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The CDCs Call for Increased JYNNEOS Vaccination
The Centers for Disease Control and Prevention (CDC) are urging clinicians, health departments, and community-based organizations to continue recommending the two-dose JYNNEOS vaccine to eligible individuals. Despite the vaccines availability at health clinics and pharmacies across the United States, the vaccination uptake has plateaued at just 25%. To protect public health and curb the spread of the virus, it is therefore essential that the uptake of the JYNNEOS vaccine is increased.
JYNNEOS, developed by Bavarian Nordic A/S, is a vaccine primarily used to protect against smallpox and monkeypox, collectively referred to as mpox. The JYNNEOS vaccine has been the subject of considerable investment by the U.S. government. Bavarian Nordic A/S secured $83 million in funding from the Biomedical Advanced Research and Development Authority (BARDA) for the vaccine, marking a second investment from the U.S. government. This brings the total investment into JYNNEOS to approximately $200 million, with an additional $12 million expected to be awarded in 2021. The funding will allow for the manufacturing of liquid-frozen doses of the vaccine and will improve preparedness against smallpox and monkeypox.
JYNNEOS is highly effective in preventing the spread of mpox. The vaccine has potential to protect against severe illness, hospitalization, and death. Numerous stories have been shared by individuals who have received the vaccine, providing first-hand accounts of its effectiveness and the importance of its widespread uptake. Not only does the vaccine protect the individual, but it also contributes to the overall health of the community by reducing the risk of spread.
Currently, there is an outbreak of mpox in the Democratic Republic of Congo (DRC). The CDC provides information about ways to reduce the risk of mpox during social gatherings and sexual activity, as well as self-care tips for those recovering from the virus. However, the most effective measure to prevent the spread of the virus is through vaccination. Therefore, the increased uptake of the JYNNEOS vaccine is crucial in containing the outbreak and protecting public health.
The JYNNEOS vaccine plays a vital role in preventing the spread of mpox and protecting against severe illness, hospitalization, and death. The CDCs call for increased vaccination rates, coupled with substantial investment from the U.S. government, underscores the importance of this vaccine. It is therefore crucial for individuals to get vaccinated and for health professionals to continue recommending the JYNNEOS vaccine. By doing so, we can protect not only ourselves but also our communities, and contribute to the global effort to curb the spread of mpox.
A limited outbreak of measles in Israel continues to grow with the Health Ministry announcing that four more cases were diagnosed in recent days. In total, 18 people have been found to have the contagious and potentially life-threatening respiratory disease since December 2023.
The first newly detected case involves a tourist from Russia who was at the emergency room at Barzilai Medical Center on February 5 from 8:30 p.m. until February 6 at 1 a.m.
The second is a boy from Holon who returned from Azerbaijan and was in the emergency department of Wolfson Medical Center from February 9 at 5 p.m. until February 10 at 4 a.m.; hed been vaccinated with one dose of the measles vaccine. The third contracted the disease from another person in the Haifa region who rode Egged bus 12 in Kiryat Yam on February 9, boarding at 12 p.m.
The fourth case is a toddler who was vaccinated with a single dose of the measles vaccine, which is appropriate for their age according to Health Ministry guidelines.
The ministry is carrying out an epidemiological investigation for each detected case. Anyone who suspects they were in proximity to a person with measles should call the ministry at 5400*. If someone develops symptoms, they should isolate themselves and be in touch with a doctor or hospital. The ministry urges Israelis to get the full set of measles vaccine shots.
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If youve presented the same arm for every dose of a particular vaccine, you may want to reconsider. Alternating arms may produce a more powerful immune response, a new study suggests.
The researchers studied responses to the first two doses of Covid-19 vaccines. Those who alternated arms showed a small increase in immunity over those who got both doses in the same arm.
[HSE chief repeats call for people to avail of flu vaccine]
For individuals who respond poorly to vaccines because of age or health conditions, even a small boost may turn out to be significant, the researchers said. At this point in the pandemic, with most people having had multiple vaccine doses or infections, alternating arms for Covid vaccines may not offer much benefit. Yet, if confirmed by further study, the results could have implications for all multi-dose vaccines, including childhood immunisations.
Im not making recommendations at this point, because we need to understand this a lot better, said Dr Marcel Curlin, an infectious disease physician at Oregon Health and Science University who led the work. But, all things being equal, we ought to consider switching up the arms.
