(SARASOTA, Fla.) — Five people caught malaria locally in the U.S. for the first time since 2003, according to health officials.
Four people in Sarasota County, Florida, and one person in Cameron County, Texas, reported cases of the mosquito-borne illness, state officials said. Cameron County is the southernmost county in Texas, about 1,300 miles away from Sarasota, Florida.
All four Florida patients “have been treated and have recovered,” according to a statewide mosquito-borne illness advisory from the Florida Department of Health released Monday. Residents have been advised to “take precautions by applying bug spray, avoiding areas with high mosquito populations, and wearing long pants and shirts when possible — especially during sunrise and sunset when mosquitos are most active,” the health department said.
The last locally acquired Texas cases occurred in 1994 and 2003 in Palm Beach, Florida, according to the Centers for Disease Control and Prevention.
The illness is caused when a person is bitten by a mosquito carrying malaria parasites, the CDC said. Malaria isn’t contagious and can’t be spread person-to-person.
Symptoms include fever, chills, muscle aches, nausea headache and anemia, and can sometimes be fatal if not treated, according to the CDC.
Malaria used to be common in the U.S., but a 1947 campaign by southeastern states to spray insecticides and drain breeding grounds eliminated transmission, according to the CDC.
There are around 2,000 malaria cases a year, the CDC said, but they’re most often diagnosed in people who caught the disease while abroad.
The risk to most people of locally acquired malaria is currently extremely low, the CDC said in a statement regarding one of the Florida cases.
Climate change could reverse progress made in fighting the illness, with warmer temperatures possibly expanding the range for mosquitoes that carry diseases like malaria, research published in the Lancet Planetary Health indicates.
“The presence of competent mosquitoes and warmer temperatures in the Southeast will likely lead to additional cases in the coming months and years,” Dr. John Brownstein, an infectious disease epidemiologist and chief innovation officer at Boston Children’s Hospital, told ABC News. “Future invasion of new mosquitoes, coupled with potential climate change effects, could significantly expand the malaria risk.”
“While the permanent return of malaria is still unlikely, these cases represent a broader warning of mosquito-borne diseases in the region,” he said.
People can protect against mosquito bites by draining standing water in gutters and flowerpots, wearing long sleeves and long pants, wearing insect repellent and using screens on windows, according to the CDC.
(SARASOTA, Fla.) — Five people caught malaria locally in the U.S. for the first time since 2003, according to health officials.
Four people in Sarasota County, Florida, and one person in Cameron County, Texas, reported cases of the mosquito-borne illness, state officials said. Cameron County is the southernmost county in Texas, about 1,300 miles away from Sarasota, Florida.
All four Florida patients “have been treated and have recovered,” according to a statewide mosquito-borne illness advisory from the Florida Department of Health released Monday. Residents have been advised to “take precautions by applying bug spray, avoiding areas with high mosquito populations, and wearing long pants and shirts when possible — especially during sunrise and sunset when mosquitos are most active,” the health department said.
The last locally acquired Texas cases occurred in 1994 and 2003 in Palm Beach, Florida, according to the Centers for Disease Control and Prevention.
This is a developing story. Please check back for updates.
(NEW YORK) — As a pediatrician, Dr. Kristina Lehman knows the ins and outs of the evidence around breastfeeding better than most.
But as a mother, she also knows that breastfeeding is hard and that following evidence-based guidelines isn’t possible or the choice for everyone.
“I’m more proud of my breastfeeding relationship than even my [medical degree],” Lehman, who is also a breastfeeding medicine specialist, internal medicine physician and associate professor at the Ohio State University Wexner Medical Center, told ABC News.
The American Academy of Pediatrics (AAP) recommends that infants be exclusively breastfeed for the first six months of life and continue breastfeeding along with other food until two years of age.
Research shows breastfeeding has many benefits, including decreased infant infections and childhood cancers as well as a decreased risk of diabetes, high blood pressure, breast, ovarian and endometrial cancer in the mother.
But only about a quarter of women meet those recommendations, according to data shared by the U.S. Centers for Disease Control and Prevention. Experts said that’s partly because health care and social systems aren’t set up to support breastfeeding.
The gap may mean groups like the AAP should consider adjusting their recommendations to remove the emphasis on exclusivity regarding breastfeeding and amend the two-year time frame due to the unattainable standard for so many, argued Seattle physician Dr. Amy Kennedy in a recent editorial in the New England Journal of Medicine.
“I encourage the AAP and other national health organizations to consider how their statements on exclusive breast-feeding are perceived by the public,” Kennedy wrote. “Everyone’s journey is different.”
But other experts said increasing support is the best way to close the gap — not changing the guidelines. Last week, Lehman and Dr. April Castillo, a preventive medicine physician and breastfeeding specialist, published an article in response on the physician-facing website KevinMD.
They argued that the health care system — including doctors themselves — needs to improve the support of women in their infant feeding choices.
The lack of social support, limited education for physicians around breastfeeding, and marketing from the formula industry adds to the stress, anxiety and isolation during an already fraught time, according to Dr. Anne Eglash, a family medicine physician and president of the North American Board of Breastfeeding and Lactation Medicine.
