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vaccinations

Where the anti-vaxxers are

A lot of them are right here.

Four Texas cities, including Houston, rank among the 15 metropolitan “hotspots” of vaccine exemptions, more than any other state, according to a new study.

The study found Austin, Fort Worth and Plano also are among the nation’s cities with the highest number of kindergartners not getting vaccinated for non-medical reasons. Since 2009, the proportion of children opting out of such recommended vaccines increased in Texas and 11 other states, the study showed.

“There are some scary trends we were able to identify,” said Dr. Peter Hotez, a Houston vaccine scientist and one of the study authors. “They’re a sign that anti-vaccine groups, such as Texans for Vaccine Choice, have been very successful at lobbying efforts – both of the Texas legislature and through social media and other advocacy — to convince parents not to vaccinate their kids.”

[…]

The overall number of people invoking non-medical exemptions isn’t yet high enough to threaten herd immunity, the idea that vaccination of most of the population provides protection for those individuals without immunity to a contagious disease. But public health officials fear clusters of “anti-vaxxers” could leave some children vulnerable.

Texas’ increasing exemptions have been well documented. Though the number is still small, they have spiked from less than 3,000 in 2003 to more than 45,000 of the state’s roughly 5.5 million schoolchildren today, a 19-fold increase.

Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital said he undertook the study because of the Texas increase. He said wanted to look at whether it was a phenomenon unique to the state or mirrored elsewhere. National vaccination rates haven’t changed much in recent years.

You can see the study here. Dr. Hotez is correct to identify the political problem as being a key aspect to this. One clear pathway to getting more kids vaccinated is to take away or at least tighten up the so-called “conscience” objections to vaccines. If the law says you have to vaccinate your kids, the odds are pretty good that you will. But first you have to pass such a law, and right now we have a legislature that’s not inclined to do that.

The anti-vaxxers had another good legislative session

Sure would be nice if we could put a stop to this.

It was mid-April, more than halfway through the legislative session, and Texans for Vaccine Choice was finally getting the fight it had been spoiling for. On April 11, a bill to require schools to report the number of unvaccinated kids had been heatedly debated in a House committee. Doctors, public health experts, parents and others had testified in favor of House Bill 2249, calling it a transparency measure that would simply provide information about vaccination rates at individual schools. The matter was pressing, they said, because more and more parents were opting their kids out of vaccinations using a “reasons of conscience” exemption created by the Legislature in 2003. Without action, recent high-profile outbreaks of mumps and measles in Texas would only grow worse.

But Texans for Vaccine Choice has a radically different frame. While the pro-vaccination crowd appeals to legislators on the basis of science and public health, the anti-vaxxers have their own funhouse mirror version. Vaccines contain toxic chemicals, they say. They cause autism. They overwhelm the immune system. But more than that, the activists, many of them mothers, framed their position as one of parental choice and personal freedom — a message that commands attention at the Texas Legislature.

“The responsibility for my son does not fall on the state or any other family,” said one woman at the committee hearing. “And I would never rely on the herd to keep my son safe.”

Two days later, Texans for Vaccine Choice held a “Freedom Fight” rally on the South Steps of the Capitol. The event featured two prominent members of the far-right House Freedom Caucus, Jonathan Stickland and Bill Zedler, close allies of the anti-vaccination activists.

“Someone asked me the other day, ‘Why do you associate with those crazy vaccine people?’” said Stickland. “I said, ‘Because I am one’.”

Stickland went on to lay out a case for “choice.”

“Where there is risk, there must be choice,” he said. “It’s not government’s job to try to influence our behavior. … The state of Texas doesn’t own our kids. They should be looking for ways to protect parents because we know what’s best for our kids.”

[…]

In the final days of the 85th legislative session, it looked like the pro- and anti-vaccine lobbies were going to have to make do with a draw. But at the 11th hour, a discussion over a bill authored by Representative Gene Wu, D-Houston, requiring Child Protective Services to give new children in its custody medical exams, suddenly turned into a feverish argument about vaccines.

Urged on by Texans for Vaccine Choice, Zedler proposed a surprise amendment that would exclude vaccinations from those checkups. Vaccines, he insisted, “do not qualify as emergency care.” He was joined by several Republican members of the Freedom Caucus, with Representative Tony Tinderholt, R-Arlington, arguing that it was an “issue of liberty.”

A plea from Representative Sarah Davis, R-West University Place, a cancer survivor, failed to move the majority of Republicans. Davis proposed a measure that would at least require foster children to be vaccinated against cervical cancer. Her proposal was defeated in a 74-64 vote. Zedler’s amendment, meanwhile, was adopted 74-58.

Though Wu’s bill died in the Senate, a similar version of Zedler’s amendment found its way onto another child welfare bill and was signed into law by Governor Abbott.

Texans for Vaccine Choice considered the session a win. In early June, the group held a victory party that featured a fajita buffet and “chips fried in a dedicated gluten free frier.“) Photos on the group’s Facebook page show Tinderholt posing with an American flag hat while Zedler opted for a crown.

Pro-vaccine lobbyist Jason Sabo is anxious that mainstream Republicans, who might ordinarily have voted against potentially harmful anti-vaccination legislation, now see it as a primary issue.

“Only the extreme of the extreme show up to vote in the primaries: the anti-vaxxers, the pro-gun people, and the anti-annexation guys. Get four or five of these groups together and you have a bloc. And it’s really smart,” Sabo told the Observer. “So next session we have a choice: We either do the same thing and get the same results, or we come back with a different strategy.”

See here for some background. Rep. Wu’s bill was HB39, and the record vote on the Zedler amendment is here. You will note that only Republicans voted for the Zedler amendment. All Democrats, and a half dozen or so Republicans voted against it. If this isn’t a partisan issue by now, it’s pretty close. I think the “different strategy” that is needed here is to recognize that this is a campaign issue, for both March and November, and to treat it as such. Follow the model of the Texas Parent PAC, recruit and support some pro-vaccination Republicans in strong-R districts, and support Democratic candidates in competitive districts, for which there ought to be more than usual this cycle. Bill Zedler won with 57% of the vote in 2016, Stickland with 55.6%; Tinderholt didn’t have a Dem challenger in 2016, but won with 56% in 2014. None of these districts are unassailable, and maybe – just maybe – making vaccinations an issue might swing a few votes away from these guys, none of whom have anything but hardcore Republican brand loyalty to recommend them. Perhaps there’s a better strategy to stem these losses in the future, but if so I don’t know what it is. I can’t guarantee that pro-vaccination forces will be successful if they try to win a few elections, but I can guarantee they’ll have a much better time of it in the 2019 legislative session if they do.

Bill to allow discrimination in adoptions and foster care passes the House

Shameful.

Rep. James Frank

Under House Bill 3859, which advanced on a 94-51 vote, providers would be protected from legal retaliation if they assert their “sincerely held religious beliefs” while caring for abused and neglected children. The measure would allow them to place a child in a religion-based school; deny referrals for abortion-related contraceptives, drugs or devices; and refuse to contract with other organizations that don’t share their religious beliefs.

Rep. James Frank, the Wichita Falls Republican who authored the bill and an adoptive father, said repeatedly during a lengthy debate Tuesday that his legislation is not meant to be exclusionary but to give providers some certainty when it comes to legal disputes. He described opposition to the bill as “fabricated hysteria.”

“You can be successful, but it will cost you,” Frank said. “The bill declares a winner and says, ‘You are protected.'”

But Democratic lawmakers who lined up at a podium at the back of the House chamber to question Frank said the legislation would give religious groups license to discriminate against LGBT — or Jewish or divorced — parents who want to foster or adopt, or to avoid getting children vaccinated. A vast array of things could be classified as a “sincerely held religious belief,” they said.

“We’re further casting these children off,” said Rep. Jessica Farrar of Houston. “We’re making it more difficult for them to be adopted.”

See here for the background. The original sin here is the state accepting the idea that it’s okay for faith-based groups to treat children who don’t conform to their faith differently than those who do. By its very definition, it’s not acting in the best interests of the child, but of the providers, who last I checked were supposed to have the best interests of the child as their primary concern. And the “sincerely-held beliefs” dodge is just that, for as Chuck Smith said in that earlier story there are a lot of harmful beliefs out there. Remember this?

So check out the short exchange in the video clip above between Cohen and Becky Riggle, a pastor at Houston’s Grace Community Church. Riggle was testifying against [HERO], arguing that it violates the religious freedom of business owners and others in Houston who think LGBT people are sinful. If a business owner has the right to refuse service to LGBT people because the owner’s religious beliefs are offended, Cohen asks, then should business owners also be able to refuse service to other people — like, say, Jews — for the same reason?

Riggle, clearly realizing she’s trapped by her own argument, proceeds to trip all over her tongue in trying to respond. She ultimately suggests that yes, religious freedom would allow her to discriminate against Jews. But she insists “that’s not the issue” in the case of the Houston ERO.

Actually, that’s exactly what this is about — whether someone’s religious beliefs give them a free pass to discriminate against anyone they choose in civil society.