[After death of man from measles, CMO concerned over high risk of outbreak in Ireland]
The few studies comparing the two approaches have been small and have produced mixed results. And none of the studies have shown a big difference in immunity.
In the new study, Dr Curlin and his colleagues repeatedly measured antibody levels in 54 pairs of university employees matched for age, gender and the time after vaccination.
[The worrying increase of vaccine hesitancy]
The participants, part of a larger research project, were randomised to get the second dose in the same arm as the first dose or in the opposite arm. The researchers excluded anyone who became infected with Covid during the study.
Switching the arms increased blood antibody levels by as much as fourfold, the scientists found. The results were published in The Journal of Clinical Investigation.
The immune response was stronger against both the original coronavirus and against the omicron variant, which emerged roughly a year after the authorisation of the first Covid vaccines. - This article originally appeared in the New York Times
But shes not talking about the Covid vaccine. Shes praising a new shot against RSV.
RSV, or respiratory syncytial virus, usually hits in fall and winter. Its mild for most people but lethal for some especially babies and older people. In a typical year, according to the CDC, as many as 80,000 children under age 5 are hospitalized, and between 100 and 300 kids die. For those 65 and over, there are up to 160,000 hospitalizations a year, and 6,000 to 10,000 deaths.
But ahead of this RSV season, for the first time ever, immunization was finally approved for the most vulnerable groups of Americans, young and old. It was also recommended for those late in pregnancy, which would protect infants from birth.
Would people get the jab? As this RSV season winds down, the answer is that by and large, they did not.
The latest data from the CDC shows that only 16 percent of eligible pregnant people got vaccinated. Among the over 60 population, it was just over one in five. And among babies and eligible young children, the uptake was low, the CDC said.
Four years after Covid hit and fueled growing vaccine hesitancy, the rollout of the RSV vaccine this fall and winter offered a case study unfolding in real time. At issue was whether the public health and medical communities had acquired the skills, speed and agility needed to counter malicious misinformation before it took hold in the publics mind.
A series of organizations and strategies sprang up, both online and off, to debunk misinformation or prebunk it or tackle it in some other way. The action has not just been on TikTok but on WhatsApp, Google and in local communities across the country. But it hasnt been enough to rebuild trust among an increasingly skeptical nation, particularly on a new vaccine against an old disease.
If the question is, is the public health community better prepared than it was three years ago? I can answer yes, said Ashish Jha, back at his post as dean of Brown Universitys School of Public Health after serving for a year as the Biden administrations Covid response coordinator.
But, Jha added, doctors, nurses, public health officers and government agencies like the Centers for Disease Control, are operating in a challenging environment where too many downplay the winter respiratory season. These minimizers dont acknowledge just how lethal such diseases, including RSV, can be for the high-risk population, adding, Its been very hard to break through that wall of bad information.
The science of countering misinformation is still young.
All sorts of strategies that would seem to be potent turn out not to persuade people or they do, but the effect is ephemeral, with people reverting to their original false beliefs in as little as a week.
Still, health organizations have begun to mobilize since the tidal wave of Covid vaccine misinformation undermined demand for the shots and drove broader suspicion toward all vaccines, including routine childhood immunization for diseases like measles. But while clinicians and health groups are more alert to the threats, much of the population is so distrustful of public health and medicine inside or outside of government that any assertions of safety immediately get sucked into the conspiracy vortex.
The attack against RSV immunization during this first season wasnt at Covid vaccine proportions, but it is out there.
Despite 12 Deaths During Clinical Trials, CDC Signs Off on RSV Shots for Newborns, read an alert from the Childrens Health Defense, the anti-vaccine group founded by independent presidential candidate Robert F. Kennedy Jr. In fact, none of those deaths were caused by the shots, and there is ample data about their safety, including during pregnancy.
That didnt stop another vaccine critic physician named Peter McCullough from urging his 979,500 followers on X (the site formerly known as Twitter) not to get vaccinated. RSV in infancy easy to treat with nebulizers, he claimed. And there were others like him on various social media platforms.
