Off the Kuff

What a depressing headline.

Amid a widespread decline in childhood measles vaccination rates since before the COVID-19 pandemic across the United States, a study published Monday found that coverage can vary substantially within a state.

Looking at county-level data in 33 states, researchers at Johns Hopkins University found that the MMR (measles, mumps and rubella) vaccination rate decreased from 93.92% in the 2017-2018 school year to 91.26% in the 2023-2024 school year. Other states were not included because they had missing vaccination data, the authors of the study said.

Of the 2,066 counties the study looked at, 78% saw a decline in vaccination rates. Only four of the 33 states — California, Connecticut, Maine and New York — saw an increase in the average county-level vaccination rate, the study found.

The data shows significant diversity in the levels of vaccination within and across states, which the authors of the study say could “help inform targeted vaccination strategies.”

[…]

The CDC has also reported state-level declines in vaccination coverage for kindergartners by school year, saying the rate among U.S. kindergartners has decreased from 95.2% during the 2019-2020 school year to 92.7% in the 2023-2024 school year.

It sure would be nice to have a federal government that had a strategy for improving vaccination rates, wouldn’t it? The one grimly optimistic thing I can think of to say here is that we have seen an uptick in measles vaxxes in Texas since this outbreak began. Nothing quite focuses the mind like the specter of actual risk. It may be a blip, but against that we’re almost certain to see more outbreaks like this, so maybe there will be more of the resulting boosts. Depressing, but it is what it is.

Pull up a chair, make yourself comfortable, and practice some deep breathing as you read this.

Sick children began showing up at Texas hospitals in January.

Dr. Leila Myrick was on call when the first child landed in Seminole’s emergency room, where she consulted a medical textbook to confirm measles, a disease she had never actually seen.

Myrick had moved her family from Atlanta to Seminole in 2020, drawn by the promise of small-town medicine in a city cut out of the desert, a conservative but diverse community where many of her patients were Mennonite and Latino. She had taken care of their families in the five years since — through Covid and baby deliveries and everything in between. A framed poster of Myrick cradling newborns hangs in the hallway outside her office.

Measles now threatened these children, and Myrick did what she could to persuade parents to vaccinate them. She gave interviews, answered calls on a local German-language radio show, stayed late at her clinic and worked weekends at the hospital.

But her message faced competition.

Children’s Health Defense, the country’s largest anti-vaccine nonprofit, has downplayed the danger of measles for decades, falsely calling it benign and beneficial to the immune system. Seminole’s outbreak didn’t deter the group, which wrongly suggested it had been caused by a local vaccination campaign and then floated other contradictory theories: that the vaccines were failing, shedding the measles virus, or perhaps working too well, leading somehow to a super virulent strain.

Myrick watched her neighbors repeat these distortions in a local Facebook group, “Seminole TX Residents NEED to KNOW,” sometimes naming her directly.

“Every doctor that pushes the jabs gets commission from the big Pharma,” one woman wrote.

In late February, the Gaines County library posted a flyer “kindly” asking that unvaccinated and measles-sick patrons not come in. By the evening, after an outcry in the comments, the library removed the post.

“I see a vulnerable population getting fed the wrong information and making decisions for their children’s health based on wrong information,” Myrick said. “And I feel helpless.”

Responsibility for managing the outbreak fell on Zach Holbrooks, executive director of the South Plains Public Health District.

Holbrooks grew up in Seminole and after stints in Lubbock and Austin moved back in 2008 to lead public health across four counties. Run on about $2 million in grants a year, the health department’s responsibilities are broad — vaccines and family planning, but also disaster response, fire protection, food safety, landfills, inspections, permits and more.

Holbrooks didn’t see measles coming, though he is quick to say he probably should have — vaccine exemptions in Gaines County had more than doubled in the last 10 years, and about 1 in 5 kindergarteners were now skipping the shots.

When the first cases were confirmed at the end of January, “my heart sank,” Holbrooks said.

The district kept only a couple of doses of the measles, mumps and rubella vaccines on hand — enough for new families moving into the area, not to meet the sudden need of an outbreak. The two epidemiologists Holbrooks had on staff were immediately overwhelmed by case investigations. Holbrooks also didn’t have outreach materials in Low German or a relationship with the Mennonite community, which he now urgently needed a way into.

