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California’s Measles Outbreak Is Over, But Vaccine Fight Continues

By Rong-Gong Lin II and Patrick McGreevy, Los Angeles Times (TNS)

LOS ANGELES — California officials on Friday declared the end of the Disneyland measles outbreak, but the political battle over immunization that it sparked continues to rage on.

In announcing that the health scare had passed, state medical authorities warned that California remains at high risk of another outbreak because immunization levels in some communities remain so low.

The state epidemiologist, Dr. Gil Chavez, said immunization rates in some schools are at 50 percent or lower, creating an ideal environment for the virus to spread quickly. A study published in JAMA Pediatrics last month calculated that the measles virus in California spread in areas where vaccination rates were less than 86 percent.

But it remains unclear how much the Disneyland outbreak changed attitudes about immunization.

Legislation in Sacramento intended to induce more parents to get their children the measles vaccine and other shots stalled this week amid an outcry from anti-immunization forces who said the government should not tell parents what to do.

The debate on the bill has turned contentious. Last week, Robert F. Kennedy Jr., a leading anti-vaccine activist, used the word “holocaust” during a film screening to describe the purported damage done by vaccines to many recipients, a statement for which he later apologized.

Democratic state Sen. Richard Pan, a pediatrician who is pushing for greater vaccination, has been bombarded with personal attacks. One Internet posting imposed a Hitler mustache on Pan’s face; another said: “Can we hang Pan with a noose instead?”

While there has been a surge in vaccinations amid intense media focus on the issue, health officials say the immunization problems are so bad in some communities that a major outbreak could easily happen again.

The idea that the measles vaccine was linked to autism has been thoroughly discredited by scientists. Still, measles vaccination rates in California’s kindergarten classes have been declining over the last dozen years.

Among those whose vaccine status was known, about 7 out of every 10 California measles patients in this outbreak were unvaccinated. “If we had higher levels of immunity in the community, this outbreak would not have happened,” Chavez said.

The Disneyland outbreak sparked an aggressive response from health officials across California and beyond that experts say helped keep the disease from spreading even further.

Public health officials contacted thousands of Californians in 12 counties potentially exposed to measles, leading to warnings in airports, malls, schools, clinics and hospitals. In one hospital alone, a single person with measles exposed 14 pregnant women and 98 infants, including 44 in the neonatal intensive care unit.

One local agency estimated spending 1,700 hours on the measles investigation.

About 1 in 5 who got the measles in California had to be hospitalized. One collapsed at home, was placed on a mechanical ventilator due to severe pneumonia and developed multiple organ injury. Another suffered acute respiratory distress syndrome and had to be treated with an experimental drug that required special approval from the U.S. Food and Drug Administration.

In all, 131 California residents were believed to have been infected with measles during the outbreak that began at Disneyland, as well as at least 26 people who resided in seven other states, Canada or Mexico, after visiting the Anaheim theme park or catching the virus from someone who went there.

Experts credited public health officials with recognizing the outbreak early and aggressively moving to identify the sick and isolate those exposed to the virus, giving out immunizations and other medicine to the exposed to keep the disease from spreading.

“It’s over, and it’s due to incredibly good public health,” said Dr. James Cherry, a University of California, Los Angeles, professor and primary editor of the Textbook of Pediatric Infectious Diseases.

The outbreak prompted two state lawmakers, Sens. Pan and Ben Allen, also a Democrat, to push for closing a loophole in state law that gives parents the right to refuse state-required vaccinations due to their personal beliefs while still sending their children to public and private schools.

Early on, the bill appeared to have momentum, winning approval of the Senate Health Committee after Gov. Jerry Brown signaled he was open to considering an elimination of all but medical waivers to vaccines.

But SB 277 stalled this week in the Senate Education Committee, where members demanded changes after hundreds of parents lined up to say they would pull their kids out of school if the bill passed. A vote is scheduled for Wednesday.

“There is a problem in denying a child a public education,” said Jean Munoz Keese, a spokeswoman for the California Coalition for Health Choice. Referring to the announcement that the measles outbreak had ended, she said, “It confirms what we have said all along: that we have no crisis.”

The bill faces a difficult future, said Larry Gerston, a political science professor at San Jose State University.

He said the opposition is a blend of libertarians suspicious of anything the government mandates, people who believe in “natural health” remedies and worry vaccines will harm their kids, religious people and parents who don’t have the means to home-school their children if they don’t get a waiver.

“That’s quite a combination,” Gerston said. “One or two of these interests might not be enough to stop the legislation, but these many different sources of opposition, Pan and his allies have their hands full.”

Pan and Allen say they believe they can salvage their legislation and are willing to consider allowing some kind of religious exemption, though Allen said he knows of no mainstream religion that is doctrinally against vaccines.

“There is still an absolute consensus amongst folks in the medical and scientific communities that we have let our vaccination rates drop too low and that any attempt to increase the vaccination rate is an important thing to do,” Allen said.