If the question is, is the public health community better prepared than it was three years ago? I can answer yes, said Ashish Jha. | Drew Angerer/Getty Images
Many people have been seeking out information on RSV, according to the Public Health Communications Collaborative, which was formed by the CDC Foundation, the de Beaumont Foundation and Trust for Americas Health in 2020. The organization, which brought in additional partners, works to provide accurate and effective messaging to the public health community and tracks online trends. It has found that when people search online for information on RSV, they see both facts and false claims. And for many people, after the last few years of competing online claims, it can be hard to figure out which is which.
In one major victory for accuracy and the public health world, Google followed guidance from experts convened under the National Academy of Medicine and the World Health Organization. Those experts outlined how tech platforms can identify credible sources of health information that can be elevated online. Its not that nothing wrong or nefarious about RSV or any other health topic will ever get through Google search or YouTube, but these practices may make it less pervasive. For instance, if you google RSV, the first items that appear on the screen come from sources like the CDC, the Mayo Clinic, the American Lung Association not from some self-appointed vaccine expert posting jeremiads about fictitious vaccine hazards from his basement.
What we did was give [Google] a rubric and a blueprint to help them justify elevating credible sources, said Antonia Villarruel, the dean of the University of Pennsylvania School of Nursing and a co-author of the credible sources report. You get fact-based information as the first component of a search.
Still, there are plenty of other online venues where misinformation metastasizes.
Once these beliefs have taken root, its harder to disabuse people of them, said Richard Baron, the president and CEO of the American Board of Internal Medicine, which has a foundation that has spent the last few years looking at misinformation and distrust in medicine. And citing the FDA and CDC doesnt work for people who believe the narrative that the FDA and the government thats supposed to protect us is either captured by industry or in on the game.
Its hard to combat falsehoods that play on fear and distrust and division. Researchers have found that fact-checking also known as debunking is helpful for reaching those people who are uncertain or worried, who need more information but arent adamantly opposed to vaccines. Many of the people who started out hesitant about the Covid vaccine did end up getting it, an outcome that reflected both mandates and growing confidence in the safety as more people took the shots.
But debunking doesnt work so well on people who are dug in. Plus, by the time something gets fact-checked or debunked, its already circulating and has taken hold among some parts of the population.
Thats given rise to an effort to prebunk, or try to get ahead of the misinformation. Sometimes efforts are broad and largely intended to educate people (sometimes through quick online games such as the Bad News game or Go Viral) so their emotions and fears arent so easily manipulated on social media. It turns out we are hard-wired in ways that make it easier to petrify than to reassure.
The second kind of prebunking aims at either anticipating misinformation or at least detecting it so quickly that the public health community can counter it before it explodes.
With vaccines, its possible to prebunk and blunt some of the predictable tropes since theres a well-known anti-vax playbook of falsehoods. The various fictions include: Vaccines havent been thoroughly tested or they cause autism or they change human DNA or the side effects are worse than the disease or the vaccine gives you the disease or natural products boost immunity better than vaccines or vaccines are just a way for Big Pharma to make more money or vaccines damage fertility. (That last one is a particularly pernicious message given that the RSV vaccine is given during pregnancy.)
Those messages persist and proliferate, despite years of accelerating efforts to swat them down. And not all negative messaging can be anticipated. Did anyone really foresee that meme about Bill Gates inserting microchips in us via Covid vaccines? How about that wild claim that Covid vaccines contain eggs that hatch synthetic parasites that thrive inside the human body?
In other words, prebunking may work up to a point against predictable messages, but public health and medicine need a way of monitoring social media to rapidly identify newly emerging misinformation. The right messages say from trusted public figures who talk about why they are getting a certain vaccine or are giving it to their child need to get out fast.
Then you begin to build the confidence so that when that one crazy story comes in, it doesnt have the same impact, said Jha.
Several efforts to develop that kind of agility are emerging.
Among the most comprehensive is the initiative from the Public Health Communications Collaborative, which partners with the Public Good Projects, a health care nonprofit that does broad, rapid monitoring of social media and works with both influencers and public health organizations.
The Public Good Projects shares with clinicians, public health officials and others a monthly survey of the health disinformation landscape. But monthly isnt good enough when lies zip around the world in seconds. So Public Good now does more real-time monitoring, and when something bubbles up, the Collaborative shares it with health departments and agencies across the country about 30,000 people as of late autumn, each of whom has their own networks. The Collaborative also sends out best practices for fighting high-risk misinformation, without inadvertently amplifying falsehoods.
