TIME Cancer

How a Common Childhood Vaccine Helps Ward Off Cancer

It reduces the risk of childhood leukemia by 20%

Scientists now understand why a common childhood vaccine reduces the risk of leukemia.

Researchers previously knew that the vaccine against Haemophilus influenza type B, or HiB, reduces the risk of acute lymphoblastic leukemia, the most common form of childhood cancer. But now a new study published in Nature Immunology explains why this is the case.

Dr. Markus Müschen and his team on the study used a mouse model and found that recurring HiB infections, which can happen easily in children who have not been vaccinated, can cause certain enzymes to activate and push common precancerous blood cells into cancer. So, vaccines against HiB infections also protect children from this path to leukemia.

Müschen told the New York Times that the HiB vaccine, which is routinely given to children, has led to a 20% reduction in the risk for leukemia.

 

TIME health

How Anti-Vaxxers Are Hurting People of Faith

Hurts for a second, helps for a long time
Bloomberg; Bloomberg via Getty Images Hurts for a second, helps for a long time

Jeffrey Kluger is Editor at Large for TIME.

A defensible vaccine opt-out is being threatened by a frivolous one

Science and religion have not always gotten along—especially when it comes to medicine. If you believe your body is a temple and your faith can keep you well, you don’t take kindly to doctors telling you how to look after yourself and your family. If you believe faith is fine but it’s medicine that saves lives, you frown on people who endanger themselves—and their children—by resisting scientific progress.

When it comes to vaccines, however, both camps—with the help of lawmakers—had reached a workable truce. All states require children to be vaccinated to attend school, and all states also provide exemptions for the small share of kids who, for legitimate medical reasons, can’t be vaccinated. All states but Mississippi and West Virginia have also allowed parents with religious objections to opt out of the vaccination rules.

It’s undeniable that that can put their kids at risk. By definition, the child who is vaccinated against polio will not contract the disease and the child who’s not vaccinated possibly could. But that possibility can be a remote one, thanks to what’s known as herd immunity. As long as about 95% of a population is vaccinated against a particular disease, it’s exceedingly difficult for a virus to find enough holes in that herd to reach the few people who aren’t protected. And since religious opt-outs had been relatively rare, the system worked.

But that’s all changed, thanks to what’s known as the philosophical or personal belief exemption, an expansion of the no-vax loophole allowing parents to refuse vaccinations for pretty much any reason at all—they don’t like the state telling them what to do, or they can’t be bothered by all those trips to the doctor, or they’ve read something on the Internet that about how vaccines are a mortal health peril, despite the fact that that virtually every medical authority on the planet assures them that that’s not so. Call it a personal belief and you get a free pass. This has done very bad things to the herd.

Many states like Colorado and California, which have easy opt-out rules, have fallen below the 95% compliance levels needed to keep their populations healthy, and recent outbreaks of measles in New York City, mumps in Columbus, Ohio, and whooping cough in California directly correlate with poor vaccination levels. A multistate measles outbreak in the southwest that is only now subsiding was similarly linked linked to a single infected person who visited Disneyland and spread the virus among unvaccinated visitors there.

Meantime, states with high vaccination rates are experiencing few of these problems. Most notable among them are Mississippi and West Virginia, which have neither religious nor philosophical opt-outs and thus have first-in-the-nation vaccine compliance levels of 99.9%.

Now some states are pushing back. As TIME reported, the California state Senate has just advanced a bill to eliminate both philosophical and religious exemptions, leaving only demonstrated medical problems as a reason for parents to refuse vaccines. Legislators who opposed the bill objected to eliminating the religious exemption, and their argument does have merit. Not only does the new bill raise First Amendment issues, statistics also make it clear that it’s not the faith community that’s causing most of the trouble. According to the New England Journal of Medicine, states that have a personal belief exemption have 2.54 times the vaccine refusal rate of states that have only the faith exemption. Left to themselves, the religious refuseniks would not be causing too much of a problem

But California legislators know the population they’re dealing with. Anti-vaxxers are like water, flowing to the nearest handy opening. Close off the personal belief portal, and they’ll just slosh over to the religious side, claiming a sudden spiritual epiphany that excuses them from vaccinating. The only way to keep kids safe is to close both exit routes.