“Sincerely held” is not a synonym for “commendable” or “worthwhile”. This is a bad idea and it will be directly harmful to children who are already pretty damn vulnerable. ThinkProgress, the Observer, and the Chron have more.

Oh, and on a separate note, there was this:

A foster care bill in the House turned into a heated debate on vaccinations for children on Wednesday.

The bill from Rep. Gene Wu, D-Houston, is part of the state’s attempt to reform its foster care system. Wu’s House Bill 39, which won preliminary approval, would limit on the number of kids a Child Protective Services worker could supervise. It would also require speedy medical evaluations of children entering the foster care system.

Rep. Bill Zedler, R-Arlington and vice chairman of the staunchly conservative Texas Freedom Caucus, authored an amendment to the bill that would have restricted doctors from including vaccinations in initial medical examinations for children. Zedler said children could be removed from their homes by Child Protective Services, and then given an unwanted vaccination.

On the floor, Zedler told lawmakers that vaccines don’t protect public health and should not be considered an emergency medication. “The vaccination is only for that child to protect that child,” he said.

[…]

Zedler’s amendment had both Democrats and Republicans up in arms. Rep. Sarah Davis, R-West University Place, attempted to change Zedler’s amendment to allow doctor’s to distribute a vaccine if it has been proven to prevent cancer. Davis, who has previously been an advocate for vaccinations, said she was “dumbfounded” that lawmakers would vote against preventing cervical cancer.

“My amendment empowers doctors to practice medicine,” Davis said during a testy exchange with Rep. Jeff Leach, R-Plano. “I think this is so important that we can eradicate cervical cancer.”

Leach said he was concerned that Davis’ amendment would revoke parental rights who do not believe in vaccination, and “rip that decision from the parents and the child and give it to the doctor.”

Emphasis mine. Zedler’s amendment passed, while Davis’ attempt to modify it was defeated. Here are the 2016 election numbers in Zedler’s district and in Leach’s district. Sure would be nice to have some better representatives in those two districts, wouldn’t it? The Trib has more.

Making vaccination information public

I support this.

While most parents in Texas vaccinate their children, the number of parents opting out of immunizations for non-medical reasons is on the rise. Since Texas changed its laws to allow parents to opt out citing a conscientious objection, the number of unvaccinated children has shot up more than 1,700 percent in 13 years, to 45,000 from 2,300. In response, parents and health advocates are backing an effort to increase public reporting on how many students who have skipped vaccines attend each school.

Currently, that data is housed at the state level and available via an open-records request. County and school district-level data also is available online.

House Bill 2249 would require the Texas Department of State Health Services to publish school-by-school data that would indicate the total number of students who forgo vaccinations, including those who opt out by choice, such as a religious objection. No names or identifying information would be listed.

Advocates for publishing the data say the information would offer parents insight into their child’s school and help them weigh whether to switch, particularly for parents of medically fragile children like Riki Graves’ daughter, Juliana. Now 3, she received a new heart at 18 days old, and doctors say she will need to attend a school where least 95 percent of the students are immunized.

“My job as a transplant mom is to protect that organ,” said Graves as she drove from her home in Sugar Land to Austin where she plans to testify before the House Public Health Committee on Tuesday. “We have the data … there’s no reason not to publish it.”

Opponents say there are plenty of reasons, including children’s medical privacy.

“If this is truly about keeping children safe, we have to have that honest conversation about keeping all people safe. It puts a target on the backs of children whose parents have chosen to opt out for various different reasons,” said Jackie Schlegel, a mother of three and executive director of Texans for Vaccine Choice, a grass-roots parent group that has ballooned in recent years as the movement against vaccinating children has gained traction. The group is planning a rally at the Capitol on Thursday, dubbed the “freedom fight.”

“At schools where you do have a high number of opt-out, we are creating a witch hunt against families, and that’s just unacceptable,” Schlegel said.

We clearly have a different definition of “unacceptable”. I think knowing that a given school has a high rate of unvaccinated children is something any parent would want to know. HB 2249 has four co-authors, two of whom )JD Sheffield and John Zerwas) are medical doctors, which ought to tell you something. As the story notes, an identical bill passed the House in 2015 but never got a hearing in the Senate. Let’s hope this year’s version meets a better fate. The Trib has more.

Still talking vaccines and measles

Because it keeps needing to be talked about.

Earlier this month, Dr. Peter J. Hotez, a pediatrician at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, detailed a disturbing prediction for 2017 in an op-ed for the New York Times: the country could be facing a measles outbreak, and the Lone Star State could among the earliest casualties. “Texas, where I live and work,” Hotez wrote, “may be the first state to once again experience serious measles outbreaks.”

[…]

The spread of measles—one of the most contagious and deadliest diseases—could be stopped by the Eighty-fifth Texas Legislature, where there are currently pending bills that take aim at correcting the anti-vaccination trend. In December, State Representative Donna Howard, a Democrat representing Austin, filed a bill that would require parents and students who choose not to be vaccinated to indicate that they will “opt-out,” as opposed to the current system in which people must “opt-in” in order to be vaccinated. The bill would also require education for parents and students before they choose to opt-out. A similar bill filed by Representative Sarah Davis, a Republican from Houston, would require parents to complete an online educational course to inform them about the dangers of opting out of vaccination.

But anti-vaxxers make up a strong political bloc, and they’ve successfully thwarted pro-vaccination efforts in the Lege before. In 2015, state Representative Jason Villalba of Dallas tried to pass a law that would have entirely removed the exemption protection for parents who claimed to have a “conscientious objection” to vaccinations. His proposal was promptly torn to pieces by a few thousand members of a Facebook group for Texas anti-vaxxers, which formed a PAC, Texans for Vaccine Choice, that ultimately killed Villalba’s bill.  “These people, they literally said it to my face—they hate me,” Villalba told the Texas Tribune in April 2016, after his bill flopped. “This is a group that is very dedicated, very organized; this issue is very important to them.” Even after the bill failed, the PAC kept on Villalba. Jackie Schlegel, the PAC’s creator, told KUT in January that PAC members “knocked on nearly 10,000 doors for his challenger.” Villalba narrowly avoided defeat. Villalba told KUT that he supports Representative Davis’s bill, but it seems unlikely he’ll try to revive his own. “I’m not interested in a suicide mission on this issue,” Villalba told the Tribune last April.

Texas remains one of only seventeen states that allow parents to exempt their children from receiving vaccinations due to philosophical objections. None of the currently pending bills in the Lege would change that. Still, the Texans for Vaccine Choice PAC has already started to push back against the pro-vaccine billse. The anti-vax crowd is active on social media, and let Davis know that they were upset about her bill. In several exchanges with these folks on Twitter in late January, Davis shot down claims that vaccines cause autism by calling such assertions “alternative facts.

See here and here for some background, then go read Rep. Davis’ Twitter battle with the anti-vaxxers. I’ve never been a big fan of hers, but my respect for her is higher than ever after seeing that. Despite the fact that the anti-vaxxers have a friend in the White House, I do believe we can get one or both of Rep. Davis and Rep. Howard’s bills passed. The anti-vaxxers are as we know an organized and vocal minority, but in the end they are still a minority. We do have them outnumbered, and we need to remember that. If you’ve gotten yourself in the habit of calling your legislators about this and that these days, please add these two bills to your list of things you ask them to support.

Trump and the anti-vaxxers

In case you needed another reason to dislike Donald Trump.

President Trump’s embrace of discredited theories linking vaccines to autism has energized the anti-vaccine movement. Once fringe, the movement is becoming more popular, raising doubts about basic childhood health care among politically and geographically diverse groups.

Public health experts warn that this growing movement is threatening one of the most successful medical innovations of modern times. Globally, vaccines prevent the deaths of about 2.5 million children every year, but deadly diseases such as measles and whooping cough still circulate in populations where enough people are unvaccinated.

Here in San Antonio, 80 miles southwest of the state capital, Texans for Vaccine Choice convened a happy hour to encourage attendees to get more involved politically. The event was among dozens of outreach events the group has hosted across the state. The relatively new group has boosted its profile, aided by a savvy social-media strategy, and now leads a contentious fight over vaccines that is gearing up in the current legislative session.

The battle comes at a time when increasing numbers of Texas parents are choosing not to immunize their children because of “personal beliefs.” Measles was eliminated in the United States more than 15 years ago, but the highly contagious disease has made a return in recent years, including in Texas, in part because of parents refusing to vaccinate their children. A 2013 outbreak in Texas infected 21 people, many of them unvaccinated children.

The modern anti-vaccine movement is based on a fraud. A study published almost 20 years ago purported to show a link between childhood vaccines and autism. The data was later found to be falsified, and the study was retracted.

[…]

Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, predicts that 2017 could be the year the anti-vaccination movement gains ascendancy in the United States. Texas could lead the way, he said, because some public schools are dangerously close to the threshold at which measles outbreaks can be expected. A third of students at some private schools are unvaccinated.

“We’re losing the battle,” Hotez said.

