center, 68 percent of adults say vaccines should be required, versus 30 percent who say that parents should be able to decide whether or not to vaccinate their children. And while Republicans are more likely to be against mandatory vaccines than Democrats, there are significant bases of opposition on both sides -- as well as among independents.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Here's everything you need to know about this issue.

The saddest story Roald Dahl ever wrote — about his daughter’s death from measles — is worth reading today

_Updated_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Some people seem to think the measles is a nuisance disease — irritating and briefly unpleasant, but otherwise harmless. For many, it’s not so bad. For others, the measles is serious and potentially fatal. Children under 5 are particularly vulnerable to complications, says the Centers for Disease Control and Prevention. One of the worst complications is measles encephalitis.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico “Acute encephalitis occurs in approximately 0.1% of reported cases,” says the CDC. “Onset generally occurs 6 days after rash onset (range 1–15 days) and is characterized by fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, convulsions, and coma. Cerebrospinal fluid shows pleocytosis and elevated protein. The case-fatality rate is approximately 15%.” Roald Dahl, the renowned author of “Boy,” “Charlie and the Chocolate Factory,” “Matilda” and scores of other books and screenplays, lost his daughter Olivia to measles encephalitis in 1962. In 1988, about seven years before his death, he wrote a poignant plea for the Sandwell Health Authority in Britain urging everyone to get their kids vaccinated. Dahl’s recounting of his experience has been rediscovered and recirculated in recent days because of the measles outbreak in California, spread largely by unvaccinated individuals who came in contact with an infected visitor to Disneyland.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Here, in part, is what he wrote: “Encephalitis has quietly been at work for hundreds of years, robbing families of their loved ones,” Ava Easton, Chief Executive of The Encephalitis Society, said in a statement emailed to the Post. She added:    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico h/t News Everyday    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Read more: Everything you wanted to know about measles**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Medical Mysteries: It wasn’t the vaccine — so why did baby have seizures?

“Men in Black” was flickering on the screen, and Laura Cossolotto and her husband were enjoying a rare night at the movies in their home town of Centerville, Iowa, when her brother-in-law rushed into the darkened theater. The couple’s third child, 6-month-old Michaela, had just suffered a serious seizure and was at a nearby hospital. As Cossolotto raced to be with the baby, she immediately remembered that Michaela had been running a fever after receiving a vaccine against diphtheria, pertussis and tetanus (DPT) three days earlier. “I thought the shot must have something to do with it,” Cossolotto recalled. “I had three kids, and nothing like this had ever happened, so what else could it have been?” At the hospital, doctors reassured her that Michaela had suffered a febrile seizure, a frightening and usually harmless event they said was unlikely to recur. As a precaution, the baby was admitted for observation. Hours later, after doctors had trouble controlling a second, more severe seizure, the infant was whisked by helicopter to a larger hospital in Des Moines, 100 miles north. That night in July 1997 marked the beginning of a 10 1 / 2-year ordeal, as more than a dozen specialists in four states tried without success to find an underlying cause for Michaela’s frequent, intractable seizures — and a treatment that would control them before they caused irreparable brain damage or death. For years Cossolotto held the DPT shot responsible for Michaela’s problems, joining legions of parents who have blamed various ingredients in pediatric vaccines for triggering serious medical and developmental ills, most notably autism. Since the early 1980s these allegations, based on discredited theoriesand more recently on an influential British study that last year was deemed an “elaborate fraud,” have flourished, largely because of their enduring popularity on the Internet. As a consequence, fearful parents have refused to immunize their children, resulting in outbreaks of vaccine- preventable diseases, including measles and whooping cough. Cossolotto, who spent hours online desperately seeking answers, found the vaccine hypothesis persuasive, particularly after doctors failed to offer another explanation. The belated discovery of what was wrong with her daughter would upend Cossolotto’s long-held views and lead to major improvements in Michaela’s life. ****It was quickly evident that Michaela’s seizures were not just febrile: They occurred when she had no fever, and doctors suspected she had epilepsy. “She would be in her bouncy seat and both arms would just shoot straight up in the air,” Cossolotto recalled. “I knew nothing about epilepsy.” She soon learned. At times Michaela’s seizures were so severe that doctors had to place her in a drug-induced coma to save her life. Eight times before she was 3, she was helicoptered to Des Moines or Iowa City for emergency treatment. “I remember sitting by her bed in the ICU wondering: Would she wake up? And if she did, would she be a vegetable?” Cossolotto recalled. Despite test after test, no doctor could say what kind of epilepsy she had, and no cocktail of medications proved effective in controlling the seizures. Nor did doctors know the reasons for problems that emerged as she aged: delayed speech, mild mental retardation and serious growth deficiency. Specialists ruled out fragile X syndrome, a chromosomal disorder that causes mental retardation, gastrointestinal malabsorption, cystic fibrosis and numerous rare metabolic problems as well as heart defects and brain malformations. Between the ages of 3 and 5, Michaela did not gain an ounce; she entered kindergarten at age 5 weighing 33 pounds, roughly the average weight of a 2 1 / 2-year-old girl. At a growth clinic where she was evaluated for failure to thrive, doctors told Cossolotto “the problem was that I allowed her to graze during the day and that I was a bad parent,” she recalled. Around the age of 4, Michaela began regressing, displaying what seemed to be classic signs of autism: She would rock for hours, avoid eye contact and seem to retreat into her own world. By this time Cossolotto was spending hours a day scouring the Internet. She quickly turned up what seemed to be a promising explanation: pediatric vaccines. Michaela's doctors were skeptical, but Cossolotto became increasingly convinced she had found a possible answer. She began taking her daughter to see a specialist in environmental medicine in St. Louis, five hours away. He embraced the vaccine theory and ran his own series of tests, diagnosing a mold allergy. At Cossolotto’s request, he signed a waiver allowing Michaela to attend kindergarten without receiving the required immunizations. “I wasn’t taking any chances,” her mother recalled. But after several months autism faded from the picture: Remedial help Michaela received in school caused the autistic behaviors to recede. Cossolotto’s belief in the vaccine theory waned, she said, but remained in the back of her mind. When Michaela was 5, Cossolotto’s youngest daughter was born with Down syndrome. At times the pressure seemed unbearable as she struggled to care for two special-needs children. The seizures unabated, Cossolotto called the Mayo Clinic in Rochester, Minn. A pediatric neurologist there began treating Michaela with various antiseizure medications while continuing the search for an underlying cause. At one point the little girl was seizure-free for nearly a year, but the convulsions returned, worse than ever. In September 2007, Cossolotto took Michaela, then 10, to see a pediatric geneticist who had been featured on a TV show about baffling medical cases. “At this time, I do not have a unifying diagnosis to explain her problems,” the specialist, who practices in Iowa, wrote. Neither did Michaela’s doctor at Mayo, who suggested a referral to Elaine Wirrell, the hospital’s new pediatric epileptologist, a neurologist who specializes in treating children with epilepsy. “I had never heard of an epileptologist,” Cossolotto said. In November 2007, Michaela saw Wirrell, the latest in a seemingly endless parade of doctors. The appointment seemed like so many others. After listening to Michaela’s history and reviewing her records, Wirrell told Cossolotto that she suspected a rare disorder and wanted to order a test. “I thought, ‘Oh, more bloodwork; we’re going to rule out another diagnosis,’ ” Cossolotto recalled. Three weeks later, Wirrell called Cossolotto with the definitive answer that had eluded her for so long. The blood test for the SCN1A gene revealed that Michaela had Dravet syndrome, also known as severe myoclonic epilepsy of infancy, a rare and serious form of the seizure disorder named after the French doctor who described it in 1978. Dravet is usually caused by a spontaneous — not inherited — genetic mutation present at birth that affects the functioning of brain cells, according to the National Institute of Neurological Disorders and Stroke. Its hallmark is severe seizures during the first year of life that are difficult to control. Many children with Dravet, which occurs in one in every 20,000 to 40,000 births, also exhibit poor language skills, behavioral problems and cognitive deficits. There is no cure for Dravet, but some medications are effective in controlling seizures. Among them are clobazam combined with stiripentol, a French drug that has not been approved by the Food and Drug Administration but can be legally imported because it treats a rare illness. In many cases Dravet emerges when a baby runs a fever, which can occur after receiving an immunization. But, notes Wirrell, chief of pediatric epilepsy at Mayo, “it’s absolutely _not_ the immunization causing Dravet” but rather the fever that causes the existing disorder to surface. Wirrell, who has seen 20 children with Dravet, said that those who have never been immunized show symptoms after spiking a fever. Several recent studies have explored the relationship between the DPT vaccine and Dravet, which was first suggested as a cause of neurological problems in a 2006 study by a team of Australian epilepsy specialists. A 2010 study in Lancet Neurology found that the vaccine did not affect the outcome of Dravet: Babies whose seizures began after the shot fared no worse than those whose illness surfaced at another time. A 2011 report in the journal Pediatrics found that five children presumed to have neurological damage caused by the DPT shot were later discovered to have Dravet. In Michaela’s case, the combination of seizures that began at six months, soon after the DPT shot, and the lack of any other cause made Wirrell suspect Dravet; the gene test confirmed it, although about 30 percent of children with Dravet do not test positive. For Cossolotto, the diagnosis meant coming to terms with the reality of her daughter’s serious, incurable illness. “I always thought that if I knew what it was, we could fix it,” she said. “But it was Dravet, and there was no fixing it. I had to keep telling myself, ‘You have an answer.’ ” “Five or 10 years ago, many people were not thinking that this is a seizure syndrome,” Wirrell said. She credits parents, especially Cossolotto, who since 2008 has been president of the support and advocacy group called Dravet.org, with raising awareness of the disorder and promoting effective treatment. Epileptologists, she added, are attuned to Dravet, while general neurologists may be unfamiliar with it. “Recurrent prolonged seizures fairly early in life should trigger a referral to a pediatric epileptic specialist,” she advised. As a result of the diagnosis and proper medication, Michaela’s life has dramatically improved. Although she still grapples with cognitive and behavioral problems, her seizures have dwindled to only a handful annually. Now 15, she is a freshman in high school with friends, a Facebook page and other trappings of adolescence. Without a diagnosis, Cossolotto said, she would probably still believe — erroneously — that the DPT shot caused Michaela’s illness. “I understand this is a genetic condition,” she said. “Having an answer does make a difference.”

Federal study estimates 1 in 88 children has symptoms of autism

About 1 in 88 children in the United States has autism and the prevalence of the condition has risen nearly 80 percent over the past decade, federal health officials reported Thursday. The survey, sponsored by the Centers for Disease Control and Prevention, is the latest evidence of a steady upward trend in a disorder whose cause remains unknown despite much research in recent years. The rising rate of autism could be the result of finding children missed in earlier surveys or an actual increase in the condition — or a combination of the two. The trend has been observed in Canada and Western Europe as well as the United States. Children with the most extreme form of autism are socially withdrawn, speak little, dislike affection and eye contact, and engage in repetitive actions. Once thought to be very rare, milder forms are now recognized. One of them, Asperger syndrome, describes bhavior that in the past might have been seen as peculiar and abnormal but not evidence of illness. The CDC study surveyed 14 states — including Maryland — for the prevalence of autism spectrum disorders among 8-year-olds in 2008. The prevalence that year of 11.3 cases per 1,000 children was 23 percent higher than in 2006. It was 78 percent higher than in 2002, when the survey began. Autistic children received their diagnosis at age 4 on average — six months earlier than in 2006, but not early enough for optimal therapy, according to many experts. The survey found large unexplained differences between sexes, among ethnic groups and in states. For example, autism is five times as common in boys as girls (a lopsided ratio found in many other studies). The fraction of autistic children with average or above-average intelligence has risen more than the fraction with “intellectual disability.” Autism prevalence in Hispanic children is two-thirds that of white children, but it is rising faster in them and in black children than in white ones. The prevalence in Utah’s children is four times that in Alabama’s. Such variation suggests that better identification of autism cases contributes to the higher number, but whether it explains the trend completely is a matter of huge debate. “This is the billion-dollar question, isn’t it?” said Li-Ching Lee, an epidemiologist who headed the survey in Maryland. In a telephone briefing with reporters, Thomas R. Frieden, CDC’s director, said the increase could be “the result of better detection. It is a possibility.” What’s not a matter of debate, he said, is that autism is common and that doctors and teachers need to find children with it earlier, when treatment is most effective. “There are many children and families who need help. There are many children who are not receiving services early enough or consistently enough,” Frieden said. Autism often has devastating effects on families, and treatment requires time, skill and extreme patience. Medical expenses for children with autism are six times as high as those for children without the disorder. Behavioral therapy, often delivered one-on-one, can cost as much as $60,000 per year. The advocacy group Autism Speaks estimates autism spectrum disorders costs the United States $137 billion a year. Most parents of autistic children — and their advocacy organizations — strongly dispute the idea that a looser definition of autism and more assiduous search for mild cases explains the trend. “Autism is now officially becoming an epidemic in the United States. We are dealing with a national emergency that needs a national plan,” said Mark Roithmayr, president of Autism Speaks. Invited by Frieden to speak at the briefing, Roithmayr respectfully disagreed with him. “Only part of the increase is better diagnosis. Something is going on here that we don’t know,” Roithmayr said. He added that “we desperately need deeper and broader funding” for treatment of the disorder and research on its causes. In recent years, some groups have blamed autism’s rise on a preservative, thimerosal, that is no longer used in childhood vaccines and on the practice of giving infants multiple immunizations at a single visit. Research has ruled out both as a cause. CDC has several studies underway assessing genetic, reproductive, environmental and behavioral variables associated with autism. One of them, the Study to Explore Early Development (SEED), is following 2,700 children and their families in six states, including Maryland. As soon as the new prevalence estimate was announced, advocacy groups jumped on the news to promote their theories and agendas. “These stunning new figures are a call to action among our elected leaders to minimize our children’s exposures to mercury and other toxic chemicals,” said Ken Cook of Environmental Working Group. “Upending the federal government’s approach to regulating toxic chemicals and putting tough emissions standards in place at power plants are two good places to start.” Research suggests that some families have a genetic predisposition for autism and that parental age may play a role. There’s also evidence the condition may begin before birth and be the end result of a disordered process of brain development. A recent study in mice showed that an autism-like disorder could be reversed by bone-marrow transplantation that restored a certain type of cell, called microglia, to the brain. In the CDC study, surveyors looked for 8-year-olds who were getting special education services or were being treated at specialty hospitals or medical units for one of three “autism-spectrum” disorders. The children’s records were then reviewed by clinical experts to see that they actually fit the diagnosis. The children themselves, however, were not examined. Among the children with a diagnosis in their medical records, 44 percent had autistic disorder (which is at the severe end of the spectrum); 47 percent had pervasive developmental disorder; and 9 percent had Asperger syndrome. The prevalence of all three subtypes has been rising in about the same proportion, according to the survey. If the rising prevalence represents an actual increase of the disorders — and is not the consequence of finding previously undiagnosed cases — that suggests there may be environmental exposure or demographic change (such as older parenthood) that is responsible, because a population’s genetic background wouldn’t change over a few decades. The autism prevalence in Maryland is 12.9 per 1,000 children at age 8, slightly above the national average. The disorder is slightly more common in white children than in blacks, but twice as common in whites as in Hispanics. The survey was done in six counties: Anne Arundel, Baltimore, Carroll, Cecil, Harford and Howard. It did not include Baltimore City, where the three hospitals with special programs for the metropolitan area are located. Lee, who is affiliated with Johns Hopkins University’s Bloomberg School of Public Health, said that Baltimore City was surveyed the first year of the survey but was dropped because principals in the city schools didn’t have enough time to cooperate with researchers. **browndm@washpost.com**

We can’t just blame anti-vaxxers for the measles outbreak. Parents skip vaccines for many reasons.

