A Big Hearing For ‘Medicare-For-All’ — In A Small Room

The first congressional hearing on a “Medicare-for-all” bill in at least a decade took place Tuesday, but without the usual phalanx of T-shirted supporters — or even the presidential candidates — who have been pushing the bill.

That’s because the hearing took place not at one of three major committees that oversee health policy in the House, but in the ornate — and comparatively miniature — hearing room of the House Rules Committee. That panel’s primary role is to set the terms for House floor debates, and its hearing room can seat about 50 people in the audience, compared with hundreds in the larger rooms of the Capitol complex’s office buildings. Also, members of the public cannot easily access the room on the third floor of the Capitol as they can the House office buildings across the street.

That arrangement was no accident — the Rules Committee is often called the “Speaker’s Committee” because it is so closely aligned with the speaker’s goals and is more heavily populated with members of the majority party than the usual committee breakdowns. House Speaker Nancy Pelosi has said repeatedly she does not want to push Medicare-for-all — a plan popular among progressive Democrats to move the country to government health care system — while Republicans control the Senate and the White House.

So, this hearing was the fulfillment of a promise she made to some of the more left-leaning members of her caucus when she courted them to support her candidacy for speaker. Another hearing, this one by the House Budget Committee — also not among the committees that would normally handle major health legislation, is expected to follow soon.

Those usual panels — Ways and Means, Energy and Commerce, and Education and Labor — are busy working on health legislation, including bills to address prescription drug prices and “surprise” medical bills, but not currently on a Medicare-for-all bill.

Rep. Michael Burgess (R-Texas) pointed out that anomaly. “I don’t want to say this hearing isn’t normal, but normally, health care policy would come … through the authorizing committees,” he said in a gibe to the House Democratic leadership. Burgess is also a member of one of those committees: Energy and Commerce.

Pelosi did make a cameo at the Rules hearing, escorting activist Ady Barkan, who has the neurogenerative disease amyotrophic lateral sclerosis, or ALS, and was the star witness for the proponents of Medicare-for-all. Barkan, an outspoken critic of Republicans’ efforts to repeal and replace the Affordable Care Act in 2017, testified Tuesday by computer-generated voice, since his disease has progressed to the point he can no longer speak easily.

Still, despite the unusual venue, backers of universal health care hope the hearing marks the beginning of a journey to a new national health system.

“This is a historic moment,” Rules Chairman Jim McGovern (D-Mass.) said, surveying the standing-room-only crowd. “I don’t think we can squeeze anyone else in here.” McGovern said he is a strong supporter of the Medicare-for-all bill introduced by Reps. Pramila Jayapal (D-Calif.) and Debbie Dingell (D-Mich.), which has more than 100 co-sponsors.

For all the political machinations and sometimes overheated rhetoric about a major overhaul of the U.S. health system, the hearing itself was remarkably unremarkable — with witnesses both for and against the idea of the federal government providing health coverage to all Americans calmly discussing the pros and cons.

“The ugly truth is this: Health care is not treated as a human right in the United States of America,” Barkan told the committee. “This fact is outrageous. And it is far past time that we change it.”

Republicans were also eager to talk about Medicare-for-all — so they could bash it.

“This bill is an extraordinary bill,” said Rep. Tom Cole (R-Okla.), the panel’s ranking member. “It would completely change America’s health care system. And not for the better.”

And while the most enthusiastic backers of the bill were not in the hearing room, they were not far away.

More than 300 members of the California Nurses Association/National Nurses United, one of the unions that has been pushing Medicare-for-all for years, watched the hearing from an overflow room in the Cannon House Office Building and visited offices to try to gin up support, said co-President Malinda Markowitz.

Markowitz said she was optimistic about the path forward for the measure. “We’re going to continue to go to legislators that aren’t supporting this and let them know we’re not letting them off the hook,” she said.

Republicans want the debate to continue in Congress, too. They hope they can stoke fear of a government takeover of health care that will work to their advantage in the next election.

