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Anti-Vaxxers Brought Their War to Minnesota—Then Came Measles

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MINNEAPOLIS — ON the first Saturday this May, residents of the Cedar-Riverside neighborhood socialized in the shadows of their towering public housing complexes. Chattering men sat for haircuts while headscarved women shopped the stalls lining the blue-bricked Riverside Mall. At nearby Currie Park, training-wheeled biker boys chased each other, circling a drained wading pool where girls played a game of tag. Their relatives picnicked in the shade.

Not so visible was the fact that this Somali-American community—Minnesota’s largest—is currently experiencing the state’s worst measles outbreak in nearly three decades. On Thursday, the count rose to 44 confirmed cases across three counties. Public health officials are now scrambling to keep the disease from reaching pockets of unvaccinated kids in other parts of the state. This means advising accelerated shot schedules to doctors and parents, and considering quarantine orders for anyone who has been exposed. The health officials know that once a measles outbreak gets going, it can be very difficult to contain, even if they expected it.

And they totally expected it. Over the last decade, anti-vaxxers have fortified this corner of Minneapolis into a bastion for pseudo-science. It all began with higher-than-normal rates of severe autism in the Somali community. And when state and university researchers failed to understand why the disorder hit so hard here, families went looking for answers elsewhere: friends, and the all-knowing internet. In came the anti-vax partisans, whose success with these frightened parents has turned the neighborhood into a beachhead for what should be a totally preventable disease.

Measles kills about 10,000 children a year in Somalia. So, when the first wave of refugees from that country’s civil war brought their kids to Minneapolis in the 1990s, vaccination rates were high—around 90 percent by 2004. Four years later, Somali parents began noticing a rising number of autistic children in their community. The cried out to city officials, who enlisted researchers from the University of Minnesota, CDC, and NIH, to launch an investigation. Those epidemiologists found that autism rates in Minneapolis’s Somali community were higher than the national average. But, the rate was identical to autism in Minneapolis’ white population.

What was different is that Somali children didn’t just get autism, they consistently got the most extreme version of it. By comparison, only about a third of non-Somali kids with autism were also diagnosed with intellectual disabilities—such as delayed speech, or difficulty understanding abstract concepts and social rules. For Somali autistics, it was 100 percent.

“In some ways that finding was very consistent with what we were hearing from the community—that autism hits Somali kids much harder,” says the study’s lead author, Amy Hewitt. But her results only told people what they already suspected, not what they were looking for: What was causing the autism.

Not that it would have mattered much if she had. By the time Hewitt’s study was published in 2013, anti-vaccination activists had already claimed Cedar-Riverside. Andrew Wakefield—the study-falsifying founder of the modern anti-vaxx movement—met with upset Somali families three times between 2010 and 2011. And Minneapolis health officials say it’s not hard to draw a line between this targeted misinformation campaign and the current measles outbreak. Kris Ehresmann, director of the health department’s Infectious Disease Division points to the precipitous drop in vaccination rates in recent years: Today, only 4 out of every 10 Somali kids in the city are protected against the disease. Even as recently as last Sunday, groups like the Vaccine Safety Council for Minnesota organized a public meeting to help Somali families understand their legal rights to refuse the same vaccinations public health officials are anxiously urging them to get.

“The answer used to be education—the more educated you were on the issue the more likely you were to get vaccinated,” says Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research. Those days are over, he says. In no small part thanks to the proliferation of misleading information on the web. “The challenge is for scientists to be humble and acknowledge that in this day and age facts will not win the day,” he says.

Minnesota’s Health Department has been trying to take a page from that playbook. It has changed up its tactics in the past few years—hiring Somali nurses and outreach workers to pave inroads into the community, and working with imams and other leaders to create a network of trusted individuals who can combat internet-fueled fears. And they’ve begun taking up alternative communication strategies. Rather than use bullet-pointed barrages of facts, they illustrate their points with stories about, say, how someone whose child came down with measles.

Catherine Mary Healy, the director of the Center for Vaccine Awareness and Research at Texas Children’s Hospital says this is a better strategy for communities that haven’t been exposed to an outbreak of vaccine-preventable diseases. “When they come across misinformation they interpret it in a different way than you or I might because they’re unable to weight the risk/benefit ratio appropriately,” she says. Healy works with many Latino immigrant groups in Texas, where she says vaccination efforts are highly successful because so many of them have experienced measles first-hand.

This echoes what officials around Minnesota have been clear about from the beginning of the outbreak: This isn’t an immigrant problem, or a Somali problem, it’s an unvaccinated problem. But there is reason to be hopeful that evidence-based information can still win the day. Research shows that the most important factor for parents making the decision whether or not to immunize comes down to their doctors’ opinion. And the investments Minnesota has made in providing tailored health care services to Somali families, especially those with autistic children may be beginning to pay off.