He turned to the state, which brought in nurses, testing supplies and vaccines. He set up a vaccine and testing clinic outside Seminole Hospital District; a spray-painted arrow on unfinished plywood signaled where to go.

Billie Dean, a nurse and site leader at the clinic, remembered one Mennonite woman who drove by every day in a compact gold car.

“We would see her pull in, and we were like, ‘Oh, she’s back,’” Dean said. Each day, they told her how many people had gotten vaccinated the day before, how none had come back with side effects. After two weeks, she rolled down her window and said she was ready. A few days later, she came back with her daughter and grandson.

Holbrooks printed flyers in English, Spanish and, with the assistance of a local author, Low German, to distribute at grocery stores, libraries, post offices and churches, and he gave updates on the local TV and radio stations.

Still, cases in the area ticked up, nearly doubling in a week to 80, a sure undercount, since officials knew many people weren’t being tested. In a letter published in February in The Mennonite Post, a German-language newspaper, a married Seminole couple reported “a lot of sick people here. Many have fever or diarrhea, vomiting or measles.”

Epidemiology deals in numbers. With measles, they go like this: With 1,000 cases, about 200 children will require hospitalization, 50 will develop pneumonia, and one to three will die.

The numbers caught up to Seminole on Feb. 26.

To invoke the old Mister Rogers maxim, there are a lot of helpers to see in this story. A lot of people in Gaines County and Lubbock and elsewhere did their level best to keep people healthy, answer their questions, get them and their kids vaccinated, and just generally beat back the avalanche of disinformation and bullshit from the professional deniers and bullshit peddlers. The article starts with a focus on one of them, so be prepared going in. And look, it’s easy for us to fall into non-empathetic ditches, in part because there are so many people involved in this story who will be on the express train to hell if such a place exists, but we can’t lose our own humanity. Look again at how many helpers there are in this saga. For all the darkness, there’s also plenty of light.

This is a good sign for the short-term future.

Measles is on a downward trend in the state, and the four people in Tarrant County who were infected appear to have not infected anyone else, Dr. Brian Byrd, director for Tarrant County Public Health, said during a recent meeting.

“The message is we’re trending in the right direction, however, we need to stay vigilant,” Byrd said at the June 2 Tarrant County Mayors’ Council meeting. “There are still pockets of unvaccinated people around Tarrant County.”

Measles symptoms appear one to three weeks after a person is exposed. Byrd said the 21-day window has passed since anyone was last exposed by the four people in Tarrant County who were infected. The four were family members.

“We don’t expect any cases stemming from those four cases,” Byrd said.

I’ve been keeping an eye on the known exposures in population centers as a possible vector for the case rate to go back up. So far it seems like the response from the local health officials has been enough to prevent that from happening. Kudos to them, let’s hope they can keep it up.

And let’s remember to do our part.

The Centers for Disease Control wants everyone with international travel plans to make sure they’re fully vaccinated against measles, a change that comes as outbreaks simmer all over North America.

A recent measles outbreak in Colorado was tied to a Turkish Airlines flight that landed in Denver. Canada and Mexico are wrestling with outbreaks, too, and now the CDC has stepped up its advice to international travelers: make sure you’re fully vaccinated or don’t go.

At least 1,088 measles infections have been reported in the U.S. so far this year — most connected to local outbreaks, including one in Texas that accounts for 742 of those cases. But CDC has also gotten 62 reports of air travelers contagious with measles while flying this year.

Each unvaccinated person on a plane with an infected traveler is at high risk for contracting the airborne virus and passing it to others, so the CDC wants travelers to confirm they’ve had both doses of the measles vaccine at least two weeks before they travel.

Travelling while unvaccinated is irresponsible. Travelling while actively sick is downright malevolent. Don’t be that guy.

We will end with some good news.

The Texas health department reported no new cases of measles on Friday, the first time the state has not recorded an increase since the outbreak began in February.

The state, which is the epicenter of the current measles outbreak, has a total of 742 confirmed cases as of Friday.

The number of new cases continues to decrease, from an average of about 12 per day around the peak to fewer than one case per day recently, Chris Van Deusen, director of media relations at the Texas health department, told Reuters in an email.

“The fact that (we) haven’t had any new hospitalizations reported in more than two weeks gives us confidence there are not major numbers of unreported cases still occurring out there,” said Van Deusen.

The United States is battling one of the worst outbreaks of the highly contagious airborne infection it has seen, with over 1,000 reported cases and three confirmed deaths.