The top Republicans on the House Ways and Means Committee on Tuesday wrote to Chairman Richard Neal (D-Mass.) urging him to schedule a hearing on the bill. “A public accounting of H.R. 1384 is necessary to inform the working families and seniors we represent to the risks of their health coverage under this proposal,” said ranking Republican on the full committee, Rep. Kevin Brady (Texas), and the health subcommittee, Rep. Devin Nunes (Calif.).

That is apparently fine with Neal. In a brief interview Tuesday, he said his committee “likely would” hold a hearing in the current Congress. “I think we should have a full-throttle debate” about Medicare-for-all, he said.

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Summer Bummer: A Young Camper’s $142,938 Snakebite

It was dusk as Oakley Yoder and the other summer camp kids hiked back to their tents at Illinois’ Jackson Falls last July. As the group approached a mound of boulders blocking the path, Oakley, then 9, didn’t see the lurking snake — until it bit a toe on her right foot.

“I was really scared,” Oakley said. “I thought that I could either get paralyzed or could actually die.”

Her camp counselors suspected it was a copperhead and knew they needed to get her medical attention as soon as they could. They had to keep her as calm and motionless as possible — the venom could circulate more quickly if her heart raced from activity or fear.

One counselor gave her a piggyback ride to a van. Others distracted her with Taylor Swift songs and candy as the van sped from their location in a beautiful but remote part of the Shawnee National Forest toward help.

First responders met them and recommended Oakley be taken by air ambulance to a hospital.

The helicopter flight transported Oakley 80 miles from a school parking lot just outside the forest to St. Vincent Evansville hospital in Indiana, where she received four vials of antivenin and was then transferred to Riley Hospital for Children in Indianapolis for observation.

Her parents, Josh Perry and Shelli Yoder, were already in bed that night when they got the call about what had happened to Oakley. They jumped in the car and arrived at Riley about two hours before their daughter. Once she made it, doctors closely observed her condition, her toe still oozing and bruised. By lunchtime, Perry said, physicians reassured the parents that Oakley would be OK.

“It was a major comfort for me to realize, OK, we’re getting the best care possible,” said Perry, who is a health care ethics professor at the business school at Indiana University Bloomington. Less than 24 hours after the bite, Oakley left the hospital with her grateful parents.

Then the bills came.

Oakley Yoder shows her now-deformed toe after a snake bit her at an Illinois summer camp in July 2018. These are the same shoes she wore when bitten.(Chris Bergin for KHN)

Patient: Oakley Yoder, now 10, of Bloomington, Ind. Insured through Indiana University Bloomington, where her father and mother work as faculty.

Total Bill: $142,938, including $67,957 for four vials of antivenin. ($55,577.64 was charged for air ambulance transport.) The balance included a ground ambulance charge and additional hospital and physician charges, according to the family’s insurer, IU Health Plans.

Service Providers: St. Vincent Evansville hospital, part of Ascension, a nonprofit Catholic health system. Riley Hospital for Children, part of Indiana University Health, a nonprofit health system. Air Evac Lifeteam, an air ambulance provider.

Medical Service: The essential part of Oakley’s treatment involved giving her four vials of snake antivenin called CroFab.

What Gives: When bitten by a venomous snake, there is no time to waste. If left untreated, a venomous bite can cause tissue damage, hemorrhaging and respiratory arrest. Children tend to experience more severe effects because of their relatively small size.

CroFab has dominated the U.S. market for snake antivenin since its approval in 2000. When Oakley was bitten, it was the only drug available to treat venomous bites from pit vipers. (Oakley probably was bitten by a copperhead snake, a type of pit viper, the camp directors told her parents.)

In short, the drugmaker, London-based BTG Plc, essentially had a monopoly.

The average list price for CroFab is $3,198 per vial, according to the health care information tech company Connecture. Manufacturing costs, product improvements and research all factor into the drug’s price, said Chris Sampson, spokesman for BTG.

A Mexican version of snake antivenin can cost roughly $200. But it couldn’t be sold in the U.S. (More about that in a moment.)