The Brian Coyle Community Center, which bustles with basketball-crazed kids, is in the middle of the Cedar-Riverside neighborhood—the outbreak’s epicenter. And just a few days ago, the community center’s walls had been pasted with flyers promoting the connection between the vaccine and autism either. But the Somali staff decided to take them down. On request, the man working the front desk Saturday afternoon (who didn’t want to share his name), produces a crumpled advertisement for last weekend’s anti-vaxx public meeting. “I don’t understand these people,” he says, shaking his head. “With my children, if the doctor says to do something, we do it. They know best.”

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Minnesota vaccination activists now are seeking political allies

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A severe measles outbreak sickened dozens of Minnesotans last year and threw a harsh light on activists with vaccination concerns, but now they are back, believing they have gained the political clout to push through legislation that would alert parents to the rare but documented risks of vaccines.

At a forum for state legislators on Wednesday, leaders of the Vaccine Safety Council of Minnesota hope to persuade lawmakers to support an “informed consent” bill, which would require doctors to discuss risks with parents before vaccinating babies.

“There’s been a shift in this country,” said Jennifer Larson, a leader of the nonprofit council and an organization called Healthchoice that organized the forum. “I think it’s tough for anyone to say more information is not better.”

Larson said her group is not anti-vaccine; they believe consumers just need more upfront information about risks. But state health officials worry that opponents want to promote unproven claims that could unnecessarily scare people away from vaccinations.

With 79 confirmed cases, last year’s measles outbreak was Minnesota’s largest in 27 years, and falling vaccination rates in the state’s Somali community played a role, said Kris Ehresmann, who directs vaccination programs for the state Health Department.

“Seventy-one of 79 were unvaccinated,” she said. “It was very much an outbreak driven by lack of vaccination.”

State records show that more than 90 percent of Minnesota children enter kindergarten vaccinated for infectious diseases such as tetanus, measles, hepatitis B, and chickenpox.

But survey data from the U.S. Centers for Disease Control and Prevention show a small decline in certain immunizations. And President Donald Trump proposed a safety commission to address vaccine concerns, though plans for that panel have stalled and the president didn’t mention vaccines in his State of the Union address last week.

Public health officials also found themselves on the defensive after a report out of Australia late last year, while not related directly to pediatric immunizations, that found that the seasonal flu vaccine is only 10 percent protective. CDC estimates for the effectiveness of the flu vaccine between 2004 and 2017 ranged from a low of 10 percent to as high as 60 percent in any one flu season. The vaccine effectiveness fluctuates because the predominant flu strain is not the same each year.

Anxiety about the safety of vaccines has created an active coalition that includes some Minnesota refugee families, proponents of “natural” medicine, and parents who believe disabilities in their children can be traced back to shots they received.

Larson is the owner of an IT business and an autism treatment center, and recently was named finance chair of the Republican Party of Minnesota, though she stressed in an interview that the new role is separate from her advocacy on vaccines.

Larson said she took on the issues of vaccine administration and informed consent after her son, now 17, developed autism following his infant vaccinations.

“My son had a very clear reaction,” she said.

The autism theory has bedeviled public health advocates, because no broadly accepted studies have proved a link between vaccines and the developmental disorder. Some who have claimed this link have been discredited. But the mere thought of a link has scared some parents into refusing or delaying vaccinations for their children, because autism is more alarming to them than diseases such as polio that largely have been eradicated by vaccination campaigns.

Larson said she believes health officials have exaggerated the safety of vaccines. She noted that the federal government’s National Vaccine Injury Compensation Program has paid $3.8 billion since 1988 to people who claimed vaccine-related illnesses or reactions. “Parents want to be told everything before they inject something into their child,” she said.

Speakers at the legislators’ forum this week will include Del Bigtree, who directed “Vaxxed,” a movie about a federal whistleblower who alleged that the government suppressed information about an autism link, and a Minneapolis woman who received federal compensation after she claimed that her son suffered a disabling reaction from the pertussis vaccine.

Larson supports legislation authored by state Rep. Cindy Pugh, R-Chanhassen, that would require doctors to disclose that neither they nor vaccine manufacturers are liable if they give shots that cause complications, and that scheduled combinations of vaccinations at single office visits haven’t been studied for safety.

Pugh did not comment for this article.

Ehresmann said federal law already requires doctors to give “vaccine information statements” to parents, and the state checks to make sure pediatricians are doing so. The statements refer to vaccine risks and the compensation fund, but also the benefits of vaccine and the threats caused by the infections they target.

“These [vaccines] protect children against some serious diseases,” said Ehresmann, recalling the case of a severe Hib (Haemophilus influenzae B) infection that occurred after parents delayed their child’s shots.

The Minnesota Medical Association, which represents the state’s doctors, opposes Pugh’s bill, according to a spokesman, because it only requires vaccine-risk information that would discourage parents, and does not require information about the risks of children being unvaccinated.

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Somalis Train to Improve First Aid Response Skills

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VOA — Somalia’s capital, Mogadishu, has been rocked by explosions for years set off by Al-Shabab militants battling to overthrow the weak U.N.-backed government. The frequent bombings have killed or injured thousands of civilians. Now, first responders are offering first aid classes to help Somalis learn how to help their neighbors before the ambulance arrives. Faith Lapidus reports.