If the Collaborative is working on the public health side, another new initiative called Coalition for Trust in Health and Science is bringing together a large and growing group of public, private and nonprofit health organizations medical, clinician, science and health care industry groups along with more traditional public health organizations.
Given the magnitude of the challenge of misinformation/disinformation and distrust we felt like this would be the moment where you had to bring together the entire health ecosystem, said one of the founders, Reed Tuckson a well-known health consultant and physician who is also a co-founder of Black Coalition Against Covid. The organization, though drawing in a broad membership, is still in the early stages.
Other advocates have developed more ad hoc approaches.
A group called ThisIsOurShot and its sister site VacunateYa, organized by young doctors and nurses during Covid, promoted the RSV vaccine on social media. Factchequeado, a Spanish language fact-checking initiative, has created a WhatsApp chatbot so people can discern health fact from fiction in their own messages.
And another group is taking a different starting point altogether: listening to local communities themselves. What are they hearing about public health, and what do they need to know? Its called iHeard.
Starting in St. Louis, in conjunction with the public health school at Washington University, iHeard distributes a weekly survey to about 200 people, which can be filled out in about three minutes. It asks about everything from vaccines to contaminated pouches of apple sauce popular with young children. iHeard is now spreading to several other cities across the country.
We put in place a system, a kind of proactive community listening, to try to get a handle on what people were hearing and when new misinformation might enter the community, said Washington University public health professor Matthew Kreuter. It began focused on Covid but has pivoted to health more broadly.
The survey information is posted on a public-facing dashboard, and its shared with partners in health, education, government and social services. The team also produces messaging that can be used on social media where people in the community are more likely to see it than on a university dashboard. The whole program has the advantage of involving community voices, which build trust.
The RSV vaccines dont generate quite as much fury as Covid, for several reasons, including the fact that there are no mandates for this shot, not at jobs, not at schools.
The audience is also narrower: Shots are recommended for people over age 60 and those who are between 32 and 36 weeks pregnant so they can pass on antibodies to the fetus. Infants not protected in utero, and other young children at high risk can get monoclonal antibodies, which isnt technically a vaccine although it is an injection. Those monoclonal antibodies were in short supply this season, as this was one place where manufacturers apparently underestimated the demand or overestimated the already considerable hesitancy.
In addition, the target population for RSV shots people over 60, people having babies are likely to be connected to the health care system; theyre already patients. That means they are more likely to have a doctor, a nurse or other provider that they know and trust. Thats not the case for some of the more militant anti-vaxxers, who are distrustful of the whole medical establishment. Yet vaccination rates were low.
Finally, public health experts noted, anti-vaccination sentiment is so high right now that the disinformation makers dont have to go after RSV specifically to instill fear and mistrust in a new shot. It just got wrapped into the whole deepening anti-vaccine gestalt. Routine childhood immunization rates are now down to 93 percent for kindergarteners, below the 95 percent threshold the CDC says is needed to thwart disease outbreaks.
Theres a level of exhaustion, right? said Katy Evans, senior program officer at de Beaumont Foundation, one of the groups forming the Public Health Communication Collaborative. You want me to get three in some cases, three vaccines this fall: a Covid booster, a flu shot and an RSV vaccine. And if I am someone who doesnt really understand why those things are valuable, that feels like a big ask.
The relatively disappointing uptake on RSV vaccination underscores just how big an ask it was.
Ultimately fighting disinformation comes down to trust. Trust is what a lot of the malevolent messengers are trying to destroy, and trust is what the public health, scientific and clinical worlds have to rebuild. Thats a resource even more valuable than the smarter, faster, better tools being developed to combat misinformation and disinformation.
It cant just be about getting ahead of a wacky narrative that resonates with people who no longer trust doctors or scientists, said ABIMs Baron. People are believing this stuff because it is consistent with a narrative they already believe. And we have to get better in constructing a different narrative.
In 2020, more than 495,000 adults around the world received a diagnosis of pancreatic cancer, making it the 12th most common cancer in the world.
In the United States, pancreatic cancer is the fourth leading cause of cancer deaths.
Pancreatic ductal adenocarcinoma is the most common type of pancreatic cancer accounting for about 90% of all cases with an average 5-year survival rate of less than 10%.
Previous research shows that traditional cancer treatments such as chemotherapy do not help increase the survival rate for this type of pancreatic cancer.
