Measles Outbreak in Ohio

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

Lena Sun at WP:

A rapidly growing measles outbreak in Columbus, Ohio — largely involving unvaccinated children — is fueling concerns among health officials that more parent resistance to routine childhood immunizations will intensify a resurgence of vaccine-preventable diseases.

Most of the 81 children infected so far are old enough to get the shots, but their parents chose not to do so, officials said, resulting in the country’s largest outbreak of the highly infectious pathogen this year.

“That is what is causing this outbreak to spread like wildfire,” said Mysheika Roberts, director of the Columbus health department.

The Ohio outbreak, which began in November, comes at a time of heightened worry about the public health consequences of anti-vaccine sentiment, a long-standing problem that has led to drops in child immunization rates in pockets across the United States. The pandemic has magnified those concerns because of controversies and politicization around coronavirus vaccines and school vaccine mandates.
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Some of the cases occurred in Columbus’s large Somali community, the second-largest Somali population in the United States after the Minneapolis area, Roberts said. Parents have said they “intentionally delayed” giving their children the measles vaccine because of their fear of autism, she said, despite considerable research disproving any relationship between vaccines and autism. Those fears echoed similar concerns of parents in Minnesota’s Somali community during a 2017 measles outbreak that infected 75 children, mostly unvaccinated preschool kids.

Studying Prevalence in Minnesota

The Politics of Autism discusses legislation before Congress.

On Tuesday, the House Energy and Commerce Committee held a hearing on several bills including the reauthorization of the Autism CARES Act.  The testimony of Amy Hewitt, Ph.D. the Director of the Institute on Community Integration, University of Minnesota

The Autism CARES Act has helped to build a critical infrastructure to further advance our understanding of autism. The Autism CARES Act supports several important programs. It supports the Autism and Developmental Disabilities Monitoring (ADDM) Network, a group of programs funded by the CDC to estimate the number of children with ASD and other developmental disabilities living in different areas of the United States. The CDC also established regional centers of excellence for ASD and other
developmental disabilities. They make up the Centers for Autism and Developmental
Disabilities Research and Epidemiology Network (CADDRE) that are working in part to
help identify factors that may put children at risk for ASD and other developmental
disabilities.

Findings from the Minnesota-Autism and Developmental Disabilities Monitoring  etwork (MN-ADDM) helps us to understand more about the number of children with  Autism Spectrum Disorder (ASD), the characteristics of these children, and the age at which they are first evaluated and diagnosed.

This is the first time Minnesota has been a part of the ADDM network, and we are building our geographic area. Through this work, we know that 1 in 42 8-year-old children were identified with ASD in 2014. We now know that boys were 4.6 times more likely to be identified than girls and that there were no significant differences found in the percentage of white, black, and Hispanic children identified with ASD.

The findings in our report reflect a limited number of children concentrated in a large metropolitan area. Through the reauthorization of the Autism CARES Act, we are hopeful that we will be able to increase our scope geographically and include the lifespan of individuals with autism. This is particularly important because in addition to the  race/ethnicity categories routinely studied by CDC, in Minnesota we were interested in understanding prevalence for our local Hmong, Somali and other immigrant populations. Expansion of the geographic area in which we gather data is the only way we will be able to know with certainty if differences exist among these groups in Minnesota.

Tight-Knit Communities and Vaccine Hesitancy

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism.   This bogus idea can hurt people by allowing disease to spread.

Sumathi Reddy at WSJ:

In 2017 it was a Somali community in Minnesota. In 2014 it was the Amish in Ohio. This year, it is Orthodox Jewish communities in New York and Eastern Europeans in Washington state.

Insular and close-knit religious or cultural groups have seen some of the worst measles outbreaks in the U.S. in recent years.

About 75% of measles outbreaks over the past five years—defined as three or more linked cases—took place in such tightknit communities, says Nancy Messonnier, acting director of the CDC’s Center for Preparedness and Response, and an expert on immunization and respiratory diseases. Such groups share the same culture and are often somewhat isolated from the larger community.

