‘Enlightened ones who think they’re smarter than decades of research.’ Emotional-discursive analysis of epidemic narratives during the 2024 Montreal measles outbreak

Outbreak narrative: China's migrant women labor in the COVID-19

Reviewed by: Contagious: Cultures, Carriers, and the Outbreak Narrative Alan M. Kraut Contagious: Cultures, Carriers, and the Outbreak Narrative. By Priscilla Wald. Durham: Duke University Press. 2008. As culture critic Roger Rosenblatt reminds us, "story-telling is what the human animal does, to progress, to learn to live with one another." English professor Priscilla Wald analyzes a particular genre of recurring story, the account of the communicable disease outbreak, the history of which is especially compelling in light of contemporary concerns about HIV/AIDS, SARS, Avian Flu, and drug-resistant strains of tuberculosis. [End Page 129] She intends her interdisciplinary analysis of outbreak narratives to aid scholars in their understanding of disease's impact upon society. Such understanding might then lead to "more effective, just, and compassionate responses both to a changing world and to the problems of global health and human welfare." (3) Outbreak narratives share a "formulaic plot," according to Wald. Each narrative, whether in fact or fiction, begins with "the identification of an emerging infection, includes discussion of the global networks throughout which it travels, and chronicles the epidemiological work that ends with its containment." (2) Wald begins in the midst of the bacteriological revolution which began in the late nineteenth century. In the treatment of Mary Mallon (a.k.a. Typhoid Mary) in the early twentieth century, Wald locates an early and culturally powerful factual outbreak narrative. George Soper, a clever epidemiologist traced typhoid deaths at a summer house to a female Irish immigrant cook, a healthy carrier, who is unwittingly spreading infection to those who ate food she prepared. It was an era before such phenomena were widely understood, and Mary's insistence of innocence, her pursuit, and her detention in isolation arouses sympathy for both the dead and for Mary, who emerges as a victim of her own body and a fearful society. Wald looks to similar historical narratives in the Cold War era and, more recently, in exchanges about the HIV/AIDS pandemic. In literature, Wald locates the outbreak theme in Michael Crichton's Andromeda Strain (1969) and Richard Preston's Hot Zone (1994). On the screen, there is Invasion of the Body-Snatchers (1956 and 1978 versions). These stories include a patient zero (the first to contract the disease), superspreaders, hot zones, and persistent pathogens, or invaders. Wald prods readers to consider how humans respond to the biological invasions of their bodies, especially by microorganisms. Her examples remind us that increasing human connectedness with its gift of shared information, also imperils us by the speed with which disease is spread. Citing journalist Laurie Garrett's The Coming Plague (1994), Wald suggest the possibility of a counter-narrative in which the world, with some humility, reconceptualizes humanity's place in the Earth's ecology and acts locally and globally to ensure every person's right to the highest possible level of health through reform in the distribution of medical care and banishing the extreme poverty that triggers outbreaks of disease. Wald also sensitizes readers to how contagion spreads and whom it affects. She cautions against confusing disease and victim, hoping to diminish medicalized prejudice and stigma often assigned to sufferers. Contagious is too rich in detail and cultural reference for most undergraduates, but scholars of American culture will applaud it. It is unlikely that Wald's cultural critique with its plethora of examples from novels and films offers the kind of data that can alter America's medical landscape, but thoughtful physicians, nurses, and public health workers who do encounter her book will never battle an "outbreak" without pondering how it might give rise to yet new cultural expressions, symbols, and social relationships. Alan M. Kraut American University Copyright © 2010 Mid-America American Studies Association

BackgroundCommunities with low vaccination rates are at greater risk during outbreaks of vaccine preventable diseases. Most Australian parents support vaccines, but some refuse and are often judged harshly by their community, especially during an outbreak. We sought the perspectives of Australian public health experts on the key issues faced when managing a measles outbreak in an area with high anti-vaccination sentiment.MethodsA measles outbreak scenario formed the basis of a 3-round modified Delphi process to identify key practitioner concerns in relation to parents/carers who don’t follow the recommended vaccination schedule. We surveyed a range of professionals in the field: policymakers, infectious disease experts, immunisation program staff, and others involved in delivering childhood vaccinations, to identify key priorities when responding to an outbreak in a community with low vaccination coverage.ResultsFindings indicate that responses to measles outbreaks in communities with high anti-vaccination sentiment are motivated by concerns about the potential for a much larger outbreak event. The highest operational priority is to isolate infected children. The two most highly ranked practical issues are mistrust from non-vaccinating members of the local region and combatting misinformation about vaccines. Trying to change minds of such individuals is not a priority during an outbreak, nor is vaccinating their children. Using media and social media to provide information about the outbreak and measures the public can take to limit the spread of the disease was a focus.ConclusionsOur findings provide a deeper understanding of the challenges faced during an outbreak and priorities for communicating with communities where there is a high level of anti-vaccination sentiment. In the context of a global pandemic, the results of this study also have implications for managing public health responses to community transmission of SARS-CoV-2, as COVID-19 vaccines becomes widely available.

