Health

(NEW YORK) — More than 6 million women of childbearing age in the United States have difficulty getting pregnant or staying pregnant, yet infertility, and specifically the emotional and physical pain that comes with it, is still a taboo topic, even among some women.

L’Oreal Thompson Payton, a 33-year-old from Chicago, said she never heard discussions about infertility and infertility treatments when she was growing up.

Even when Payton, a writer, found herself in her early 30s, married, unable to conceive and turning to in-vitro fertilization, she said she found few people talking honestly about the reality of what she calls “the messy middle” — that time between starting infertility treatments and, if it all goes according to plan, having a baby.

“IVF is a full-time job and it can wreck you physically, emotionally, mentally,” Payton told Good Morning America. “You’re just putting your body under a lot of physical stress and emotional stress as well, because you’re doing this with the hope that you’re going to get the result and the outcome that you want, and as we’ve learned firsthand, that’s not always the case.”

As a Black woman, Payton said she felt a particular stigma around help with getting pregnant, and then opening up about the toll it took on her body. Black women who have never given birth are almost twice as likely than white women to self-report infertility, but they seek medical help for it half as much, according to data from the U.S. Centers for Disease Control and Prevention.

Infertility is defined as the inability to become pregnant after one year of having regular sexual intercourse without the use of birth control, according to the American College of Obstetricians and Gynecologists. The time span is shortened to six months without becoming pregnant for women age 35 and older.

“Because of the shame and stigma surrounding [infertility], you don’t hear a lot about it,” said Payton. “And so it does sort of put the onus on the person going through it to share with their network this is what’s happening, and this is what I need, and that requires a lot of vulnerability.”

‘Undergoing IVF is basically surrendering your body’

In IVF, the most well-known treatment for infertility, a woman’s eggs and a man’s sperm are combined in a laboratory to create an embryo, or embryos. The sperm may come from the woman’s partner or a donor.

Five to 10 days after the embryo is created, it is examined by an embryologist to determine its viability. If the embryo is viable, it is transferred into the woman’s uterus through her cervix.

And even before those steps, women have to undergo ultrasounds and blood work and take injectable and oral medications to stimulate the ovaries.

That is the “messy middle” that Payton said she was unprepared for, especially the side effects that took a toll on her body.

“Undergoing IVF is basically surrendering your body to the medication, to the doctors, to the appointments and the protocol,” she said. “You are no longer in control.”

Payton said she experienced scars, bruising and bloating while taking the daily hormone injections, describing it all as an “ugly process.”

“When we were going through our first egg retrieval, I felt super bloated and heavy, like my pants weren’t fitting and leggings were my best friends,” she said. “The symptoms are very similar to pregnancy, and also similar to PMS, so it can really mess with you. Things are sensitive and your hormones are out of whack.”

When undergoing IVF, a woman’s ovaries grow from the size of approximately a walnut to the size of an orange, according to Dr. Meggie Smith, a Nashville, Tennessee-based fertility specialist.

“The injection medications that we give [women] are trying to get at all the eggs that are available that month to grow,” said Smith. “So your ovary, which is normally pretty small, gets much bigger than it normally would be, and your estrogen, which is a hormone, goes so much higher than it normally would.”

“Estrogen causes us to retain water, so that’s one reason why you feel really bloated, and then the size of the ovaries is so much bigger than they normally are,” she said. “A lot of patients describe pelvic pressure feeling bloated and uncomfortable, and that’s why that’s happening.”

Taking multiple shots a day for several weeks, which happens during both the IVF and egg-freezing processes, is a common source of pain for women as well, according to Smith.

“A lot of women also talk about pain where they’ve been giving [the injections],” she said. “[There may be] bruising, depending on how easily you bruise.”

Smith noted that the physical pain women feel during infertility treatments can be made even more difficult by the fact that the pain is not something visible, like a broken arm, for example, or something that all women feel free to talk about.

“Infertility has been a taboo topic for so long,” she said. “Most people don’t view infertility as a disease.”

