H5N1

‘Monkey, rat and pig DNA’: How misinformation is driving the measles outbreak among ultra-Orthodox Jews

Via The New York Times: ‘Monkey, Rat and Pig DNA’: How Misinformation Is Driving the Measles Outbreak Among Ultra-Orthodox Jews. Excerpt:

“The Vaccine Safety Handbook” appears innocuous, a slick magazine for parents who want to raise healthy children. But tucked inside its 40 pages are false warnings that vaccines cause autism and contain cells from aborted human fetuses. 

“It is our belief that there is no greater threat to public health than vaccines,” the publication concludes, contradicting the scientific consensus that vaccines are generally safe and highly effective. 

The handbook, created by a group called Parents Educating and Advocating for Children’s Health, or Peach, is targeted at ultra-Orthodox Jews, whose expanding and insular communities are at the epicenter of one of the largest measles outbreaks in the United States in decades.  

On Tuesday, Mayor Bill de Blasio declared a public health emergency in parts of Brooklyn in an effort to contain the spread of measles in ultra-Orthodox neighborhoods there. He said unvaccinated individuals would be required to receive the measles vaccine — or be subjected to a fine — as the city escalated its campaign to stem the outbreak.  

Peach’s handbook — with letters signed by rabbis and sections like “Halachic Points of Interest” — has become one of the main vehicles for misinformation among ultra-Orthodox groups, including Hasidim. Its message is being shared on hotlines and in group text messages. 

“Vaccines contain monkey, rat and pig DNA as well as cow-serum blood, all of which are forbidden for consumption according to kosher dietary law,” Moishe Kahan, a contributing editor for Peach magazine, said in an email. 

Vaccines are often grown in a broth of animal cells, but the final product is highly purified. Most prominent ultra-Orthodox rabbis agree that vaccines are kosher, and urge observant Jews to be immunized. 

Still, from enclaves in suburban Rockland County to the bustling streets of Brooklyn’s Borough Park neighborhood, fliers tell the Hasidim to be skeptical of immunizations. On a recent Sunday evening, a four-hour conference call promoted to ultra-Orthodox families — with call-in numbers for a variety of countries — offered advice from speakers who were presented as experts in vaccine science.

The anti-vaccine movement goes beyond the confines of the ultra-Orthodox community. There are thriving and growing pockets of vaccine opponents across the country that span ideological boundaries: In Washington State, some liberal communities shun vaccinations while conservative populations in Texas also oppose them.

In New York’s ultra-Orthodox community, the anti-vaccine movement has no clear public leader. Jewish leaders have said its message has spread through grass-roots activism and has found a foothold largely because many Hasidim have limited access to the internet or rigorous scientific research.  

By some estimates, there are approximately 300,000 ultra-Orthodox Jews in New York; most live in Brooklyn’s Williamsburg and Borough Park neighborhoods and in Rockland County. A handbook created by Parents Educating and Advocating for Children’s Health. “It is our belief that there is no greater threat to public health than vaccines,” the handbook states.

The majority of ultra-Orthodox Jews emphatically say they would never go against the advice of doctors, and health officials say most Hasidim are vaccinated. “I don’t understand anyone that doesn’t vaccinate,” Abe Kornbluh said as he stood at the front of Bleu, his restaurant on 13th Avenue in Borough Park. 

But there have been dozens of sick children whose parents have hid their measles diagnoses from the public. And as public officials have scrambled to curtail the highly contagious disease, groups like Peach, whose members are mostly anonymous and are supported by national anti-vaccine organizations, have only intensified their messaging.

Canada: BC government granted $428K to group that spreads anti-vaccine claims

Via CBC News: B.C. government granted $428K to group that spreads anti-vaccine claims. Excerpt and then a comment:

Over the last 12 years, a Vancouver group has raked in hundreds of thousands of dollars in grants from the B.C. government, while screening anti-vaccination movies, sharing content from anti-vaccination websites and complaining about "censorship" from a social media company that blocked anti-vaccination propaganda. 

Federal records show about one-third of the Health Action Network Society's revenue last year came from the B.C. government — a $40,000 Community Gaming Grant taken from provincial gambling revenues.  

Since 2007, the group has received $428,500 worth of these grants. 

That funding deserves some scrutiny, according to Dr. Eric Cadesky, a family physician and president of Doctors of B.C.  

"I think it's important to review the ways that we assess where money is going," he told CBC News.  

 It seems the province agrees.

