AJPH Embargoed October Issue

Universal vaccinations can miss seniors, vulnerable people

Even with universal vaccination requirements, measles outbreaks can occur in people at high-risk for the disease, according to a study in the October issue of AJPH. 

In the study, published in the October issue of APHA’s American Journal of Public Health, researchers examined a 2019 measles outbreak in a Singapore residential home for people with intellectual disabilities. The outbreak – which involved 16 residents — was unexpected, as it occurred despite longtime measles vaccination requirements in childhood. Government-ordered vaccinations were implemented in Singapore’s National Childhood Immunization Program in 1975 and made compulsory in 1985. 

The outbreak exposed a gap in delivery and a need for catch-up shots for older and vulnerable populations. Because of limited social interaction, people who lived in the residential home may have had lower measles immunity than the general population, the researchers said. They also may have missed the national vaccination program, or did not attend regular or special education schools where proof of vaccination was required for school registration. 

Researchers noted that screening for immunity to measles and other vaccine-preventable diseases should be considered to prevent outbreaks. 

“There is risk of community introduction of measles to these small pockets of susceptive population, resulting in outbreaks,” the study authors said. “These findings may be applicable to other sheltered or isolated populations, underscoring the special needs of such populations.” 

[Author contact: Vernon Lee, Communicable Diseases Division, Ministry of Health, Singapore. “Outbreak of Measles in a Residential Home for the Intellectually Disabled in Singapore in 2019.”]

Restricting firearms not significantly linked to homicides by other means

When access to firearms is restricted, there is little evidence that homicides by other means significantly increase, according to a study in AJPH’s October issue. 

As part of a systemic review, researchers analyzed data from 16 studies that provided 60 estimates of the impact of firearm laws on firearm deaths. While strong data was available on the effect on homicides, there was insufficient data on suicides, they said. Based on their findings, the researchers concluded policies that are designed to prevent firearm homicides are likely to have significant benefits for public health. But further studies are needed to determine whether such policies could lead to an overall reduction in suicides. 

“If a gun law prevents 100 firearm homicides, it is expected to prevent 99 total homicides after accounting for possible lethal means substitution, violence contagion and other possible second-order effects,” the study said. 

In 2017, there were more than 47,000 suicides in the U.S., half of which were firearm-related. Another nearly 20,000 people died in homicides, nearly 75% of which were firearm-related. 

[Author contact: Roxanna Smart, Rand Corporation, Santa Monica, California. “Impact on Nonfirearm Deaths of Firearm Laws Affecting Firearm Deaths: A Systematic Review and Meta-Analysis.”]

Commentary: Thanks to partnerships, community intervention on asthma pays off in post-Katrina Louisiana 

Community-based interventions have had positive public health impacts in areas of Lousiana damaged by Hurricane Katrina in 2005, particularly in regard to asthma, according to a commentary in in the October issue of AJPH. 

Hurricane Katrina devastated communities in the region, killing about 1,800 people. Among its other long-term impacts, flooding left widespread mold in homes and other structures, increasing childhood asthma. The Head-off Environmental Asthma in Louisiana study stepped up to address the issue, using counseling, exposure reduction and other measures to reduce risks for children. The study used a community-based participatory research approach, involving parents, leaders and others closely in its work, which was key to its success. 

After the intervention, participants were more likely to take their prescribed asthma medications, have a provider for follow-up care, experience fewer financial and insurance problems for appointments and have fewer problems obtaining asthma medications, the commentary noted. 

The study illustrated the unique vulnerability of the community, especially with the interconnected threats of historic disparities, persistent environmental health stressors and disasters. It also showed the importance of community involvement. Many study hurdles were overcome by leveraging community resources, such as hiring local staff and heeding the advice of community advisory group members, the authors noted. 