More than 90% of people with pancreatic cancer have mutations in their KRASgenes, which play an important role in normal cell growth and death.
Now researchers from The University of Texas MD Anderson Cancer Center have discovered that people with pancreatic cancer with certain types of KRAS mutations have a better survival rate than those with other mutation types.
The study, recently published in the journal NPJ Precision Oncology, adds to the ongoing research examining KRAS mutations as a potential target for a cancer vaccine for pancreatic and colorectal cancers.
Dr. Dan Zhao, researcher in the Department of Gastrointestinal Medical Oncology in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center and co-lead author of this study explained to Medical News Today:
Pancreatic ductal adenocarcinoma is projected to be the second leading cause of cancer death, but its treatment options remain limited. The 5-year overall survival rate for patients who have metastatic disease is less than 5%. The incidence of pancreatic cancer is rising. Effective treatment for pancreatic ductal adenocarcinoma is in urgent need.
The pancreas is situated behind the stomach in the upper left portion of the abdomen.
As part of the digestive system, the pancreas creates enzymes used to break down food and also makes insulin to help keep a persons blood sugar levels steady.
Pancreatic ductal adenocarcinoma forms in the cells that line the ducts of the pancreas.
Pancreatic cancer is one of the hardest to find in its early stages because most people will not have any symptoms and tumors are hard to detect because of where the pancreas is located.
Pancreatic cancer treatment depends on what stage the cancer is caught. If the cancer has not spread to other areas of the body, surgery may be possible.
In its later stages, past studies show traditional cancer treatments do not help with pancreatic ductal adenocarcinoma, resulting in the need for new therapies.
According to Dr. Zhao, the Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) gene was initially isolated from cancer cell lines more than 30 years ago.
In healthy environments, the KRAS gene plays an important role in cell growth and turnover. However, if the KRAS gene becomes mutated it may start causing cancer cells to grow and spread.
The protein it encoded is a GTPase, which has enzymatic activity to convert GTP to GDP and induce the downstream signaling transduction, she explained.
The KRAS gene is the most mutated oncogene in cancer causing activation of the signaling pathways to promote cancer cell growth and suppress cancer immunity, Dr. Zhao noted.
In addition to pancreatic cancer, previous studies have also found KRAS mutations in:
For this study, Dr. Zhao and her team analyzed data from 803 people with pancreatic ductal adenocarcinoma.
The researchers found that study participants with KRAS wildtype and KRAS G12R mutations had better survival than those with KRAS G12D or KRAS Q61 mutations.
Additionally, the scientists found that KRAS G12D mutations were correlated with metastatic disease and KRAS G12R mutations were common in well- to moderately-differentiated tumors.
The results are not surprising, Dr. Zhao said. They are consistent with the findings in other types of cancer and the biochemical features of different KRAS mutation subtypes.
KRAS G12R is most prevalent in pancreatic ductal adenocarcinoma (~15%) but rare in other cancers (~1%), she continued.
It is known that KRAS G12R mutation has difficulty growing cancer in conventional mouse models. It was reported that the KRAS G12R mutant has different downstream signaling pathways and the KRAS Q61 mutant was more oncogenic in laboratory research. This study is one of the first and largest studies in pancreatic cancer patients to elucidate the molecular and clinical features of KRAS-mutated pancreatic ductal adenocarcinoma.
Dr. Dan Zhao, co-lead study author
Dr. Zhao said that targeting KRAS has been challenging until the recent discovery of the KRAS G12C inhibitor.
Currently, two KRAS G12C inhibitors Sotorasib and Adagrasib have been approved by the U.S. FDA for lung cancer treatment, but not in pancreatic ductal adenocarcinoma yet, she added.
In addition to this study, Dr. Zhao is the principal investigator of a clinical trial that she said could provide more information on the safety and efficacy of Adagrasib monotherapy in pancreatic ductal adenocarcinoma.
I hope the results of this trial can help the development of KRAS-targeted therapy and guide future combination therapy strategies for targeting KRAS, she added.
The KRAS G12C inhibitor is currently driving research toward a potential cancer vaccine.
For example, earlier this year the phase 1 clinical trial results for ELI-002 a potential vaccine for colorectal and pancreatic cancers showed it could help prevent the reemergence of cancer in those who had already experienced cancer treatment.