There are other ways to achieve higher vaccination rates. One idea is to make it harder to get a vaccine exemption, said Saad Omer, an associate professor at Emory University and expert in vaccine policy.

For instance, the state could require parents at the beginning of every school year to write a letter explaining why they don’t want to vaccinate their child, and require it to be notarized and the parents to be counseled by a physician on the risks of not vaccinating.

New York City’s public school system, for example, requires parents to submit a written explanation of religious principles that guide objections to immunizations. Under New York state law, the school system can reject a request for an exemption, and it tells parents that state law does not permit exemptions based on personal, moral, secular or philosophical beliefs.

A federal appeals court in January upheld the New York law as constitutional.

(c)2015 Los Angeles Times, Distributed by Tribune Content Agency, LLC

Photo: Vials of measles, mumps and rubella vaccine are displayed on a counter at a Walgreens Pharmacy on January 26, 2015 in Mill Valley, California (AFP/Justin Sullivan)

Obama: U.S. To Be ‘More Aggressive’ In Monitoring Ebola Response

Washington (AFP) – U.S. President Barack Obama on Wednesday pledged a “much more aggressive” response at home to the Ebola threat, and insisted that the risk of a serious outbreak on U.S. soil was low.

After a crisis meeting with top aides at the White House, Obama underlined the importance of helping African countries stem the spread of the virus, calling such aid “an investment in our own public health.”

“If we are not responding internationally in an effective way… then we could have problems,” Obama said in comments aired on U.S. television.

The meeting — attended by Vice President Joe Biden, Defense Secretary Chuck Hagel, Health and Human Services Secretary Sylvia Burwell and Homeland Security Secretary Jeh Johnson, among others — came after a second U.S. Ebola infection was diagnosed at a Texas hospital where a Liberian man died a week ago.

Obama said meeting participants discussed “monitoring, supervising, overseeing in a much more aggressive way exactly what’s taking place in Dallas” to ensure those lessons are “transmitted to hospitals and clinics all across the country.”

“This is not a situation in which, like a flu, the risks of a rapid spread of the disease are imminent,” Obama said, adding he “shook hands with, hugged and kissed” nurses who had treated an Ebola patient at Emory University hospital in Atlanta.

“They followed the protocols. They knew what they were doing and I felt perfectly safe doing so,” he said.

“I am absolutely confident that we can prevent a serious outbreak of the disease here in the United States… The key thing to understand about this disease is that these protocols work.”

The White House said Obama had canceled plans to visit Rhode Island and New York on Thursday so he could follow up on the Ebola meeting.

So far, Ebola has killed nearly 4,500 people, the vast majority of them in West Africa, where the outbreak began early this year.

Since the announcement last month that the United States would send at least 3,000 troops to West Africa to help fight the outbreak, Obama has repeatedly criticized the international response to the health crisis as insufficient.

AFP Photo/Brendan Smialowski

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Texas Case Forces U.S. To ‘Rethink’ Ebola Approach

Washington (AFP) — The United States must rethink its approach to controlling the Ebola virus after a Texas health care worker was infected with the often deadly virus, health authorities said Monday.

“We have to rethink the way we approach Ebola infection control, because even a single infection is unacceptable,” said Centers for Disease Control and Prevention director Tom Frieden.

Frieden spoke to reporters a day after Texas Health Presbyterian Hospital Dallas announced one of its staff members had contracted Ebola — marking the first case of infection inside the United States.

However, he gave few specifics about what precisely was going to change.

“What we will be doing in the coming days and weeks is doubling down on the amount of education, training, outreach, and support we provide,” Frieden said.

He also said experts still don’t know exactly how the woman was infected while caring for Liberian Thomas Eric Duncan, who died of Ebola on Wednesday and was the first person diagnosed with Ebola outside Africa.

Local media WFAA identified the woman as Nina Pham, a 26-year-old who had recently completed the nursing program at Texas Christian University.

She treated Duncan multiple times during his hospital stay and had extensive contact with him, but had worn extra safety gear including a mask, face shield, gown and gloves according to CDC guidelines, officials have said.

Duncan was hospitalized September 28 and died of Ebola on Wednesday.

– More cases possible –

Frieden said CDC workers are still interviewing other health workers at the hospital to see if anyone else is experiencing Ebola symptoms or is at risk of infection.

“We have to consider the possibility that there could be additional cases particularly among health care workers,” said Frieden, adding that he would “unfortunately not be surprised” to see more such cases.

A prominent nursing group, National Nurses United, lashed back at the CDC on Sunday, saying that hospitals needed to provide better protection to health care workers.

Holding signs that said “Stop Blaming Nurses” at a press conference, members called for proper training against Ebola and hazardous materials suits to guard against the virus.

A spokesman for the group told AFP that nurses want access to hazmat suits, and said three quarters of nurses polled said they had not been briefed by their hospitals on how to handle an Ebola case.

Frieden said Sunday that a “breach of protocol” was the reason for the infection of the woman who helped care for Duncan.