“There’s still a lot of shame, just because we all think that getting married and having children is something [women] are supposed to do. We’re supposed to bear children,” Smith added. “The idea that may not be a woman’s will at all times is kind of a relatively new concept, and the idea that being able to have children is not easy for everybody is also kind of a new concept that people are starting to wrap their heads around.”

The idea for women that their body is not easily doing what they believe it should be doing, getting pregnant, can also turn infertility into a hidden, emotional struggle for women.

“For so much of our lives, especially in our 20s, and maybe even our 30s, we’re trying to not get pregnant, and then when we flip the switch, it’s a lot harder, I think, than people realize,” said Smith. “I think a lot of time women don’t realize this as a disease, and they think it’s something they’re doing wrong, and for that reason, they don’t want to talk about it as much.”

Infertility is associated with high rates of “clinically significant symptoms of depression and anxiety, suicidal tendencies, and a strong conceptualization of grief,” according to the World Health Organization.

“Therapy has been such a help as well with the mental and emotional side of it,” Payton said of how she’s coped with her still ongoing infertility journey. “I don’t know what I would do without it.”

Smith said she also encourages her patients to speak with therapists and even, more specifically, reproductive psychiatrists and psychologists, as they go through infertility treatments.

“There are so many highs and so many lows and it can even happen within the same day, so it’s a huge emotional roller coaster,” said Smith. “I often say it’s a little bit of a depression induction, because there’s so many expectations that we have, that either are met or not met, and so you’re constantly having to readjust your own expectations to manage all the emotions that come along with trying to have a baby.”

Women who are looking into or undergoing infertility treatments should make sure they have a doctor they feel comfortable with and one with whom they can have open and honest conversations, according to Smith.

Those types of open and honest conversations — among doctors and patients, couples, friends, parents and children — are what will continue to knock down the stigma around infertility, noted Smith.

“I think people such as yourself, who are talking so openly about their stories is one big way that we’re going to do this,” Smith said to Payton, who writes about her infertility journey on her blog and on social media. “The more women hear about other women struggling to have a baby, I think it will open up more conversations where more people feel comfortable sharing.”

“The more we talk about [infertility], that can make a huge difference in normalizing what is so common,” she said.

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(WASHINGTON) — Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, called the recent ruling by a Florida judge striking down the federal mask mandate on mass transit “a real challenge.”

“This is not going to be the last of the need for public health measures we’ve taken for any crisis,” Osterholm told “This Week” Co-Anchor Martha Raddatz exclusively on Sunday. “And what could be the crisis of tomorrow?”

The Transportation Security Administration announced last week that the travel mask requirement will no longer be enforced by the agency since the mandate was struck down. But the Department of Justice is appealing the decision after the Center for Disease Control weighed in.

“On precedence, this case is very, very important,” Osterholm added. “I think the confusion around the mask mandate itself and how effective it is, is a secondary issue, but one that is still important, too.”

Raddatz followed up, asking Osterholm about telling The New York Times this week that public health messaging around masking has been “way off the mark.”

“Well, it is off. First of all, let me be really clear, I am very, very strongly in support of a respiratory protection,” he said. “Someone can do a great deal to protect themselves and protect others if they’re using an N95 respirator. But this virus is transferred by what we call aerosols. It’s very fine particles that float into the air. It’s like smoke. It’s like perfume. And you have to have a high-quality respiratory protection device to protect yourself.”

“I think that what we want to do is stop talking about masking and talking about effective respiratory protection,” Osterholm added.

“And how do you do that?” Raddatz asked.

“First of all, the U.S. public is done with the pandemic, even though the virus is not done with us,” Osterholm responded. “And we have to recognize that in public health.”

“So, what is it that we can do? Well, we have to have credibility,” he added. “And again, what has happened is this has become … really a philosophical and political issue, not a science issue.”

Despite his objections to cloth masks, Osterholm still strongly recommends the use of N95 respirators, “particularly if you’re an immune-compromised individual.”

“If everybody can do that, they would keep in on to the duration of a flight, not wear it underneath their nose, then that would be a very effective way to have a mandate,” Osterholm said.