Although the anti-vaccine movement has been strong in other states, including California, Oregon, Washington and Colorado, experts say the effort in Texas is among the most organized and politically active.

“It’s a great example of an issue that has a targeted, small minority but an intense minority who are willing to mobilize and engage in direct action,” said Mark Jones, a political science professor at Rice University in Houston.

We’ve discussed this plenty of times before, and as you know I agree with Mark Jones. There’s no reasoning with these people. There’s only organizing, and making it so that being anti-vaccination – and let’s be clear, that’s what allowing broad parental-choice exemptions for vaccinating children is – is a disqualifier for public office. Either we vote these enablers out, or we suffer the consequences.

Plague vaccines

Cool.

More than six centuries after the Black Death wiped out more than a third of the population of Europe, a University of Texas Medical Branch at Galveston team has shown that in experiments with rodents, their three vaccines effectively protected against the infection that causes the disease. Just as important, they did not cause side effects.

“If this research is borne out, a vaccine like this could negate future epidemics and pandemics,” said Ashok Chopra, a UTMB professor of microbiology and immunology and the study’s principal investigator. “Given the increasing threat, the optimal strategy for protecting people is through vaccination.”

The plague, caused by the bacterium Yersinia pestis, can be cured with antibiotics if drugs are started soon after infection. Without prompt treatment – initial symptoms can resemble the flu – it is nearly always fatal.

In an online paper last month in the journal NPJ Vaccines, Chopra’s team reported on the vaccines’ use against pneumonic plague, the most virulent type of the disease and the one that spreads through airborne transmission. Chopra said they also work against bubonic plague, the type most associated with the 14th century pandemic that killed an estimated 50 million people.

A copy of the study is here. The good news is that the plague is relatively rare – only a few thousand cases worldwide per year – but it’s very nasty and fatal if untreated in time. It’s also the case that a resistant strain of this bacteria can be weaponized, so yeah, an effective vaccine would be nice. Keep up the good work, y’all.

The coming measles outbreak

I hope we’re wrong about this.

Peter Hotez used to worry mostly about vaccines for children in far-away places. An infectious diseases researcher at Baylor College of Medicine in Houston, Texas, Hotez is developing shots against diseases in poorer countries such as hookworm and schistosomiasis.

But now, Hotez is anxious about children much closer to home. The number of schoolchildren not vaccinated against childhood diseases in Texas is growing rapidly, which means that the state may see its first measles outbreaks in the winter or spring of 2018, Hotez predicted in a recent article in PLOS Medicine. Disgraced antivaccine physician Andrew Wakefield has set up shop in the Texan capital, Austin, and a political action committee (PAC) is putting pressure on legislators facing a slew of vaccine-related bills.

“Texas is now the center of the antivaxxer movement,” Hotez says. “There is a big fight coming,” adds Anna Dragsbaek of The Immunization Partnership, a nonprofit organization in Houston that advocates for vaccinations.

Texas still has one of the highest vaccination rates for childhood diseases overall, 97.4%, according to the U.S. Centers for Disease Control and Prevention. But the number of children not vaccinated because of their parents’ “personal beliefs”—as opposed to medical reasons—has risen from 2300 in 2003, when such exemptions were introduced, to more than 44,000 so far this year, according to numbers prepared by The Immunization Partnership based on Texas Department of State Health Services data. The actual number may be much higher because an estimated 300,000 Texan children are schooled at home, says Susan Wootton, an infectious disease pediatrician at the University of Texas in Houston; though the law requires these kids to be immunized too, parents don’t need to submit proof of vaccination.

Measles is an extremely contagious pathogen and often the first one to spread when vaccination rates dip below about 95%. The risk of outbreaks is even greater because unvaccinated children aren’t randomly distributed. In Gaines county in western Texas, for instance, the exemption rate is already 4.8%, and at one school in Austin, it’s 40%. “I would describe Texas as sitting on a ticking time bomb,” Wootton says.

[…]

Meanwhile, a PAC named Texans for Vaccine Choice has sprung up after state Representative Jason Villalba, a Republican lawyer from Dallas, proposed scrapping nonmedical exemptions last year. (The Texas House of Representatives voted down the bill.) “While they do not have a whole lot of money, they have a lot of people that they can deploy to interfere in primary campaigns,” Dragsbaek says. “They made Villalba’s primary campaign very, very difficult.” Rebecca Hardy, director of state policies at Texans for Vaccine Choice, says the group is not trying to convince parents that vaccines are dangerous, but fighting for their right not to immunize their children. (It’s also helping them apply for exemptions.)

Though almost all U.S. states allow religious exemptions from vaccination, only 18 permit exemptions based on personal beliefs; with 27 million residents, Texas is the most populous one. Another hotbed of resistance to vaccines, California, stopped allowing “philosophical exemptions”—which covered religious and personal beliefs—this year, after a measles outbreak that sickened more than a hundred people. The change in legislation led some Californians opposing vaccines to move to Texas, Hotez says.

The Texas legislature is now pondering several bills that would help shore up vaccination. One would make it compulsory for parents to complete an online course before refusing vaccination; another would require them to discuss their decision with a doctor. The bill with the best chances may be one that would allow parents to know the immunization rates at their child’s school. “This does not infringe on anyone’s right to have an exemption, it simply allows parents who need to protect their children to have adequate information to do so,” Dragsbaek says. But Hardy says her PAC is opposed to even this bill: “If it’s truly about a parent’s right to know the health status of a campus, then why are we not proposing bills that would give the rates of HIV-positive kids on campus, or hepatitis B-positive kids?” she asks.

The problem, as I’ve noted before, is that the anti-vax forces are vocal and organized, which gives them a disproportionate amount of influence in the Lege. If you’re still mad about the November election (and you should be!) and you’re looking to Do Something to make our state a better place, organizing in favor of pro-vaccination candidates and officeholders, in all levels of government, would be a good way to channel that energy. Note this does not have to be strictly partisan – Rep. Villalba, who drew the wrath of the anti-vaxxers in 2015, is a Republican. But until there’s a countervailing force against the likes of Texans for Vaccine Choice, they’re going to gain all the ground. You can’t fight something with nothing, and the pro-vaccine forces have nothing right now.

We’re going to be fighting about vaccinations for a while

I wish it weren’t so, but it is.

Texas is one of 18 states that allow non-medical exemptions to the vaccines required for school attendance. California had a similar law allowing non-medical exemptions, until last year when it enacted a law that has one of the strictest requirements in the country after a 2014 outbreak of measles traced to the Disneyland theme park infected more than 100 people around the country.

Many of the parents opting out of the immunizations, which are widely recommended by doctors, say they fear a link between the vaccines and health problems such as autism. But studies that they cite have been widely debunked by public health officials.

“Year after year we’ve seen a steady increase in the number of students with a conscientious exemption from vaccination in Texas,” said Christine Mann, a spokeswoman for the Texas Department of State Health Services. “But overall, the numbers are small.”

Even though statewide levels of vaccinations remain high, at over 98 percent, what concerns public health officials are the growing clusters of geographic areas with high rates of unvaccinated children. Texas went from just 2,314 “conscientious exemptions” in 2003 to 44,716 this year, according to the Texas Department of State Health Services.

Some parents are pressing state officials to let them know how many of their children’s peers are unvaccinated. Jinny Suh, who has a 4-year-old son, is helping spearhead a petition drive asking legislators to change state law so that the number of school exemptions is public. Currently, exemption rates are available for individual private and charter schools, but only district-wide for public schools.

State Rep. César Blanco, a Democrat from El Paso, introduced a bill during the last legislative session that would have required schools to notify parents about vaccination rates at the school level, but the bill was stalled in committee.

“As a parent, there are lots of things that people get very passionate about,” Suh said, “but for some reason, in my experience, vaccinations remains an almost taboo topic besides a few passionate people.”

Yes, the anti-vaxxers are a minority, but they are a vocal and organized minority, which is a recipe for political success. Unfortunately, the end result of that political success is a growing public health problem, which is compounded by a lack of leadership in our state government. Honestly, what we need here is for an organized pushback against the anti-vaxxers, a pro-vaccine Moms Demand Action kind of thing. The main difference here isn’t that there is an anti-vaccination legislative faction that needs to be countered. I doubt there are that many legislators who are truly anti-vaccination, though there are a decent number who are in favor of “conscience” objections to some extent. It’s more that there isn’t a vocal and active pro-vaccination legislative force that can advance the cause and/or defend against attempts to weaken vaccination requirements. People who want to see more kids get vaccinated and fewer kids get exempted from vaccinations need to elect a few of their own. Until that happens, we’re going to see more stories like this one.

Too many kids are not getting vaccinated

We let this happen, thanks to the fervor of a vocal minority.

The number of Texans who exempt their children from vaccination for non-medical reasons rose nearly 9 percent last school year, continuing a now 12-year-long trend that public health officials worry could eventually leave communities vulnerable to outbreaks of preventable diseases.