Postpartum depression and anxiety — which affect 1 in 8 people after delivery, according to the CDC — can make the process even more challenging.
The current system makes it difficult for parents to actually make a choice either way, according to Eglash, who told ABC News that “no one is supporting” parents.
Eglash described a situation in which medical providers tell the public people should breastfeed, but then send new parents, “out to run that marathon and there’s a desert and no one’s offering any water.”
Changes that could help might include improving doctors’ education around breastfeeding, putting resources towards systems that can help parents find infant feeding experts like lactation consultants, and increasing awareness around postpartum depression, according to Eglash and Castillo.
There also need to be more resources around mixed feeding, which combines breastfeeding and formula feeding, Castillo told ABC News.
But even with improvements in support, meeting guidelines still might still not be feasible for some parents, according to Kennedy.
She said she had many resources at her disposal and a supportive partner, but breastfeeding was difficult for her. She said she wasn’t able to exclusively breastfeed for six months, much less breastfeed for two years.
Still, all the experts agreed that people feeding infants need compassion, regardless of the way they navigate the journey.
“I think a lot of women think that it is all or nothing. And so when they try all and it’s too hard, they totally quit instead of backing off a little bit. But that’s where you need that individualized support to be able to say, what are your goals?” Lehman said. “It’s a conversation and it has to be individualized.”
Eglash noted that the goals aren’t the problem — the system needs to change to help people have the best possible experience.
“I think the big thing is that we all want babies fed, right? And we want parents to meet their intentions, to have the right to feed their babies the way they intend,” Eglash said.
Danielle Craigg, MD, is a senior general preventive medicine and public health resident at Renaissance School of Medicine at Stony Brook University and a member of the ABC News Medical Unit.
(NEW YORK) — Shortly after a Tennessee trigger ban on abortion went into effect last September, a group of maternal fetal medicine specialists, family planning physicians, bioethicists, neonatologists and a lawyer gathered to form a panel tasked with determining whether the facility could provide medically necessary abortion care in line with state law.
Physicians decided it was best to evaluate and gain a consensus in situations where patients were requesting abortion care or doctors are recommending it.
“It really came about from the fact that many of us are very concerned and nervous for our own safety, and felt that some of these would be decisions that are better made in a group setting,” Dr. Sarah Osmundson, a maternal fetal medicine specialist in Tennessee, told ABC News.
“Usually these are time-sensitive issues,” Osmundson said. “So, even though we have meetings every other month, when a case arises, it usually means that we have to either ad hoc meet or talk or communicate over email and explain the patient’s situation. And then we ask for three physicians to review the chart and to weigh in on whether they think an abortion would meet the standards set by the current laws.”
Tennessee’s law only makes exceptions for cases where it is necessary to prevent death or serious and permanent bodily injury to the mother.
“We are basically looking at these cases individually and trying to guess whether we think a reasonable group of other Tennesseans would look at these individual cases and agree that an ongoing pregnancy represents a risk of death to the patient or serious medical impairment,” Osmundson said.
Physicians in several states told ABC News that facilities are using termination boards or medical ethics boards to navigate whether they can provide patients with medically necessary abortions in line with exceptions allowed in their states.
Dr. Nicole Teal, a maternal fetal medicine specialist, told ABC News that abortions past 20 weeks of pregnancy in the hospital where she works in North Carolina require two physicians to sign off in cases where the mother’s life is at risk. In most cases, both physicians are specialists. In July, North Carolina will start enforcing a ban that prohibits abortions past 12 weeks of pregnancy, with an up to 20-week exception for rape or incest and 24 weeks for fatal fetal anomalies.
If physicians feel the case is a gray area and they are unsure whether the abortion would be permitted under the ban, they get the hospital’s legal and ethics teams involved before providing care.
“Logistically speaking, what happens when someone comes in and they’re sick and it’s Saturday night? The ethics committee is not going to convene Saturday night at midnight to come up with an answer,” Teal said.
Some common pregnancy complications could be deadly if left untreated, but patients may not be showing signs of illness or an imminent threat to their life when they first show up at a hospital. This leaves doctors’ hands tied.
Teal told the story of one patient who came in who came in with “very severe preeclampsia,” a serious and sometimes fatal pregnancy complication that occurs after 20 weeks, but physicians had to wait until her health got worse before they could help her because the state’s 20-week ban was in effect.
“We knew it was happening, her blood pressure was getting higher, her labs were starting to get off. But we basically waited until her labs got bad enough that we could say, ‘It’s an imminent threat to her life.’ Basically we had to wait until her labs started crashing before we could take care of her,” Teal said.
“Preeclampsia sometimes progresses really rapidly, like in a couple days, and sometimes it takes weeks and we couldn’t say for sure it would it be one day or seven days before it was an imminent threat to her life,” Teal said.
Teal said several friends who practice medicine in southern states — like Florida, Mississippi, Georgia, Tennessee and even Texas — have been reaching out about patients whose health is in danger asking if she could provide them with abortion care. That access could no longer be available when a 12-week abortion ban goes into effect in July.
One patient with pulmonary hypertension, a serious condition that has over a 50% maternal mortality rate if the mom remains pregnant, was denied an abortion in Mississippi by an ethics committee, according to Teal. She traveled to North Carolina to receive care, Teal said.
