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New York City declares public health emergency linked to measles epidemic
By
Kate Randall
April 11, 2019
A major measles outbreak in the Orthodox Jewish community in parts of Brooklyn prompted Mayor Bill de Blasio to declare a public health emergency on Tuesday. Health officials said the city would require unvaccinated people living in certain postal codes in the Williamsburg area to be vaccinated against measles or be subject to a citation, or even a fine of 1,000 dollars.
The decision was made following an outbreak of measles infections in New York, where 285 cases have been confirmed since the beginning of the epidemic in the fall. Twenty-one of these cases required hospitalization, of which five were admitted to intensive care units.
According to the Centers for Disease Control and Prevention (CDC), there were 78 new cases of potentially fatal measles virus in the United States last week, bringing the number of cases registered this year to 465, the second largest number of cases registered in North America. one year since measles was declared eliminated in the United States in 2000.
At the current rate, the number of measles cases in the middle of the year would exceed 667 cases in 2014, the highest number since 2000. The 2014 cases were due in part to exposure to measles in Disneyland. California and an epidemic in unvaccinated Amish. communities in Ohio.
The first week of April, Florida, Indiana, Mbadachusetts and Nevada confirmed their first measles patients. Fifteen other states have reported cases this year: Arizona, California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas and Washington.
In recent months, a measles epidemic has rocked Rockland County, a suburb of about 320,000 in the Hudson Valley in New York, which has a large population of Hbadidic Jews. In April, 167 cases of measles had been reported in the county since the beginning of the 2018-2019 epidemic. Eighty-five percent of these cases were children aged 18 and under. Nearly 60% of cases involved children aged 6 and under, and 15% of those affected were children under one year of age.
On Wednesday, officials in Westchester County, New York, confirmed eight cases of measles, mostly among unvaccinated children in the same family aged 6 months to 14 years. The children were exposed to measles while they were attending family events in nearby Rockland County and Brooklyn.
Earlier this year, officials from the Washington State Department of Health declared the state of emergency while they were battling a measles outbreak in two counties of the state. There were 36 confirmed cases and 11 suspected cases of viral infection in countries with a lower than normal vaccination rate. Most cases involved children aged 1 to 10 years who had not been vaccinated.
Low immunization rates do not provide "collective immunity"
Health officials at the federal, state and local levels report a lower vaccination rate than that which confers "collective immunity" to the disease, the cause of the upsurge in measles cases. Collective immunity means that enough people have been vaccinated so that the disease does not spread easily, even among those who can not be vaccinated, including newborns, people with allergies to vaccine and some people whose immune systems are compromised.
The measles vaccine is given as part of the combined measles, mumps and rubella (MMR) injection. The CDC recommends that children receive two doses: one for 12 to 15 months and the second for 4 to 6 years. Overall, about 91% of young children were hit in 2016, according to the CDC.
However, there are dozens of counties in the country where non-medical exemption rates for the vaccine exceed the national average. Camas County, Idaho, dominated the country in 2016-17, with a disengagement rate of 27%.
The measles virus is airborne and is spread by droplets from the nose, mouth or throat of an infected person, usually released by coughing or sneezing. These small particles can remain suspended in the air for long periods and can live on surfaces for up to two hours. The virus strikes after an incubation period of 10 to 12 days. So, people with the virus can pbad it on to other people even before they know they have the disease.
The usual symptoms include fever, cough, stuffy nose, then appearance of the characteristic red rash. Loss of appetite, lethargy and confusion are common. While in simple cases, patients, who are mostly children, begin to recover soon after the onset of the rash and feel better about two or three weeks later, until 40% of patients – usually children under five, adults over 20, undernourished and immunosuppressed – suffer from complications.
The probability of death from measles is highest among children under 5, with pneumonia being the most common cause. Blindness, croup, mouth ulcers, ear infections and severe diarrhea are less common complications. Some children develop brain swelling or encephalitis that can lead to seizures, loss of hearing, mental retardation, or death.
