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Inside the public health campaign to stop polio in New York’s Jewish community

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Imagine you’re an epidemiologist, tasked with convincing a dubious public about the spread of a dangerous disease that could have devastating consequences for those who contract it — but so far, only one person has gotten seriously ill from it. In the meantime, it circulates undetected, a silent stalker. People forget about the disease. They move on to issues that feel like more immediate concerns in their lives.

That’s the challenge public health experts and educators face in New York’s Rockland County, where a young man contracted polio over the summer, leaving him paralyzed. It was the first paralytic polio case in the United States in nearly a decade. Before polio vaccines were developed in the 1950s, the disease paralyzed roughly 16,000 people a year in the U.S.

“We’re asking people, please, pull a fire alarm in a large building, which will cause a humongous response. But do so because they tell you there’s a fire, but you don’t smell smoke, you don’t see flames and no one is saying fire,” said Shoshana Bernstein, a writer and health educator who lives in Monsey, a heavily Jewish city in Rockland County. “That’s what polio is. There’s no sign of polio anywhere.”

She means there’s no visible sign of polio, but epidemiologists have been tracking wastewater in the area for months, finding indications that the virus is still circulating in the area. (Traces of poliovirus come out in people’s fecal matter.)

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“We can detect it in the sewage, and indeed, in five counties across many, many months, we’ve been continually detecting poliovirus up until right this month,” said Eli Rosenberg, deputy director for science in the office of public health at the New York State Department of Health. “We have ongoing evidence of circulation in the community, and that means it’s essentially a matter of time until we see more paralytic cases.”

The patient was identified in local media reports as an unvaccinated Jewish man in his 20s, touching off a massive vaccination campaign in the area, where vaccination rates are far lower than state and national averages.

But at a time when distrust of public health officials is high, and people are tired of living through other public health emergencies, reaching a skeptical public is difficult. Public health officials are instead taking a bottom-up approach that engages local leaders and doctors, and intends to avoid stereotyping the Orthodox community, which is in part a corrective to how the public health apparatus handled recent measles outbreaks and the COVID-19 pandemic.

“Vaccine hesitancy is not a Jewish thing. It is a national issue,” said Bernstein. Vaccine skepticism has increased across the board since the COVID-19 pandemic.

“We’re trying to take, I think, a little more of a softer approach, but still benefiting from all the lessons learned,” Rosenberg acknowledged. He pointed out that when New York ended religious exemptions for vaccines in 2019, it did lead to an increase in vaccination rates. But it had negative consequences, too. “That was effective, but it has also sowed some distrust, or some resentment. No one likes being told what to do,” added Rosenberg.

Bernstein, who has worked with public health authorities since the 2015 measles outbreak, agrees that the approach has changed. “There’s definitely a focus on getting health education into the community in a culturally sensitive manner,” she said. “There’s definitely an understanding of the need to shift to the community level, because from the top down is not working. We need to connect with people across every spectrum and across the entire nation at a level that resonates with each community.”

The New York State Department of Health estimates that between 5,000 and 10,000 people have been infected with the poliovirus, which is believed to have been acquired locally. (A similar strain of the virus was found in wastewater in Jerusalem and London, leading authorities to suggest someone may have brought it back into the U.S.)

Some countries, including Israel, use a version of the polio vaccine that exposes recipients to the live virus, which on rare occasions can allow it to spread. Vaccinated people can still contribute to the spread of polio, although they will not get sick from it.

“If they have been vaccinated, they wouldn’t be paralyzed, but they could potentially be participating in transmission,” said Kimberly Thompson, a polio expert who founded a nonprofit called Kid Risk, which researches global transmission of the virus. “We look at a place like Rockland County, the Hasidic Jews there, and Haredim in general, the low vaccine coverage puts them at risk. And because there’s intense transmission potential in the population, anybody who’s unvaccinated up to any age is at risk.” People can receive the vaccine regardless of age, even if they missed it when they were a child.