At a leading health care facility in Houston, medically necessary abortions have to be approved by at least 75% of a panel made up of about six multidisciplinary physicians and a lawyer, according to Dr. Alireza Shamshirsaz, a maternal fetal medicine specialist who moved from Texas to Massachusetts last year.
Shamshirsaz said this usually only happens when a mother is very sick. Physicians need lab work, vital signs and sometimes cultures that show her health deteriorating.
“You can act [without getting their approval] and [retroactively] submit this data to the board, but then you need to be a very brave physician, because now you put your credentials and your career on the line,” Shamshirsaz told ABC News.
Before he left the hospital where he worked in Texas, Shamshirsaz said he had a patient pregnant with twins who went into labor early. After delivering the first of the two babies, the umbilical cord was prolapsed in the vagina, a rare medical emergency, and because the fetus still had a heartbeat, the board denied abortion care.
After staying in the hospital for several days, the patient was sent home, Shamshirsaz said. She later came back in septic shock and lost one of her kidneys. Shamshirsaz said she will likely need a transplant or dialysis in the future.
At the Boston facility where he currently works, Shamshirsaz said physicians can provide abortions up to 26 weeks and six days without needing approval. In complex late-term abortions that go past that threshold, Shamshirsaz gets other physicians at the Boston facility to sign off on the care as a safety net for himself.
Dr. Kelly Mamelson, a second-year resident who has lived in Florida almost her entire life, told ABC News the facility she currently works at requires two physicians to sign off on a medically indicated abortion — the only abortions it provides — whether that be maternal or fetal indication, before it can be performed.
“There is certainly a lot of anxiety behind [the laws’ ambiguity] and it can lead to delays in care,” Mamelson said.
For patients with pre-viable rupture of membranes — a condition fatal for fetuses if they are not at a gestational age compatible with life that can also be dangerous for mothers — if there is still a fetal heartbeat, physicians at her hospital in Florida have to wait until the mother is showing signs of an infection before they provide abortion care, Mamelson said.
“By waiting until you’re in a very dire situation, or potentially fatal situation, you’re doing a lot of harm to the patient. So, waiting for a mom to become septic, to then perform a procedure is extremely problematic. And I think it really highlights the lack of medical knowledge that seems to be pretty common among the legislators making these decisions,” Mamelson said.
Even after Tennessee lawmakers added an exception allowing abortions for ectopic pregnancies, physicians fear abortion laws when it comes to providing lifesaving care, Osmundson said.
“I think we are also balancing our ethical obligations as physicians and the oath that we took, and many of us have just decided that we’re going to do what we think is right for patients to ensure that nobody dies or has serious morbidity as a result of not performing care,” Osmundson said.
“Most of us do this at great personal risk. Unfortunately, I don’t think that we feel super protected by the current laws,” Osmundson said.
Even though the hospital where she works has told physicians it would provide criminal defense coverage if it ever comes to that, Osmundson said the risk of prosecution is still a huge burden. She also said the risk is far greater for physicians who do not work in a large medical center that would be willing to support them.
“It’s a huge mental and emotional burden to experience some of these cases along with patients and to try to care for these patients. And I would love the state of Tennessee to be witness to how challenging that is. I think it would help them empathize with what our patients go through,” Osmundson said.
“I never thought I would have to entertain what the state of Tennessee thinks is right or wrong,” Osmundson said.
(NEW YORK) — For the past year, Michelle Colon, a reproductive health advocate in Jackson, Mississippi, has not been able to bring herself to drive past the Pink House.
The state’s lone abortion clinic operated by Jackson Women’s Health Organization had been forced to close its doors last July, just days after losing its legal battle before the Supreme Court and the state’s abortion ban took effect.
Now, the building is painted white, the site of an upscale consignment shop — as much a symbol of victory for anti-abortion groups as the Pink House was once a symbol of defiance.
Operating in the state instead are some 40 faith-based “crisis pregnancy centers” that state officials say are expanding operations thanks to $10 million in tax credits for businesses that donate to them.
“I still can’t bring myself to go down that street,” Colon, cofounder and executive director of SHERo Mississippi, a Black women’s reproductive justice organization, told ABC News. “It was such a beautiful building .. and was the heart of that neighborhood.”
A year after the Supreme Court’s landmark case overturning a half century of abortion rights under Roe vs. Wade, abortion is banned entirely with exceptions for rape reported to law enforcement and to protect the life of the mother. There is no exception for incest.
Performing an abortion is a felony punishable by up to 10 years.
Researchers estimate there are roughly 3,150 fewer legal abortions in the state as a result, although it’s not entirely clear if those patients are opting to give birth or traveling out of state for abortions — a trip that could take a full day’s worth of driving to Illinois or Florida.
While the Pink House is no longer, within miles of its old location are nearly half-a-dozen crisis pregnancy centers, or pregnancy resource centers, non-medical facilities that offer free ultrasounds and pregnancy tests as well as support ranging from free diapers to clothing and parenting classes to women who choose to continue on with their pregnancy.
Shelby Wilcher, press secretary for Mississippi Gov. Tate Reeves, said the centers are critical to the state helping women and families.
