tag:theconversation.com,2011:/institutions/indiana-university-school-of-medicine-1907/articlesIndiana University School of Medicine2022-03-11T13:19:52Ztag:theconversation.com,2011:article/1784632022-03-11T13:19:52Z2022-03-11T13:19:52ZGuns, not roses – here’s the true story of penicillin’s first patient<figure><img src="https://images.theconversation.com/files/451134/original/file-20220309-25-206ycs.jpg?ixlib=rb-1.1.0&rect=62%2C209%2C3357%2C2439&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Penicillin ushered in the antibiotics revolution, with amazing results during war and peace.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-1928-alexander-fleming-a-scottish-researcher-discovered-news-photo/90736822">Science & Society Picture Library/SSPL via Getty Images</a></span></figcaption></figure><p>Albert Alexander was dying. World War II was raging, and this police officer of the county of Oxford, England, had developed a severe case of sepsis after a cut on his face became badly infected. His blood was now teeming with deadly bacteria. </p>
<p><a href="https://doi.org/10.1136/bmj.289.6460.1721">According to his physician</a>, Charles Fletcher, Alexander was in tremendous pain, “desperately and pathetically ill.” The bacterial infection was eating him alive: He’d already lost one eye and had oozing abscesses all over his face and in his lungs.</p>
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<a href="https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man in 1940s police uniform" src="https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=829&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=829&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=829&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1041&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1041&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1041&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Albert Alexander in uniform.</span>
<span class="attribution"><span class="source">Courtesy of Linda Willason</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>Since all known treatment options were exhausted and death appeared imminent, Fletcher decided that Alexander was the perfect candidate to try a new, experimental therapy. On Feb. 12, 1941, Alexander became the first known person to be treated with penicillin. Within days he began to make a stunning recovery.</p>
<p>I am a <a href="https://medicine.iu.edu/faculty/13502/sullivan-william">professor of pharmacology</a>, and Alexander’s story is the prelude to my yearly lecture on antibiotics. Like many other microbiology instructors, I’d always told students that Alexander’s septicemia arose after he scratched his cheek on a thorn while pruning rosebushes. This popular account dominates the scientific literature as well as recent articles and books.</p>
<p>The problem is, while descriptions of the miraculous effect of penicillin in this case are accurate, the details of Alexander’s injury were muddled, likely by wartime propaganda.</p>
<h2>Breaking the mold</h2>
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<a href="https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man looking into microscope" src="https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=672&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=672&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=672&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=845&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=845&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=845&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Bacteriologist Alexander Fleming discovered antibiotic penicillin in 1928.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/alexander-fleming-scottish-bacteriologist-18-december-1943-news-photo/102730610">Daily Herald Archive/SSPL via Getty Images</a></span>
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<p>The promise of penicillin as an antibiotic was first noted in 1928, when microbiologist Alexander Fleming noticed something funny in his petri dishes at St. Mary’s Hospital in London. Fleming’s cultures of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048009/">staphylococcal bacteria did not grow well</a> on plates contaminated with a penicillium mold. Fleming discovered that the mold’s “juice” was lethal to some types of bacteria. </p>
<p>A decade later, a team of scientists led by Howard Florey at Oxford University began the arduous task of purifying the active substance from the “mold juice” and formally testing its antimicrobial properties. In August 1940, Florey and his colleagues published their striking findings that <a href="https://doi.org/10.1016/S0140-6736(01)08728-1">purified penicillin safely wiped out numerous bacterial infections</a> in mice.</p>
<p>Florey then sought Fletcher’s help to try penicillin in a human patient. That patient would be Alexander, whose death seemed inevitable otherwise. As Fletcher stated, “There was all to gain for him in a trial of penicillin and <a href="https://doi.org/10.1136/bmj.289.6460.1721">nothing to lose</a>.”</p>
<p>At the time, purified penicillin was extremely scarce, since the mold was slow to grow and yielded precious little of the drug. Despite recycling unprocessed penicillin from Alexander’s urine, there just wasn’t enough available to finish off the infection once and for all. After 10 days of improvement, Alexander gradually relapsed. <a href="https://doi.org/10.1136/bmj.289.6460.1721">He died on March 15, 1941</a>, at the age of 43.</p>
<p>Despite the tragic outcome, Alexander’s case turbocharged interest in penicillin research. As Fletcher observed, “There was <a href="https://doi.org/10.1136/bmj.289.6460.1721">no doubt about the temporary clinical improvement</a>, and, most importantly, there had been no sort of toxic effect during the five days of continuous administration of penicillin.”</p>
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<span class="caption">An ad promoting penicillin and its role in the war effort.</span>
<span class="attribution"><a class="source" href="https://www.nlm.nih.gov/exhibition/fromdnatobeer/exhibition-making-yellow-magic.html">Schenley Laboratories, Inc. advertisement, 1944</a></span>
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<p>Almost exactly a year later, on March 14, 1942, doctors in Connecticut administered the antibiotic to a woman named <a href="https://www.nytimes.com/1999/06/09/us/anne-miller-90-first-patient-who-was-saved-by-penicillin.html">Anne Miller</a> who was deathly ill with streptococcal septicemia. She made a full recovery and became the first patient cured with penicillin. <a href="https://www.washingtonpost.com/history/2020/07/11/penicillin-coronavirus-florey-wwii-infection/">Mass production of penicillin</a> became a top priority of the U.S. War Department, second only to the Manhattan Project. It is widely believed that <a href="https://us.macmillan.com/books/9780805077780/the-mold-in-dr-floreys-coat">penicillin helped the Allies during World War II</a>, preventing wound infections and helping soldiers diagnosed with gonorrhea to return to the battlefield.</p>
<h2>The rosebush tale has been a thorn in their sides</h2>
<p>Albert Alexander has earned a place in history as the first known person to be treated with penicillin for a clinical condition. Almost as famous as his name is the purported cause of death: sepsis due to a scratch from rosebushes.</p>
<p>However, an alternative explanation was revealed in a <a href="https://www.ox.ac.uk/news/science-blog/penicillin-oxford-story">2010 interview with Eric Sidebottom</a>, a historian and author of “<a href="http://www.offoxpress.com/oxford-medicine-a-walk-through-nine-centuries.html">Oxford Medicine: A Walk Through Nine Centuries</a>.” He claimed that Alexander was injured when his police station was hit during a German bombing raid on Nov. 30, 1940. Shrapnel from this attack caused the facial lacerations that led to Alexander’s fatal blood poisoning, he said.</p>
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<a href="https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="elderly woman holds up a black and white photo" src="https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=538&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=538&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=538&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=676&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=676&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=676&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sheila LeBlanc holding photo of her father, Albert Alexander, in 2012.</span>
<span class="attribution"><span class="source">Courtesy of Linda Willason</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>Alexander’s daughter, Sheila LeBlanc, who moved to California and became an artist, confirmed Sidebottom’s account in a <a href="https://www.pe.com/2012/11/02/redlands-local-artists-share-childhood-bond/">2012 interview</a> with a local newspaper. She also revealed the grim consequences Alexander’s death had on his family. Since they’d lived in a house provided by the village, for the village constable, his death forced them to move out. LeBlanc, who was seven at the time, and her older brother were sent to an orphanage, since their mother had to find work.</p>
<p>Michael Barrett, a professor of biochemical parasitology at the University of Glasgow, also spoke to LeBlanc about the cause of Alexander’s injury. <a href="https://mosaicscience.com/story/penicillin-first-patient-history-albert-alexander-AMR-DRI/">Writing in 2018, Barrett stated</a> that while LeBlanc recalled that the constable’s house did have a beautiful rose garden, <a href="http://www.fnrcnewbury.org.uk/biography.asp?BiogID=225&PersonID=2467">her father’s fatal cut</a> was sustained during the German blitz.</p>
<p>In February 2022, I contacted Alexander’s granddaughter, Linda Willason, who is also an artist in California, to help set the record straight. Willason validated the shrapnel account and suggested that the rosebush story was “a bit of wartime propaganda.” By downplaying bombing injuries, the government likely hoped to maintain the public’s stiff upper lip.</p>
<p>While the nature of Alexander’s injury may seem a trivial detail, correcting the historical record is important. Alexander died in the line of duty, and the apocryphal rosebush story obscures his honorable actions. His descendants are hopeful the true account of his injury will now eclipse the false one.</p>
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<a href="https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="blue plaque with white text on brick wall" src="https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A plaque dedicated in 2021 shares the real story of Alexander’s injury.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Albert_Alexander_plaque.jpg">Newbury Town Council/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>In 2021, <a href="https://www.bbc.com/news/uk-england-berkshire-57208267">a plaque commemorating Alexander</a> was installed in Newbury that reads: “On war support duty in Southampton on 30th November 1940, Albert was injured in an air raid. Contracting staphylococcal and streptococcal septicaemia, he was transferred to the Radcliffe Infirmary in Oxford, where he was selected for the first clinical application of penicillin. … His place in the history of antibiotics is secure.”</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/178463/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Albert Alexander was the first known person treated with penicillin. While his ultimately fatal case is well known in medical histories, the cause of his illness has been misattributed for decades.Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1590242021-04-16T12:37:59Z2021-04-16T12:37:59ZAmerica goes back to school – 5 essential reads on parenting in the pandemic<figure><img src="https://images.theconversation.com/files/395138/original/file-20210414-17-dz256e.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3205%2C2469&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents may find it challenging to get their children comfortable going back out into the world.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/student-is-welcomed-back-to-school-by-school-counselor-news-photo/1312167251?adppopup=true">Paul Bersebach/Orange County Register via Getty Images</a></span></figcaption></figure><p>Beyond safety and survival, a paramount question throughout the pandemic has been: When will things get “back to normal”? But as the nation <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">gradually gets vaccinated</a> against COVID-19 and various facets of society begin to reopen, it becomes evident that a return to normalcy poses a whole new set of questions, challenges and concerns.</p>
<p>Perhaps nowhere is this more apparent than when it comes to the education and parenting of America’s school-age children, whose childhoods have been uprooted in unparalleled ways since the pandemic struck in early 2020. Here we highlight five articles that help parents and educators better understand and do what it takes to get kids back to their classrooms, friends and regular routines.</p>
<h2>1. How can America’s schools safely reopen?</h2>
<p>That’s a question that <a href="https://theconversation.com/profiles/brandon-guthrie-1218844">Brandon Guthrie</a>, an epidemiologist at the University of Washington, takes up in a piece about <a href="https://theconversation.com/how-can-all-schools-safely-reopen-157475">the conditions that must be met</a> in order for in-person instruction to resume.</p>
<p>On the question of how many teachers need to be vaccinated for schools to safely reopen, Guthrie writes that there is “no magic number.”</p>
<p>“In fact, the Centers for Disease Control and Prevention advises that in-person learning can start safely as long as other mitigation protocols like mask-wearing and adequate ventilation are in place,” Guthrie writes. “Vaccines offer an added level of protection.”</p>
<h2>2. How soon can kids get the COVID-19 vaccine?</h2>
<p><a href="https://theconversation.com/profiles/james-b-wood-1219392">James B. Wood</a>, an assistant professor of clinical pediatrics at Indiana University School of Medicine, <a href="https://theconversation.com/when-can-kids-get-the-covid-19-vaccine-a-pediatrician-answers-5-questions-parents-are-asking-157512">addresses five questions parents are asking</a> about when their children can get vaccinated.</p>
<p>“Before kids under 16 can be vaccinated, clinical trials need to be completed in thousands of young volunteers to assess the vaccines’ safety and efficacy, and the results must be fully reviewed and the vaccine authorized by the FDA,” Wood writes.</p>
<h2>3. What about physical school conditions?</h2>
<p>COVID-19 isn’t the only threat children face as in-person instruction becomes more common. <a href="https://theconversation.com/profiles/michael-addonizio-688882">Michael Addonizio</a>, an education policy scholar at Wayne State University, shines light on the <a href="https://theconversation.com/america-gets-a-d-for-school-infrastructure-but-federal-covid-relief-could-pay-for-many-repairs-156831">deteriorating conditions at many of America’s schools</a> and the threat those conditions pose to students.</p>
<p>“Many kids are attending public schools this spring with the use of COVID-19 safety protocols, including more desk spacing, more frequent cleaning and mandates to wear masks,” Addonizio writes. “But far too many of the school buildings themselves remain dilapidated, toxic and in desperate need of structural improvements.”</p>
<h2>4. How can children’s stress be reduced?</h2>
<p>With all the concerns about what it takes to safely reopen the physical buildings that house America’s schools, it can be easy to forget that child well-being is a critical part of the equation. With that in mind, <a href="https://theconversation.com/profiles/amanda-sheffield-morris-1183546">Amanda Sheffield Morris</a>, a professor of human development and family science, and Jennifer Hays-Grudo, a professor of psychiatry and behavioral sciences, offer <a href="https://theconversation.com/10-parenting-strategies-to-reduce-your-kids-pandemic-stress-151419">10 research-proven strategies</a> on how parents can help their children reduce the stress brought about by the pandemic.</p>
<p>Among other things, they prescribe “protective and nurturing experiences” – such as keeping homes free of chaos and clutter – that they describe as “powerful antidotes to stress and adversity and prepare children to cope with hard times for years to come.”</p>
<p>“Decades of research have taught us that adversity during childhood has damaging effects on health and development,” the two professors write. “Fortunately, developmental scientists have identified ways to help children survive and thrive during times of adversity.”</p>
<h2>5. How can kids overcome fear of going outside?</h2>
<p>Some parents may find it difficult just to get their children to even want to go back out into the world.</p>
<p><a href="https://theconversation.com/profiles/dominique-a-phillips-1220208">Dominique A. Phillips</a>, a Ph.D. student in clinical psychology, and <a href="https://theconversation.com/profiles/jill-ehrenreich-may-1220209">Jill Ehrenreich-May</a>, a professor of psychology, offer insights on how to help kids <a href="https://theconversation.com/heres-how-to-help-your-kids-break-out-of-their-pandemic-bubble-and-transition-back-to-being-with-others-157732">break out of their pandemic bubble</a>.</p>
<p>“While it may feel easier in the moment to accommodate your child’s desire to avoid social situations that feel more awkward or overwhelming than before, it is important not to reinforce such behavior,” the duo from the University of Miami write. “Prolonged avoidance can lead to even more anxiety and less confidence in socializing.”</p>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/159024/count.gif" alt="The Conversation" width="1" height="1" />