Despite the slowing spread of the infection in Texas, the country continues to record weekly increases in measles cases elsewhere.

The U.S. Centers for Disease Control and Prevention said a total of 1,168 confirmed measles cases were reported by 34 jurisdictions as of Thursday, an increase of 80 cases since its previous update last week.

Since 2000, the only time infections surpassed the 1,000 mark was in 2019, when the country reported 1,274 cases.

There have been 17 outbreaks, defined as three or more related cases, reported in 2025, the CDC said.

There were four cases in the Tuesday report, so four for the week, and a step down from the around-ten-per-week plateau we’d been at. If this is the new normal, then so much the better.

He’s a liar.

Health Secretary Robert F. Kennedy Jr. says his “Make America Healthy Again” Commission report harnesses “gold-standard” science, citing more than 500 studies and other sources to back up its claims. Those citations, though, are rife with errors, from broken links to misstated conclusions.

Seven of the cited sources don’t appear to exist at all.

Epidemiologist Katherine Keyes is listed in the MAHA report as the first author of a study on anxiety in adolescents. When NOTUS reached out to her this week, she was surprised to hear of the citation. She does study mental health and substance use, she said. But she didn’t write the paper listed.

“The paper cited is not a real paper that I or my colleagues were involved with,” Keyes told NOTUS via email. “We’ve certainly done research on this topic, but did not publish a paper in JAMA Pediatrics on this topic with that co-author group, or with that title.”

It’s not clear that anyone wrote the study cited in the MAHA report. The citation refers to a study titled, “Changes in mental health and substance abuse among US adolescents during the COVID-19 pandemic,” along with a nonfunctional link to the study’s digital object identifier. While the citation claims that the study appeared in the 12th issue of the 176th edition of the journal JAMA Pediatrics, that issue didn’t include a study with that title.

As the Trump administration cuts research funding for federal health agencies and academic institutions and rejects the scientific consensus on issues like vaccines and gender-affirming care, the issues with its much-heralded MAHA report could indicate lessening concern for scientific accuracy at the highest levels of the federal government.

The Department of Health and Human Services did not respond to a request for comment on the report’s citation inconsistencies prior to publication of this story.

The anxiety study wasn’t the only one the report cites that appears to be mysteriously absent from the scientific literature. A section describing the “corporate capture of media” highlights two studies that it says are “broadly illustrative” of how a rise in direct-to-consumer drug advertisements has led to more prescriptions being written for ADHD medications and antidepressants for kids.

The catch? Neither of those studies is anywhere to be found. Here are the two citations:

Shah, M. B., et al. (2008). Direct-to-consumer advertising and the rise in ADHD medication use among children. Pediatrics, 122(5), e1055- e1060.

Findling, R. L., et al. (2009). Direct-to-consumer advertising of psychotropic medications for youth: A growing concern. Journal of Child and Adolescent Psychopharmacology, 19(5), 487-492.

Those articles don’t appear in the table of contents for the journals listed in their citations. A spokesperson for Virginia Commonwealth University, where psychiatric researcher Robert L. Findling currently teaches, confirmed to NOTUS that he never authored such an article. The author of the first study doesn’t appear to be a real ADHD researcher at all — at least, not one with a Google Scholar profile.

In another section titled, “American Children are on Too Much Medicine – A Recent and Emerging Crisis,” the report claims that 25% to 40% of mild cases of asthma are overprescribed. But searching Google for the exact title of the paper it cites to back up that figure — “Overprescribing of oral corticosteroids for children with asthma” — leads to only one result: the MAHA report.

The corticosteroids study’s supposed first author, pediatric pulmonologist Harold J. Farber, denied writing it or ever working with the other listed authors. He pointed to similar research he’s conducted, but said that even if the MAHA report cited that study correctly, its conclusions are “clearly an overgeneralization” of the findings.

“It is a tremendous leap of faith to generalize from a study in one Medicaid managed care program in Texas using 2011 to 2015 data to national care patterns in 2025,” Farber said in an email.

There’s more than that, from sloppiness to misstating conclusions and more. The story has an update at the end that the MAHA report was amended after their reporting to remove the seven references to reports that do not exist. Mistakes happen, and usually as long as they get fixed when they’re noticed it’s not a problem. This level of error suggests much bigger issues; former HHS Secretary Xavier Becerra called bullshit on the whole thing. Even if you could credibly assign it all to massive incompetence, it’s a terrible look for the agency and the authors of that report. And of RFK Jr, whose name is on it.

