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Unfounded Autism Fears Are Fueling Minnesota’s Measles Outbreak Listen· 3:41

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Khadra Abdulle, a resident of St. Paul, stops to shop at the Riverside Market in the Cedar-Riverside neighborhood of Minneapolis. It's the inaccurate information about a link between vaccines and autism, she says, that's keeping some well-meaning parents from getting their kids vaccinated against measles. Mark Zdechlik/MPR

Health officials in Minnesota have been scrambling to contain a measles outbreak that has sickened primarily Somali-American children in the state. So far health officials have identified 34 cases, still mostly in Hennepin County, and they’re worried there will be more.

In Minnesota, the vast majority of kids under two get vaccinated against measles. But state health officials say most Somali-American 2-year-olds have not had the vaccine — about six out of ten. As the outbreak spreads, that statistic worries health officials, including Michael Osterholm, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy.
“It is a highly concentrated number of unvaccinated people,” he says. “It is a potential kind of gas-and-match situation.”

Measles is a highly contagious respiratory disease that causes a rash and fever. It can be deadly, but the Centers for Disease Control and Prevention says two doses of vaccination are about 97 percent effective in heading off the disease.

The Minnesota Department of Health says the outbreak began in Hennepin County, home to Minneapolis and the heart of the nation’s Somali-American community.

Somali-American leaders here are in firm agreement with the Minnesota health department in trying to knock down the pseudoscience behind the unfounded claims that getting vaccinated can lead to autism. But anti-vaccine groups have been quick to fan fears, even as the outbreak spreads.

A social and commercial hub of the community is the Cedar-Riverside neighborhood, adjacent to downtown Minneapolis. Inside a building called the Riverside mall, more than a dozen stalls are tightly clustered, open-air style.

Sprawling from stall to stall are brightly-colored clothes and other textiles along with small home furnishings. Most of the Somali-Americans shopping here want nothing to do with a reporter’s questions. But Khadra Abdulle offers her thoughts about the measles outbreak.

“I heard [about] it,” she says, “but I haven’t seen it. I don’t know anybody who has that problem right now.”

“They believe it causes autism.”

A weekend meeting in Minneapolis, organized by anti-vaccine groups (the Vaccine Safety Council of Minnesota, the Minnesota Natural Health Coalition, the National Health Freedom Action and Minnesota Vaccine Freedom Coalition and The Organic Consumers Association) attracted dozens of Somali-Americans. Some members of the audience shouted down physicians — including pediatrician Dr. Stacene Maroushek — who showed up to try to convince them vaccination is crucial.

“We know If there’s less than a certain rate of vaccination, the virus is much more likely to spread,” she told the gathering. “That’s a scientific fact.”

Kris Ehresmann, the infectious disease division director at the Minnesota Department of Health, describes the Minnesota measles outbreak as a “public health nightmare” — a lot of unvaccinated people, living in densely populated neighborhoods and a tremendously contagious disease.

Ehresmann says she’s beyond frustrated with the dis-information campaign by anti-vaccine advocates, who have been working against efforts to contain the outbreak.

“I’ll be honest. It makes me very angry,” she says.

But Ehresmann says the desire to get the truth out is mobilizing public health officials.

“We’ve had people on Somali TV, Somali radio. We’ve participated in chat rooms. The commissioner met with imams to talk to them about how we can work with the faith community to do outreach,” she says.

In 2000, U.S. public health officials declared that measles had been eliminated in the U.S., thanks to a strong vaccination program. That means measles is longer native to the U.S., but as vaccination rates have eroded in some areas, it can spread quickly if a sick traveler brings it in. In 2014, there were 667 cases in the U.S., including a large outbreak among Amish communities in Ohio. In 2015, there were 188 cases, including some linked to an outbreak that started at the Disneyland amusement park. Prior vaccination is critical to keeping people from contracting the virus if they are exposed to it.

Almost 30 years ago measles sickened 460 people in Minnesota and three children died in that outbreak. Osterholm served as the state epidemiologist at the time, and says those deaths still haunt him. He’s worried it could happen again.

“I think we could surely see a major increase in the number of cases beyond what we have now,” he says. “With that comes the increasing likelihood someone will die.”

This story is part of a reporting partnership with NPR, Minnesota Public Radio and Kaiser Health News.

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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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