YCLOAK

An ongoing measles outbreak in Minnesota has shined a light on the fact that many Somali immigrants choose not to vaccinate their children.   

According to the Minnesota Department of Health, 63 measles cases have been reported statewide as of May 16, and 53 of those cases were Minnesotans of Somali origin. Sixty of the reported cases involve individuals confirmed to not be vaccinated.

Public health officials blame false rumors that vaccines are linked to autism and other health problems for the high rate of unvaccinated children in Minnesota’s Somali-American community.  

The department’s disease director, Kris Ehresmann, said anti-vaccination groups have targeted the community with events and have even translated the anti-vaccine documentary “Vaxxed: From Cover-Up to Catastrophe” into Somali.

“They have been very aggressive and are continuing in their efforts to reach out to the community with misinformation throughout the duration of this outbreak,” Ehresmann said.

Anti-vaccine views

In interviews with Somali mothers, VOA’s Somali Service found that anti-vaccine views are widespread.

“I have a baby boy who was well before the vaccine, but eventually he became autistic because of the vaccine. After him, I have never vaccinated my children,” said Safia Sheikh Mohamed, a mother of four children.

Mohamed listed a number of problems she believes are associated with vaccines, including food allergies, ear infections and eczema, a treatable condition in which the skin becomes inflamed or irritated.

Another mother said she vaccinated her child, but did so later in life. “I never gave vaccines to my last born child before he turned 6, during his first year of school.”  

Community leaders reach out

Multiple large-scale studies have found there is no connection between autism and the measles, mumps and rubella (MMR) vaccine, despite rumors to the contrary.

The Minnesota Department of Health is working hard to dispel such beliefs through outreach campaigns.  The department has a Somali staff member and a group of Somali health advisers who meet one-on-one with people and attend various community meetings.

“Our challenge at this point is really scalability,” Ehresmann said. “If we could multiply our efforts by 10-fold or more, that would be great, but obviously there are resource challenges.”

Ahmed Roble, a Somali-American physician who owns a clinic in Minnesota, said he and his colleagues try to dispel misinformation.

“As health professionals, our aim is not only to cure the patient but also to give them counseling,” he said. “That is what we do for the worrying mothers and fathers who are skeptical about MMR vaccination.”

Perhaps the best argument for vaccinating children is the current outbreak, which may be frightening parents into action. Prior to the outbreak, about 30 Somali children per week received the MMR vaccine in Minnesota, but, since the outbreak, that number has grown to 500 children per week.

“We know that as a result of the outbreak and perhaps as a result of seeing measles in real life there, that combined with other messaging has made an impact on a number of the parents,” Ehresmann said.

Additionally, parents are beginning to see the consequences of not vaccinating children. Children who are not vaccinated are forced to stay out of daycare for 21 days if a measles case is reported and could be forced to stay out indefinitely if multiple cases occur.

State Rep. Ilhan Omar, the first Somali-American elected to serve in a state legislature, invited parents, doctors, owners of clinics and community leaders to share their thoughts at a meeting on Wednesday. She called for parents who do not vaccinate their children to take responsibility.

“It will be the parents’ responsibility if they don’t want to vaccinate. They should go and discuss with doctors, and then, if they insist, it’s their responsibility.  It will be documented,” she said.

The state is bracing for an uptick in cases as the month of Ramadan approaches in late May and June and families gather for the celebration. The final celebration of Eid al-Fitr has the greatest potential for spreading the disease.

“It would represent the biggest risk for potential transmission,” said Ehresmann, because “it’s bringing together kids and adults and everybody, and it’s not just the population of a single mosque, it’s multiple mosques coming together.  That factor means that could have the potential for transmission.”

Reporter Steve Baragona contributed to this report.
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Cuba said on Thursday 1,847 residents had so far contracted the mosquito-borne Zika virus, warning that certain provinces on the Caribbean island still had high rates of infestation despite a series of measures to stave off the epidemic.

At the start of the global Zika outbreak, Cuba managed for months to fend off the virus that can cause microcephaly in babies as well as Guillain-Barre syndrome, even as neighboring territories like Puerto Rico were hard hit.