But as always, the chaos is the point.

Health and Human Services Secretary Robert F. Kennedy Jr. stunned federal health officials on Tuesday by abruptly announcing that the COVID-19 vaccine would no longer be recommended for children and healthy pregnant women—a major policy reversal reportedly made without input from the Centers for Disease Control and Prevention.

According to The Washington Post, agency officials were left scrambling after Kennedy dropped the news, not in a press release or internal memo, but in a video posted to X. That’s how CDC staff—and the rest of the country—found out.

This is literal life-and-death policy, yet Kennedy is treating it like a social media stunt.

Five hours after the video dropped, CDC officials finally received a one-page “secretarial directive” dated May 19—nearly a week earlier. It was signed by Kennedy but contradicted parts of his own video, deepening the confusion, according to multiple federal health officials who spoke to the Post anonymously.

In the video, Kennedy suggested he had unilaterally reversed CDC guidance recommending annual COVID shots for everyone six months and older, including healthy pregnant women. CDC officials told the Post that they learned about this “when it was tweeted.”

“People were scrambling to find out what it meant,” one federal health official said.

Kennedy also claimed the recommendations had already been pulled from the CDC website when they hadn’t. And how could they have been? Top CDC officials said they were blindsided, which is galling considering it’s the CDC’s job to issue that kind of advice in the first place.

As of Thursday, the CDC still recommended the COVID-19 vaccination for everyone six months and older, including people who are pregnant, breastfeeding, trying to conceive, or planning to get pregnant.

The directive, meanwhile, shared internally only after the fact, ordered the CDC to remove the COVID-19 vaccines from both the child and adolescent immunization schedule and the list of recommended vaccines during pregnancy. But its vague wording raised even more questions: Did Kennedy’s directive apply to all children, or just “healthy” ones?

“It’s unclear,” one official told the Post.

Adding to the disconnect, top officials at the U.S. Food and Drug Administration had just published a piece in the New England Journal of Medicine affirming that pregnancy is a high-risk condition for COVID-19 and a reason to get vaccinated, directly contradicting Kennedy’s claim.

The lying and misinformation go hand in hand with the chaos. And the bottom line is we’re all at greater risk because of RFK Jr.

The federal government announced Wednesday that it is canceling a contract to develop a vaccine to protect people against flu viruses that could cause pandemics, including the bird flu virus that’s been spreading among dairy cows in the U.S., citing concerns about the safety of the mRNA technology being used.

The Department of Health and Human Services said it is terminating a $766 million contract with the vaccine company Moderna to develop an mRNA vaccine to protect people against flu strains with pandemic potential, including the H5N1 bird flu virus that’s been raising fears.

[…]

Jennifer Nuzzo, the director of Brown University’s Pandemic Center, said the decision was “disappointing, but unsurprising given the politically-motivated, evidence-free rhetoric that tries to paint mRNA vaccines as being dangerous.”

“While there are other means of making flu vaccines in a pandemic, they are slower and some rely on eggs, which may be in short supply,” Nuzzo added in an email. “What we learned clearly during the last influenza pandemic is there are only a few companies in the world that make flu vaccines, which means in a pandemic there won’t be enough to go around. If the U.S. wants to make sure it can get enough vaccines for every American who wants them during a pandemic, it should invest in multiple types of vaccines instead of putting all of our eggs in one basket.”

The cancellation comes even though Moderna says a study involving 300 healthy adults had produced “positive interim” results and the company “had previously expected to advance the program to late-stage development.”

“While the termination of funding from HHS adds uncertainty, we are pleased by the robust immune response and safety profile observed in this interim analysis of the Phase 1/2 study of our H5 avian flu vaccine and we will explore alternative paths forward for the program,” Stéphane Bancel, Moderna’s chief executive officer, said in a statement. “These clinical data in pandemic influenza underscore the critical role mRNA technology has played as a countermeasure to emerging health threats.”

The administration’s move drew sharp criticism from outside experts.

“This decision puts the lives and health of the American people at risk,” said Dr. Ashish Jha, the dean of the Brown School of Public Health, who served as President Biden’s COVID-19 response coordinator.