Dr. Leslie Boyer, founding director of the VIPER Institute, a venom research center at the University of Arizona, acknowledges that some of the price in the U.S. can be attributed to strict Food and Drug Administration requirements for testing and monitoring.

But more than that, she added: “It’s a profitable drug, and everyone wants a piece of it.”

She should know: Funded by government grants and at times working with colleagues over the border in Mexico, her group was instrumental in developing CroFab.

Antivenins were first developed more than a century ago. Although CroFab is safer and purer than antivenins of the past, the process — while labor-intensive — remains fundamentally the same. Snakes, spiders and other creatures are milked for their venom, then a small amount of the toxin is injected into animals like horses or sheep. They then make antibodies without falling ill, and the protective molecules are extracted from their blood and processed to make antivenin.

Despite the longtime use of antivenins, CroFab and other such products remain a lucrative prospect for manufacturers. Who wouldn’t pay top dollar for an antivenin when their child has been bitten by a venomous snake?

What patients pay for CroFab can widely vary. Treatment may require a few vials or dozens of them — it depends on factors like the size of the patient, the potency of venom in the bite and how quickly the patient is treated. The more antivenin needed, the higher the cost.

(Story continues below.)

But hospitals also jack up the price, even though some of these facilities purchase the drug at a discount, said Dr. Merrit Quarum, chief executive officer of WellRithms, a health care cost containment company.

In Oakley’s case, St. Vincent Evansville hospital charged $16,989.25 for each unit of CroFab, according to the facility’s bill. That’s more than five times as high as the average list price.

WellRithms analyzed Oakley’s bill from St. Vincent Evansville at Kaiser Health News’ request and found providers generally accept $16,159.70 for all four vials of the drug.

In a statement, St. Vincent Evansville noted that the family was not responsible for that full tab and instead was expected to pay less than $3,500. But the facility appears to have since lowered its price for CroFab. According to its price list — posted online to satisfy a recent federal requirement — the drug now costs $5,096.76 per vial.

And the snake antivenin market now has another drug competing for patients: Anavip. The Mexican product — launched in October — has a list price of $1,220 a vial in the U.S, a fraction of what Latin Americans pay for it, according to Rare Disease Therapeutics, which distributes the drug in the U.S.

Anavip’s arrival was stalled by a lawsuit filed by BTG in 2013 that claimed the drug infringed on its patent.

The drug’s true effect on the market remains unclear. CroFab and Anavip are not entirely interchangeable. (The FDA hasn’t approved Anavip for copperhead bites, for instance.) And, as part of the legal settlement, Anavip makers must pay royalties to BTG until the CroFab patent expires in 2028.

Yoder’s father, Josh Perry, teaches a class on the ethics of health care finance at Indiana University, yet he said the cost of Oakley’s care shocked him.(Chris Bergin for KHN)

Resolution: The insurer, IU Health Plans, negotiated down the antivenin and air ambulance charges and ended up paying $44,092.87 and $55,543.20, respectively. After adjustments to additional bills, IU Health Plans paid a total of $107,863.33. Oakley’s family did not pay a dime out of pocket for her emergency care, but such high outlays contribute to rising premiums.

Secondary insurance offered through the summer camp covered $7,286.34 in additional costs that otherwise would have come out of Perry and Yoder’s pockets for their deductible and coinsurance. The policy covers up to $25,000 in damages.

Oakley’s foot is healed, but her toe bends slightly downward and is sensitive to pressure. She intends to return to the same camp this summer.

Perry teaches a course on the ethics of the health care industry, and yet he said the cost of Oakley’s care shocked him. But he is aware of how rarely a patient ends up paying nothing for health care. “I know that in this country, in this system,” he said, “that is a miracle.”

Takeaway: Hospitals and insurers can negotiate; snakes don’t. If you’ve been bitten by a snake, “take care of your injury,” said Boyer. Don’t wait while you worry about the cost.

When you get a bill, compare what the facility charged against other health care providers’ prices using their public charge lists online. Cost estimation tools like Fair Health Consumer or Healthcare Bluebook allow you to see how your bill compares with the average.