“While Mississippi is proud to have led the nation in overturning Roe v. Wade, winning a court case was never our true objective. It was building a culture of life throughout our state and country,” she said in a statement.
For abortion rights advocates like Colon, the centers stand as a symbol of what’s gone wrong in the state post-Roe.
“You can give somebody today a little gift bag with, you know, one pack of Pampers and a pack of baby wipes … that’s enough to get you through, what, a couple of days,” Colon said. “But we’re talking about long-term assistance, that long-term help they claim that they do and that’s just not true.”
Boon in tax credits for Mississippi CPCs
Crisis pregnancy centers have existed in cities and towns across the country for decades but have grown in number in recent years. As of 2021, there were around 3,000 CPCs in the U.S., according to the Charlotte Lozier Institute, an anti-abortion research and policy organization.
The centers are typically faith-based nonprofit organizations that rely mostly on private donations from churches, businesses and individuals.
In at least one dozen states, CPCs also receive state funding.
When abortion was banned in Mississippi last year, Reeves pledged to support women staying pregnant and having babies.
He’s since extended postpartum Medicaid coverage from two months to one year and is setting up a task force to improve the state’s foster care and adoption system.
But the most immediate impact has been the millions of dollars in tax credits funneled to crisis pregnancy centers in the state.
Last year, Reeves signed a law authorizing a $3.5 million tax credit for businesses and individuals that donate to crisis pregnancy centers in Mississippi, becoming one of the first states to do so. This April, Reeve expanded that tax credit to $10 million.
To qualify for the donations, the centers must meet specific requirements, including not spending more than 20% of the money on administration costs and not paying for providing abortions or financially supporting another organization that does.
Sara Smith, executive director of the Center for Pregnancy Choices in Meridian, said she envisions the center being able to greatly expand its services with money it receives from the tax credit.
“In a perfect world, we’d be able to buy a building and not have a mortgage,” Smith told ABC News. “And be able to have a bigger spot for the medical services and then a bigger donation room and have a bigger diaper bank because we know that diapers are one of the most needed supplies for babies.”
What is the money doing for women?
Supporters of crisis pregnancy centers say the additional funding from the tax credit is needed to support families and offset the impact of Mississippi’s abortion ban.
But it’s not entirely clear what’s happening to those patients who would have sought an abortion previously and whether they are opting to travel out of state, ordering abortion medication online or opting to continue the pregnancy.
State data on births is out of date and Smith and other CPC leaders say they haven’t seen a dramatic increase in clients because of the ban.
Smith said the center has seen a slight increase in clients over the past year but attributed the rise to the center’s increased marketing and community outreach efforts. She said women are still coming to the center unsure of whether they want to continue with their pregnancy.
“If they say, ‘I don’t know if I can do this,’ we ask them if they have the time and if they’re willing to discuss what they mean by that and we listen and observe what they’re saying and where they’re coming from,” Smith said. “Then we take a holistic approach and we say, ‘Who’s in your corner with you? Where do your supports come from? Where do you think you need more support?’ And we start thinking in our mind … what can we do to fill these needs, to meet these needs?”
Terri Herring, president of Choose Life Mississippi, a nonprofit organization that provides grant money to CPCs through the sale of Choose Life specialty license plates, told ABC News the increase in women at CPCs over the past year has “not been overwhelming by any sense.” She said what she has noticed is increased support for CPCs since the overturning of Roe.
“I think getting abortion outside the courts has provided an incentive for people to do more,” Herring said, adding, “We can now look at this and say, we have achieved our goal, which was the overturn of Roe v Wade, and basically closing the last abortion clinic in Mississippi and ending abortion as we know it in Mississippi. So now that we have achieved that goal, how can we move forward in helping these women now that they choose life, or help them choose life, help them through their pregnancy?”
Shannon Bagley, executive director of the Center for Pregnancy Choices in Vicksburg, said the center has also not seen a dramatic increase in women seeking help with their pregnancies over the past year.
She said there has been an increase in demand for parenting classes, which the center began to offer online during the coronavirus pandemic. As is the case at most CPCs, when a person completes a class through the Center for Pregnancy Choices in Vicksburg, they earn so-called “baby bucks” which they can then redeem for diapers and donated supplies like clothes, breast pumps, cribs and mattresses.
Bagley acknowledged that most of the support the center offers goes up until a child is age 4. Beyond that, she said she focuses on building community support for families and their kids, an effort she said she’s even more focused on post-Roe.
She and other CPC leaders ABC News spoke with describe the centers as a “hub of knowledge” where people can be connected to the support they need.
“We have found that even at the four-year mark, I can now send her over to another facility that does similar things that we do but they do [ages] 4 and up,” Bagley said. “So it’s saying, “OK, we’ve got what you need, but also have somebody else that can help you too,’ or, ‘Oh look, I’ve got all these resources, how can we come together as a community to support you as a family?'”
Carra Powell, a volunteer at The Care Center, in Southaven, Mississippi, said her center has also seen an increase in demand over the past year for the free parenting and childbirth classes it offers.
