Scientists Thought They Had Measles Cornered. They Were Wrong.
"Jim GM4DHJ ..." wrote in message
...
On 06/04/2019 07:29, David P wrote:
Scientists Thought They Had Measles Cornered. They Were Wrong.
Following intensive vaccination efforts, measles cases plunged across the
world. Now clusters of new infections some linked, some not have
confounded health officials.
By Donald G. McNeil Jr., April 3, 2019, NY Times
The measles outbreak that led to a state of emergency in New Yorks
Rockland County began far away: in an annual Hasidic pilgrimage from
Israel to Ukraine.
It is emblematic of a series of fierce, sometimes connected measles
outbreaks in places as diverse as Indonesia, the Philippines,
Madagascar and Venezuela that have shaken global health officials,
revealing persistent shortcomings in the worlds vaccination efforts and
threatening to tarnish what had been a signature public health
achievement.
In 2001, the United Nations declared war on measles. With help from the
federal government, the American Red Cross and big donors like Ted Turner
and Bill and Melinda Gates, the U.N. began the Measles and Rubella
Initiative and created Gavi, the Vaccine Alliance.
Together, they poured billions of dollars into buying vaccines and
helping countries deliver it safely, which meant building refrigerated
storage facilities, supplying clean needles, training vaccinators and
countering other logistical obstacles common in poor countries.
Public health officials worldwide tracked the results, monitoring cases
and tracking outbreaks. The news was good: Measles declined worldwide by
nearly 80 percent between 2000 and 2016, with fatalities mostly among
children younger than age 5 plummeting to about 90,000 per year from
about 550,000.
But two years ago, measles cases unexpectedly popped upward again, rising
30 percent in a single year. The virus re-invaded countries where it had
been vanquished.
The biggest factor in that increase, World Health Organization officials
said, was poverty: Medical systems in many countries remain too weak to
vaccinate enough children year after year to wall out the virus.
To stop imported cases from spreading, about 95 percent of a countrys
citizens must be immune, either through vaccination or because they had
measles as children. As babies are born, new pools of potential victims
are created unless vaccination is constant.
Anti-vaccine activists, false rumors and serious missteps by some vaccine
companies have all contributed to the global rebound. Jet travel has
fueled the spread, as it has with viruses like MERS and Zika.
So have diaspora networks, said Dr. Heidi J. Larson, director of the
Vaccine Confidence Project at the London School of Hygiene and Tropical
Medicine people connected by culture around the world who share
beliefs, and sometimes pathogens.
Israels measles outbreak began in March 2018, apparently in a small
Orthodox community in Tzfat, in the north, said Dr. Patrick M. OConnor,
leader of the rapid disease control team at the W.H.O.s European office,
which oversees Israel.
Resistance to vaccines was not the reason. Orthodox rabbis have no issue
with vaccination its seen as a lifesaving good, Dr. OConnor said.
And Israels chief health officer, Yaakov Litzman, is an Orthodox rabbi
who grew up in Brooklyn; his ministry provides vaccines free.
But there is a mismatch between Israels health system and the
population its supposed to serve, Dr. OConnor added.
The clinics offering vaccines were often not open on convenient days or
couldnt accommodate big groups. Orthodox families may include up to a
dozen children, and ensuring that all have had two measles shots on
schedule can be difficult.
(To comply with Israels health ministry schedule, a child needs nine
doctors appointments before age 6 to be fully vaccinated against 14
diseases. Children get measles shots at ages 1 and 6.)
Vaccination rates among the Orthodox in Israel were in the 80 percent
range better than in many other countries, but not enough to stop
measles. Another contributing factor: Even if they are sick, children are
often brought to Orthodox weddings or other gatherings.
At first, the virus moved slowly through Orthodox communities in
Jerusalem and Tel Aviv. Then in September, Dr. OConnor said, a major
outbreak in Ukraine supercharged Israels modest one and probably led,
indirectly, to outbreaks in Britain and in the United States.
The Ukraine connection
Ukraine is suffering through a measles outbreak that began in 2017. The
country has had almost 70,000 cases more than any other country in
recent years.
The infections have not been confined to a particular ethnic group. The
country is at war with pro-Russian separatists on its eastern border,
distrust in government is high, and rumors about vaccines are rife one
of which began when a 17-year-old died of unrelated causes after getting
a shot.
The Ukrainian government also rejected cheaper Indian and Korean vaccines
in favor of European ones, but they cost more than the government could
afford, Dr. Larson said.
But the real problem appears to have begun at Rosh Hashana.
Each year on the holiday, tens of thousands of Orthodox men travel to
Uman, a Ukrainian city where the grave of Rabbi Nachman of Breslov,
founder of one branch of Hasidism, has become a popular pilgrimage site.
(The festivities have been called the Hasidic Burning Man.)