On Monday, he apologized for appearing to place the blame on her when he cited a lapse of safety procedures.

“Some interpreted that as finding fault with the hospital or the healthcare workers, and I am sorry if that was the impression given. It was certainly not my intention,” said Frieden, telling reporters he felt “awful” upon learning of the case.

“All of us have to work together to do whatever is possible to reduce the risk that any other healthcare worker becomes infected.”

– White House meeting –

President Barack Obama met Monday with members of his public health and national security team to receive an update on the response to the diagnosis of the second Ebola case in Dallas, Texas.

Ebola has killed more than 4,000 people in West Africa since the start of the year, and is spread through close contact with bodily fluids.

Frieden said the latest Texas case “doesn’t change the fact that we know how Ebola spreads. It doesn’t change the fact that we know how to take care of Ebola safely.

“But it does change substantially how we approach it.”

Photo via Louis DeLuca via Dallas Morning News/MCT

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Ebola Cases To Explode Without Drastic Action: WHO

Geneva (AFP) — The Ebola epidemic is set to explode unless the response is radically intensified, the WHO said Tuesday, warning that hundreds of thousands could be infected by the end of the year.

The U.N. agency said in a report that new cases would surge from hundreds each week to thousands without “drastic improvements in control measures”, with the number of infections set to more than triple to 20,000 by November.

“We’ve rather modestly only extended the projections to November 2, but if you go to… January 2, you’re into hundreds of thousands,” said Christopher Dye, the head of strategy at the World Health Organization and a co-author of the study.

The research paper warns that the outbreak could drag out for years and become entrenched in west Africa, which has already seen almost 3,000 deaths.

The epidemic might simply “rumble on as it has for the last few months for the next few years,” Dye said, adding that “the fear is that Ebola will become more or less a permanent feature of the human population”.

Liberia, the hardest-hit nation, has seen 3,000 cases of Ebola and almost 1,600 deaths, with health workers turning people away from treatment units due to chronic shortages of beds and staff.

The country has some 150 foreign specialized medical workers on the ground but the U.N. has said they need at least 600, and health authorities are aiming to scale its current 400 Ebola beds up to around 2,000 within weeks.

Its response has been bolstered by a U.S. military mission, already being deployed, which will see 3,000 troops providing training and logistics.

– Threat of civil war –

But Antonio Vigilante, U.N. deputy special representative for recovery and governance in Liberia, likened the struggle to “trying to remedy an earthquake when it is happening”.

Liberia said Tuesday the slow international response risked allowing the country to slide back into civil war alongside neighboring Sierra Leone, and could reignite civil unrest in Guinea.

“The world cannot wait for Liberia, Sierra Leone and Guinea to slip back into conflict, which could be the result of this slowness in response,” Information Minister Lewis Brown told AFP late Monday.

Sierra Leone, where more than 1,800 have been infected and nearly 600 have died, reported “an overflow of bodies” after a nationwide curfew helped uncover more than 200 new cases.

The WHO study, carried out with Imperial College London and published in the New England Journal of Medicine, forecast the number of cases would rise to around 6,000 in Guinea, 10,000 in Liberia and 5,000 in Sierra Leone by November 2 without action.

And it warned that the fatality rate in the current outbreak was likely more than 70 percent rather than the current estimate of one in two, based on recovery rates rather than cases where the outcome was still unknown.

“We are seeing exponential growth and we need to act now,” Dye said.

The United Nations is seeking to raise nearly $1 billion (778 million euros) to defeat the Ebola outbreak, the worst ever recorded, which the Security Council has declared a threat to world peace.

The U.N. has also produced a list of urgent “in kind” requirements, including helicopters, mobile laboratories, 3.3 million items of protective clothing and Ebola treatment centers.

– Weak health systems –

Ebola fever is one of the deadliest viruses known to man.

It can fell its victims within days, causing severe muscle pain, vomiting, diarrhea and — in many cases — unstoppable internal and external bleeding.

The current crisis, which quietly began in southern Guinea last December, has killed far more than all other known Ebola outbreaks combined.

Dye said that while the virus ravaging west Africa was spreading similarly to previous outbreaks, what has changed is the density and mobility of the affected populations.

Cultural practices like washing and touching dead bodies have compounded the problem, as has the very slow response in affected countries, which have never before seen the virus, and the international community, he said.

Weak health systems in the hardest-hit countries are also largely to blame, said Christl Donnelly, a professor of statistical epidemiology at the Imperial College and a co-author of the study.

“In Nigeria, for example, where health systems are stronger, the number of cases has so far been limited, despite the introduction of infection into the large cities of Lagos and Port Harcourt,” she said.

Ebola is only transmitted through contact with body fluids, so halting its spread is usually relatively simple.

Even in this epidemic, each Ebola patient on average infects only 1.7 people in Guinea, 1.8 in Liberia, and two in Sierra Leone, the study showed.

AFP Photo/Ed Jones

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