“I think a lot of people think a pregnancy resource center is strictly just serving women that are expecting, but there are many different families and women in different stages of parenting that are using the center,” she said, describing the center as a “no-judgement zone.” “We also provide aftercare for women, so clothing, cribs, continuing education classes, food services.”
‘Some of these women are delivering on the side of the road’
Colon and other reproductive health care advocates say the money from the $10 million tax credit signed into law by Reeves would go farther if it helped families care for their children, create jobs, provide long-term health care and afford housing instead.
“It’s a tragedy that there’s funding that has been created and it’s funneling to these entities when that money could be situated to help the real and existing families of Mississippi,” Colon told ABC News.
Reproductive health care advocates point in particular to data showing Mississippi remains in one of the worse situations in the country when it comes to maternal and infant care.
Dr. Elizabeth Cherot, senior vice president and chief medical and health officer at the March of Dimes, told ABC News that Reeves’ extension of Medicaid for postpartum women to one year is a potential “game changer.” Still, she said, there remains serious gaps in care for women.
It’s estimated that more than half of counties in Mississippi didn’t have a single birthing center, hospital or obstetrics provider when the abortion ban took effect, according to March of Dimes’ data. Many hospitals in the state are shutting down due to financial reasons and a lack of staff and some doctors have expressed concerns about legal liability.
The lack of access to obstetrics care means pregnant women will travel on average of nearly 16 miles to see a doctor, according to Cherot. In particularly rural counties in Mississippi, it’s not uncommon for women to travel an hour each way.
“Some of these women are delivering on the side of the road, putting their baby on their lap and driving if they don’t have somebody to help them, or they’re bringing the rest of their children in the car,” Cherot said. “So this is a real problem that women are facing that gives me chills to think about this is what’s happening in the United States.”
According to the state’s own maternal mortality report released in January, the pregnancy related mortality ratio has increased to 36.0 deaths per 100,000 live births. Nearly 88% of pregnancy related deaths were deemed preventable and the maternal mortality rate for Black, non-Hispanic women is four times higher than for white women.
The infant mortality rate in Mississippi is 8.72 deaths per 1,000 live births, much higher than the U.S. rate of 5.87, according to data from the Mississippi Department of Health.
Wilcher, with Gov. Reeves, told ABC News it will take time to see results.
“The governor’s office will continue to do everything in its power to deliver the support moms and babies deserve,” Wilcher said in a statement.
(NEW YORK) — The latest caffeinated beverage craze has made many young consumers eager for a drink, which has prompted a new alert for parents.
Prime, a beverage brand that offers a range of sports drinks, mixes and energy drinks, is backed by two massive internet personalities. YouTuber, rapper and boxer Olajide Olayinka Williams “JJ” Olatunji, known professionally as KSI, and WWE wrestler and social media personality Logan Paul, are the joint faces of the drink, which is manufactured by Louisville-based Congo Brands.
The drink, first released in the U.K. in 2022, has gone from just another variety beverage to a status symbol with its much-hyped marketing on TikTok.
With flavors like tropical punch and strawberry watermelon, Paul has touted on his TikTok videos that Prime is “the fastest growing sports drink in history.”
Other videos show KSI looking at a group of kids rapidly approaching a branded Prime drink bus.
The drink comes in energy and hydration forms and has become wildly popular with kids. The bottled hydration version has no caffeine and is made with coconut water and electrolytes. The canned energy version, which does contain caffeine, has raised concerns with some experts looking out for younger consumers.
A 12-ounce can of Coca Cola contains 34 milligrams of caffeine and an 8.4-ounce can of Red Bull has 80 milligrams. A 12-ounce can of Prime energy, by contrast, contains 200 milligrams of caffeine.
ABC News medical contributor Dr. Alok Patel said 200 milligrams “is a huge amount of caffeine.”
“That is too much for any growing child,” Patel told ABC News’ Good Morning America. “That much caffeine can cause some adverse effects, such as disrupted sleep, mood disorders, upset stomach, even abnormal heart rhythms.”
The warning label on Prime energy drink products note that it’s not recommended for children under the age of 18.
Patel offered additional medical insight and advice to parents whose children may be consuming or asking to drink highly caffeinated beverages.
“First thing that parents out there should do is make sure that their kids are getting enough sleep so the kids aren’t tired in the middle of the day and then running to go get a stimulant,” he said.
“If your kids get bored with just water, which is the preferred hydration source, you can try other flavored waters with fruit,” Patel added, noting other options might include things like coconut water.
(NEW YORK) — Dr. Nicole Teal, a maternal fetal medicine specialist, had just finished her training in North Carolina, when she was offered a good position in the state that would have allowed her to stay closer to family.
But there was one problem: North Carolina’s 12-week abortion ban set to go into effect on July 1.
She has chosen to move to California.
“Being able to provide abortion care after 20 weeks is really fundamental to my practice and comes up for me on a weekly basis,” Teal told ABC News.
Teal said that she often diagnoses fetal anomalies sometime between 18 and 20 weeks of pregnancy because many anomalies cannot be seen earlier in pregnancy. Providing abortion care could come even later.
Patients often do not develop high-risk conditions until after 21 weeks of pregnancy, Teal said, so the state’s current 20-week ban is already changing how she’s allowed to practice medicine.
