By Lisa Brown
Vaccines are safe and effective
The large ongoing measles outbreak linked to Disneyland in California is a topic of discussion in nearly every newspaper, news blog, and other journalistic outlet across the country, as well as on personal blogs and websites that either support or negate the value of vaccination. At last count, there were 121 cases of measles in 17 states and the District of Columbia, and 80 percent occurred among unvaccinated individuals. Although it’s difficult to keep up with the constant flow of new material, the main story is about vaccination—are you for it, or against it? This type of coverage may have the unintended effect of confusing vaccine-hesitant parents by exaggerating the true size of the antivaccination movement and by giving potentially confused parents reason to believe that choosing whether or not to vaccinate their child is an important controversy worthy of debate. It’s not. Nothing about vaccination is controversial.
Here are the facts:
Vaccine-preventable diseases are dangerous. Prior to widespread childhood vaccination, measles infected three to four million people in the United States every year; this is approximately 100 times the population of the Boston University student body. Among those infected, 500 died, 48,000 were hospitalized, and 1,000 had permanent brain damage from measles encephalitis annually. Worldwide, 146,000 people still die from the disease each year.
Vaccination is safe. US federal laws require extensive clinical testing before a vaccine is licensed, and vaccines cannot be licensed unless their potential benefits clearly outweigh their risks. Once in use, the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and independent researchers continually monitor vaccinated individuals to ascertain previously unseen rare reactions or increases in known reactions and to identify individual vaccine lots with unusual events. If a problem is detected, the CDC and the FDA initiate decisive action such as immediate withdrawal of a vaccine recommendation, as was done in 1998 following the identification of a small, but larger than expected, number of cases of a rare side effect known as intussusception less than a year after the introduction of a new rotavirus vaccine.
Vaccination is effective. Measles, mumps, and rubella (MMR) vaccination is 97 percent effective against development of measles. Since the introduction of measles vaccine in the United States in 1963, there has been a 99 percent decline in the incidence of measles and a 100 percent decline in measles deaths due to the combined effects of individual vaccination and the herd immunity that has been afforded to those who are too young or too ill to be vaccinated. Until recently, there were only 50 to 100 measles cases per year in the United States, and all of these cases were attributed to importation of measles from other countries.
The American public is overwhelmingly in favor of vaccination. For the past 15 years, the United States has consistently achieved or exceeded the public health target of 90 percent vaccination for each of the recommended childhood vaccines. At the start of the 2013–14 school year, 95 percent of kindergartners were appropriately vaccinated against measles, and only 1.7 percent of children had evidence of a nonmedical vaccine exemption. In a study based on a nationally representative sample of parents of two-to-three-year-old toddlers, even parents who chose to follow a delayed vaccine schedule showed strong support for vaccination: 95 percent of parents who delayed at least one of their child’s vaccines believed that “vaccines are necessary to protect the health of children.”
What is controversial is knowing the best approach to address the concerns of vaccine-hesitant parents. Vaccine-hesitant parents represent a heterogeneous group of parents, who because they love their children very much may purposely delay or avoid certain vaccines because they have concerns about vaccine safety. There are three notable things about vaccine-hesitant parents. First, there are more vaccine hesitators than vaccine refusers. Second, vaccine-hesitant parents typically have moderate concerns and do not reject vaccination completely. Third, these parents often seek out vaccine information and are influenced by what they find.
Meaningful research that specifically addresses the needs of vaccine-hesitant parents is just beginning, and in a few years we will know more. In the meantime, there are reports suggesting that constant attention on vaccine refusers may lead vaccine-hesitant parents to wrongly infer that the antivaccination movement is mainstream. But it’s not. In order for this message to be heard, we need to refrain from participating in relentless debates that often include trading insults with semianonymous online commentators and to instead engage in respectful conversations with our family, our friends, and the occasional random acquaintance who exists in our social network. As we engage in conversation, we should remember that vaccination is not controversial, but how we perceive what we are told about vaccination can be.
“POV” is an opinion page featured on BU Today that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international.