From 1 March 2023 to 29 February 2024, 30 EU/EEA Member States reported a total of 5 770 cases of measles, 4 864 (84.3%) of which were laboratory-confirmed. Th7e highest number of cases were reported by Romania- at the time of writing, 11,397 confirmed cases, including 12 deaths from 1 January 2023 to 7 April 2024. Measles is a highly infectious disease. The best mitigation is vaccination which is highly effective. Outbreaks in many countries have been driven by decreases in vaccine coverage with a two-dose measles-containing vaccine (MCV), especially evident since the COVID-19 pandemic. In many countries, vulnerable migrant populations, ethnic groups and communities experiencing social deprivation have been over-represented in cases and under-covered by vaccine programmes. We know that prisons contain such populations. Historic seroprevalence studies of prison populations, which themselves are scant, show that prison populations are under-vaccinated. Prisons are a setting that can cause disease amplification. Given these facts, it is perhaps surprising that many countries in Europe cannot provide specific surveillance data on either cases in prisons or vaccine coverage specifically in prison populations. Further, that prisons are not often cited as specific settings for vaccine catch-up programmes in national or regional programmes. This is despite evidence of measles cases and outbreaks historically and currently in several European countries. In the presentation we will ask why this ‘blind spot’ in national and international disease surveillance continues and what Member States could and should do to prevent the risk of mass outbreaks of measles in prisons, causing pressures on justice and health systems and risking wider community outbreaks. Finally, we will reflect on how this experience should alert us to the risk of other infectious diseases going undetected, unprevented, and under-studies in prisons, threatening our collective health security.

Background: Military conflict has been an ongoing determinant of inequitable immunisation coverage in many low- and middle-income countries, yet the impact of conflict on the attainment of global health goals has not been fully addressed. This review will describe and analyse the association between conflict, immunisation coverage and vaccine-preventable disease (VPD) outbreaks, along with country specific strategies to mitigate the impact in 16 countries.Methods: We cross-matched immunisation coverage and VPD data in 2014 for displaced and refugee populations. Data on refugee or displaced persons was sourced from the United Nations High Commissioner for Refugees (UNHCR) database, and immunisation coverage and disease incidence data from World Health Organization (WHO) databases. Demographic and Health Survey (DHS) databases provided additional data on national and sub-national coverage. The 16 countries were selected because they had the largest numbers of registered UNHCR "persons of interest" and received new vaccine support from Global Alliance for Vaccine and Immunisation (GAVI), the Vaccine Alliance. We used national planning and reporting documentation including immunisation multiyear plans, health system strengthening strategies and GAVI annual progress reports (APRs) to assess the impact of conflict on immunisation access and coverage rates, and reviewed strategies developed to address immunisation program shortfalls in conflict settings. We also searched the peer-reviewed literature for evidence that linked immunisation coverage and VPD outbreaks with evidence of conflict.Results: We found that these 16 countries, representing just 12% of the global population, were responsible for 67% of global polio cases and 39% of global measles cases between 2010 and 2015. Fourteen out of the 16 countries were below the global average of 85% coverage for diphtheria, pertussis, and tetanus (DPT3) in 2014. We present data from countries where the onset of conflict has been associated with sudden drops in national and sub-national immunisation coverage. Tense security conditions, along with damaged health infrastructure and depleted human resources have contributed to infrequent outreach services, and delays in new vaccine introductions and immunisation campaigns. These factors have in turn contributed to pockets of low coverage and disease outbreaks in sub-national areas affected by conflict. Despite these impacts, there was limited reference to the health needs of conflict affected populations in immunisation planning and reporting documents in all 16 countries. Development partner investments were heavily skewed towards vaccine provision and working with partner governments, with comparatively low levels of health systems support or civil partnerships.Conclusion: Global and national policy and planning focus is required on the service delivery needs of conflict affected populations, with increased investment in health system support and civil partnerships, if persistent immunisation inequities in conflict affected areas are to be addressed.