After CBC reached out to Housing Minister Selina Robinson, whose ministry oversees the grant program, she requested a review of the annual funding for HANS, according to an email from the ministry. 

The provincial government says Community Gaming Grants are not to be used for lobbying or any programs that don't comply with B.C. laws and public policies. 

'Scientific-type' language 

HANS claims it is not anti-vaccination, but says "vaccine safety" is one of the issues it focuses on. 

To Cadesky, there's no real difference. He says much of the vaccine-related content shared by HANS is simply false. 

He said organizations like HANS, "have become so good at using scientific-type language, they have become so good at using flashy, professional websites, that it's very difficult for anyone who wants to get good information to know the difference between a good source of information and a source of misinformation."  

Vaccines are just one area of concern for HANS, which also advocates for wider use of homeopathy, campaigns for labelling of genetically modified foods and pushes for more action on climate change.

A visit to the HANS website is worthwhile. British Columbians will recall that this funding began during the previous Liberal government and ran for a decade under their benign oversight. 

Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo

Via The Lancet Infectious Diseases: Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. It's discouraging to learn that after all these months, a quarter of the population still thinks Ebola is fake news. But they won't be persuaded if we simply disapprove of them. The summary:

Background 

The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD). 

Methods 

We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours. 

Findings 

Among 961 respondents, 349 (31·9%, 95% CI 27·4–36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7–29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21–0·22, and 1·40, 1·39–1·42) and seeking formal health care (0·06, 0·05–0·06, and 1·16, 1·15–1·17). 

Interpretation 

The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD.

Branswell: The measles virus was down and out. Now it's primed for a comeback

Via STAT, Helen Branswell writes: The measles virus was down and out. Now it's primed for a comeback. Excerpt:

Back near the start of this century, before the full damage of Andrew Wakefield’s debunked study linking measles vaccine and autism became clear and social networking sites turbo-charged the disruptive power of vaccine opponents, some experts believed the world was ready to rid itself of measles once and for all.  

These days, with massive outbreaks in the Philippines and Ukraine, more than 80,000 cases in the past year in Europe, and ongoing epidemics in New York, Washington, Texas, Illinois, and California, measles does not feel like an endangered virus.  

There’s less talk about measles eradication in 2019. In fact, projections about the future of measles are much more somber now than they were in the early aughts. More measles, not less, appear to be on the horizon, at least in the near term, experts glumly admit. 

“I think that’s almost a certainty,” said Dr. Art Reingold, a professor of infectious diseases epidemiology in the school of public health at the University of California, Berkeley.

Reingold spent more than a decade on scientific bodies that advise the World Health Organization and the Centers for Disease Control and Prevention on vaccine policy, and has a deep understanding of the effectiveness and safety profiles of vaccines. To see the effort against measles moving in the wrong direction is frustrating as hell, he acknowledged. “But I’m not smart enough to know what the answer is,” he told STAT. 

Dr. Nancy Messonnier, director of the CDC’s center for immunization and respiratory diseases, said she believes recent increases in measles cases — after years of very low numbers in the United States — mark a “new normal.”

Shot in the dark: On vaccinations for measles and other diseases, data gaps leave Canadians guessing

Via The Globe and Mail: Shot in the dark: On vaccinations for measles and other diseases, data gaps leave Canadians guessing. Excerpt:

When health officials confirmed several cases of measles at three Vancouver schools last month, they rushed to check that the students had been immunized.  

Vancouver Coastal Health, the health authority for the region, was able to determine the vaccination status of most students at the schools almost immediately. But for about another 20 per cent it had no records, and it took a week to track them down. Over that period, the health authority confirmed about a dozen more cases and declared an outbreak. 

The delay didn’t necessarily worsen the outbreak, but it did complicate the response, making it more difficult for public health workers to determine which students might be most at risk of catching the highly contagious disease.  

In British Columbia, as in every Canadian province and territory except Ontario and New Brunswick, parents are not required to provide schools with their children’s immunization records – just one immunization data gap among many in a country seeing a resurgence of diseases that can be thwarted with vaccines.  

As outbreaks become more common, calls to fix Canada’s patchwork system of immunization record-keeping are growing. The gaps are putting Canadians at risk. Comprehensive electronic registries, experts say, are key to preventing the spread of diseases such as measles, diphtheria and whooping cough. 

