Mumps outbreak hits more than 1,500 in N.Y., N.J.
More than 1,500 cases of mumps in New York and New Jersey have prompted the CDC to update the public on the outbreak in its Morbidity and Mortality Weekly Report.
According to the CDC, the outbreak appears to have originated with an 11-year-old boy who returned from a trip to the United Kingdom and then attended a summer camp for observant Jewish boys. The illness was transmitted to other attendees and staff members and has since spread as those people returned home. The CDC says 97 percent of the people with mumps “are members of the tradition-observant Jewish community.”
Child with mumps (Photo: Public Health Image Library)
The CDC’s report includes information about how many of the people found to have mumps have been vaccinated - 88 percent had received one dose and 75 percent had received two doses.
The CDC says that, since 1967, when the mumps vaccine was licensed, to the early 2000s, the number of reported cases has gone from 186,000 to less than 500 annually but points out that “the effectiveness of the mumps component of the MMR vaccine is lower than that of the measles and rubella components.”
“The CDC hypothesized that the relatively closed social world of the communities and the large family sizes within them have played a role in preventing the disease from spreading further,” according to a brief from the Center for Infectious Disease Research and Policy.
Parikh examines media’s role in vaccine-autism link
In his latest dispatch, Salon.com contributor and pediatrician Rahul Parikih describes the media as the willing enablers of the decade of hysteria brought about by what he describes as “Dr. Andrew Wakefield’s now infamous study linking the MMR vaccine to autism.” Parikh starts by describing exactly how Wakefield artfully manipulated the media from the beginning:
The anti-vaccine hysteria, after all, began like so many other big stories: with a press conference. That’s where Andrew Wakefield first staked his claim that the MMR vaccine caused autism, according to Paul Offit’s book, “Autism’s False Prophets.” Wakefield wasn’t flanked by doctors or hospital officials but by P.R. folks he had hired himself. “One case of [autism] is too many,” he said. “It’s a moral issue for me, and I can’t support the continued use of [the MMR vaccine] until this issue has been resolved.”
The problem, of course, is that a news conference loads a gun that the media usually pulls the trigger on: Headlines like “Ban Three-in-One Jab, Doctors Urge” started rolling off the presses. While measles made a tragic resurgence, few reporters attempted to scrutinize Wakefield or his audacious claim.
Finger successfully pointed, Parikh then goes on to analyze, with the help of AHCJ member Gary Schwitzer, exactly how the media was duped. He finds that it comes down to the fact that science is pretty complicated stuff, while the news cycle is not.
Frankly, progress in science and medicine occurs much more slowly than the news cycle can tolerate. “Science,” says Schwitzer, “is like a slow winding stream. It has ebbs and flows, and twists and changes in its path that, if you don’t follow, can fool you. But too many reporters, unfortunately, like to dip their toe in the water, run back and report about it without following that river to where it leads.”
Parikh also blames the reporters’ technique of adding “balance” to a story by including opposing opinions that may come from discredited fringe elements, but adds that it’s not entirely the media’s fault.
The Lancet, one of the world’s most well-known medical publications, played an enormous role here, showing us how medical journals are at risk for their own kinds of malpractice. Offit’s “False Prophets” details how Richard Horton, then the journal’s editor in chief, seemed enamored of the notion of publishing something muckraking. As Offit writes, “By ignoring the criticisms of several reviewers, the warnings of an accompanying editorial, Wakefield’s history of holding press conferences, a British press primed for controversy, and a public distrustful of pubic health officials, Richard Horton allowed the public to question the safety of a vaccine based on flimsy, irreproducible data. The loss of the public trust that followed was entirely predictable.”
Parikh ends his piece on a positive note, praising Brian Deer’s investigations into Wakefield’s research in The Sunday Times (of London).
Prisons to get H1N1 vaccines before everyone else?
Poynter’s Al Tompkins, always quick to seize on an interesting emerging story, rounds up reports that inmates are getting H1N1 vaccines before the general population.
McNeil Island Prison, in Puget Sound off the coast of Washington State, where some prisoners have already been vaccinated. Photo by worldislandinfo.com via Flickr.
Predictably, this revelation has spawned a bit of outrage. According to Tompkins, the vaccines go to prisons because they are high-risk areas in which a large number of people live in close quarters.
Will pharmacists play a role in H1N1 vaccinations?
In some states, pharmacists can administer influenza vaccinations. However, laws do differ from state to state. Some states allow pharmacists - who must be certified - to give flu shots based on an established protocol agreed upon with a physician. Other states, such as Oklahoma (until Nov. 1), require patients to obtain a prescription from a doctor before a pharmacist can administer a vaccine.
The differing standards and regulations have the potential of creating barriers to access for vaccinations, something that should be of concern as the H1N1 vaccine makes its way to health care providers.