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In Ohio, when a measles outbreak hit an Amish community in 2014, they were willing to get the MMR vaccine when they saw the effect the disease was having, says Michael Brady, associate medical director at Nationwide Children’s Hospital in Columbus. The issue wasn’t the vaccine, he says, but their philosophy of not accepting anything from the government.

In Washington state where a measles outbreak has been contained, advocates and health experts say there is documented vaccine hesitancy in the Ukrainian and Russian-speaking populations.

Tetyana Odarich, a family medicine physician in Portland, Ore., sees many patients from the Ukrainian and Russian community in the area and says roughly half don’t want to get their children vaccinated.

Enlisting Muslim Help to Fight the Vaccine Myth

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

At The Independent, Andrew Buncombe reports on Minnesota's efforts to improve vaccination rates among the state's Somali population. Measles had erupted after Wakefield convinced Somalis that vaccines cause autism.

“The biggest impact is connecting a condition that is one that challenges any parent who has a child with autism, and connecting that to immunisations, and specifically MMR,” Lynn Bahta, the immunisation clinical consultant with the Minnesota Department of Health (MDOH), told The Independent last summer as it fought to tackle the outbreak.

“Among our Somali American community we have their rates go from 92 per cent, which was higher than non-Somali rates, down to 42 per cent. And that puts them in a very, very vulnerable position.”

To help the state get its message delivered most effectively, officials asked for help from community leaders, in particular imams, who lead prayers at neighbourhood mosques.

Bahta said they told them that the MDOH does not believe that the information being given to them by Wakefield and others was true. She said the community was particularly vulnerable as it already believed there was a higher rate of autism among Somali American boys, something officials in the state say is not supported by data. In the end, more than 30 agreed to help.

“The imams are very concerned about their community and they are very willing to work with us in whatever way they can. They have appreciated the information that we have been able to give them about the outbreak and what they can do as spiritual leaders of the community,” Bahta said.

She said the imams provided officials with direct access to the community. In addition, she said the imams could “bring disease and prevention of disease within the context of their faith. That is something that we don’t have the words for, but they do”.

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One of the imams who was central to the state’s response to the outbreak was Sharif Abdirahman, the Muslim leader at the Dar al Hijrah mosque in the Cedar-Riverside neighbourhood of Minneapolis. He said he was able to appeal to people using both religion and science. He could also appeal as a parent.

“Islam is a religion of expertise,” he said, sat in the second-floor office of the community centre that also contains a mosque.

“Verses in the Quran say ... if you don’t a know subject ask the advice of people who know the subject very well.”

Measles, Minnesota, and Texas

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Dr. Lindy McGee, chair of the advocacy committee for the Immunization Partnership, writes at The San Antonio Express-News:

About six years ago, a Texas resident visited Minnesota three times to talk with its Somali community. Not just any Texas resident: This was Andrew Wakefield, the doctor disgraced for his fraudulent 1998 study claiming a connection between autism and the measles vaccine.

Dozens of studies have since proven Wakefield wrong, but scientific fact hasn’t stopped him from continuing to spread harm.

That harm is very real and obvious today. Continued targeting of Minnesota’s Somali community led the vaccination rate to plummet by more than half, to 42 percent, in 2014. And recently, 69 Minnesotans, most of them young children, most of them Somali, almost all of them unvaccinated, fell sick with measles.

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Texas is, unfortunately, one of the strongholds of anti-vaccine sentiment, perhaps not surprising considering Wakefield lives in our midst. State lawmakers have refused to take even the most basic steps to fend off a Minnesota-like scenario. Bills died this legislative session that would have allowed parents to view the vaccination rates at individual public schools — would you want your child attending a school with a 42 percent immunization rate? — and that would have had parents take a simple online course to educate them about immunization before they could send their children to school unvaccinated.

Measles, Antivax, and Prejudice

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.  One consequence has been a measles outbreak within Minnesota's Somali community.