Kimberly Shea is a School of Public Health assistant professor of epidemiology. Her research interests include the epidemiology of infectious diseases, especially the epidemiology of vaccine-preventable diseases and the post-licensure effectiveness of vaccination. She can be reached at email@example.com
Members of the Medical Campus are invited to the Feb. 6 Cancer-focused Seminar Series (CFSS). The goal of the CFSS is to promote interaction and collaboration of cancer researchers across the Medical and Charles River campuses. Three talks will be presented at this seminar.
- Tracy Battaglia, MD, MPH, Battaglia Lab, “Repairing the Disconnect: Optimizing Cancer Care Delivery Through Patient Centered Research”
- Charina Ortega, Dominguez Lab, “Mining CK2 in Cancer”
- Kevin Chandler, PhD, Costello Lab, “Studying Posttranslational Modifications of Vascular Endothelial Growth Factor Receptor 2 (VEGFR-2) in Tumor Angiogenesis
What: Cancer-focused Seminar Series
When: Friday, Feb. 6, Noon-1:15 p.m.
Where: BUSM Instructional Building, L-110
Mark your calendar for future seminars March 6, April 3, May 1. All future seminars will take place noon-1:15 p.m. in Bakst Auditorium.
Sugarcane workers in northwestern Nicaragua experienced a decline in kidney function during the harvest, with field workers at greatest risk, suggesting that heat stress or other occupational factors may be playing a role in the high rates of chronic kidney disease in the region, a new study led by School of Public Health researchers shows.
The study, published online in the International Journal of Occupational and Environmental Health, is a step toward identifying factors contributing to an unexplained epidemic of chronic kidney disease (CKD) in Central America that disproportionately affects young, male agricultural workers.
BU researchers have been working since 2009 to uncover the causes of the epidemic, which has claimed the lives of at least 20,000 people in Central America in the last two decades. The illness is not related to diabetes or hypertension—the most common drivers of kidney disease in the United States.
The research team recruited 284 Nicaraguan sugarcane workers performing seven different tasks. They measured urine albumin and serum creatinine and estimated glomerular filtration rate—markers of kidney function—both before and towards the end of the harvest season. Workers were queried on the quantity of water and electrolyte solution packets they consumed during a typical workday. The mean age of the workers was 33.6; most were men.
The researchers found that kidney function declined during the six-month harvest season and varied by job category, and that workers with longer employment duration had worse kidney function. Over the harvest season, the decline in kidney function was greatest among seed cutters, irrigators, and cane cutters—jobs that require strenuous labor in a hot and humid environment. The results provide evidence that one or more risk factors for the disease are occupational, the authors said.
The research team said that inadequate hydration also might play a role. While there was no effect of water or electrolyte solution consumption on kidney function among all workers, the study did find a protective effect of electrolyte solution consumption among the cane cutters—workers who have the heaviest workload.
The results are “consistent with the hypothesis that heat stress and dehydration may play a role in (kidney disease),” the researchers said. They said further study is needed to directly measure workers’ exposures to heat and dehydration, rather than using job categories as a surrogate exposure measure.
The study did not find support for the hypothesis that agricultural chemicals are a causal agent for kidney disease. Instead, among field workers, agrichemical applicators, who have the most direct contact with chemicals, were found to experience the smallest decline in kidney function.
Still, the authors said, “Agrichemicals are used extensively in the region and widely believed among community members as the cause of the epidemic.” They noted that in September 2013, El Salvador’s National Assembly voted to ban 53 agrichemicals due to the perceived link to CKD.
“Agrichemicals, therefore, remain an important hypothesis and warrant further study,” the researchers wrote.
The research team is now planning a new study to quantify exposure to heat and agrichemicals among manual laborers, including sugarcane workers, in Central America, and to determine whether those exposures are associated with kidney injury.
Authors on the study from SPH included: Rebecca Laws, a doctoral student in environmental health; Madeleine Scammell and Michael McClean, associate professors of environmental health; and Daniel Brooks, associate professor of epidemiology. Researchers from Tufts Medical Center, VA New York Harbor Healthcare System and Department of Medicine, Universidad Autónoma de Madrid, and Yale University contributed.