In Oklahoma, for example, I saw about a dozen people arrive at a pharmacy counter for their flu shots, only to be told they had to get a prescription. Those people left the pharmacy, presumably to visit their doctor, a visit that likely required a co-pay or other payment. Every time someone left, I had to wonder whether they would follow through and return with a prescription. In my case, I went to a walk-in clinic where I only waited a few minutes - though I had to fill out several forms - then had my vitals recorded and answered a series of questions, first from a nurse and then from the doctor. I then returned to the pharmacy, filled out more forms very similar to what I had completed for the doctor and waited until the pharmacist was available to give me a flu shot. The whole process took about two hours - time that many people can’t afford to spend.
Presumably, states are allowing pharmacists to give influenza vaccinations to increase the public’s access and boost immunizations. But are the regulations guiding such vaccinations working or are different barriers being created? It remains to be seen whether pharmacists will be giving H1N1 vaccinations, but a number of organizations are discussing the possibility.
Carolyn C. Ha, Pharm.D., of the National Community Pharmacists Association, has provided a state-by-state breakdown of requirements for pharmacist-provided immunizations.
The Association of State and Territorial Health Officials recently released an “Operational Framework for Partnering with Pharmacies for Administration of 2009 H1N1 Vaccine” that includes information about requirements in each state. (contact: Paula A. Steib, senior director communications, Association of State and Territorial Health Officials, 202-371-9090 ext. 3173)
The American Pharmacists Association has provided information about vaccine distribution. The organization is working with the National Association of Chain Drug Stores, the National Community Pharmacists Association, state associations, CDC, and the Association of State and Territorial Health Officials to get pharmacies included in each state’s 2009 H1N1 influenza virus immunizing program.
The CDC’s has contact information for state/jurisdiction officials and guidelines for clinicians. The CDC’s Advisory Committee on Immunization Practices also will have information about H1N1 vaccinations.
For more about the certification process for pharmacists, read “Incorporating an Immunization Certificate Program into the Pharmacy Curriculum,” from the American Journal of Pharmaceutical Education and from the American Pharmacists Association.
Oransky on H1N1, pandemic, vaccination and 1976
Filed under: Health journalism, Hot Health Headline, Public health
AHCJ board member Ivan Oransky appeared on Brian Lehrer Live to discuss H1N1. The relevant segment starts at about 38:50 into the show.
Among the issues discussed:
- Why H1N1 is a “pandemic,” what that really means, and how the designation has affected the public perception of the outbreak.
- The effectiveness of the widespread adoption of hand sanitizers, especially in the context of flu and other viral outbreaks.
- Vaccination and the lessons/relevance of the 1976 swine flu “outbreak,” in which the vaccine turned out to be more dangerous than the actual flu.
- The level of immunity created by the first wave of H1N1 earlier this year.
- Media behavior during this outbreak, and the media’s responsibility to communicate as much information as possible without being “sensationalist.”
Journalists attend two-day CDC flu briefing
AHCJ has sponsored 12 journalists to take part in a two-day workshop at the CDC about covering seasonal influenza and the A-H1N1 flu virus, now grabbing the headlines.
The workshop, taking place today and tomorrow, includes a series of on-the-record sessions with CDC experts to prepare front-line journalists for the upcoming flu season. Public health experts are providing a primer on the flu, examine how it is being tracked, expectations for vaccines and antivirals, and what communities can do to deal with the fallout.
On Monday, HHS Secretary Kathleen Sebelius, joined by CDC director Thomas R. Frieden, was a surprise addition to the schedule.
The AHCJ-sponsored journalists are:
- Erin Allday, San Francisco Chronicle
- Ran An, China Newsweek
- Kim Archer, Tulsa World
- Lorna Benson, Minnesota Public Radio
- Blythe Bernhard, St. Louis Post-Dispatch
- Don Finley, San Antonio Express-News
- Jeff Hansel, Rochester Post-Bulletin
- Sandra Jordan, St. Louis American
- Alma Martinez, Radio Bilingue
- Pohla Smith, Pittsburgh Post-Gazette
- Fred Tasker, The Miami Herald
- Eric Whitney, Colorado Public Radio
Autism and vaccines: A failure to communicate
When it comes to vaccine safety, findings that scientists regard as proven facts haven’t been strong enough to shake public suspicion about a link between childhood immunizations and autism.
Photo by slideshow bob via Flickr
One in four Americans still believes vaccines cause autism, notes an exhaustive and fascinating analysis of the enduring controversy over vaccine risk published by PLoS Biology. An unfortunate fact is now indisputable: As parents shun vaccines, infectious diseases ranging from measles to whooping cough have mounted a comeback.
Medical anthropologist Sharon Kaufman finds profound meaning in the persistence of belief in the vaccine-autism theory. To her, the PLoS article says, the problem illustrates a broader, profound erosion of trust in experts. “People think if you blindly follow experts, you’re not taking personal responsibility,” Kaufman says.
The media is part of the story, says one of the world’s foremost vaccine experts. Paul Offit, chief of infectious diseases at Children’s Hospital of Philadelphia, tells PLoS the vaccine myth is kept alive in part by the “journalistic mantra of ‘balance,’ ” when science supports only one side.
Refusal to vaccinate puts others at risk
The Marin Independent Journal’s Rob Rogers, reporting from a county where an above-average number of parents ask to exempt their children from vaccinations, finds that a sizable group of unvaccinated children can put the whole community at risk.