The Communist-run country called out the military to help fumigate, activated neighborhood watch groups to check for places with standing water where mosquitoes breed, and instituted health checks at airports and other entry points to the island.

“Even though we have managed to reduce the cases of infestation … there are still provinces like Havana, Guantanamo, Cienfuegos and Camaguey, with big risks and rates of infestation,” the head of the Civil Defense’s Department of Disaster Reduction, Gloria Gely, was quoted as saying by state-run media.

Although generally a mild disease, the virus is a particular risk to pregnant women as it can cause microcephaly – a severe birth defect in which babies are born with abnormally small heads and underdeveloped brains.

Gely did not detail how many of the cases were contracted locally nor whether there had been any instances of babies born with microcephaly on the island of 11.2 million inhabitants.

There is no preventive treatment against Zika, but drug companies are rushing to develop a vaccine. The virus has spread to more than 60 countries and territories since the current outbreak was identified in Brazil during 2015.
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We producing nearly 300 million tons of plastic every year, half of which is used once, then thrown away. In the United States, we discard more than 33 million tons of plastics, and only a little more than 14 percent is recycled or used as fuel. The rest ends up in landfills or strewn along roadways or washed into the ocean. Getting rid of it will be an enduring challenge, but one man has a plan to start cleaning up our mess. VOA’s Faith Lapidus reports.
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Despite the health warnings, smoking in many places is still the “thing to do.” For those who have quit but still want to hang out with their smoking friends, a French design group has the Sifflu. It lets people act like they are smoking while teaching them how to breathe, but without the worry of cancer and a shortened life span. VOA’s Kevin Enochs reports.
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Most doctors did not discuss the cost of cancer treatment with patients, spent less than two minutes on it when they did, and usually did so only after patients brought it up, a study that taped hundreds of visits at several large hospitals finds.

Cancer patients are three times more likely to declare bankruptcy than people without cancer are, but many doctors are not having the conversations that might help prevent this and sometimes don’t know the cost themselves, the results suggest.     

“That would not occur in any other industry I can think of” where a service or product is sold, said the study leader, Dr. Rahma Warsame of the Mayo Clinic.

Results were released Wednesday by the American Society of Clinical Oncology and will be discussed next month at its annual meeting in Chicago.

The study has some limitations – it’s not nationwide, and it includes newly diagnosed patients, where cost is most likely to come up, as well as others further along in treatment who may have discussed this earlier.

But the larger point is clear, Warsame said: The “financial toxicity” of treatments that can cost more than $100,000 a year is growing, and talks about that aren’t happening enough.

“I’ve had people say ‘no’ to really life-extending therapies” because of worries about bankrupting their family, she said.

For the study, researchers taped 529 conversations between doctors and patients with various types of cancer at three outpatient clinics – the kind of places chemo often is given – at Mayo, Los Angeles County Hospital and the University of Southern California’s Norris campus in Los Angeles.

Patients and doctors knew they were being taped but didn’t know why. Cost came up in 151 of the visits. Patients brought it up in 106 cases and doctors did in 45.

Appointments lasted about 15 minutes on average at the two California hospitals and half an hour at Mayo, but cost discussions ran only one to two minutes when they occurred at all.

Even when doctors acknowledged a cost concern, they rarely acted on it. Only six patients were referred to social services to seek help with affording care.

“Maybe a lot of patients don’t know to ask questions” about cost, said Karla Mees, 63, a nursing instructor from Rochester, Minnesota, who was treated for breast cancer at Mayo Clinic.

Doctors warned her in advance that she might have to pay $4,500 for gene tests on her tumor to help determine care, but she never knew how much chemo and radiation would cost until the bills came.  

“I just remember thinking, ‘I need the stuff, I’ll worry about payment later,’” she said, thankful that her insurance capped her annual out-of-pocket costs at $2,500.

Doctors also may be reluctant to talk money and have to give medical issues top priority in the short time they have during patient visits, said Dr. Lowell Schnipper, a cancer expert at Boston’s Beth Israel Deaconess Medical Center and head of the cancer group’s panel on value in cancer care.