Funding for the study was provided by the Compliance Advisor/Ombudsman (CAO) of the World Bank Group and the Comite Nacional de Productores de Azucar. The CAO managed all funds and maintained the contract to conduct the research.
Submitted by Lisa Chedekel
Research Associate Professor in the Department of General Dentistry Dr. Sok-Ja Janket and Group Practice Leader and Assistant Professor in the Departments of General Dentistry and Periodontology Dr. Eleni Kanasi contributed a chapter to a new book titled, Infection and Autoimmunity, 2nd Edition, which was published by Elsevier in January 2015.
Their chapter titled, “Oral Infections and Autoimmune Diseases,” discusses the potential causal role oral infections may play in triggering the pathogenesis of autoimmune diseases. Highly associated with genetics and oral infections, autoimmune diseases may be involved in the pathogenic mechanism in genetically susceptible individuals. Many autoimmune diseases manifest in the oral cavity, and while dentists are familiar with identifying and managing the symptoms, looking at the oral infection as the causative factor is a new concept. The chapter was co-authored by Dr. Alison Baird, a professor at the SUNY Downstate Medical Center. Dr. Baird is a neurologist and longtime collaborator with Dr. Janket.
The pathogenesis of autoimmune diseases involves the development of naïve T-cells into Th17 cells and leads to disease with the help of the multiple transcription factors and cytokines also expressed in oral infections. The chapter describes the molecular biology of oral infections in the framework of autoimmune pathogenesis and provides evidence of a causal relationship between oral infections and various autoimmune diseases including atherosclerosis, rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, antiphospholipid syndrome, Sjögren’s syndrome, and Crohn’s disease.
Dr. Janket was invited to write this chapter by the president of the Congress, Dr. Yehuda Shoenfeld, at the 9th International Congress on Autoimmunity last spring, after giving a well-received presentation on how salivary immunoglobulin can predict autoimmune diseases such as type 1 Diabetes. Animal modeling is a major component of the research to elucidate the pathogenesis of complex disease like autoimmune diseases, and Dr. Janket’s expertise as an epidemiologist is essential in order to translate the results from animal and in vitro studies for human populations.
Drs. Janket and Kanasi are thrilled to have their work published in such a highly regarded textbook on the interactions between infectious agents and autoimmunity. “It is great honor to be included in this textbook with so many accomplished colleagues.” said Dr. Janket.
If you are interested in picking up a copy of the book, contact Dr. Sok-Ja Janket at firstname.lastname@example.org
Provided by GSDM Communications office.
Boston University School of Medicine has developed an affiliation with Northern California Kaiser Permanente to offer two new clinical clerkship sites for our third-year medical students.
Beginning in May 2015, 12 third-year students will begin their clerkships at Kaiser Permanente Medical Centers in San Jose and Santa Clara. After an orientation with their classmates in Boston, six will stay for a full year, while six will stay for six months. Students will rotate in family medicine, OB/GYN, internal medicine, psychiatry and neurology at the San Jose site and in pediatrics, surgery, radiology and psychiatry at the Santa Clara site. Although this program is new for BU, Kaiser has a strong and well-established medical education framework that includes students from Stanford, UC-San Francisco, UC-Davis and Drexel.
In addition to an excellent clinical experience, the Kaiser Campus Third-Year Curriculum Program will expose students to Kaiser’s healthcare technology, preventive medicine and progressive healthcare delivery model. Students will participate in quality improvement training programs, master their electronic health system, and develop their own quality improvement projects.
Kaiser has revolutionized health care and health-care technology, providing more immediate and responsive patient care. A leader in patient safety and quality improvement, the Kaiser system has been the model for the future of medicine. Their focus on preventive care and an outpatient-centered care model reduces hospital admissions and testing.
“We are delighted to offer our students the opportunity to work in another innovative and evidenced-based system that is committed to high-value, high-quality medical care,” said Karen Antman, MD, BUSM dean and provost of the BU Medical Campus.