Saad Omer writes at STAT:

My colleagues and I assessed the risk of large measles outbreaks in the US. In a paper published in the American Journal of Epidemiology, we reported that approximately 12.5 percent of US children and adolescents are susceptible to measles. Moreover, we found that even a modest drop in the vaccination rate could result in the breach of the “herd immunity threshold” — that could result in breakdown of community level protection against measles.

When such outbreaks happen, it is often minority groups that get blamed for bringing disease into the country. For example during the so-called Disneyland outbreak of 2014-2015, multiple politicians expressed unfounded concerns about illegal immigrants bringing measles into the US. Then there is the not so proud history of blaming infectious disease importation and spread on ethnic and sexual minorities.

It is in this context that many of us in public health, who also believe in civil and human rights, worry about the Minnesota Somali-American community being blamed for something bigger than the current outbreak — even though the community itself has been a victim of an onslaught of propaganda and misinformation disguised as empathy.

Antivax Activists, Somali Minnesotans and Measles

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Helen Branswell reports at STAT:

As of Monday, there were 48 confirmed cases of the highly contagious — and potentially deadly — infection, all but two in children under the age of 10. Of the sick, 45 had not been vaccinated against measles. And 41 of the patients are Somali Minnesotans.

[Fatuma] Ishtar, a community outreach worker in Minneapolis, blames the anti-vaccination lobby. “They are everywhere. Like, every event, every forum,” she said. “They continue to push the community. I feel offended by this group.”

Michael Osterholm, former state epidemiologist, goes further. Actually, he uses the verb “exploit.”

“What they say is, ‘Remember, measles is just a five-to-seven-day disease. Autism is forever,'” he said. Osterholm, however, knows the dangers of measles. He was the state epidemiologist in 1990, when Minnesota had a large measles outbreak — 460 cases in Minneapolis and St. Paul.

Three children died.

Christopher Mele reports at The New York Times:

Mohamud Noor, executive director of the Confederation of Somali Community in Minnesota, said anti-vaccine activists had met one-on-one with families and had been more aggressive than public health educators in getting their message out.

Though the medical research has debunked the connection of vaccines to autism, the notion is deeply rooted in the community, Mr. Noor said on Friday, adding that the “main fight” was combating that perception.

The Washington Post reported Friday that the fear was so entrenched that parents in the community believe the risk of measles is preferable. The Post reported that one of the anti-vaccine movement’s founders, Andrew Wakefield, was among those who had met with the parents. Asked if he felt at fault for the outbreak, he replied: “I don’t feel responsible at all,” according to The Post.

In 2014, the United States had a record number of measles cases — 667 — since the disease was thought to have been eliminated in 2000. Nearly 400 of them occurred in unvaccinated Amish communities in Ohio.

Measles and Somalis

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Lena Sun reports at The Washington Post:

Salah [Suaado, Somali immigrant mother of children with measles] no longer believes that the MMR vaccine triggers autism, a discredited theory that spread rapidly through the local Somali community, fanned by meetings organized by anti-vaccine groups. The activists repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents.

 Immunization rates plummeted, and last month the first cases of measles appeared. Soon there was a full-blown outbreak, one of the starkest consequences of an intensifying anti-vaccine movement in the United States and around the world that has gained traction in part by targeting specific communities.

Uncertainty is a major theme of my book.  Although we know that vaccines do not cause autism, we are not yet certain about what does cause it.  And this uncertainty, in turn, gives rise to myths, misinformation, and conspiracy theory.  Sun writes in the same vein

While scores of studies from around the world have shown conclusively that vaccines do not cause autism, that is often not a satisfactory answer for Somali American parents. They say that if science can explain that vaccines do not cause autism, science should be able to say what does.

Housing in Minnesota

Abby Simons reports at the Minneapolis Star-Tribune:

Across Minnesota, families with children who have autism or other disabilities struggle to stay in rental homes in the face of disruptions or damage caused by the kids. The situation is particularly acute in the Somali community, where one in 32 children between ages 7 and 9 is on the autism spectrum, according to a University of Minnesota study. That compares to 1 in 48 for children of that age in the overall population.