Raddatz also asked about the pandemic as cases rise in most states.

“What is the true state of the pandemic right now?” she pressed.

“You know, Martha, every day is a brand new day with this pandemic, relative to the variants,” Osterholm said. “We know that we have strains that are much more infectious, so that, you know, you can’t come up with an answer today to say this is where we’re at because tomorrow, it could change.”

Despite rising caseloads, hospitalizations stemming from the virus are still at all-time lows nationwide, something Osterholm called “good news.”

“But I want to emphasize that could all change tomorrow, and that’s what the public is not willing to hear,” he added. “They want this to be over.”

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(LONDON) — A rise in hepatitis cases among children is under investigation by experts.

Some recent reports from the U.S., U.K., and EU health organizations including the U.S. Centers for Disease Control and Prevention, show that some children between 11 months and 13 years old have been diagnosed with hepatitis.

The exact cause is still unknown, experts say.

Hepatitis is a characterized by liver inflammation and damage. It can sometimes be caused by a virus, but sometimes caused by other factors, such as toxins or medications.

Pediatric hepatitis cases were first reported in the U.K. with 10 cases report on April 5, according to the World Health Organization. However, WHO’s report from April 15 showed there were 108 cases across the U.K. in the following days.

On Tuesday, the European Centre for Disease Prevention and Control announced in a statement that there were more cases in Denmark, Ireland, the Netherlands and Spain.

Meanwhile, in the U.S., nine cases of acute hepatitis were in children between 1 and 6 years old in Alabama, according to the U.S. CDC. In a statement on April 21, the CDC asked clinicians to be on the lookout for symptoms and to report any suspected cases of hepatitis of unknown origin to their local and state health departments.

While mild hepatitis is common in children, “severe inflammation of the liver in these children is a big concern,” Graham Cooke, professor of infectious diseases at Imperial College London told ABC News.

According to WHO’s report, some cases required transfer to specialists and six children have undergone liver transplantation.

“Six patients requiring a liver transplantation in such a short period is a big number,” Cooke said.

Cooke said the child hepatitis cases are “distributed widely across the UK,. with a higher density in UK’s northwest.

“But there is no information whether the cases are linked or if the disease is a contagious one,” he added.

There is no indication the cases are linked to COVID-19 vaccines. In fact, “None of the currently confirmed cases in the UK has been vaccinated” against COVID-19, according to a UKHSA report.

Hepatitis is often caused by viral infections, most commonly hepatitis viruses. , But laboratory testing has excluded hepatitis virus types A, B, C and E in the U.K. children.

Regarding the preventive effect of hepatitis vaccination against the new acute hepatitis outbreak, Cooke said: “one can expect they [the recent hepatitis cases] are vaccinated against the common hepatitis,” he said, clarifying specifically against hepatitis type B. He said that the information on the hepatitis vaccination of the recent cases is not officially stated in the medical reports yet.

“However, there are different causes that may lead to liver inflammation. The cause of this specific outbreak is not of the ones known and it may some take time until the real case is discovered,” he added.

“Of the confirmed cases, 49 are in England, 13 are in Scotland and the remainder are in Wales and Northern Ireland,” the U.K. Health Security Agency wrote in its updated report on April 21.

“As of 11 April, no death has been reported among these cases and one epidemiologically linked case has been detected,” the report added.

International teams are working to investigate the matter, Cooke said.

According to the UKHSA report: ‘adenoviruses’ are one of several potential causes under investigation.

The UKHSA’s update on its investigation, including information from patient samples and surveillance systems, continues to point toward “a link to adenovirus infection.”

Adenoviruses are commonly spread through the respiratory route, from person to person, and by touching contaminated surfaces. UKHSA advises the most effective way to minimize the spread of adenoviruses is to practice good hand and respiratory hygiene and supervise thorough handwashing in younger children.

However, other possible causes are also being actively investigated, including COVID-19, other infections or environmental causes.