In the panic over measles’ spread in California and beyond, the public has been quick to blame vaccine refusers concentrated in wealthy, educated communities for being too ignorant to realize that measles can be a serious disease.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico This charge, however, ignores the history of measles. It’s an intractable disease that, despite decades of vaccination, rebuffs our best efforts at elimination. And each time it flares up, its resurgence points out unresolved tensions between this country’s “haves” and “have-nots.” When the first measles vaccine was released in 1963, vaccine developers and health officials were optimistic that it would be as widely used as the polio vaccine, which parents scrambled for when it first came out in the mid-1950s. But within just a few years, it was clear that only some segments of the population sought the new vaccine: predominantly white, middle- to upper-class families. As a result, a California epidemiologist noted at the time, measles became “a disease of the Negro population and the population with Spanish surnames.” Across the country, measles began to cluster in poor urban areas. And as the decade progressed, the pattern only worsened. When the Centers for Disease Control and Prevention announced a campaign to eradicate measles domestically via vaccination by the end of 1967, class disparities in measles infection rates provided part of the impetus. But the campaign, perhaps inadvertently, played to white, middle-class fears of diseases emanating from the “slums.” One cartoon depicted measles as a red-faced, yellow-eyed fiend who popped out of metal garbage cans left on the sidewalk and climbed through school windows to menace white children. Nonetheless, the number of measles cases declined dramatically. But at the end of the 1960s they ticked up again. They were once again concentrated in urban "ghettos" and central city indigent areas. And blame for measles’ persistence was often placed squarely on the poor;  on their purported ignorance of the disease, on their lifestyles, even on their living conditions in new urban high-rise apartments, where tight quarters fueled the disease’s spread. Laws requiring measles and other vaccines for school were adopted in the early 1970s, in part because they promised to address class disparities. As a CDC immunization official noted, “To reach the single preschool child in the slum is difficult, but to mount a campaign to attain really high levels of immunization in … school should be relatively easy.” And it was. President Jimmy Carter’s administration announced a renewed campaign to eliminate measles later that decade. By 1980, 96 percent of all children were vaccinated against measles and cases fell to an all-time low in 1981. But by the end of the 1980s, measles again climbed to epidemic heights. And again cases concentrated among minority children in inner cities. President George H.W. Bush proposed tying welfare payments to children’s vaccination status; the outbreaks, in this view, were a matter of personal responsibility. Democrats, meanwhile, tied the outbreaks to a health-care system that shut out the nation’s poor. New federal funds for vaccinating poor and uninsured children drove measles rates way down in the 1990s. In 2000, the CDC declared the disease "eliminated”: measles still occurred, but only when brought into the United States from abroad. In recent years, however, the size of measles outbreaks has grown, as has the number of cases coming in from outside the country.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico As in the past, today’s vitriolic rhetoric around the causes of measles’ return tells us something about class relations in our own time. Blaming purportedly selfish upper-middle class families reflects a collective cultural discomfort with the wealthy’s increasing ability to opt out of shared responsibility for community welfare.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico But as we focus on the alleged selfishness of wealthy, overeducated vaccine skeptics, other factors at the root of the outbreak are, as in the past, getting lost in the conversation. Parents avoid or delay children’s vaccines for an array of reasons: poverty, other challenges accessing health care, medical reasons, religious beliefs and an ever-expanding list of required vaccines. Parental acceptance of some immunizations has eroded in recent decades precisely because the overall number of vaccines and vaccine doses required for children has grown to historically unprecedented levels. We need to acknowledge these factors — just as we need to recognize that our vaccination debates continue to thinly veil class anxieties deeply rooted in our history. _Elena Conis is an assistant professor of history at Emory University in Atlanta and the author of "Vaccine Nation."_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Read more: 2015 measles total is already greater than number of cases in a typical year    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Measles spreads to New York    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Christie clarifies comments on vaccinations    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Get your kids vaccinated, Obama tells parents    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Millennials more likely to say vaccination should be a choice    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The ethical negligence of refusing to vaccinate children    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Refusing vaccination is anti-social, not irrational

The recent outbreak of measles in Disneyland and the increase in measles cases nationwide have led to public health concerns, as well as a backlash against parents who refuse to vaccinate their children. Most media coverage has framed the issue as science versus irrationality, ignorance, and fear. However, this framing misses a key motivation for refusing vaccination. In some cases, the problem arguably isn’t the reluctance of anti-vaccine parents to accept overwhelming scientific evidence that vaccines are safe and effective. It’s that anti-vaccine parents are exploiting others by behaving rationally and strategically.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Public health experts see parents who refuse to vaccinate their children as irrational people who cannot accept clear and convincing evidence that vaccines are safe and effective. Public health experts encourage vaccination by emphasizing our vast historical experience with vaccines and the absence of significant side effects. Some commentators have linked parental decisions to refuse vaccines to broader skepticism about science and experts. However, vaccine skeptics have pushed back, claiming that they have conducted research and made independent judgments about risks of vaccination based on the evidence.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Public health experts do not argue that vaccination is risk free. Rather, they argue that the risk of vaccination is insignificant compared to the public health benefit from preventing the outbreak and spread of infectious diseases. This is settled science. However, parents who decide not to vaccinate their children are not deciding whether to have their children live in a world without vaccines. Their choice is whether or not to subject their own child to the very slight risk of vaccine-related side effects or instead to make their child a rare exception by refusing vaccination. Public health research reluctantly acknowledges that rational parents may refuse to vaccinate their kids. This survey looked at parents of intentionally undervaccinated children in San Diego following a measles outbreak in 2008. A child is intentionally undervaccinated when the parent refuses or delays vaccination. The survey revealed that most of the children’s families were affluent, white and college-educated. It’s extremely unlikely that most of these parents were motivated by religious concerns. Vaccine skeptics moderated their views when they considered the possibility of international travel (which would be likely to expose their kids to more infectious diseases). It’s also clear from the survey that these parents had accepted some debunked claims about the risks of vaccination, in particular the possibility that vaccination may cause autism or other adverse reactions. But this doesn’t fully explain why parents decided not to vaccinate.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico A second, experimental study of motivations for immunization provides a clue. This study identified altruism, free riding and bandwagon effects as affecting these decisions. This highlights, as the authors note, a clash between public health concerns and individual self-interest. People who accept vaccination not only reduce their own chances of contracting contagious diseases, they also reduce the possibility that they will transmit the disease to others. This “herd immunity” provides a social benefit. Altruistic people are motivated in part by this social benefit when they get vaccinated. However, others see things differently. As the proportion of the population that is vaccinated grows, the individual benefits of vaccination decline, because people are less likely to contract the disease. This makes it more attractive for people to free ride on the vaccination decisions of others. The results of the experiment show that people experience cross-cutting motivations when making vaccination decisions. Bandwagon effects were the most powerful motivating force, suggesting that people are most likely to get their children vaccinated when others around them are doing the same. However, differences in people’s levels of altruism and willingness to free ride also affected their decisions, especially when the issues of vaccination were framed in particular ways.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico This clinical report in Pediatrics provides further evidence that parents may refuse vaccination because they are making a strategic decision to exploit herd immunity by free riding on the affirmative vaccination decisions of others. Parents who refuse immunization on behalf of their children are, in a sense, free riders who take advantage of the benefit created by the participation and assumption of immunization risk or burden by others while refusing to participate in the program themselves (p. 1429).    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Anti-vaccine parents do not live in a world in which they weigh the risk of infectious diseases versus the risk of vaccination. They live in a world in which their child faces only very slight risks of contracting infectious disease, due to the decisions of all the other socially responsible parents around them who vaccinate their children. This allows them — if they are narrowly self-interested — to avoid the even slighter risk of side effects from vaccination. It is only the socially responsible decision of parents who vaccinate their children that allows anti-vaccine parents to live in that world. When you put it all together, this evidence suggests that vaccine refusal can be strategic and rational. Many people who refuse to vaccinate their children do not fit the profile of irrational science skeptics; they are affluent and well-educated. In addition, skeptics are more likely to accept vaccinations when there is lower protection from herd immunity (as during international travel). Experimental research shows that people are likely to recognize and exploit vaccination decisions made by others. Clinical advice from pediatricians identifies free riding as a substantial barrier to affirmative vaccination decisions. Free riders may be anti-social, but they are not irrational. To the contrary, free riders are rationally pursuing their narrow, individual self-interest by exploiting the socially responsible behavior of everyone else. This may, of course, eventually make things worse for everyone. It may also be self-defeating, especially if free riders are clustered together. However, education about the social benefits of vaccines is unlikely to solve the problem of selfishly rational people who refuse to vaccinate their kids. What’s needed instead is government intervention to enforce socially responsible (though not individually risk-free) norms. _Robert Stoker is an associate professor of political science and public policy at George Washington University._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Why a few unvaccinated children are an even bigger threat than you think

The measles outbreak traced back to Disneyland has spread to 14 states, with as many as 102 cases reported. Media outlets are highlighting the rise of anti-vaccination sentiments. Scientists are expressing their dismay at people who reject sound medical advice and put their families and communities in harm’s way.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Measles was considered eliminated in the United States in 2000. But if the first month of 2015 is any indication, this year will easily beat the record number of measles cases recorded in 2014.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The narrative during this outbreak, or any measles outbreak really, is that measles is a highly transmissible disease. So transmissible in fact that 90 percent to 95 percent of people must be vaccinated in order to protect the entire population, or achieve what is called herd immunity.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico That is partly true. Measles is highly transmissible, not least because people can be contagious days before symptoms develop. But there are three problems with this line of reasoning about vaccination rates. First, the numbers are based on calculations that assume a world of random mixing. Second, the vaccination coverage is not a perfect measure of immunity in the population. Third, and most problematic in my view, it gives people a seemingly scientific justification for not getting vaccinated – after all, if not everyone needs to get vaccinated in order to attain herd immunity, can it really be so bad if I opt out of it? **What exactly is herd immunity?**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Let’s look at the concept of herd immunity first. The basic idea is that a group (the “herd”) can avoid exposure to a disease by ensuring that enough people are immune so that no sustained chains of transmission can be established. This protects an entire population, especially those who are too young or too sick to be vaccinated. But how many people need to be immune to achieve this?    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In order to calculate the number of people who need to be immune for herd immunity to be effective, we need to know how many people will get infected, on average, by an infectious person. Imagine that a newly infected person will on average pass on the disease to two other people. Those two will each infect another two people, who will themselves pass it on, and so on, resulting in the classical pattern of an exponentially growing outbreak. In order to stop the growth in the number of transmissions, we need to ensure that each individual case causes, on average, less than one new infection. So, let’s say that one case leads on average to two more infections, but instead we want that number to be less than one. That means at least 50 percent of the population needs to be immune, so that at most, only one of the two people who might have been infected by an individual will be. **How many people need to get vaccinated to achieve herd immunity?**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico So, how do we calculate what fraction of a population needs to be immune to reach herd immunity? First, we need to know what the reproduction number, or _R_ , is. That’s how many new cases a single case of an infection will cause.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Imagine that you are infected in a completely susceptible population, and you pass on the infection to five other people (ie _R=5_ ). In order to prevent an outbreak, at least four out of those five people, or 80 percent of the population in general, should be immune. Put differently, 20 percent of the population may remain individually susceptible, but the population would still remain protected.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico So if you can estimate the reproduction number for a given disease, you can calculate the fraction of the population that needs to be immune in order to attain herd immunity. For influenza and Ebola, the number R is about two. For polio and smallpox, it is around five to eight. But for measles it is much higher, somewhere between 10 and 20. And because of that, the goal for measles vaccination coverage is typically around 90 percent to 95 percent of a population. But there’s a problem with this calculation. **The population is not random**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The assumption underlying the calculation for herd immunity is that people are mixing randomly, and that vaccination is distributed equally among the population. But that is not true. As the Disneyland measles outbreak has demonstrated, there are communities whose members are much more likely to refuse vaccination than others.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Geographically, vaccination coverage is highly variable on the level of states, counties, and even schools. We’re fairly certain that opinions and sentiments about vaccination can spread in communities, which may in turn lead to polarized communities with respect to vaccination.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico And media messages, especially from social media, may make the problem worse. When we analyzed data from Twitter about sentiments on the influenza H1N1 vaccine during the swine flu pandemic in 2009, we found that negative sentiments were more contagious than positive sentiments, and that positive messages may even have back-fired, triggering more negative responses.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico And in measles outbreak after measles outbreak, we find that the vast majority of cases occurred in communities that had vaccination coverages that were way below average.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The sad truth is this: as long as there are communities that harbor strong negative views about vaccination, there will be outbreaks of vaccine-preventable diseases in those communities. These outbreaks will happen even if the population as a whole has achieved the vaccination coverage considered sufficient for herd immunity. If negative vaccination sentiments become more popular in the rest of the population as well, we may start to see more sustained transmission chains. Once those chains are sufficiently frequent to connect under-vaccinated communities, we may again be in a situation of endemic measles. The solution often proposed is that we should do a better job of convincing people that vaccines are safe. I’m all for it. But I would also suggest that we should stop basing our vaccination policies on models that made sense in a world of constrained vaccine supply, and aim for 100 percent vaccination coverage among those who can get vaccinated. This would also solve another problem, often glanced over: There are many people who cannot get vaccinated for medical reasons, either because they are too young, or because they have other conditions that prevent them from acquiring immunity through vaccination. Herd immunity against measles requires that 90 percent to 95 percent of the _entire_ population are immune, whereas vaccination coverage is measured as the percentage vaccinated of the _target_ population – which only includes people who are eligible for vaccination. This means that to achieve 95 percent immunity in the population for measles, vaccination coverage needs to be higher than 95 percent. This is the scientific argument for a public health policy that aims at 100 percent vaccination coverage.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico More importantly, there is an ethical argument to be made for the goal of 100 percent vaccination coverage. It sends the right message. Everyone who can get vaccinated, should get vaccinated – not only to protect themselves, but to protect those who can’t, through herd immunity. _This article was originally published onThe Conversation. Read the original article._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Even in 2015, the public doesn’t trust scientists    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Listen up, guys: You should get the HPV vaccine, too    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Sorry, Jenny McCarthy: Grownups need vaccinations    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Ethnicity complicates patient-doctor discussion of death