“Strengthening that system to allow us to make sure we have immunization records for every child would be a benefit,” said Réka Gustafson, a medical health officer with Vancouver Coastal, at a media briefing in late February. “It would limit the disruption to families. It would limit the amount of health-care resources we are spending to try to confirm immunization status. So absolutely, there are improvements to be made.” 

B.C. Health Minister Adrian Dix last month pledged that, by September, all parents in the province will be required to provide immunization records before enrolling their children in school. Public health leaders applauded the move. This week, he said the province would launched a measles immunization catch-up drive from April to June to help bring immunization coverage for school-aged children closer to 95 per cent.

MMWR: Tetanus in an unvaccinated child — Oregon, 2017

Via MMWR, a report that's received widespread media coverage: Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017. Excerpt, with a kicker in the last paragraph:

Tetanus is an acute neuromuscular disease caused by the bacterium Clostridium tetani. Bacterial spores found in soil can enter the body through skin disruption, with subsequent onset of clinical illness ranging from 3 to 21 days (usually within 8 days). In 2017, a boy aged 6 years who had received no immunizations sustained a forehead laceration while playing outdoors on a farm; the wound was cleaned and sutured at home. 

Six days later, he had episodes of crying, jaw clenching, and involuntary upper extremity muscle spasms, followed by arching of the neck and back (opisthotonus) and generalized spasticity. Later that day, at the onset of breathing difficulty, the parents contacted emergency medical services, who air-transported him directly to a tertiary pediatric medical center. The boy subsequently received a diagnosis of tetanus and required approximately 8 weeks of inpatient care, followed by rehabilitation care, before he was able to resume normal activities. 

Upon hospital arrival, the child had jaw muscle spasms (trismus). He was alert and requested water but was unable to open his mouth; respiratory distress caused by diaphragmatic and laryngeal spasm necessitated sedation, endotracheal intubation, and mechanical ventilation. Tetanus immune globulin (3,000 units) and diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) were administered for presumed tetanus. 

He was admitted to the pediatric intensive care unit and cared for in a darkened room with ear plugs and minimal stimulation (stimulation increased the intensity of his spasms). Intravenous metronidazole was initiated, and the scalp laceration was irrigated and debrided. 

His opisthotonus worsened, and he developed autonomic instability (hypertension, tachycardia, and body temperatures of 97.0°F–104.9°F [36.1°C–40.5°C]). He was treated with multiple continuous intravenous medication infusions to control his pain and blood pressure, and with neuromuscular blockade to manage his muscle spasms. 

A tracheostomy was placed on hospital day 5 for prolonged ventilator support. Starting on hospital day 35, the patient tolerated a 5-day wean from neuromuscular blockade. On day 44, his ventilator support was discontinued, and he tolerated sips of clear liquids. On day 47, he was transferred to the intermediate care unit. Three days later, he walked 20 feet with assistance. On day 54, his tracheostomy was removed, and 3 days later, he was transferred to a rehabilitation center for 17 days. 

The boy required 57 days of inpatient acute care, including 47 days in the intensive care unit. The inpatient charges totaled $811,929 (excluding air transportation, inpatient rehabilitation, and ambulatory follow-up costs). One month after inpatient rehabilitation, he returned to all normal activities, including running and bicycling. 

Despite extensive review of the risks and benefits of tetanus vaccination by physicians, the family declined the second dose of DTaP and any other recommended immunizations.

The real horror of the anti-vaxxers

In The New York Times, Frank Bruni says, "I say they're nuts and I say the hell with them": The Real Horror of the Anti-Vaxxers. Excerpt:

Again and again, until blue in the face, medical authorities have debunked the renegade assertion that there’s a link between the M.M.R. vaccine, so named because it inoculates against measles, mumps and rubella, and autism. On Tuesday, a group of Danish researchers who looked at more than 650,000 children over 10 years announced that they had found no such association. 

Again and again, until out of breath, those same medical authorities have also explained why making sure that all or nearly all children are vaccinated is so crucial: It creates a critical mass of resistance, known as herd immunity, that doesn’t give a disease the chance to spread.  

Nonetheless, enough parents plug their ears that the World Health Organization lists “vaccine hesitancy” — a euphemism if ever I heard one — among 10 global health threats in 2019.  

They choose their own alternative facts. Take Darla Shine, the wife of Bill Shine, who just announced his resignation as the White House communications director. Last month, amid alarms about new cases of measles, she took to Twitter with the cockamamie claim that not being vaccinated and coming down with measles or mumps was a big-picture plus, a hardiness builder that could help a person fight cancer down the line. 