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(NEW YORK) — Firearms surpassed car accidents as the No. 1 killer among children and teens, according to startling new data released by the U.S. Centers for Disease Control and Prevention Friday.

As firearm deaths for all Americans reached a new peak in 2020 — 45,222 — researchers said the numbers were particularly troubling among people under 19 years old.

Gun deaths in that age group saw a 29.5% jump from 2019 to 2020, which was more than twice as high as the relative increase in firearm deaths seen in the general population, according to the CDC.

For the last 21 years, gun deaths were second to motor vehicle crashes as the leading cause of death among children and adolescents, however, the gap between the two categories has been narrowing since 2016, the CDC said.

The cause behind the surging gun deaths in America was largely due to firearm-related homicides, which saw a 33.4% increase in the crude rate from 2019 to 2020, the CDC said. Firearm-related suicides in the U.S. increased by 1.1% during that period, according to CDC data.

In a letter to the editor published in the New England Journal of Medicine Friday, CDC researchers couldn’t provide a reason for the increase in gun deaths, but stated “the new data are consistent with other evidence that firearm violence has increased during the COVID-19 pandemic.”

“It cannot be assumed that firearm-related mortality will later revert to pre-pandemic levels,” the researchers wrote.

The researchers called for more investments in organizations and programs aimed at curbing community violence.

“The increasing firearm-related mortality reflects a longer-term trend and shows that we continue to fail to protect our youth from a preventable cause of death shows that we continue to fail to protect our youth from a preventable cause of death,” they wrote.

Dr. Grace Cullen, an internal medicine resident at the Mayo Clinic in Rochester, Minnesota, and a member of the ABC News Medical Unit, contributed to this report.

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(NEW YORK) — The Centers for Disease Control and Prevention announced Thursday that the public health agency is looking into a cluster of hepatitis cases among children.

According to a press release, the federal agency is studying nine hepatitis cases in Alabama “of unknown origin in children ranging in age from 1 to 6 years old, all of whom were previously healthy.” The children have also tested positive for adenovirus infection, which most commonly causes respiratory illness, but depending on the type, can cause gastrointestinal infection in children.

How significant is this national health alert?

The rise in hepatitis cases in the U.S. mirrors an increase in cases among youths in the U.K.

“It falls under the category of the fact that the CDC is actively engaged in non-COVID surveillance and this is a perfect example of that,” ABC News’ chief medical correspondent Dr. Jen Ashton told Good Morning America.

“Hepatitis — that umbrella term for inflammation of the liver — can be caused by viruses but it can also be caused by toxins, medications. [It’s] very unusual to see it in this pediatric population,” Ashton added.

Should parents be concerned?

Parents should be aware that there are cases where children are getting sick and if they notice symptoms or suspect a case of hepatitis or liver inflammation, they should consult their child’s pediatrician immediately.

“At this point, this is rare. It’s just something CDC is keeping an eye on,” Ashton said.

What causes hepatitis?

Hepatitis viruses are the most common cause of hepatitis in the world, including hepatitis A, B, and C, but they’ve been ruled out in the Alabama cluster. Researchers at the CDC suspect that the adenovirus infections may have caused the pediatric hepatitis cases and are still working to find out more information.

What are the symptoms of hepatitis?

Hepatitis symptoms include jaundice or yellowing of the skin and eyes, abdominal pain, nausea, or vomiting, dark-colored urine, or pale bowel movements.

What can parents do?

The CDC recommends that children receive vaccinations for hepatitis A and B. There is currently no vaccine available for hepatitis C.

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(NEW YORK) — When a judge on Monday overruled the mask mandate on public transportation, parents with kids too young to be vaccinated felt renewed anxiety about the country moving too quickly toward pre-pandemic normalcy while they were still stuck in a pre-vaccine world.

But there is hope that parents will be able to vaccinate their kids under five years old soon — perhaps as early as June, according to top Biden administration officials.

Neither vaccine companies, Moderna or Pfizer, have fully submitted their data to the FDA yet, the FDA said on Thursday.