Talking about death is never easy, even for medical professionals. But a new study has found that difficulty discussing end-of-life medical treatments is complicated further when there are ethnic differences that can create subtle barriers between the doctor and patient.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico A survey of more than 1,000 medical professionals by researchers at Stanford University’s Medical School found that virtually all of them encountered difficulties holding end-of-life discussions with their patients. The difficulty was magnified by cultural and ethnic differences that hindered discussion about end-of-life treatment, with 86 percent rating them as “challenging.” Asian physicians reported the most struggles (91.3 percent), followed by African American (85.3), Caucasian (83.5) and Latino doctors (79.3), according to the study, which appeared Wednesday in the journal PLOS ONE.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Miscommunication or a lack of communication arise for a variety of reasons. Sometimes it’s because the physician isn’t familiar with the religious or spiritual beliefs embraced by some families and hasn’t been trained to understand them. In some cultures, for example, people believe that talking about death is an ill omen that speeds its likelihood, the study says. Other times, the barriers exist simply because of language differences, even when medical translators were brought in. That’s because medical jargon is not always easily translated. Neither are common phrases such as “heroic measures.” The medical translators can also contribute to the distance between a provider and patient, making it harder to talk frankly about death. Other hindrances to communication came about because of greater distrust of medical professionals among some ethnic groups because of the legacy of the Tuskegee experiments and less “health literacy,” or familiarity with health-care procedures. Yet planning end-of-life care has become a more urgent topic of discussion in the United States as its population ages and becomes more diverse — a phenomenon the paper calls the “silver-brown tsunami.” By 2050, the number of Americans 65 or older will more than double to a projected 88.5 million, compared with 40.2 million in 2010, the Census Bureau says. The United States is also trending toward a minority-majority society by 2042.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico At the same time, the federal government is eager to hold down rising health-care costs, a major portion of which are incurred in the last years of life. An estimated 78 percent of costs in the final year of a person’s life is spent on high-intensity, costly measures that are often ineffective and that many people associate as intrusive and clash with their idea of a peaceful death. What’s more, the study says ethnic patients are more likely to incur higher end-of-life costs and are less likely to use hospice care. And then there is the human cost, borne by people whose prolonged deaths become needlessly agonizing for the patient and their loved ones. “In my practice, I see patients and families, especially terminally ill, dying persons, [and] a lot of times they have never had a conversation with their doctor about what they want in terms of care options as they get close to the last chapter of their lives,” VS Periyakoil, a physician who is the study’s lead author, said in an interview Wednesday. When patients fail to have those conversations and agree on  directives and then fall ill, they can set themselves up for long, futile struggle with treatments and procedures that make their experience of dying even worse. “The health-care system is like a river,” Periyakoil said. “If they are not clear about what they want or don’t want, the system sweeps them along and they end up in the ICU.” Some patients are reluctant to broach the topic because they worry that doctors would interpret end-of-life directives limiting care as withholding treatment, Periyakoil said. But she said doctors usually will go overboard in the absence of clear directives not to. “Our bias is always to do more and more,” she said. “If there is one thing people need to hear, it is not that doctors will undertreat them. It’s that doctors will overtreat them.” The survey took place between 2010 and 2012 at Stanford Health Care (formerly called Stanford Hospital & Clinics) and the Veterans Affairs Palo Alto Health Care System. The questionnaire was given to people in 11 medical specialties, including surgeons, psychiatrists, pediatricians and others. Periyakoil, who said she believes her study is the first major survey of doctors’ views on discussing end-of-life barriers, said she believes the culture is reexamining attitudes toward death and recapturing control over its practices from the medical profession in much the same way that the birthing process changed from one driven by doctors to one driven by parents. To that end, Stanford has also promoted its “Letter Project,” by which people can obtain templates for writing simple letters to their physicians explaining their wishes for end-of-life care.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico “In the same way to me, death is an intimate, social event,” Periyakoil said.

New study doubles estimate of global malaria deaths

The number of people who die annually of malaria is roughly double the current estimate, with a huge overlooked death toll in adults who, according to conventional teaching, rarely die of the tropical disease. That’s the conclusion of a new study that, if widely accepted, could affect billions of dollars of charitable spending and foreign aid in the developing world. The new estimate is likely to spur increased competition for global health spending, which has stalled in the economic downturn. The report, published in the Lancet , describes malaria as a problem not only far bigger than thought `but also declining rapidly because of better prevention and treatment. According to the new calculations, global malaria deaths peaked in 2004 at 1.81 million but by 2010 had fallen to 1.24 million. That year, 524,000 people age 5 or older died of the disease — about 42 percent of the global toll. In contrast, the World Health Organization estimates that 655,000 died of malaria in 2010, with 91,000 — 14 percent — being people age 5 and older. The WHO agrees that malaria deaths peaked in 2004. “In the global health landscape, being twice as big as people thought is pretty important,” said Christopher J. L. Murray, who headed a team at the Institute for Health Metrics and Evaluation at the University of Washington that prepared the new estimate. The team also found that malaria accounts for a higher fraction of African children’s deaths — 24 percent — than previously thought. He predicted the findings will be controversial. Malaria was eliminated from the United States in 1951 and from Europe in 2009. More than 90 percent of deaths from the infection now occur in sub-Saharan Africa, where children are at highest risk. The disease, transmitted by mosquitoes, has become an object of attention and spending by rich countries in the last decade. Financial assistance to low-income countries increased from $150 million in 2000 to $2 billion in 2011. Most of the money comes through the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has disbursed $15.1 billion to fight those three diseases over the past 10 years. Malaria accounts for 30 percent of the fund’s grants. By the end of last year, Global Fund money had bought and distributed 235 million insecticide-treated mosquito nets and more than 200 million doses of curative drugs containing artemisinin, a compound first used in Chinese herbal medicine that has transformed malaria therapy. The largest donor country is the United States, whose President’s Malaria Initiative, started by President George W. Bush, spent $500 million in 2010 on malaria control. The U.S. government’s spending on global health has been flat at $8.9 billion a year for two fiscal years. In November, the Global Fund, which is headquartered in Geneva, said it would not make any new grants for two years. Asked if the higher death toll would change Global Fund spending, the organization’s director of strategy, Rifat Atun, said: “That’s a billion-dollar question, literally.” He said it seems clear that adults need to be targeted targeted more in malaria programs. “There are implications for productivity and effects on economic activity from illness in these individuals. There are impacts beyond just health,” Atun said. The head of the advocacy organization Malaria No More, David C. Bowen, wouldn’t speculate about policy implications of the higher estimates. “I don’t think the answer is to rob Peter to pay Paul,” he said. “What the world has been doing is working and desperately needs to continue.” The coordinator of strategy for the WHO’s global malaria program, Richard Cibulskis, played down the conflict between Murray’s data and the WHO’s. There is a large margin of error in the estimates, and in most cases, they fall within each others’ upper and lower bounds. “I wouldn’t say they are that different,” he said. The one area where there is complete incompatibility is deaths in Africans age 5 and older, where Murray’s estimate is eight times higher than the WHO’s. The University of Washington team used many sources to get its number: 435,000 deaths in 2010. The sources included not just vital statistics registries, “verbal autopsy” reports of people who died of fever and academic studies, but also mortality predictions based on treatment practices, population movement and parasite transmission rates. One of the skeptics of such a high malaria death rate in adults is Kevin Marsh, a physician with the KEMRI-Wellcome Trust research program in Kenya who has spent 22 years in Africa. He said he and others have repeatedly investigated reports of hospitals with high malaria mortality and none have proved true. “I’m not saying it’s impossible, but with all we know, it’s highly unlikely,” he said. In his experience, he said, severe illness in adults is often incorrectly attributed to malaria because it’s an illness that practitioners are familiar with and know how to treat.

The truth about vaccines, autism and Robert F. Kennedy Jr.’s conspiracy theory

First things first: Vaccines do not cause autism.   The debunked claim that there is a causal relationship between vaccines and autism largely stems from the late 1990s. At the time, autism diagnoses had been increasing, and doctors didn't know why. In 1998, British researcher Andrew Wakefield published his infamous paper linking autism to the vaccine for measles, mumps and rubella (MMR). Prompted in part by Wakefield's research, U.S. agencies investigated a mercury-based vaccine additive called thimerosal, which was widely used as an antifungal and antiseptic agent. Because of new research on the dangers of mercury poisoning, the government wanted to ensure that thimerosal didn't pose a risk to children who were being vaccinated. The Food and Drug Administration, along with the National Institutes of Health, the CDC, the AAP and several other agencies, concluded that there was no evidence that thimerosal caused any harm. But the additive was removed from most vaccines anyway, as a precautionary measure. Meanwhile, research linking the MMR vaccine to autism was unraveling. Evidence emerged that Wakefield had been paid by attorneys for parents who were suing MMR manufacturers and that Wakefield's data were fraudulent. The Lancet retracted his study in February 2010. That year, Wakefield was found guilty of professional misconduct by Britain's General Medical Council and his license was revoked.  The consensus of the medical and scientific establishment hasn't deterred vaccine skeptics, many of whom say that the government must be covering up the risk. This conspiracy theory found fertile ground in Kennedy.  The article contained several factual errors, and Salon.com eventually retracted it. Rolling Stone left the piece on its site but had to publish more than half a dozen corrections. A decade later, the evidence continues to reaffirm the conclusion that vaccines have no connection of any kind to autism.  Kennedy says he is “pro-vaccine,” insisting that he just wants to ensure vaccines are “as safe as they possibly can be.” But medical professionals argue that the seeds of doubt that Kennedy and others like him have planted can have dangerous consequences, weakening parents' faith in something the medical establishment knows is vital.  Soon after news of Kennedy's appointment broke, the AAP issued a statement from its president, Fernando Stein, and vice president, Karen Remley, affirming the “safety and importance of vaccines.” They emphasized the risks of delaying vaccinations, something that Trump said he was in favor of during a 2015 Republican primary debate. “I want smaller doses over a longer period of time,” Trump said. The AAP's response was blunt: “Vaccines are safe. Vaccines are effective. Vaccines save lives,” Stein and Remley wrote. “We stand ready to work with the White House and the federal government to share the extensive scientific evidence demonstrating the safety of vaccines, including the recommended schedule.” The real danger, they point out, lies in refusing or delaying vaccines.

2015 U.S. measles outbreak already at 84 cases, more than in a typical year

The 2015 measles outbreak already has spread to 84 people, more than health officials typically see in an entire year, the Centers for Disease Control and Prevention reported Thursday. Most of the cases are traceable to an outbreak at Disneyland and another theme park in Southern California that began in late December and now has spread to six other states, including Utah, Washington, Oregon and Colorado. In all, measles has reached 14 states, according to Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases. The outbreak has generated sometimes fierce criticism of people who, for personal reasons or because they mistrust the vaccine, choose not to have their children immunized and prompted at least two school systems in California to ban unvaccinated students from school. Schuchat held a briefing for reporters and others Thursday in an attempt to “prevent measles from getting a foothold and becoming endemic again.” She urged parents to get the measles, mumps, rubella vaccine for their children and themselves, noting that the two-dose regimen is 97  percent effective and has been proven safe despite unproven concerns that it can lead to autism. She also said children should get their first dose at age 1, when it is recommended. Some parents have been delaying the age of first immunization. “MMR vaccine [is] very safe, very effective, really necessary,” Schuchat said. “And the 12-month routine first dose, we really strongly recommend. ">Measles, which is caused by a virus, is highly contagious. The respiratory illness is airborne, spread from person to person by coughing and sneezing. It is so infectious that an unvaccinated person can contract it by inhaling the virus hours after a person with the disease has left a room.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It can lead to potentially serious complications, including pneumonia, brain damage and deafness. About 15 percent of the people infected in the current outbreak required hospitalization, Schuchat said. The United States declared measles eliminated in 2000, but it has been resurgent in recent years, fueled by huge epidemics in other countries that were imported into the United States by travelers and spread mostly among unvaccinated people. Last year, for example, when the measles toll in the Philippines reached 50,000 cases, the United States saw 644, including a cluster in Ohio among unvaccinated people in the Amish community.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Brazil may have fewer Zika-related microcephaly cases than previously reported