“Vaccines are very effective, but there is a small failure rate,” said Dr. Rob Schechter, chief of immunization at the state Department of Public Health. “When the whole population is highly immunized, the few vulnerable children are protected by the immunity of the community. But when there is a high rate of exemptions, diseases can spread even to people who are immunized.”
The effects of this high rate of exemptions, many of which are requested by younger parents who may not be familiar with the consequences of vaccine prevented diseases, are starting to show.
An outbreak of chicken pox affected more than 40 students at the Lagunitas and San Geronimo Valley elementary schools in 2007, where 17 and 57 percent of students had received personal belief exemptions from vaccination. In addition, the Lagunitas School District excluded about 70 students from the two schools for three weeks out of concern that they were at high risk of contagion. Many of them had never been vaccinated.
Rogers quotes sources on both sides of the vaccine debate, including public health professionals, parents and a chiropractor who said “Vaccination is based on the medical fallacy that our bodies are stupid … The truth is that the body has a nearly infinite capacity to protect itself against infection as well as other diseases. When I was a kid, everybody got measles, mumps or chicken pox, and nobody died.”
A panel of experts will be discussing this very topic at Health Journalism 2009 this week.
Two vaccines keeping kids out of ERs
Maryn McKenna writes in Annals of Emergency Medicine that the impressive recent success of rotavirus and pneumococcus vaccines has caused emergency room doctors to ask “Where have the kids gone?”
The vaccines, Prevnar and Rotateq, were introduced earlier in the decade, and their effects are beginning to be felt across the country.
The benefits of such sharp changes in incidence include not only reduced burden of disease but reduced health care utilization and cost; one 2007 study found that, thanks to Prevnar, annual hospitalization and ambulatory expenditures for children younger than 2 years shrank 45% between 1999 and 2004, from $688.2 million to $376.7 million.3 There are more subtle effects as well, some as simple as reducing the stress on a child and his parents because less blood work means fewer needle sticks during an ED stay.
Interestingly, McKenna found physicians worrying that colleagues who entered the profession after these vaccines hit the market would be underexposed to cases of the now widely prevented diseases, and may thus find it difficult to recognize them if or when they do occur.
Physicians who have been in the specialty long enough to have experienced the introduction of Hib vaccine in the mid 1980s, with its extraordinary suppression of bacterial meningitis, and the subsequent introduction of Prevnar, caution that success brings its own risks as well. The lower the incidence of a disease, the less likely younger physicians are to experience it in their training — and thus the more careful medicine must be to make sure certain procedures are still taught.
CDC working to uncover cause of autism
This is a guest post from Elizabeth Fernandez of the San Francisco Chronicle. Fernandez is among the first class of AHCJ-CDC Health Journalism Fellows who are spending the week studying public health issues at two Atlanta campuses of the Centers for Disease Control and Prevention.
Amid a seeming explosion nationally in rates of autism, advances are emerging in science’s understanding of the illness, but no cause has yet been found to explain the profoundly puzzling disorder, a government researcher said Thursday in Atlanta.
Multiple causes — a combination of complex genetic and environmental interactions — are likely responsible, said Catherine Rice, Ph.D., of the Centers for Disease Control and Prevention’s National Center for Birth Defects and Developmental Disabilities.
Marshall Allen, of the Las Vegas Sun, asks Catherine Rice if the prevalence of autism is increasing or just more easily diagnosed. (Photo: Christy Stretz)
Vaccines have become the focus of concern in recent years among some parents as a possible trigger, but studies generally have found no connection between the two, Rice said.
“There is a strong genetic component, but genes don’t explain everything,” she said.
Autism Spectrum Disorder is the term for a variety of developmental disorders including autism, atypical autism, Asperger’s disorder, and Rett Syndrome — Rett alone has a biologic confirming test.
An estimated 560,000 youths in the U.S. have the disorder. It’s far more prevalent among boys: three to seven boys are affected with the illness for every girl with autism.
“Our best estimate is 1 in 150 or 6-7 per 1,000 children have autism,” Rice said.
Despite a hike in rates over the past quarter-century, attributed to better assessment tools and to a broadening of the diagnostic category, researchers are “more concerned that children are being under-identified than over-identified,” Rice said. She expects a “leveling off” in rates over the next 12 years.
The disorder typically begins to unfold during the first two years of life, often noticed through a lack of interest in interacting with family. The child may engage in repetitious play behavior, may not respond to the parents’ voice “but would respond to, say, the opening of the refrigerator,” Rice said.
By age three, the disorder becomes much more evident. The median age of formal diagnosis is between 4½ and 5½.
Some children with autism have a wide range of impairments; they may have ADHD or self-injurious behaviors. Some children become overwhelmed by sounds, sights, smells. They may suffer from gastrointestinal problems, food sensitivities and sleeping disorders. Preoccupied within their “own world,” some children lack a sense of safety, and may wander into streets or other hazards.
“Children can have a lot of frustration because of their difficulty communicating,” Rice said. “It’s a lifelong disorder. We consider autism an urgent public health concern.”
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