The current data for pancreatic cancer vaccine in phase 1 clinical trials are exciting, Dr. Zhao said. I look forward to seeing the results in more patients in phase 2 trials, especially with randomized controlled trials soon.
MNT also spoke with Dr. Anton Bilchik, surgical oncologist, chief of medicine, and director of the Gastrointestinal and Hepatobiliary Program at Providence Saint Johns Cancer Institute in Santa Monica, CA, about this study.
Dr. Bilchik said this study is very important because pancreas cancer is a deadly disease, however, there has been very little progress over the last 20 years in prolonging survival.
KRAS is a really important target for a vaccine, he continued. I think one of the issues is we just dont know how long the benefit is because some have speculated that vaccine therapy may only have a very short-lived response. And also there are many different KRAS subtypes so were trying to learn which particular subtype may be the most important to target.
So theres still a lot of work that needs to be done, but definitely very exciting because no immunotherapy or vaccine therapies so far has been shown to be beneficial in pancreas cancer, Dr. Bilchik stated.
Exclusion Day rapidly approaching, Mult. Co. offering three more free clinics to residents
PORTLAND, Ore. (KATU)
We are looking ahead to Wednesday, February 21st, known as Exclusion Day in Oregon.
That's the day kids need to be up to date on their vaccines in order to stay in school or daycare.
If your child still needs a vaccine, Multnomah County is hosting three more vaccination clinics to help.
They will be held on February 14th, 17th, and 21st.
The countys immunization clinics are free and available to children from 5 to 19 years old. Details are available on the Multnomah County website.
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OPINION
Since the outbreaks were first identified in 2016, 37 states have publicly reported the following as of January 12, 2024:
Hardly a week goes by that there is not yet another announcement of a hepatitis A positive employee putting co-workers, customers and the restaurant brand at risk. There have been illnesses, deaths, thousands of customers have had to stand in long lines to get preventative vaccines, some restaurants have shuttered and there certainly have been lawsuits.
All preventable by a hepatitis A vaccination the only foodborne illness that is vaccine preventable.
It really is past time for public health to recommend the same. Here is what I have asked the CDC for:
ACIP Secretariat Advisory Committee on Immunization Practices 1600 Clifton Road, N.E., Mailstop H24-8 Atlanta, GA 30329-4027 acip@cdc.gov
Re: Letter to theCDCs Committee on Immunization Practices It is time to deal with Hepatitis A and Food Service Workers
Dear ACIP Secretariat:
TheAdvisory Committee on Immunization Practices (ACIP)provides advice and guidance to the Director of the CDC regarding use of vaccines and related agents for control of vaccine-preventable diseases in the civilian population of the United States. Recommendations made by the ACIP are reviewed by the CDC Director and, if adopted, are published as official CDC/HHS recommendations in the Morbidity and Mortality Weekly Report (MMWR).
Presently, approximately 5% of all hepatitis A outbreaks are linked to infected food-handlers.
Here is what the CDC continues to say about vaccinating food-handlers:
Why does CDC not recommend all food handlers be vaccinated if an infected food handler can spread disease during outbreaks?
CDC does not recommend vaccinating all food handlers because doing so would not prevent or stop the ongoing outbreaks primarily affecting individuals who report using or injecting drugs and people experiencing homelessness. Food handlers are not at increased risk for hepatitis A because of their occupation. During ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare becausestandard sanitation practices of food handlers help prevent the spread of the virus. Individuals who live in a household with an infected person or who participate in risk behaviors previously described are at greater risk for hepatitis A infection.
The CDC misses the point; granted, food service workers are not more atrisk of gettinghepatitis A because of their occupation, but they are arisk for spreadingit to customers. Food service positions are typically low paying, and certainly have the likelihood of being filled by people who are immigrants from countries where hepatitis A might be endemic or by people who have been recently experienced homelessness.
Over the past several years, there has been an ongoing outbreak of hepatitis A in the United States. As of February 2, 2023, there have been a total of 44,779 cases with a 61% hospitalization rate (approximately 27,342 hospitalizations). The death toll stands at 421. Since the outbreak started in 2016, 37 states have reported cases to the CDC.
The CDC recommends to the public that the best way to prevent hepatitis A is through vaccination, but the CDC has not explicitly stated that food service workers should be administered the vaccination. While food service workers are not traditionally designated as having an increased risk of hepatitis A transmission, they are not free from risk.