Brazil is enduring an extraordinary outbreak of microcephaly, a rare birth defect that results in infants being born with abnormally small heads and brains. Since last fall, more than 4,000 suspected cases have been reported, and authorities have blamed an unusual virus, Zika, carried by mosquitos. But now it appears that a number of those cases may not in fact be microcephaly, or not linked to Zika. On Wednesday, Brazil’s Ministry of Health said 4,180 cases of Zika-related microcephaly had been reported since October. The country is trying to find out which cases it could actually confirm from notifications provided by doctors — a slow and complicated process as the information is compiled and checked by health secretariats in 26 states and one federal district spread across South America’s biggest country. After experts scrutinized 732 of the cases they found that more than half either weren’t microcephaly, or weren’t related to Zika. Just 270 were confirmed as microcephaly that appears to be linked to Zika or other infectious diseases, according to the latest ministry bulletin. It’s not yet clear whether the same pattern will emerge from the rest of the 3,448 cases that Brazil has to examine. And health experts say the huge number of cases is still very worrisome — as is the rapid spread of Zika through the Americas. (Brazil reported just 147 cases of microcephaly in 2014). Microcephaly causes babies to be born with abnormally small heads, and can cause motor and learning difficulties, among other problems. The condition can also be caused by genetic factors or drug or alcohol abuse during pregnancy. Some scientists said the new data suggest that Brazil will have fewer cases of Zika-related microcephaly than originally feared. The country may have over-counted microcephaly cases because it initially asked doctors to report all births of babies with a head circumference of 33 centimeters or less — but some of those were simply children with normally small heads. “It is possible that the number of cases of microcephaly with suspected relationship to Zika will be much less,” said Esper Kallas, an infectious diseases specialist and professor of medicine at the University of São Paulo. “I think it will be less than a third” of the possible cases that have been reported, he said. Kallas also said the outbreak had made Brazil realize that microcephaly unrelated to Zika was more common than authorities realized in the past. Other specialists, though, were wary of the new data, questioning the methodology that was being used. They noted that authorities in one of the badly affected areas, the northeastern state of Bahia, have used relatively cheaper transcranial ultrasound imaging — rather than CT brain imaging scans —  to try to confirm and discard cases of microcephaly. The more inexpensive test might not spot milder cases of the condition, said Ganeshwaran Mochida, a pediatric neurologist and researcher at Boston Children’s Hospital. “There could be some cases mistakenly discarded due to not enough sensitivity,” he said. Zika was first confirmed in Brazil in May last year, and has spread rapidly in the hemisphere, reaching 23 countries and territories. Its explosive growth has alarmed health professionals who worry about the suspected linkage to microcephaly and a rare nervous system syndrome known as Guillain-Barré that can lead to paralysis. The World Health Organization has convened an emergency meeting to explore ways of stopping the transmission of Zika for Monday.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico “The level of alarm is extremely high, as is the level of uncertainty," Margaret Chan, the director-general of the World Health Organization, said during a briefing of member countries on Thursday in Geneva. In October, when the Brazilian government began requiring doctors to report suspected cases, they were instructed to notify the Health Ministry if the circumference of a newborn baby’s head was 33 centimeters (about 13 inches) or less. In December, the ministry reduced the figure to 32 centimeters (12.6 inches) or less, roughly in line with WHO guidelines. The ministry said some babies with the larger measurement were later found to be healthy, although a ministry spokeswoman said she did not have exact figures on how many. Some officials at the state level say they also believe that many of the cases of possible Zika-linked microcephaly will also be found to be something else. In northeastern Pernambuco state, one of the areas hardest-hit by the health crisis, authorities estimate that less than half of the 1,373 reported suspect cases are likely to be microcephaly linked to Zika. Some children just have small heads, others could have microcephaly caused by genetic factors, or alcohol or drug abuse by the mother during pregnancy -- cases which do not show the same type of brain malformation. So far, the state has investigated 248 cases, using CT brain imaging scans. A total of 138 cases were confirmed as probable Zika-related microcephaly, and 110 were discarded, local authorities said. “There are many normal children who were included [in the original count]. This generates a lot of anguish for the families, for the general population,” said Vanessa van der Linden, a pediatric neurologist in Recife. Van der Linden was the first doctor to identify the microcephaly outbreak in Brazil. Mochida from Boston Children's Hospital said that using standard U.S. growth charts, the 33- centimeter guide would put 10 percent of American newborns in the category of suspected microcephaly — clearly way too high a percentage. Authorities in Bahia state have so far confirmed 35 of the reported cases of Zika-related microcephaly, and discarded 27. The state still has 533 other suspected cases of Zika-related microcephaly that it will investigate, officials said. Although some of the suspected cases of Zika-related microcephaly have been discounted, scientists and health officials are hardly breathing easy. There is some preliminary evidence that even babies born in Brazil with normal-size heads may have developmental defects, according to Albert Ko, an infectious disease doctor and chair of the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health. Ko has been working with colleagues at maternity hospitals in Salvador, Brazil’s third-largest city and one of the places where the epidemic is most pronounced, to study what is causing the birth defects in newborns. Ko cautioned that the evidence so far is “extremely anecdotal.” But it is worrisome, he said, because clinicians are finding neurological lesions and smaller brains even in babies who look normal. Clinicians started identifying larger than expected numbers of fetuses with birth defects during ultrasound screenings in July, August and September, he said. Some of the babies were born with intracranial lesions that may be due to infection with Zika virus. Researchers in Brazil are working with the Brazilian health ministry to pin down answers, he said. _Sun reported from Washington._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Read more:   Brazil may be close to a more reliable test for the Zika virus    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico As Zika fear spreads, Brazilian mothers opt for mosquito-resistant baby clothing    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Brazilians panic as mosquito-borne virus is linked to brain damage in thousands of babies    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Zika virus: WHO declares global public health emergency, says causal link to brain defects ‘strongly suspected’

The World Health Organization designated the Zika virus and its suspected complications in newborns as a public health emergency of international concern Monday. The action, which the international body has taken only three times before, paves the way for the mobilization of more funding and manpower to fight the mosquito-born pathogen spreading "explosively" through the Americas. Zika, first identified more than 50 years ago, has alarmed public health officials in recent months because of its possible association with thousands of suspected cases of brain damage in babies. The WHO has estimated that the virus will reach most of the hemisphere and infect up to 4 million people by year's end. WHO Director-General Margaret Chan said at a media briefing Monday that the primary reason for the designation was the "strongly suspected" causal relationship between Zika and the rare congenital condition called microcephaly. Even before that association is scientifically confirmed or disproved, members of an 18-member advisory panel said the seriousness of the cases being reported required action. Chan concurred, saying the consequences of waiting were too great. “Even the clusters of microcephaly alone are enough to declare a public health emergency because of its heavy burden" on women, families  and the community, Chan said. In addition, she noted, there is significant concern given the lack of vaccines and rapid, reliable diagnostic tests, as well as the absence of any viral immunity in the population since the Americas are being affected for the first time. A potential link to Zika is also suspected in adults who have been diagnosed with Guillain-Barré syndrome, a rare condition that can cause paralysis. According to the latest figures on the epicenter of the outbreak, Brazil has 4,000 suspected cases of microcephaly, with 270 confirmed with evidence of an infection. The WHO declaration represents its highest level of alert and is only invoked in response to the most dire threats. The first time was in 2009 during the H1N1 influenza epidemic that is believed to have infected up to 200 million worldwide; the second in May 2014 when a paralyzing form of polio re-emerged in Pakistan and Syria; and the third in August 2014 with Ebola in West Africa. Identifying a global public health emergency now allows the WHO to help coordinate surveillance efforts, such as recording and monitoring cases of Zika, microcephaly and other neurological complications. Officials said countries need to standardize their surveillance for microcephaly, in which an abnormally small head signals incomplete brain development. Zika’s emergence as a major concern has taken infectious disease experts by surprise. The virus has been popping up in various parts of the world for decades, but individuals have typically only suffered mild symptoms such as a rash or body aches. Nearly all those infected in the past recovered fully, though there were rare cases of complications. In recent months, however, as reports about brain-damaged newborns began increasing, health officials have worried about Zika's impact on fetal development and have focused on trying to protect pregnant women from the virus. In January, the U.S. Centers for Disease Control and Prevention issued a travel advisory urging pregnant women to avoid travel to areas where the virus is actively spreading. That advisory has been expanded repeatedly and now lists more than two dozen countries and territories in Central America, South America and the Caribbean. The WHO said Monday there is no reason for travel or trade restrictions at this time. Instead, health officials there reiterated their advice to pregnant women to wear appropriate clothing, use insect repellent and take other practical measures, such as sleeping under a bed net to avoid being bitten. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the WHO’s declaration is the "official global sounding bell that governments and others need to start really paying attention to this." Infectious disease experts and others have pressured the WHO to escalate its response to Zika for several months, warning of the mistakes world leaders made during the Ebola crisis when a lack of coordination delayed quarantines and treatment. Chan seemed to reflect their calls when she asked rhetorically during Monday's media briefing, "Can you imagine if we do not do all these works now and wait until the science comes out, then people will say, 'Why don't you take action?'" Bruce Aylward, the WHO's director of outbreaks and health emergencies, said that the evidence pointing to both a “temporal and geographic association” between Zika and microcephaly was strong. "This is definitely the right measure to be taking at this time based on the information available," he said. Some public health experts said the WHO did not go far enough. Lawrence Gostin, a public health and law expert at Georgetown University, said it was a mistake that WHO did not issue a travel alert for pregnant women visiting Zika-affected countries. The organization's failure to do so puts it at odds with the CDC's travel warning to pregnant women. The countries affected typically have younger populations, which means more women of childbearing age who will be worrying about the virus and its potential harm. Some of these countries have had among the world’s higher birth rates recently. From 2011-2015, according to data from the World Bank, Guatemala had 27 births per 1,000 people; Haiti, 25; and Bolivia, 24. The rate in Brazil – South America’s most populous country by far – was 15 births per 1,000 people during that same period. Gostin said parents concerned for the welfare of their daughters should advise them to avoid going to affected areas if they are pregnant. "If this wave of Zika infections is followed by a wave of birth defects in nine months, it would be unconscionable," he said in a statement. Some countries are asking women to indefinitely delay pregnancy. But most Latin American countries also restrict access to contraception and abortion, and that puts a heavy and unfair burden on young and often poor women, he said. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas, sees most countries in the Americas as ill-equipped to preemptively fight the disease. It already has moved rapidly from South America north into Mexico. “What do you do that’s meaningful to prevent microcephaly?” Hotez asked. “It’s going to go beyond the current health budget of these countries. You’re going to have to get the buy-in of the presidents of these nations.” Zika may even be harder to defeat than Ebola, according to Hotez. While that virus was more deadly and could spread from human to human, it was easier to contain by isolating infected patients and ensuring safe burials. Ebola affected roughly 30,000 people in four West African countries.  Zika could affect millions of people throughout the entire Western Hemisphere. “This is more challenging and more complicated because of the vector and what you’re up against,” Hotez noted. In an interview with the Reuters news agency, Brazilian Heath Minister Marcelo Castro said the outbreak is his country is worse than previously believed because an estimated 80 percent of people who become infected with the virus do not exhibit known symptoms. Castro also said every municipality in Brazil will be required to report all Zika cases to a central database starting next week. In further controls, Brazil will join other nations in banning blood donations from people who had the virus. Castro warned last week that Brazil was “badly losing” the battle against the mosquito blamed for spreading Zika and said that more than 220,000 members of Brazil’s military would be mobilized in eradication efforts. The plans included distributing mosquito repellent to about 400,000 pregnant women, according to Brazil’s O Globo newspaper.

This is why the Paris attacks have gotten more news coverage than other terrorist attacks

It seemed like the world stopped. News outlets devoted nonstop coverage to the terrorist attack in Paris. Many people changed their Facebook or Twitter profile pictures to show solidarity with France. Why this attack? Why didn’t the suicide bombs the day before in Lebanon, or the slaughter of more than 100 college students in Kenya earlier this year, draw such an outcry? Some analysts accuse Western media of racism. Lebanese observers suggested that perhaps Arab lives mattered less. There is, indeed, probably bias in the coverage. People are more likely to be concerned about victims they can identify with. Research tells us that U.S. media outlets are more likely to cover terrorist attacks with U.S. victims. The news media are more likely to cover disasters in wealthier countries. And tragedies that are physically closer to the United States are more likely to appear in U.S. news.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _[Here is what social science can tell us about the Paris attacks]_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico But there is more to the story. **What’s news?**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico It’s important to keep two things in mind about how the news media sets its priorities. First, “news” is generally considered to be something especially unusual. The journalism truism is that “dog bites man” is not a story, but “man bites dog” is. That’s not a judgment on whether dog bites matter; it’s a judgment about what’s surprising. Second, news outlets are influenced by their consumers. Human beings are especially interested in events that might affect them personally. If the media outlet’s readers or viewers are likely to feel that an event has implications for them, that will be covered as a more important story than if the events are unlikely to touch the audience’s lives. Given that, here are some of the reasons the Paris attacks drew such an overwhelming amount of media attention (including this blog post). **France is an unusual target**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico One reason the attack drew so much international attention was that France doesn’t experience nearly as much terrorism as countries with comparable recent attacks, such as Lebanon or Kenya. Last year, Lebanon had more than 200 terrorist attacks, killing 114 people, according to the Global Terrorism Database. One such attack was a car bomb that killed four people, including a Hezbollah leader. Kenya was struck by terrorists more than 100 times in 2014, resulting in more than 300 deaths.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In France in 2014, however, only one person died as a result of terrorism. For France, this year already had been more violent than last, given the attack on the offices of the satirical newspaper Charlie Hebdo in January. Nonetheless, France in recent years has experienced much less terrorism than many other countries. **Paris is a top global tourist destination**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The attack on Paris also shocked observers around the world because many have been there, or plan to visit. France is the most visited country in the world.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico This creates an “it could happen to me” factor, and also suggests that terrorism could affect someone we know. Terrorists, of course, seek out such targets. Attacking tourism hot spots is excellent for drawing attention to their cause. The economic consequences for the tourism industry, unfortunately, can be substantial.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _[Maps: Where the Paris attacks occurred]_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Because Paris is such a prominent travel destination, people from many countries have an interest in violence there, especially when tourists and other foreigners get killed. At least 25 foreigners died in the Paris attacks.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **Random civilians were targeted using shocking tactics**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The Paris attack also stands out for the tactics used by the perpetrators. This attack played out over time in multiple public locations. It also seemed to target everyone, instead of a specific group. Suicide bombers struck a soccer stadium filled with thousands of people, including the president of France, but they only killed one person besides themselves. Other terrorists attacked restaurants, shooting down people drinking or dining.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _[The Islamic State’s attacks in Paris were attacks on Muslims, too]_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The concert attack left dozens dead, with hundreds more trapped inside the hall. Observers around the world wondered if and when the Paris police would intervene. Overall, these attacks were unusually terrifying precisely because they did _not_ target a particular class of people — such as only Christians, university students, or government officials. They targeted anyone and everyone.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico A life lost in this manner is not “more tragic” than a life lost in a civil war. However, it might be more newsworthy, because it’s unusual (see above). **Are we seeing a new battleground for the Islamic State?**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The Paris massacre also is drawing international attention because it suggests a new outward turn for the Islamic State. The Islamic State has mostly attacked in Syria and Iraq, with some attacks in neighboring countries, such as Lebanon. As a result, some analysis has suggested that the Islamic State is less of a threat to the rest of the world than al-Qaeda. A terrorism expert noted in April that while the Islamic State inspired lone wolf attacks in the West, it had not focused on organizing attacks in the West.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Islamic State leaders “have not made a priority of organizing strikes on the West,” the New York Times stated just three months ago.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico However, with the Paris attack, it appears that the group is branching out into Western countries that rarely experience terrorism. The Islamic State leadership apparently directed the attack, according to French officials. That would set it apart from attacks that were only _inspired_ by the group, such as the few killings that have occurred in Western countries in the past year.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _[What do the Paris attacks tell us about foreign fighters?]_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The explosion of the Russian plane in Sinai, killing 224 people, could also be part of the new outward turn of the group — if the Islamic State bombed the plane, as evidence suggests and as the group has claimed. However, the actual bomb would have been placed on the plane in Egypt, where the Islamic State has already been operating. Also, there is not a consensus, especially among Russian and Egyptian authorities, that the plane’s explosion was indeed a terrorist attack.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In claiming credit for the Paris attack, the Islamic State promised more such attacks. Given that many foreign fighters have already left Syria, and now are throughout Europe, this rightly should put the continent on edge.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **This was a complex, coordinated attack. And that’s worrisome.**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico If we are indeed seeing a change in Islamic State behavior in the West, from only inspiring lone actors to apparently directing more complex attacks, it is a substantial shift. An undirected lone individual trying to stab some people is one thing. An orchestrated attack on multiple locations by combat veterans strapped with suicide bombs is another.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico For such an attack, terrorist organizations have to find capable and committed foot soldiers who can work with others, without the authorities catching on. Planning and communication among perpetrators — without getting caught — is especially challenging in a state with advanced surveillance capabilities. One reason why we often see lone-actor attacks in high-capability states is that organized terror is difficult to accomplish in these countries, as I argued in a recent article.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The realization that the Islamic State is apparently willing and able to carry out complex, coordinated attacks in developed countries outside of its home region has European security services worried. Beyond Europe, what other targets might be next? This further adds to the global interest in the Paris attack.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico **In sum, Paris shocked the world for a reason.**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The Paris attack shocked the world for many reasons. It’s true that terrorism in less-developed countries is worth our attention as well. Crises, such as the Syrian civil war, deserve much more media coverage and policy focus. But the Paris attack continues to draw interest because of the relative rarity of terrorism in France, the fact that the country receives visitors from around the globe, the shocking nature of the attack, and the potential implications for the Islamic State’s future plans. _Brian J. Phillips is assistant professor of international studies at Centro de Investigación y Docencia Económicas (CIDE). His research on terrorism and violence has been published in the Journal of Politics, the Journal of Conflict Resolution, and International Studies Quarterly, among other journals._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Rise in mumps outbreaks prompts U.S. officials to weigh third vaccine dose