The new numbers represent a 19-fold increase since 2003, the first year that Texas law allowed parents to decline state immunization requirements for “reasons of conscience.” The number of such exemptions are still small, a little under 45,000 of the state’s roughly 5.5 million schoolchildren, but they’ve spiked from less than 3,000 that first year, according to the new state data.

“The trend is going in the wrong direction,” said Anna C. Dragsbaek, president and CEO of The Immunization Partnership, a pro-vaccine group. “It’s time for the community to step up and take action on this very troubling trend.”

Concern has picked up in recent years amid the re-emergence of diseases such as measles and whooping cough. A large measles outbreak last year, linked to an initial exposure at Disneyland in California, sparked particular distress.

Texas is one of 18 states that allows waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only two states – Mississippi and West Virginia – don’t grant exemptions from immunization requirements on religious grounds, and all states allow exemptions for medical conditions, such as a compromised immune system.

[…]

Pushed by the Immunization Partnership, the 2015 Legislature considered a bill that would have required the Texas Department of State Health Services to post the exemption numbers of every school on its website.

Under the current law, the department is only required to post aggregate numbers for each school district.

The bill passed the House but died in the Senate. Dragsbaek, impressed at the traction the legislation got, said the partnership will push hard on behalf of any such bill again in 2017.

The bill to require school-specific information called for the inclusion of delinquency numbers, also a big problem. At HISD, for instance, more than 3 percent of children in 2015-2016 – who hadn’t obtained a conscientious exemption – had not received at least one of each vaccine by the district’s age-specified deadline. Enforcement of such deadlines is up to the principal.

“Eleven percent of HISD’s prekindergarten students hadn’t received their first dose of measles vaccine 90 days into the school year,” said Dr. Susan Wootton, a pediatrician at University of Texas Health Science Center at Houston who is leading an HISD task force on immunization delinquency. “That needs to be fixed. Nepal does better than that.”

Harris County’s overall conscientious exemption rate is still relatively low, just 0.62 percent, but it’s doubled in the last five years. So has Montgomery County’s, now 1.73 percent. Brazoria County has gone from 0.30 to 0.80. Gaines County in West Texas has the state’s highest conscientious exemption rate, nearly 5 percent.

That would be a worthwhile bill, but the real goal needs to be to eliminate the “personal belief” exemptions, which are an increasing threat to public health. Unfortunately, the pushback on that last session was ferocious, and that has emboldened the anti-vaxxers. I don’t know how much optimism I have about the school-specific information bill as a result. There are plenty of people who would like to see better vaccination laws, but the energy and organization is on the other side. It would help to get some leadership from, say, the Governor’s office, but he has none to offer, so the rest of us are on our own.

Anti-vaxxers gain ground in Texas

There’s a lesson in here that we need to learn.

On a Friday night little over a year ago, a Texas mother of three was attending a school dance when she got a text message that stopped her cold.

A state lawmaker from Dallas had filed legislation taking aim at a provision in state law that allows parents to opt their children out of school immunization requirements.

“I looked at that text and I just kind of was like, ‘Oh no he didn’t,’” said Jackie Schlegel-Polvado, who lives near Bastrop. “This is Texas. We believe in parental rights in Texas. Like, that is just a fundamental belief that most Texans have that parents make decisions for their children, not the state.”

It was an issue that directly affected Schlegel-Polvado and her family. Since 2007, she has been one of a small but growing number of parents in Texas who obtain “conscientious exemptions” from state vaccine requirements.

What was several worried parents exchanging text messages over the next few days turned into a Facebook group that within two weeks had more than 1,300 members, and then, ultimately, a political action committee.

Texans For Vaccine Choice’s mission, according to Schlegel-Polvado, is to guard parents’ rights to opt out of vaccine requirements — whether that means targeting legislators who seek to close non-medical exemptions or pushing for policies that otherwise protect parents who choose not to vaccinate, like preventing physicians from excluding them from their practices.

In this year’s primary elections, that meant going after state Rep. Jason Villalba, the Dallas Republican who filed the bill.

“The animus that was leveled against me for that was very surprising to me,” said Villalba, who ultimately won his race. “These people, they literally said it to my face — they hate me. That was troubling. Because I get it, they care about their children — but I care about my children too, and the children of the community.”

[…]

State law requires that children at all public and private schools have 10 different immunizations, including for tetanus, measles and pertussis, the bacterial disease known as whooping cough. Generally, children must receive those vaccines by the time they are in kindergarten, though they receive others, like for hepatitis B, in later grades.

If parents wish to opt out of school immunization requirements, they must file a what’s known as a “conscientious exemption” form with their child’s school at the start of the year. All but two states — West Virginia and Mississippi — grant exemptions from school immunization requirements on religious grounds. Texas is among 18 that also waive requirements because of personal beliefs, according to the National Conference of State Legislatures.

Under Villalba’s initial measure, Texas would have only allowed students to receive exemptions for medical reasons, such as an allergic reaction or in instances where a weakened immune system could cause health complications.

Pediatricians — many of whom have watched with dismay as the number of parents choosing not to vaccinate their children has climbed — widely support the elimination of non-medical exemptions to immunization requirements.

[…]

During the 2015 legislative session, Villalba said he quickly became acquainted with the passion of the anti-vaccine movement’s supporters, many of whom believe the undue influence of pharmaceutical companies has led to an overabundance of immunization requirements that come at the expense of children’s health.

“This is a group that is very dedicated, very organized; this issue is very important to them,” he said.

[…]

For now, the new organization’s strength appears to lie in its mobilizing abilities. A February campaign finance report showed just over $1,000 in contributions. And while its members made their presence felt in Villalba’s race, he still managed to win with 55 percent of the vote.

But Villalba said that without the engagement of the group, he would have expected his margin of victory to be larger.

It also may have accomplished a broader goal. The lawmaker said that for the 2017 legislative session, he does not plan to re-file his bill narrowing exemptions to the state’s vaccine requirements.

“I’m not interested in a suicide mission on this issue,” he said. “I sense — and this is unfortunate — the only way a bill like this gets any traction is an even worse large-scale outbreak, between now and session. Short of that I just don’t think there is going to be the appetite to do this bill.”

See here for some background. The lesson here is that intensity matters. A group of people that care passionately about a single issue and organizes around it can often get what they want in our political system, even if they’re a distinct minority. These anti-vaxxers are but one example; I’m sure you can think of many others. The number of unvaccinated children in Texas schools is still fairly small, less than one percent of the total, but it’s grown by more than ten times since 2004. This kind of idiocy is the reason why measles has made a big comeback in the US and around the world after being declared eradicated. I can’t blame Rep. Villalba, who was left hanging by Greg Abbott, for not wanting to deal with this crap next session. If the rest of us want someone else to pick up the ball on this, we’re going to need to make at least as much noise about it as these dangerous fanatics have done. Complaining about them is easy. Doing something about it is hard. It’s up to us.

Fighting pertussis

Sure hope these folks can make a lot of progress in their work.

Of the more than 30,000 children hospitalized with pertussis in the United States each year, 10 to 20 will die. Worldwide, pertussis infects more than 16 million and causes nearly 200,000 deaths a year.

“We need to come up with some therapeutic options,” [Dr. Mary Healy, a pediatric infectious disease specialist with Texas Children’s Hospital and Baylor College of Medicine] said. “We have very little to offer.”

That soon could change. Last month, a research team led by scientists from the University of Texas at Austin reported progress developing antibodies that could be used to combat pertussis infections in those too young to be vaccinated.

The work was led by Jessica Maynard, an associate professor of chemical engineering at UT, who previously had worked on an Ebola treatment

Pertussis is a bacterial infection that colonizes the lungs and secretes about 20 disease-causing compounds and toxins.

“We can’t really agree on which of them are the most important,” Maynard said. “But we think it’s the pertussis toxin, because it’s directly responsible for the increase in your white blood cell count.”

Those cells flood into the blood and can clog the lungs and other organs. Antibiotics can help clear the bacteria, but they do not affect the toxins that are doing all the damage. Researchers previously tried pulling various antibodies from vaccinated people and using those to treat infants, with little success.

Maynard’s team decided to focus on two antibodies that would bind tightly to the pertussis toxin and deactivate it. They cloned the antibodies to deliver them to infants in massive amounts.

“We’re really trying to go after the symptoms,” Maynard said.

In laboratory tests, the antibodies protected mice from being infected with pertussis, much like a vaccine. The researchers also tested the antibodies as a treatment in baboons that were sick with pertussis. The antibodies did not clear the bacteria, but they lowered white blood cell counts, speeding recovery.

[…]

Widespread vaccination still is the key strategy in the United States for protecting infants.

The current vaccine is effective but imperfect. Immunity tends to wane after three years. And since the disease is less severe in older children and adults, siblings or parents of infants could be infected and not know it. They unknowingly can pass on the infection to vulnerable babies.

Public health experts advocate a strategy called cocooning, in which adults and adolescents who will be in contact with a baby get vaccinated at least two weeks earlier.

“Probably the most important thing you can do is vaccinate a pregnant woman in the third trimester of pregnancy,” Healy said. “The theory then is they won’t get pertussis and give it to the baby.”