“Bird Flu is a well known threat and the virus has continued to evolve. If the virus develops the ability to spread from person to person, we could see a large number of people get sick and die from this infection,” Jha said. “The program to develop the next generation of vaccines was essential to protecting Americans. The attack by the Administration on the mRNA vaccine platform is absurd.”

But totally on brand. And sooner or later there’s going to be a big mess to clean up. If it happens on RFK Jr’s watch, how much do you trust him to be able to handle it? Your Local Epidemiologist has some thoughts.

And finally, here’s your case count update.

The measles outbreak in Texas has grown by nine cases since the last update Tuesday, according to the Texas Department of State Health Services.

This brings the total new cases in the last week to 10 after one was reported Tuesday. The Texas health department estimates that less than 1% of the cases, or fewer than 10, are actively infectious. Measles is infectious four days prior to and four days after rash onset.

Since the outbreak began in January in Gaines County, located in West Texas along the state border with New Mexico, 738 cases of measles have been confirmed. Two school-age children, who were not vaccinated, have died during the outbreak. Ninety-four people have been hospitalized.

With 409 cases, Gaines County represents the vast majority of cases in the outbreak at 55.4%. Other counties with high case counts include Terry County, which neighbors Gaines, with 60 cases, and El Paso County with 57 cases. Lubbock County has 53 cases. Officials said the counties with ongoing measles transmission include Cochran, Dawson, Gaines, Lamar, Lubbock, Terry and Yoakum.

Another 32 cases have been reported that are not connected to the West Texas outbreak. This includes four cases in Tarrant County, two in Denton County, two in Collin County and one in Rockwall County.

Health officials earlier this week warned residents of measles exposure at four public venues in McKinney: a 24 Hour Fitness, the Cubana Grille, Market Street and the Moviehouse & Eatery.

Most of the confirmed cases have been children, according to DSHS. Children age 17 and under represented 495 cases, while children 4 and under represented 215 cases.

About 700 of the patients have been either unvaccinated or had an unknown vaccination status.

Ten cases a week continues to be the new normal. We also continue to get new reports of exposure in various public places, though so far none of them seem to have turned into super spreader events. I hope that luck keeps on holding up.

UPDATE: Slightly good news, but the chaos and uncertainty persists.

Days after Health Secretary Robert F. Kennedy Jr. announced that Covid shots would be removed from the federal immunization schedule for children, the Centers for Disease Control and Prevention issued updated advice that largely countered Mr. Kennedy’s new policy.

The agency kept Covid shots on the schedule for healthy children 6 months to 17 years old, but added a new condition. Children and their caregivers will be able to get the vaccines in consultation with a doctor or provider, which the agency calls “shared decision-making.”

The shots will also remain available under those terms to about 38 million low-income children who rely on the Vaccines for Children program, according to an emailed update from the C.D.C. on Friday.

Mr. Kennedy’s original pronouncement on Tuesday had caused an uproar among pediatricians and public health experts, who pointed out that very young children and pregnant women face high risks of severe illness from the virus. Many also worried that the new policy would prompt insurers and government programs to reduce or drop coverage of the cost of the shots.

The latest changes clarify coverage for healthy children older than 6 months. But they leave those highest-risk groups — pregnant woman and young infants who are covered by immunization during pregnancy — without a formal recommendation.

[…]

The policy changes on vaccines did not end uncertainty for pregnant women.

Last week, the Food and Drug Administration cited pregnancy as a high-risk condition that would qualify a woman for a Covid vaccine, which also contradicts the decision by Mr. Kennedy to drop pregnant women from the C.D.C.’s recommendations.

The dropped guidance for pregnant women is troubling to experts who point to research showing that the risk of stillbirth, preterm birth, hospitalization and death rises if pregnant women contract Covid.

Dr. Michelle Fiscus, a pediatrician and chief medical officer with the Association of Immunization Managers, said that she had expected a modified recommendation from the C.D.C. advising pregnant women to get the vaccine

“So that’s concerning,” she said.

On the C.D.C.’s website, the section on pregnancy and the Covid vaccine continues to urge pregnant and postpartum women to get the shot. If pregnant, women are “more likely to need hospitalization, intensive care or the use of a ventilator or special equipment to breathe if you do get sick from Covid-19.”

“Severe Covid-19 illness can lead to death,” the agency warns.

Who the hell knows with these malevolent idiots?

UPDATE: Of course the use of AI may be to blame for those citations of non-existent work. Of course.