Prior to the introduction of the measles vaccine in the United States in 1963, there were 4 million cases of measles with 48,000 hospitalizations and 500 deaths in the United States each year. Measles was also a leading cause of death among children worldwide. Intense pockets of transmission still exist around the world, especially in low-income countries. Europe has had more than 41,000 cases of measles in the first half of 2018, and this increase is also attributable to the growing number of unvaccinated people.
Non-vaccine-based beliefs
In addition to medical reasons, Americans have chosen not to use the vaccine for themselves and their children for religious and philosophical reasons, as well as for the mistaken belief that the vaccine can cause autism, deficit disorder of attention / hyperactivity (ADHD) and other developmental problems in children.
One of the most prominent proponents of the link between vaccines and autism is the British doctor Andrew Wakefield, who is now being written off. He was the principal author of a 1998 Lancet study linking autism to MMR vaccine. The study covered only 12 children, 8 of which parents were already convinced of the link between MMR and autism. Ten of the 12 co-authors of the document eventually released a retraction. the Lancet also admitted that Wakefield had not revealed that his research had been funded by attorneys representing parents in lawsuits against vaccine-producing companies.
Science shows that the serious complications of MMR vaccine are so rare that a cause-and-effect relationship can not be established. However, despite the unblocking of Wakefield's work, these unproven anti-scientific theories persist and have taken root in some communities. In the ultra-Orthodox Jewish community of Brooklyn, a significant number of people refuse to be vaccinated, along with their children, on the basis of an unfounded belief that vaccines would harm their children.
While most ultra-Orthodox rabbis urge practicing Jews to be vaccinated, a 40-page "Vaccine Safety Manual" was released in the Brooklyn community. The latter includes false alerts that the vaccines are causing autism and contain aborted human fetal cells. The publisher of the group that created the manual, Parent Education and Child Health Defense, told the New York Times in an email, "Vaccines contain monkey, rat and pig DNA as well as cow serum blood".
For-profit health care and social inequality
Contributing also to the anti-vaccine movement is a well-deserved distrust of the pharmaceutical industry. As part of the for-profit health care system in America, the activities of pharmaceutical companies are aimed at improving their bottom line, not at protecting and improving the health of the American population.
Unless it's a new flagship vaccine like Gardasil 9, manufactured by Merck and widely aired on American television for protection against human papillomavirus, vaccines do not yield much for drug manufacturers. Gardasil led Merck's vaccine business for 2017, generating $ 2.3 billion and 6% growth over 2016. In contrast, Merck's MMR II vaccine and Varivax, a chickenpox vaccine, have 39, reported only 1.4 billion in 2014, overall sales.
Pharmaceutical giants have little interest in developing vaccines that are only given a few times in life to protect them from life-threatening diseases. The development of drugs against cancer, heart disease, diabetes and other chronic conditions would bring a lot more.
This was demonstrated during last year's flu season, when doctors and clinics faced a shortage of influenza vaccines. The Federal Institutes of Health only committed $ 30 million out of an already inadequate budget of $ 230 million in 2017 for the development of a universal flu vaccine that would protect an individual for life.
The Department of Health and Social Services (HHS) recognizes that its national vaccine program is accountable to the private market and writes on its webpage: "Vaccines are developed through public-private partnerships, including researchers, governments, manufacturers, buyers and policymakers. decision makers – who have successfully brought the new vaccines to license for wide use. These partnerships are critical to the success of vaccine innovations. "
As with all aspects of health care delivery in America, even public programs developed to promote immunization fail to deliver to the poor and most vulnerable in society. The CDC's Children's Vaccination Program (VFC), which aims to help children whose families can not afford the recommended vaccinations to be vaccinated on time, does not serve many children.
Parents must first find a provider who participates in the VFC program. Then there may be fees for the office visit. Fees may also be charged for unvaccinated services, for example for conditions that may be detected during a visit to the office. These fees may discourage parents from using the program.
Social inequality is a determining factor in the ability of working-clbad families to obtain general health services. Child Trends found that children not covered by health insurance are less likely than children receiving coverage to have undergone a checkup on their child in 2017, or 66% vs. 91%, respectively. .
An HHS report released in 2014 found that only 63 percent of children enrolled in Medicaid, the government's poor health care program, had undergone at least one medical exam in 2013, which is well below the target. 80% set by the department.
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