24% of hepatitis A cases are asymptomatic, which means a food-handler carrying the virus can unknowingly transmit the disease to consumers. Historically, when an outbreak occurs, local health departments start administering the vaccine for free or at a reduced cost. The funding from these vaccinations is through taxpayer dollars.
A mandatory vaccination policy for all food service workers was shown to be effective at reducing infections and economic burden in St. Louis County, Missouri.
From 1996 to 2003, Clark Country, Nevada had 1,523 confirmed cases of hepatitis A, which was higher than the national average. Due to these alarming rates, Clark County implemented a mandatory vaccination policy for food service workers. As a result, in 2000, the hepatitis A rates significantly dropped and reached historic lows in 2010. The county removed the mandatory vaccine rule in 2012 and are now part of the ongoing hepatitis A outbreak.
According to the CDC, the vaccinations cost anywhere from $30 to $120 to administer, compared to thousands of dollars in hospital bills, and offer a 95% efficacy rate after the first dose and a 99% efficacy after the second dose. Furthermore, the vaccine retains its efficacy for 15-20 years.
During an outbreak, if a food service worker is found to be hepatitis A positive, a local health department will initiate post-exposure treatment plans that must be administered within a two-week period to be effective. The economic burden also affects the health department in terms of personnel and other limited resources. Sometimes, the interventions implemented by the local health department may be ineffective.
Though there are many examples of point-source outbreaks of hepatitis A that have occurred within the past few years around the country, a particularly egregious outbreak occurred in the early fall of 2021 in Roanoke, Virginia. The health department was notified about the outbreak on September 21, 2021, after the first case was reported by a local hospital. The Roanoke Health Department, along with the Virginia Department of Health, investigated this outbreak.
Three different locations of a local restaurant, Famous Anthonys, were ultimately determined to be associated with this outbreak. The Virginia Department of Health published a community announcement on September 24, 2021, about the outbreak and the potential exposure risk.
For purposes of the investigation, a case was defined as a [p]erson with (a) discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels and (c) [who] tested positive for hepatitis A (IgM anti-HAV-positive), and frequented any of three Famous Anthonys locations, or was a close contact to the index case patient, during the dates of August 10 through August 27, 2021.
As of November 2021, a total of 49 primary cases (40 confirmed and 9 probable) were identified in this outbreak. Two secondary cases were also identified. Cases ranged from 30 to 82 years of age (median age of 63). In all, 57 percent of cases were male. Thirty-one cases included hospitalizations, and at least 4 case patients died. Illness onsets occurred between August 25 and October 15, 2021.
Ultimately, the outbreak investigation revealed that a cook, who also had risk factors associated with hepatitis A, had been infected with hepatitis A while working at multiple Famous Anthonys restaurant locations. This index cases mother and adult son also tested positive for hepatitis A. Following an inspection, the outbreak inspector noted, due to the etiology of hepatitis A transmission, it is assumed the infectious food handler did not perform proper hand washing or follow glove use policy. It was determined that person-to-person spread was the most likely mode of transmission in this outbreak. Environmental contamination was also considered a possible mode of transmission.
Overwhelmed by the number of victims who pursued legal action for their injuries, Famous Anthonys filed for bankruptcy and several of its locations have been closed.
The tragedy of this preventable hepatitis A outbreak cannot be overstated. Four people died. In one family, two of its members lost their lives. Most of the victims were hospitalized. Many risked acute liver failures. At least one person required both a liver and kidney transplants. Medical bills for the victims totaled over $6,000,000 in acute costs with millions of dollars in future expenses. And this all because one employee did not receive a $30-$120 hepatitis A vaccine.
Affordable prevention of future tragedies like the Famous Anthonys outbreak is possible and necessary. The time has come to at least recommend vaccinations to food service workers to reduce the spread of hepatitis A.
Sincerely, Bill Marler On behalf of 31 hepatitis Avictims and families
1Privately, via mail, I am providing medical summaries for 31 of the victims so there can be a clear assessment of the impacts of hepatitis A on consumers of food at the hands of one unvaccinated food service worker.
Michigan is on pace to have the lowest flu shot coverage of the last five years.
Through the end of January, the state health department was reporting about 2.75 million doses administered, more than 300,000 doses shy of the coverage at the same time last year. The states goal is 4 million people vaccinated.
