Why Funding to the Environmental Protection Agency Should Matter to You

Many news sources are reporting that funding for new grants and contracts at the Environmental Protection Agency (EPA) are frozen and scientists are barred from communicating with the public. This may be a normal part of the transition between administrations as new political appointees enter the agency. However, the new administration has made it clear they want to slash the EPA’s budget and this is something that should concern us all.

The mission of the EPA is to protect human health and the environment. If you enjoy clean water and air, you can thank the hard working people at the EPA. Budget cuts could mean that clean up and monitoring of Superfund sites may be neglected. There is a Superfund site very close to the municipal ground water wells that supply my family and 300,000 other people with drinking water (want to know if you live near a Superfund site: https://www.epa.gov/s…/search-superfund-sites-where-you-live). An EPA grant is being used to test the lead levels in Flint, Michigan. I could go on and on about the valuable work done by federal funding to the EPA.

The scientists at the EPA are funded by us, the taxpayers, and we deserve to know what they are finding. Hiding evidence of climate change or pollution by industry doesn’t change the fact that it is happening. Reasonable people can disagree on what action we should take and how to prioritize jobs, the environment, and other factors, but we should all be working off the best available evidence.

Happy National Immunization Awareness Month: Spotlight on the Chickenpox Vaccine

August is National Immunization Awareness Month and a time to celebrate all the pain, suffering, and deaths avoided thanks to vaccines. I’m currently on maternity leave and very thankful for all of the people who have been vaccinated and help to protect my daughter until she is old enough to be fully vaccinated. Unfortunately, the Bay Area has dangerously low immunization rates in many places (you can find out the immunization rate at the kindergartens in CA here), which compromises herd immunity. This month is a great time to discuss how vaccinations can protect your children from painful and often deadly diseases. In a previous post I discussed how serious a case of the measles can be, especially for babies where there is a 1-2 in 1000 chance they will die. Today I’d like to talk about the importance of the Varicella or Chickenpox Vaccine.


Babies like my daughter rely on herd immunity to stay safe from vaccine preventable diseases

Some people think that children are given too many vaccines and often point to the chickenpox vaccine as one that is unnecessary. There is extensive evidence that the vaccine schedule suggested by the CDC and endorsed by every reputable medical organization is safe and effective so I won’t spend time on that here (see the Children’s Hospital of Philadelphia’s Vaccine Education Center or the CDC for more information). What I would like to discuss is why it is important for your child to get the chickenpox (varicella) vaccine.

Chickenpox is an unpleasant and sometimes fatal disease

If you are my age you have likely had chickenpox and probably remember the itchy bumps. Chickenpox is extremely contagious and most of us had it along with our siblings. For most children chickenpox is a mild disease, though definitely unpleasant and disruptive to school attendance and parent work schedules.  About 1 in 1000 children will get severe pneumonia, though, and before the widespread use of the chickenpox vaccine about 70 children died every year. Chickenpox is especially dangerous for babies under 1 yr old and anyone over 15. There are heartbreaking stories of babies too young to be vaccinated and adults that never got chickenpox dying from a ‘simple’ case of chickenpox. If there is a chance my baby can die from a disease I definitely want her to be vaccinated.

The virus that causes chickenpox can lead to a painful case of shingles later in life

Following a case of the chickenpox, the virus remains dormant in your body and can reappear later in life as a painful disorder, shingles. Shingles causes a painful, blistering skin rash that persists for 2-4 weeks. A common side effect of shingles is post-herpetic neuralgia (PHN) where the pain from shingles lingers for months or years. Some people also experience vision loss from shingles.  About 1 in 3 Americans will get shingles in their life and there are ~1 million shingles cases in America per year. The incidence of shingles increases with age and about half of shingles cases occur in people over 60. The chickenpox vaccine uses a live but weakened strain of the virus that can still cause shingles, but at a much lower rate than the live virus. In about 40 years once the first generation vaccinated for chickenpox ages we will know the level of shingles reduction that can be gained by widespread chickenpox vaccination. For now, there is a shingles vaccine that is recommended for people over 60.

The chickenpox vaccine is very safe and side effects are usually mild

The most common side effects from the chickenpox vaccine are pain at the injection site, a low grade fever, and a rash near the injection site (rash occurs in ~4 in 100 people). The chickenpox vaccine is very safe and helps prevent your children from getting an uncomfortable and potentially deadly disease. Seeing a child get shots is often hard on parents, but you can find some evidence based tips for how to keep your child as happy as possible during routine vaccinations at the Science of Mom blog.

Want to learn more about vaccines? 