As more people get vaccinated and different facets of society slowly reopen, challenges remain in the nation’s quest to get back to normal. Here are five articles that help illuminate the path.Jamaal Abdul-Alim, Education Editor, The ConversationAlvin Buyinza, Editorial and Outreach Assistant, The Conversation USLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1575122021-03-24T12:26:15Z2021-03-24T12:26:15ZWhen can kids get the COVID-19 vaccine? A pediatrician answers 5 questions parents are asking<figure><img src="https://images.theconversation.com/files/391011/original/file-20210322-23-19q2w46.jpg?ixlib=rb-1.1.0&rect=0%2C59%2C7951%2C5237&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Adolescents could soon be eligible, but vaccine trials are just getting started for younger children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-wearing-face-mask-of-a-schoolboy-studying-royalty-free-image/1279862521">FGTrade via Getty Images</a></span></figcaption></figure><p><em>A big question among parents and teachers as more schools reopen is when their kids will be vaccinated against COVID-19. Some have wondered whether the vaccine is even necessary for children.</em> </p>
<p><em>A vaccine for children is getting closer. Pfizer on April 9, 2021, became the first vaccine maker to <a href="https://cdn.pfizer.com/pfizercom/2021-04/EUA-12-15yo-Statement-9-April-2021.pdf">formally ask</a> the Food and Drug Administration for emergency use authorization that would allow its COVID-19 vaccine to be given to adolescents ages 12 and older. Pfizer <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-biontech-announce-positive-topline-results-pivotal">has said its vaccine trials in children show</a> the vaccine is as effective in ages 12-15 as it is in young adults, however those results still have to be reviewed by the FDA.</em> </p>
<p><em><a href="https://news.iu.edu/iu-experts/profile/m/1046/wood-james">Dr. James Wood</a>, a pediatrician and assistant professor of pediatric infectious diseases, explains what doctors know today about the risk children face of getting and spreading the coronavirus and when vaccines might be available.</em></p>
<h2>Do kids really need to get the COVID-19 vaccine?</h2>
<p>The short answer is yes. A lot of studies have shown that COVID-19 <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html">isn’t as severe in children</a>, particularly younger kids – but that doesn’t mean kids aren’t at risk of getting infected and potentially <a href="https://doi.org/10.5694/mja2.50823">spreading the virus</a>. </p>
<p>Children under 12 who get COVID-19 do tend to have mild illnesses or no symptoms, while teenagers seem to have responses somewhere between what adults and younger kids have experienced. The Centers for Disease Control and Prevention found that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6939e2.htm?s_cid=mm6939e2_w">teens were about twice as likely</a> to be diagnosed with COVID-19 as children ages 5-11. </p>
<p>Researchers are still trying to understand why we’re seeing these differences between older and younger kids. Behavior probably plays a part. Teenagers are more likely to engage in social or group activities, and they may or may not be wearing masks. <a href="http://doi.org/10.1126/scitranslmed.abd5487">Immune differences</a> and <a href="http://jamanetwork.com/article.aspx?doi=10.1001/jama.2020.8707">biologic factors</a> may also play a role. Non-SARS-CoV-2 coronaviruses are <a href="https://doi.org/10.1128/jcm.00636-10">common in children</a>, often resulting in upper respiratory infection. Is their frequent exposure to other coronaviruses helping protect them from severe COVID-19? That is one hypothesis. We know younger kids’ immune responses in general are different from adults, and likely play a role in protection.</p>
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<p>It’s important to remember that while most children get only mild symptoms, they still face risks. At least <a href="https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#AgeAndSex">251 U.S. children</a> with COVID-19 have died, and <a href="https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/">thousands have been hospitalized</a>.</p>
<p>The key to minimizing the risk is to make sure kids eventually get vaccinated, follow social distancing recommendations and wear masks.</p>
<h2>Are kids spreading the virus?</h2>
<p>In a setting like a school where mask-wearing and social distancing are enforced, young kids seem to not spread the virus very much when the rules and guidelines are being followed. One CDC review found <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7003e1.htm">little difference in community cases</a> in counties with elementary schools open and those with remote learning.</p>
<p>If precautions aren’t being taken, children infected with the coronavirus very well could <a href="https://www.cidrap.umn.edu/news-perspective/2020/12/study-kids-adults-equally-susceptible-home-covid-19-spread">spread it to adults</a>. What isn’t clear yet is how great that risk is.</p>
<figure class="align-center ">
<img alt="A girl wearing a mask heads to school past adults without masks." src="https://images.theconversation.com/files/390902/original/file-20210322-19-16jobq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390902/original/file-20210322-19-16jobq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390902/original/file-20210322-19-16jobq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390902/original/file-20210322-19-16jobq5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390902/original/file-20210322-19-16jobq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390902/original/file-20210322-19-16jobq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390902/original/file-20210322-19-16jobq5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In school settings, younger children have been less likely to spread the virus to adults.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/students-go-into-perry-elementary-school-on-the-first-day-news-photo/1269168961">Ben Hasty/MediaNews Group/Reading Eagle via Getty Images</a></span>
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<p>To keep schools as safe as possible, continuing schoolwide mask and social distancing policies will be important. With teenagers in particular, mask rules can’t hinge on whether the person has been vaccinated or not. Until <a href="https://www.nature.com/articles/d41586-021-00728-2">herd immunity</a> within the whole community is at a good level, social distancing and masking is still going to be the recommendation.</p>
<h2>So, when can kids get vaccinated?</h2>
<p>Right now, the Pfizer vaccine is the only one in the U.S. authorized for teenagers <a href="https://www.fda.gov/media/144412/download">as young as 16</a>. Before kids under 16 can be vaccinated, clinical trials need to be completed in thousands of young volunteers to assess the vaccines’ safety and efficacy, and the results must be fully reviewed and then authorized by the FDA.</p>
<p>Results from Pfizer’s adolescent trials are expected to be <a href="https://cdn.pfizer.com/pfizercom/2021-04/EUA-12-15yo-Statement-9-April-2021.pdf">reviewed in the coming weeks</a>. Vaccine manufacturer <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html">Moderna</a> has <a href="https://clinicaltrials.gov/ct2/show/NCT04368728">trials underway with adolescents</a>. And <a href="https://www.jnj.com/johnson-johnson-expands-phase-2a-clinical-trial-of-covid-19-vaccine-candidate-to-include-adolescents">Johnson & Johnson</a> – maker of the third vaccine authorized for adult use in the U.S. – announced in early April that it had also started trials in adolescents. If their vaccines are shown to be safe and effective and regulators authorize them, kids 12 and up could be vaccinated before school starts in the fall. Vaccine supply will partly determine how soon that happens.</p>
<p>Realistically, younger children probably won’t be eligible for the vaccine until late fall or winter at the earliest. Moderna announced in mid-March that it had started testing its vaccine <a href="https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-first-participants-dosed-phase-23-study-0">in children ages 6 months to 11 years</a>. Pfizer said it is <a href="https://www.businesswire.com/news/home/20210331005503/en/">also starting testing</a> in young children, but these trials take time. </p>
<h2>What’s different about the vaccines kids will get?</h2>
<p>The composition of the COVID-19 vaccines for children is the same as used in adults – the difference is that children may require a different dose.</p>
<p>The first step in vaccine trials is to figure out the right dose. The companies want to find the lowest possible dose that is both safe and produces a target level of antibodies. For example, Moderna uses a 100-microgram dose in adults. It is testing three different doses for children under age 2 – 25, 50 and 100 micrograms – and two doses for children over age 2, at 50 and 100 micrograms. </p>
<p>Once the company determines the optimal dose, it will launch a placebo-controlled trial to test its effectiveness, in which some children will get a placebo and some will get the vaccine.</p>
<figure class="align-center ">
<img alt="A student plays a flute through a mask during band practice." src="https://images.theconversation.com/files/391014/original/file-20210322-13-1q1f277.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391014/original/file-20210322-13-1q1f277.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391014/original/file-20210322-13-1q1f277.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391014/original/file-20210322-13-1q1f277.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391014/original/file-20210322-13-1q1f277.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391014/original/file-20210322-13-1q1f277.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391014/original/file-20210322-13-1q1f277.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Students are now seated farther apart in many schools. The CDC recently changed its recommendation from 6 feet between children in K-12 schools to 3 feet unless the community has a high rate of viral spread.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakCaliforniaSchools/319919ae7a8240d2a1b0d0439c24241c/photo">AP Photo/Haven Daily</a></span>
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</figure>
<p>A rigorous system for pediatric vaccine trials is <a href="https://doi.org/10.1203/01.PDR.0000106317.36875.6A">well established</a> in the U.S. These trials are key to assessing the safety and efficacy of vaccines in children, which can differ from adults. </p>
<p>I am optimistic that a safe and effective vaccine will be available for children. Thus far, there have not been any safety signals from either the adult or adolescent studies that have been worrying to me as a pediatrician, but the studies still need to be done in children.</p>
<h2>How can parents create safe playdates for kids?</h2>
<p>When I talk to parents, I explain that it’s a risk-versus-benefit question. Each family has a different tolerance.</p>
<p>From a medical standpoint, the mental health of kids and having them play with other kids is an important part of childhood.</p>
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<p>I would say that unvaccinated kids playing indoors without masks on is still not a great idea. The risk is just too high at this point. As weather warms up, I would encourage kids to play outside. Ride bikes, play and socialize – just do it in a safe manner.</p>
<p>We all have pandemic fatigue, including medical professionals. As the weather gets warmer, I think everyone just wants to get back to normal. The worst thing we can do, right as we <a href="https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases">start to see a light at the end</a>, is fall backward again – because that would just make it that much longer for everyone.</p>
<p><em>This story was updated April 9, 2021, with Pfizer’s request for emergency use authorization.</em></p><img src="https://counter.theconversation.com/content/157512/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James B. Wood does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Early test results look promising, and Pfizer has asked the FDA to review and authorize its vaccine for use in teens. That doesn’t mean putting away the face masks, though.James B. Wood, Assistant Professor of Clinical Pediatrics, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1545652021-02-08T13:36:43Z2021-02-08T13:36:43ZIn mice, a mother’s love comes from the gut<figure><img src="https://images.theconversation.com/files/382806/original/file-20210205-21-5llpuf.jpg?ixlib=rb-1.1.0&rect=0%2C196%2C3753%2C2014&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being a good mother depends on many factors, including the the bacteria in the mouse mother's gut.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/mother-mouse-walking-with-pram-royalty-free-illustration/488316168?adppopup=true">IvonneW/iStock/Getty Images Plus</a></span></figcaption></figure><p>There is perhaps nothing more heartbreaking and confusing than a mother who neglects her children. </p>
<p>In 2017, approximately 675,000 children in the U.S. were victims of mistreatment, with <a href="https://www.childrensrights.org/newsroom/fact-sheets/child-abuse-and-neglect/">75% reported as neglected</a>. The early postnatal months are critical to ensure proper physical and psychological development; children who are neglected during this phase can experience <a href="https://doi.org/10.1515/jpem-2014-0231">stunted growth</a> as well as <a href="https://www.childwelfare.gov/pubPDFs/long_term_consequences.pdf">behavioral and learning problems</a>. What could possibly subvert the basic instinct for a mother to take care of her child? </p>
<p>Scientists have uncovered a number of biological and environmental factors that can influence maternal behavior in numerous types of mammals. Many of these studies have pointed to deficits in oxytocin, a hormone released during birth and while breastfeeding that <a href="https://doi.org/10.1126/science.aab2490">facilitates mother-child bonding</a>. <a href="https://doi.org/10.1016/j.yfrne.2019.03.001">Defects in the levels of serotonin</a>, a key neurotransmitter that regulates mood and depression, can also interfere with the maternal instinct.</p>
<p>Recently a research team from the Salk Institute in La Jolla, California, led by <a href="https://www.salk.edu/scientist/janelle-ayres/">Janelle Ayres</a> reported a new influence on maternal behavior arising from an unexpected source: the bacteria that dwell in the mother’s gut. Their intriguing study, published in <a href="https://doi.org/10.1126/sciadv.abe6563">Science Advances</a>, was performed using mouse mothers and their offspring.</p>
<p>As a pharmacologist and microbiologist at the <a href="https://medicine.iu.edu/faculty/13502/sullivan-william">Indiana University School of Medicine</a>, and <a href="https://authorbillsullivan.com">author</a> of <a href="https://nationalgeographicpartners.com/2019/10/pleased-to-meet-me-genes-germs-and-the-curious-forces-that-m/">“Pleased to Meet Me: Genes, Germs, and the Curious Forces That Make Us Who We Are</a>,” I study the surprising effects that microbiota – the microbes that live on and inside another organism – have on behavior. Ayres’ study has uncovered a new way that microbiota can fundamentally alter behavior in mice, including a basic instinct such as motherly nurturing.</p>
<h2>Proper development of newborns depends on microbiota</h2>
<p>Emerging research is uncovering a clear role for intestinal microbiota in the proper development of newborns, <a href="https://doi.org/10.4137/cmped.s2008">including humans</a>. Our intestines are populated by trillions of bacteria, which are first introduced into the body by the mother during birth. Mice are frequently used by scientists to gain insights into potential functions the microbiota may have in humans. </p>
<p>By feeding them high doses of antibiotics, researchers can create “germ-free” mice that lack microbiota. Alternatively, germ-free mice can be birthed using sterile techniques. Germ-free mice grow more slowly and suffer from a number of <a href="https://doi.org/10.1016/B978-0-12-381300-8.00008-3">immune system deficits and social behavior issues</a>. In addition to helping digest food and manufacture nutrients, <a href="https://doi.org/10.1073/pnas.1607235113">a newborn’s gut bacteria regulate production of insulin-like growth factor 1</a>, a crucial growth hormone and that promotes proper development of bone and tissues. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382850/original/file-20210206-23-1i37pd2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Could the microbes in a human mother’s gut actually influence how she cares for her newborn baby?</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/black-mother-kissing-baby-son-on-cheek-royalty-free-image/740523319?adppopup=true&uiloc=thumbnail_same_series_adp">Jose Luis Pelaez Inc/DigitalVision/Getty Images</a></span>
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<p>In Ayres’ new study, she and her colleagues found a novel way that intestinal microbes contribute to mother-child bonding. For the first time, her research team found that the mother’s microbiota can impact her behavior in a way that can be detrimental to her pups. While it is widely accepted that <a href="https://doi.org/10.4137/cmped.s2008">an infant’s microbiota is important for proper development</a>, the affect of the mother’s microbiota on nurturing behavior had not been previously considered. </p>