The most urgent need when it comes to stopping the spread of polio is increasing vaccination rates. The state ran vaccination clinics throughout the summer in conjunction with local authorities and religious leaders, as well as health centers. “We’re not coming in visibly, loudly, you know, showing up with a truck that says CDC, or New York State on the side, but sort of taking a little more of a nuanced approach,” said Rosenberg.

According to state data, 60% of Rockland County residents have received the three doses of the polio vaccine by age 2, the recommended vaccination timeline. The statewide average is 79%, and the national average is 92%.

New York State’s response to the virus has focused on the Jewish community because that’s where the virus appears to be spreading, Rosenberg said — and not because of any animus toward those Orthodox communities where vaccination rates are lower.

“There are other groups for sure that are lagging behind,” said Rosenberg, noting that some immigrant communities have relatively low vaccination rates, too. “Our biggest concern is still in these Jewish communities, particularly because that’s where our data are pointing [to] the lowest coverages. We have these sort of zip code breakdowns, so we know where those areas of lowest coverage are.”

But a vaccination drive, even if effective, is not the only answer. There might be a fire right now, but the public health response to polio requires an understanding that vaccine education is an ongoing, never-ending priority.

“There’s no one single action or publication or outreach that’s going to seal the deal. It’s going to have to be an emergency response when there’s an emergency and a constant state of education. Constant. We can’t ever drop the ball on educating about vaccines,” said Bernstein, who is at the forefront of that work.

She worked with local, state and national public health authorities to create a booklet called “Tzim Gezint”, Yiddish for “to your health” (a phrase commonly used after a person sneezes). It offers a comprehensive, easy-to-digest overview of vaccines and why Orthodox families should vaccinate their children.

“​​It starts off with the Torah perspective from a rabbinical source that would resonate with the Satmar sect, which is the type of Hasidic people that live in Kiryas Joel,” said Bernstein. (The booklet was designed specifically for the Hasidic community in Orange County, 25 miles north of Monsey.) “It wasn’t focused on one vaccine. It was focused on the history, really educating the community on what a vaccine is. Why do we have it? Why is it good? How are they made?”

While it is adults who make decisions for their children, it is the children’s health that is at risk if they go unvaccinated. An animated video Bernstein produced, called “Dovi and Rochel Stay Healthy,” shows two young Orthodox children learning about how vaccines keep us healthy.

“Thank you Hashem, for giving us vaccines,” a young boy in tzitzit sings while riding around on a scooter.

Over the summer, more than a dozen Rockland County rabbis published an open letter urging people to get vaccinated. But local public health educators are also investing in making sure pediatricians and primary care physicians are also well-suited to prepare the benefits of vaccination to their patients.

“What we’ve heard from community members, from a lot of leadership, is actually that people want to hear from their doctors, and they actually will listen to what their pediatrician has to say around vaccination oftentimes more closely than what faith leaders and rabbis might have to say,” said Rosenberg.

The way to message it: “The health care professional that you trust to cure you when you’re sick,” said Bernstein, “should also be the person you trust to keep you healthy.”

Rosenberg said the state has seen a “modest bump” in vaccinations since opening the clinics this summer, although not the level they had hoped for. In the period from July 21 to October 31, 21% more polio vaccine doses were administered to children 18 years and younger in Rockland, Orange, Sullivan and Nassau Counties than in the year before, according to data submitted to the New York State Immunization Information System.

“As a Jewish epidemiologist helping to lead response efforts,” said Rosenberg, “we want to get ahead of this, to make sure that the Jewish community is a model of good health and protecting ourselves and our neighbors, and that those are things that are part of Jewish values.”

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Good Oral Health Crucial in People with Sickle Cell Anemia, Study Finds – Oral Health

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A new study from Saudi Arabia found that good dental health is vital for people with sickle cell anemia (SCA). The findings observed that multiple disease-causing bacteria were seen much more in the patients with poorer oral health than those with better oral health.

Patricia Valerio, PhD, noted, “The findings also indicated that patients with low levels of hemoglobin F – a type of hemoglobin normally produced during fetal development – had a significantly higher prevalence of harmful bacteria species than those who had higher levels of the protein.”