The internet contains a lot of misinformation about vaccines and it is important to get your information from trusted sources. The Children’s Hospital of Philadelphia has a great Vaccine Education website with easy to understand information about every vaccine recommended for your child, including the dangers of your child contracting that disease and the known side effects of each vaccine. This site has been recognized for its accurate information by the World Health Organization (WHO) and is a member of WHO ‘s Vaccine Safety Net, which aims to provide accurate public health information to the public online. The Centers for Disease Control (CDC) also has a very good Vaccine Safety site.

Bill Reintroduced to Limit Overuse of Antibiotics in Agriculture

This week Senators Dianne Feinstein (D-CA) and Susan Collins (R-ME) reintroduced the Prevention of Antibiotic Resistance Act. This measure would act to strengthen recent FDA guidelines discouraging the use of antibiotics in order to promote weight gain in food animals. If passed, this bill would require the FDA to rescind approval of medically-important antibiotics for use in animals unless the manufacturer can show that there is no danger to human health. This bill would also require more veterinary oversight of antibiotic use.

Antibiotics are one of the most important medical advances in history, but antibiotic resistant bacteria are developing with alarming frequency. Antibiotics are widely used for non-medical reasons in agriculture and are over-prescribed in the clinic.  The combination of improper and overuse of antibiotics coupled with a drop in the number of new antibiotics developed each year is leading to worrisome increases in the prevalence of antibiotic resistant infections around the world. In India last year, over 58,000 infants died after contracting antibiotic resistant infections while in the US over 2 million people were infected by antibiotic resistant bacteria and ~23,000 died.

It is unclear how much this new bill will help to decrease the improper use of antibiotics, but any step taken to limit antibiotic use is at least a step in the right direction. You can support this bill by contacting your legislators and asking them to support the Prevention of Antibiotic Resistance Act.

Potentially a more effective way to limit the use of antibiotics in agriculture is to put pressure on major food producers and vote with your dollars. Many supermarkets carry meat from animals raised without antibiotics, although you will usually pay extra so this is not a practical option for everyone. The good news is that some companies are responding to public pressure about antibiotic use.  McDonald’s announced this week that it will stop buying chickens raised using antibiotics, saying that it was “listening to our customers”. Due to the huge purchasing power that McDonald’s has, this is likely to have a big impact on the use of antibiotics in chickens. If more large corporations do the same, antibiotic use in agriculture could be severely curtailed.

Resources About Antibiotic Resistance

“Imagining the Post-Antibiotic Future” by Maryn McKenna in Medium.com

“Resistance” documentary by Michael Graziano (reviewed in Nature News here)

“Hunting the Nightmare Bacteria” PBS Frontline

Talk to Your Friends and Family About Science: Vaccines Edition

The number of people who have contracted measles from an outbreak started in Disneyland has topped 50 this week, making it a very good time to talk to your friends and family about the importance of vaccination. Vaccines are one of the most successful public health advances, practically eliminating such awful diseases as polio and smallpox. Since 2000, vaccines have been credited with decreasing the number of worldwide childhood deaths by 3.6 million, even though the population has increased by 1 billion in the same time frame. Sadly, the success of vaccination may be contributing to the current outbreaks of diseases, like the measles, that we thought were a thing of the past. Without the memory of closed public pools and rows of iron lungs in hospital wards it is easier to weigh the perceived risks of vaccination as the scarier option. Below are ways you can answer some common questions about vaccination as well as some resources about the safety and efficacy of vaccination.

 Is a Measles Outbreak Really That Bad?

Short answer: YES! In 1980, before widespread vaccination 2.6 million people died of the measles. In 2012, with 84% of babies vaccinated that number was only 122,000 worldwide. About 1 or 2 in 1,000 babies who contract the measles will die, whereas the worst vaccine side effect, a severe allergic reaction, only occurs in 1 in 1,000,000 babies. The measles are one of the most contagious diseases known. Measles spread through the air and an unvaccinated person can still contract the disease if they enter the room 2 hours after the infected person has left. The Ro, or average number of people one sick person will infect, for measles is 18! For comparison, the Ro for Ebola is 2. This is why it is important to quarantine unvaccinated people potentially exposed to the measles. A measles outbreak is also incredibly costly, with contact tracing and other measures costing ~$33,000 per person infected.

 Shouldn’t It Be My Choice Whether To Vaccinate My Children?