<p>Ayres’ team administered several different kinds of <em>E. coli</em> bacteria into germ-free mice and discovered that mothers housing one called <em>E. coli</em> O16:H48 had pups with stunted growth. Pups born to these mothers had impaired signaling through the insulin-like growth factor 1 that led to less fat and muscle development.</p>
<h2>How microbes cause a mother to neglect her offspring</h2>
<p>Several possibilities could account for their developmental delays, but the researchers found no behavioral issues in the pups that would lead them to consume less food than usual. In addition, the mother was producing milk normally. Further study suggested that the stunted growth was a result of maternal neglect, causing the pups to be malnourished. Mothers colonized with <em>E. coli</em> O16:H48 spent less time on maternal behaviors such as nest-building, grooming and nursing. </p>
<p>The maternal instinct to feed her pups appeared to have been erased in mothers harboring <em>E. coli</em> O16:H48. To confirm their hypothesis, the researchers transferred the newborn pups of mothers with <em>E. coli</em> O16:H48 to the care of foster mothers displaying normal nurturing activities. Pups raised by the foster mothers developed normally. At least in mice, <em>E. coli</em> O16:H48 makes good mothers go bad.</p>
<p>These findings lend further support to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/">the gut-brain axis</a>, which refers to the complex array of chemical signals that microbiota in the gut send to the brain. Different species of intestinal bacteria produce different chemical signals, which contributes to the variations in behavior observed between individuals. Evidence that the gut-brain axis can also influence child-rearing underscores the importance of microbiota across generations. </p>
<p>Future research will focus on how <em>E. coli</em> O16:H48 in the mother’s gut alters the mother’s behavior and which bacterial molecules are responsible. A 2016 study by a different group demonstrated that <a href="https://doi.org/10.1016/j.cell.2016.06.001">the oxytocin system can be modulated by the intestinal microbiota</a>. But Ayres’ team did not find alterations in oxytocin in mothers with <em>E. coli</em> O16:H48. Analysis of the <em>E. coli</em> O16:H48 genome suggests that this bacterial strain may exert its detrimental effect on behavior by altering levels of the neurotransmitter serotonin in the mothers.</p>
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<p>It should be stressed that there is currently no evidence that this <em>E. coli</em> strain operates in humans as it does in mice to affect a mother’s attentiveness to her young. Moreover, the study was performed using germ-free mice colonized with only a single strain of <em>E. coli</em> bacteria. </p>
<p>Nonetheless, these findings warrant further investigation into how a human mother’s microbiota may influence behaviors that can affect the welfare of children. It now appears that optimal infant care requires more than the baby’s diet; future research should consider the composition of mother’s microbiota as well. Doctors commonly agree that a <a href="https://www.psychologytoday.com/us/blog/mood-microbe/201912/what-give-your-microbes-the-holidays">healthy microbiota can be cultivated</a> through a sensible diet that includes plentiful fiber and fermented foods, along with regular exercise.</p><img src="https://counter.theconversation.com/content/154565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Microbes can alter the minds of mouse mothers and disrupt their natural instinct to nurture their young.Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1524292020-12-22T13:36:26Z2020-12-22T13:36:26ZWhy should I trust the coronavirus vaccine when it was developed so fast? A doctor answers that and other reader questions<figure><img src="https://images.theconversation.com/files/376268/original/file-20201221-21-25j20e.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3982%2C2664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacist Jessica Sahni prepares a Pfizer COVID-19 vaccine in New York City. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/walgreens-pharmacist-jessica-sahni-prepares-a-pfizer-covid-news-photo/1230249071?adppopup=true">Bryan R. Smith/AFP via Getty Images</a></span></figcaption></figure><p><em>Editor’s Note: With a coronavirus vaccination effort now underway, you might have questions about what this means for you and your family. If you do, <a href="mailto:lynne.anderson@theconversation.com">send them to The Conversation,</a> and we will find a physician or researcher to answer them. Here, <a href="https://medicine.iu.edu/faculty/4406/dbeibo-lana">Dr. Lana Dbeibo</a>, a clinical assistant professor of medicine at Indiana University School of Medicine, answers reader questions about the vaccine and compromised immune systems and whether to get the vaccine if a person has had previous adverse reactions to a vaccine.</em></p>
<p><strong>I fully support the use of vaccines, but I worry about possible long-term side effects with the new vaccines. How can anyone say with any confidence there will be no long-term consequences with vaccines that have been developed so rapidly?</strong></p>
<p>There are reasons the <a href="https://theconversation.com/covid-19-vaccines-were-developed-in-record-time-but-are-these-game-changers-safe-150249">vaccines were developed rapidly</a>: First, the production started before the end of <a href="https://www.nccn.org/patients/resources/clinical_trials/phases.aspx">phase 3 clinical trials</a>. Second, there was a lot of interest in volunteering for the trials that tested the vaccines’ effectiveness, which expedited the process. Researchers often wait many months and sometimes even years to get people to volunteer to be part of trials. </p>
<p>Last, there was a lot of disease in the community which made it faster to see whether the vaccine was effective. The coronavirus has caused disease in millions of people in the U.S. alone, while <a href="https://www.cdc.gov/vhf/ebola/index.html">Ebola</a> and <a href="https://www.cdc.gov/zika/index.html">Zika </a>viruses, while extremely serious, affected far fewer.</p>
<p>I worry much more about the <a href="https://www.nature.com/articles/d41586-020-02598-6">long-term effects of the virus</a>, which can be very debilitating and start soon after the infection. We have not seen reports of major effects of the vaccine in the past few months that it was studied; if there were major effects, I believe we should have started to see them by now. This could can change, however, and scientists would update recommendations accordingly.</p>
<p><strong>My husband is 72 and undergoing chemo treatment for metastasized cancer in his lymph nodes. So far, treatment is showing shrinkage of tumors and no new spread.
I’m 73. Should I get the vaccine?</strong></p>
<p>There are two issues to address here. First, there is a question of <a href="https://www.nytimes.com/2020/12/08/health/covid-vaccine-mask.html">whether someone who has been vaccinated could spread the disease to someone else</a>. There is very limited data on whether the vaccine effectively limits spread of the disease, but we are waiting on studies to answer this question. </p>
<p>The second issue you raise is about people with compromised immune systems and whether they should get the vaccine. While the efficacy of the COVID-19 vaccines was not studied in immunocompromised people, the <a href="https://www.ajmc.com/view/taking-immunosuppressants-fauci-says-get-the-covid-19-vaccine">danger of COVID-19 to patients with a weaker immune system like your husband’s is very high</a>. Because the benefit may exceed the risk, the Centers for Disease Control and Prevention <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html">did not list being immunocompromised</a> as a contraindication to receive the COVID vaccine. Please consult with your physician to have a conversation about this.</p>
<p><strong>I have rheumatoid/psoriatic arthritis. I am taking the <a href="https://www.medicinenet.com/biologics_biologic_drug_class/article.htm">biologic</a> <a href="https://www.actemra.com">Actemra</a> and <a href="https://www.rxlist.com/solu-medrol-drug.htm">Solu Medrol</a> as an infusion, monthly. I also take <a href="https://medlineplus.gov/druginfo/meds/a682019.html">methotrexate</a> twice a week. Is the vaccine considered safe for people with compromised immune systems?</strong></p>
<p>The answer to this is very similar to the answer above. The CDC did not list having a weakened immune system as a reason not to get the vaccine, or what we doctors call a <a href="https://www.medicinenet.com/contraindication/definition.htm">contraindication</a>. Still, it is important for you to talk to your physician about your particular case. </p>
<figure class="align-center ">
<img alt="A man receiving the COVID-19 vaccine." src="https://images.theconversation.com/files/376270/original/file-20201221-15-51zgwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/376270/original/file-20201221-15-51zgwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/376270/original/file-20201221-15-51zgwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/376270/original/file-20201221-15-51zgwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/376270/original/file-20201221-15-51zgwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/376270/original/file-20201221-15-51zgwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/376270/original/file-20201221-15-51zgwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Herbie Severe receives Moderna’s COVID-19 vaccine at Hartford Hospital in Hartford, Connecticut, on Dec. 21.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/herbie-severe-recieves-the-covid-19-vaccine-with-the-first-news-photo/1230250350?adppopup=true">Joseph Prezioso/AFP via Getty Images</a></span>
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<p><strong>My 22-year-old son had a reaction to the <a href="https://www.cdc.gov/vaccines/vpd/mmr/public/index.html">MMR vaccine</a> when he was approximately 6 years old. He ran a fever for several days and developed <a href="https://medlineplus.gov/ency/article/000535.htm#:%7E:text=Immune%20thrombocytopenic%20purpura%20(ITP)%20is,few%20platelets%20in%20the%20blood.">the bleeding disorder ITP</a> within a month or two after receiving the MMR vaccine. Should he be concerned about receiving the coronavirus vaccine?</strong></p>
<p>Having any type of allergy other than <a href="https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468">anaphylaxis</a>, which is a severe and sometimes life-threatening allergic reaction, to vaccines or components of the COVID vaccine <a href="https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19/clinical-considerations.html">is not a contraindication to receive the COVID vaccine</a>. Everyone who receives either one of the drugs that have received emergency use authorization will be monitored for 15-30 minutes in the clinic after the vaccine dose because serious reactions will happen in the first few minutes after the vaccine is given. </p>
<p><strong>At age 7 or 8, I received tetanus antitoxin (horse serum) and quickly lost consciousness for about four days. Subsequently, I remember having hives a few times in childhood and mild asthma until I was about 25. I do not now have significant allergies. I have had several cardiac procedures, including open thoracotomy for mitral and aortic bovine valve replacement in 2010 and a <a href="https://www.watchman.com/en-us/how-watchman-device-works.html">“Watchman”</a> procedure. I have a pacemaker and daily take <a href="https://www.medicalnewstoday.com/articles/metoprolol-oral-tablet">Metoprolol</a>, <a href="https://medlineplus.gov/druginfo/meds/a601212.html">Torsemide</a> and <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Penicillin-g">penicillin g</a> (after two episodes of <a href="https://www.mayoclinic.org/diseases-conditions/endocarditis/symptoms-causes/syc-20352576">endocarditis</a>. Also a <a href="https://www.healthline.com/health/hemicolectomy">hemicolectomy </a>for cancer. No problem with flu shots. Generally I am feeling better than I have in the past several years. I drive without difficulty. Should I get the vaccine?</strong> </p>
<p>My answer here would be similar to one answered above – having any allergy other than anaphylaxis to vaccines or components of the COVID vaccine is not a contraindication to receive the COVID vaccine. Similarly, having asthma or seasonal allergies is not a contraindication. I would recommend you consult with your doctor for specifics related to your other health issues.</p>
<p>And remember that scientific observations of the vaccine are ongoing. The CDC, FDA and other government agencies will update the public on significant changes if they occur.</p><img src="https://counter.theconversation.com/content/152429/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lana Dbeibo does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Now that two COVID vaccines have been authorized by the FDA, questions arise. Today, a physician from Indiana University School of Medicine answers five reader questions.Lana Dbeibo, Assistant professor of clinical medicine, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1355252020-04-09T12:08:52Z2020-04-09T12:08:52ZHere’s how Americans coped during the beginning of the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/326552/original/file-20200408-153819-1n9he2c.jpg?ixlib=rb-1.1.0&rect=10%2C1724%2C3423%2C2462&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most people felt they were doing OK – with lots of TV and news updates.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/iUHDzbdudC4">Erik Mclean/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The COVID-19 pandemic has changed everyday life for Americans. How well are people across the country dealing with the new reality of closed businesses, shuttered schools, social distancing and the threat of the coronavirus itself? </p>
<p><a href="https://psychology.iupui.edu/risc-lab">As psychology</a> <a href="https://scholar.google.com/citations?user=fZr3zoUAAAAJ&hl=en&oi=ao">researchers</a>, we decided to conduct an online survey to find out. On March 26, we asked 500 adults from age 19 to 78 a series of questions to help us better understand how Americans are mentally coping with the pandemic. The group represented 47 U.S. states and roughly matched the age, race and gender demographics of the nation. </p>
<p>Though not yet peer-reviewed, these responses provide a snapshot of Americans’ mental health as the coronavirus pandemic really started to ramp up, as well as a hint about groups who might struggle during this unprecedented time.</p>
<h2>Doing basically OK</h2>
<p>Overall, our survey indicated that Americans were coping fairly well as of late March. Our respondents reported only moderate levels of stress and worry about COVID-19, estimating their individual likelihood of becoming infected as only around 30%, on average.</p>
<p>Despite the anecdotal impression that younger people are less worried about the pandemic, all age groups reported similar levels of worry and estimated they had about the same chance of being infected.</p>
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<p>There were no big surprises in how individuals reported most commonly coping with pandemic-related challenges: They were talking with friends, watching TV, exercising, listening to news and engaging in hobbies. The most effective coping strategies included problem-solving, exercising, engaging in hobbies and focusing on what they felt thankful for. These strategies were associated with lower self-reported stress and better self-reported coping with the pandemic.</p>
<h2>Some people having a tougher time</h2>
<p>However, not all Americans were coping well. There were some groups who appeared more vulnerable to negative effects of pandemic stress.</p>
<p>About 35% of our survey respondents reported changes in their employment since the beginning of the U.S. COVID-19 pandemic. This is an increase from earlier estimates in mid-March that <a href="https://www.newsweek.com/coronavirus-pandemic-sees-nearly-1-5-americans-either-lose-their-job-have-their-hours-reduced-1492725">1 in 5 American workers had lost their jobs</a> or had them reduced.</p>
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<p>Not only are they dealing with the usual stressors related to the pandemic; they also have to worry about whether they’re going to make it through this period financially. Unsurprisingly, these individuals reported more stress and worry, rated their chances of being infected with COVID-19 as higher and said they were coping less effectively with the pandemic. </p>
<p>Americans living in urban regions also reported more worry about the pandemic and were coping less effectively than those in suburban and rural regions. This might be because COVID-19 first hit urban areas, including Seattle, New York and Los Angeles. However, people across rural, urban and suburban regions all put their own odds of getting infected with COVID-19 around the same 30% chance.</p>
<p>About 18% of the sample reported being at a higher risk for COVID-19 due to a pre-existing condition, including being immunocompromised, having a respiratory illness or being over the age of 65. Unsurprisingly, people in this group reported more worry, rated their chances of becoming ill as higher and stated they were coping less effectively.</p>
<h2>Women bearing more, coping less well</h2>
<p>Women reported more anxiety, stress and worry, believed they had higher chances of being infected with COVID-19 and were coping less effectively than men.</p>