The Minnesota Legislature tried in 2013 to help alleviate the problem by creating a $500,000 fund aimed at providing housing for families like Ahmed’s. But bureaucratic glitches have kept the money in limbo, with the families unable to access it.

The money initially was allocated to the Minnesota Housing Finance Agency, which finances housing for low- and middle-income families. MHFA then advertised for community-based organizations to apply for the money so it could be distributed to needy families. Although they initially showed interest, Habitat for Humanity and City of Lakes Community Land Trust never applied.

Twin Cities Habitat for Humanity spokesman Matt Haugen said that because the organization works both as a builder and a lender, it would risk violating fair lending laws if it took money tied to a specific goal, like housing for families of autistic children facing eviction. “It’s certainly not a matter of what we want to do; it’s a matter of how we do it,” Haugen said. City of Lakes did not respond to requests for an interview.

Minnesota, Somalis, Vaccines, and Dysfunction

At The Minneapolis Star-Tribune, Dan Browning writes about dysfunction on Minnesota's Autism Spectrum Disorder Task Force:

Brad Trahan, a parent from Rochester, chaired the group until he resigned in June 2013, writing to House Speaker Paul Thissen that he could no longer tolerate what he called false allegations and complaints filed against him by Idil Abdull — the task force member who nominated him for the job.

Abdull, of Burnsville, founded the Somali American Autism Foundation. Both she and Trahan have children diagnosed with autism, and both have become tireless advocates for families affected by the disorder.

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In an interview, Abdull said she opposed the [insurance mandate] bill because it did nothing for poor children, many of whom are on Medicaid, and did not apply to self-insured health plans run by many large employers. “Every child should be on the same bus at the same time for the same thing — otherwise, we don’t approve it,” Abdull said.

Abdull also parted ways with her colleagues over a $300,000, grant application by the state Health Department to help pay for autism services. The task force voted to endorse the grant, and Trahan wrote a letter of support stipulating that the money should be distributed in a way that reaches “the underserved communities with the most disparities (Native American, Somali, Hmong, African-American, Rural, Hispanic).”

That failed to satisfy Abdull. “Unless you put a specific dollar sign, support could be $2,” she said. “I wanted specific dollars … going into minority-based organizations. They’re going to do the legwork of going into communities of color.”\

The rancor has stung several other task force members, including Barb Dalbec, who manages the Health Department’s section for children with special needs. Abdull called her a “village idiot,” and has demanded that she be fired. Dalbec declined to comment, and a department spokesman said a complaint filed against Dalbec was closed without any disciplinary actions; records also show that Dalbec received a state award for leadership this year.

Matt Carey writes at Left Brain/Right Brain:

Autism in the U.S. Somali Community has gathered significant attention in recent years (as has autism in other Somali communities outside of Somalia, for example in Sweden). Most of the attention in the U.S. can be traced back to vigorous advocacy by people like my fellow IACC public member Idil Abdul. Not all attention is good. For example, Minnesota Somali parents received a lot of attention from groups promoting the failed vaccine/autism link. When news of the possibly high prevalence in the Minnesota Somali community arose, David Kirby used the story to promote the idea of vaccines causing autism.Generation Rescue brought in Andrew Wakefield to talk to Somali parents in closed door meetings.

With the discussion of vaccines and autism comes fear and with fear of vaccines comes a reduced uptake. One recent story reports that the MMR uptake in the Minnesota Somali community dropped from 90% to 54% in the past 10 years. Sadly, that same story discusses how the Minnesota Somali community is presently involved in one of the largest measles outbreaks in recent history.

The question is, what are the views of the Somali community on vaccines and autism? To answer that, a new study has just been released: Childhood vaccine beliefs reported by somali and non-somali parents. (note the lack of capitalization of Somali is in the original). The full paper is available online ... To answer the question–yes, Somalis in Minnesota do think that the MMR causes autism more than their non-Somali counterparts. Nearly 5 times more likely. But, the majority do not believe–about 35% of Somali parents and 8% of non-Somali parents believe that autism is caused by vaccines

Study of Autism and Somali Children

Previous posts have discussed autism among Somali immigrants.  The New York Times reports:

A long-awaited study has confirmed the fears of Somali residents in Minneapolis that their children suffer from higher rates of a disabling form of autism compared with other children there.