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Somali woman researches health risks of skin-lightening practices

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Ibrahim Hirsi

For some Somali women, having lighter skin tone is the ultimate beauty goal and they use skin products containing dangerous chemicals to reach that goal, according to a new University of Minnesota study.

“To be a beautiful Somali woman, one has to have lighter skin color,” Amira Adawe, co-author of “Skin-Lightening Practices and Mercury Exposure in the Somali Community,” said in a recent interview describing the attitude of some women.

Several Somali women who were interviewed for the study published in July said they mix products that include lemon herbal whitening cream, lulanjina, diana and dermovate — some of which have mercury, a poison that can damage the nervous system, according to the study.

“These chemicals are proven neurotoxins and have been linked to birth defects if used by women during the prenatal period,” stated the study. “Inorganic mercury exposure is associated with rashes, skin discoloration, scaring, secondary bacterial and fungal infections, and even renal impairment and damage to the nervous system.”

The study added: “It should also be noted that mercury … can be transferred from mother to infant through breast milk.”

The Minnesota Department of Health recently tested 27 bleaching products, 23 creams and four soaps. The department found that 11 products contained mercury levels ranging from 135 to 33,000 parts per million. “This has prompted both state and federal health officials to issue warnings about the use of these products,” according to the study.

Although Minnesota law bans beauty products that contain mercury, the study said that immigrants have been smuggling the cosmetics from Latin America, Asia, the Middle East and Africa. The products are then secretly sold in Twin Cities-area stories.

“This is not practiced by only Somali women,” said Adawe, a health educator at St. Paul-Ramsey County Department of Public Health. “It’s widely used by Hispanics, Asians and African-Americans.”

Skin-lightening practices

There are various reasons some Somali women rub their body twice a day with skin-bleaching substances, the study stated. Some of them use the chemicals to get rid of the facial masks of pregnancy, which are pigments women develop during pregnancy.

These pigments often appear on cheekbones, forehead, nose, forearms and other parts of the body that are exposed to the sun. Women with darker skin are more prone to skin pigmentation than those with fair skin tone, health reports suggest.

The study indicated that women also use skin-lightening products to attract men. “They see having light skin as more socially acceptable and believe it will increase their chances of finding a husband,” according to the study.

Adawe, who was born in Somalia, said she knows many Somali women who use the products. “You can tell who uses it and who doesn’t,” she said. “You can’t mistake it with naturally light-skin people. These creams give people more of yellowish color.”

Adawe said the women who use the products often aren’t open about the practice. “Actually, they’ll deny when you ask them,” she said.

How study began

Growing up in Mogadishu and in Minneapolis, Adawe said she encountered many women who regularly used the skin-lightening products. She said became involved in the study a few years ago after coming across an article about bleaching cosmetics that reportedly contained mercury. Adawe said he began to worry about the health of women she knew who used these products, so she started investigating the issue in 2011.

After several interviews with Somali women in the Twin Cities, Adawe learned that some of the women used products containing mercury. Adawe then took her findings to officials at the St. Paul and Ramsey County health department. Soon after, the FBI raided stores in Minneapolis and found Minnesota-banned skin-lightening products and took action against owners, said Adawe, a public health graduate student at the University of Minnesota.

Adawe’s investigation prompted the study, thanks in part to her professor and mentor, Charles Oberg, who co-authored the research paper.

Public awareness efforts

Adawe’s is working to tell others about the dangers of skin-lightening practices by speaking out at community and educational forums, appearing on radio and television shows, and meeting with leaders and activists of the Somali community.

Adawe also engages in conversations with 244 members of the Somali community on a Facebook page she created named “Skin-lightening practices & chemical exposure among Somali women.”

Members share articles, videos and studies about the risks of skin-lightening practices, and they discuss ways they can help limit such practices.

On June 11, Adawe posted on the page: “To those of you who are scholars or know the Islamic religion well, can you please educate us about what Islam says about skin-lightening practices?”

Awil Egal, a group member, replied: “Islam has forbidden men or women to change the creation of Allah: Skin color, hair color and the likes. ”

Egal added: “Using cosmetics, creams and other things that are made from chemicals or impure substances and which may have dangerous side effects is definitely haram [forbidden]. It is also another form of deceiving that can create mistrust between people.”

Other members wrote simple lines of encouragement. Khadijo Abdi, for instance, posted: “Beautiful people, leave your skin as God intended!”

Adawe is optimistic the Somali community will understand the risks of the chemicals. And with social media, she said, she’s even more hopeful that the people will be informed faster.

“Everybody is on Facebook and Twitter these days,” Adawe said. “Social media is a great tool to use for spreading awareness on issues like this one.”

Adawe said there are significant numbers of Somali women satisfied with their natural skin tone and don’t consider using the skin products.

“It all depends on their confidence and level of education,” Adawe said. “Uneducated people tend to use these products more often.”

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