“Most of us are not very well skilled in bringing it up,” he said. “In school you’re trained to simply take the best care you can of your patient and not worry about anything other than doing exactly that.”

In 2015, the cancer society launched a tool to help doctors and patients decide whether a cancer drug is worth it – the amount of benefit it gives versus its cost. It’s a good starting point for money talks, he said.
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Scientists say they have identified the “sea monster” that washed ashore on an Indonesian beach.

The badly decomposing carcass measures over 15 meters long and baffled scientists since it washed up on Seram Island last week.

Marine biologists now believe the carcass is a dead baleen whale, largely because of a visible skeleton, which would rule out speculation that the creature was a giant squid.

“Giant squid are invertebrates and there are clearly bones visible, so I am very comfortable saying it’s some type of rorqual whale,” said Regina Asmutis-Silvia, executive director of Whale and Dolphin Conservation in an interview with the Huffington Post. “Certain species of baleen whales (rorquals) have ‘ventral grooves’ which run from their chin to their belly button. It is stretchy tissue that expands when they feed.”

Alexander Werth, a whale biologist at Hampden-Sydney College in Virginia agrees with the assessment after seeing photos of the carcass on social media that showed the nearly amorphous carcass surrounded by blood in the water. He added that the carcass probably stinks “to high heaven.”

“That’s yet another reason you don’t want to be close to these things, not because it’s a scary, spooky creature, but [because] it would just be releasing some pretty foul, noxious gases,” Werth told Live Science.

Locals have asked the government for help in removing the whale.
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Pregnant women who come down with the flu are at greater risk of illness requiring hospitalization. A new study found that in resource-poor countries, flu vaccination reduced the risk of illness to mother and baby.  

An estimated 40 percent of the world’s population lives in subtropical and tropical zones, where influenza sometimes circulates year-round. Yet influenza vaccine is rarely used.

Mark Steinhoff is director of the Global Health Center at Cincinnati Children’s Hospital in Ohio. He said the influenza virus, which is often mild in healthy people, can result in hospitalization of pregnant women.  

With a growing fetus pressed up against their lungs, Steinhoff says, women with the flu can have trouble breathing.  He also said a pregnant woman is  more susceptible to illness as the growing baby siphons off her natural defenses.

But in a first-of-its-kind study, Steinhoff and colleagues found vaccinating women year-round in a developing country, Nepal near the Indian border, dramatically reduced the incidence of influenza in mothers and benefited their babies.

The study was published in the journal Lancet Infectious Diseases.

“It reduced disease in the mothers and in the infants by about 60 percent reduction in the second year. It’s really quite remarkable. But it also reduced the rate of low birth weight — that is, kids born less than 2.5 kilos. It reduced that by 16 percent,” said Steinhoff.

Babies benefited from the shots because they received antibodies against the illness from their mothers while in the womb.

The study

The study ran between April 2011 and September 2013 and involved a total of 3,693 mothers between the ages of 15 and 40.   

There were two phases of the trial, with one group of women being vaccinated in the first year and a different group of pregnant women the following year.  Half of the women received a placebo.

Because influenza in some countries can circulate year-round, there’s no particular flu season as in more temperate climates. The women were therefore vaccinated at various times with a shot that contained three inactivated flu strains. Each group was followed for up to 180 days to see whether they developed fevers and body aches.

Steinhoff said the benefits of influenza vaccination have long been known in the United States and other Western countries.

“The vaccine you know was developed many years ago. It was known to be safe. There were no bad reactions to it,” Steinhoff said.

He said it’s up to individual countries to decide whether they want to launch influenza vaccination campaigns for pregnant women. In the meantime, he said, researchers will be obtaining additional data on year-round immunization programs in developing countries.
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A regional drought has displaced more than half a million people in Somalia and left the country at risk of famine. A cholera outbreak is further complicating relief efforts, in particular in the southern part of the country where some villages remain under al-Shabab control.

Bay Regional Hospital, the biggest in the southwest federal state, is filled with patients suffering from stomach pain, vomiting, and diarrhea.