Addressing vaccine inequities among Ukrainian refugees

Outbreaks of vaccine-preventable diseases frequently occur in low and middle-income countries (LMICs), requiring outbreak response immunisation (ORI) programmes for containment. To inform future investment decisions, this study aimed to estimate the cases, deaths, disability-adjusted life years (DALYs) and societal economic costs averted by past ORI programmes. Outbreaks of measles, Ebola, yellow fever, cholera and meningococcal meningitis in LMICs between 2000 and 2023 were considered. 210 outbreaks (51 measles, 40 cholera, 88 yellow fever, 24 meningitis, 7 Ebola) across 49 LMICs were identified with sufficient data for analysis. Data were sourced from publicly available outbreak reports and literature. Agent-based models were calibrated for each disease such that after controlling for baseline vaccine coverage, response time, vaccination rate, environmental variables or endemic prevalence of the disease, observed outbreaks were within the distribution of simulated outbreaks. A status-quo and no ORI scenario were compared for each outbreak. Across 210 outbreaks, ORI programmes are estimated to have averted 5.81M (95% uncertainty interval 5.75M-5.87M) cases (4.01M measles, 283K cholera, 1.50M yellow fever, 21.3K meningitis, 820 Ebola), 327K (317K-338K) deaths (20.0K measles, 5215 cholera, 300K yellow fever, 1599 meningitis, 381 Ebola), 14.6M (14.1M-15.1M) DALYs (1.27M measles, 220K cholera, 13.0M yellow fever, 113K meningitis, 16.6K Ebola) and US$31.7B (29.0B-34.9B) (US$710M measles, US$156M cholera, US$30.7B yellow fever, US$97.6M meningitis, US$6.72M Ebola) in economic costs. Often, the more rapidly the ORI was initiated the greater impact. ORI programmes are critical for reducing the health and economic impacts of outbreaks of vaccine-preventable diseases.

NSW immunisation performance: continuing progress but no room for complacency

Measles outbreaks in Italy: A paradigm of the re-emergence of vaccine-preventable diseases in developed countries

In the 2015 European refugee crisis, nonprofit and nongovernmental organizations (NGOs) offered help and actively advocated for millions of refugees. The current study aims to understand what communication strategies are most effective for NGOs to influence media coverage and the public’s social media conversations about refugees. We found that agenda building on traditional media and in social media conversations require different strategies. Specifically, although providing information subsidies could powerfully influence traditional media coverage, its effect waned in the context of social media conversations. In contrast, NGOs’ hyperlink network positions emerged as the one of the influential factors for NGOs’ prominence in social media conversations. Moreover, stakeholder-initiated engagement could influence agenda building both in traditional media coverage and social media conversations. Finally, organizational resources and characteristics are important factors as well. Theoretical and practical implications are discussed.

Актуальность. В условиях пандемии COVID-19 во многих странах происходит снижение уровней охвата вакцинацией, что в дальнейшем может способствовать возникновению новых вспышек вакциноуправляемых заболеваний. Уже сегодня значительное количество детей рискуют не получить необходимую прививку против кори. Цель исследования: оценить грамотность студентов-медиков в вопросах иммунизации против кори, проанализировать их отношение к вакцинации и установить, что влияет на принятие решения, определить основные вопросы, которые беспокоят относительно вакцинации против кори. Материалы и методы. Проведено анонимное онлайн-анкетирование 350 студентов-медиков с помощью Google Forms. Результаты. Согласно Национальному календарю прививок, 80 % участников получили две дозы вакцины против кори, паротита, краснухи (КПК), 2,9 % — одну, 12,9 % — три, 1,4 % оказались непривитыми и 2,9 % не владели точной информацией о вакцинальном статусе. Основные причины, помешавшие иммунизации, следующие: частые заболевания в детстве, наличие хронических заболеваний, отсутствие вакцины, сомнения в качестве вакцины. Во время вспышки студенты вакцинировались по требованию учебного заведения (31 %), собственной инициативе (50 %), совету родителей (17,2 %) и врачей (9,5 %). Среди возможных источников информации студенты выбирали советы врачей (73,9 %), данные интернет-ресурсов (36,9 %) и специальной медицинской литературы (34,2 %). Почти все студенты (95 %) знали схему введения вакцины КПК. Большая часть из них (66,6 %) была осведомлена об условиях хранения, приоритетном месте и пути введения вакцины, но не владела информацией о вспомогательных компонентах, входящих в состав вакцины, ее эффективности и продолжительности иммунитета после иммунизации. Вакцинацию как профилактическое мероприятие поддержали всего 53,3 % студентов. Выводы. Полученные данные указывают на необходимость повышения осведомленности в вопросах вакцинопрофилактики, разработки новых стратегий общения с пациентами о преимуществах иммунизации. Изучение причин отказов от прививок, повышение грамотности иммунизации путем эффективной коммуникации как будущих врачей, так и простых граждан с целью содействия принятию обоснованного решения могут помочь работникам здравоохранения в повышении охвата вакцинацией КПК.