The victims in all this are the truly devout. Lawmakers have long made clear that not all religious objections to medical procedures will be tolerated, particularly when it comes to the welfare of minors. Parents who cite religious beliefs in refusing to treat a child for, say, leukemia will likely lose that child to the state, which will provide the necessary care.

In the case of vaccines, however, there is—or was—a workaround. With the thinning of the herd, however, religious practices have to come second to saving the lives and health of babies. People of faith may resent the states, but if blame is to be laid, it belongs to the anti-vaxxers. They’re a crowd that’s always excelled at making avoidable messes, and they’ve just added one more to their long and growing list of them.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Infectious Disease

California Bill to Scrap Vaccine Exemption Moves Forward

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom for TIME

Bill that would prohibit parents from not vaccinating their kids passes state senate

The California senate has passed a bill that could help ensure that parents vaccinate their children, months after a measles outbreak in the state linked to low vaccination rates.

The bill, which passed the senate 25 to 10, would prohibit parents from not vaccinating their kids for religious or philosophical beliefs, public radio station KPCC reports. The bill now moves on the state assembly. If it eventually becomes law, California would become the 32nd state to ban such exemptions from vaccines.

The bill comes only a few months after a measles outbreak which infected 169 people from 20 states was traced back to a Disneyland theme park in the state. Researchers point to low vaccination rates as the reason for the outbreak.

Opponents of the bill argues it goes against parents’ rights to make decisions about their children’s health. Kids who can’t be vaccinated for medical reasons would still be exempt.

 

TIME Infectious Disease

Americas Region Becomes World’s First to Eliminate Rubella

The last major endemic cases in the region were in 2009

The Americas region has become the first to successfully eliminate rubella, a contagious viral infection with similar symptoms to measles, health officials announced on Wednesday.

Medical experts are calling the milestone against the endemic transmission of the infection a “historic achievement.” Rubella and congenital rubella syndrome (CRS) are now the third and fourth vaccine-preventable diseases to be eliminated in the Americas, following small pox in 1971 and polio in 1994, and experts say it also speaks to the success of a 15-year initiative to provide widespread vaccination against mumps and rubella (MMR) in the area.

“It shows how important it is to make vaccines available even to the remotest corners of our hemisphere,” Carissa F. Etienne, Pan American Health Organization/World Health Organization (PAHO/WHO) director, said during a news conference.

Before mass vaccination was available, medical experts say an estimated 16,000 to 20,000 children were born with CRS in Latin America and the Caribbean. The last major endemic cases in the region were in 2009. The virus is usually mild, but it can cause birth defects and miscarriages when women are infected during pregnancy.

Rubella is less contagious and typically less severe than the measles, but health officials say measles is the next target and that many countries have set a goal to eliminate the disease in their borders as well. The U.S. has experienced new clusters of measles outbreaks in the last year, with low vaccination rates blamed among some communities.

Though rubella has been eliminated in the Americas, it’s still prevalent in other regions in the world. Dr. Susan E. Reef, the team leader for rubella in the Global Immunization Division at the U.S. Centers for Disease Control and Prevention (CDC), told reporters on Wednesday that the Americas region and the European region are the only two regions that have an official elimination goal for the disease.

“Now that we have achieved this goal,” Reef said, “the next step is to continue to maintain it.”

TIME medicine

Vaccines Don’t Cause Autism, Even in Kids at Higher Risk

"We are able to look at the vaccines and show there is no association with autism"

In the latest study on the vaccines, researchers find even more evidence that childhood immunizations aren’t linked to autism.

In a study published in the Journal of the American Medical Association, a group led by Dr. Anjali Jain of the Lewin Group, a health care consulting organization, found that brothers and sisters of children with autism were not at any higher risk of developing the disorder if they were vaccinated compared with brothers and sisters of those without autism.

Numerous studies have found an increased risk of autism among those with older siblings with the condition, and some parents who believe that their older child’s autism is connected to vaccinations, specifically the MMR vaccine, have been reluctant to immunize their younger children. Indeed, Jain found that vaccination rates among siblings of autistic children were lower, at about 86% at 5 years, compared with 92% among those without autistic brothers or sisters.

