Off the Kuff Rotating Header Image

World Health Organization

Perspective on the anti-vaxx situation

Maybe it’s not as bad as we think.

It’s certainly true that pockets of vaccine refusal persist in this country, as they have for many years. If those pockets are now experiencing greater numbers of measles cases, it may be on account of dire trends in far-off places.

This global explanation only kicks the can a little farther down the road, however. Measles cases are spreading here because they’re spreading overseas—OK, fine. But why is measles spreading overseas?

[…]

Are vaccination rates really on a downward trajectory? Once again, the actual data complicate this narrative. Global immunizations against measles, like those in the U.S., are at or near an all-time high. Since the start of this century, the proportion of people around the world who have received at least one dose of the measles vaccine has increased by almost one-fifth. Meanwhile, the use of a second dose of the vaccine (which makes it more effective) has more than quadrupled on the global scale. In 2000, just 15 percent of people were getting both shots. Now, that number is up to 67 percent and still rising.

The salutary effects of all this work could not be more apparent. The global number of people who contract measles and the global number of people who die from it have each gone down by about 80 percent since 2000. As recently as 1980, more than 4 million cases of measles were reported every year. Despite massive population growth since then—an uptick of several billion people, worldwide—the annual number of measles cases has dropped to about one-fiftieth of what it used to be, to a few hundred thousand cases per year.

Given all this recent progress, the global measles crisis that’s underway seems somewhat paradoxical.

Basically, the argument is that outbreaks like we’ve seen with measles tend to burn quickly through the susceptible population, then run out of steam, and that the biggest cause of not being vaccinated in the US is not anti-vax foolishness but lack of access to medical care. The author argues that the full picture of the data is often not represented or mis-represented in media stories, which has caused some level of overreaction among vaccine proponents. There’s a lot of detail, so read it all and see what you think.

Our measles risk

Do I spend too much time worrying about stuff like this, or do I not spend enough time on it?

Harris County is one of the nation’s most vulnerable counties to a measles outbreak, according to a new study based on international travel and the prevalence of non-medical vaccine exemptions.

The study, published Thursday in the journal Lancet Infectious Diseases, ranks Harris County as the county 9th most at risk of having clusters of people contract measles, the highly contagious, potentially fatal virus that has re-emerged as a public health threat after having been largely eradicated at the turn of the century. Tarrant and Travis counties also are at high risk of an outbreak, according to the study.

“Texas’ showing is on par with the other 16 states that allow vaccine exemptions for conscientious or personal reasons,” said Sahotra Sarkar, a University of Texas Austin professor and the study’s lead author. “You can expect the state, like other parts of the nation, to see more cases.”

Sarkar said Harris County’s vulnerability is mostly the result of its considerable international travel. The county’s number of non-medical vaccine exemptions was not among the state’s highest in a Texas health department report released earlier this week.

[…]

The new study was conducted by Sarkar and a Johns Hopkins University researcher using risk assessment models similar to one they used to correctly predict that Zika, the mosquito-born virus that can cause serious birth defects, would first affect Texas and Florida after it began spreading from the Southern Hemisphere midway through this decade. It also correctly predicted areas already experiencing measles outbreaks, such as Washington, Oregon and New York.

The authors didn’t consider the locations of measles cases already recorded. Instead, they looked at non-medical vaccine exemptions, international air travel and the incidence of measles in countries from which people came to the United States, particularly India, China, Mexico, Japan, Ukraine, Philippines and Thailand. In all, some 112,000 people have been diagnosed with measles outside the U.S. this year, according to the World Health Organization.

Peter Hotez, a Baylor College of Medicine professor of infectious disease and vaccine advocate, called the new study an advance over research he published last year that identified “15 hotspots” of vaccine exemptions among a subset of states. Harris County ranked seventh on that list.

“I think this is a nice refinement on our first attempt,” said Hotez. “It confirms the high risk of Texas counties to measles, something that we’ll need to consider seriously when planning for epidemics.”

It’s not clear what if anything can be done to mitigate this particular risk, so I’m back to wondering how much I should worry about it. Keep working to close the gap in vaccination rates, I guess. It annoys the crap out of me that we have to worry about this sort of thing in 2019, but here we are.

Two data points on e-cigarettes

The World Health Organization wants them to be regulated more strongly.

Governments should ban the use of electronic cigarettes indoors and in public places and outlaw tactics to lure young users, the World Health Organization said in a report released on Tuesday. It also raised concerns about the role of big tobacco companies in the fast-growing market.

Considering the numerous uncertainties surrounding e-cigarettes, which have been on the market for less than a decade, the United Nations organization said it was appropriate to prohibit their use indoors “until exhaled vapour is proven to be not harmful to bystanders.”

It also called for regulation to ensure the products contain a standard dose of nicotine, as the drug content now varies widely between manufacturers. And to stop children from picking up the habit, it said that e-cigarette sales to minors should be banned and that fruity, candy-type flavorings should be prohibited.

[…]

Electronic nicotine delivery systems “are the subject of a public health dispute among bona fide tobacco-control advocates that has become more divisive as their use has increased,” the report notes. Some experts embrace them as a means of reducing the harm associated with traditional cigarettes while others view them as a threat to the progress that has been made in “denormalizing” the use of tobacco.

Proponents of e-cigarettes argue that they are safer than tobacco, because they do not contain the carcinogens found in tar and other tobacco components. Anecdotal evidence suggests e-cigarettes may hold promise as smoking cessation aids, too. But the World Health Organization report noted that there is scant evidence for their effectiveness in helping smokers give up the habit; the only randomized trial to date to have compared e-cigarettes with nicotine patches “showed similar, although low, efficacy for quitting smoking.”

The organization said e-cigarette advertisers should be prohibited from making any health claims, including on the product’s purported value as a smoking cessation aid, “until manufacturers provide convincing supporting scientific evidence and obtain regulatory approval.”

The report is here. I’ve been following this stuff because while some municipalities are treating e-cigarettes like traditional tobacco products, others like Houston have made no move to amend their existing anti-smoking ordinances. Some jails in Texas are allowing the use of e-cigarettes on the less-harmful-than-tobacco theory, while others aren’t. It’s a coming public debate, and as things stand right now there’s a lack of information about their effects. A lot of entities are waiting to hear more from organizations like the WHO and the Surgeon General.

Also in the news: adolescents who use e-cigarettes are much more likely to try tobacco, according to the CDC.

The morass of conflicting information about e-cigarettes and tobacco use grew deeper Monday, when the Centers for Disease Control and Prevention released a new study showing that adolescents who vape say they are much more likely to smoke conventional cigarettes.

The results show that 43.9 percent of sixth- through 12th-graders who had used e-cigarettes said they intended to light up conventional cigarettes over the next year, compared with 21.5 percent of youth who had never used the electronic nicotine delivery systems.

Overall, more than 263,000 adolescents who had never smoked before used e-cigarettes in 2013, up from 79,000 in 2011, the CDC reported in a study in the journal Nicotine and Tobacco Research. The data come from the agency’s National Youth Tobacco Surveys for 2011-2013.

The study also showed that 21.9 percent of the youth who had never smoked traditional cigarettes intended to give them a try in the next year — almost exactly the same proportion as the 21.5 percent who had never tried an e-cigarette — and that, overall, the percentage of youths who reported an intention to smoke declined “significantly” in the 2013 survey.

We all know that smoking is terrible for you, but we don’t yet know how much, or even if, e-cigarettes are “better” than tobacco. If there is a correlation between vaping and smoking among teenagers, that’s a pretty strong piece of evidence that they’re not any better.