The Dose (August 11)
This week started off with a bang with an executive order on routine childhood vaccinations. So much for this administration not touching childhood vaccines before the midterms. I try to break down the signal from the noise for you below (there was a lot of noise.)
Plus: Michigan health officials say iceberg lettuce is now all clear, but we have a new produce item making us sick in 27 states: jalapeños. Covid-19, fire smoke, and heat risk continue to march forward. And we end with some good news.
Here’s your “disease weather report”, and most importantly, what it may mean for you and your family.
Disease weather report
Record-breaking Cyclosporo outbreak coming to a halt
The nationwide cyclosporiasis count is now more than 20,000 cases for the year, but that’s an undercount, since many people with milder symptoms simply stay home rather than seek care. The total will keep climbing, both because multiple outbreaks are underway and because the largest, centered in Michigan, is still working through a backlog of investigations. This could easily become the largest foodborne outbreak in history.
The contaminated lettuce behind it appears to be out of circulation: several metrics are declining quickly, including the test positivity rate. In Michigan, the outbreak’s epicenter, emergency department visits are falling, and the number of recent new infections is nearly zero. (See below.) That second metric is especially useful because it isn’t skewed by reporting delays or lab-confirmation backlogs.
Thanks to an FDA Enforcement Report, we now know the actual number of lettuce cases recalled was 236,192! Interestingly, only 2.5% of recalled lettuce was from Taco Bell. Almost half of the recalled product was supplied to Walmart. This makes Taylor Farms’ communications that much more atrocious because it means that many got sick when everyone thought it was just Taco Bell.
What this means for you: You can now return to all your leafy greens.
Salmonella in jalapeños
Another, separate outbreak (Salmonella this time, which means getting sick 12-72 hours after eating) is now active and linked to fresh jalapeños from Sinaloa, Mexico. The latest official CDC count is 345 people sick across 27 states, with 36 hospitalized. Two cases have antibiotic-resistant strains.
Chipotle and Qdoba both pulled the supplier’s jalapeños, and the recall has since expanded downstream to include prepared foods from brands such as Taylor Farms (yes, again), Ready Meals, Meal Simple, Higher Harvest, and Deli Kitchen that used the contaminated peppers as an ingredient.
What this means for you: Throw away (or avoid purchasing) jalapeños and associated foods at Hannaford, Kroger, Stop and Shop, Target, Trader Joe’s, Walmart, and Whole Foods.
Covid-19 summer wave continues to rise
Covid-19 levels remain low, but emergency visits are increasing in 43 states. We are clearly in a wave that has come like clockwork every summer since the pandemic, for reasons that still puzzle epidemiologists. As expected, hospitalizations have begun to increase after the typical lag in testing trends, but they remain at a record low.
What this means for you: If you don’t want to get sick, the time to wear a mask in crowded, indoor areas is starting.
Air quality and heat galore
Air quality remains poor in the Northwest due to wildfires, which seem to be becoming increasingly common these days.
Also, more than 75 million people, concentrated in the South, will be at risk of heat illness.
What this means for you: Here are six things you need to know about heat illness.
6 things to know about heat illness
When I picture a heat death, I used to imagine someone collapsing outside in the blazing sun while working at a construction site. That definitely happens, but what I learned while working at CDC is that it can also look like Shirley.
Spotlight: Executive order on childhood vaccines
Yesterday, an executive order and a press conference announced changes to the routine childhood vaccination schedule. (So much for the administration pulling back on vaccine policy before the midterms. More than 80% of Americans still strongly support having access to vaccines.) As expected, it was a lot of craziness, so instead of refuting everything, I’m here to tell you what it means for you today:
Not much. Families can still access all vaccines on the AAP schedule. Pediatricians should continue offering vaccines, and these vaccines remain covered without cost-sharing under current law.
What it is: Most of what the EO does is set direction and ask for plans. HHS has 90 days to present a plan for offering MMR as separate shots, which isn’t possible yet because single-antigen measles, mumps, and rubella vaccines aren’t currently manufactured in the U.S. In fact, nowhere in the world is there a single-dose version of vaccines. It would take years of research and development to execute this. Other pieces, such as a framework proposing to reclassify hepatitis A, hepatitis B, and rotavirus vaccines away from “recommended for all children” or the development of new vaccine adjuvants, don’t have set timelines at all.
What it is NOT: There is no new scientific data to justify a new policy. This is also not legislation. In other words, Congress didn’t pass it, and it can’t override state or federal law on its own. (Remember, vaccine policy is mainly determined by the states rather than the federal government.)
When I will worry: If one of three things happens:
Autism is added to the Vaccine Injury Table. This could bankrupt the compensation program by opening it to a flood of lawsuits. If the program collapses, two things follow: families with vaccine injuries would lose their main source of compensation, and manufacturers, no longer protected from massive liability, would likely stop producing vaccines altogether.
Funding for the Vaccines for Children Program is withdrawn, which would halt free vaccines for 1 in 2 children in the U.S.
Federal powers (such as withholding funding) are used to compel states to change their vaccine exemption policies.
This EO may reach #3. It directs the Department of Justice to pursue legal action against states that don’t offer religious or medical exemptions from school vaccine requirements. Only a handful of states (California, Maine, West Virginia, Connecticut, and New York) have no religious exemptions, so they would be impacted the most, but it would take years with legal battles. All the other states could be impacted in other ways, but that depends on how the legal fights unfold, how far DOJ pushes it, and how states respond. Too many variables to call yet.
What this means for you: Chaos and confusion are the point. Keep a steady head. Families can still access all vaccines on the AAP schedule. Pediatricians should continue offering vaccines, and these vaccines remain covered without cost-sharing under current law.
Good news
Major depression among teens continues to decline, showing roughly a 30% drop in depression since peak years. This was also the case for deaths from suicide in older teens and adults through age 34. (Dr. Thomas Farley)
Figure by Dr. Thomas Farley An ancient protein could aid existing cancer treatments. C3, a protein that evolved long before the human circulatory system, may help with treating cancer more efficiently. When produced inside tumors, C3 blocks cells that suppress the immune system and provides an opportunity for immunotherapy to work more effectively. This effect was observed even in treatment-resistant tumors. (ScienceDaily)
Bottom line
Lettuce is safe, jalapeños aren’t (for now), and despite the headlines and a purposefully confusing press conference from the Health Secretary, nothing about your kids’ vaccines actually changed this week. Keep a steady head out there. It’s a lot to keep up with.
Love, YLE
Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. The YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members.
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