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<p>We suspect this increased vulnerability may in part be due to caregiving responsibilities. Women in our sample disproportionately reported taking care of kids, experiencing a loss of privacy and personal time, and struggles between work and family responsibilities during this pandemic. </p>
<p>Women reported engaging in more coping strategies than men did, by seeking out support from others, engaging in faith practices and focusing on what they are thankful for. Those strategies were associated with better self-reported coping. However, women also reported more maladaptive coping strategies, like stress eating and irritability. </p>
<h2>Hazardous alcohol drinkers drinking more</h2>
<p>Alcohol use may be on the rise with this pandemic, with some reports indicating <a href="https://www.newsweek.com/us-alcohol-sales-increase-55-percent-one-week-amid-coronavirus-pandemic-1495510">large increases in alcohol sales</a>. In our sample, about a quarter of current alcohol drinkers reported drinking more since the beginning of the COVID-19 pandemic in the U.S. They attributed this mostly to “boredom” or to “dealing with the stress” of the pandemic.</p>
<p>This same group in our sample who’d increased their drinking are particularly vulnerable since for the most part they were already drinking hazardously before the pandemic, meaning that any increase could be harmful for their health.</p>
<p>On average, these people are now drinking at “<a href="https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking">binge levels</a>” – four drinks per drinking occasion for women, five drinks for men – which is associated with worse alcohol-related health outcomes. These individuals tended to live in urban or suburban areas, be quarantined with others, report more stress and worry about the pandemic, and were coping less well than other alcohol drinkers.</p>
<p>Importantly, about 30% of drinkers reported drinking less since the start of the COVID-19 pandemic in the U.S. This was mostly due to not being able to go out to bars or restaurants, trying to save money or as an effort to not suppress their immune system. </p>
<p>Life in the U.S. during the time of coronavirus continues to change rapidly. We hope to track Americans’ mental health as the pandemic progresses, especially as typical coping strategies and treatment options become less accessible.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/135525/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Cyders receives funding from the National Institute of Alcohol Abuse and Alcoholism and the Indiana University Addictions Grand Challenge program.</span></em></p><p class="fine-print"><em><span>Martin H. Plawecki receives funding from the National Institute of Alcohol Abuse and Alcoholism and SmartStart Inc.</span></em></p><p class="fine-print"><em><span>Christiana Prestigiacomo and Melissa Liu do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A survey of 500 adults in the US provides a snapshot of the ways people are dealing with life during a pandemic and how well they think they’re doing.Melissa Cyders, Associate Professor of Psychology, IUPUIChristiana Prestigiacomo, Ph.D. Student in Psychology, IUPUIMartin H. Plawecki, Assistant Professor of Psychiatry, Indiana University School of MedicineMelissa Liu, Ph.D. Student in Psychology, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1350122020-04-01T12:07:04Z2020-04-01T12:07:04Z‘We don’t talk in terms of supply numbers, we talk in terms of days’<figure><img src="https://images.theconversation.com/files/324417/original/file-20200331-65499-y0heax.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C613%2C459&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Paper bags hold N95 masks that staff in the Eskenazi Hospital COVID-19 ICU need to save for reuse.</span> <span class="attribution"><span class="source">W. Graham Carlos/Indiana University</span>, <span class="license">Author provided</span></span></figcaption></figure><p><em>The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can <a href="https://theconversation.com/us/topics/covid-19-front-lines-84846">find all of the stories here</a>.</em></p>
<p>Brown paper bags line the windowsill of the COVID-19 intensive care unit at <a href="https://eskenazihealth.edu/">Eskenazi Hospital</a> in downtown Indianapolis. The bags are filled with the N95 masks we’re reusing, labeled with the handwritten names of my staff: Patrick, Angela, Brittany. They are mothers, fathers, brothers and sisters. </p>
<p>As of this writing, we are caring for more than double our average number of ICU patients and using more than triple our average number of ventilators. We expect those numbers to keep climbing.</p>
<p>To prevent exposure to coronavirus, we use gowns, gloves, goggles and masks. The N95 mask in particular is critical because it protects front-line hospital staff from aerosols emitted during high-risk procedures, such as placing someone on life support. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/324481/original/file-20200401-66125-vd3nfj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/324481/original/file-20200401-66125-vd3nfj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1014&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324481/original/file-20200401-66125-vd3nfj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1014&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324481/original/file-20200401-66125-vd3nfj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1014&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324481/original/file-20200401-66125-vd3nfj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1275&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324481/original/file-20200401-66125-vd3nfj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1275&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324481/original/file-20200401-66125-vd3nfj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1275&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr. W. Graham Carlos.</span>
<span class="attribution"><a class="source" href="https://eskenazihealth.edu/news/dr.-w.-graham-carlos-iii-and-dr.-babar-khan-honored-with-2017-achievement-in-medicine-(aim)-awards">Eskenazi Health</a></span>
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<p>One of my roles as the <a href="https://medicine.iu.edu/faculty/4846/carlos-william">chief of internal medicine and an intensivist</a> working in the ICU is to teach my staff why we are taking steps that we wouldn’t ordinarily take, such as saving their N95 respirator masks in paper bags.</p>
<p>Supplies of protective gear are dwindling. We are worried about the number of ventilators we have available for patients. We don’t talk about supplies in terms of numbers anymore; we talk in terms of days. And I need a way to talk to my staff about this that is both truthful and calming.</p>
<p>My team of nurses, physicians and therapists are selflessly serving patients afflicted with a deadly and highly contagious virus. I need words that work. </p>
<p>Communicating decisions like this is difficult, and I know that what I say and how I say it has never been more important. I prepare myself.</p>
<h2>Rationing supplies</h2>
<p>“What do we do when we run out?” I am asked frequently, regarding personal protective equipment and ventilators.</p>
<p>Given the effect that SARS-CoV-2 has on the lungs, many patients require mechanical ventilators to infuse enough oxygen into their bodies to keep them alive. These machines use hospital supplies of oxygen and deliver air into the lungs under pressure to open them up. </p>
<p>Ventilators are used all of the time in surgery and critical care, but they are expensive and strictly limited in supply. Ventilator allocation describes a process in which a committee, typically comprised of three people including an intensivist, follow a predetermined algorithm taking into account a patient’s age, underlying illness and severity of current illness to determine who should get priority to receive a ventilator when there are none left. The idea is that we would make decisions in advance based on objective data, so we aren’t influenced by bias and emotion when tough decisions have to be made. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&rect=98%2C0%2C13100%2C7157&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&rect=98%2C0%2C13100%2C7157&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=329&fit=crop&dpr=1 600w, https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=329&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=329&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=413&fit=crop&dpr=1 754w, https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=413&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/323823/original/file-20200329-146689-aesnz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=413&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Eskenazi Hospital.</span>
<span class="attribution"><span class="source">Indiana University</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Hospitals all over the country are <a href="https://www.nejm.org/doi/pdf/10.1056/NEJMp2005689?articleTools=true">preparing their allocation teams</a> and documents, and it is terrifying. We are encouraged to see factories ramping up production of ventilators, but we are still worried. Will they be here in time, or will it be too little too late?</p>
<p>On a national level, I serve the American Thoracic Society as chair of the Section on Medical Education. I have been <a href="https://www.atsjournals.org/doi/abs/10.1164/rccm.2020C1">working on documents</a> to rapidly communicate important information to patients and providers, including <a href="https://twitter.com/atscommunity/moments">two Twitter chats</a>. These serve to increase awareness and share vital information to health care systems and providers worldwide. In addition to interviews on local and national news outlets, I am <a href="https://twitter.com/GrahamCarlos">using social media</a> to share the truth about the virus and advocate for communities to keep social distancing to slow the spread of COVID-19. </p>
<p>I am saying, prepare, but don’t panic. </p>
<p>Now that the virus is endemic with community spread, we are seeing hospitals fill up. Systems to conserve protective equipment, cohort patients with the virus together and keep hospital staff educated are vital. </p>
<p>We should prepare for the “just in case,” in the event that the ventilator supply runs low, by creating allocation teams and electronic medical records that extract data for those teams. </p>
<p>We need to prepare for this to continue. Early estimates considering how the virus acted in China mean we could be looking at surge capacity for hospitals well into April. </p>
<p>We also need to prepare our staffs mentally. Celebrate “wins” when patients get better. Take time to reflect on all that is good. </p>
<p>I look at the brown paper bags lined up next to each other as a symbol of solidarity in mission and purpose. We are all in it together. We have never needed each other more.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for our newsletter.</a>]</p><img src="https://counter.theconversation.com/content/135012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>W. Graham Carlos does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A pulmonologist at Eskenazi Hospital in Indianapolis provides a firsthand look at how the hospital is preparing to allocate resources and supplies in response to coronavirus.W. Graham Carlos, Chief of Medicine for Eskenazi Health; Bicentennial Professor for Indiana University, Pulmonary & Critical Care Attending Physician, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1337452020-03-24T12:14:49Z2020-03-24T12:14:49ZJust as in coronavirus, young people are key to stopping tuberculosis<figure><img src="https://images.theconversation.com/files/322459/original/file-20200323-112688-1jjh0r.jpg?ixlib=rb-1.1.0&rect=18%2C18%2C4090%2C2712&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">World TB Day awareness rally and skit featuring young people on March 24, 2018 in Mumbai, India. </span> <span class="attribution"><a class="source" href="https://theconversation.com/drafts/133976/edit#"> Bachchan Kumar/Hindustan Times via Getty Images</a></span></figcaption></figure><p>The world is experiencing a historic pandemic of a novel coronavirus that has completely altered our daily lives and the entire world economy. Younger people experience more mild or moderate infections, although <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w">they are not spared from severe disease</a>.</p>
<p>There is increasing concern that the massive disruption of this crisis may bring about a <a href="https://www.forbes.com/sites/madhukarpai/2020/03/17/covid-19-and-tuberculosis-we-need-a-damage-control-plan/#7a7b65b0295c">resurgence of tuberculosis</a>, or TB – an ancient disease, in contrast to COVID-19 – due to the overwhelming impact of the coronavirus on health systems and on public health capacity. Given severe disruption to daily life and to health services, people suffering from TB may be <a href="https://www.forbes.com/sites/madhukarpai/2020/03/17/covid-19-and-tuberculosis-we-need-a-damage-control-plan/#7d5bc6e1295c">unable to access care</a> – for example, if they are unable to get transportation, if clinic or hospital activities are diverted to COVID-19 and unable to treat TB patients, or if labs stop processing TB testing. With delayed diagnosis and care, TB cases may increase.</p>
<p>Experts estimate that <a href="https://www.who.int/tb/publications/global_report/en/">TB kills 4,000 people every day</a> and 1.5 million people every year, making it the leading infectious cause of death globally. Progress made in ending TB <a href="https://www.who.int/tb/publications/global_report/en/">has not been fast enough</a>. Ending the TB pandemic requires a comprehensive approach that ensures optimal treatment for the most vulnerable groups.</p>
<figure>
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<figcaption><span class="caption">Phumeza Tisile is a former extensively drug-resistant TB (XDR-TB) patient and a TB advocate.</span></figcaption>
</figure>
<p><a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C15&q=Leslie+Enane&btnG=">As a pediatric infectious disease physician and researcher</a>, I study how to improve care engagement and outcomes for adolescents and young adults living with TB or HIV. In a study in Botswana, our team interviewed health care workers about <a href="https://doi.org/10.5588/ijtld.19.0416">what changes are needed in youth TB management</a> to improve outcomes. I believe that tackling TB infections and transmission must include addressing youth needs in TB care and putting young people at the forefront of this fight.</p>
<h2>Current approaches don’t serve youngsters well</h2>
<p>Youth between 10 and 24 years old experience <a href="https://doi.org/10.1183/13993003.02352-2017">17% of all TB disease</a>, or 1.8 million cases annually, and disease in youth may contribute to TB transmission within communities and households. Despite this, dedicated public health approaches or treatment guidelines <a href="https://doi.org/10.1016/S2352-4642(19)30337-2">have not been developed</a> for youth with TB. Young people face challenges <a href="https://doi.org/10.1016/j.ijid.2015.03.008">accessing TB diagnosis</a> and <a href="https://doi.org/10.5588/ijtld.16.0060">completing treatment</a>. </p>
<p>The transitions of adolescence can make it challenging for youth to engage with health services, particularly for complex and stigmatized diseases such as TB and HIV. They often <a href="https://doi.org/10.5588/ijtld.19.0416">rely on family to keep them engaged in care</a>, but if they don’t have consistent support and resources, <a href="https://doi.org/10.5588/ijtld.16.0060">they may leave treatment</a>. </p>
<p>Adolescents may be particularly affected by TB/HIV stigma, challenges in adhering to medications and structural barriers to care. They are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248846/">less likely to engage in testing and treatment for HIV</a>, which often coincides with TB disease. </p>
<p>While health care workers attempt to adapt their management to adolescent needs, they have limited time and resources to do this, and lack dedicated guidelines, training or evidence-based models to guide their efforts. One nurse we <a href="https://doi.org/10.5588/ijtld.19.0416">interviewed</a> told us, “if you don’t address the challenges, they end up lost.”</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/321995/original/file-20200320-22598-r0qbzq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/321995/original/file-20200320-22598-r0qbzq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/321995/original/file-20200320-22598-r0qbzq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/321995/original/file-20200320-22598-r0qbzq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/321995/original/file-20200320-22598-r0qbzq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/321995/original/file-20200320-22598-r0qbzq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/321995/original/file-20200320-22598-r0qbzq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nandita Venkatesan is a young TB advocate. UN Photo / Laura Jarriel.</span>
<span class="attribution"><span class="source">UN Photo</span></span>
</figcaption>
</figure>
<p>Despite longstanding knowledge that youth are at risk for TB, current care models <a href="https://doi.org/10.1016/S2352-4642(19)30337-2">may not meet young people’s needs</a>. </p>
<p>What might more responsive care look like? The health care workers we <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2020/00000024/00000002/art00014">interviewed</a> strongly advocated for youth-friendly interventions similar to those being implemented in <a href="https://www.who.int/hiv/pub/guidelines/adolescents/en/">HIV treatment</a>. That can include peer support groups or networks to help provide socialization and education about treatment. These groups go a long way to <a href="https://doi.org/10.1080/09540121.2019.1668530">break through the isolation and stigma</a> that young people experience. </p>