Momentum is growing for government action on drug prices. In states and in Congress, various proposals have been floated, which include: allowing Medicare to negotiate drug prices, tying the U.S. price of expensive drugs to the average price in other developed countries and allowing the government to inject competition into the market when there is none — such as by speeding generic drug approvals or allowing imports.

Consumers should keep an eye on these proposals as they move through the political process.

NPR produced and edited the interview with Kaiser Health News’ Elisabeth Rosenthal for broadcast. Jake Harper of WFYI in Indianapolis provided audio reporting.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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FDA permits sale of Philip Morris IQOS tobacco-heating alternative to cigarettes

(Reuters) – The U.S. Food and Drug Administration on Tuesday said it would allow Philip Morris to sell a heated tobacco product called IQOS in the United States, a major victory for the international tobacco giant as it looks to sell more alternatives to traditional cigarettes.

FILE PHOTO: A man tries Philip Morris’ IQOS 3 device after its launching event in Tokyo, Japan, October 23, 2018. REUTERS/Kim Kyung-Hoon/File Photo

Following a review of about two years, the FDA determined that authorizing the device for sale in the U.S. market was “appropriate for the protection of public health” because the products produce “fewer or lower levels of some toxins than combustible cigarettes.”

Unlike combustible cigarettes, the IQOS devices heat tobacco-filled sticks wrapped in paper, which generates an aerosol that contains nicotine. They are different from e-cigarettes such as the popular Juul device, which vaporizes a nicotine-filled liquid.

Altria Group Inc, which sells Marlboro cigarettes in the United States, will market IQOS devices as part of a licensing agreement with Philip Morris International.

Altria Chairman and CEO Howard Willard said the IQOS will first be introduced in the Atlanta area. The move gives Altria yet another stake in a product designed as an alternative to traditional cigarettes, following its $12.8 billion deal in December to take a 35 percent stake in Juul Labs Inc.

André Calantzopoulos, CEO of Philip Morris International, called the FDA announcement a milestone. “All of us at PMI are determined to replace cigarettes with smoke-free alternatives that combine sophisticated technology and intensive scientific validation,” he said.

While Tuesday’s FDA decision allows Philip Morris to sell IQOS products, they must carry the same warning labels as traditional cigarettes. The FDA is still reviewing the company’s request to make claims that the products pose less of a health risk than cigarettes.

IQOS is currently available in Japan, South Korea, the United Kingdom and throughout much of Europe. Tuesday’s announcement by the FDA opens a huge market for the devices and the decision is likely to be cited by health regulators in other countries as Philip Morris expands distribution.

Philip Morris International has made the IQOS a centerpiece of what it is calling its “smoke-free future” initiative, which the company has promoted heavily in full-page newspaper advertisements in the United States and across the world.

Company executives have promoted the idea that non-combustible products such as IQOS will replace cigarettes and that the company is well positioned to help smokers switch to less harmful products.

Anti-smoking and public health advocates have criticized the campaign, asking why the company does not stop selling cigarettes altogether.

Last year Philip Morris International derived about 14 percent of its annual revenue from “reduced-risk products” such as IQOS.

Reporting by Chris Kirkham in Los Angeles and Tamara Mathias in Bengaluru; Editing by Shinjini Ganguli and Bill Trott

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Trump, Democratic leaders to meet on drug prices soon: White House

FILE PHOTO: U.S. President Donald Trump delivers remarks at a Make America Great Again rally at the Resch Center Complex in Green Bay, Wisconsin, U.S. April 27, 2019. REUTERS/Yuri Gripas/File Photo

WASHINGTON (Reuters) – U.S. President Donald Trump will meet with congressional Democratic leaders soon to discuss drug prices, the White House said on Tuesday following infrastructure talks with House Speaker Nancy Pelosi and Senate Democratic leader Chuck Schumer.

The White House said in a statement that the three agreed to meet “in the near future” over the health issue and that Trump “feels there is a long way to go” to lower drug costs, without elaborating.

The Trump administration made lower medication prices a top issue in his presidential campaign but has yet to unveil any detailed plan since taking office in January 2017.