Among the outbreaks in recent years, 19 occurred last year on college campuses. Arkansas has been battling an outbreak that began in one community last summer and has since infected 2,815 people, the largest recorded in that state.  Federal officials said Thursday that they are looking into whether mumps immunity decreases over time and whether there would be benefits to a third dose. State and local health authorities are particularly interested in that additional shot as a preventive measure, Mona Marin, a viral diseases expert at the Centers for Disease Control and Prevention,  told the Advisory Committee on Immunization Practices.  Currently, the CDC recommends that children receive two doses of the MMR vaccine — for measles, mumps and rubella — with the first dose at 12 to 15 months of age and the second at 4 to 6 years. The mumps component of the MMR vaccine is about 88 percent effective when a person gets two doses; one dose is about 78 percent effective. By comparison, two MMR doses are about 97 percent effective at preventing measles, and a single dose is about 97 percent effective at preventing rubella. The country's mumps vaccination program began in 1967, a point when the virus represented a universal childhood disease and roughly 200,000 cases were reported annually. Even with the 2016 spike in outbreaks, there has been a 99 percent decline in mumps cases compared with the pre-vaccination era. The advisory committee, established more than 50 years ago to provide expert advice to the CDC, meets regularly to discuss all aspects of vaccine safety for children and adults. It has formed a mumps work group to review issues related to the outbreaks, including the duration of immunity after two doses and evidence on benefits of a third dose.       In Arkansas, the ongoing outbreak started in a community of Marshall Islanders in the state's northwest. The Marshallese live in crowded housing conditions, often with 15 to 20 people in a home, state epidemiologist Dirk Haselow said in an interview. From there, the outbreak quickly spread across the state to include broader communities and all age groups.    “It's clear the vaccines make the disease milder than what would otherwise be seen,” Haselow said.

More than 1 in 5 U.S. adults are infected with cancer-causing HPV, CDC report says

That percentage jumped to more than 42 percent during 2013 to 2014 if any type of genital HPV was included, the CDC found. In both groups, prevalence was higher in men than in women. “We tend to overlook the fact that 20 percent of us are carrying the virus that can cause cancer,” said Geraldine McQuillan, lead author of the report and a senior infectious-disease epidemiologist in the Division of Health and Nutrition Examination Surveys at the CDC's National Center for Health Statistics. “People really need to realize that this is a serious concern.” This is the first data CDC has compiled on HPV rates among men. Its previous research among teen girls and women looked at far fewer strains of the virus and included a younger, narrower age range — and, perhaps because of that, found a lower prevalence of high-risk HPV.    Lingering misconceptions and fears are among the reasons for the lower use of HPV vaccination, said Electra Paskett, a cancer control researcher at Ohio State University's Comprehensive Cancer Center. Some people still think vaccination encourages youth to become promiscuous. “The way [the vaccine] was introduced in Australia and the United Kingdom was as a cancer vaccine, which is truly what it is. It is a cancer vaccine,” Paskett said. The CDC report also addresses oral HPV infections. From 2011 to 2014, their prevalence was 7 percent among those aged 18 to 69, it found. As with genital HPV, rates were higher for men than women overall and in all racial and ethnic groups. The same disparities also were found among those groups: Asians had the lowest rates and blacks had the highest rates.

Decision to get vaccinated against measles is ‘almost obvious,’ says health official

Measles is a contagious but preventable disease, and the choice to get vaccinated against it is "really almost obvious," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Sunday. The measles outbreak that originated at Disneyland in December and continues to spread across the country has sparked a debate over whether parents should vaccinate their children. There are people with deep, philosophical reasons for refusing vaccines, but there are others who can be convinced otherwise, Fauci said during an interview on CBS's "Face the Nation." The CDC is working with local and state public-health officials to educate the public about the measles vaccine, he said, referring to the Centers for Disease Control and Prevention. "You have a very good vaccine, you have a highly contagious disease, and you have a disease that's entirely preventable. When you look at the data, with a safe vaccine, the conclusion is really almost obvious," Fauci said. The current outbreak is not yet a major epidemic, but it is affecting vulnerable populations, he said. It has been especially harmful to those who cannot get vaccinations, he said, such as children under 1, children with leukemia and others with weakened immune systems. His comments referenced the concept of herd immunity, according to which a large segment of a population must be immunized to reduce the risk of exposure to everyone within the community, including the most vulnerable, who can't receive vaccines, or those who refuse them. In a separate interview on "Fox News Sunday," retired neurosurgeon Ben Carson said that concerns about side effects to vaccines have been "debunked." Carson, who said he could formally announce a bid for the 2016 Republican presidential nomination by May, compared getting vaccinated to wearing seat belts or not engaging in texting while driving: "That's not optional. We know that it works."    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico "You look at the benefit-to-risk ratio for vaccinations: way in favor of getting them. Is there an occasional problem? An occasional allergic reaction? Of course there is. But you have to look at the overall good," Carson said.

Why is there a measles outbreak?

There has been an outbreak of measles in the United States for the past two months. During this time, you may have read about the outbreak or overheard your parents talking about it. KidsPost thought it would help to explain what’s going on. **What is measles?** Measles is a viral infection that used to be a common childhood disease in the United States. Before the measles vaccine was given to American children in 1963, there were about 500,000 cases and 450 deaths reported each year. In the past 10 years, there have been an average of 60 cases of measles each year. Compare that to the 20 million cases that occur worldwide each year. **Is measles serious?** Most kids who get measles are sick for seven to 10 days. It begins with the symptoms of a cold: runny nose, cough, sore throat, conjunctivitis (pink eye) and fever. After a few days, a red, blotchy rash starts on the face and spreads all over the body. Serious complications include dehydration, pneumonia or an inflammation of the brain called encephalitis. **Is measles contagious?** When the Ebola scare hit last summer, one of the things doctors told people is that Ebola, while serious, is not highly contagious. The reason for this is because you can’t catch Ebola unless you come in direct contact with the bodily fluids of someone who has the infection. Health officials reassured the public that Ebola was not airborne. That means you can’t catch it from breathing the same air as someone who has the infection. But measles is one of the most contagious viruses known to science. People with measles can spread the infection for four days before the onset of the rash and four days after. (That means people are contagious before they know they have measles.) Not only is measles spread through airborne exposure, but the virus can remain in the air for two hours after an infected person has left the area. **How is measles treated?** Like most viral infections, there is no specific treatment for measles. If someone gets the infection, he is treated with rest, fluids and fever medication. In some cases, people are hospitalized because they developed a complication of the disease. **When did the current outbreak begin?** The outbreak began in December and was linked to Disneyland in Anaheim, California. It’s presumed that the original patient entered the United States from another country. The infection spread rapidly to people who had not been immunized against it. To date, more than 120 confirmed cases have been reported in 17 states and the District of Columbia. **Are you at risk for catching the infection?** Most children receive two measles shots. The first is usually given between 12 months and 15 months. The second is usually given between ages 4 and 6. Vaccines aren’t completely effective, but if you’ve had both measles vaccines, your chances of becoming infected after being exposed to the virus are less than 2 percent. **Why have so many people come down with measles?** Over the past two decades, some parents have become concerned that vaccines are more dangerous than the diseases they prevent. Many scientific studies have shown this isn’t true, but some people are still reluctant to give their children shots. Most states require children to be vaccinated against measles and other diseases to attend school. The reason for this policy is simple. The more people who are vaccinated, the less likely an outbreak will occur. This process is called herd immunity. Each jurisdiction has its own rules about mandatory vaccinations. Some, such as Maryland, have a very strict policy about immunizing students. But all states other than Mississippi and West Virginia allow parents not to vaccinate their children because of the family’s religious beliefs. Nineteen states also allow parents that option if the vaccinations are against their personal beliefs. **Why are some people upset about the outbreak?** Because there is a vaccine for measles, it is a preventable disease. And the way to prevent the spread of the disease is to keep most of the population immunized against the virus. However, some children can’t get the vaccine because they have cancer, other diseases that weaken their immune system or they are too young. If parents choose not to vaccinate their children, it puts others at risk. That’s why some people are upset about what’s taking place. **— Howard J. Bennett  **

Zika: More than 2,500 babies born with microcephaly in Brazil, WHO predicts

The World Health Organization said Tuesday that it expects Brazil will have more than 2,500 babies born with a severe birth defect known as microcephaly if current trends continue in the Zika virus outbreak. Data from Brazil, the epicenter of an epidemic that has hit more than three dozen countries and territories in the Americas, show that about 39 percent of 2,212 investigated cases of microcephaly are already confirmed for the rare congenital condition. To date, that's 863 babies born with the characteristic abnormally small heads and underdeveloped brains, WHO detailed at a news conference in Geneva. "If that rate continues, we expect more than 2,500 cases will emerge of babies with brain damage and clinical signs of microcephaly," said Anthony Costello, who heads WHO's department of maternal, newborn, child and adolescent health. WHO Director-General Margaret Chan said new evidence is becoming clear daily about the mosquito-borne virus. A pattern seems to be emerging: Initial detection of Zika is followed within about three weeks by an unusual increase of Guillain-Barré syndrome, a rare condition that can cause paralysis and sometimes death. Detection of microcephaly and other fetal abnormalities typically comes about six months later, WHO officials said, as pregnancies of infected women come to term. Brazil and Panama are now reporting cases of microcephaly -- including 6,480 suspected cases in Brazil. Panama has one reported case. Colombia is investigating many cases for a possible link. A WHO team is currently in Cape Verde to investigate that country's first reported case of microcephaly, Chan said. A total of 12 countries and territories have now seen an increase in the incidence of Guillain-Barré or actual lab confirmation of Zika among cases with the syndrome, she said. Although Zika has hit countries in Latin America and the Caribbean the hardest, Chan warned that no one can predict if it will spread to other parts of the world and trigger the same pattern of health complications. In other affected countries, the virus has not been circulating long enough for pregnancies to come to term, she said. "If this pattern is confirmed beyond Latin America and the Caribbean, the world will face a severe public health crisis," she said. Chan said the Zika virus initially looked "reassuringly mild," with no hospitalizations or deaths reported when it first showed up in Brazil last May. But in less than a year, she said, "the status of Zika has changed from a mild medical curiosity to a disease with severe public health implications." The possibility that a mosquito bite could be linked to severe fetal abnormalities "alarmed the public and astonished scientists," she said. The world community needs to shift thinking and preparations for the long term, she said. Countries need to build health capacity and social support to help families cope with the "heartbreaking strain" from caring for such babies. The Cape Verde archipelago off West Africa has more than than 7,000 Zika infections, including its first case last week of a newborn with microcephaly. Although the link between Zika and fetal abnormalities has not been proven, "the circumstantial evidence is now overwhelming," she said. Urgent action should not wait for definitive proof, she added. Recent studies have detailed how the pathogen could attack fetal brain development as well as trigger complications at any stage of pregnancy. In a study published last week the Lancet medical journal, researchers analyzed a 2013-2014 Zika outbreak in French Polynesia and said the risk of microcephaly is about one for every 100 women infected with the virus during the first trimester of pregnancy. The research, based on statistical and mathematical models, was conducted after the outbreak was over. Researchers cautioned, however, that outbreaks differ, and the risk will depend on how the virus spreads and the makeup of the affected population. WHO officials said they don't have enough information yet to say what the risk of microcephaly is for pregnant women in Brazil or elsewhere. Between 2001 and 2014, Brazil had, on average, about 163 cases of microcephaly a year.  For vaccines, there are more than 23 projects underway by 14 vaccine developers in the United States, France, Brazil, India and Austria, WHO officials said. Although clinical trials might start before the end of the year, including one underway at the National Institutes of Health, health authorities have said it will be several years at least before a fully tested, licensed Zika vaccine is ready. Although the "first explosive wave" of Zika's spread may be over before a vaccine is available, Chan said there will continue to be need for a vaccine in the years ahead."We expect it to be a long haul," she said.