<p>Other models include having youth-friendly spaces, resources for more intensive counseling and dedicated training for health care workers to provide youth-friendly care. Other strategies such as increasing community-based care models or home visits bring treatment closer to young people. </p>
<p>Most importantly, we found that <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2020/00000024/00000002/art00014">young people should be involved</a> at each stage of planning, implementing and assessing the impact of such interventions. Youth can speak to their own needs and can best advocate for improvements to care and public health agendas. </p>
<p>Young TB activists <a href="https://www.theguardian.com/global-development-professionals-network/2014/jul/07/tb-south-africa-patents-drug-resistance-phumeza-tisile-medicins-sans-frontieres">Phumeza Tisile</a> and <a href="https://www.npr.org/sections/goatsandsoda/2018/09/26/651551034/life-after-tb-she-is-deaf-she-still-dances-she-addressed-the-u-n-today">Nandita Venkatesan</a>, who were both left deaf by the toxicities of medications for drug-resistant TB, have given powerful voice to TB survivors. Further, youth who have gone through TB treatment can serve as a key resource for their peers. As one nurse <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2020/00000024/00000002/art00014">noted</a>, “after they complete treatment they are different people than when they came, and they can be the best teachers for others.” </p>
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<h2>Young people are central to the fight</h2>
<p>On March 16, as the White House introduced stronger <a href="https://www.whitehouse.gov/articles/15-days-slow-spread/">guidelines</a> for social distancing in an effort to avoid a catastrophic surge in COVID-19 cases, Ambassador Deborah Birx, who coordinates the coronavirus response, had a distinct message for young people. “I think the millennials can help us tremendously. … Public health people like myself don’t always come out with compelling and exciting messages that a 25- to 35-year-old may find interesting and something that they would take to heart. The millennials can speak to one another about how important it is in this moment to protect all (vulnerable) people … There’s more millennials now than in any other cohort, and they can help us in this moment.”</p>
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<p>Birx is directly applying lessons from her <a href="https://www.theguardian.com/world/2020/mar/12/coronavirus-dr-deborah-birx-hiv-aids">decades of fighting HIV</a> to the novel coronavirus pandemic. Young people have always been leading the fight against HIV. In the 1980s, it was young <a href="https://www.npr.org/sections/health-shots/2019/02/09/689924838/how-to-demand-a-medical-breakthrough-lessons-from-the-aids-fight">ACT UP activists</a> who pioneered patient advocacy and revolutionized the process by which novel drugs were quickly tested in clinical trials, speeding advancements to effective antiretroviral therapy.</p>
<p><a href="https://www.pbs.org/newshour/health/remembering-ryan-white-the-teen-who-fought-against-the-stigma-of-aids">Ryan White</a>, a world-changing teenager, courageously fought against HIV stigma and discrimination, and his legacy includes the <a href="https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program">comprehensive national HIV care program that bears his name</a>. Among the lessons of the HIV pandemic are that young people have the ability to drive social and systemic change. </p>
<p>We don’t yet know what lies ahead for the global TB, HIV or coronavirus pandemics. But we would do well to look to adolescents and youth to advocate for the solutions that will bring an end to this crisis, and to all global infectious disease emergencies. </p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklysmart">You can get our highlights each weekend</a>.]</p><img src="https://counter.theconversation.com/content/133745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie A. Enane receives funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. </span></em></p>Today is World TB Day. With attention turned toward coronavirus, it might seem too much to think about. But there’s a lot to consider about the role of young people in stopping both diseases.Leslie A. Enane, Assistant Professor of Pediatrics, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1227642019-09-03T13:40:36Z2019-09-03T13:40:36ZStop calling it a choice: Biological factors drive homosexuality<figure><img src="https://images.theconversation.com/files/290563/original/file-20190902-175705-15kuqu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Biological factors shape sexual preference.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lgbt-lesbian-couple-moments-happiness-concept-575079754?src=-1-53">Rawpixel.com/SHutterstock.com</a></span></figcaption></figure><p><a href="https://doi.org/10.1126/science.aat7693">Across cultures, 2% to 10% of people report having same-sex relations</a>. In the U.S., <a href="https://www.statista.com/topics/1249/homosexuality/">1% to 2.2% of women and men</a>, respectively, identify as gay. Despite these numbers, <a href="https://www.pewresearch.org/global/2013/06/04/the-global-divide-on-homosexuality/">many people still consider homosexual behavior to be an anomalous choice</a>. However, biologists have <a href="https://us.macmillan.com/books/9780312253776">documented homosexual behavior in more than 450 species</a>, arguing that same-sex behavior is not an unnatural choice, and may in fact play a vital role within populations.</p>
<p>In <a href="https://doi.org/10.1126/science.aat7693">a 2019 issue of Science magazine</a>, geneticist Andrea Ganna at the Broad Institute of MIT and Harvard, and colleagues, described the largest survey to date for genes associated with same-sex behavior. By analyzing the DNA of nearly half a million people from the U.S. and the U.K., they concluded that genes account for between 8% and 25% of same-sex behavior. </p>
<p><a href="https://www.nature.com/news/sex-redefined-1.16943">Numerous studies have established that sex is not just male or female</a>. Rather, it is a continuum that emerges from a person’s genetic makeup. Nonetheless, misconceptions persist that same-sex attraction is a choice that warrants condemnation or <a href="https://www.apa.org/pi/lgbt/resources/just-the-facts">conversion</a>, and leads to discrimination and persecution.</p>
<p><a href="https://wjsulliv.wixsite.com/sullivanlab">I am a molecular biologist</a> and am interested in this new study as it further illuminates the genetic contribution to human behavior. As the author of the book, <a href="https://www.penguinrandomhouse.com/books/608709/pleased-to-meet-me-by-bill-sullivan/9781426220555/">“Pleased to Meet Me: Genes, Germs, and the Curious Forces That Make Us Who We Are,”</a> I have done extensive research into the biological forces that conspire to shape human personality and behavior, including the factors influencing sexual attraction.</p>
<h2>The hunt for ‘gay genes’</h2>
<p>The new finding is consistent with multiple earlier studies of twins that indicated same-sex attraction is a heritable trait.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1200&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1200&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1200&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A new study suggests that genes are responsible for between 8% and 25% of same-sex preference.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/dna-multi-color-isolated-on-white-717211195?src=-1-47">Guru 3D</a></span>
</figcaption>
</figure>
<p>The 2019 study is the latest in a hunt for “gay genes” that began in 1993, when Dean Hamer <a href="https://doi.org/10.1126/science.8332896">linked male homosexuality to a section of the X chromosome</a>. As the ease and affordability of genome sequencing increased, additional gene candidates have emerged with potential links to homosexual behavior. So-called <a href="https://doi.org/10.1038/s41598-017-15736-4">genome-wide association studies identified a gene called <em>SLITRK6</em></a>, which is active in a brain region called the diencephalon that differs in size between people who are homosexual or heterosexual.</p>
<p>Genetic studies in mice have uncovered additional gene candidates that could influence sexual preference. A 2010 study <a href="https://doi.org/10.1186/1471-2156-11-62">linked sexual preference to a gene called fucose mutarotase</a>. When the gene was deleted in female mice, they were attracted to female odors and preferred to mount females rather than males. </p>
<p>Other studies have shown that <a href="https://doi.org/10.1038/nature06089">disruption of a gene called <em>TRPC2</em></a> can cause female mice to act like males. <a href="https://doi.org/10.1126/science.1069259">Male mice lacking <em>TRPC2</em></a> no longer display male-male aggression, and they initiate sexual behaviors toward both males and females. Expressed in the brain, <em>TRPC2</em> functions in the recognition of pheromones, chemicals that are released by one member of a species to elicit a response in another.</p>
<p>With multiple gene candidates being linked to homosexuality, it seemed highly unlikely that a single “gay” gene exists. This idea is further supported by <a href="https://doi.org/10.1126/science.aat7693">the new study</a>, which identified five new genetic loci (fixed positions on chromosomes) correlating with same-sex activity: two that appeared in men and women, two only in men, and one only in women.</p>
<h2>How might these genes influence same-sex behavior?</h2>
<p>I find it intriguing that some of the genes from men identified in Ganna’s study are associated with olfactory systems, a finding that has parallels to the work in mice. Ganna’s group found other gene variants that may be linked with sex hormone regulation, which other scientists have previously suggested plays a large role in shaping the brain in ways that influence sexual behavior. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=846&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=846&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=846&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1063&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1063&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1063&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Conditions in the uterus during pregnancy are thought to influence the sexual preferences of the child.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-pregnant-woman-shopping-bags-outdoors-503149633?src=-1-18">Anna Om/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Males with a genetic condition called <a href="https://ghr.nlm.nih.gov/condition/androgen-insensitivity-syndrome">androgen insensitivity syndrome</a> can develop female genitalia and are usually brought up as girls, despite being genetically male – with an X and Y chromosome – and they are attracted to men. This suggests that testosterone is needed to “masculinize” a prenatal brain; if that doesn’t happen, the child will grow up to desire men. </p>
<p>Similarly, girls who have a genetic condition called <a href="https://www.nichd.nih.gov/health/topics/cah">congenital adrenal hyperplasia</a> are exposed to unusually high levels of male hormones like testosterone while in the womb, which may masculinize their brain and increase the odds of lesbianism. </p>
<p>It’s also possible that hormonal shifts during pregnancy could affect how a fetus’ brain is configured. In rats, <a href="https://doi.org/10.1210/en.2011-0277">manipulation of hormones during pregnancy</a> produces offspring that exhibit homosexual behavior.</p>
<h2>Why does homosexual behavior exist?</h2>
<p>Several hypotheses have been advanced to explain how homosexuality can be beneficial in perpetuating familial genes. One idea involves the concept of kin selection, whereby people work to ensure the passage of their family’s genes into subsequent generations. Gay uncles and aunts, for example, are “<a href="https://doi.org/10.1177/0956797609359623">helpers in the nest</a>” that help raise other family members’ children to nurture the family tree.</p>
<p>Another idea suggests that homosexuality is a “trade-off trait.” For example, certain genes in women help increase their fertility, but <a href="https://doi.org/10.1111/j.1743-6109.2008.00944.x">if these genes are expressed in a male</a>, they predispose him toward homosexuality.</p>
<p>Sexual behavior is widely diverse and governed by sophisticated mechanisms throughout the animal kingdom. As with other complex behaviors, it is not possible to predict sexuality by gazing into a DNA sequence as if it were a crystal ball. Such behaviors emerge from constellations of hundreds, perhaps thousands, of genes, and how they are regulated by the environment.</p>
<p>While there is no single “gay gene,” there is overwhelming evidence of a biological basis for sexual orientation that is programmed into the brain before birth based on a mix of genetics and prenatal conditions, none of which the fetus chooses.</p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/122764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study of nearly 500,000 individuals finds that many genes affect same-sex behavior, including newly identified candidates that may regulate smell and sex hormones.Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1211712019-08-01T12:32:40Z2019-08-01T12:32:40ZWhy the ‘brain-eating’ amoeba found in freshwater lakes – while rare – is so deadly<figure><img src="https://images.theconversation.com/files/286270/original/file-20190730-186805-1ts8haj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Computer-generated representation of the amoeba _Naegleria fowleri_, which causes deadly brain infections.</span> <span class="attribution"><a class="source" href="https://www.cdc.gov/parasites/naegleria/">Centers for Disease Control and Prevention</a></span></figcaption></figure><p>Composed of a single cell, amoeba seem harmless enough: They look like playful critters waltzing under the spotlight of a microscope until they come upon a group of bacteria. Then, these previously innocuous amoeba suddenly morph into sinister blobs, engulfing the bacteria and slowly ripping them apart with a bevy of digestive enzymes. It’s hard to cry over murdered bacteria, but the digestive power of amoeba is the stuff of nightmares when it plays out in a human brain. </p>
<p>Infections with <em>Naegleria fowleri</em>, the so-called brain-eating amoeba, are extremely rare, but also extremely deadly. <a href="https://www.cdc.gov/parasites/naegleria/infection-sources.html">Nearly 150 cases have been reported in the U.S. since 1962</a>, with only four surviving the infection; so there is a 97% chance of death. According to the C.D.C., in the 10 years from 2009 to 2018, <a href="https://www.cdc.gov/parasites/naegleria/general.htm">34 infections were reported in the U.S.</a> On <a href="https://www.cnn.com/2020/09/26/us/brain-eating-amoeba-found-in-texas-water-supply-trnd/index.html">September 25, 2020, the Texas Commission on Environmental Quality</a> issued a water advisory for eight cities, warning customers not to use any water since authorities detected the brain-eating amoeba in the water supply. </p>
<p>I study parasites and have a particular interest in those that target the brain, which is why this amoeba captured my interest.</p>
<h2>How <em>N. fowleri</em> gets into the brain</h2>
<p><em>N. fowleri</em> dwells in warm bodies of fresh water where it dines on bacteria in the sediment. As such, <a href="https://www.cdc.gov/parasites/naegleria/state-map.html">most infections with this amoeba in the U.S. have occurred in southern states</a>, especially Texas and Florida, during the summer. When the sediment of a lake is disrupted, amoeba get stirred into the water. Swimmers can then inhale the parasite through their nose. From there, <em>N. fowleri</em> invades the olfactory nerves and migrates to the brain, where it causes a dangerous condition called <a href="https://www.cdc.gov/parasites/naegleria/index.html">primary amoebic meningoencephalitis</a>.</p>
<p>While swimming in fresh water is the most likely source of this amoeba, this <a href="http://doi.org/10.1080/10410236.2015.1047145">same organism</a> and <a href="https://www.ijidonline.com/article/S1201-9712(18)34525-9/pdf">other species of amoeba</a> can cause brain infections in people who use tap water instead of sterile water or saline when using the nasal-flushing Neti pot.</p>
<p>The brain is moist and warm, just like the lakes and hot springs where the amoeba thrives. But the brain doesn’t have bacteria for the amoeba to eat, so the organism attacks brain cells for nutrients.</p>
<p>The immune system does not sit idly by, however, while the parasite eats its way through the brain. It unleashes a massive swarm of immune cells to the infected zone, which causes inflammation and brain swelling. Unfortunately for the person whose brain is infected, this battle is being waged inside a sturdy skull, which cannot expand to accommodate a swelling brain. The increase in cranial pressure disrupts the brain’s connection to the spinal cord, compromising communication with other parts of the body like the respiratory system.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286271/original/file-20190730-186841-am7220.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Naegleria fowleri</em> enters the brain through the nasal passage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/braineating-amoeba-infection-naegleriasis-image-shows-773663599?src=--AFKOFkS-vEjMNQL0jewg-1-23&studio=1">Kateryna Kon</a></span>
