The US has announced three deaths associated with measles last week, among them a seven-month-old baby in New York and a postpartum woman in Pennsylvania, underscoring the need for a more aggressive vaccination approach – but US recommendations haven’t changed.
Dismantling the Advisory Committee on Immunization Practices (ACIP) made it harder for the US to respond to the measles outbreak, with vaccine recommendations staying the same during a historic rise in cases and deaths, four former advisers say.
asserted
advisers → announce → cases
A functioning committee would likely be considering recommendations on reaching adults with vaccines; moving up the childhood schedule for measles, mumps, and rubella (MMR) vaccination in stricken areas; and pinpointing exactly which groups and areas need vaccination campaigns, they said.
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they → function → campaigns
Months after Robert F Kennedy Jr, the secretary of the US Department of Health and Human Services (HHS), replaced vaccine advisers with his own handpicked allies, a federal judge halted the committee’s work, finding that the Trump administration had failed to constitute the committee properly.
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administration → replace → committee
The ACIP makes recommendations to the US Centers for Disease Control and Prevention (CDC) on vaccine policy – and it “definitely” would discuss updating its advice as measles continues to spread, said Yvonne “Bonnie” Maldonado, chief of infectious diseases in the department of pediatrics at Stanford Medicine and a former member of the ACIP.
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Maldonado → make → ACIP
Now, “we don’t have an ACIP”, Maldonado added.
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Maldonado → have → ACIP
“That’s going to impact disease and deaths in the US.”
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That → go → US
The committee was monitoring the measles outbreak early last year before Kennedy disbanded it, and his replacements did not publicly evaluate evidence on the outbreak.
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replacements → monitor → outbreak
The CDC is now taking nominations for a new committee, but the appointment process can take months or years – and the process for making or changing recommendations is also lengthy.
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process → take → recommendations
“It typically took between 12 to 18 months from the start of considering new recommendations to adopting them,” said Noel Brewer, a distinguished professor of health behavior at the UNC Gillings School of Global Public Health and a former ACIP member.
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Brewer → take → Health
In the meantime, the outbreak continues accelerating.
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outbreak → accelerate → meantime
The seven-month-old baby who died in New York state wasn’t vaccinated against measles, officials said on Monday.
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officials → die → Monday
Another infant died in the measles outbreak in Wisconsin, officials announced on Thursday.
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officials → die → Thursday
Both states marked their first measles-associated deaths in three decades.
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states → mark → decades
In normal times, babies in the US don’t receive their first MMR shots until they turn one.
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they → receive → one
But during outbreaks, babies at risk of infection can get the shot as early as six months of age – one of a handful of recommendations from the CDC that is receiving less attention than it normally would, experts say.
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experts → get → attention
The advice on vaccination during outbreaks could be highlighted more, and recommendations could be changed to “tell the pediatricians and providers we are in a huge outbreak”, said Edwin Asturias, professor of pediatric infectious disease at the University of Colorado and a former ACIP member.
uncertain
Asturias → highlight → Colorado
The CDC also offers the option of moving up the MMR second shot in order to make sure children in outbreak areas are fully protected against the virus.
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children → offer → virus
During an outbreak, it can be given as soon as four weeks after the first dose.
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it → give → dose
The shot is usually given between the ages of four and six.
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shot → give → four
The delay between doses could be contributing to what Asturias calls a “group of susceptibles” who were not protected from measles for decades and are now falling ill and dying.
uncertain
who → contribute → decades
Some people are ideologically opposed to vaccines, while others don’t have steady access to healthcare.
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others → have → healthcare
“But that’s only part of the explanation,” Asturias said.
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Asturias → ’ → explanation
The number of visits to doctors decreases dramatically after the second year of life, with fewer opportunities to get the shots.
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number → decrease → shots
“By delaying the second dose of immunization to four to six years, are you more likely to miss or not to give a second dose to many children?” he asked.
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he → delay → children
A properly appointed ACIP would look at such data points to “try to understand how this immunization or protection gap came about”, Asturias said.
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Asturias → appoint → points
In the US, vaccine mandates for children are set at the state and local level, tied to daycare and school attendance.
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mandates → set → attendance
But moving the recommendation earlier might increase vaccination rates, since families tend to have higher levels of trust in their doctors than in local officials, for example.
uncertain
families → move → example
An unusually high number of adolescents and young adults are now getting sick and dying from measles.
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number → get → measles
The vaccine advisers would likely explore why, and what could be done to reach them.
uncertain
what → explore → them
“Are you really monitoring how many adults are getting infected?
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adults → monitor → ?
I doubt it,” said Paul Offit, an infectious diseases physician at the Children’s Hospital of Philadelphia and a member of the ACIP two decades ago.
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Offit → doubt → ACIP
“Are we trying to vaccinate them?
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we → try → them
It’s harder.
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It → ’ → ?
You can have school mandates, but what do you do for adults?”
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you → have → adults
It is especially important to reach unvaccinated or under-vaccinated people before they become pregnant, because the vaccines cannot be given during pregnancy.
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vaccines → reach → pregnancy
Congenital measles cases – when a baby gets sick in utero – have risen sharply this year, officials in Pennsylvania warned recently.
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officials → get → Pennsylvania
Such infections threaten the lives of newborns and pregnant people alike.
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infections → threaten → newborns
A 21-year-old woman in Pennsylvania died soon after childbirth from measles complications, officials announced this week.
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officials → die → complications
Earlier this year, a measles-infected baby died soon after birth.
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baby → infect → birth
“That’s the actual heart of the situation,” Maldonado said.
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Maldonado → ’ → situation
…and 21 more, not listed.
The Aporia