House Democrats, who took over the U.S. House of Representatives this year following election gains due in part to their vows to protect healthcare, have launched an investigation into pharmaceutical industry pricing practices and held hearings on the issue.

The Republican-led U.S. Senate has also held hearings on the issue and its Judiciary committee plans to hold another next week. Any legislative effort to rein in pharmaceutical costs would have to pass both chambers and win Trump’s support to become law.

Several drugmakers temporarily froze price increases last year after criticism from Trump, but they started raising prices again at the start of this year, albeit at lower levels than in previous years.

Reporting by Jeff Mason; writing by Susan Heavey and Michael Erman; editing by Jonathan Oatis, Chizu Nomiyama and Richard Chang

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Feel the pressure—blood pressure, that is

About 1 in 3 U.S. adults have high blood pressure—and you could be one of them. If you haven’t checked your blood pressure lately, now’s the perfect time. High blood pressure usually has no signs or symptoms, but it can lead to a higher risk of heart disease, stroke, and kidney failure.

It’s important for you to know your blood pressure numbers, even when you’re feeling fine. Medicare covers blood pressure checks during your “Welcome to Medicare” preventive visit and yearly “wellness” visits at no cost to you.

If you have high blood pressure, you can help control it with lifestyle changes and medicine. You may be at risk for high blood pressure if you:

  • Smoke
  • Eat salty foods
  • Don’t exercise enough
  • Drink too much alcohol
  • Have a family history of high blood pressure
  • Are overweight

May is National High Blood Pressure Education Month. Find out more about how to prevent high blood pressure and get checked today!

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Consumer Protections: Celebrating First Steps Toward a New Insurance Marketplace

By Karen Pollitz, Director for Consumer Support, CCIIO. Cross-post from Healthcare.gov

During the past year, thanks to the Affordable Care Act, some of us have personally experienced just how important the consumer protections—and other provisions– are in addressing some of the most glaring problems in the insurance marketplace.

Among those celebrating the Affordable Care Act’s birthday is the Schley family of Circleville, New York. Thanks to the Affordable Care Act, David and Patricia’s 23 year-old-daughter, who was diagnosed with Crohn’s disease, was added to the family health insurance plan. But before their daughter could be added to the family health plan in January 2011, she needed coverage for the month before the dependent coverage provision became effective. Patricia and David read about the New York program for covering people with a pre-existing condition in the newspaper—a program that is now available in every state in the country as a result of the Affordable Care Act. Patricia next tapped into another resource that was available through the Affordable Care Act—the Consumer Assistance Program (CAP) in New York that provides case workers to help with insurance problems and questions. A caseworker in New York’s Consumer Assistance Program helped the family get the short-term coverage they needed in a timely manner. “Having a sick child, at any age, is stressful enough,” Patricia Schley said, but if your child in uninsured and the treatment for a condition like Crohn’s disease can cost up to $800 a month—having “to worry about how you’re going to pay for one bill after another only adds to the stress.”

For the Schley’s, the Affordable Care Act served up a “triple play” of protections, in the words of Elisabeth Benjamin, Vice President of Health Initiatives with the Community Service Society, which runs the Consumer Assistance Program through 25 community-based organizations across New York. The triple play included: access to the new Pre-existing Condition Insurance Program (PCIP), coverage for adult children who are under 26, and the strengthening of Consumer Assistance Programs (CAP) through federal grants to a number of states and territories—including New York.

We may not all need a “triple play” to resolve a health insurance problem. But even a “single” play can resolve some problems that can be devastating. Just ask the 100 million Americans whose health insurance coverage imposed lifetime dollar limits before they were prohibited under the Affordable Care Act. Or the estimated 2 to 4 million individuals who faced high out-of-pocket spending when they used out-of-network emergency care providers before consumer protections were enacted.

Over the next couple of days, I’ll be writing in more detail about the new consumer protections and services, including the ones that helped the Schleys. Please check back to find out more about how these can help you and your family.

Ed note: this is the first in a series of three blogs about new consumer protections made available thanks to the Affordable Care Act.