“It’s really put me in a position of moral distress on more than one occasion,” Teal said.
In interviews with ABC News, physicians in Texas, North Carolina, Ohio and Florida said they decided to leave their states due, at least largely, to the impact abortion bans have had on their ability to practice medicine and provide the best care possible for patients.
In the year since the U.S. Supreme Court overturned Roe v. Wade, ending federal protections for abortion rights, at least 15 states have banned or severely restricted abortion.
Even with limited exceptions to abortion in states with bans in place — such as to save the life of the mother — doctors told ABC News it is difficult to determine what patients qualify for care.
Dr. Alireza Shamshirsaz had lived in Houston for close to a decade when he decided to move.
Shamshirsaz is a maternal fetal medicine physician who specializes in fetal surgeries, operating on pregnancies to fix anomalies while babies are in the womb. He worked at one of the best facilities in the country providing surgeries and intervention not available elsewhere, with patients coming from all over the South for care.
He considered many factors, but his decision to move his family from Texas to Boston ultimately hinged on one thing: Texas’ abortion bans.
Ultimately, the limitations bans would impose on his job pushed him to leave the state. Shamshirsaz said physicians in Texas have become collateral damage, with many worrying that they will be targeted. He also said the bans will disproportionately impact women in the South.
“Rich people can do it,” Shamshirsaz said of those able to travel elsewhere for abortions. “Who do we hit? We will hit the low social economy people.”
Shamshirsaz said it is a traumatizing experience to force patients who discover their pregnancies are nonviable or have fatal anomalies to have to continue carrying a pregnancy to term.
“By default, 10% to 20% of patients get postpartum depression,” Shamshirsaz said. “How do you think these people will cope after that type of pressure for months?”
Dr. Jackie Mostow, a family medicine physician who works at a county health clinic in California, told ABC News she had always planned to move back home to Ohio, but that decision now depends on the state’s abortion laws.
Ohio’s six-week abortion ban is temporarily on hold by the state’s Supreme Court while a legal challenge continues.
“The California version of Medicaid pays for abortion care and it’s just common sense that it should be that way. And I think it would be really hard for me to practice somewhere else. I think if I were to move it would be with a goal of trying to push the agenda further and right now, Ohio’s not in a place for that,” Mostow said.
Dr. Kelly Mamelson, a second-year resident who has lived in Florida almost her entire life, told ABC News she plans to leave the state next year and apply for a complex family planning fellowship.
“Those programs only really exist in the Northeast and out west, because it’s complex contraception, and then termination for either elective or medically indicated,” Mamelson said. “But of course, with the new laws, those fellowship training locations are limited now.”
Mamelson said the Florida Supreme Court’s decision on whether it will uphold a 15-week abortion ban, which will also determine whether a six-week ban goes into effect, will be a key factor in determining whether she will return to Florida after her fellowship.
“Not being able to practice the way I was trained and the way that I think is objectively the services that women need the option to have, it would definitely preclude me from working in the state,” Mamelson said.
Mamelson said a lot of her colleagues feel the same way and are disheartened by the fact that they need to travel so far to get abortion training.
Physician shortages, which have predated bans, will only get worse in states with bans, some doctors told ABC News. Knowing how to perform abortions is a skill that could be necessary to save a patient’s life, Shamshirsaz said.
“If you don’t train new people, nobody can do it themselves and therefore these people will end up with lots of disasters and unfortunately, there will be a significant increase in maternal mortality,” Shamshirsaz said.
Dr. Sarah Osmundson, a maternal fetal medicine specialist in Tennessee, told ABC News she has colleagues who have already begun to leave the state because of the bans.
She said she feels a sense of obligation to her community and patients, and will be staying in her state, at least for now.
“Who else is going to care for these patients?” Osmundson said.
“There are some of us that really feel that we need to stay and be part of the care for our very high-risk patients, and to be part of the advocacy that, hopefully, will transform some of these laws so they’re not so dangerous to patient care,” she added.
(WASHINGTON) — A respiratory syncytial virus, or RSV, vaccine for older adults could soon be available after an advisory committee for the Centers for Disease Control and Prevention voted to recommend them Wednesday.
During a meeting, the agency’s Advisory Committee on Immunization Practices looked at clinical trial data for two vaccines, one by Pfizer and the other by GSK.
Short of a full recommendation, the committee said adults aged 60 and over may get the vaccines based on individual needs and after consultation with a doctor.
The vaccines have already received approval from the U.S. Food and Drug Administration, so the final step is for CDC director Dr. Rochelle Walensky to sign off on the recommendations, which she is expected to do.
Here’s what the panel’s vote could mean for older Americans:
Why is RSV so dangerous for older adults?
RSV can affect people of all ages, though some age groups are at higher risk, including adults aged 65 and older — particularly those with chronic lung or heart conditions and weakened immune systems — according to the CDC.
Most people develop mild infections with symptoms including coughing, runny nose and fever, but, in some cases, people may need to be hospitalized if they are having trouble breathing or are dehydrated.
So far, during the 2022-23 season, there have been 67.5 RSV-associated hospitalizations per 100,000 people for senior citizens, according to CDC data.