Americans are much, much more likely to be killed by guns than people in other countries

When nine people are gunned down at an Oregon community college, or 14 people fatally shot at a holiday party in California, or nine parishioners killed at a church in Charleston, the world pays attention. These bursts of violence are terrifying and specific, mass killings of the sort that can break through what is otherwise the grim, pervasive background noise of gun violence in America. This daily parade of shootings and killings can capture local attention and live in brief segments on the news and frighten communities and they otherwise come and go without much public notice.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico How unusual is this, though? How does it actually compare to life in other countries? Researchers recently decided to see, using the World Health Organization’s 2010 mortality data to compare rates in the United States with those found in other populous, high-income countries. The numbers they found suggest that a person is much, much more likely to be killed by a gun in the United States than in any of these other countries, and it isn’t remotely close. The gun homicide rate in the United States was more than 25 times higher than in other high-income countries, according to a new study in the American Journal of Medicine that examined death rates per 100,000 people.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico In the United States, the overall homicide rate is seven times higher than these other countries, while the homicide rate when discounting guns was 2.7 times higher, the study said. All told, the rate of deaths involving guns in the United States was 10 times higher than these other countries. This study looked at a total of 23 countries — the United States included — and this country accounted for a little less than half of the residents covered by the research. But, the researchers noted, more than 8 in 10 gun-related deaths they saw still took place in the United States, and 9 out of 10 women and children killed by guns were in the United States. The study also noted that while the firearm death rate in other countries fell between 2003 and 2010, it was unchanged in the United States, further expanding the gap between this country and the others. This divide was particularly acute for young people. The gun homicide rate for Americans between the ages of 15 and 24 is an astronomical 49 times higher than it is for people that age in other, comparable countries. The rate of unintentional deaths involving guns was also more than six times higher here. The study’s authors, Erin Grinshteyn and David Hemenway, wrote that their research showed a country with “an enormous firearm problem.” Grinshteyn is an assistant professor at the University of Nevada, Reno, while Hemenway is a professor at the Harvard School of Public Health. All told, car crashes and guns kill roughly the same number of Americans annually, according to the Centers for Disease Control and Prevention. More than 33,000 people are killed in vehicle crashes and by firearms each year, and firearm deaths were able to catch up largely because of the big drop in how many Americans were killed in traffic accidents over the last half- century.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Funding for gun-related research was decimated after it was targeted by the National Rifle Association and its allies in Congress, a decision that reverberates two decades later. “We have to understand what the problem is, how to approach the problem, and do our approaches work,” Hemenway, director of the Harvard Injury Control Research Center, told the Trace last year about the problems involving funding for gun research. “And we just don’t know anything.”    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico The FBI has said that the number of overall violent crimes increased last year, which came as murder rates also went up in cities nationwide after years of falling violent crime. Americans, for what it’s worth, are generally very convinced that crime is going up, saying that they think crime is on the rise year after year, even when it turns out it was declining.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Gun homicides have fallen considerably in recent decades, declining by about half since the early 1990s. While dozens of people are fatally shot each day, the total gun death rate has fallen by nearly a third since 1993, according to a Pew Research Center analysis of death certificate data. There is one worrisome exception, though: While the gun homicide rate has remained flat in recent years, the gun suicide rate has ticked up since 2010.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico According to the new study comparing the United States to other countries, suicides involving guns were also a much bigger issue here than elsewhere. Two out of three gun deaths in the United States are suicides, the CDC reports. And the new study shows that the rate of suicides involving guns was eight times higher in the United States than other countries. In the new study, Grinshteyn and Hemenway wrote that their research shows that the country “suffers disproportionately from firearms,” ultimately coming to this conclusion: “These results are consistent with the hypothesis that our firearms are killing us rather than protecting us.” **Related:**    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico How Americans actually feel about stronger gun laws    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Almost 1,000 people have been killed in attacks on health-care facilities since 2014, WHO says

The WHO's data was drawn from online databases and simple Web searches, so the report isn't built on the strongest statistical foundation, but it is one of the first attempts at a comprehensive analysis of attacks on health-care facilities and workers, which is a war crime, if intentional, and is becoming more common.  More than half of the attacks included in the report were against facilities, while a quarter were against health-care personnel themselves. There were 594 attacks in total, with 228 in Syria alone, representing 38 percent of the total. Although there were four times as many documented attacks in 2014 as 2015, both Syria and the Palestinian territories saw increases in 2015. Hospital attacks in Syria have gained widespread attention since multiple facilities run by Doctors Without Borders, often referred to by its French initials MSF, were bombed in February and May, killing dozens. MSF says on its website that its facilities or those it supports in Syria were attacked 94 times in 2015, with 12 instances resulting in total destruction. Eighty-one medical staff at MSF-supported hospital were killed or wounded in Syria in 2015. Two attacks on MSF hospitals in Yemen and Afghanistan also rocked the international community last year. On Oct. 3, U.S. forces bombed an MSF hospital in Kunduz, Afghanistan, killing 44, including women and children. The U.S. military has claimed that mechanical and communication failures led to this grievous mistake, but a recent investigation by Matthieu Aikins for the New York Times Magazine raises the possibility that Afghan forces knowingly led the Americans into the attack out of spite for MSF, which they believed was harboring Taliban fighters. Later that month, a Saudi-led airstrike destroyed an MSF hospital in Yemen, though all inside made it out alive.

7 things about vaccines and autism that the movie ‘Vaxxed’ won’t tell you

On its surface, the movie “Vaxxed: From Cover-Up to Catastrophe” appears to be a slickly produced scientific documentary with lots of charts and data about one of the most important issues of our time. The central premise of the film is that the country’s mandatory measles, mumps and rubella (MMR) vaccine — when given to children under age 2 — may be leading to an epidemic of autism diagnoses. It contains heartbreaking footage of happy, laughing toddlers who, their parents say, became profoundly disabled almost overnight after receiving the shot. It explains the findings of a study that confirms the link and unearths recordings from a former Centers for Disease Control and Prevention scientist who purportedly claimed the government quashed findings of the connection. But what the movie doesn’t get into is as compelling as what it does present. There are numerous facts, backstories and events that the filmmakers pretend didn’t happen that challenge many of the main points of the film. Here’s what you need to know to put “Vaxxed” into context: 1) The most important thing to know is that the link between vaccines and autism has been debunked — widely and repeatedly. The original study that raised the issue was published in 1998 in the journal the Lancet and involved 12 patients who, after receiving the MMR vaccine, suffered ill effects that appeared to be autism. While many researchers were skeptical of the finding, panicked parents in both Great Britain and the United States pushed vaccination rates down sharply. Outbreaks of the measles, mumps and rubella on both sides of the Atlantic soon followed. In 2004, Sunday Times journalist Brian Deer reported serious ethical violations by the 1998 paper’s lead author, gastroenterologist Andrew Wakefield. Deer accused Wakefield of having been paid by a law firm that had been planning to sue vaccine manufacturers and of subjecting some of the children to unnecessary, invasive procedures for the study. After the revelations, most of the researchers named as co-authors in the study disavowed the findings and withdrew their names from the paper. In 2010, the Lancet’s editors retracted the paper. Three months later, Britain’s General Medical Council revoked Wakefield’s medical license. In 2011, the British medical journal the BMJ published a detailed investigation into the research, calling it an “elaborate fraud” by Wakefield and lamenting the harm it had caused and would continue to cause to the public health.  2) The director of “Vaxxed” — and the main expert who appears on camera — is that same Andrew Wakefield. 3) Actor Robert De Niro, who has an autistic son, originally lobbied to put the film on the schedule for the Tribeca Film Festival in March. But several days later, he said he had a change of heart. “My intent in screening this film was to provide an opportunity for conversation around an issue that is deeply personal to me and my family,” he said in a statement. “But after reviewing it over the past few days with the Tribeca Film Festival team and others from the scientific community, we do not believe it contributes to or furthers the discussion I had hoped for.” 4) One of the main figures in the film, CDC scientist William Thompson, is heard only in voice recordings. Those recordings, the movie discloses, were of phone conversations Thompson had with another researcher who secretly recorded the calls. “Oh, my God. I cannot believe we did what we did. But we did,” Thompson says at one point, purportedly about omitting findings confirming a link between the MMR vaccine and autism from an official 2004 report.  Hooker said he is “suspect of any analysis coming from the CDC due to the historic nature of the agency’s scientific misconduct and conflicts of interest specifically around any link between vaccines and autism.” He also detailed his conversations with Thompson: 5) While the issue of vaccines and autism still comes up regularly — as it did when presidential contender Donald Trump mentioned his belief in the theory in a debate last year — most scientists consider the connection between vaccines and autism to be discredited. Dozens of top journals — including the New England Journal of Medicine, the Journal of Pediatric Infectious Diseases and the Journal of Autism and Developmental Disorders — have published papers that looked into a possible link and found none.  6) While experts still don't know what causes autism, it is thought to be a combination of genetic and environmental factors such as infections or exposure to certain chemicals that may lead to differences in the shape and structure of a child’s brain. According to an estimate by the CDC published last year, 1 in 45 (or 2.24 percent) of children age 3 to 17 may have autism — a steep rise over the past few decades. Researchers have theorized that part of the rise could be attributable to a greater awareness of the condition. The CDC said the most recent jump from 2011 to 2014 may have a very mundane reason behind it: a change in the questionnaire the agency uses to track cases.

Measles cases put Texas megachurch under scrutiny

NEWARK, Tex. — The teachings of televangelist Kenneth Copeland and his family focusing on the virtues of trusting God to keep healthy are under scrutiny after a cluster of measles cases linked to his family’s North Texas megachurch revealed that many congregants hadn’t been vaccinated against the highly contagious disease. Although Kenneth Copeland Ministries officials were quick to act after the outbreak — including hosting clinics in August where 220 people received immunization shots — and have denied that they are against medical care or vaccinations, people familiar with the ministry say there is a pervasive culture that believers should rely on God, not modern medicine, to keep them well. “To get a vaccine would have been viewed by me and my friends and my peers as an act of fear — that you doubted God would keep you safe. . . . We simply didn’t do it,” former church member Amy Arden told the Associated Press. Health officials say 21 people were sickened with the measles after a person who contracted the virus overseas visited the 1,500-member Eagle Mountain International Church on the vast grounds of Kenneth Copeland Ministries in Newark, about 20 miles north of Fort Worth. Of the 21 people who contracted measles linked to the church, 16 were unvaccinated. The others may have had at least one vaccination but had no documentation. The Centers for Disease Control and Prevention recommends that children get two doses of the combined vaccine for measles, mumps and rubella, called the MMR. The first dose should be given when the child is 12 to 15 months old and the second at 4 to 6 years old. During an August 2010 broadcast, Copeland expressed shock at the number of vaccinations recommended for his great-grandchild. And his wife, Gloria, bragged during a conference that she and her husband don’t need prescription drugs, adding that the Lord heals all diseases. Robert Hayes, risk manager for the ministries, denied that the church’s teachings ever have advised against immunizations. Ole Anthony, president of the Dallas-based religious watchdog group Trinity Foundation, said that while there might not be specific guidance on topics such as vaccinations, the views of the leadership are clear. “The whole atmosphere is to encourage them to have faith, and it’s not faith if they go to the doctor, that’s the bottom line,” Anthony said. In a sermon posted online after the outbreak, Copeland’s daughter, Terri Pearsons, who is a senior pastor at Eagle Mountain along with her husband, encouraged those who hadn’t been vaccinated to have it done, but added that if “you’ve got this covered in your household by faith and it crosses your heart of faith, then don’t go do it.” ** — Associated Press  ** ****