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Is Insulin’s High Cost Keeping Diabetes Patients From Taking Their Medicine?

High prescription drug prices are fast becoming a leading political topic, with medications like insulin emerging as a poster child for the issue. Nearly doubling in price from 2012 to 2016, the diabetes medication has commanded bipartisan attention on Capitol Hill and even a shoutout in a recent Netflix comedy special.

Voters say curbing such prices should be a top priority for lawmakers — and Democratic presidential candidates are paying attention.

At an April 22 CNN town hall, Sen. Kamala Harris (D-Calif.), among the field of Democrats vying for the 2020 nomination, responded to a health care question by spotlighting insulin’s spiraling price tag.

“One out of 4 diabetes patients in our country cannot afford their insulin,” she said.

That would be a shockingly high number, researchers point out, and could become a talking point Democrats return to throughout the campaign season. The cost of insulin particularly resonates given diabetes’ incidence rates.

According to the American Diabetes Association, about 1.25 million Americans have Type 1 diabetes —less common than Type 2 — and cannot live without insulin.

With that in mind, we decided to dig in to see if Harris’ statement checks out.

Three Different Datasets Back Harris’ claim

When asked about this particular statement, Harris’ campaign first cited a peer-reviewed study published in December, which looked at people with diabetes being treated at the Yale Diabetes Center in New Haven, Conn. Of 199 participants, 51 people — just over 25% — reported they either reduced or stopped taking insulin because of the cost.

The study is small and limited to one metropolitan area. But it likely paints a more-or-less accurate picture nationally, three health care academic researchers said.

“The characteristics of the people that were included look reasonably well-distributed across measures we’d be thinking about, like age, insurance type, race, ethnicity,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University. “They probably are pretty much on target.”

The study also corresponds with other surveys, though they too have limitations.

One, commissioned by the American Diabetes Association and made public last May, polled about 530 people online whose demographics corresponded to the national data of people with the illness. About 27% of respondents suggested the price of insulin had “affected their past year purchase or use of insulin.”

There is also an online opt-in survey administered by T1 International, an advocacy group for people with diabetes. Its 2018 results and methodology are undergoing peer review and have not yet been published in full, said James Elliott, one of the organization’s trustees. He suggested it would likely ultimately support Harris’ “1 out of 4” talking point.

There’s Some Extrapolation, But The Point Is ‘More True Than Not’

The caveat is that Harris’ comment is based on limited data, and only one of the papers has been peer-reviewed.

Though insulin’s price has skyrocketed in recent years, no sizable national survey or study has tracked insulin affordability, said Dr. Jing Luo, an instructor at Harvard Medical School who was involved with the Yale study and has researched insulin pricing more generally.

That perhaps limits any effort to make an argument about insulin access nationwide, or at the very least requires some extrapolation.

That said, the 1-in-4 figure is “more true than not,” Luo said.

“It’s as accurate as the data available allows,” Luo said. “It’s a reasonable estimate. Really, there’s no data to suggest otherwise.”

We also asked about Harris’ specific word choice: “cannot afford their insulin.” All the research examining this issue doesn’t ask that precise question, but rather, asks if the cost has resulted in a patient’s purchasing or using less medication.

That, analysts said, is, in fact, a good proxy for whether people can’t afford insulin. And it may understate the problem, said Dr. Kasia Lipska, the endocrinologist who led the Yale study, since it doesn’t account for people who keep buying medication but skimp on groceries or other necessities as a result.

Our Ruling

The lack of a national study is an issue, for sure, and to some extent limits the extent to which we can put stock in Harris’ 1-in-4 figure. It’s also important to remember that it refers to a narrower group — only patients with Type 1 — rather than all people with diabetes.

But experts broadly suggested that the findings in the three reports referenced — one peer-reviewed academic paper and two surveys — amply support her claim. And the broad meaning of the phrase “cannot afford” means the problem could be more significant than these datasets suggest since they measure only people going without medication, not those for whom insulin prices maybe create other financial issues.

This statement is accurate but needs some additional information. We rate this claim Mostly True.