But Moderna, which has a two-dose vaccine for children under five, is expected to officially file a request for authorization with the Food and Drug Administration by the end of April, a spokesperson for the company confirmed.

And Pfizer, which has been conducting clinical trials on a three-dose vaccine for kids under five, is expected to have results by early May, which it will then turn over to the FDA. In a recent podcast interview, the company’s CEO said he expects an authorization sometime in June.

In the meantime, the Food and Drug Administration has already notified the members of its independent panel, which would review the vaccine data ahead of the authorization, to reserve time for a meeting as soon as June 1, according to a source familiar with the plans. However, the dates were flexible and could get pushed back.

The question, however, is whether regulators will authorize Moderna a few weeks ahead of Pfizer, or wait to authorize them at the same time — in June — in an effort to minimize confusion.

In an interview on Thursday with CNN+, White House medical advisor Dr. Anthony Fauci suggested that regulators will wait.

Fauci said that the purpose of authorizing both at once, rather than Moderna a few weeks ahead of Pfizer, would be to not “confuse people.”

“It’s going to be two separate companies, two products that are similar but not identical, particularly with regard to the dose,” he said, explaining that Moderna’s regimen for kids under five is two doses, while Pfizer’s is three doses.

“And what the FDA wants to do is to get it so that we don’t confuse people,” Fauci said.

Asked multiple times by CNN’s Kasie Hunt why parents couldn’t be expected to navigate having two options separately authorized around the same time, particularly for those who are eagerly waiting for a vaccine as soon as possible and would take whichever came first, Fauci said he couldn’t answer.

“I can’t really honestly answer that question because I don’t know the answer to that question. Because I don’t have all the data in front of me,” Fauci said, adding that the data before the FDA was confidential while it was under review.

Still, Fauci confirmed that Pfizer’s vaccine would likely be authorized in June, meaning the wait would only be a few weeks, at most.

It would be unusual for the FDA to make a decision based on expected vaccine uptake, though Dr. Peter Marks, the FDA’s vaccine chief, has said that it’s a priority to handle the authorization of vaccines for young kids with extensive care so parents trust the final product. In older age groups, like kids 5 to eleven, only around a quarter of kids have been vaccinated since it was authorized five months ago.

“We know that in this population, we have to do our job extremely well to … ensure that there is a very good evaluation of the safety and effectiveness, so that when we make our recommendation, people will trust that recommendation,” Marks said at a press conference last month.

On Thursday, the FDA said it would work with urgency to authorize vaccines for kids once the companies submit the data, while also “adhering to our rigorous standards for safety and effectiveness.”

The agency also said that lower case counts and hospitalizations since the omicron surge had no effect on the urgency of the process.

“It is inaccurate to say that minimal hospitalizations and death play a part in any timeline as one death of a young child is tragic,” FDA spokesperson Abby Capobianco said in a statement.

But questions remain about the potential for regulators to authorize both vaccines at once, which could mean parents have to wait a few weeks longer to vaccinate their young children.

Dr. Diego Hijano, a pediatric infectious disease specialist at St. Jude Children’s Research Hospital, cautioned against the FDA “overthinking” and trying to predict how people will take vaccine news.

When it comes to vaccine hesitancy, “most people have made their choice already,” said Hijano, who is also an investigator for the Pfizer vaccine trials.

“So the fact that we are still wondering how it will affect people’s confidence in the vaccine — people’s confidence in vaccine has not changed significantly over the last year,” Hijano said.

Instead, Hijano vouched for authorizing the Moderna vaccine as soon as its ready. Even if the vaccine is two shots now, he said he predicted that the Moderna shot, like the Pfizer vaccine, would eventually be a three-shot vaccine — as most vaccines now are with the addition of boosters — and they would be very similar.

“Today, there are no options,” Hijano said. “And the Moderna vaccine data, it’s really good. So why wouldn’t you offer that to parents that want something to protect their kids?”

But Hijano also stressed that the timeline for kids under five getting vaccinated has been unpredictable. To help with anxiety, he’s moved away from focusing on dates and advises parents to try to find ways to feel normal in the meantime.