But among the 95,000 children with older siblings included in the study, children who received the MMR and had autistic older siblings were no more likely to develop autism than children who were vaccinated and didn’t have any autistic older siblings. In fact, the relative risk of autism among those with older autistic brothers or sisters was lower if they were vaccinated compared with those who were not vaccinated.

“Our study confirmed that in kids with older siblings who we know are at increased risk of developing autism themselves, those kids are being vaccinated less,” says Jain. “But in the kids who did develop autism who were vaccinated, there was no increased risk from the vaccine compared to kids who did not get the vaccine.”

The results, she says, should put to rest any concerns that parents of autistic children might have that vaccinating their younger kids will somehow increase their risk of developing autism. The large size of the study, and the fact that vaccination and autism information wasn’t collected for purposes of a vaccines-and-autism study but as part of a larger health insurance database, also reinforce the strength of the findings. (The Lewin Group is an editorially independent part of Optum company, which collected the data.)

“We may not understand what is causing autism in these kids or families,” says Jain. “There could be a host of both genetic and environmental factors. But we are able to look at the vaccines themselves and show there is no association with autism.”

Read next: HPV Vaccine May Work for People Who Already Had the Virus

Listen to the most important stories of the day.

TIME ebola

A New Ebola Vaccine Shows Promise

With nearly a dozen Ebola vaccines now in various stages of development, researchers of one report promising results against the recent strain

A vaccine designed from a crippled virus with Ebola genes stitched in—the first tested against the strain that caused the outbreak in West Africa that has killed 10,000 and infected thousands more—protected every monkey tested from being infected with Ebola.

Reporting in the journal Nature, Thomas Geisbert, a virologist from the University of Texas Medical Branch, and his colleagues describe a vaccine made from a virus that commonly infects cows—called vesicular stomatitis virus (VSV)—that’s had some of its genetic material replaced with genes for surface proteins from the Ebola virus. None of the eight monkeys inoculated with the shot showed any signs of severe Ebola infection after being exposed to the virus 28 days later, while both of the control animals died of the disease seven and eight days after infection.

MORE: Ebola Vaccine Is Safe and Effective, According to First Study

The vaccine is the second generation of one that Geisbert and Heinz Feldmann, from the National Institute of Allergy and Infectious Diseases, co-developed in the 2000s. But because the vaccine relies on a live, albeit hampered virus, it raised concerns about safety that killed-virus vaccines, like polio and hepatitis A, don’t have. Neither the VSV nor Ebola virus are capable of replicating, since the VSV has part of its genome cut out and replaced with Ebola material, and the Ebola virus only has its outer surface genes and none of its dividing machinery. But a growing virus, even a slowly growing one, can cause problems. That’s what researchers saw in an early human trial of the first generation VSV Ebola vaccine, which was tested among 40 healthy volunteers in the Washington DC area. Some developed arthritis-like conditions, which added to existing concerns about the vaccine’s safety profile.

MORE: The Ebola Fighters

“Clearly there was a lot of room for improvement. It’s a balancing act,” says Geisbert. “What makes it such a good vaccine is that it grows. But we are trying to find the balance between efficacy and safety.”

MORE: The First Ever Large-Scale Ebola Vaccine Trial Begins in Liberia

He may have hit upon that parity with the latest version of the shot. By changing where in the VSV genome he inserted the Ebola genes, he found a vector that seems to deliver the same immune response against the Ebola virus, yet at lower cost to the person being vaccinated. The VSV loaded with Ebola grew at a five to 10 times slower rate than it did in the first vaccine, and animals inoculated with the newer vaccine showed 10 to 50-fold lower levels of both VSV and Ebola in their blood compared to animals given the first generation shot.

The slower growing VSV, says Geisbert, “in a well ordered universe is associated with less possibility of an adverse event” from the vaccine.

That won’t be known for sure until the vaccine is tested in the first healthy human volunteers, which may happen as soon as this summer.

TIME health

When Did Mandatory Vaccinations Become Common?