“I had the #Measles #Mumps #Chickenpox as a child and so did every kid I knew,” she tweeted, adding that her own kids were, regrettably, vaccinated. “They will never have the lifelong natural immunity I have. Come breathe on me!” Thanks but no thanks. I suspect my breath is better spent elsewhere.  

A week and a half ago, a Republican state representative in Arizona said on her Facebook page that pressure on parents to vaccinate children “is not based on American values but, rather, Communist.” Bet you didn’t know that the original symbol of the Russian Revolution wasn’t a hammer and sickle. It was a syringe. 

I shouldn’t joke, and I should add that anti-vaxxers run the political gamut. They’re on the left, their professed concern for social welfare proven hollow by the risk that their unvaccinated children pose to newborns and others who haven’t yet been — or can’t be — vaccinated. They’re on the right, among people who see the government and its edicts as oppressive forces. Paranoia has no partisan affiliation.

The measles mess: How to fix it

The Tyee has published my article The Measles Mess: How to Fix It. Excerpt:

Measles was once just another childhood disease, like mumps and chicken pox, something that kids like me in 1940s had to put up with. A measles vaccine was developed in the 1960s, and combined with vaccines with mumps and rubella (“German measles”), the MMR shot gradually became part of every baby’s life.

The mid-20th century worried about nuclear war, but it didn’t lose a moment’s sleep about vaccines. We took our shots and clamoured for more.  

That was because we knew that diseases like measles could be fatal. According to a 2004 study, Canadian measles fatalities peaked in 1926 at 892. After the vaccine was adopted, recurring outbreaks showed that two doses worked better. A two-dose program was adopted in 1996-97, and succeeded remarkably well.  

The study concluded, “Despite imported cases and outbreaks in certain religious communities … the absence of spillover into the general population supports our belief that immunization coverage in the general population is high and that population immunity is more than adequate to prevent reestablishment of endemic transmission.” 

Mass immunity, mass amnesia 

Unfortunately, mass immunity comes at the price of mass amnesia about the original threat. Vancouver’s recent outbreak suggests population immunity is growing patchy. Twelve of 15 measles cases were in schools after one student returned from overseas travel. That indicates “herd immunity” — normally strong with a 95 per cent vaccination rate — is well below that rate.  

Public health experts feel understandably frustrated. A disease halted over 50 years ago ought to be a mere footnote in medical textbooks. Instead it’s turning up in Canadian families who ought to know better.  

To some extent, the experts themselves are to blame. When the science is as settled as it is on vaccination, questioning it sounds stupid, and experts in any field tend to be impatient with what they see as stupidity. The health experts forget that their patients didn’t have years of training in this field — but their patients do have access to every quack and snake-oil peddler on the internet.

'It's a war around the truth': Health experts, Facebook and YouTube play catch-up with anti-vaxxers

Via CBC News: 'It's a war around the truth': Health experts, Facebook and YouTube play catch-up with anti-vaxxers. Excerpt:

With 15 cases of measles now reported in a British Columbia outbreak, both the medical community and social media companies need to step up their game in combating anti-vaccination misinformation that continues to spread — largely uncensored — on platforms such as Facebook and YouTube, experts say.  

"This is huge," said Fuyuki Kurasawa, director of the global digital citizenship lab at York University in Toronto. "It's a war around the truth and around information and it's a major public health crisis." 

Because of the widespread availability of vaccinations, "measles was actually declared eliminated in Canada in 1998, and the cases that we still do see are linked to travel. When outbreaks occur, they tell us that some groups of people do not have adequate immunity," the Public Health Agency of Canada said in a statement.   

If vaccine coverage drops below 95 per cent in a community, the risk of infection rises, the agency said, noting the current national level of coverage is 89 per cent.    

Measles killed more than 110,000 people around the world in 2017 — most of them children under five, according to the World Health Organization. This year, the organization has identified the reluctance or refusal to vaccinate against preventable diseases — known as "vaccine hesitancy" — as one of the top 10 threats to global health. 

Social media showdown  

Yet, despite the fact they're on the wrong side of the scientific evidence, Kurasawa said, anti-vaccination advocates — also known as "anti-vaxxers" — have gained the upper hand in a raging social media battle. 

That's because public health authorities have been "relatively slow" to respond to anti-vaccination propaganda in ways that are appealing to social media audiences, he said. Instead, they have relied on the assumption that "putting out the truth and factual information" is enough.  