Even factoring in reporting delays, the state appears headed for a third consecutive year of declining flu shot uptake, dating back to the 2020-21 flu season.
Thus far, Michigans flu season has been relatively mild.
Test positivity remains below 20% and the states level of influenza-like illness is moderate, according to the U.S. Centers for Disease Control and Prevention. Thats better than the 13 states, including neighboring Ohio, that currently have high level flu activity.
Flu activity in Michigan climbed to a high level briefly in late December, around the time residents were gathering for the holidays. It declined for a few weeks but has since started to rise again.
Dr. Lea Monday, an infectious disease physician for Detroit Medical Center, called it the bunny ear pattern. Most years there are two waves of flu activity with a break in the middle.
Its hard to tell if the second peak will be as big as the first or if itll just go back down but its not an unusual pattern, Monday said.
In 2022-23, flu cases jumped earlier than in recent years but had tailed off by February. Flu seasons in 2018 and 2019 had their peaks in March and April, so it is possible there could be a rise in cases in the coming months.
For the week ending Feb. 3, about 3.7% of Michigans outpatient hospital visits, based on data collected from a sampling of Michigan heath care providers, were for flu-like illness. That was up from 3.3% the week prior, but remained below the national average (4.4%).
Dr. Russ Lampen, medical director of infection prevention for Corewell Health in West Michigan, said its difficult to draw conclusions from one year to the next when looking at flu cases and vaccinations.
We can have a bad year even when vaccination rates are high due to a poor match of the virus to the vaccine, Lampen said. Conversely, we can have low admission rates when circulating strains and the vaccine match well. Our influenza season last year was pretty severe, but also occurred earlier than normal. Our current influenza season appears to be occurring later in the year, with cases still on the rise.
Across the state in Detroit, Monday said itll still be a few months before the medical community will know the efficacy of this years flu shot. However, evidence from the Southern Hemisphere, which undergoes its flu season first, suggests it has been effective at preventing serious illness.
The fact that (vaccination) rates are low and were not seeing worse numbers may be a reflection that people who have gotten the shot arent getting severely sick, Monday said. If youre not getting the shot, youre really throwing the dice.
Monday attributes the decline in flu shot uptake to two factors both related to the COVID-19 pandemic fatigue and the politicization of vaccines. Theres also the misconception that getting the flu means the vaccine didnt work.
We have to think of it like the CDCs wild to mild campaign, Monday said. Its not that you wont get it ... the idea is vaccination takes it from being catastrophic if youre unlucky, to a mild inconvenience.
To date, the CDC estimates there been at least 22 million flu cases, 250,000 hospitalizations and 15,000 deaths. There have been 74 pediatric deaths from the flu this season, none of which have been reported in Michigan.
Counties with the lowest flu shot coverage in the state, according to health department data, include:
If the city of Detroit was a county, it would have the second-lowest uptake at 12.6% vaccinated.
Meanwhile, counties with the highest flu shot coverage include:
To find a flu vaccine near you, contact your local health department or physicians office, or visit the online vaccine finder at vaccines.gov/find-vaccines.
MINNEAPOLIS The Minnesota Department of Health confirmed Monday that there is a case of measles in the Twin Cities metro area.
The department provided little information on the case, but said the risk to the public is "extremely low." MDH is investigating and will inform anyone who may have been exposed.
RELATED: Search tool: Look up kindergarten vaccination rates in Minnesota schools
Measles was officially declared eradicated in the United States more than 20 years ago, but declining vaccination rates are increasing the risk of the spread of the disease. Communities need high vaccination rates tomaintain herd immunity and prevent outbreaks, experts say.
According to the health department, in the 2023-24 school year, only 87.2% of kindergarten students were fully vaccinated with the measles, mumps and rubella (MMR) vaccine. Comparatively, in 2019, 92.6% of kindergarteners were fully vaccinated with MMR. Officials believe the decline is likely due to people not having routine well-child visits during the pandemic.
Parents and guardians can go onlineto find out how to access their children's immunization records and make sure they are up-to-date on all vaccinations.
Riley Fletcher Moser is a digital line producer at wcco.com. At WCCO, she often covers breaking news and feature stories. In 2022, Riley received an honorable mention in sports writing from the Iowa College Media Association.
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