“I think at this point, parents should just sit back and say the vaccine will be ready when it’s ready. We cannot plan around when the vaccine is going to be ready,” Hijano said.

“So the way we have been approaching this with parents is, ‘Okay, let’s just take a step back and say, what are the things we can do to protect kids under five? And when the vaccine becomes available, then you vaccinate them.’ But at this point, that’s very uncertain,” he said.

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(AUGUSTA, Maine) — A Maine resident has died from a rare but potentially dangerous tick-borne illness, health officials said.

The Maine Center for Disease Control and Prevention said Wednesday it has confirmed a fatal case of Powassan virus, an illness spread by the bite of infected deer (aka black-legged) or woodchuck (aka groundhog) ticks.

The person, a resident of Waldo County in south-central Maine, developed neurologic symptoms and died in the hospital, according to the Maine CDC. The person likely became infected in Maine, health officials said. No further details on the case were provided.

“Ticks are active and looking for a host to bite right now,” Nirav D. Shah, director of the Maine CDC, warned residents in a statement. “I urge Maine people and visitors to take steps that prevent tick bites.”

Cases of Powassan virus are very rare, with about 25 reported each year in the U.S. since 2015, according to the Maine CDC. Since 2010, Maine has identified 14 cases, the agency said.

Though rare, the number of reported cases of people sick from the virus has increased in recent years, according to the U.S. Centers for Disease Control and Prevention. Most cases occur in the Northeast and Great Lakes regions from late spring through mid-fall, it said.

Many people infected with Powassan virus do not get sick, according to the Maine CDC. Symptoms can start one week to one month after the bite and can include fever, headache, vomiting, weakness, confusion, loss of coordination, memory loss, slurred speech or seizures. The virus can also cause serious neurologic problems, like brain inflammation, known as encephalitis, which can be deadly.

There is no vaccine to prevent Powassan or medicine to treat the disease. The best protection against any tick-borne disease is to prevent tick bites in the first place.

Health officials advise avoiding tick habitats — wooded and bushy areas with tall grass — whenever possible and to stay in the middle of trails when hiking. People can further protect themselves with EPA-approved repellants on skin and clothing.

During tick season, people should perform tick checks on themselves every day, especially after leaving a tick habitat and upon returning home. They should also check their clothing, gear and pets for ticks.

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(SAN FRANCISCO) — Dozens of high school students in California contracted COVID-19 after attending their prom.

San Mateo High School held the party on April 9 at the Asian Art Museum in San Francisco, about 18 miles away. Following the event, however, 90 out of the 600 students who attended tested positive for the virus.

“I was not very sick. I had a sore throat for a couple of days, like two, and then congestion,” junior Parker Del Balso, one of the 90 to contract COVID, told local affiliate ABC 7.

According to San Mateo Union High School District Superintendent Kevin Skelly, all of the cases were mild.

The outbreak comes as several other superspreader events have been reported, mostly recently this month’s Gridiron Club dinner in Washington, D.C., that saw several high-profile politicians test positive for the virus including House Speaker Nancy Pelosi, Attorney General Merrick Garland and Secretary of Commerce Gina Raimondo.

However, the cases were all reported to be either asymptomatic or mild, and no one required hospital care.

Experts said these outbreaks are a sign that BA.2 — a highly infectious subvariant of the original omicron variant and the predominant variant in the U.S — is not having a major impact on hospitalizations or deaths.

“These events, either among students or politicians, we are seeing signs of superspreader events,” said Dr. John Brownstein, an epidemiologist at Boston Children’s Hospital and an ABC News contributor. “But they’re not severe because of widespread vaccinations and people are overall protected from severe illness and death.”

Masks were optional at the event. However, according to guidance from the Department of Public Health in San Francisco, where the prom was held, masking is only required in high-risk settings such as health care facilities and homeless shelters.

In other settings, masking is only recommended based on individual risk tolerance, where there is high levels of community spread and if someone is at high risk of severe illness.