This figure is much higher than usual, with CDC data going back to the 2016-17 season showing the cumulative rate has never been higher 31.5 per 100,000 at this point in the season for older adults.
Between 60,000 to 160,000 older adults in the U.S. are hospitalized due to RSV every year and 6,000 to 10,000 of them die, the CDC said.
“There is no really effective treatment for [RSV] in terms of antivirals,” Dr. Paul Goepfert, a professor of medicine in the University of Alabama at Birmingham Hospital division of infectious diseases, told ABC News. “So really the only treatment is supportive management, so ideally what you want to do is prevent it.”
How do the vaccines work and are they effective?
GSK’s vaccine, called Arexvy, and Pfizer’s vaccine, called Abrysvo, target a protein from the virus called the F protein that RSV uses to attach to human cells and infect people.
The vaccine stimulates antibodies against the protein and protects against infection. GSK’s shot just protects against the A strain and Pfizer’s protects against the A and B strains.
Data from clinical trials showed GSK’s vaccine was 82% effective at preventing lower respiratory tract illness and 94% effective among those with at least one underlying medical condition.
Pfizer’s vaccine was found to be more than 85% effective at preventing lower respiratory tract illness in older adults, trial data showed, with efficacy waning to about 79% after 18 months.
Pfizer and GSK have not released data on the effectiveness of their vaccine against severe RSV illness leading to hospitalization.
Side effects were mostly mild and included injection site pain, headache, fatigue, muscle pain and joint pain, the clinical ttrials found.
“We know from the start that this vaccine has durability, which is important versus the COVID vaccine, [which] can lose efficacy after four to six months, reducing public confidence in the vaccine,” Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center and Harvard Medical School, told ABC News. “These vaccines have high efficacy that last at least two seasons.
What the CDC’s advisory panel vote means
The panel voted twice Tuesday, first asking if 60-to-64-year-olds may receive the vaccine after consulting with their doctor, which received 13 yeses and one abstention.
The second vote asked the same question but for those aged 65 and older, receiving nine votes for the recommendation and five votes against.
“In my opinion, it is the right step because it is such a difficult disease and hard to treat and a good recommendation to at least be an option for people who at least want to protect themselves from this infection,” Goepfert said.
Doctors told ABC News the committee members were concerned the clinical trials did not have very many trial participants over age 75.
Committee members were also concerned about the price. Pfizer told the panel it would charge anywhere from $180 to $270, while GSK said it would charge between $200 to $295.These do not reflect the prices insured vaccine recipients would pay.
“The recommendation that we received from the CDC advisors was one that was a more restrained recommendation than they typically deploy for their for their vaccine guidance,” Dr. Jason Schwartz, an associate professor of health policy at the Yale School of Public Health, told ABC News. “What they’ve recommended is that individuals aged 60 and above may receive this vaccine following conversations with their health care providers, something that’s referred to as ‘shared clinical decision making.'”
“That’s a notch below their full-throated recommendation that often says these individuals should receive a vaccine in that age group, but it reflects a bit of the uncertainties about the vaccine, the concern about the cost of the vaccines,” he continued.
Why the vaccine could be a game-changer
Researchers have attempted to develop an RSV vaccine before, but without success.
In the late 1960s, a vaccine was produced in which the virus was inactivated with formalin, a chemical that kills viruses. The shot was given to children in Washington, D.C., but 80% of those immunized became sick and two children died from the shots.
“For 60 years, there’s been no RSV vaccine because the early clinical trials showed the vaccine actually made disease worse, what’s known as vaccine-associated enhanced disease,” Dr. Gregory Poland, head of the Mayo Clinic’s vaccine research group, told ABC News. “That’s like putting a blanket over the field of RSV vaccine development.”
Experts said the two vaccines are a significant step forward and provide an additional tool for preventing disease, but it will be important to keep an eye on real-world data, once the shots start being administered, in how well they protect the elderly and the immunocompromised.
“It has the ability to be a game changer, we just need to see how it plays out in the real world
(ATLANTA) — Infants eligible for a measles vaccine should receive one prior to international travel, the Centers for Disease Control and Prevention said amid rising cases of the highly contagious disease during the summer travel season.
The guidance came as part of a Health Alert issued by the CDC this week, warning Americans about rising measles cases linked to international travel. The agency says more than twice as many Americans are expected to travel abroad this summer compared to last.
The agency reinforced recommendations that all eligible Americans should be vaccinated against measles prior to international travel. This includes a recommendation that infants in the U.S. going abroad who are 6-11 months old should receive an extra measles, mumps and rubella vaccine (MMR), regardless of the international destination.
The CDC says there has been an increase in measles cases in the U.S. As of June 8, 16 cases have been identified across 11 jurisdictions, compared to just 3 over the same time in 2022. Nearly 90% of cases this year have been linked to international travel, according to the CDC.
The MMR vaccine is routinely given to children starting at 12-15 months and again at 4-6 years old, but can safely be given as early as 6 months in the right circumstances. The CDC is reinforcing that all infants traveling abroad this summer who are 6-11 months old should receive their first dose before travelling.
A 2019 study published in JAMA Pediatrics found that less than half of all MMR-eligible infants received the recommended dose before international travel.