</figcaption>
</figure>
<h2>A stealthy and quick assassin</h2>
<p>Symptoms can appear as early as two days, or as late as two weeks, following inhalation of <em>N. fowleri</em>. The first symptoms include headache, fever, nausea and vomiting, and a change in the sense of smell or taste (due to damaged olfactory nerves mentioned above). The infection rapidly progresses through the central nervous system, producing stiff neck, confusion, fatigue, loss of balance, seizures and hallucinations. Patients usually succumb to the infection within five to seven days after the onset of symptoms.</p>
<p>There are several reasons why <em>N. fowleri</em> is so deadly. First, the presence of the parasite leads to rapid and irrevocable destruction of critical brain tissue. Second, the initial symptoms can easily be mistaken for a less serious illness, costing valuable treatment time. Third, there is no quick diagnostic test for <em>N. fowleri</em>, and patients are often mistreated for <a href="https://www.cdc.gov/meningitis/viral.html">viral</a> or <a href="https://www.cdc.gov/meningitis/bacterial.html">bacterial meningitis</a>. </p>
<p>Finally, there are no established medications with proven efficacy against the amoeba, although <a href="https://doi.org/10.1016/j.tmaid.2016.12.005">miltefosine</a> is showing promise. Compounding the problem is the fact that most drugs have trouble penetrating the brain and, as primary amoebic meningoencephalitis is a rare disease, very little research is being conducted.</p>
<p>It is important to keep in mind that millions of people are exposed to <em>N. fowleri</em> and never fall ill. Those who study this amoeba don’t know why a tiny subset of exposed individuals develop primary amoebic meningoencephalitis; they may have a genetic difference that makes them more vulnerable to the infection, or may have forcefully inhaled an overwhelming amount of the parasite. </p>
<p>So if you’re going swimming in warm freshwater lakes or streams, especially if you like diving or going under water, consider wearing a nose clip to help keep amoeba parasites out of your brain. <a href="https://www.cdc.gov/parasites/naegleria/swimming.html">Experts also advise</a> that people avoid stirring up the sediment at the bottom of these bodies of water where the amoeba live.</p>
<p><em>This article was updated on September 27, 2020, adding information about a report of Naegleria fowleri in a southeast Texas water supply and removing a reference to a Florida case in July 2020.</em></p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/121171/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The brain-eating amoeba Naegleria fowleri kills 97% of its victims, and infections are almost impossible to diagnose quickly. Here is how it kills.Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1003612018-08-17T10:20:51Z2018-08-17T10:20:51ZCould different cultures teach us something about dementia?<figure><img src="https://images.theconversation.com/files/232090/original/file-20180815-2924-1wn6l44.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Other cultures view dementia differently. Could they help us be better caregivers? </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/parkinson-alzheimer-female-senior-elderly-patient-696318976?src=CZiOkjYNrFKtmyhDC9QlJA-1-39">BlurryMe/Shutterstock.com</a></span></figcaption></figure><p>Picture two different families, each dealing with a diagnosis of dementia in one of its members. In one case, the patient is a retired executive, whose family tries as long as possible to keep the diagnosis secret, relying primarily on professional caregivers and eventually a nursing home. In another case, the patient is a grandmother. As soon as the diagnosis is suspected, her family pulls together, bringing her into their home and surrounding her with affection.</p>
<p>These two approaches to dementia reflect very different attitudes toward the disease. One regards it as an irreversible neurologic condition associated with considerable stigma, a problem best left to health professionals and kept out of public view. While not denying that dementia is a medical condition, the other seizes on it as an opportunity to draw together around a loved one in need, giving family members not a secret to keep but an opportunity to care.</p>
<h2>A disease of patients and their families</h2>
<p>Dementias touch many lives. For example, the most common dementia, <a href="https://www.alz.org/alzheimers-dementia/facts-figures">Alzheimer’s disease</a>, currently afflicts 5.7 million Americans and is expected to afflict 14 million by 2050. This increase partly mirrors population growth. But because risk increases with age, the rise also reflects our success in battling other causes of death, such as heart disease and stroke, enabling people to live longer. And the <a href="https://www.alz.org/alzheimers-dementia/facts-figures">effects</a> of the disease are not confined to patients; 16.1 million Americans now provide uncompensated care to dementia patients.</p>
<p>If you asked a physician to define dementia, most of us would probably describe it as a neurodegenerative disorder marked by declining cognitive abilities and memory. While this account is true as far as it goes, there is a problem: attacking most types of dementia as strictly <a href="https://theconversation.com/the-two-obstacles-that-are-holding-back-alzheimers-research-86435">biological entities</a> has largely failed to advance our ability to diagnose and treat it. In the case of Alzheimer’s disease, definitive diagnosis still requires a biopsy, and new drugs to prevent, retard, or reverse it have proved disappointing.</p>
<h2>A cultural perspective</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/232091/original/file-20180815-2912-16fmun7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/232091/original/file-20180815-2912-16fmun7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/232091/original/file-20180815-2912-16fmun7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/232091/original/file-20180815-2912-16fmun7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/232091/original/file-20180815-2912-16fmun7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/232091/original/file-20180815-2912-16fmun7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/232091/original/file-20180815-2912-16fmun7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Having a wide circle of friends throughout life may be an important part of dealing with dementia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/childlike-seniors-wearing-superhero-costumes-1096065977?src=vOE1pAEKrTWxjjucbCUbPQ-1-44">Rawpixel/Shuttersock.com</a></span>
</figcaption>
</figure>
<p>Perhaps the time has come to <a href="https://theconversation.com/how-being-friends-with-someone-who-has-dementia-can-be-good-for-you-both-76750">expand our thinking about dementia </a>to encompass not only cellular but cultural perspectives. Our society needs to recognize that dementia is not only a brain disorder of the person suffering from it but also a <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002274">social disorder</a> that can be understood in a variety of different ways. In other contexts, such disorders tend to be viewed in light of a larger circle of social relationships and cultural traditions. All generalizations must be qualified, but we have much to learn from other cultures.</p>
<p>In <a href="http://journals.sagepub.com/doi/abs/10.1177/0956797612446025">Japan</a>, for example, to age well is not only to avoid contracting diseases but also to maintain a circle of family and friends right up to the moment when we breathe our last. Being of sound mind and body means continuing to exert ourselves both mentally and physically, remaining deeply invested in our personal relationships and receiving help from and helping others. So long as we continue to enrich others’ lives, we can remain “whole” in ways that exceed the mere absence of a medical diagnosis.</p>
<p>A large segment of traditional <a href="https://www.ncbi.nlm.nih.gov/pubmed/22467411">Chinese culture</a> tends to see such matters similarly. Confucianism places a premium on family, and the decline of cognitive capacities of those who have led long and full lives can be seen not as the onset of a disease but as an opportunity for friends and family to express how much they care. Assuming increasing responsibility for an aging loved one represents an opportunity to show how strong the family really is.</p>
<p>The <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1532-5415.2005.53025.x">Hindu culture</a> of India also prizes the opportunity to care for parents. What Americans tend to regard as a lamentable medical condition can be seen as a part of life’s natural cycle and the passage into a second childhood. The emphasis is not on the stigma of dementia, but rather on a withdrawal from worldly affairs to focus on other more essential matters. When an older person begins to show such signs, it is time for a natural transfer of authority to younger members of the family.</p>
<h2>Seeing dementia anew</h2>
<p>Viewing dementia from the standpoint of other cultures can help Americans see it with fresh eyes and re-pose fundamental questions that lie at its heart. What, for example, is a person, and how is personhood situated in the larger context of family and community? How does such a condition relate to what it means to be a good person and lead a good life? To what degree does dementia fracture us and what are the possibilities that it could bring us closer together?</p>
<p>The point of such a cultural approach is not to argue that biomedical accounts of dementia are fundamentally wrong. In virtually any disease state, but especially with a condition such as dementia, the experience of patients and families involves social, moral, and even spiritual perspectives, no less than biological ones. Perhaps because of our high regard for self-sufficiency and independence, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29602733">dementia</a> in the U.S. it tends to be relatively stigmatized.</p>
<p>Conceiving of dementia in different terms could offer new opportunities for prevention and treatment. Suppose, for example, that we Americans viewed it in terms similar to physical fitness. If we do not <a href="https://www.jwatch.org/na46930/2018/06/18/your-intellect-use-it-or-lose-it">utilize</a> our mental, physical, and social capacities, they will tend to dwindle – use it or lose it. On the other hand, if we remain active and challenged in each of these spheres, contributing where we can to enrich the lives of others, we can ease the strain of dementia in our lives.</p>
<p>To be sure, healthy neurons require adequate rest, nutrition, and even medical care. But the health of a person is more than the functioning of cells. People also need opportunities to put abilities to the test, connect with others, and lead lives that make a real contribution. If we tend not only to our neurons but also our intellects, characters, and relationships, there is good reason to think that we can lighten dementia’s burden and make the most of the opportunities to care for those living with it.</p><img src="https://counter.theconversation.com/content/100361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More than 16 million people in the U.S. take care of people with dementia. Could we learn something from how other cultures view dementia as more of a social disease rather than a lonely one?Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana UniversityLily Wolf, Medical student , Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/876982017-12-11T05:21:22Z2017-12-11T05:21:22ZKetika banyak orang tua meragukan vaksinasi, penyedia layanan kesehatan harus bilang apa?<figure><img src="https://images.theconversation.com/files/197923/original/file-20171206-943-r0ut9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Membantu orang tua memutuskan untuk memvaksinasi anak mereka mungkin cuma masalah komunikasi.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/armydre2008/15837608614">frankieleon</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Dalam beberapa tahun terakhir, Amerika Serikat dilanda beberapa wabah penyakit yang sebenarnya bisa dicegah oleh vaksin, seperti <a href="http://www.cdc.gov/pertussis/surv-reporting.html">pertusis</a> (batuk rejan) dan <a href="http://www.cdc.gov/measles/cases-outbreaks.html">campak</a>. </p>
<p>Sementara itu, pada kurun waktu yang sama, tingkat penolakan vaksin <a href="http://dx.doi.org/10.2105/AJPH.2014.302190">meningkat</a>, dan makin banyak orang tua yang meminta modifikasi jadwal vaksin, yang berbeda dari yang <a href="http://www2.aap.org/immunization/IZSchedule.html">direkomendasikan</a> oleh American Academy of Pediatrics.</p>
<p>Mayoritas orang tua memvaksinasi anak-anak mereka sesuai jadwal. Hanya sebagian kecil yang menolak semua vaksinasi untuk anak-anak mereka. Ada pula yang ingin anak-anak mereka menerima vaksin tapi tidak semuanya, atau menginginkan jadwal vaksin yang berbeda.</p>
<p>Mengapa kelompok ini mengabaikan rekomendasi asosiasi dokter? Sebuah <a href="http://dx.doi.org/10.1377/hlthaff.2011.0396">studi tahun 2011</a> menunjukkan, hal tersebut banyak dipengaruhi oleh ketakutan mengenai efek samping vaksin. Beberapa orang tua khawatir soal “komposisi kimia” vaksin atau soal pemberian vaksin sekaligus dalam satu waktu. </p>
<p>Ada yang tidak percaya bahwa vaksin itu efektif. Sebagian lainnya menganggap bahwa penyakit seperti influenza atau varicella (cacar air) tidak terlalu serius. Yang juga perlu diperhatikan, Komite AAP soal Bioetik <a href="http://dx.doi.org/10.1542/peds.2005-0316">mencatat</a> bahwa beberapa orang tua mungkin menolak vaksin karena masalah biaya atau hambatan untuk mengakses layanan kesehatan yang memadai.</p>
<p>Meski riset telah membuktikan keamanan dan efektivitas vaksin, serta mengindikasikan bahwa risiko efek samping dari vaksin kanak-kanak sangatlah kecil, banyak orang tua yang masih memiliki kekhawatiran.</p>
<p>Orang tua sekarang ini memiliki akses ke begitu banyak informasi melalui internet, yang telah terbukti secara <a href="http://dx.doi.org/10.1155/2012/932741">signifikan berpengaruh</a>. Orang tua pun punya tantangan tersendiri untuk memisahkan mana informasi yang bisa diandalkan, dan mana yang tidak. </p>
<p>Sementara itu, kita cenderung mencari, lebih memperhatikan, dan lebih mengingat informasi yang kita duga mungkin benar. Ini disebut <a href="http://dx.doi.org/10.1037/0022-3514.37.11.2098">asimilasi bias</a>. Jadi orang tua yang percaya bahwa vaksin berbahaya mungkin memilih hanya mencatat informasi yang mendukung sudut pandangnya.</p>
<h2>Kontinum perilaku vaksin</h2>
<p>Perilaku vaksin berlangsung dalam rangkaian <a href="http://dx.doi.org/10.1016/j.vaccine.2014.01.081">kesatuan/kontinum</a>. Di satu sisi, ada orang tua yang sepenuhnya mendukung vaksin, dan di sisi lain ada orang tua yang menentang vaksin. </p>
<p>Di tengah-tengah, terdapat spektrum yang luas dan rumit yang berisi orang tua yang ragu-ragu atau tidak yakin dengan vaksin. Tetapi mereka semua sama: berusaha melakukan apa yang mereka anggap terbaik bagi anak-anak mereka.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=703&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=703&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=703&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=883&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=883&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=883&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Selebaran yang dimaksudkan untuk mengedukasi tentang virus rubella dan manfaat vaksin..</span>
<span class="attribution"><span class="source">CDC/ Molly Kurnit; Melanie Jankun</span></span>
</figcaption>
</figure>
<p>Ketika berhadapan dengan orang tua yang masuk ke golongan penentang vaksin, penyedia layanan kesehatan bisa menghadapi kesulitan. Sebab mereka memiliki pendapat yang kuat dan sangat yakin akan kebenaran yang mereka percayai. </p>
<p>Namun orang tua di tengah-tengah spektrum, sering kali hanya kurang yakin mengenai vaksinasi (belum sampai tahap menentang). Karena itulah beberapa peneliti menekankan pentingnya usaha intervensi yang proaktif ditujukan ke sekelompok luas orang tua yang <a href="http://dx.doi.org/10.1038/473443a">meragukan vaksin</a>. Sebab mereka umumnya bisa menerima informasi mengenai vaksinasi dari sumber terpercaya. </p>
<p>Karenanya, cara perawat dan dokter berkomunikasi dengan mereka tentang vaksinasi, sangatlah penting.</p>
<h2>Bagaimana sebaiknya penyedia layanan kesehatan membicarakan vaksin?</h2>
<p>Ada banyak riset yang menjelaskan komunikasi tentang vaksin, dan para peneliti masih mengidentifikasi metode apa yang berfungsi baik. Komunikasi tentang vaksin terjadi dalam berbagai cara, mulai dari percakapan pribadi dengan dokter dan perawat, hingga cakupan berskala luas seperti papan reklame dan iklan radio. </p>
<p>Yang bisa membuat komunikasi menjadi rumit adalah keputusan dan perilaku orang tua <a href="http://dx.doi.org/10.1016/j.vaccine.2013.08.104">yang bervariasi</a>, tergantung dari misalnya, jenis vaksin. Ketika orang tua memiliki perilaku negatif tentang vaksin, sering kali itu didasarkan pada informasi yang salah atau narasi emosional tentang reaksi merugikan dari vaksin. </p>
<p>Jadi, penyedia layanan kesehatan punya tantangan untuk memperbaiki persepsi yang salah mengenai <a href="http://dx.doi.org/10.1016/j.vaccine.2012.02.025">risiko vaksin</a>.</p>
<p>Ada beberapa strategi yang bisa digunakan oleh penyedia layanan kesehatan saat membicarakan soal imunisasi dengan orang tua yang meragukan vaksin. Adalah penting untuk membicarakan <a href="http://dx.doi.org/10.1542/peds.2005-0316">kekhawatiran spesifik</a> orang tua. Dokter harus mendiskusikan vaksin dari berbagai perspektif, seperti manfaat vaksinasi (mencegah penyakit bagi seseorang dan orang lain), serta risikonya bila tidak divaksin (rentan terhadap penyakit). </p>