Despite the outbreak, school leaders and students said having the prom was worth it to provide a sense of normalcy during the pandemic.

“This has been a really hard year for kids, and we need to keep having as many activities as we can,” Skelly said.

Del Baso, the junior student, agreed, telling the local station, “Overall, I think it was worth it. It was a great, fun time.”

Skelly told ABC 7 that other schools in the district will be adding more mitigation measures to their proms so they don’t experience similar outbreaks.

“We’re going to be more careful about activities,” he said. “We’re going to test more students beforehand to make sure they’re not going into the dance COVID positive.”

Dr. Ali Mokdad, an epidemiologist with the University of Washington’s Institute for Health Metrics and Evaluation in Seattle, said the timing of the test before such events is very important.

“If you are doing a rapid PCR test and the event happens within two to three hours, that’s a good idea,” he told ABC News. “The timing and quality of the test will give you a good sense of security.”

He continued: “But if you get tested 48 hours before the event, you could catch the virus within that time and spread it.”

San Mateo Union High School District did not immediately return ABC News’ request for comment. The Asian Art Museum also did not reply to a request for comment.

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(ATLANTA) — National vaccination coverage for kindergarteners during the 2020-2021 school year fell below the nationwide target of 95% coverage, according to a new Centers for Disease Control and Prevention analysis.

This includes MMR, DTaP and varicella vaccines, which protect against multiple diseases including measles, mumps, rubella, chicken pox, whooping cough, tetanus and chickenpox. The analysis did not include COVID-19 vaccines, which were authorized for children 5 and older after the end of the 2020-2021 school year.

Although the drop was small — down to 94%, representing a 1% drop from the prior school year — the CDC says the new analysis underscores growing concerns that pandemic disruptions could inadvertently lead to a growing number of vaccine-preventable illnesses among children.

“This might not sound like much, but it amounts to at least 35,000 more children across the United States that entered kindergarten without documentation of complete vaccinations against common diseases,” said Dr. Georgina Peacock, director of the Division of Human Development and Disability at the CDC.

Researchers attributed the drop in vaccination rates to pandemic-related causes, including lower school enrollment, missed pediatrician appointments and lower data reporting from schools.

In addition to the 35,000 children who entered school without completed vaccinations, remote and in-person school enrollment was approximately 10% lower than the previous year, according to data from 48 states and Washington, D.C.

“This means around 400,00 fewer children entered kindergarten than expected. Those children also might not be up to date on their routine vaccinations,” said Peacock.

Mississippi had some of the highest vaccine coverage rates, with over 95% for MMR, DTaP, varicella, while Washington, D.C., had some of the lowest reported coverage rates, with 78-79% coverage per vaccine.

During the 2020-2021 school year, fewer states were able to report data back to the CDC due to pandemic-era capacity problems. Forty-seven states and the District of Columbia contributed to the new analysis, but Alaska, Illinois and West Virginia did not report vaccination coverage data due to the impact of COVID-19 on data collection, and were excluded from the analysis.

Some states allowed for eased vaccination requirements for remote learners and reduced submission of documentation by parents. This meant less time for school nurses to follow-up with students missing documentation or vaccines, fewer staff members to conduct kindergarten vaccination coverage assessment and reporting activities, and lower response rates from schools.

“This is further evidence of how the pandemic-related disruptions to education and health care could have lingering consequences for children. The good news is, routine vaccination coverage remains high and we can recover ground loss during the pandemic,” said Peacock.

Despite concerns about rising vaccine hesitancy, the rate of children with religious or medical exemptions remained low, at 2.2%, and the percentage of exempt children actually decreased in 37 states.

The report noted that more than half of the states’ schools are allowing under-vaccinated children to attend school under provisional enrollment, which allows a student without complete vaccination or an exemption to attend school while completing a catch up vaccination schedule or with a grace period status, which is a set number of days during which a student can be enrolled and attend school without proof of complete vaccination or exemption, according to Dr. Shannon Stokely, associate director for Science at the Immunization Services Division of the CDC.