Despite the distance from Boston campus, students will receive uniform didactic instruction. Program Manager Monica Parker-James is coordinating the online educational experiences. Recorded lectures can be reviewed at the student’s convenience. The students also will be able to participate in live small-group discussions and case vignettes with Microsoft Lync access.
Microsoft Lync is a platform for unified communications including online meetings, instant messaging, audio and video calls, availability info and sharing capabilities.
Dr. Harley Goldberg, who has a long history of service in the Kaiser system and is involved in quality evaluations at San Jose, will coordinate the training and supervision of our students in California. He will work with students via video conferencing prior to June and will orient and mentor the students during their time in the Kaiser facilities. He has worked closely with the BUSM Kaiser Committee and clerkship directors to provide a seamless transition for the students.
Assistant Dean Paige Curran in the Office of Student Affairs will monitor student mental and physical health and support academic and career development through online communication and quarterly visits to California.
The BUSM students will have faculty support while in California and many will also be close to family and friends. In addition, we are planning a California BUSM alumni network for additional student support, mentoring and career development. Several alumni have already expressed interest, including Veronica Santini, BUSM class of 2000, an assistant professor of neurology at Stanford.
“We are impressed by how vested our counterparts in California are in making this a successful partnership,” said Anna Hohler, MD, assistant dean of academic affairs at BUSM. “This collaboration is a win-win. Kaiser will work with students who are smart, dedicated and professional. Our students will train in a leading health care system that shares our commitment to high-quality medical education, devotion to diverse patient populations and a vision for excellence in health care. We are thrilled to be able to offer this opportunity to our students.”
Researchers from Boston University’s Slone Epidemiology Center have developed a breast cancer risk prediction model for African- American women that found greater accuracy in predicting risk for the disease. The use of this model could result in increased eligibility of African Americans in breast cancer prevention trials.
The effectiveness of breast cancer prevention and early detection strategies depends in part on the ability to accurately identify individuals at increased risk of the disease. Models for predicting absolute risk of breast cancer have been used for chemoprevention decision-making and for determining eligibility for recruitment into prevention trials. The well-respected Gail Model has been used widely for breast cancer risk prediction in white women but has been shown to underestimate risk in African-American women. Underestimation of risk for African-American women has contributed to their underrepresentation in breast cancer prevention trials.
Researchers used prospective data from 55,000 African-American women age 30-69 at baseline in the Boston University Black Women’s Health Study to develop a breast cancer risk prediction model specifically for African-American women. It included family history of breast cancer, history of benign breast disease, age at menarche, age at first birth, bilateral oophorectomy, oral contraceptive use, hormone use, body mass index at age 18 and adult height.
“The model was well calibrated in that it predicted 486 cases in comparison to an observed 506 cases during the additional five years of follow-up,” explained senior author Julie Palmer, senior epidemiologist at Boston University’s Slone Epidemiology Center and professor of epidemiology at Boston University School of Public Health. “Based on the Black Women’s Health Study model, 14.6 percent of women age 30-69 were predicted to have a five-year risk of at least 1.66 percent. This is considerably higher than the proportion predicted by previous models to be above that end point,” said Palmer.
According to the researchers previous breast cancer risk prediction models for African-American women have used information on only a few factors and may have underestimated risk. “The new model appears to improve prediction and, if used for determining eligibility for entry into prevention trials, would likely result in a greater number of African-American women invited to enroll in the trials,” she added.
Funding for this study was provided by the Susan G. Komen for the Cure Foundation and the National Cancer Institute.
Jan. 26 Exploring the Role of Social and Cultural Determinants Influencing Latino HIV and Substance Abuse Health Disparities
BU Medical Campus faculty, residents and PhD students are invited to a colloquium sponsored by the BU School of Social Work. Join Mario De La Rosa, PhD, Professor at Florida International University, Miami as he discusses “Exploring the Role of Social and Cultural Determinants Influencing Latino HIV and Substance Abuse Health Disparities” on Monday, Jan. 26 at 10:45 a.m. Dr. De La Rosa is a candidate for the inaugural Director of the Center for Innovation in Social Work and Health. A luncheon will immediately follow the colloquium, RSVP required by Jan. 22 to email@example.com
- “Exploring the Role of Social and Cultural Determinants Influencing Latino HIV and Substance Abuse Health Disparities”
- Mario De La Rosa, PhD, Professor at Florida International University, Miami
- Colloquium: Monday, Jan. 26, 10:45 a.m.