<p>Riset menunjukkan bahwa menyesuaikan perbincangan dengan kekhawatiran orang tua bisa secara positif mempengaruhi hubungan antara penyedia layanan kesehatan dengan orang tua, dan <a href="http://dx.doi.org/10.1186/1471-2431-12-154">memelihara rasa percaya</a>.</p>
<p>Penyedia layanan kesehatan harus memasukkan informasi yang akurat tentang risiko vaksin <a href="http://dx.doi.org/10.1186/1471-2431-12-154">dalam percakapan</a>. Jangan hindari diskusi mengenai kemungkinan efek samping negatif dari vaksin, sebab <a href="http://www2.aap.org/immunization/pediatricians/pdf/vaccine-hesitant%20parent_final.pdf">komunikasi risiko adalah vital</a>.</p>
<p>AAP menyarankan untuk menyesuaikan percakapan dengan orang tua, memahami dan merespons kekhawatiran spesifik mereka. Dokter harus berbicara kepada orang tua mengenai pengelolaan efek samping yang biasa terjadi, dan apa yang harus dilakukan bila terjadi reaksi yang lebih serius. </p>
<p>Beberapa orang tua juga merasa perlu untuk membandingkan risiko memvaksin versus risiko tidak memvaksin.</p>
<h2>Bagaimana dengan mendiskusikan imunitas kelompok (herd immunity)?</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Selebaran Kesehatan Publik San Fransisco yang mempromosikan vaksin untuk orang dewasa.</span>
<span class="attribution"><span class="source">Raed Mansour</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Sebuah studi pada 2013 menunjukkan, orang dewasa lebih mungkin divaksin jika orang di sekitar mereka <a href="http://dx.doi.org/10.1016/j.amepre.2013.02.016">juga melakukannya</a>. Pada orang dewasa, bukti juga <a href="http://dx.doi.org/10.1037/a0031590">menunjukkan</a> kepedulian akan <a href="http://www.vaccines.gov/basics/protection/">imunitas kelompok</a>—atau ketika ambang kritis individu divaksinasi sehingga membuat penyakit lebih sulit menyebar—bisa memberikan efek positif pada niat seseorang untuk divaksin. </p>
<p>Meski orang dewasa paling khawatir soal risiko pribadi terkena sakit, mereka juga bisa menjadi sensitif terhadap <a href="http://dx.doi.org/10.1177/0272989X11427762">manfaat sosial vaksinasi</a>. Akan tetapi, begitu menyangkut soal keputusan orang tua untuk memvaksin anak atau tidak, mungkin lebih penting untuk fokus pada manfaat langsung imunisasi <a href="http://dx.doi.org/10.1542/peds.2013-4077">untuk anak-anak</a>.</p>
<h2>Berasumsi atau tidak berasumsi?</h2>
<p>Untuk meningkatkan cakupan vaksin di kalangan orang tua untuk anak-anak mereka, <a href="http://dx.doi.org/10.1542/peds.2013-2037">beberapa peneliti</a> merekomendasikan pendekatan “dugaan”, yang berasumsi bahwa orang tua akan memvaksin anak-anaknya. </p>
<p>Ada pula pendekatan “partisipatif” di mana penyedia layanan kesehatan menanyakan orang tua mengenai preferensi mereka soal vaksinasi. Para penyelidik ini <a href="http://www.npr.org/blogs/health/2015/02/06/384322665/to-get-parents-to-vaccinate-their-kids-dont-ask-just-tell">menanyakan kepatutan</a> pengambilan keputusan bersama dalam konteks keputusan vaksin. </p>
<p>Akan tetapi, <a href="http://dx.doi.org/http://www.biomedcentral.com/1471-2431/12/154">peneliti lain</a> menganjurkan pendekatan “bimbingan”. Di sini, fokusnya adalah membicarakan kekhawatiran orang tua yang meragukan vaksin, dan membantu mereka memahami penting dan perlunya vaksin. Ini berbeda dengan pendekatan “direktif” di mana penyedia layanan kesehatan intinya menginstruksikan orang tua untuk melakukan vaksinasi.</p>
<p>Diperlukan lebih banyak lagi riset untuk menentukan intervensi dan cara komunikasi seperti apa yang paling efektif mengurangi keraguan dan penolakan orang tua. </p>
<p>Yang jelas, penelitian menunjukkan bahwa komunikasi yang disesuaikan serta penuh rasa hormat, dan rekomendasi langsung dari penyedia layanan kesehatan, terbukti berpengaruh pada <a href="http://dx.doi.org/10.1016/j.vaccine.2013.07.013">peningkatan cakupan vaksinasi</a>.</p><img src="https://counter.theconversation.com/content/87698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristin S. Hendrix menerima dana dari National Institutes of Health.</span></em></p>Penyedia layanan kesehatan perlu menyesuaikan perbincangan guna menjawab kekhawatiran orang tua yang spesifik tentang vaksin.Kristin S. Hendrix, Assistant Professor of Pediatrics, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/596372016-05-24T00:23:21Z2016-05-24T00:23:21ZTouch creates a healing bond in health care<figure><img src="https://images.theconversation.com/files/123064/original/image-20160518-13484-1q8gsiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Touch is a powerful tool in medicine.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-163127006/stock-photo-measuring-pulse-on-light-blue-background.html?src=ceJoAThkmEGbv6KO_8ZwaA-2-54">Hands via www.shutterstock.com.</a></span></figcaption></figure><p>In contemporary health care, touch – contact between a doctor’s hand and a patient – appears to be on its way out. The expanding role of CT and MRI imaging is decreasing reliance on touch as a way of making diagnoses. Pressures to move patients through the system more quickly leave health professionals with fewer opportunities to make contact. Our experience suggests that when doctors spend fewer <a href="http://khn.org/news/15-minute-doctor-visits/">minutes</a> with patients, less time is available for touch. </p>
<p>Yet despite the rise of scanners, robots and other new medical technologies, the physician’s hand remains one of medicine’s most valuable diagnostic tools. Touch creates a human bond that is particularly needed in this increasingly hands-off, impersonal age. Medical practice is replete with situations where touch does more than any words to comfort and reassure.</p>
<p>The USC psychologist Leo Buscaglia, whose habit of hugging those he met soon earned him the sobriquet “Doctor Love,” bemoaned our neglect of touch in his book, <a href="https://books.google.com/books/about/Love.html?id=nfSHfoTn8bkC">“Love,”</a> in these terms:</p>
<blockquote>
<p>Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. </p>
</blockquote>
<p>For thousands of years, touch has been recognized as an essential part of the healing arts. Native American <a href="http://www.issseem.org/content/uploads/files/Bridges%201994_1.pdf">healers</a> relied on touch to draw out sickness, and kings and queens were long believed to possess the “<a href="http://www.sciencemuseum.org.uk/broughttolife/techniques/kingsevil">Royal Touch,”</a> through which the mere laying on of hands could heal. The Bible contains numerous stories of the healing power of touch.</p>
<h2>Touch is an essential part of our well-being</h2>
<p>An indication of our need for touch can be found among our primate relatives. <a href="http://greatergood.berkeley.edu/article/item/hands_on_research">Psychologists</a> have observed that many such species spend upwards of five hours of each day touching one another, partly through grooming. For many human beings, however, the daily dose of touching would be measured not in hours but minutes, perhaps even seconds.</p>
<p>Lack of touch can be hazardous to health. In experiments with primates some 60 years ago, researcher <a href="http://www.nytimes.com/2003/02/02/books/no-more-wire-mothers-ever.html">Harry Harlow</a> demonstrated that young monkeys deprived of touch did not grow and develop normally. Mere food, water and shelter are not sufficient – to thrive, such creatures need to touch and be touched.</p>
<p>The same can be said for human beings. During the 20th century, wars landed many babies in orphanages, where their <a href="http://pediatrics.aappublications.org/content/30/6/995">caretakers</a> observed that no matter how well the infants were fed, they would fail to thrive unless they were held and cuddled on a frequent basis. Touch offers no vitamins or calories, yet it plays a vital role in sustaining life.</p>
<p>More recent studies have corroborated these findings. “<a href="http://www.prematurity.org/baby/kangaroo.html">Kangaroo care</a>,” using papoose-like garments to keep babies close to their mothers, decreases the rate at which they develop blood infections. Touching also improves weight gain and decreases the amount of time that newborns need to remain in the hospital.</p>
<h2>Touch creates a bond between doctor and patient</h2>
<p>Novelist and physician Abraham Verghese has argued that touching is one of the most important features of the patient-physician interaction. When he examines a patient, he is not merely collecting information with which to formulate a diagnosis, but also establishing a bond that provides comfort and reassurance.</p>
<p>The notion that touch can reassure and comfort has a scientific basis. Ten years ago <a href="http://www.ncbi.nlm.nih.gov/pubmed/17201784">researchers</a> used MRI scans to look at the brains of women undergoing painful stimuli. When subjects experience pain, certain areas of the brain tend to “light up.” The researchers studied subjects when they were alone, when they were holding a stranger’s hand, and when they were holding their husband’s hand.</p>
<p>They found the highest levels of pain activation when the women were alone. When they were holding a stranger’s hand, the pain response was decreased. And levels of activation were lowest of all when they were holding their husband’s hand. Interesting, the higher the quality of subjects’ marriages, the more pain responses were blunted.</p>
<h2>Touch from parents helps kids in intensive care</h2>
<p>We have been studying this phenomenon in our own institution, looking at the effect of touch not only on patients but on the parents of patients admitted to the pediatric intensive care unit. </p>
<p>The project, called ROSE (<a href="https://vimeo.com/155025967">Reach Out, Soothe, and Embrace</a>), sought to determine whether increasing opportunities to touch patients could promote parent well-being without compromising patient safety. </p>
<p>Instead of merely determining whether patients could be taken off the ventilator or fed, we also identified patients who could be safely touched and even held in their parents’ arms. When a patient was deemed safe to hold, a magnet bearing the image of a red rose embraced by two hands was placed on the door to the patient’s room.</p>
<p>While we are still analyzing the results and further study is needed to fully delineate the health benefits of touch, several findings are already clear. </p>
<p>First, increasing opportunities for touch does not compromise patient safety. Second, the subjective well-being of family members is enhanced when touching is encouraged. Third, promoting touch empowers family members to become more involved in their child’s care.</p>
<p>To be sure, inappropriate and unsafe touching can be harmful. But when touch is encouraged in the right ways and for the right reasons, it is good for patients, family, friends and health professionals alike. Touch is one of the most fundamental and effective ways to create a sense of connection and community among human beings.</p>
<p>In the words of the 20th-century theologian Henri Nouwen, who wrote in his book, <a href="https://www.avemariapress.com/product/0-87793-495-9/Out-of-Solitude/">“Out of Solitude”</a>:</p>
<blockquote>
<p>When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.</p>
</blockquote>
<p>So next time you find yourself confronted by a person in distress, remember the power of touch. Medicines and words both have healing power, but so does touch, and it is perhaps the most widely available, financially responsible and safest tool in the healing arts. When we touch, we connect, and when we connect, we create a healing bond for which there is simply no substitute.</p><img src="https://counter.theconversation.com/content/59637/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Brian LeLand receives funding from Indiana University Health Values Grant Board. 2 year grant awarded through IU Health of $50,000 per year. Grant awarded in 2014. </span></em></p>Despite the rise of scanners, robots and other new medical technologies, the physician’s hand remains one of medicine’s most valuable diagnostic tools.Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana UniversityBrian LeLand, Fellow, Section of Pediatric Critical Care, Department of Pediatrics, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/469622015-09-04T10:39:05Z2015-09-04T10:39:05Z‘The greatest man in the world’: on the 50th anniversary of Albert Schweitzer’s death<figure><img src="https://images.theconversation.com/files/93674/original/image-20150902-14070-1utdt8o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-88903750/stock-photo-germany-circa-a-stamp-printed-in-the-germany-shows-dr-albert-schweitzer-medical.html?src=cZv-4ASnfFg3UjqTeQ7_eQ-1-1">Albert Schweitzer stamp via www.shutterstock.com.</a></span></figcaption></figure><p>In 1947, Time magazine dubbed him “<a href="https://books.google.com/books?id=b3NBAgAAQBAJ&pg=PA282&lpg=PA282&dq=time+magazine+schweitzer+greatest+man+in+the+world+1947&source=bl&ots=JaBeoi9yd2&sig=6TqWM7Ok-4ZiJ09BqJYDSMXV8_8&hl=en&sa=X&ved=0CDIQ6AEwBGoVChMIt_6KxvvWxwIVBFuSCh3lhQqw#v=onepage&q=time%20magazine%20schweitzer%20greatest%20man%20in%20the%20world%201947&f=false">the greatest man in the world</a>.” He was one of the world’s most famous organists, whose scholarly studies of Bach remain definitive today. As a theologian, he produced groundbreaking studies of the historical Jesus and the mysticism of the apostle Paul. And as a physician, he founded perhaps the most influential medical mission hospital in the world. In 1952, his philosophy of reverence for life was recognized with the <a href="http://www.nobelprize.org/nobel_prizes/peace/laureates/1952/schweitzer-facts.html">Nobel Peace Prize</a>. September 4 marks the 50th anniversary of his death at age 90.</p>
<p>We are referring, of course, to Albert Schweitzer, the person Winston Churchill called “a genius of humanity.” And though Schweitzer’s contributions are fading fast from living memory, some of the most pressing challenges facing the world today call us to revisit his life and legacy. In an age when wealth so often seems to be worshiped, the pursuit of power seems virtually unbridled and war continues to be regarded as an inescapable fact of human life, it is more important than ever that we pause to ponder Schweitzer’s views on the purpose of life. </p>
<p>We are a father-son duo of a medical school faculty member and student who have used works by Schweitzer in our own studies and teaching on callings, and these experiences have shown us the transformative effect they can have on the outlooks of students, helping them gain a clearer sense of their own calling in life. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/93677/original/image-20150902-14050-112zoxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/93677/original/image-20150902-14050-112zoxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=951&fit=crop&dpr=1 600w, https://images.theconversation.com/files/93677/original/image-20150902-14050-112zoxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=951&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/93677/original/image-20150902-14050-112zoxv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=951&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/93677/original/image-20150902-14050-112zoxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1195&fit=crop&dpr=1 754w, https://images.theconversation.com/files/93677/original/image-20150902-14050-112zoxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1195&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/93677/original/image-20150902-14050-112zoxv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1195&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Schweitzer the musician.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-138005444/stock-photo-germany-circa-stamp-printed-by-germany-shows-albert-schweitzer-at-the-organ-with-score-of.html?src=pp-same_artist-60698317-cZv-4ASnfFg3UjqTeQ7_eQ-8&ws=1">Stamp via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<p>Born in 1875 in the Alsace region of what is now France, Schweitzer was the son of a Lutheran pastor. As a student, he earned doctorates in <a href="https://books.google.com/books?id=RI2mrkTaM2UC&pg=PA71&dq=how+many+doctorates+did+albert+schweitzer+have?&hl=en&sa=X&ved=0CDEQ6AEwAGoVChMImPj16_zWxwIVh0OSCh1cewZs#v=onepage&q=how%20many%20doctorates%20did%20albert%20schweitzer%20have%3F&f=false">four fields</a>, including philosophy, theology and medicine. His decision to pursue a career in medicine came relatively late, at age 30, in answer to a call for missionaries. After seven years of medical study, he and his wife Helene, who trained as a nurse in order to assist him, traveled 4,000 miles to Gabon in west-central Africa, where he founded a hospital for local people in Lambaréné. There Schweitzer lived and worked for most of the next 50 years.</p>
<p>Schweitzer collected huge amounts of money over his lifetime, but he did so with the intent of giving it away. When he and his wife left to found his mission hospital, their efforts were funded not by a government or philanthropic foundation, but by Schweitzer himself. The funds he generated from his many concerts and lectures over the years likewise went toward his mission. And Schweitzer donated the entirety of his Nobel Prize stipend to <a href="http://www.nobelprize.org/nobel_prizes/peace/laureates/1952/schweitzer-bio.html">building a leprosarium</a> next to his hospital. Clearly, he thought about money differently from most people.</p>