Last year, Rosh Hashana fell in early September. Later that month,
measles cases exploded in Israel, rising to a peak of 949 in October. The
cause? Numerous pilgrims came back from Ukraine with the virus, experts
believe.
New Yorks outbreak began in October; the first patient was a child in
the Bensonhurst section of Brooklyn who had visited Israel. At the same
time, a measles outbreak began among Orthodox Jews in London.
The Israeli government responded rapidly, recruiting Orthodox Jews onto
vaccine advisory groups and sending mobile clinics into their
neighborhoods.
Coverage improved immensely, and the numbers are getting smaller, Dr. OConnor
said.
Orthodox Jews in Britain and the United States also have big families and
may struggle to keep everyone vaccinated. But vaccine skepticism is more
common in the United States than in Israel and much more common in
Britain.
The false rumor that measles vaccines cause autism was started in 1998 by
Andrew Wakefield, a British doctor whose medical license was later
revoked.
Many outbreaks, many triggers
Several other measles outbreaks are crisscrossing the globe. They follow
similar patterns but have unique triggers and pose individual public
health challenges.
Many countries are having outbreaks bigger than Israels. Madagascar has
seen 66,000 cases of measles, with more than 900 dead. India has had
63,000 cases; Pakistan, 31,000; Yemen, 12,000; Brazil, 10,000; and
Venezuela, 5,700.
Most of these countries have chronically low vaccination rates. But some
are worsened by unique constellations of challenges.
Yemen is in the middle of a civil war. Venezuelas medical system has
broken down; part of Brazils outbreak is in refugees from Venezuela.
Madagascar is one of the worlds poorest countries. It is an island with
a high birthrate, and there had been no measles outbreak since 2003, so
it had a huge pool of susceptible children and teenagers. And many of
those children are dangerously malnourished.
In wealthy countries, measles kills about one in every 1,000 victims. But
when children are malnourished, and when they cannot get hospital care
for complications like pneumonia or encephalitis, measles can kill one in
10 children, sometimes even more in refugee camps, said Dr. Katrina
Kretsinger, a W.H.O. medical officer.
Since 2000, when the United States eliminated domestic measles, all cases
here have come from overseas. In the early 2000s, most arrived from
Japan, where the government had made measles shots voluntary after a
locally made vaccine was blamed for cases of meningitis.
In 2011, American tourists brought back 13 cases from a major outbreak in
France. An outbreak in North Carolina in 2013 originated in India.
Most recently, a long-lasting measles epidemic in the Philippines caused
an outbreak in Amish communities in Ohio in 2014, started by a returning
missionary, and the infamous 2015 Disneyland outbreak, which led
California to tighten its vaccine laws.
The Philippines has long had difficulty vaccinating its people, said
Katherine OBrien, the W.H.O.s director of immunization.
The country has a population of 100 million spread out over more than
2,000 islands. Its health care system is decentralized, inept in places
and bad at tracking childrens medical records. Some islands have armed
conflicts.
The risks of an outbreak were compounded in 2017, when the rollout of the
worlds first promising dengue vaccine backfired spectacularly.
The vaccine, Dengvaxia, was withdrawn after evidence emerged that it had
the same sinister drawback as the dengue virus itself: The vaccine
appeared to make a second infection more deadly.
Angry Filipinos rebelled against all vaccines; vaccination rates fell to
60 percent, the countrys health ministry said.
Something similar happened there in the early 1990s, said Dr. Larson of
the Vaccine Confidence Project.
A conservative Catholic group heard that a new injectable contraceptive
would include a protein used in tetanus vaccine. Misunderstanding the
science, the group spread the alarm that tetanus vaccine was secretly a
birth-control method.
The mayor of Manila banned the vaccine, and the rumor spread through
Catholic anti-abortion networks as far as East Africa and South America.
Ultimately, the W.H.O. had to ask the Vatican to intervene and say the
vaccine was safe.
The next country in line for an epidemic that could spread to the United
States, Dr. Larson predicted, is Poland.
It was the lowest-ranked European Union country on her organizations
recent vaccine confidence survey. Respondents are asked, for example,
whether they feel vaccines are safe, effective and compatible with their
religious beliefs.
Poland has a vocal anti-vaccine movement called Stop Nop, and its
immunization rates have dropped steadily since 2010. And, Dr. Larson
noted, Poland has many Ukrainian refugees, any one of whom could import
the virus.
Poles in Scotland are already echoing attitudes in their homeland, she
said.
I would not be surprised if the negative sentiment and consequent
vaccine refusal spread to the Polish communities in the U.S.
https://www.nytimes.com/2019/04/03/h...ne-israel.html
I blame the fuzzy wuzzies ....
I blame degenerate cross dressing hairy legged
haggis gorgers who dont even wear any underwear.
|