You know how I feel about vaccinations. It’s more than a little scary to realize that I could have been a carrier and passed it on to one of my kids before they were old enough to be immunized. And while pertussis may be less severe in adults than in kids, it can still be really, really awful. So please, make sure your vaccinations are up to date. And send some happy thoughts to Dr. Maynard and her team.

How to deal with anti-vaxxers

It’s a big problem.

Certain that they are right, struggling to find ways to get their message across, public health officials are exasperated by their inability to convince more U.S. parents to vaccinate their children.

“I think we’re all kind of frustrated,” said Stephen Morse, a Columbia University infectious disease expert. “As scientists, we’re probably the least equipped to know how to do this.”

They say they are contending with a small minority of parents who are misinformed — or merely obstinate — about the risks of inoculations. The parents say they have done their own research and they believe the risks are greater than health authorities acknowledge; they are merely making their own medical choices, they say.

Most parents do bring their children for shots, and national vaccination rates for kindergarteners remain comfortably above 90 percent. Experts aren’t even sure the ranks of families who don’t vaccinate are growing to any significant degree.

But in some states, the number of parents seeking exemptions from school attendance vaccination requirements has been inching up. In some communities, large proportions of household skip or delay shots. The rise has come despite unsettling outbreaks of some vaccine-preventable diseases that had nearly disappeared from the United States.

“Part of the reason everyone is so concerned about this is because they don’t know whether things will get worse,” said Dr. Walter Orenstein of Emory University, considered one of the nation’s leading experts on vaccines.

[…]

Experts see the cooperation of physicians as a key to prodding families to get old and new vaccines. They believe too many family physicians and pediatricians have been lax. Some doctors perhaps see themselves as too busy to spend time debating the value of vaccines with resistant families. Some have complained about the cost and hassle of stocking the shots. A smaller contingent may have their own questions about vaccine, and indulge families that want to postpone or skip shots.

ACIP has been looking at the problem. So has another national panel — the National Vaccine Advisory Committee, chaired by Orenstein — which two years ago convened a Vaccine Confidence Working Group to study the issue. In a draft set of recommendations presented this month, the group said there’s not enough good information on where clusters of unvaccinated people are, to what extent they are growing, and why they exist.

The workgroup is recommending more study, and better training of physicians so that they will work harder to present childhood vaccination as the sensible way to go.

Another strategy is to simply make more parents vaccinate, through a concerted effort to eliminate philosophical exemptions to vaccinations or to make the exemption application process more demanding. Several experts interviewed believed reducing exemptions is the most practical approach, in a country where individual freedoms are sometimes celebrated at the expense of the communal good.

I’m on record as being in favor of severely limiting personal exemptions for vaccinations, and taking a punitive approach as needed to compel the obstinate holdouts to comply. If you want to call this a matter of freedom, I say it’s my freedom to live a healthy life that’s at stake. Be that as it may, it would be much better if people were more willing to comply on their own. Ruth Graham, writing in Slate, makes an important point about this.

“There is a history of paternalism in medicine,” said Jordynn Jack, an associate professor of English at the University of North Carolina at Chapel Hill whose 2014 book Autism and Gender explores how ideas about gender have affected debates about autism, including the vaccine controversy. “The language that’s used by the scientific community to communicate that vaccines are safe sometimes falls into that paternalistic model. ‘I’m telling you what’s right, and I’m telling you as a scientific authority,’ ” Jack said. “For some people that’s persuasive, but for others it’s not.” In her book, Jack dissects how contemporary mothers often think of themselves as “warriors” on behalf of their sick children, fighting first for a diagnosis and then for treatment. If procuring basic care for a sick child feels like a battle, then why trust the enemy’s propaganda?

Concern about not being taken seriously by medical professionals causes other problems for women as well. Surely by now we have learned that a successful outreach program depends on being able to speak to people in a way they will relate to. Seems to me that’s a good place to begin here as well. Of course, as this AusChron post points out, people have to be willing to listen, and to understand what they’re being told, too.

Abbott waffles on vaccinations

Come on, dude.

Weighing in on a national debate, Texas Gov. Greg Abbott made clear this week that he supports laws that include exemptions to requirements that parents vaccinate their children.

“Abbott recognizes the public health benefits of vaccines and encourages all parents to have their children vaccinated, as he and the First Lady did with their daughter,” spokeswoman Amelia Chasse said, but the governor “supports current Texas law that he believes strikes the right balance of requiring vaccinations while still allowing parents to opt out under certain circumstances.”

That law gives parents the right to opt out if they have religious or personal objections to vaccines, or if they can cite valid medical reasons.

The governor’s position pits him opposite a high-profile suggestion that Texas eliminate the religious and personal exemptions in response to several recent outbreaks of measles.

I’m sorry, but that’s a load of bull. Unless you’re a Christian Scientist, your right to endanger yourself and/or your kids ends where my and my kids’ immune systems begin. There’s no longstanding tradition here, and no reason to needlessly put children’s health at risk. Go talk to Rep. Villalba, Governor. This isn’t about ideology, and it isn’t about “freedom”. There’s a right answer and a wrong answer here. Don’t screw it up.

Improving infections disease response

This is an Ebola-inspired bill, but not an Ebola bill. So say the stakeholders, anyway.

Months after three people in Texas were diagnosed with Ebola, several key state lawmakers on Wednesday proposed ways to prepare the state for the next disease-related emergency.

The proposal, Senate Bill 538, would allow the governor to declare a state of infectious disease emergency, create stockpiles of protective equipment, and grant health officials greater power to stop public transportation vehicles and detain individuals who may be infected.

“We’d have a clear line of authority,” state Sen. Charles Schwertner, R-Georgetown, chairman of the Senate Health and Human Services Committee, said at a Capitol press conference. “There would be stockpiles of personal protective equipment. First responders would be able to know when they were going to have to be around individuals with potentially infectious disease, a deadly infectious disease.”

The legislation stems from recommendations by a task force established by then-Gov. Rick Perry in October after a man in Dallas became the first person in the United States diagnosed with Ebola. The bill is designed to fix problems — highlighted by the Ebola scare — with the state’s ability to respond to an outbreak.

“This bill, although based on the Ebola emergency, is not an Ebola bill,” said Dr. Brett Giroir, director of the Texas Task Force on Infectious Disease Preparedness and Response. “This is preparation for any infectious disease emergency in the future.”

[…]

Based on the task force’s recommendations, two Ebola treatment facilities were established in Galveston and North Texas in October. A more detailed report released in December by the task force recommended establishing a treatment facility for children, training health workers to identify new diseases and expanding state executive power in disease-related emergencies.

“This emergency highlighted needs for profound changes in our training, in our preparedness, our protocols,” said Giroir, who is also CEO of the Texas A&M Health Science Center.

The bill would implement several of those changes, including new authority to quarantine infected people.

Under current law, the head of the Department of State Health Services can order a potentially exposed or infectious person to remain in his or her home, Giroir said. But the state cannot enforce that order until after the person has already broken the order and left the home, a redundancy that the new bill would eliminate.

See here and here for some background. I’m okay with this. I agree with Dr. Giroir that this is unlikely to be an “Ebola bill” in the sense that there are other infectious diseases that are much more likely to need containment in Texas. Measles, for example. We’ve got another bill that would help with that, and I hope it gets at least as much attention as this one does.

Ending exemptions for vaccines

Hear, hear.

A Texas Republican is taking aim at a provision in state law that allows parents with personal or religious objections to vaccines to opt their children out of school immunization requirements.

State Rep. Jason Villalba, R-Dallas, said Friday he will soon propose legislation to eliminate what are called “conscientious exemptions” because of the reemergence of diseases like measles and whooping cough attributed to growing numbers of parents choosing not to vaccinate their children.

“We are just saying, ‘Look, if you are going to send your children to public schools, they need to be vaccinated,'” he said. “We are going to ask that you keep other children safe.”

The measure, which Villalba said he would file next week, comes as several other states are reevaluating their immunization laws as they battle a measles outbreak linked with exposure to an unvaccinated woman in a California amusement park.

Texas is among 20 states that waive school vaccine requirements because of personal beliefs, according to the National Conference of State Legislatures. All but two states — Mississippi and West Virginia — grant exemptions from school immunization requirements on religious grounds.

Under Villalba’s proposal, Texas would not allow an exemption for either of those reasons. Students would still be able to receive medical waivers, which doctors grant in cases where an allergic reaction or a weakened immune system could cause health complications.

As you know, I’m down with this. Texas’ overall rate of getting exemptions isn’t that high, but in some places it is. That’s an outbreak waiting to happen, so I hope the rest of the Lege falls in behind Rep. Villalba’s bill when it is filed. On that score, the Senate may be a challenge.

Even with a measles outbreak dominating headlines, don’t expect an avalanche of immediate support for a high-profile idea to cut down on the ability of Texas parents to opt their children out of school immunization requirements.

Two state Senate committee chairmen told the Houston Chronicle they have hesitations about a bill that state Rep. Jason Villalba said Friday he plans to introduce to eliminate religious and philosophical exemptions to the requirements.