But social media "relies on short, relatively catchy or attention-grabbing memes, messages, videos ... an informal tone," Kurasawa said. 

Anti-vaccination groups have mastered that style — attracting people to false content ranging from claims that vaccines cause autism (an idea that was scientifically debunked long ago) to insisting that being infected by measles as a child can protect against heart disease and cancer later in life. 

Some anti-vaccination groups also solicit donations online from their supporters to continue making — and sometimes advertising — such content.  

"They've been very savvy. They've been very well funded," said Richard Carpiano, a professor of public policy and sociology at the University of California, Riverside. 

It's a stark contrast to the approach public health authorities have taken in disseminating information, he said.  

"They've been kind of really heavily pushing on a very old type of model of medical authority," Carpiano said. "You know, 'trust us ... I'm a doctor and I tell you that vaccines are good. And here's our website.'"

Extensively drug-resistant typhoid fever in Pakistan

A letter in The Lancet Infectious Diseases: Extensively drug-resistant typhoid fever in Pakistan.

We read the Article by Farah Qamar and colleagues about the outbreak of ceftriaxone-resistant Salmonella enterica serotype Typhi in Hyderabad, Pakistan, with great interest. S Typhi was observed as being twice as prevalent in the Qasimabad subdistrict of Hyderabad City (attack rate 15 per 1000 residents) as in the Latifabad subdistrict (seven per 1000 residents), two areas that differ socioeconomically. In most cases, children younger than 15 years were affected. The main reason for the outbreak was the mixing of drinking water and sewage in two subdistricts. 

Up to 21 million people contract typhoid each year, often by consuming food or water contaminated by faeces, of whom up to 161 000 die. 3·6 cases of typhoid per 100 000 persons-years are estimated to occur in south Asia, which includes Pakistan. Among the 16 countries in Asia where typhoid is prevalent, inhabitants of the Punjab and Sindh provinces of Pakistan were at the highest risk of developing typhoid. 

Extensively drug-resistant typhoid fever is spreading in Pakistan, raising fears of antibiotic failure at global level. Experts believe that Pakistan's abysmal sewage and water systems coupled with low vaccination rates and overpopulated city dwellings are the root causes of the spread of extensively drug-resistant typhoid. In a 10-month period between 2016 and 2017, health authorities in Pakistan detected more than 800 cases of extensively drug-resistant typhoid in the city of Hyderabad alone. 

A new typhoid conjugate vaccine, Typbar-TCV, recently pre-qualified by the WHO, has been used by the public health officials in the province of Sindh to vaccinate 250 000 children in Hyderabad. However, the local population is reluctant to use vaccination as rumours are circulating that vaccination is a foreign plot to poison Pakistan's children, and vaccinators face refusals almost every day. 

Extensively drug-resistant typhoid has the potential to spread globally by replacing less resistant strains where they are endemic. One remaining oral antibiotic, azithromycin, is still active against extensively drug-resistant typhoid; however, further genetic mutation could make typhoid untreatable in some areas. 

The provincial government of Sindh, Pakistan, which deals with the water and sanitation issues has started revamping the water filtration plant of Jamshoro, Hyderabad, after the judicial commission appointed by the Supreme Court of Pakistan ordered an inquiry into mixing of sewage water into natural waterways. The provincial government has also sanctioned 399·74 million Pakistani rupees for restoration of the water distribution network and 414·13 million Pakistani rupees for revival of the sewage system in Hyderabad.

These initiatives can also curb the practices of using hand-operated water pumps in the vicinity of affected areas, which was one of the reasons cited in the paper, causing mixing of sewage and drinking water. Another initiative that should be started by the government is the education of local people, particularly children, about hygiene practices and use of boiling water in cooking food and drinking through pictorial pamphlets and school education programmes. Another major step that should be made by the newly established Sindh Food authority is the inspection of the local restaurants and eateries for unhygienic practices. 

The spread of extensively drug-resistant typhoid should be an alarming sign that the world is slowly moving towards a pre-antibiotic era because of widespread overuse of antibiotics. This has become a serious concern in developing nations such as Pakistan, where antimicrobial surveillance is poor and in urgent need of strengthening. 

Both governmental and non-governmental organisations in Pakistan need to actively promote vaccination campaigns and healthy hygiene habits and discourage irrational use of antibiotics to prevent the mortality and morbidity associated with increasing antibiotic resistance in pathogens.