Cholera has sickened more than 40,000 people in Somalia since December. More than half of the cases have been in this state. Most of the victims have been malnourished children.

Five-year-old Fatuma was admitted to the cholera treatment ward last night. Her mother Bisharo Mohammed says she can not lose another child.

She says her eldest daughter was suffering from diarrhea, and she died two months ago in Busley village on the outskirts of Baidoa. She says the girl was seven years old.

Cholera treatment

Cholera is treatable. The World Health Organization recommends “prompt administration of oral rehydration salts.” Mohamed says Fatuma is already feeling better with treatment. They hope to be released soon.

But they will not be going home.

Aid agencies say the areas worst hit by cholera and hunger are villages like Busley which are under al-Shabab control. Accessing them is a challenge. Fatuma and her family are among the tens of thousands of people who have walked to government-controlled areas like Baidoa to seek help and are now living in makeshift camps.

World Health Organization cholera expert Dr. Abdinasir Abubakar says the outbreak is getting worse due to security challenges.

“If you look at Bay, Bakool, Middle Juba, Gedo some of those areas where none of us is able to access, the deaths and cases due to cholera is very high, and we expect the situation will get worse,” says Abubakar.

Rains this month in southern and central Somalia have contributed to a surge in cholera cases, according to Bay Regional Hospital cholera treatment ward deputy supervisor Salima Sheikh Shuaib.

She says “the cholera cases were going down, but the past three days we have seen an increase in cholera cases. This morning, we have received 16 cases and most of them are children under the age of five.”

Life in camps

More than 150,000 displaced people are living in the makeshift camps around Baidoa and more continue to arrive.

At the camps, many families do not have plastic tarps or covered places to sleep. Stagnant puddles and mud dot the walkways. There is no regular food provided. Clean water is available, but it is not enough.

Medics supported by UNICEF and the WHO are going to IDP camps around Baidoa to provide oral cholera vaccination to children.

But Abubakar of the WHO says it is hard to contain the spread of cholera so long as the general humanitarian situation is not improving.

“We cannot only solve cholera. We cannot only deal with cholera unless we deal with food insecurity, unless we deal with water issues, malnutrition and I think collectedly both the wash, the health, the nutrition, and the food security partners we are working closely and we are coordinating but again in Somalia one of the challenges. We are facing a shortage of resources to support all these interventions,” says Abubakar.

Somalia continues to report between 200 and 300 cases of cholera nationwide each day.
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The beaches on a remote, uninhabited island in the middle of the Pacific Ocean have the highest amount of plastic debris in the world.

Researchers from the University of Tasmania say Henderson Island, which is more than 5,000 kilometer from any major population center, is strewn with roughly 37.7 million pieces of plastic waste.

Put another way, the beaches on Henderson Island are covered with about 671 pieces of plastic litter per square meter, which researchers say is the highest density ever recorded.

“What’s happened on Henderson Island shows there’s no escaping plastic pollution even in the most distant parts of our oceans,” said Jennifer Lavers of the Institute for Marine and Antarctic Studies and lead author of a paper about the pollution in the journal Proceedings of the National Academy of Sciences.

Henderson Island, which is part of the UK’s Pitcairn Islands territory, sits right in the middle of the Pacific Gyre current, which makes it a “focal point” for garbage from South America as well as from fishing boats.

Researchers say their sampling of the debris at five sites on the island leads them to believe there is more than 17 tons of plastic on the island and around 3,570 new pieces of litter being deposited every day.

Lavers noted, “It’s likely that our data actually underestimates the true amount of debris on Henderson Island as we were only able to sample pieces bigger than two millimeters down to a depth of 10 centimeters, and we were unable to sample along cliffs and rocky coastline.”

Every year, the world produces some 300 million tons of plastic, much of which is not recycled. Plastic disintegrates very slowly, and when it ends up floating in the ocean, it can lead to “entanglement and ingestion” by animals, birds and fish.

“Research has shown that more than 200 species are known to be at risk from eating plastic, and 55 percent of the world’s seabirds, including two species found on Henderson Island, are at risk from marine debris,” Lavers said.
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