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The 1976 U.S. swine flu vaccinations may offer lessons for the COVID-19 pandemic – CBC.ca

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For Pascal Imperato, a communicable disease epidemiologist who in 1976 was in charge of immunizing New York City against a potential swine flu epidemic, the effort to vaccinate the population against COVID-19 feels like a familiar challenge.

“We were going to vaccinate six million people in six weeks,” he said in a phone interview. “And we were absolutely certain we could pull it off. And we would have.”

Would have, because, ultimately, the largest national immunization program that had ever been undertaken in the U.S. was cut short as the epidemic never materialized, and public skepticism about the program began to mount.

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Still, while the COVID-19 pandemic is very real, and the population is much larger, the vaccination program of 1976 may offer some lessons as governments around the world prepare to inoculate the public at large.

“If the program is well organized, mobilizing all of the resources that are capable of administering this vaccine, there [shouldn’t] be any problem whatsoever,” Imperato said. 

In March 1976, the administration of then president Gerald Ford launched a $137 million US nation-wide vaccination program to immunize every American citizen by the end of the year.

The diagnosis of swine flu on a New Jersey army base had led to panic among top U.S. scientists and officials who feared the disease could spread and potentially precipitate a health crisis similar to the deadly Spanish flu outbreak of 1918.

Even though it was cut short, by December 1976 more than 40 million Americans — about one-fifth of the population — had been vaccinated, and about 650,000 in New York City.

Utilizing volunteers, setting up sites

Imperato said that on any given day they had about 900 people who were involved in getting the vaccine out to the general public. That included 500 to 600 volunteers who were recruited each day through the city’s chapter of the American Red Cross.

University graduates, sanitary inspectors and public health nursing assistants were also hired and trained to use automatic jet injectors and to give cardiopulmonary resuscitation. 

Sixty vaccination sites were established in places that included schools and police precincts.

“Anywhere we could,” said Imperato, who is the founding dean and distinguished service professor at SUNY Downstate Medical Center School of Public Health.

Mary O’Brien, 77, resident of the St. Augustine Home, Chicago, winces as she is inoculated against the swine flu in 1976. (Bettmann Archive/Getty Images)

As well, 15 mobile teams were created to vaccinate over 40,000 people in more than 200 nursing homes and about 100,000 people in 150 senior citizen centres.

“This required military organization, if you will, and we were able to put together a team and put into place the people that we needed to bring this about,” he said.

A great deal of administrative and clerical support goes into a program of this kind, he said.

“We have to have people register. We had to have as much information about them as possible, because we needed to know who we were vaccinating and if any of them had any reaction. We had to have teams of people checking on adverse events.”

Local capacity can be the ‘weak link’

Nationwide, however, there  were some logistical problems, said Harvey Fineberg, a physician who was tasked with co-authoring a review into the 1976 Swine flu vaccine program.

The actual immunizations were quite erratic in their frequency in different communities, he said.

“So a lesson that’s still relevant today, whether in different provinces in Canada or different states and counties and the U.S., is the local capacity,” he said.

“That last mile, getting the immunization into the arms of the recipients, that’s the weak link in the chain.”

What made the difference  was the degree of organization and capacity of the public health departments in each community to plan and administer the vaccine, Fineberg said.

“So it wasn’t that it was only cities or only rural, rich or poor, it boiled down to ability to deliver.”

WATCH | Experts discuss strategies for Canada’s COVID-19 vaccine rollout 

As Canada prepares to distribute millions of doses of COVID-19 vaccines in January, Chair of the National Advisory Committee on Immunization Dr. Caroline Quach-Thanh and David Levine, who managed the H1N1 vaccine rollout for Montreal, say this vaccination campaign won’t be without challenges. 3:56

Dealing with ‘coincident events’

But one of the more significant problems of the program was the poor job officials did in communicating to the public when headlines emerged linking potential adverse effects to the vaccine, experts say.

“There are definitely — and this is going to be true this coming year — there will be coincident events,” Fineberg said.

“Preparing the public for expected coincidences simply because stuff happens every day, that’s really, really key,” he said.

During the 1967 vaccination program, three elderly people in Pittsburgh had heart attacks after receiving their vaccine. The publicity and headlines it generated led to a handful of states suspending their vaccination programs while they investigated a potential association, said George Dehner, an associate professor of history at Witchita State Univeristy and authour of Influenza: A Century of Science and Public Health.

While no link to the vaccination was found, polls at the time showed a significant decrease in the number of people who said they would get the vaccine because they feared some adverse effect, Dehner said.

A patient takes part in Pfizer’s COVID-19 vaccine clinical trial in May. On Sunday, a U.S. health official said the country’s first immunizations could begin on Dec. 12. (University of Maryland School of Medicine/File/The Associated Press)

There will be a certain expected death rate of people of a certain age on any given day, Pascal said. And what one has to look at is the death rate above the expected rate when running an immunization program.

“And so the CDC in this particular case did not do a good job of anticipating that and explaining that,” Dehner said.

But the vaccination rollout also saw dozens of people come down with the rare neurological disorder Guillain-Barre syndrome at a much higher rate than would be expected. Unlike the heart attacks, where no link was found, a scientific review has found there was an increased risk of Guillain-Barre syndrome after the swine flu vaccinations, according to the CDC. The exact reason for this link remains unknown.

In a 2009 interview with the The Bulletin, the health journal of the World Health Organization, Fineberg said those cases wouldn’t have been “a blip on the screen had there been a pandemic but, in the absence of any swine flu disease, these rare events were sufficient to end the programme.” 

Focus on science, not politics

When Guillain-Barre syndrome increased, some members of the public “became very skeptical and saw the whole thing as politically based, and not science-based,” said Richard Wenzel, emeritus chairman and professor of the Department of Internal Medicine at Virginia Commonwealth University.

“There was a concern that maybe politics was driving some public health responses.”

“One of the things that I would say we’re still trying to learn is policy should be scientifically based. What I mean is that whoever gives the message has to say, ‘Here’s what we know, here’s what we don’t know. And here are the assumptions we’re making currently that guide our policy.

“That sounds simple, but it’s rarely done, even today.”

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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