The study — by the University of Minnesota, the Centers for Disease Control and Prevention, and the research and advocacy group Autism Speaks — found high rates of autism in two populations: About one Somali child in 32 and one white child in 36 in Minneapolis were on the autism spectrum.

The national average is one child in 88, according to Coleen A. Boyle, who directs the C.D.C.’s Center on Birth Defects and Developmental Disabilities.

But the Somali children were less likely than the whites to be “high-functioning” and more likely to have I.Q.s below 70. (The average I.Q. score is 100.)

 The Minneapolis Star-Tribune reports:

While the study established a high rate of autism in Somali children, Hewitt said, it was not designed to address some of the pressing “why” questions — such as why autism rates vary so sharply among racial and ethnic groups. Nor did it address some of the persistent fears inMinneapolis’ growing Somali immigrant community about the origins of autism in their children.

Some in the community believed that autism was only a problem among children born in the United States, and not among Somali children who moved here with their parents. Hewitt said that wasn’t addressed by this study, but that researchers have birth record data to address that question next. The report also didn’t address fears among some in the community that pediatric vaccines were somehow to blame.

The study did find that children of all races and ethnicities in Minnesota aren’t assessed for an autism diagnosis, on average, until they are 5. That is late considering that the disorder can reliably be detected by age 2.

A Vaccine Forum, and Somalis in Minneapolis

At The Minneapolis Star-Tribune, Maura Lerner reports:

A panel of health experts and opinion leaders spent nearly two hours at a Somali community forum Saturday night, trying to convince skeptics that the measles vaccine is safe and necessary.

But by the time it was over, there was little sign that anyone's minds had been changed. And a vaccine clinic, set up outside the meeting room at the Brian Coyle Center in Minneapolis, was still awaiting its first customer.

More than 50 people turned out for what was described as an educational forum prompted by the current measles outbreak in Hennepin County, which has sickened 11 people, including five Somali children, since February.

Dr. Abdirahman Mohamed, one of two Somali physicians on the panel, warned that families who don't vaccinate their children are putting their lives in danger. He said he knows of six Somali-American children who have caught measles and died during visits to Africa since 2008, including two children from Minnesota.

Also according to Lerner, Andrew Wakefield had spoken to the community a few days earlier:

Dr. Andrew Wakefield, a controversial British doctor whose research purported to link vaccines to autism, met privately with a gathering of Somali parents in Minneapolis on Wednesday night.

Wakefield, who arrived amid the city's first measles outbreak in years, declined to answer questions about the purpose of his visit. Reporters were barred from the meeting, which was described as a "support group" for parents of autistic children.

Health officials say that vaccination rates have been dropping in the Somali community because of fears about vaccine safety, fueled by Wakefield's now-discredited research

But not everyone in the community takes Wakefield's side. On Friday, Lerner wrote of autism mom Hodan Hassan:

In December, she said, she turned out to hear Andrew Wakefield, the hero of the anti-vaccine movement, at a Somali community meeting in Minneapolis. Wakefield conducted a now-discredited 1998 study suggesting a link between autism and the measles, mumps and rubella (MMR) vaccine.

Later, Hassan said, a local doctor challenged her to do her own research on Wakefield, who was accused of scientific misconduct in connection with the study, and ultimately stripped of his medical license in England.

Now she is one of his biggest critics. "I was shocked when I found out people used to die [of measles]," she said. Many still do in her native Somalia, she noted, and in other in parts of the world where vaccines are not available.

"If we could all go back in time, we would have appreciated it," she said.

Just this week, Wakefield returned to Minneapolis for a private meeting with Somali families. Members of the news media were barred from Wednesday's gathering, which reportedly drew only about a half-dozen Somali parents.

But one of the organizers, Patti Carroll of Shoreview, said she doesn't believe parents are worried about the measles outbreak.