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U.S. measles outbreak triggers quarantine at two Los Angeles universities

LOS ANGELES (Reuters) – A nationwide measles outbreak has led health officials to quarantine dozens of people at two Los Angeles universities, officials said on Thursday.

The quarantine affects the University of California, Los Angeles (UCLA) and California State University, Los Angeles (Cal State LA) and comes as the United States battles the highest number of measles cases since the country declared the virus eliminated in 2000.

The United States has confirmed 695 cases of measles, the U.S. Centers for Disease Control and Prevention said on Wednesday. Many of the case occurred in the states of New York and Washington.

California has confirmed 38 cases, state health officials have said.

The people ordered quarantined at the two California campuses were exposed to measles and could not provide evidence they had been immunized against the disease, the Los Angeles County Department of Public Health said in a statement.

“Both universities are assisting with the implementation of quarantine orders and determining how best to support students who must be quarantined and who live on campus,” the Department of Public Health said.

At Cal State LA, the quarantine is related to a measles exposure at a library on April 11. The quarantine initially affected about 200 employees, including some student-employees, the university said in a statement.

That number was later reduced to 156 people, the Department of Public Health said in an email on Thursday, and the quarantine will end in a week.

At UCLA, 119 students and eight staff members who were exposed to measles at the campus earlier this month and could not provide proof of immunity were ordered quarantined on Wednesday, the university said in a statement.

Since then, officials have released more than 40 people from the quarantine after establishing they had immunity. The UCLA quarantine will end by Tuesday, according to the Department of Public Health.

Slideshow (2 Images)

The virus can lead to deadly complications, but no measles deaths have been reported in the latest U.S. outbreak.

U.S. public health officials have blamed the nationwide outbreak, which coincides with a global rise in the prevalence of the disease, in part on the spread of misinformation about the safety of vaccines.

Although the disease was eliminated from the country in 2000, meaning the virus was no longer continually present year-round, outbreaks still happen via travelers coming from countries where measles is common, the U.S. Centers for Disease Control and Prevention says.

Reporting by Alex Dobuzinskis; editing by G Crosse and Leslie Adler

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Factbox: What you need to know about the U.S. measles outbreak

(Reuters) – The United States so far this year has recorded 704 cases of measles in 22 states, its largest outbreak since public health officials in 2000 declared the disease eradicated, according to the Centers for Disease Control and Prevention.

FILE PHOTO: A vial of the measles, mumps, and rubella virus (MMR) vaccine is pictured at the International Community Health Services clinic in Seattle, Washington, U.S., March 20, 2019. REUTERS/Lindsey Wasson

The CDC on Monday released updated figures on the number of cases recorded so far this year, which have hit a 25-year-high.

Here are key facts about the outbreak:

– Public health officials blame the measles resurgence on the spread of misinformation about vaccines. A vocal fringe of parents opposes vaccines, believing, contrary to scientific studies, that ingredients in them can cause autism.

– The largest outbreaks are concentrated in Orthodox Jewish communities in New York City’s Williamsburg neighborhood, where some 390 cases have been confirmed, and Rockland County north of New York City, which has recorded 202 cases. Those figures include infections from last year and are not directly comparable to the CDC numbers.

– Other outbreaks have been reported in Washington state, New Jersey, California’s Butte County and Michigan.

– The disease is highly contagious and can be fatal, killing one or two of every 1,000 children who contract it, according to the CDC. It can also cause permanent hearing loss or intellectual disabilities. It poses the greatest risk to unvaccinated young children.

– The United States’ 2000 declaration that measles was eradicated meant that the disease was no longer present in the country year round. Measles remains common in some countries in Europe, Asia and Africa, and unvaccinated travelers to those countries can bring it back to the United States. The current outbreaks are believed to trace back to visits to Israel and Ukraine.

– New York City officials said some 21,000 people have received the measles-mumps-rubella vaccine in affected areas since the outbreak began in October. The city has begun fining unvaccinated adults.

– Lawmakers in Oregon, California and Washington state are considering bills to eliminate nonmedical exemptions that allowed unvaccinated children to attend public schools.