Many of the health decisions that we make, like what foods we eat, are choices that mainly affect us as individuals. The choice to refuse vaccination, though, affects society at large since the success of vaccines rests on herd immunity. Transmission of a disease can be prevented if the majority of people are immune. Herd immunity protects those who cannot be vaccinated because they are too young or have a compromised immune system that prevents them from being vaccinated. Herd immunity also protects the minority of people vaccinated that don’t gain protection (most vaccines are ~80-85% effective, which is pretty darn good, and the measles vaccine is ~95-98% effective.). As long as between 83-94% of the population is vaccinated, it is highly unlikely that a disease will spread. US vaccination rates are now ~91% on average, lower than half the countries in the world, and even lower in certain areas, including Marin County, CA where only 83% of kindergartners were vaccinated in 2010. If only a few families opt out of vaccinations, they still receive protection from herd immunity. Once too many people opt out, the rest of us are placed in danger, just like the 2 babies too young for vaccination that contracted the measles at Disneyland. It is in society’s best interest to start making the cost of refusing to vaccinate higher, especially since the safety of vaccination has been shown repeatedly (serious side effects from vaccines are very rare). For instance, unvaccinated children are barred from entering many daycare facilities and we could make it much harder to receive vaccination exemptions for children in public schools. Similarly some pediatricians are refusing to treat unvaccinated children, which will protect their other patients.

But Don’t Vaccines Cause Autism?

No, vaccines do not cause autism. This idea was started thanks to a fradulent, now retracted paper by Andrew Wakefield (who has since had his medical license revoked). Since the publication of that paper, many studies including over 14.7 MILLION children have found NO LINK between autism and vaccination. Anti-vaxxers will trot out figures showing increasing autism rates as vaccination rates have increased. Don’t fall for this, that is simply correlation, not causation. In fact, there is a similarly good correlation between autism rates and organic foods sales, which I’m sure we can all agree is a highly unlikely cause of autism.




Some Great Resources About Vaccines

Wonderful cartoon by the Nib explaining how vaccines work, how shady the Wakefield study was, and how important vaccinations are.

Upworthy infographic sponsored by the Bill and Melinda Gates Foundation showing the evidence that vaccines do not cause autism.

Business Insider video explaining herd immunity and why ‘If you don’t vaccinate your kid, please don’t ask me not to judge you.’

Skeptical Raptor’s explanation of the mumps outbreak in the NHL and why vaccinated players can still get the mumps.

Journal article for clinicians refuting 3 common anti-vaxx arguments (behind a paywall).

 * *Updated on 2/8/15 to include risk of death from measles vs risk of severe allergic reaction to MMR vaccine, efficacy rate of MMR vaccine, and clarification that I am in no way suggesting the sale of organic food causes autism.**

Talk to Your Friends and Family About Science: Ebola in the US

Somewhat inevitably with the global nature of travel these days, the first Ebola case in the US has been reported in Dallas. While this is obviously scary for the patient and his family, there is almost zero chance this will lead to a widespread outbreak in the US. Below are a few things to remember about Ebola.

Only people showing symptoms are contagious

Although the Ebola patient did travel on an airplane, he was not showing symptoms at that time and therefore was not contagious. The public health team in Dallas has traced his contacts since arriving in the US and will be monitoring those people to ensure they do not develop Ebola (Ebola has a 21 day incubation period).

Ebola is only transmitted through infected bodily fluids

Ebola is actually relatively hard to get. Ebola is not spread via airborne droplets and there is no reason to believe airborne transmission of Ebola will develop. Like with HIV, you must come in contact with bodily fluids from a person showing symptoms to contract Ebola. Just being in the same room with the person will not lead to Ebola spread.

The US Public Health infrastructure is equipped to deal with Ebola

Unlike in West Africa, the US has a robust public health system, well trained medical professionals in every community, and no shortage of the personal protective equipment necessary to prevent the spread of Ebola. In fact, Ebola related viruses like Marburg and Lassa Fever, have already made it to the US and no widespread outbreak occurred.

We should be more worried about the effect of the Ebola outbreak in West Africa

While we really shouldn’t be worried about a US Ebola outbreak, we should be more worried about the havoc occurring in West Africa. The outbreak is causing a tremendous amount of suffering in West Africa. The public health system is completely overwhelmed and non-Ebola medical care is suffering as well. There are extreme shortages of trained medical professionals, personal protective equipment, beds for those suffering from Ebola, and other basic medical supplies.

If you are worried about Ebola, consider donating to Doctors Without Borders to help fight the spread of Ebola in West Africa. Aid groups on the ground, like Doctors Without Borders, are also asking for help from any trained medical professionals willing to volunteer in West Africa.

A Few Other Resources About Ebola in the US:

CDC Ebola Information Website and Press Release

Tara C. Smith’s article in the Guardian about why we shouldn’t panic about a US Ebola Epidemic