State Sen. Charles Schwertner, R-Georgetown, who leads the Health and Human Services Committee, said through a spokesman that while he views vaccines as a “critical component of protecting the public health…(he) would prefer to increase education about the safety of these vaccines rather than imposing new mandates that would ask Texas parents to act against their own conscience or their deeply-held religious beliefs.”

The chairman of the Senate education committee, Republican Larry Taylor of Friendswood, offered a more moderate response but noted that in Texas, “there is also a long standing tradition of giving parents the right to make decisions regarding their children’s healthcare.”

“I stand ready to hear parents’ and legislators’ opinions on this very serious issue,” Taylor said.

I hope he’s also ready to hear doctors’ opinions, too. California’s legislature is taking similar action, as are legislatures in several other states. Hopefully, at least one good thing will come out of the Disneyland measles epidemic of 2015.

Measles

We haven’t had an outbreak in Texas. Yet.

Measles has replaced Ebola as the infectious disease threat of the moment, but the only recent case in Texas occurred in Fort Worth in mid-January and was unrelated to the current outbreak that originated in Disneyland.

The Houston health department has tested two suspected cases and both came back negative, but local officials still express concern about the possible risk to infant children who can’t yet be immunized.

“Parents should be alarmed about this outbreak if they have children under 12 months,” said Kathy Barton, spokeswoman for the Houston health and human services department. “Infants travel to other areas, and the measles virus can be imported to any area at any time, including this one.”

Barton said parents of children who have been immunized should feel confident the vaccine will protect their child.

Children are eligible for the first dose of the combination MMR (measles, mumps, and rubella) vaccine at 12 months through 15 months of age. The second dose, recommended at 4 to 6 years of age, is required of Texas schoolchildren, though conscientious objectors can opt out by signing an affidavit. Those numbers in Texas are small (38,197 people, or 0.75%, in 2013-2014) but growing.

[…]

The national rate of people opting out of vaccination remains under 1 percent, but the number can vary according to community. In Texas, where the percentages have grown significantly in the last decade, the 2013-2014 rate exceeds 3 percent in five counties — Jeff Davis (3.1), Blanco (3.6), Robertson (4.1), Gaines (4.3) and Lampasas (5.2). Harris County’s rate is 0.57, up from 0.19 in 2007. The state’s county-by-county numbers are here.

Tiffany recently underwent a round of booster shots in anticipation of some business travel. I’ve been thinking of doing the same thing for myself. I don’t feel like herd immunity is good enough to rely on any more.

Cherise Rohr-Allegrini reminds us that however enjoyable it is to publicly shame anti-vaxxers, it doesn’t do much to actually get them to vaccinate their kids. Research has shown that no persuasion strategy for overcoming anti-vaxx sentiment is likely to succeed. As such, I personally agree with Jamelle Bouie that where persuasion fails, coercion is the way to go. There’s a reason Mississippi – Mississippi, for crying out loud! – has the best vaccination rate in the country: They don’t allow exemptions. Vaccinate your kids or they don’t get to go to school. In Texas, that would likely mean more home-schooling, so the next level of this strategy is to require vaccinations for participation in any kind of interscholastic activity, from sports to debate to music to whatever else. If it involves other school-age kids, you have to have your shots. Finally, I’d take aim at the one thing that will make all those highly-privileged anti-vaxxers from California squirm, and that’s to put pressure on colleges and universities to require vaccinations as a condition of entry, just as kindergartens used to do before anyone heard of “conscientious objections”. This can be accomplished by the Legislature for public schools. For private schools, it’ll likely take a campaign from alumni organizations. If their kids can’t get into Harvard without having had their shots, they’ll get their shots. Lisa Falkenberg and Harold Pollack have more.

It’s skunk vaccination time

Again.

Fresh from victories over rabies strains in the coyote and gray fox, Texas [launched] its annual aerial assault on one of the state’s top remaining carriers: skunks.

The state health department Wednesday [began] dropping 1.4 million doses of edible rabies vaccines over a 17-county area between Houston and Austin, where laboratories have consistently confirmed skunk cases. The area covered has been expanded since the strategy first was attempted on skunks in 2012.

“It makes sense to turn our attention to skunks since they’re now the most likely terrestrial animal in Texas to have rabies,” Dr. Laura Robinson, director of the Texas Department of State Health Services’ Oral Rabies Vaccination Program, said in a statement. “Every year, hundreds of animals are infected with the skunk strain of rabies, and there’s a risk they could spread the virus to livestock, pets or humans.”

Texas has more laboratory-confirmed cases of rabies in wildlife than any other state, according to the U.S. Centers for Disease Control and Prevention. The number of confirmed cases in 2014 topped 1,000, though final data are not yet in. In 2013, the state confirmed 937 cases, including 432 in bats and 402 in skunks. The oral rabies vaccination program eliminated the coyote strain and virtually eliminated the gray fox strain.

A Texas map of the sites where rabies cases in all wildlife has been confirmed can be found here.

See here and here for the background. If you’re out in the countryside and you see some odd little plastic packets lying on the ground, please don’t touch them. They’re for the skunks. The program has been quite successful so far, so kudos to the DSHS for their work. If only we could vaccinate more people this easily.

Please get a flu shot

It’s always a good idea, even if it’s more effective in some years than in others.

The flu vaccine may not be very effective this winter, according to U.S. health officials who worry this may lead to more serious illnesses and deaths.

Flu season has begun to ramp up, and officials say the vaccine does not protect well against the dominant strain seen most commonly so far this year. That strain tends to cause more deaths and hospitalizations, especially in the elderly.

Only 48 percent of the 85 samples of H3N2 influenza viruses that have been tested since Oct. 1 are closely related to the strain that was picked for the vaccine distributed in North America, according to the agency.

“Though we cannot predict what will happen the rest of this flu season, it’s possible we may have a season that’s more severe than most,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, at a news conference Thursday.

CDC officials think the vaccine should provide some protection and still are urging people to get vaccinated. But it probably won’t be as good as if the vaccine strain was a match.

Flu vaccine effectiveness tends to vary from year to year. Last winter, flu vaccine was 50 to 55 percent effective overall, which experts consider relatively good.

[…]

Current flu vaccines are built to protect against three or four different kinds of flu virus, depending on the product. The ingredients are selected very early in the year, based on predictions of what strains will circulate the following winter.

The ingredients always include a Type A H3N2 flu virus. The most severe flu seasons tend to be dominated by some version of that kind of flu bug. The three most deadly flu seasons of the last 10 years – in the winters of 2003-2004, 2007-2008, and 2012-2013 – were H3N2 seasons.

In March, after the H3N2 vaccine strain was vaccine production was underway, health officials noted the appearance of a new and different strain of H3N2. “This is not something that’s been around before,” Frieden said.

But health officials weren’t sure if the new strain would become a significant problem in the United States this winter until recently, they said. Lab specimens from patients have shown that the most commonly seen flu bug so far is the new strain of H3N2. Specifically, about 48 percent of the H3N2 samples seen so far were well matched to what’s in the vaccine, but 52 percent were not, the CDC said.

Not perfect, but your odds are still a lot better with the vaccine than without. As the story notes, in an average year about 24,000 Americans die from the flu. I’ll have to check my math on this, but I’m pretty sure that’s more than the number of Americans that die from Ebola. (Which we still need to fight against as well, but Congressional Republicans have lost interest in Ebola since it’s not generating scary cable news stories any more.) So don’t fall for the hysteria. Please put the odds in your favor and get a flu shot, OK? Thanks.

We really need to do better on vaccinations

Cherise Rohr-Allegrini, PhD, MPH and self-proclaimed “crunchy granola hippie”, writes in the Rivard Report about how we are letting infectious diseases regain a foothold.

In 1998, the World Health Organization declared that measles would be eradicated worldwide by 2007. In 2000, public health officials declared measles to be eliminated from the US. But instead of being eliminated, it returned with a vengeance: the CDC reported 11 outbreaks in the US in 2013.

In 2014 it’s been even worse, with Texas and California hit particularly hard. When one looks at the numbers, they tend to say “Ah, only a couple of hundred cases, that’s not much.” But what they’re forgetting is this: Measles kills. Like most vaccine-preventable diseases, it doesn’t always kill, but once we reach a critical number of cases, the likelihood that one of those children will die becomes much greater. For measles, that’s 500 cases.

It’s been many years since we’ve seen more than 500 cases in the US. But this year, as of May 14, there have been 216 cases in the US. Ever closer, we inch towards that critical threshold.

And it’s not just measles. The second M in MMR stands for Mumps. By May 27, 2014, there have been 464 cases of mumps in the U.S., most linked to outbreaks at Ohio State University and Fordham University in New York City.

And then Congenital Rubella (the “R” in MMR) rears its ugly head. For most of us, rubella is a mild illness, often not even noticed. But for pregnant women, it often results in the death of their fetus. If the baby survives, then there’s a high likelihood the baby will be born with severe abnormalities, all due to a preventable disease.