Smallpox Vaccination
New York Daily News Archive/Getty Images Joseph Burns, 8, grimaces as doctor vaccinates him at St. Joan of Arc Parochial School in Jackson Heights, Queens, New York, in 1947

Anti-Vaxxers are upset with mandatory Measles vaccinations. But mandatory vaccinations have a long history in the United States

History News Network

This post is in partnership with the History News Network, the website that puts the news into historical perspective. The article below was originally published at HNN.

Herbal panaceas, special cloths, strict diets, cool drinks, eschewing fireplaces, and the edict that a patient’s bedclothes be no higher than the patient’s waist—these were the prescriptions of the pre-inoculation era when someone contracted smallpox. For centuries pandemic diseases devastated much of mankind. Hardly more than a century ago, 20% of children fell to disease before the age of five, a staggering 20% more died before entering into adolescence, survivors finding little recourse in adulthood from the scourges of the age—diphtheria, yellow fever, small pox, measles, pertussis, and a deadly handful of others. It was in such a dire period that the first federal health mandates were made and bore the political origins of compulsory vaccination.

A string of yellow fever outbreaks erupted between 1793 and 1798, taking thousands of lives and leaving the nation dizzy with loss. Shortly after the outbreaks, John Adams signed and established the first federal quarantine law against the recurrent epidemics of yellow fever. According to Carleton B. Chapman, an MD, the Federal Quarantine Proposal of 1796 met “virtually no opposition.”

A couple of years later, in 1798, Congress returned to the issue after a high percentage of marine workers succumbed to yellow fever. For the first time ever,, Congress required privately employed sailors to own insurance and authorized the collection of a monthly payroll tax to fund it. John Adams promptly signed the law when it reached his desk.

Chapman states that few founders contested the federal government’s responsibility to protect the population from epidemics like yellow fever. The real issue, he reports, “was which level of government should enact and enforce quarantine.” This was the same question that arose years later when vaccination gained popularity in the medical field. Wendy K. Marine, George J. Annas, and Leonard Glantz explain that while Jeffersonians were uncomfortable with a strong federal role, Jefferson himself favored a bill that required the federal government to “guarantee and distribute effective vaccine” and signed it into law in 1813. Ultimately, Congress decided that the best approach was to leave the implementation of vaccination efforts up to state and local authorities.

America had many years of experience with vaccinations. The Puritans provided for vaccinations against smallpox after an outbreak devastated New England. But immunizations weren’t required anywhere in the United States until 1809, when Boston imposed mandatory vaccination to quell recurring outbreaks of smallpox that patchy, voluntary vaccination was permitting. Subsequently, some states adopted similar legislation. Scholars Alexandra Minna Stern and Howard Markel report that incidences of smallpox markedly declined between 1802 and 1840, but made major reappearances in the 1830s and 1870s when public memory of life imperiled by disease had dimmed and “irregular physicians” of the 1850s challenged the practice of immunization with “unorthodox medical theories.” One skeptical leader, British immigrant and reformer William Tebb, claimed, facts notwithstanding, that vaccination induced 80% of smallpox cases. Further, he alleged 25,000 children were “slaughtered” in Britain each year thanks to the program. The arguments were preposterous and contrary to evidence, but resonated with the public.

There’s a striking parallel to current anti-vaxxer scares playing on people’s fears, like the discredited and recanted study that alleged vaccination induced autism. Anti-vaccinationist Dr. J.F. Banton warned that vaccination would introduce “bioplasm” into the bloodstream and expose subjects to the “vices, passions, and diseases of the cow.” Stern and Markel relate that critics of vaccination claimed it was a “destructive and potentially defiling procedure of heroic medicine” akin to blood-letting. Many working-class people voiced the fear you hear today that the work of scientists was an “assault on their communities by the ruling class” and an “intrusion of their privacy and bodily integrity.”

The upshot? Smallpox cases surged to numbers that had not been seen in decades. Consequently, many states enacted new vaccination laws while others began enforcing existing laws. This, in turn, stirred increased opposition. California, Illinois, Indiana, Minnesota, Utah, West Virginia, and Wisconsin, repealed compulsory laws in response to the agitation.