“[With] most schools back to in-person learning, extra effort is needed to catch up children who missed vaccines and to maintain high levels of routine childhood vaccinations and equitable coverage to help protect children, their families and their communities against vaccine preventable diseases,” said Peacock.

Dr. Grace Cullen is an internal medicine resident at the Mayo Clinic in Rochester, Minnesota, and a contributor on the ABC News Medical Unit.

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(NEW YORK) — Almost half of Americans — 137 million people — are experiencing more days of “very unhealthy” and “hazardous” air quality than in the previous two decades combined, according to a report published this week by the American Lung Association.

The annual “State of the Air” report looked at Americans’ exposure to two types of air pollution: ozone, also known as “smog,” and particle pollution, also known as “soot.” It found that over 63 million Americans are now impacted by deadly particle pollution, an increase of nearly nine million people from previous years.

This particle pollution or “particulate matter” comes from wildfires, wood-burning stoves, coal-fired power plants and diesel engines, and can cause multiple health problems, including asthma attacks, heart attacks and strokes. With repeated exposure, it can cause lung cancer.

“We’ve seen much better air quality in most areas today than when we started the report. But over the last five years, we’ve seen an uptick, and we attribute a lot of that to climate change. We’ve had some of the hottest years on record — creating dry conditions that lead to drought and wildfires,” said Paul Billings, senior vice president of public policy for the American Lung Association.

Last summer, over 100 wildfires in the West carried smoke and ash thousands of miles, affecting places as far as New York City, where the air quality index (AQI) for fine particulate matter reached levels greater than 150, which is 10 times above health exposure recommendations, according to the World Health Organization’s 2021 updated Air Quality Guidelines. The new guidelines reflect strong evidence that air pollution can have major health consequences, including premature death, at even lower concentrations than previously understood.

Dr. John Balmes, a professor of environmental health sciences at the University of California in Berkeley and a volunteer medical spokesperson for the ALA, has studied the effects of California’s air pollution for over three decades and said all the progress in the Mountain West “has pretty much been undone by wildfires.”

Fresno, California, displaced Fairbanks, Alaska, as the metropolitan area with the worst daily spikes in particle pollution, and Bakersfield, California, continued in the most-polluted slot for year-round particle pollution for the third year in a row.

Balmes said his wife has “fairly severe asthma,” and because of the wildfires in California, they’ve had to increase the central filtration in their ventilation system and now have two portable HEPA filters.

“She always wears an N95 when she goes out during wildfires, and she tries not to go out,” he said.

Echoing earlier research, the report also found that people of color were 61% more likely than white people to live in a county with a failing grade for at least one pollutant. Balmes said that because of where they live, “Low-income communities of color have the highest exposure to diesel exhaust” and often do not have “ventilation and filtration appliances to reduce exposure in their homes.”

Dr. Franziska Rosser, assistant professor of pediatrics in the division of pulmonary medicine at University of Pittsburgh, researches the effects of air pollution on children with asthma. She recommends that parents of children with asthma check the AQI by going to AirNow.gov and to either avoid outdoor air pollution exposure when it reaches unhealthy levels or choose activities where kids are not breathing as heavily.

But when it comes to creating real change, Rosser said, “Personal interventions for air pollution are unfair. Air pollution cannot be controlled by one person. It is a societal problem and a global problem. The absolute best interventions for air pollution are policy.”

Balmes said it’s time to double down on climate emergency solutions, which includes reducing reliance on fossil fuel for transportation and power generation. He also recommends more investment in forest management.

“We’ve long advocated for much more protective standards,” Billings added, noting that the organization is asking the Biden administration to strengthen the national limits on particulate matter air pollution.

“The public has a right to know when air pollution threatens their health and the health of their children, seniors and families,” he said.

In a statement, the Environmental Protection Agency said, “Improving air quality is a major priority for EPA and we appreciate the ALA’s focus and attention on air quality and health.”

To learn more about U.S. air quality, go to the EPA website AirNow.gov or download the AirNow.gov app, which contains air pollution forecasts on the local level and historical air pollution data.

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