Pertussis is probably the most widespread vaccine preventable illness we see today. In 2000, if we’d seen more than 2,218 cases we saw in 2012, DSHS would have declared an epidemic. Today, this is the endemic level – the “new normal.”

[…]

In Bexar County, 65.7 percent children under the age of three have received all the required vaccinations.

That sounds pretty good, except when you learn that the US National Goal is 80 percent, and for some diseases, we need at least 90 percent of all kids vaccinated to fully protect the entire population.

Why? Why would anyone not prevent a disease when it’s so easily preventable?

Partly it’s the disinformation coming from uninformed and/or dishonest sources that scares people into misidentifying the relative risks (spoiler alert: childhood vaccines are totally safe), partly it’s the public health profession being a victim of its own success – out of sight, out of mind, and all that – and partly it’s insufficient outreach. The main thing to keep in mind is that a lack of vaccination – and Bexar County is not alone in its low participation rate, as you’ll see if you click over – puts us all at risk. You and I may have been vaccinated as kids, but most vaccines eventually run out of potency and need to be supplemented later in life. Without a high enough vaccination rate to ensure herd immunity, even healthy previously vaccinated adults can come down with these diseases. So please, vaccinate your kids, tell everyone you know to vaccinate their kids, and support policies and politicians that provide funds and resources for vaccinating as many kids as possible. The person you save from getting measles or pertussis later in life may be you.

Vaccinating skunks

To prevent rabies, of course.

Texas, which has long campaigned for family pets to be vaccinated against rabies, is now attacking from the sky one of the state’s foulest carriers of the disease: skunks.

Skunks would obviously put up quite a stink if caught and hauled in to a veterinarian’s office for shots. So the state health department is taking the rabies vaccine to the vermin.

Twin-engine airplanes this month are crisscrossing 8,800 square miles of East and Central Texas to drop 1.2 million vaccine packets.

Each vaccine is the size of a fast-food ketchup packet and is coated with smelly fish meal to entice skunks to eat it.

Packets will rain down at a rate of about 150 per square mile, as pilots try to evenly disperse the vaccines over rural portions of Montgomery, Fort Bend, Waller and 14 other counties to the west and north of Houston.

The massive airdrop – which should skirt around residential neighborhoods – is part of an expanded test by the Texas Department of State Health Services of the V-RG vaccine – the same preventative used over the past two decades to nearly eliminate the canine and fox strains of rabies.

“We want to know if it will be just as effective in wiping out the skunk strain as it did the other two,” said Tom Sidwa, state public health veterinarian.

See? It is possible for uninsured people to get health care in Texas, if by “uninsured people” you mean “skunks”, and by “health care” you mean “air-dropped vaccination packets”. Details, details.

Seriously, this is a good idea that worked with one strain of rabies and ought to work equally well with another. I hope to read a future report about how successful this effort was.

Teaching creationism in Texas

Zack Kopplin reports on some unconstitutional behavior by a national charter school operator that has several campuses in Texas.

When public-school students enrolled in Texas’ largest charter program open their biology workbooks, they will read that the fossil record is “sketchy.” That evolution is “dogma” and an “unproved theory” with no experimental basis. They will be told that leading scientists dispute the mechanisms of evolution and the age of the Earth. These are all lies.

The more than 17,000 students in the Responsive Education Solutions charter system will learn in their history classes that some residents of the Philippines were “pagans in various levels of civilization.” They’ll read in a history textbook that feminism forced women to turn to the government as a “surrogate husband.”

Responsive Ed has a secular veneer and is funded by public money, but it has been connected from its inception to the creationist movement and to far-right fundamentalists who seek to undermine the separation of church and state.

Infiltrating and subverting the charter-school movement has allowed Responsive Ed to carry out its religious agenda—and it is succeeding. Operating more than 65 campuses in Texas, Arkansas, and Indiana, Responsive Ed receives more than $82 million in taxpayer money annually, and it is expanding, with 20 more Texas campuses opening in 2014.

Charter schools may be run independently, but they are still public schools, and through an open records request, I was able to obtain a set of Responsive Ed’s biology “Knowledge Units,” workbooks that Responsive Ed students must complete to pass biology. These workbooks both overtly and underhandedly discredit evidence-based science and allow creationism into public-school classrooms.

A favorite creationist claim is that there is “uncertainty” in the fossil record, and Responsive Ed does not disappoint. The workbook cites the “lack of a single source for all the rock layers as an argument against evolution.”

I asked Ken Miller, a co-author of the Miller-Levine Biology textbook published by Pearson and one of the most widely used science textbooks on the market today, to respond to claims about the fossil record and other inaccuracies in the Responsive Ed curriculum. (It’s worth noting that creationists on the Texas State Board of Education recently tried, and failed, to block the approval of Miller’s textbook because it teaches evolution.)

“Of course there is no ‘single source’ for all rock layers,” Miller told me over email. “However, the pioneers of the geological sciences observed that the sequence of distinctive rock layers in one place (southern England, for example) could be correlated with identical layers in other places, and eventually merged into a single system of stratigraphy. All of this was established well before Darwin’s work on evolution.”

[…]

Responsive Ed’s butchering of evolution isn’t the only part of its science curriculum that deserves an F; it also misinforms students about vaccines and mauls the scientific method.

The only study linking vaccines to autism was exposed as a fraud and has been retracted, and the relationship has been studied exhaustively and found to be nonexistent. But a Responsive Ed workbook teaches, “We do not know for sure whether vaccines increase a child’s chance of getting autism, but we can conclude that more research needs to be done.”

On the scientific method, Responsive Ed confuses scientific theories and laws. It argues that theories are weaker than laws and that there is a natural progression from theories into laws, all of which is incorrect.

The Responsive Ed curriculum undermines Texas schoolchildren’s future in any possible career in science.

There’s a lot more, so go read it all, or at least go read the Observer’s summary. Remember, your tax dollars are being used to help pay these guys’ bills. Will the Legislature do anything about it? Maybe, but if Dan Patrick gets elected Lt. Governor, I wouldn’t count on his taking any action. TFN Insider has more.

Endorsement watch: For Christie

The Chron endorses freshman CM Jack Christie in At Large #5.

Jack Christie

Jack Christie

At-Large council members act as a sort of minister without portfolio. While district council members focus on constituent issues, at-large members can set their own agendas. The previous incumbent for At-Large Position 5, Jolanda Jones, said her goal was to serve as “the voice of the voiceless.” Not everyone liked what they heard. Her calls for scrutiny slowed down business as usual at City Hall – for better or worse. Several of Jones’ fellow council members, not to mention former Mayor Bill White, united behind Jack Christie to defeat Jones in 2011. He won in the runoff.

Despite his low-profile status at City Hall, one would be pressed to find an incumbent on Council who faces such animosity from challengers. Their criticisms have little to do with his overall performance and instead focus on a single point: Christie doesn’t support vaccinations.

Christie has served for three terms as a member of the State Board of Education and three terms on the Spring Branch Independent School District Board of Trustees, but he’s also a chiropractor, and as one he has as deep skepticism of modern medicine. This came to light during a vote to accept a federal grant that would fund flu shots for poor kids and the elderly. “You don’t die from the flu,” Christie remarked at council, casting the only no vote.

People do die from the flu – thousands in U.S. every year. Christie’s conspiracy theories have no place in public policy. These unfounded fears of vaccinations have led to the return of once-scarce illnesses. For example, a measles outbreak struck 25 people in Newark, Texas, this past August, centered around a church whose senior pastor had criticized vaccinations.

To his credit, Christie expressed his dangerous position, cast his protest vote and moved on.

I’ve interviewed CM Christie three times now – here is this year’s interview. I find him to be engaging and likable, and generally speaking I think he’s been a decent Council member. But the vaccination issue just gobsmacks me. I know people who share his views; I’m related to at least one of them. This belief that vaccines are harmful defies all logic and reason, is based on a fraud, and yet is unshakeable in its adherents. It’s also demonstrably dangerous, as the measles outbreak cited by the Chron made clear recently. It would be one thing if this belief were strictly a personal matter, but we’ve already seen that it directly intersects with Council matters. Christie’s opponents are right to hammer on it, and the Chron is wrong to dismiss them for it. It’s true that CM Christie’s irrational opposition to that grant amounted to little more than a meaningless “No” vote, and that unlike some other Texas politicians I could name, he didn’t do any further damage to the system or the process for the sake of defending his indefensible belief. But he doesn’t deserve a pass for it. If the Chron didn’t think that either James Horwitz or Dr. Carolyn Evans-Shabazz were suitable for Council, then perhaps they should have taken a pass on this race. At the very least, they should have taken their own stated concerns more seriously.