<p>Schweitzer did not see wealth primarily as a means to acquire more things for himself – especially not the sort of luxury goods with which some people try to prove that they are better than others. Instead, Schweitzer regarded money as a means to serve, and he devoted both the money he earned and the work that produced it to the service of others. True wealth, he believed, cannot be measured in dollars. “Those who thank God greatly are the truly wealthy,” he wrote. “Our inner happiness depends not on what we experience but on the degree of our gratitude to God, whatever the experience.”</p>
<p>Schweitzer also harbored deep misgivings about power, at least the kind of power that enables one person to coerce another. From his point of view, the history of European involvement in Africa had been largely one of exploitation, from the pillaging of natural resources to the capture and sale of native peoples into slavery. Far from spreading enlightenment and prosperity, Schweitzer believed Europe’s superior economic and military power had been used to sow the seeds of disease, dependency and discord. By today’s standards, even Schweitzer is not immune to criticism on these counts, having been accused of adopting an excessively paternalistic approach and failing to do more to cultivate the abilities of the people he served. He characterized his own missionary efforts not as benevolence but atonement. </p>
<p>Instead of pursuing power over one another, Schweitzer argued that people should strive for understanding and mutual confidence. “The only way out of today’s misery,” he wrote, “is for people to become worthy of one another’s trust.” He promoted a different kind of power, one with which people would seek not to control but to empower one another, working together to “to establish a spiritual and humane relationship with all people and living creatures within our reach. Only in this fashion can we go to the aid of others wherever they need us.”</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/93676/original/image-20150902-14056-1yfd2ql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/93676/original/image-20150902-14056-1yfd2ql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=957&fit=crop&dpr=1 600w, https://images.theconversation.com/files/93676/original/image-20150902-14056-1yfd2ql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=957&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/93676/original/image-20150902-14056-1yfd2ql.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=957&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/93676/original/image-20150902-14056-1yfd2ql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1203&fit=crop&dpr=1 754w, https://images.theconversation.com/files/93676/original/image-20150902-14056-1yfd2ql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1203&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/93676/original/image-20150902-14056-1yfd2ql.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1203&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Schweitzer the writer.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-60698317/stock-photo-germany-circa-stamp-printed-by-germany-shows-albert-schweitzer-circa.html?src=cZv-4ASnfFg3UjqTeQ7_eQ-1-40">DDR stamp via www.shutterstock.com.</a></span>
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<p>Schweitzer was especially alarmed by the view that hostility is an inescapable fact of life. He lived through two world wars and witnessed firsthand instances of the heartless conduct to which such conflicts give rise. Schweitzer argued that acts of cruelty are not the product of some base or evil instinct in the heart of human beings, but a reflection of deeply ingrained habits of thoughtlessness. To overcome such prejudices, he believed, it is necessary to appeal to the minds and hearts of people, who can learn new habits of thoughtfulness and love.</p>
<p>Schweitzer espoused a philosophy he called “reverence for life.” In one of the greatest Nobel Prize addresses ever composed, entitled “<a href="http://www.nobelprize.org/nobel_prizes/peace/laureates/1952/schweitzer-lecture.html">The Problem of Peace</a>,” he argues that the technology of war has advanced far beyond the wisdom needed to restrain its use. He appeals to the consciences of all human beings to follow the words of the apostle Paul: “If it be possible, as much as lies in you, live peaceably with all men.” To do otherwise, he holds, is a transgression not so much against the laws of men or nations as against life itself.</p>
<p>On each of these topics – wealth, power and war – Schweitzer aimed his appeals not at political or economic institutions but at the minds and hearts of human beings. He believed that placing faith in such organizations is a mistake, because they can express only what is in the minds of people. In his Nobel lecture he wrote:</p>
<blockquote>
<p>Only when an ideal of peace is born in the minds of the peoples will the institutions set up to maintain this peace effectively fulfill the function expected of them.</p>
</blockquote>
<p>Schweitzer was not entrepreneur, statesman or military commander. He was a prophet, calling people to listen to their hearts.</p>
<p>The hope for humanity, Schweitzer believed, lies not in laws or institutions, but in love – a profound love that must be deeply rooted in thought. In recognizing that we are offspring of one God, he argued, we can rediscover the threads that bind together all life. “Out of this,” he wrote, “develops reverence for the mystery of life. It brings us close to all beings, to the poorest and smallest as well as all the others.” </p>
<p>When we feel this kinship with all life, we cease to worry so much about getting and spending, commanding and controlling, and conquering and ruling, and instead devote ourselves to lives of service through love. Even now, a full 50 years after Schweitzer’s death, his words of wisdom continue to ring out in classrooms around the world.</p><img src="https://counter.theconversation.com/content/46962/count.gif" alt="The Conversation" width="1" height="1" />
In 1947, Time magazine dubbed him “the greatest man in the world.” He was one of the world’s most famous organists, whose scholarly studies of Bach remain definitive today. As a theologian, he produced…Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, IUPUIPeter Gunderman, Theology, Medicine, and Culture Fellow at Duke University and medical student, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/379572015-03-09T09:59:32Z2015-03-09T09:59:32ZWhen parents hesitate about vaccines, what should health-care providers say?<figure><img src="https://images.theconversation.com/files/73981/original/image-20150305-3306-vfbyso.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Helping parents decide to immunize their children may be a matter of communication.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/armydre2008/15837608614">frankieleon</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>In recent years, the US has witnessed multiple outbreaks of vaccine-preventable illnesses, including <a href="http://www.cdc.gov/pertussis/surv-reporting.html">pertussis</a> (whooping cough) and <a href="http://www.cdc.gov/measles/cases-outbreaks.html">measles</a>. In the same time frame, vaccine refusal rates <a href="http://dx.doi.org/10.2105/AJPH.2014.302190">have gone up</a>, and an increasing number of parents are requesting modified vaccine schedules that differ from the <a href="http://www2.aap.org/immunization/IZSchedule.html">one recommended</a> by the American Academy of Pediatrics (AAP). </p>
<p>The majority of parents do have their children vaccinated on schedule. It’s a small number of parents who refuse all vaccinations for their children. A slightly larger minority want their children to receive some but not all vaccines or want a different vaccination schedule.</p>
<p>Why do these groups disregard AAP recommendations about vaccination? A 2011 <a href="http://dx.doi.org/10.1377/hlthaff.2011.0396">study suggests</a> it has a lot to do with fear of vaccines’ negative side effects. Some parents worry about the “chemical composition” of vaccines or multiple vaccines being given at once. Some don’t believe vaccines are effective. Others feel the illnesses some vaccines protect against, like influenza or varicella (chickenpox), aren’t that serious. Importantly, though not the focus of this article, the AAP Committee on Bioethics <a href="http://dx.doi.org/10.1542/peds.2005-0316">notes</a> that some parents might refuse vaccines due to cost issues or barriers to accessing appropriate health services.</p>
<p>Although research overwhelmingly supports the safety and effectiveness of vaccines and indicates that the risk of negative side effects from childhood vaccines is extremely small, many parents still have concerns about vaccine safety. </p>
<p>Parents today have access to incredible amounts of information via the internet, which has been shown to <a href="http://dx.doi.org/10.1155/2012/932741">significantly affect</a> parents’ vaccine attitudes. Within this wealth of information about immunization, it can be challenging for parents to separate what’s reliable from what’s not. And, we tend to seek out, pay more attention to, and recall information that we suspect might be true. This is called <a href="http://dx.doi.org/10.1037/0022-3514.37.11.2098">biased assimilation</a>. So a parent who believes vaccines are dangerous might preferentially register information supporting that view.</p>
<h2>The continuum of vaccine attitudes</h2>
<p>Vaccine attitudes <a href="http://dx.doi.org/10.1016/j.vaccine.2014.01.081">fall on a continuum</a>. At one end, there are parents who are completely in favor of vaccines, and at the other end are parents who oppose vaccines. In between there is a broad and complex spectrum of parents who are vaccine-hesitant or vaccine-uncertain. The common thread among all parents – no matter their vaccination choices – is that they’re trying to do what they feel is best for their children. </p>
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<a href="https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=703&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=703&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=703&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=883&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=883&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73984/original/image-20150305-3310-1qxtt17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=883&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A flyer meant to educate about the rubella virus and benefits of the vaccine.</span>
<span class="attribution"><span class="source">CDC/ Molly Kurnit; Melanie Jankun</span></span>
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</figure>
<p>With parents who fall towards the vaccine-opposing end of the spectrum, health-care providers can experience difficulty when trying to change attitudes about vaccines. These parents may have strong feelings and be very confident in what they believe to be true about vaccines. But parents somewhere in the middle of the spectrum, who are hesitant or uncertain about vaccines, are oftentimes less set in their beliefs about vaccination. That’s why some researchers stress the importance of proactive intervention efforts aimed at the very broad group of <a href="http://dx.doi.org/10.1038/473443a">vaccine-hesitant parents</a>. Parents on this part of the continuum are typically receptive to information about vaccination from trusted health-care providers. Thus, the way nurses and physicians communicate with these parents about vaccination is very important.</p>
<h2>How should health-care providers talk about vaccines?</h2>
<p>There is a wealth of research examining communication about vaccines, and researchers are still identifying what methods tend to work well. Communication about vaccination occurs in a variety of ways, from one-on-one conversations with doctors and nurses to large-scale outreach from health departments, such as billboards and radio ads. </p>
<p>What can make the provider-parent discussion about childhood vaccination a complex one is that parents’ <a href="http://dx.doi.org/10.1016/j.vaccine.2013.08.104">decisions and attitudes vary</a>, depending, for example, on the type of vaccine. And, in many cases when parents have negative attitudes about vaccines, they’re often based on erroneous information or hearing emotional narrative accounts about adverse reactions from a vaccine. It can also be very challenging for health-care providers to correct people’s <a href="http://dx.doi.org/10.1016/j.vaccine.2012.02.025">misperceptions about risks</a>.</p>
<p>There are a few strategies that health-care providers can use when talking about immunization with vaccine-hesitant parents. In clinical settings, although potentially time-consuming in already-short appointments, it’s important to address parents’ <a href="http://dx.doi.org/10.1542/peds.2005-0316">specific concerns</a>. Clinicians should discuss vaccines from multiple perspectives, like the benefits of vaccination (preventing illness for oneself and others), as well as the risks of not vaccinating (being susceptible to illness). Research suggests that tailoring the discussion to parents’ concerns can positively affect the provider-parent relationship and <a href="http://dx.doi.org/10.1186/1471-2431-12-154">foster trust</a>. </p>
<p>Since health-care providers can help build public trust in vaccines, communicating accurate information about risks <a href="http://dx.doi.org/10.1186/1471-2431-12-154">should be part of the conversation</a>. Here, it might be tempting to avoid discussion about the risk of any negative side effects of vaccination, even though the risk is very low. But <a href="http://www2.aap.org/immunization/pediatricians/pdf/vaccine-hesitant%20parent_final.pdf">risk communication is vital</a>.</p>
<p>The AAP suggests tailoring the conversation to the parents, understanding and responding to their specific concerns. Physicians should talk to parents about managing common side effects and what to do if a more serious reaction occurs. For some parents, quantifying the risks of vaccinating versus not vaccinating could be helpful. Providing written materials to explain risk is another strategy. It is important to note, however, that more research is needed. <a href="http://pediatrics.aappublications.org/content/early/2014/02/25/peds.2013-2365">Several researchers</a> urge caution about some vaccine communication strategies for fear they may “backfire” and decrease parents’ intentions to vaccinate their children. </p>
<h2>What about discussing herd immunity?</h2>
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<img alt="" src="https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74113/original/image-20150306-13546-hcrtdz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A San Francisco Public Health flyer promoting vaccines for adults.</span>
<span class="attribution"><span class="source">Raed Mansour</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>A 2013 study on what influences adults to the get the flu shot suggests people may be more likely to get vaccinated <a href="http://dx.doi.org/10.1016/j.amepre.2013.02.016">if their peers do it</a>. Among adults, evidence also <a href="http://dx.doi.org/10.1037/a0031590">suggests</a> awareness of <a href="http://www.vaccines.gov/basics/protection/">herd immunity</a> - or when a critical threshold of individuals is vaccinated so as to make it harder for an illness to spread - can have a positive effect on one’s intention to be vaccinated. Though adults are most concerned about their personal risk of getting sick, they can also be sensitive to the <a href="http://dx.doi.org/10.1177/0272989X11427762">societal benefits of vaccination</a>. However, when it comes to parents deciding whether to vaccinate their children, it may be more important to focus on the direct benefits of immunization <a href="http://dx.doi.org/10.1542/peds.2013-4077">for the child</a>. Though mentioning societal benefits of vaccination will likely not hurt.</p>
<h2>To presume or not presume?</h2>
<p>In order to increase vaccine uptake among parents for their children, <a href="http://dx.doi.org/10.1542/peds.2013-2037">some researchers</a> recommend a “presumptive” approach, which assumes parents are going to vaccinate their children. This is compared to a “participatory” approach in which the health-care provider asks parents about their preferences on vaccination. These investigators <a href="http://www.npr.org/blogs/health/2015/02/06/384322665/to-get-parents-to-vaccinate-their-kids-dont-ask-just-tell">question the appropriateness</a> of shared decision making in the context of vaccine decisions. </p>
<p>However, <a href="http://dx.doi.org/http://www.biomedcentral.com/1471-2431/12/154">other researchers</a> advocate for a “guiding” approach. Here the focus is on addressing vaccine-hesitant parents’ concerns and helping them to understand vaccines’ importance and necessity. It differs from a “directive” approach wherein the provider essentially instructs parents to vaccinate. </p>
<p>More research is needed to determine which interventions and ways of communicating information about vaccination are most effective at reducing parents’ vaccine hesitancy and refusal. What is clear from existing research is that respectful, tailored communications and recommendations to immunize coming directly from the health-care provider are associated with <a href="http://dx.doi.org/10.1016/j.vaccine.2013.07.013">increased vaccination uptake</a>.</p><img src="https://counter.theconversation.com/content/37957/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristin S. Hendrix receives funding from the National Institutes of Health. </span></em></p>Research shows that what’s most effective is when health-care providers tailor the conversation to address parents’ particular concerns.Kristin S. Hendrix, Assistant Professor of Pediatrics , Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.