- Hiebert Lounge, BUSM Instructional Building
- Luncheon following colloquium, RSVP required by Jan. 22, firstname.lastname@example.org
Making the Case-The Added Values of Social Work in Health Care and Service Delivery, Jan 12 Colloquium
BUMC faculty and PhD students are invited to attend a colloquium presented by Darrel Wheeler, PhD, MSW, MPH, Dean and Professor at Loyola University, Chicago. Dr. Wheeler is a candidate for the inaugural Director of the Center for Innovation in Social Work and Health and he will speak on “Making the Case-The Added Values of Social Work in Health Care & Service Delivery.”
- Monday, Jan. 12
- Colloquium: 10:45 a.m.-noon
- Lunch: noon- 1 p.m
- Hiebert Lounge, BUSM Instructional Building
BUMC Faculty and PhD students, RSVP to Patty Frasso by Thursday, Jan. 8 email@example.com
Jan. 22 Celebrate the Legacy of Martin Luther King, Jr., ” The Enduring Legacy and Lessons of MLK: From Birmingham to Ferguson”
All members of the BU Medical Campus are invited to a special presentation commemorating the legacy of Rev. Martin Luther King, Jr.
Kermit A. Crawford, PhD is a forensic psychologist and associate professor of Psychiatry at BU School of Medicine. He is the Executive Director of the Massachusetts Marathon Bombing Victims/Survivors Resiliency Center and the Director of the Center for Multicultural Mental Health, providing leadership across the nation in the aftermath of disasters, ranging from Sept. 11, 2001, to the Boston Marathon bombings.
Crawford has been honored with a doctorate from Boston College, as well as a doctoral degree of humane letters from the Massachusetts School of Professional Psychology. He has a variety of peer-reviewed publications and book chapters, and is the recipient of the Commissioner’s Excellence Award, the 2012 Excellence in Diversity Training Award from APPIC, the 2012 American Psychological Association’s Minority Fellowship Program James Jones Lifetime Achievement Award and the 2014 Culturally and Linguistically Appropriate Services Individual Award. He also has made presentations on culturally competent practices in mental health at several acclaimed national organizations.
Following Dr. Crawford’s presentation, a musical performance sponsored by the Boston University Medical Campus Arts Program, will feature BMC patient Joseph Payne (vocals) and Moisès Fernández Via (piano).
Celebrate the Legacy of Martin Luther King, Jr.
- Speaker: Kermit A. Crawford, PhD
- Topic: The Enduring Legacy and Lessons of MLK: From Birmingham to Ferguson
- Date: Thursday, Jan. 22
- Time: 12:30-1:30 p.m.
- Location: Keefer Auditorium
This event is brought to you by BUSM Office of Diversity and Multicultural Affairs in collaboration with BU Goldman School of Dental Medicine Office of Diversity, BU School of Public Health, BMC Human Resources Department and the BMC Minority Recruitment Program.
A Forum on the US Senate’s Committee Study of the CIA Interrogation Program
The release of the Senate’s Report on CIA Post-9/11 Interrogation Methods and Results has created wide-ranging debate on the use of torture, the results of torture (both in terms of intelligence obtained and harm done to the prisoners), and the role of physicians, psychologists and health care providers in the CIA’s torture and interrogation programs. Panelists will address these issues, national and international law on torture, the relevance of the Nuremberg Principles, applicable medical ethics standards regarding the physician’s role in torture and prison medicine, and what health and medical-related obligations, if any, the US owes.
Panelists: Sondra Crosby, MD, Michael Grodin, MD, George Annas, JD
Moderator: Leonard Glantz, JD
When: Tuesday, Dec. 16, 4-5 p.m.
Where: Bakst Auditorium
Sponsored by the Department of Health Law, Bioethics & Human Rights, BU School of Public Health and Global Lawyers & Physicians.