Cambridge, Massachusetts found itself in the throes of a smallpox outbreak in 1902. Disease beset the area and threatened to spread into a major epidemic. To stop this from happening in the future the state passed a law giving city boards of health the authority to mandate vaccinations. But some people objected. When officials ordered Henning Jacobson, a Swedish immigrant and Lutheran pastor to be vaccinated, he refused treatment on grounds of past harm, saying both he and his son had experienced “extreme suffering.” Jacobson’s status as an ethnic and religious minority likely contributed to his decision to refuse treatment. His distrust of authority is shared today by many African Americans, who well remember that racist scientists performed experiments such as the Tuskegee syphilis study on people of color.

In a sense, Jacobson represented the quintessential anti-vaxxer, which may be why his case caught the eye of the anti-vaccination league, which encouraged Jacobson’s recalcitrance and may or may not have provided the Harvard-trained James W. Pickering and Henry Ballard to represent him in court. Eventually the case made its way to the United States Supreme Court. In 1905 the Supreme Court ruled 7-2 in favor of the state against Jacobson; the Court having found that an immunization rate of 85-90 percent confers protection on the entire group. The landmark Supreme Court case Jacobson v Massachusetts served as the precedent for future court decisions and the foundation of public health laws.

The Supreme Court considered the ordinance again in 1922 when some objected to the requirement that school children be vaccinated. Once again, the principle of mandatory vaccination was upheld. By 1969 compulsory immunization laws in twelve states—Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, Rhode Island, Tennessee, and West Virginia—had expanded to include smallpox, measles, poliomyelitis, diphtheria, pertussis, and tetanus. Meanwhile, seven states—Arizona, California, Minnesota, North Dakota, South Dakota, Utah, and Washington—found it unlawful to compel citizens to be vaccinated for smallpox while still requiring pre-enrollment immunization for other diseases like measles.

Since its inception compulsory public health laws have generated skepticism and resistance. Today, recent measles outbreaks—176 affected from January 1st to March 13th, 2015—have revitalized a long-lived debate and precipitated discussion about new approaches to public education.

Cristina Valldejuli, a graduate of the University of Iowa, is an HNN intern.

TIME Innovation

Five Best Ideas of the Day: March 19

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Instead of fighting about the Iran nuclear talks, Congress and the White House should be planning smart sanctions in case a deal falls through.

By Elizabeth Rosenberg and Richard Nephew in Roll Call

2. DARPA thinks it has a solution to Ebola — and lots of other infectious diseases.

By Alexis C. Madrigal at Fusion

3. A stand-out rookie’s retirement after one year in the NFL over fears of brain injury should be a wake-up call for all of football.

By Ben Kercheval in Bleacher Report

4. When patients are urged to get involved in their course of treatment, they’re more confident and satisfied with their care.

By Anna Gorman in Kaiser Health News

5. We don’t need “diversity” on television. We need television to reflect the world around us.

By Shonda Rhimes in Medium

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Infectious Disease

Disneyland Measles Outbreak Linked to Places With Low Vaccination Rates

Measles California
Jae C. Hong—AP Sleeping Beauty's Castle is seen at Disneyland on Jan. 22, 2015, in Anaheim, Calif.

Poor vaccination rates may be to blame for recent measles outbreak

The areas hit by the recent measles outbreak had vaccination rates as low as 50%, which allowed the disease to spread, new research suggests.

Researchers at Boston Children’s Hospital analyzed case numbers reported by the California Department of Public Health as well as other regional surveillance data to estimate the vaccination rates of areas affected by the measles outbreak in California, Arizona and Illinois. The team published a research letter of their findings in the journal JAMA Pediatrics.

The researchers found that the vaccination rates for the areas were somewhere between 50% to 86%, which is significantly lower than the 96%-to-99% rate needed to create herd immunity — when a significant portion of the population is protected so that there’s a low risk of an infectious-disease outbreak.

“Our data tell us a very straightforward story — that the way to stop this and future measles outbreaks is through vaccination,” said study author John Brownstein, of the Children’s Hospital Informatics Program, in a statement. “The fundamental reason why we’re seeing the number of cases we are is inadequate vaccine coverage among the exposed.”