Anyway. As noted, my interview with CM Christie is here, and my interview with James Horwitz is here. I did not interview Dr. Evans-Shabazz, but she did a Texpatriate Q&A; Horwitz also did Q&As from Texpatriate and Texas Leftist. The Chron ran two endorsements yesterday, but I decided to treat them as separate posts this time. I’ll blog about the other one tomorrow. Finally, Noah Horwitz, one of the Texpatriate bloggers and the son of James Horwitz, sent a letter to the editor of the Chron in response to their endorsement of CM Christie, which I have reproduced below. These are his words and not mine – I’ve said my piece above – but I agreed to print his letter in case the Chron didn’t.

(more…)

Pertussis

Not good.

State health officials warn that Texas is on track to see the highest number of whooping cough cases it has registered in 50 years if occurrences of the disease continue at the current rate.

As of this week, Texas has reported 1,670 cases of pertussis, better known as whooping cough, to the Centers for Disease Control and Prevention. The Texas Department of State Health Services stresses that the disease is serious, especially in young children.

Two whooping cough deaths have been reported this year in the state – children too young to be vaccinated, according to the department’s website. Thirteen percent of the whooping cough cases have required hospitalizations, with almost all of them involving infants younger than 1 year old.

Babies are especially vulnerable to the infection because they don’t have full protection against it until they’re 6 months old, when they receive the last of three shots.

Dr. Robert Lapus, pediatric emergency services director at Children’s Memorial Hermann Hospital, said two infants suffering from whooping cough recently were admitted to the hospital. Both were younger than 6 months.

[…]

The disease was common, with hundreds of thousands of cases reported annually, until the 1940s when the vaccine was introduced. For about 25 years, fewer than 5,000 cases were reported annually in the United States. The numbers started to climb again in the 1990s.

The Centers for Disease Control reports there were 159 whooping cough deaths in the United States from 2004 to 2011. Almost all the deaths – 141 of the 159 – were babies younger than 3 months old.

More than 41,000 cases were reported across the country in 2012, with 18 deaths. In Texas, there were 2,218 cases, with 159 in Harris County, 32 in Montgomery County, 12 in Fort Bend County and 10 in Galveston County.

As the story notes, low vaccination rates and higher infection rates are a national problem. As that CDC link suggests, the Affordable Care Act ought to help, since more people will be able to get primary care, which of course includes vaccinations. The bottom line is that we all need to be aware of these things. The vaccinations we got as kids don’t last forever. It’s a good idea to check and see what shots you may need now.

The HPV vaccine

This story about HPV and its vaccine is from a couple of weeks ago, but it needs to be read.

The vaccine that blocks a sexually transmitted infection that causes cervical, oral and other cancers was hailed as a home run when it was approved seven years ago, but, given usage rates, doctors still aren’t sure if it’ll ever live up to the promise and render any of the diseases a shadow of their current lethality.

Instead, doctors are huddling to determine how to improve inoculation rates that hover at 33 percent, a figure attributed to controversy that beset the vaccine from the beginning. The controversy included concerns that the vaccine would encourage premarital sex and Gov. Rick Perry’s 2007 attempt to require it of Texas school girls.

“It’s just wrong that politics should play a role in this,” says Dr. Lois Ramondetta, a University of Texas M.D. Anderson Cancer Center gynecologic oncologist who treats cervical cancer, the cancer for which the vaccine initially was approved. “This is the only cancer for which we know an infection is the cause and have a vaccine that prevents it. Getting vaccinated should be a no-brainer.”

The virus also is associated with a number of other cancers that researchers have begun finding are spiking – oral cancers that involve the back of the throat, tonsils and base of the tongue, and cancers of the vagina, vulva, penis and anus. Dr. Otis Brawley, chief medical officer of the American Cancer Society, recently referred to the increase as “one of the epidemics of the 21st century.”

[…]

Two vaccines – Gardasil and Cervarix – have been shown to protect against the strains of the virus that cause cervical cancer. Because neither provides any therapeutic benefit once an infection takes hold, the Centers for Disease Control recommends a series of three shots to girls at 11 to 12 years of age.

But it was that recommendation that roiled the waters. A Yale study found parental concern the vaccine could make adolescents less wary of casual sex was the biggest single factor in the decision not to vaccinate.

When Perry issued his order – overturned by the Texas Legislature later that session – making the vaccine mandatory for public school girls, the outcry included not just members of the religious right, but the leadership of the Texas Medical Association, who argued that it should stay voluntary until safety and liability issues were vetted.

“Education needs to come first,” said Dr. Joseph Bocchini at the time, then the chairman of the American Academy of Pediatrics chairman of infectious diseases. “Much of the public doesn’t know about HPV and its link to cervical cancer and other diseases. You can’t put a mandate ahead of that.”

The whole controversy over Perry’s order – you can see my blogging about it here was bizarre to me. It’s always strange to see Rick Perry do the right thing, though of course in this case he was motivated in large part by helping one of his cronies, who had a large piece of the company that was going to provide the vaccine. I suppose the backlash was predictable, and Lord knows it would probably be even worse today, but it was still depressing to watch. I remain grateful to Rep. Jessica Farrar for being a voice of reason and compassion throughout the debacle. I wonder how many lives might have been saved if sanity had prevailed. I can only hope the next time this comes up, the needs of the kids will come first.

Some things you can vaccinate against

Saying dumb things isn’t one of them.

CM Jack Christie

As the council considered a proposal Wednesday to accept $3.1 million in federal funding for childhood immunizations, Councilman Jack Christie voiced his opposition to the measure, apparently conflating it with flu vaccinations.

“I’m going to vote against this,” Christie said before the 15-1 vote. “You don’t die from the flu.”

Christie backed down somewhat from his comment on Friday. What he meant to say, he said, was that “People should not die from the flu.”

“First of all, that’s $3 million that the federal government doesn’t really have,” Christie said of the funding proposal. “It’s borrowed money we eventually have to pay back. But more important is the media’s embellishment of the extreme fear of encouraging flu vaccinations.

“Every year there’s going to be a flu,” he said, “and vaccines create synthetic immunity, which does not trump natural immunity to disease.”

Christie, who said he has never taken a flu shot, suggested the medical community should focus more attention on prescription drug abuse that claims thousands of lives annually in the U.S.

Dr. Joshua Septimus, associate professor of internal medicine at Methodist Hospital in the Texas Medical Center, called Christie’s comments irresponsible.

“That is totally wrong,” he said. “The flu kills anywhere from a few thousand to tens of thousands in the U.S. alone. There is very good evidence that the flu shot reduces deaths from the flu. That flu vaccine is a very low risk and with very high potential benefits.”

So much here to deal with. First, the idea that not accepting this funding is fiscally responsible is ludicrous. This money has already been appropriated. Not accepting it doesn’t mean it magically gets transmuted from a liability to an asset on the federal budget balance sheet. It means it gets to be granted to some other city. There are sometimes good reasons to turn down federal funding, but this is money for childhood immunizations. Spending money to keep kids healthy is about the best spending we can do. It’s an investment with a big payoff, both in terms of spending less later on sick kids, and the greater lifetime earnings potential of kids who grew up healthy and in some cases who got to grow up at all.

Second, the bit about the medical community needing to focus more on prescription drug abuse is a complete non sequitur. Last I checked, the medical community was big enough to handle more than one thing at a time. It’s also unlikely to change its priorities based on one screwball City Council voting down a grant for childhood immunizations. If you want to send a message to the American Medical Association, writing a letter to them is probably the better approach.

Finally, and not to put too fine a point on it, but even Helena Brown voted to accept these funds. Let me say that again: Even Helena Brown voted to accept these funds. When you’re off on an island that even Helena Brown isn’t inhabiting, you need to check your coordinates, know what I mean?

Eradicating rabies

Did you know that the state of Texas has been funding a program to wipe out rabies in foxes and coyotes by dropping vaccines for it from airplanes. It’s called the Texas Oral Rabies Vaccination Project, and it’s been a smashing success.

Vaccination from above

Vaccination from above

The program began in 1995 as a desperate experiment. The most serious outbreak of dog rabies in the United States in decades had moved within 40 miles of San Antonio, killing two people in its path, as it swept northward from Mexico, spread by infected coyotes.

Hundreds of animals, including pets and livestock, were infected and died. Some 2,000 people received post-exposure shots. And a separate outbreak of rabies in foxes that began in West Texas had already reached the San Antonio area.

Since then, millions of baits have been dropped over Texas. By 2004, the federal government declared the canine strain eliminated from the state.

And although the last rabid fox was found in Wink, near the New Mexico border, in May 2009, health officials want to make sure it, too, is gone before declaring victory.

“It’s very rewarding,” said Dr. Ernest Oertli, a veterinarian who heads the program for the Texas Department of State Health Services. “I’m sure it’s what was felt with polio and pox, when you can say – even within this one geographical area – that public health is making a difference.”

Yes, that’s the government at work, running a program that saves lives. Who knew they did that, right? You can learn more about it here. The U.S. Department of Agriculture has a wildlife rabies program as well, aimed at rabies in raccoons, which has also been quite successful. There’s still skunk rabies, which officials here hope to combat next, and bat rabies, for which there isn’t a plan just yet. Still a pretty nifty accomplishment, and something to keep in your back pocket the next time you hear some nihilist denigrate what government can do.