Five myths about suicide

It populates our most ancient stories, spelling the ends of figures both infamous and innocent, from to Brutus to Judas to Juliet — but we still don’t fully understand suicide. Are the causes hereditary? How much does brain chemistry matter? What are the best ways to detect the impulse? Despite decades of research, scientists, clinicians and counselors are just beginning to unlock the mysteries of self-inflicted death. Sadly, the federal government currently allocates more money to problems like headaches, Lyme disease and lupus than to suicide, according to the National Institutes of Health; no other leading cause of death (in the United States, it is No. 10) has so little money dedicated to it. The absence of consistent, well-funded, quality research has led to a proliferation of myths about suicide and the people whose lives it claims. _1\. We’re currently experiencing a suicide epidemic._ The Centers for Disease Control and Prevention released new data last month showing that the suicide rate in the United States rose between 1999 and 2014. Many media outlets, including the Guardian, the Washington Times and Foreign Policy, reported this as “an epidemic.” These reports are misleading in several ways. Suicide is neither a disease nor contagious, so it doesn’t fit the literal definition of an epidemic. But the metaphorical use of “epidemic” doesn’t match, either: Suicide is not actually gaining sudden prevalence. The high rates of suicide reflected in the CDC’s report are not new. Yes, the rate in the United States has increased over the past 15 years or so, but it decreased over the 15 years before that. Today, 13 of every 100,000 people in the United States kill themselves; in 1914, 16 per 100,000 did. Suicide has always been a major public health problem. It is the 10th leading cause of death in the United States, while worldwide, more people die from suicide than from wars, genocide and interpersonal violence combined — more than 800,000 every year, according to the World Health Organization. This means that we are each more likely to die by our own hand than by someone else’s. Unfortunately, that’s nothing new. _2. Suicides are most common during the winter holidays._ The notion that suicides peak during the holiday season is a longtime misconception with cultural precedent in films like _It’s a Wonderful Life_. In 2014, the Annenberg Public Policy Center at the University of Pennsylvania found that 70 percent of news articles linking the holidays and suicide between November of 2013 and January of 2014 suggested that suicides surge during the holiday season. It’s easy to see why people might believe this myth: During the winter holiday season, there are fewer hours of sunlight, meaning shorter days and longer nights. It is cold and dreary. And while many people cheerily spend time with family and friends, others are not so fortunate and are left feeling sad and lonely. Sounds like the time of year when the suicide rate goes up, right? Wrong. The rate is consistently highest in the spring, specifically in April and May. Experts do not fully understand why this might be the case, although one recent study by researchers from the University of Vienna, published in the journal JAMA Psychiatry, showed that as hours of sunlight increase, so does the risk of suicide. The authors speculate that sunlight could boost energy and motivation, thus giving people who are depressed the ability to take action and make a suicide attempt. _3. Most suicides are impulsive acts._ Suicide is often described as an act born of a sudden, fatal decision. “Indeed, many people who commit suicide are more momentarily desperate than classically depressed,” Elisabeth Rosenthal wrote in a 2013 New York Times article. “The role of impulsiveness is one of the saddest things about suicide,” Business Insider opined after actor Robin Williams’s death in 2014; the nonprofit Brady Campaign to Prevent Gun Violence says on its website that “impulsivity” is “the link between guns and suicide.” In 2015, Vox’s Ezra Klein echoed that sentiment, tweeting that “suicide is impulsive, and can be prevented if it fails.” In reality, most people who attempt to kill themselves make a plan to do so, and even those classified as “impulsive” often have suicidal thoughts before they try it, according to a 2007 Australian study . (In that same study, only about 25 percent of people who attempted suicide considered their behavior to be impulsive.) Likewise, a recent review of research on this topic concluded that the link between impulsivity and suicide is weak. This is good news for prevention efforts: According to a 2002 study published in the American Journal of Psychiatry, nearly half of those who die by suicide visit their doctors in the month before their deaths, and nearly two-thirds tell someone that they want to die or are thinking about suicide. That provides not only clues that they are at risk but also opportunities to help them. _4. There is a “suicide gene.”_ Suicide is a perplexing problem. As with many other leading causes of death that we don’t fully understand (including cancer and Alzheimer’s ), many of us want “the cause” to be discovered so we can devise a treatment. We want, in short, a “suicide gene.” And several studies published in the past few years have identified aspects of DNA that seem to differ between some people who have died by suicide and those who haven’t. When such studies are reported in the media, they are often described as having found “a gene for suicide.” In 2014, the Huffington Post announced that “this gene could tell you who is at risk for suicide,” while similar headlines ran in Forbes and the Guardian. But things aren’t so simple. Unfortunately, there is no gene for suicide. Suicide is the result of a complex interaction among many factors that cannot be reduced to a single piece of genetic code. And none of the genetic factors that have been linked to suicide are unique to suicidal behavior. Instead, they seem to be markers for things like a tendency to have low mood, sleep problems and anxiety — all of which increase the risk of suicidal behavior but don’t code for it specifically, and often exist in non-suicidal people. For example, one of the most recent and lauded studies detected a genetic defect that could affect how the brain manages stress hormones — which is perhaps related to suicidal behavior but far from its only cause. Ultimately there is no one cause, genetic or otherwise, for suicide. As Kenneth Kendler put it in a 2005 article in the American Journal of Psychiatry: “The phrase ‘X is a gene for Y’ . . . [is] inappropriate for psychiatric disorders. The strong, clear, and direct causal relationship implied by the concept of ‘a gene for . . .’ does not exist for psychiatric disorders.” _5. We know how to prevent suicide._ Many organizations and public health campaigns say suicide is preventable. The National Institute of Mental Health, for instance, dubs suicide a “major, preventable mental health problem.” After all, it’s a behavior based on human decision-making, and in that sense it can theoretically be spotted and stopped. But we are not yet very successful at this. There are many well-intentioned prevention programs out there, but we have very little data on which ones work and which ones don’t. Likewise, several proposals for reducing suicide rates have been made over the years — among them restricting gun access (as posited by a 2015 paper analyzing suicides in Connecticut and Missouri) or doing more screening (as suggested by the Substance Abuse and Mental Health Services Administration). But studies haven’t been carried out. We do know what factors put people at elevated risk for suicide — depression, substance use, a family history of suicide — and according to a study published this year in the journal PLoS Medicine, some treatments appear to reduce the chance of reattempts among those who have previously tried to kill themselves. But we have no programs backed up by evidence from randomized controlled trials, the highest standard, showing that they stop people from ever attempting suicide. Our best bet for preventing suicide is to ramp up research and hopefully shed more light on this troubling phenomenon. **Twitter: @NockLabHarvard** Five myths is a weekly feature challenging everything you think you know. You can check out previous myths, read more from Outlook or follow our updates on Facebook and Twitter.

The Syrian war’s horrific toll on children

The details couldn’t be more jarring. When children have arrived at Syrian hospitals, their limbs have been amputated because facilities were too damaged to treat them properly. Newborns have died in incubators because of power outages. And some patients have asked to be “knocked out with metal bars” because there wasn’t any anesthesia available. The numbers, according to a Save the Children report released Sunday, are just as bad.    *[WSU]: Wayne State University Following more than three years of civil war in Syria, violence has killed more than 10,000 children. More than 1.2 million have fled the conflict. And another 4.3 million need humanitarian aid. But, as the report points out, it’s not just violence tha has crippled the country, but its crumbling medical services. “It is not just the bullets and the shells that are killing and maiming children,” Save the Children said. “They are dying from the lack of basic medical care.” Nearly half the nation’s doctors have fled the country. Nearly two-thirds of the hospitals have been damaged or destroyed. Nowhere has the story been worse than Aleppo, which was once home to 2,500 doctors. Today, the report says only 36 remain. The report draws its conclusions from data provided by the United Nations, the World Health Organization, the European Center for Disease Prevention and Control, Doctors Without Borders and the Syrian government.    *[WSU]: Wayne State University “What we’re seeing is that the focus in the public discourse is the fighting and the political situation, but what we see really missing is the human impact,” Misty Buswell, the group’s regional advocacy director, told the New York Times. “So many children are dying and being injured and maimed, so we wanted this report to bring the focus back.”    *[WSU]: Wayne State University

Map: 113 countries have higher measles immunization rates than the U.S. for 1-year-olds

What do Libya, Russia, China, Zimbabwe and Iran have in common? According to the World Health Organization, they have a higher measles immunization coverage among 1-year-olds than the United States. And, as this interactive map shows, they are far from alone.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico WHO recommends all states have their infants vaccinated with at least one dose before their first birthday. With a measles vaccination coverage of 91 percent, the United States is more vulnerable to measles outbreaks compared to many other countries, according to 2013 data from WHO. Contrary to recent positive trends elsewhere, the overall U.S. immunization rate against measles slightly declined from 2012 to 2013 by one percentage point.    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Some Latin American nations, as well as many African countries, have even lower immunization rates than the United States. Among the world's worst, for example, is the Central African Republic with only 25 percent, as well as South Sudan with 30 percent. However, many countries have been more successful than the United States in vaccinating their 1-year-olds at least once. Among them are: Canada, Brazil, Bolivia, Uruguay, Paraguay, Cuba, Algeria, Morocco, Botswana, Zimbabwe, Tanzania, Egypt, Saudi Arabia, Iran, Kazachstan, China, Australia, Thailand, Russia, Kenya, New Zealand, nearly all European countries, Vietnam, Mongolia, Turkmenistan and Turkey. That list is by far not exhaustive. It begs the question: Why do so many countries outperform the United States in immunizing 1-year-olds against measles? There are four key reasons. _Graphics editor Lazaro Gamio contributed to this post._    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico _ **Related:**_    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico Everything you need to know about measles    *[WSU]: Wayne State University   *[Tue]: Tuesday   *[Wed]: Wednesday   *[UNM]: University of New Mexico

Five myths about AIDS

**1. The case of the Mississippi baby means we’re close to curing AIDS.** ****What happened with the baby girl in Mississippi was remarkable, but it’s not clear what lessons the case has for improving the health of other children or fighting the epidemic generally. The infant never developed AIDS, the disease caused by HIV.And scientists are debating whether she was truly infected with the virus. Here’s what is known: The baby’s mother was infected and had not had prenatal care. After delivery, the baby had some HIV in her blood. Aggressive treatment with a combination of powerful drugs drove the virus to undetectable levels. Doctors were surprised, however, when a long break in treatment (after the mother started missing appointments) didn’t lead to a resurgence of HIV. The virus remained undetectable, though it’s too soon to know if it is permanently gone. This case was very unusual. HIV infections in pregnant women are routinely detected during prenatal care, allowing time to start effective drug regimens that keep the virus from infecting babies. Such strategies are all but universal in wealthier nations and now reach more than half of infected women in the parts of Africa where HIV is widespread. But given how cheap and easy it is to prevent infection in infants, it’s a tragedy that more than 300,000 contract HIV each year. The developments in the Mississippi case are unlikely to have a direct impact on most of them. **2. AIDS is the leading killer of babies worldwide.** ****Infant mortality is a scourge of poor nations. But AIDS is not the main cause. Diarrhea, pneumonia and malaria are. Together they are responsible for more than a third of the nearly 7 million deaths annually of children under age 5, according to UNICEF. AIDS is responsible for about 2 percent of those deaths. Even in the nations where HIV is most common, AIDS usually kills fewer babies than other diseases that can be treated using relatively inexpensive interventions, such as oral rehydration salts or antibiotics. Every life is precious, and AIDS programs should not be shortchanged. But if the goal is saving young lives, there are other maladies that could be reduced dramatically with some low-tech investments. These include water treatment, nutrition programs and family-planning services, so mothers can control how many babies they bear. General medical care and sanitation go a long way toward creating healthy communities. **3. Mothers with HIV should never breast-feed.** ****A baby has a nearly 1 percent risk per month of contracting HIV from an infected mother who is breast-feeding, and many AIDS experts once believed that the risk of transmitting HIV during nursing made infant formula a better choice in almost all situations. That thinking has shifted in recent years with mounting evidence about the value of breast milk andthe dangers of using formula in areas where clean water and a steady supply of formula aren’t reliably available. A mother’s milk gives her baby essential nutrients and fluids — especially important in profoundly poor regions prone to drought — as well as antibodies that fight the diseases that are even more likely than AIDS to afflict babies. Infected mothers who live in developed countries are still urged not to breast-feed their babies. But where most of the world’s poorest babies are born and raised, forgoing mother’s milk can be more dangerous than the risk of contracting HIV during nursing. **4. Drugs are the key to preventing HIV’s spread.** ****The widespread provision of AIDS drugs — withcrucial help from the U.S. government — has been one of the most stirring public health successes of our time, extending and improving the lives of millions of people. These medicines, when given to infected women before labor and to their newborns shortly afterward, also help prevent infection in babies. And, if started quickly enough, a short course of AIDS drugs can protect people recently exposed to HIV — such as rape victims and health professionals stuck with infected needles — from contracting the virus. Yet for all their powers, the ability of these medicines to slow the sexual transmission of HIV — its main route across the planet — remains unclear. People whose HIV is treated effectively are much less likely to pass the virus to sexual partners, but in communities with easy access to AIDS drugs, risky behavior often arises because there is less fear of the disease. There are some other powerful prevention tools. HIV thrives in regions where it’s fairly common to have more than one regular sexual partner at the same time, creating webs of interaction that the virus can follow from victim to victim. Condoms can help slow the spread, as can HIV treatment. But the most potent force in reducing infections, as discovered in Uganda, Zimbabwe and several other places, is lowering the number of sexual partners of the average adult. Also remarkably effective is circumcision, an African tradition that had fallen out of favor in certain areas, including the ones now hit hardest by AIDS. Circumcised men are at least 65 percent less likely to contract HIV than uncircumcised men. Of course, fewer infected men means fewer infected women — and fewer infected babies. **5. AIDS can’t be defeated.** ****Reports about the Mississippi baby have garnered so much attention in part because people fear that the epidemic is out of control. U.N. officials estimate that 34 million people have HIV, with 2.5 million new infections and 1.7 million deaths in 2011 alone. Even in the United States, with its routine access to modern medical care, there were an estimated 8,300 AIDS deaths in 2010. But there is room for optimism. The spread of HIV peaked in 1997, and the pace of new infections has been falling gradually ever since. Deaths have peaked in recent years, both because of declining infection rates and better access to treatment. This has happened even though the long, expensive search for a vaccine remains far from fruition. To defeat AIDS, much more needs to be done to curb infection rates and to get medicine to those with HIV. And while debate remains fierce over what prevention measures are most important, there is consensus that some combination of what’s currently available can eventually overcome the epidemic. These include making male circumcision safe and available, encouraging adults to have fewer sex partners, making condoms more accessible, providing clean needles to drug users and treating infected people before they develop full-blown AIDS. To keep babies safe from this terrible disease, the most important priority is to keep women from contracting HIV in the first place. In public health, curing diseases is great. Preventing them is even better. **timbergc@washpost.com ** **dhalpe@gmail.com ** Craig Timberg and Daniel Halperin are the authors of “Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It,” released in paperback this month. Timberg covers technology for The Washington Post. Halperin is a professor of epidemiology at the Ponce School of Medicine and Health Sciences in Puerto Rico. Doctors last Sunday announced that by giving powerful drugs to the baby of an HIV-infected mother in Mississippi shortly after her birth, they had apparently eliminated the virus from her body. The news fueled renewed optimism about the prospects of finally curing AIDS. But a true cure is almost certainly years away.