Between Jan. 1 to March 13, 176 Americans were infected with measles and reported to the U.S. Centers for Disease Control and Prevention. Most of the people in the recent outbreak were not vaccinated, and many of the cases were linked to a Disneyland amusement park in California.

TIME ebola

Why West Africa Might Soon Have 100,000 More Measles Cases

Now more than ever: Measles vaccinations have dramatically cut disease rates in Africa
Spencer Platt; Getty Images Now more than ever: Measles vaccinations have dramatically cut disease rates in Africa

One lethal epidemic could give rise to another

Correction appended, March 12

There’s not a war college in the world that couldn’t learn a thing or two from the way viruses operate. They’re stealthy, they’re territorial, they seek and destroy and know just where to hit. And, just when you think you’ve got them beat, they forge an alliance with another of your enemies. That, according to a new paper published Thursday in Science, is what’s poised to happen with Ebola and measles—and it’s the babies and children of Africa who will overwhelmingly pay the price.

The Ebola epidemic is by no means over, but it is being contained and controlled. With nearly 24,000 cases and more than 9,800 fatalities so far—mostly in Guinea, Sierra Leone and Liberia—the epidemic is still claiming new victims, though more slowly. The crisis, however, has disrupted health-care delivery across the entire affected region, preventing children from receiving badly needed measles vaccines. That, the new study reports, could result in an additional 100,000 measles cases over the next 18 months, leading to an additional 2,000 to 16,000 deaths. Rates of vaccination against other diseases—particularly polio and tuberculosis—have fallen too. But measles’ ease of transmission makes it especially worrisome.

“When there’s a disruption of medical services, measles is always one of the first ones in the door,” says Justin Lessler, of the Johns Hopkins Bloomberg School of Public Health, a co-author of the paper. “The Ebola epidemic significantly increases the likelihood of a major measles outbreak occurring.”

Lessler and his co-authors arrived at their numbers painstakingly. First, they used health data to map and estimate the share of vaccinated and unvaccinated children in 5 km by 5 km (3.1 mi. by 3.1 mi.) squares across the three affected countries. They then estimated a 75% reduction in vaccination rates during the epidemic and projected forward by 6, 12 and 18 months. They factored in the transmissability of the virus within each region and estimated the likely number of deaths using what’s known as a Case Fatality Ratio—a mathematical tool that, as its name suggests, estimates lethality for any particular disease under any particular set of circumstances.

The final numbers—especially the potential 16,000 deaths—rightly alarmed the researchers, though lessler does admit that they are by no means a certainty. “The 75% decrease in vaccinations is a little too pessimistic,” he concedes. But the critical word in that admission is “little,” and the investigators did consider 25%, 50% and 100% rates too, before settling on 75% as at least the most plausible. No matter what, the odds are still high of a five figure death rate and a five to six figure additional case rate—and the Ebola epidemic, which led to the problem in the first place, has not even fully abated.

Lessler and his colleagues are not waiting until it does to sound the alarm, urging global health groups to mobilize a vaccination campaign now so it can be ready to launch in the affected areas the moment the Ebola all-clear sounds. The new push would first target children who were born during the Ebola epidemic since they would have likely received almost no medical attention at all up until that point, and then expand to all children in the most measles-susceptible age group—about 6 months to 5 years.

“The best time to start the campaign would be as soon as it’s logistically feasible,” says Lessler. “For every month no campaign begins, the risk of an outbreak occurring and the impact of such an outbreak worsens.”

The happy news, Lessler believes, is that done right, the campaign could not only prevent the measles epidemic from beginning, but could actually put West Africa in a better position than it was before Ebola, with vaccine coverage for measles and other diseases exceeding the pre-outbreak rates. “Previous campaigns have reached coverage in excess of 90%,” he says.

Victory in the battle against Ebola—to say nothing of the battle against measles—is by no means yet assured. But, again as the war colleges would teach, with the right cooperation and the right deployment, the good guys can win.

Correction: An earlier version of this story misidentified an assistant professor at the Johns Hopkins Bloomberg School of Public Health. He is Justin Lessler.

Your browser is out of date. Please update your browser at http://update.microsoft.com