– In order to achieve herd immunity that protects those unable to get the measles vaccine, such as infants and people with compromised immune systems, 90% to 95% of the population needs to be vaccinated.

Sources: U.S. CDC, World Health Organization, public health offices in New York State and City, Washington state, California and Michigan

Reporting by Scott Malone; Editing by Bill Berkrot

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U.S. measles outbreak raises questions about immunity in adults

(Reuters) – Adults in the United States who were vaccinated against measles decades ago may need a new dose depending on when they received the shot and their exposure risk, according to public health experts battling the nation’s largest outbreak since the virus was deemed eliminated in 2000.

FILE PHOTO: A vial of the measles, mumps, and rubella virus (MMR) vaccine is pictured at the International Community Health Services clinic in Seattle, Washington, U.S., March 20, 2019. REUTERS/Lindsey Wasson/File Photo

Up to 10 percent of the 695 confirmed measles cases in the current outbreak occurred in people who received one or two doses of the vaccine, according to the U.S. Centers for Disease Control and Prevention.

The figure illustrates what can happen when a large number of individuals, even those who have been vaccinated, are exposed to the measles. CDC recommends that people who are living in or traveling to outbreak areas should check their vaccination status and consider getting a new dose.

Dr. Allison Bartlett, an infectious disease expert at the University of Chicago Medicine, said the “continued vulnerability to infection” is why high-risk adults such as healthcare workers are routinely advised to get a second dose of the measles vaccine if they have not had one.

But knowing your vaccination status can be tricky, experts said.

“It’s complicated and often futile because it’s very difficult to resurrect those old records,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center.

People vaccinated in the United States since 1989 would most likely have received two doses of the combined measles, mumps and rubella (MMR) shot under federal guidelines, and that is still considered the standard for protection.

Anyone vaccinated between 1963 and 1989 would likely have received only one dose, with many people immunized in the earlier years receiving an inactivated version of the virus. Americans born before 1957 are considered immune as they would have been exposed to the virus directly in an outbreak.

Merck & Co Inc is the sole U.S. provider of the MMR vaccine. The company said in a statement that it has “taken steps to increase U.S. supply” of the vaccine due to the current outbreak.

HIGHLY CONTAGIOUS

The measles virus is highly contagious and can cause blindness, deafness, brain damage or death. It is currently spreading in outbreaks in many parts of the world.

According to the World Health Organization, 95 percent of a population needs to be vaccinated to provide “herd immunity,” a form of indirect protection that prevents infection in people too young or sick to be vaccinated. U.S. public health officials have blamed the current outbreak in part on rising rates of vaccine skepticism that have reduced measles immunity in certain communities. 

For travelers to outbreak areas abroad, the CDC recommends adults consider getting another dose of MMR unless they have proof of receiving two prior doses, take a blood test showing immunity, or were born before 1957.

In general, the CDC says two doses of the measles vaccine should provide 97 percent protection; one dose should offer 93 percent protection. However, immunity can wane over time.

This has occurred even in adults with two documented doses of the vaccine, said Dr. Michael Phillips, chief epidemiologist at NYU Langone Health, which serves parts of New York City, a hot spot in the U.S. outbreak.

FILE PHOTO: An illustration provides a 3D graphical representation of a spherical-shaped, measles virus particle studded with glycoprotein tubercles in this handout image obtained by Reuters April 9, 2019. Centers for Disease Control and Prevention (CDC)/Handout via REUTERS/File Photo

He said in kids, “the vaccine is really effective,” but in some adults, memory T-cells, which recognize and attack germs, do not fight the virus as effectively as they once did.

Rapid blood tests are available that can detect whether a person is immune based on the level of measles antibodies, but the tests are not 100 percent reliable.

Adults who have any doubt about their immunity should get another dose, Schaffner said: “It’s safe. There’s no downside risk. Just roll up your sleeve.”

Reporting by Julie Steenhuysen in Chicago; Additional reporting by Mike Erman and Gabriella Borter in New York; Editing by Lisa Shumaker

Our Standards:The Thomson Reuters Trust Principles.

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