Children are dying because of America’s lax gun policies

THE TOLL of gun violence on American children is laid out in the grim numbers of a new government study. Nearly 1,300 children are killed and nearly 6,000 injured every year. That is more than three children killed a day and more than 15 children a day treated for gunshot wounds. The heartbreaking tragedy embodied in those numbers can be seen through the prism of three days that preceded the study’s release. A 4-year-old girl in South Carolina was accidentally shot to death Friday by her 6-year-old sibling. Two girls were wounded Friday in a shooting during a picnic at a Chicago elementary school. An 8-year-old boy in Mississippi was caught in gunfire and shot in the head Saturday while he slept in the back seat of his mother’s car. An 11-year-old Florida boy was taken to the hospital Saturday in grave condition after accidentally shooting himself in the eye. A 4-year-old Pennsylvania boy fatally shot himself Sunday after getting hold of a gun. So commonplace are bloody weekends such as this in the United States that, according to the report published Monday in Pediatrics by the U.S. Centers for Disease Control and Prevention, gun-related deaths are the third-leading cause of death overall among children ages 1 to 17 years. The study confirms previously released information but is the most comprehensive, with an examination of national databases that track death certificates, emergency- room visits and coroner and medical-examiner records. More than half of gun deaths were homicides, with many connected to domestic violence. Boys, particularly African Americans, were the most vulnerable to risk of gun homicide, and suicide, which accounted for more than a third of gun-related deaths, sharply increased from 2007 to 2014. The report frames the impact of gun violence on children as a serious public-health problem that demands attention and scientifically sound solutions. It calls for programs to help youths manage their emotions and their problems and cites the usefulness of laws that prohibit people who are subject to domestic violence protective orders from possessing firearms. It also underscores the importance of safely storing guns to prevent both unintentional and intentional shootings. The risk of suicide increases in homes where guns are kept unlocked and loaded, and a previous analysis of school shootings by Everytown for Gun Safety showed that more than half the perpetrators obtained guns from home. There are no laws at the federal level making it a crime to leave a firearm accessible to a child, and, according to the Law Center to Prevent Gun Violence, just 14 states have laws that make adults criminally liable for negligently storing firearms when a child gains access. Massachusetts is the only state that generally requires all firearms be safely stored in a locked container or with a trigger lock when the owner is not carrying the gun. We can, of course, thank the National Rifle Association and the lawmakers who cower before it for this lunacy. Opposed to any kind of restrictions, the gun lobby has fought storage standards as an invasion of privacy for gun owners. It offers as a substitute an educational gun safety program for children that uses Eddie Eagle and other cartoon characters to instruct kids who discover a gun to “stop, don’t touch, run away, tell a grown-up.” It’s good advice, but as every parent knows, children don’t always do as they are told. Children do look to adults for protection. That, at a minimum, should include requiring the safe storage of guns. **Read more on this topic:** The Post’s View: Children continue to be traumatized by shootings. When will America act? Robert J. Spitzer: The NRA wants to suppress one of guns’ most important safety features The Post’s View: Gun violence isn’t just about who dies — it’s also about who gets wounded and lives Colbert I. King: The guns that don’t make the news — one by deadly one The Post’s View: The nation’s capital, where children live in fear

Anti-vaccine activists spark a state’s worst measles outbreak in decades

The young mother started getting advice early on from friends in the close-knit Somali immigrant community here. Don’t let your children get the vaccine for measles, mumps and rubella — it causes autism, they said. Suaado Salah listened. And this spring, her 3-year-old boy and 18-month-old girl contracted measles in Minnesota’s largest outbreak of the highly infectious and potentially deadly disease in nearly three decades. Her daughter, who had a rash, high fever and cough, was hospitalized for four nights and needed intravenous fluids and oxygen. “I thought: ‘I’m in America. I thought I’m in a safe place and my kids will never get sick in that disease,’ ” said Salah, 26, who has lived in Minnesota for more than a decade. Growing up in Somalia, she’d had measles as a child. A sister died of the disease at age 3. Salah no longer believes that the MMR vaccine triggers autism, a discredited theory that spread rapidly through the local Somali community, fanned by meetings organized by anti-vaccine groups. The activists repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents. Immunization rates plummeted, and last month the first cases of measles appeared. Soon there was a full-blown outbreak, one of the starkest consequences of an intensifying anti-vaccine movement in the United States and around the world that has gained traction in part by targeting specific communities. “It’s remarkable to come in and talk to a population that’s vulnerable and marginalized and who doesn’t necessarily have the capacity for advocacy for themselves, and to take advantage of that,” said Siman Nuurali, a Somali American clinician who coordinates the care of medically complex patients at Children’s Hospitals and Clinics of Minnesota. “It’s abhorrent.” Although extensive research has disproved any relationship between vaccines and autism, the fear has become entrenched in the community. “I don’t know if we will be able to dig out on our own,” Nuurali said. Anti-vaccine activists defend their position and their role, saying they merely provided information to parents. “The Somalis had decided themselves that they were particularly concerned,” Wakefield said last week. “I was responding to that.” He maintained that he bears no fault for what is happening within the community. “I don’t feel responsible at all,” he said. MMR vaccination rates among U.S.-born children of Somali descent used to be higher than among other children in Minnesota. But the rates plummeted from 92 percent in 2004 to 42 percent in 2014, state health department data shows, well below the threshold of 92 to 94 percent needed to protect a community against measles. Wakefield, a British activist who now lives in Texas, visited Minneapolis at least three times in 2010 and 2011 to meet privately with Somali parents of autistic children, according to local anti-vaccine activists. Wakefield’s prominence stems from a 1998 study he authored that claimed to show a link between the vaccine and autism. The study was later identified as fraudulent and was retracted by the medical journal that published it, and his medical license was revoked. The current outbreak was identified in early April. As of Friday, there were 44 cases, all but two occurring in people who were not vaccinated and all but one in children 10 or younger. Nearly all have been from the Somali American community in Hennepin County. A fourth of the patients have been hospitalized. Because of the dangerously low vaccination rates and the disease’s extreme infectiousness, more cases are expected in the weeks ahead. Measles, which remains endemic in many parts of the world, was eliminated in the United States at the start of this century. It reappeared several years ago as more people — many wealthier, more educated and white — began refusing to vaccinate their children or delaying those shots. The ramifications already have been significant. A 2014-2015 measles outbreak infected 147 people in seven states and spread to Mexico and Canada. In California, high school students were sent home because of infected classmates. One patient who was unknowingly infectious visited a hospital and exposed dozens of pregnant women and babies, including those in the neonatal intensive care unit. Another adult patient was hospitalized and on a breathing machine for three weeks. Federal guidelines typically recommend that children get the first vaccine dose at 12 to 15 months of age and the second when they are 4 to 6 years old. The combination is 97 percent effective in preventing the viral disease, which can cause pneumonia, brain swelling, deafness and, in rare instances, death. State health officials are now recommending doses for babies as young as 6 months if there is concern for ongoing measles exposure. Minnesota’s Somali community is the largest in the country. The roots of the outbreak there date to 2008, when parents raised concerns that their children were disproportionately affected by autism spectrum disorder. A limited survey by the state health department the following year found an unexpectedly high number of Somali children in a preschool autism program. But a University of Minnesota study found that Somali children were about as likely as white children to be identified with autism, although they were more likely to have intellectual disabilities. Around that time, health-care providers began receiving reports of parents refusing the MMR vaccine. As parents sought to learn more about the disorder, they came across websites of anti-   vaccine groups. And activists from those groups started showing up at community health meetings and distributing pamphlets, recalled Lynn Bahta, a longtime state health department nurse who has worked with Somali nurses to counter MMR vaccine resistance within the community. At one 2011 gathering featuring Wakefield, Bahta recalled, an armed guard barred her, other public health officials and reporters from attending. Fear of autism runs so deep in the Somali community that parents whose children have recently come down with measles insist that measles is preferable to risking autism. One father, who did not want his family identified to protect its privacy, sat helplessly by his daughter’s bed at Children’s Minnesota hospital last week as she struggled to breathe during coughing fits. The 23-month-old was on an IV for fluids and had repeatedly pulled out the oxygen tube in her nose. Her older brother, almost 4, endured a milder bout. Neither had received the MMR vaccine. The children now have antibodies to protect against measles, but they still need the vaccine to prevent mumps and rubella. Their father, who is 33 and studying mechanical engineering while working as a mechanic, wants to wait. His worry: autism. A colleague has a son “who is mute.” “I would hold off until she’s 3 . . . or until she fluently starts talking,” he said. His wife no longer harbors doubts, however. As soon as both children are well, she said, “they are going to get the shot.” The pervasive mistrust was evident Sunday night during a meeting, sponsored by several anti-vaccine groups, that drew a mostly Somali crowd of 90 to a Somali-owned restaurant here. Patti Carroll, a member of the Vaccine Safety Council of Minnesota, described its goal as giving parents more information, including about their right to refuse to vaccinate. People have been “bullied big-time” by doctors and public health officials, she said. The presentation by anti-vaccine activist Mark Blaxill drew cheers and applause. Blaxill, a Boston businessman whose adult daughter has autism, played down the threat of measles and played up local autism rates. “When you hear people from the state public health department saying there is no risk, that [vaccines] are safe, this is the sort of thing that should cause you to be skeptical,” Blaxill said. Two pediatricians in the audience stepped up to a microphone to denounce the claims. “I am very concerned, especially in the midst of a measles outbreak, to have folks come into a community impacted by this disease and start talking about links between MMR and autism,” said Andrew Kiragu, interim chief of pediatrics at Hennepin Medical Center in Minneapolis. “This is a travesty.” He and the other doctors were interrupted by boos and yelling. “For God’s sake, I want to know if vaccines are safe!” Sahra Osman shouted. She has a nearly adult son who received an autism diagnosis when he was 3. “My people are suffering! We’re not ignorant. I read a lot. I know a lot. I educate myself. . . . You don’t know what you are talking about.” While scores of studies from around the world have shown conclusively that vaccines do not cause autism, that is often not a satisfactory answer for Somali American parents. They say that if science can explain that vaccines do not cause autism, science should be able to say what _does._ But researchers don’t really know. A growing body of evidence suggests that brain differences associated with autism may be found early in infancy — well before children receive most vaccines. Other studies have found that alterations in brain-cell development related to autism may occur before birth. There are some genetic risk factors for autism, and advanced parental age has been associated with the condition. Meanwhile, the ongoing spread of the anti-vaccine message is making it harder to control the burgeoning number of measles cases. The groups continue advising parents, “in the middle of their crisis,” on how to opt out of vaccines, said pediatric nurse practitioner Patsy Stinchfield, an infection-control expert leading the outbreak response at Children’s Minnesota. That message is “exactly the opposite of what clinicians and public health officials are urging, which is to get vaccinated as soon as possible.” Staffers at her hospital have been working round-the-clock to vaccinate hundreds of people who may have been exposed; an MMR dose given within 72 hours of exposure can prevent measles. When their two sick children are well, Suaado Salah and her husband, Tahlil Wehlie, plan to talk to friends and acquaintances to spread the word that the anti-vaccine groups are wrong and that all youngsters should get immunized. “Because when the kids get sick, it’s going to affect everybody. It’s not going to affect only the family who have the sick kid,” she said. “They make sick for everybody. That’s when you wake up and say, ‘Okay, what happened?’ ” But she understands the apprehension that fed the outbreak. With a parent whose child has autism, she said, “it’s something that you’re looking for an answer for how it happened and what happened to your kid.” Alice Crites in Washington and Emily Sohn in Minneapolis contributed to this report.

When it comes to vaccines, rich parents get away with child neglect

_Linda C. Fentiman is a professor at the Elisabeth Haub Law School at Pace University and author of the new book “Blaming Mothers: American Law and the Risks to Children’s Health.”_ Public health experts once again must defend the safety — and necessity — of vaccination, this time in response to misinformation spread among the Somali community in Minnesota by anti-vaccine activists. The rising skepticism about vaccines is dangerous on its own, of course. Last year, a study in the journal Pediatrics found that more parents than ever believe vaccines are simply unnecessary to prevent childhood diseases. But the anti-vaccine movement highlights another, troubling aspect in the world of child health: Wealthy people are more likely to be let off easy when they do things that can harm their children than low-income people are. Parents in affluent communities enjoy a privileged status under the law that manifests most clearly — and most dangerously — when they refuse to have their children vaccinated. These parents are vaccination “free-riders” who are not held legally accountable for putting their own children — as well as other people’s children — at risk of potentially fatal childhood diseases. Take a look at where the highest rates of vaccine exemptions cluster and you quickly begin to see a pattern: These are relatively affluent enclaves, including suburban Marin County, Calif., and wealthy areas of Chicago, Los Angeles and Manhattan. In fact, many state legislatures changed their laws to accommodate these parents, often on First Amendment or due-process grounds. Eighteen states permit parents to refuse vaccination on the basis of personal beliefs; 47 states permit parents to “opt out” based on their religious beliefs. Indeed, so many parents have succeeded in opting out of vaccination that in many communities across the country, the rates of immunization have fallen to record lows, threatening to undercut the dramatic advances in children’s health made possible by the vaccine revolution of the 20th century. This extraordinary deference is being paid even as prosecutors around the nation have ramped up the severity of charges they are using to prosecute pregnant women and mothers — particularly those on the lower end of the socioeconomic scale — for other behaviors seen as risking the health of their children. Women have often been prosecuted for behavior while pregnant including for using drugs, for refusing to have a cesarean section or even for having an accident. Some poor women have faced criminal charges for choosing to breastfeed their infants — for failing to deliver adequate nutrition, delivering drugs via their breast milk or just for having two beers at dinner while nursing. Other mothers have faced criminal charges for child abuse “by omission,” based on a failure to protect their children from an abusive partner. Take, for example, the prosecution of Regina McKnight in South Carolina. McKnight, a young, homeless and mentally impaired African American woman, delivered a stillborn baby in 1999 after using cocaine while pregnant. In many cases, the cause of a stillbirth is unknown and the science on the effect of illegal drugs on a developing fetus is far from conclusive. Nonetheless, prosecutors successfully convinced a jury that McKnight was guilty of murder based on her drug use. The trial judge sentenced her to 20 years in prison, and the conviction was affirmed by the South Carolina Supreme Court. The McKnight case seems to have inspired zealous prosecutors across the country. In 2004, for example, Utah prosecutors charged Melissa Rowland with first-degree murder after she declined a C-section and later delivered a stillborn son; only after public outcry did the prosecutor reduce the charges to child endangerment. And in 2013, Alicia Beltran — a 28-year-old pregnant woman from Wisconsin who had weaned herself off a prescription painkiller addiction — was arrested after acknowledging her drug use at a prenatal visit. She spent 78 days in involuntary confinement before being released. It would be comforting to believe that American law takes no notice of class, gender and race, but this prosecutorial disparity makes it all too clear that these factors still play an important role in how people are treated. Wealthy mothers who endanger their children and the larger community because of misguided beliefs about vaccination get a pass, while poorer women are expected to shield their children regardless of the structural obstacles arrayed against them. When these mothers fail to do so, the law does not give them the benefit of the doubt. This double standard in protecting children must end. All parents — regardless of socioeconomic status — must accept the responsibility for children’s health and safety as a collective obligation. That includes safeguarding children from abuse, but it also includes a duty to vaccinate for the public’s health. Citizens should demand that state governments tighten their requirements for vaccination and enact laws based on solid science and the need to protect the community at large. The government’s inaction on vaccination stands in stark contrast to the charges brought against poorer mothers in other circumstances. These women face overly punitive measures even when it is unclear that they are responsible for the harm suffered by their children. Yet affluent mothers often have no such worries, even when they expose their children and the community to indisputable danger. The science on the efficacy and safety of vaccines is clear. So is the message sent by the law’s prosecution of some mothers and not others. **Read more on this topic:** The Post’s View: If Trump keeps stoking vaccine fears, he will endanger lives Susan Okie: Scientist argues vaccines, GMOs and cell phones are not threats to our well being Michael Gerson: Vaccines and what we owe to our neighbors Gal Adam Spinrad: I used to be a vaccine skeptic. Now I’m a believer.