BackgroundParental vaccine hesitancy is a growing concern, and Europe has witnessed significant outbreaks of Vaccine-Preventable Diseases (VPDs) over the past two decades. Unvaccinated children are at increased risk of contracting VPDs, and the incidence of several VPDs has been on the rise. Vaccine hesitancy is a serious global health challenge. Nevertheless, the specific association between intentionally unvaccinated children and VPD outbreaks in Europe remains inadequately explored. This rapid systematic review aims to identify and examine studies focused on VPD outbreaks in Europe that involve intentionally non-vaccinated children and the factors associated with vaccine hesitancy.MethodsA rapid systematic review was conducted with a comprehensive search of electronic databases, including Medline, Embase, and Academic Search Elite. The population, exposure and outcome (PEO) framework was used to formulate the research question, inclusion and exclusion criteria. Publications from 2010 to and including August 2023 were included.ResultsOf the 330 studies initially identified, a total of nine were included in the final review. The included studies indicated that unvaccinated children due to parental refusal are contributing to outbreaks of measles, diphtheria and tetanus in the European region.ConclusionThis systematic review provides compelling evidence of an association between intentionally unvaccinated children—those unvaccinated due to parental refusal—and outbreaks of vaccine-preventable diseases (VPDs). The findings strongly suggest that this group contributes significantly to VPD outbreaks within the European region. To deepen our understanding, further research is needed to compare the role of intentionally unvaccinated children with that of other unvaccinated groups (e.g., those unvaccinated due to medical contraindications, immunosuppression, or limited access to healthcare) in the emergence and spread of VPDs.

Introduction: The Latin American Society of Pediatric Infectology (SLIPE for its acronym in Spanish) is working hard to contribute with strategic actions to prevent the recurrence of Vaccine-Preventable Diseases and to prevent the reduction of vaccine coverage in the region of the Americas. Areas covered: On Friday, September 25th, a Latin American forum of experts on immunization services during the COVID-19 pandemic was held through Webex platform. Issues such as: the imminent risk of occurrence and outbreaks of vaccine-preventable diseases, the importance of epidemiological surveillance and the vaccination campaign challenges, in the context of a pandemic were discussed. Expert opinion: Vaccination campaigns should no longer be postponed or delayed; instead, they must be reactivated; governments, scientific societies, and physicians must promote vaccination programs to avoid outbreaks of vaccine-preventable diseases. On the eve of a SARS-CoV-2 vaccine, it is necessary to insist on the availability of sufficient doses to avoid dose shortages in disadvantaged areas of the region.

To develop a model for identifying areas at high risk for sporadic measles outbreaks based on an analysis of factors associated with a national outbreak in South Africa between 2009 and 2011. Data on cases occurring before and during the national outbreak were obtained from the South African measles surveillance programme, and data on measles immunization and population size, from the District Health Information System. A Bayesian hierarchical Poisson model was used to investigate the association between the risk of measles in infants in a district and first-dose vaccination coverage, population density, background prevalence of human immunodeficiency virus (HIV) infection and expected failure of seroconversion. Model projections were used to identify emerging high-risk areas in 2012. A clear spatial pattern of high-risk areas was noted, with many interconnected (i.e. neighbouring) areas. An increased risk of measles outbreak was significantly associated with both the preceding build-up of a susceptible population and population density. The risk was also elevated when more than 20% of infants in a populous area had missed a first vaccine dose. The model was able to identify areas at high risk of experiencing a measles outbreak in 2012 and where additional preventive measures could be undertaken. The South African measles outbreak was associated with the build-up of a susceptible population (owing to poor vaccine coverage), high prevalence of HIV infection and high population density. The predictive model developed could be applied to other settings susceptible to sporadic outbreaks of measles and other vaccine-preventable diseases.

Infectious disease crisis in the Philippines