"They'd rather have them get the measles than deal with the effects of unsafe vaccines," said Carroll, a volunteer with Generation Rescue, an autism advocacy group.

Last year, at his On Risk blog, David Ropeik wrote more generally of the perceived risk balance of autism and vaccines:

Several risk perception factors are at work here. Those who refuse to acknowledge the overwhelming evidence that there is no link between autism and vaccines don’t trust the government and pharmaceutical industry, and mistrust fuels fear. Parents with autistic kids have so little control over their children’s fate, and lack of control fuels fears. And any risk to kids evokes more fear than the same risk to adults. These risk perception factors are real, as real as the evidence disproving the autism-vaccines link. So despite a mountain of such evidence, the fears persist, and fuel a rising doubt about vaccines in general. I observed that this Perception Gap between the fear and the facts is dangerous, not only for parents who choose not to vaccinate their kids, but for everyone else, since herd immunity is important to keep largely defunct diseases like measles from spreading again.

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There is another risk perception factor at work here too. Risk v. Benefit. Not long ago when measles and other childhood diseases were widespread, and lethal in hundreds of cases, the benefit of the vaccines outweighed their risk. Now the risk of the diseases has become so low that we only worry about the drugs. Curious. Because they’ve succeeded, we worry more about the vaccines than the diseases from which they are protecting our children.

Autism and Somalis

A press release from Autism Speaks:

Autism Speaks, the world's largest autism science and advocacy organization, today announced a collaboration with the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to investigate the prevalence of autism spectrum disorders (ASD) in the Somali population located in Minneapolis, Minn. Autism Speaks is contributing funding to this project to be initiated in early 2011. The Autism Speaks funding will allow rapid deployment of the project.

“There have been concerns about higher prevalence of ASD in Minneapolis' Somali population. We believe it is important to verify if a true increase in prevalence exists, and if so, why it exists,” explained Autism Speaks' Chief Science Officer Geraldine Dawson, Ph.D. “In this circumstance Autism Speaks has both the resources and facility to allocate a budget to initiate this effort in a timely manner.”

In March 2009, the Minnesota Department of Health released a report that examined preschool program participation rates in the Early Childhood Special Education Programs of the Minneapolis Public Schools (MPS). Results showed that there were more children of Somali descent participating in the ASD special education programs than children from other racial and ethnic groups.

In October 2010, Somali parent and founder of the Somali American Autism Foundation, Idil Abdull, spoke at the Interagency Autism Coordinating Committee (IACC) meeting and asked that a systematic investigation of the prevalence of ASD in Somali children living in Minnesota be conducted. Subsequently, members of the committee decided to form a partnership to fund an investigation of this issue. While follow-up plans are still in the developmental stage, it is anticipated that the project will investigate prevalence of ASDs among a select population of children in Minneapolis using surveillance methods developed at the CDC.

Thomas Insel, M.D., Director of the National Institute of Mental Health and Chair of the IACC commented, “This shared effort between NIH, CDC, and Autism Speaks demonstrates how members of the IACC can respond quickly and cooperatively to an issue brought to the Committee by the public. An increased prevalence of ASD among this specific Somali population would represent both a scientific opportunity and an urgent public health need.”

If findings suggest that children of Somali descent have a higher ASD prevalence than children of other racial/ethnic groups, then future research will need to address what factors could account for the increase, such as factors related to immigration or nutrition. Such research could be of potential benefit in helping children with ASD of Somali background and understanding the causes of ASD.

Minnesota Public Radio reports:

The Minnesota Department of Health released a report in 2009 confirming higher rates of Somali-American kids participating in special education classes for children with autism in Minneapolis. But it's still unclear why.

It could be that Somali parents prefer to enroll their children in school-based programs, as opposed to seeking help from autism specialists in the medical community.

Last month, Andrew Wakefield -- who has been widely discredited for his controversial research claiming a link between childhood vaccinations and autism -- visited Minneapolis to gather data and money for research into autism rates among Somali-American children. [emphasis added]

Just weeks later, the British Medical Journal declared Wakefield an outright fraud for faking data.