This research shows how important good oral hygiene is for patients with SCA and low hemoglobin F.

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Read more about this study from Sickle Cell Disease News.


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Respiratory viruses on decline: Province – Brandon Sun – The Brandon Sun

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Hospitalizations due to influenza, COVID-19 and respiratory syncytial virus (RSV) have all decreased in Manitoba, according to the province’s latest epidemiological respiratory virus surveillance report.

Data for the week of Jan. 15 to Jan. 21 indicates this respiratory virus season may finally be nearing its end, after it began earlier than usual and caused surges of severe illness and hospitalizations, particularly among babies and toddlers.

There were two flu-related hospital admissions that week, none requiring intensive care, while the Influenza A test positivity rate fell to 0.8 per cent, compared with 1.9 per cent the previous week. No cases of Influenza B have been detected provincially yet this season.

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There were 105 detected cases of RSV, with a weekly RSV test positivity rate of 8.3 per cent. The previous week, the test positivity rate for RSV was 8.7 per cent.

There were seven patients with COVID-19 in hospital, as well as three in intensive care. No new COVID deaths were reported, but the province retroactively updated its COVID-19 death toll. There were 15 deaths added to the total count last week, for an overall number of 316 Manitobans who lost their lives to COVID since this fall.

» Winnipeg Free Press

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Curious about intermittent fasting? Here's what experts say you should know – CBC.ca

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The Dose21:36What are the benefits of intermittent fasting?

Intermittent fasting is becoming more widely discussed, with research still emerging. This week, Dr. Jason Fung, a nephrologist and expert on intermittent fasting, shares his tips on who should fast and how to do it.

Intermittent fasting (IF) isn’t a new way to eat, but researchers and experts say it’s an area that has potential. 

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It is important to know that research on intermittent fasting “is still in its infancy,” said Amy Kirkham, an assistant professor in the University of Toronto’s clinical cardiovascular health department. She has also led several studies on time-restricted eating, a form of IF. 

Intermittent fasting is generally defined as the cycle of eating and then fasting. 

The length of fasting can vary, depending on the person or approach. 

“The idea is not deprivation or to go into excess, but to balance the feeding and the fasting because both are very essential for us,” Dr. Jason Fung, a nephrologist and author of several books on IF, told CBC’s The Dose guest host Dr. Peter Lin.

Anar Allidina, a registered dietitian based in Richmond Hill, Ont., says that intermittent fasting is “like a reset” for our bodies. The break from eating prompts our bodies to cleanse itself and get rid of more old cells, she adds. 

Fung and others say there is some promising research showing the health benefits of IF, like improved cardiovascular health.

Research has shown that many of the health benefits of fasting are usually seen between the 14 to 16-hour mark, says Allidina. 

“Studies have shown that during this time that you’re fasting, [it] can have really important markers in your metabolic health, for example with cholesterol, with blood sugars and inflammation. So it can really help with lowering those levels,” she said. 

But before you even consider fasting, Allidina and Fung emphasized that it isn’t for everyone. 

So if you’re interested, here’s what experts say you should know about intermittent fasting.

Is it safe?

For most people, it is absolutely safe to pause eating for periods of time, says Allidina. 

“Giving your body that break is absolutely OK and it’s actually good for you,” she said.

Those who shouldn’t try intermittent fasting are:

  • Anyone with a history of an eating disorder.
  • Anyone who is underweight or malnourished.
  • Pregnant women. 
  • Women who are breastfeeding.
  • Children. 

Allidina and Fung recommend speaking with your health-care provider before trying intermittent fasting.

Is there only one way to intermittently fast?

There are several different approaches to intermittent fasting. 

Time-restricted eating (TRE) is a common way as it limits when you eat your meals and snacks to a specific time period.

Experts say there aren’t hard and fast rules with intermittent fasting and that it can be adapted to your work or social schedule. (Mediteraneo/Adobe Stock)

Fung says the most common fasting strategy is 16 hours of fasting and eating within an eight-hour time period. 