“Drawing on lessons learned through HEAL, post-disaster health studies utilizing a participatory design should also integrate a disaster plan into the study design, incorporate the community’s cultural context, and build on factors influencing community resilience to avoid exacerbating vulnerability,” commentary authors wrote. 

[Author contact: Hannah Covert, Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University. “A Community-Based Participatory Research Approach to Hurricane Katrina: When Disasters, Environmental Health Threats and Disparities Collide.”]

Editorial: Protests inspire hope for change 

The COVID-19 pandemic has exposed inequities in U.S. public health and justice systems. But continued demontrations for social justice and evolving political changes show that unjust systems have the potential to be transformed, according to an editorial in the October issue of AJPH. 

Recent widespread protests that have swept the nation are a way to move public health forward, said author Nancy Krieger, who noted that it is “past time to say ‘enough.’”

COVID-19 inequities reflect the impacts of structural racism that have been in place since the U.S. began as “settler-colonial nation and slave republic,” Krieger noted. Those historic wrongs have echoed across generations, leading to modern-day Black and American Indian people living sicker and shorter lives, even before the pandemic. 

Since the protests spurred by the police killing of Minneapolis resident George Floyd, governments have declared racism a public health crisis, and there is new interest in community investment and safety over police funding, she said. 

“Whether this new awareness translates into meaningful change will depend on sustained mobilization of social movements that recognize both painful histories of past injustice and powerful histories of resistance, thereby inspiring hope for repair and a better equitable and sustainable future,” Krieger noted. 

[Author contact: Nancy Krieger, Department of Social and Behavioral Sciences at Harvard T. H. Chan School of Public Health, Boston, Massachusetts. “Enough: COVID-19, Structural Racism, Police Brutality, Plutocracy, Climate Change — Time for Health Justice, Democratic Governance and an Equitable, Sustainable Future.]

Check out the full list of AJPH papers that will be published online Aug. 20:

• Exploration of the STOP Act and Opioid Deaths in North Carolina (2010-2018)
• A Community-Based Participatory Research Approach to Hurricane Katrina: When Disasters, Environmental Health Threats and Disparities Collide
• Leisure Activity Engagement Among the Oldest-Old in China, 1998 to 2018.
• Rural Legal Deserts are a Critical Health Determinant
• Impact on Non-firearm Deaths of Firearm Laws Reducing Firearm Deaths: A Systematic Review and Meta-Analysis
• Environmental Health Impact of Hurricane Katrina on New Orleans
• Trends of Extreme Distress in the USA, 1993-2019
• Colonial Neglect and the Right to Health in Puerto Rico after Hurricane Maria
• Outbreak of Measles in a Residential Home for the Intellectually-Disabled in Singapore in 2019.
• Purchaser Licensing, Point-of-Sale Background Check Laws and Firearm Homicide and Suicide in Four U.S. States, 1985-2017
• Frequent Cannabis Use and Cessation of Opioids Injection, Vancouver, Canada, 2005-2018
• Policy Views and Negative Beliefs about Vaccines in the United States, 2019
• Water and Sanitation in Urban America, 2017-2019
• Implementation of a Statewide Policy Mandating School-based Fitness Assessment Screening
• Disability, Ethics and Health Care in the COVID-19 Pandemic
• Identifying Incidents of Public Health Significance Using the National Poison Data System— 2013–2018
• 15 years after Katrina: Paving the Way for Health Care Transformation
• Re-imagining Public Health in the Aftermath of a Pandemic
• Enough: COVID-19, Structural Racism, Police Brutality, Plutocracy, Climate Change — Time for Health Justice, Democratic Governance and an Equitable, Sustainable Future
• The Paradoxical effects of Hurricane Katrina on Births and Adverse Birth Outcomes
• Katrina: When Disasters, Environmental Health Threats and Disparities Collide

The articles above were published online August 20, at 4 p.m. ET by AJPH. 

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org 

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Media Relations at APHA. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at AJPH.org. For direct customer service, call 202-777-2516, or  email us. 

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