This recommendation is not new, but many people may not have been aware of it unless traveling to certain high-risk locations or locations with active outbreaks. Experts say this health alert speaks to the emergence of vaccine-preventable diseases and declining vaccine rates post-pandemic
“It’s absolutely highlighting the global concern that we have for the re-emergence of vaccine preventable diseases,” Dr. John Brownstein, Ph.D, the chief innovation officer at Boston Children’s Hospital and an epidemiologist told ABC News.
Brownstein also says that measles isn’t just a growing problem when traveling abroad but here in the U.S. too.
“So what’s happened is it’s become all too common to see cases, he said. “You know, these are not like highly clustered in a couple of locations. We’re seeing the rise in localized case cases, diffuse across the country and that’s directly related to the fact that we’re seeing under vaccination across the country.”
The CDC says people can come in contact with measles anywhere in the U.S.
What to know about this extra dose
According to the CDC, if any child receives the MMR vaccine before their first birthday, they will need two more vaccines to complete the series. The second dose is given between 12 and 15 months of age, and the third dose is given at least 28 days following the second dose.
Children traveling who have already turned a year old should receive two doses prior to international travel if able. Because the MMR vaccine is a live virus vaccine, it cannot be given to children who are immunocompromised.
What should parents know about measles?
Measles is a highly contagious virus — one person infected can spread it to 9 out of 10 unvaccinated close contacts, according to the CDC. Children are one of the most at-risk groups for severe illness, especially those under the age of 5 and who are unvaccinated.
Symptoms of measles include high fever, runny nose, diffuse rash, and red, watery eyes. Severe cases can lead to inflammation around the brain that may cause confusion, seizures or death. The CDC estimates that 1-3 out of every 1,000 people who get measles will die from the disease, even with adequate care.
Dr. Dean A Blumberg, M.D., a professor and division chief of Pediatric Infectious Diseases at UC Davis Children’s Hospital, tells ABC News that measles shouldn’t be minimized.
“Although most patients recover, it’s important to remember that prior to widespread use of measles vaccine in the US, measles resulted in 3-4 million cases, 400-500 deaths, 48,000 hospitalizations, and 4,000 cases of encephalitis or inflammation of the brain every year,” he said.
Experts recommend talking to your child’s pediatrician about upcoming travel to make sure they get all recommended vaccines.
Dr. Jade A Cobern, M.D., M.P.H., board-eligible pediatrician and general preventive medicine resident at Johns Hopkins, is a member of the ABC News Medical Unit.
(ATLANTA) — Monthly e-cigarette sales skyrocketed during the first two years of the COVID-19 pandemic, according to a new study published Thursday by the Centers for Disease Control and Prevention.
Between January 2020 and December 2022, monthly unit sales increased by 46.6%, from 15.5 million units to 22.7 million units, the study found.
Researchers found the surge was mostly driven by disposable e-cigarettes in flavors, including fruit and candy, which are popular among youth and young adult users.
Over the period, the share of total sales made up by tobacco-flavored products fell from 28.4% to 20.1%, and the share of mint-flavored products saw a similar decline from making up 10.1% of all sales to 5.9%. Meanwhile, other flavors went from 29.2% of all sales to 41.3%.
Additionally, while the share of pre-filled e-cigarette cartridges decreased from 75.2% to 48% of total sales, the share of disposable e-cigarette units increased from 24.7% to 51.8% of total sales.
The study found this may be due to an announcement the U.S. Food and Drug Administration made in January 2020 that prioritized enforcement against prefilled cartridges in flavors other than tobacco and menthol.
While total sales increased during this period, there was a 12.3% decrease between May 2022 and December 2022, which the CDC said may have been driven by multiple factors, including FDA regulatory actions, local and state e-cigarette restrictions and supply chain disruptions linked to COVID-19.
The study also looked at the top-selling brands. At the start of the study period in January 2020, JUUL was the top monthly seller, followed by Vuse, NJOY, My Blu and Puff, respectively.
By the end of the study period in December 2022, Vuse was the top-selling brand, followed by JUUL, Elf Bar, NJOY and Breeze Smoke, respectively.
“The dramatic spikes in youth e-cigarette use back in 2017 and 2018, primarily driven by JUUL, showed us how quickly e-cigarette sales and use patterns can change,” Dr. Deirdre Lawrence Kittner, director of the CDC’s Office on Smoking and Health, said in a press release. “Retail sales data are key to providing real-time information on the rapidly changing e-cigarette landscape, which is essential to reducing youth tobacco use.”
The CDC noted in its report that e-cigarette use is more common among young people than adults overall.
In 2021, 4.5% of all adults aged 18 and older used e-cigarettes at least once in the last 30 days compared to 11% of adults between ages 18 and 24 and 14.1% of high school students.
Nicotine exposure from e-cigarettes can hinder brain development in adolescents and young adults, which can continue into the mid-20s, the CDC says, and can also increase risk of addiction to other drugs.
The CDC also says aerosol from e-cigarettes can contain heavy metal, potentially cancer-causing chemicals and other substances that can damage the lungs.
The CDC states “use of e-cigarettes is unsafe for kids, teens, and young adults.”