“So you might eat for example from 11 a.m. to 7 p.m. or you might do it early, say 9 a.m. until 4 p.m. There’s various ways to do it, but that’s one of the more popular schedules,” he said.

Another approach is the 5:2 method, where you eat normally for five days and then restrict calories two days a week to about 500 calories a day for women and 600 calories for men. 

Alternate day fasting, or ADF, is when someone consumes food during an eight-hour period and then doesn’t eat the next day, which translates to roughly 36 hours of fasting. 

Fung adds there is flexibility with intermittent fasting.

“There’s pluses and minuses of all of those strategies. So it’s not like one is right and one is wrong. It’s finding what really works for you,” he said.

Are there health benefits?

Yes, but it depends on the length of the fast and fasting type.

Anecdotally, Fung and Allidina have heard from people who tried intermittent fasting that they feel more alert and energized, and less tired.

Research on other health benefits is varied. 

University of Illinois researchers who published a review of clinical trials found that the three major types of intermittent fasting — TRE, the 5:2 diet and ADF — can cause “mild to moderate weight loss” in those who were overweight and obese. 

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They said that mild to moderate weight loss was a change of about one to eight per cent from baseline. But, they said ADF and the 5:2 diet are “the only fasting approaches that produce clinically significant weight loss,” according to their review published in the peer-reviewed Annual Review of Nutrition journal in 2021.

They went on to say that these regimens “may also improve” some aspects of cardiometabolic health such as blood pressure.

Korean researchers who published their systemic review and meta-analysis in the peer-reviewed Nutrients journal in 2020 found that time-restricted eating can help some shed some pounds and have better cardiovascular health. 

Fung says people may lose weight while fasting because the body uses two different types of energy: sugar and fat. 

When the body runs out of glucose (the main type of sugar in the blood), it’ll turn to fat stores, a process known as metabolic switching. 

Yet, there is research — including a study published a week ago in the Journal of the American Heart Association — that suggests intermittent fasting approaches may not be better for weight loss than restricting calories. 

A study published in the New England Journal of Medicine last year showed that among 139 obese participants, time-restricted eating with calories restricted was “not more beneficial” than daily calorie restriction. 

Other researchers who led a randomized clinical trial and published results in 2020 found that time-restricted eating did not show significantly different weight loss nor cardiometabolic benefits compared to the controlled group. 

In another study published in 2017 in the peer-reviewed JAMA, researchers did not find alternate-day fasting better for weight loss or weight maintenance compared with daily calorie restriction. 

Kirkham says more studies on intermittent fasting are needed.

“We certainly do need more research to really fully understand all the different parameters and its potential health effects and certainly its safety within specific populations,” said Kirkham, who was recently awarded funding by Diabetes Canada to research which intermittent fasting period best impacts blood-sugar control.

More research is needed on intermittent fasting approaches, especially on the long-term effects, according to several researchers who have published studies.

If I want to try it out, how can I start?

Before anyone starts intermittent fasting, Allidina suggests people ensure their diet is full of essential nutrients.

“Once that’s done, then you can bring in the intermittent fasting slowly, starting with the 12-hour fasting and increasing it up to 14 to 15 to see how you feel with that,” she said. 

Poster of Canada's Food Guide in Misty Rossiter's office.
Before you start intermittent fasting, registered dietitian Dr. Anar Allidina recommends making sure your diet is made up of healthy foods and essential nutrients. (Kirk Pennell/CBC)

She adds that fasting doesn’t need to happen every single day in the beginning, as it will take time to build it into your schedule.

There are also free apps that can help people keep track of their intermittent fasting, Kirkham says.

Most people cope with the eating schedule change after that first week, she adds. When starting out, it’s important to remember that minor symptoms like headaches, feeling hungry or irritability are common.

“It may be a bit of a shock to the system initially, but I think if you try it for two weeks … and if you don’t feel better then maybe you have your answer,” said Kirkham.

“Like any health intervention, it’s not a one-size-fits-all.”

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