disease

WASHINGTON — While millions of soccer fans cheer or groan over World Cup matches spanning North America, health officials are on high alert for germs.

A heat wave may be the most obvious health threat. But infectious diseases can spread in a crowd, and experts are scrutinizing wastewater, hospital visits, even social media for any signs that an outbreak might be brewing.

Measles, one of the most contagious diseases, is among the top concerns, sparking a warning this week from the Pan American Health Organization, PAHO. With a nearly six-week stretch of packed stadiums, bars and tourist sites in 16 cities, officials are on the lookout for a long list of infections, from the stomach bug norovirus to mosquito-borne dengue fever.

“This is truly a marathon,” said Palak Raval-Nelson, Philadelphia’s health commissioner.

The mass gatherings come at a tense moment for budget-strapped health agencies in the U.S. The Centers for Disease Control and Prevention, hit hard by Trump administration staffing cuts, already was grappling with a growing Ebola outbreak in central Africa and a cruise ship hantavirus outbreak. While CDC officials have advised state and local health departments behind the scenes, it’s expected World Cup disease surveillance dashboard still was “in final development” days before games began, according to the Department of Health and Human Services.

“Our public health professionals are pretty stretched,” said global health specialist Rebecca Katz of Georgetown University, who is leading an unusual new hub to help.

At the Health Security Operations Center, a joint effort between Georgetown and MedStar Health, workers are analyzing data from around the country so they can alert health authorities, even emergency rooms, to any early signs of trouble. The center is issuing daily “situation reports” about disease trends around World Cup host cities and team base camps to several hundred local and federal public health groups, emergency management and hospital officials and others who’ve signed up.

“It’s important that we don’t become alarmist,” said MedStar emergency medicine specialist Dr. Shane Kappler. “We’re trying to be the insurance policy.”

Measles is a top concern for potential World Cup spread

Already more than 2,000 people in the U.S. have come down with measles this year, nearly as many as during all of last year, according to the CDC. Patients can spread measles before the rash appears and they realize they’re sick. Not too long ago, the U.S. seldom saw measles except from international travel by unvaccinated people.

Now with frequent U.S. outbreaks, “actually a lot of our international partners are worried about measles being exported to them after the games,” said Georgetown’s Katz.

Measles is spreading in Canada, too, and has exceeded 11,000 cases in Mexico, according to PAHO. It’s urging soccer fans to be sure they’re vaccinated, with a health campaign saying a single measles patient can spread the virus to up to 18 unprotected people.

Is Ebola a concern at the World Cup?

Brown University’s Dr. Craig Spencer, who survived Ebola while working in the West Africa outbreak over a decade ago, said he’s repeatedly asked about the risk of Ebola during the World Cup — but “for me, Ebola is not the No. 1 or No. 2 or even No. 3 threat.”

“I am concerned about importation of measles, I am much more concerned about the importation of other infectious threats that may not seem as scary to us as Ebola,” Spencer said.

Many health experts agree that the risk of Ebola spreading in the U.S. is very low. That’s partly because of government travel screenings and restrictions on people recently in outbreak-affected areas. Moreover, Ebola spreads by contact with bodily fluids from someone showing symptoms, not through the air like measles or respiratory viruses.

“One fortunate thing about this virus is you’re most contagious when you’re really quite ill. It’s not like COVID, where you could be sitting next to someone who doesn’t even know they’re infected and perhaps contract the virus,” said Jennifer Nuzzo, director of Brown’s Pandemic Center.

How to spot brewing diseases

There’s precedent for germs invading major sporting events. Canadian scientists linked a community measles outbreak to the 2010 Olympics in Vancouver, and clusters of norovirus had to be contained during the Olympics this year in Milan and in 2018 in South Korea.

One way to detect signs of trouble: People with certain viral or bacterial infections shed genetic material that sophisticated testing of wastewater can spot. For example, measles can appear in wastewater days before an emergency room sees its first patients.

A recent surveillance reports from Katz’s center note that wastewater testing recently found diarrhea-causing rotavirus, hepatitis A and norovirus in some parts of the U.S., something to watch as soccer crowds arrive.

In Dallas, officials ramped up wastewater screening including at the international airport, casting a wide net rather than looking for specific illnesses, said Dr. Phil Huang, director of Dallas County Health and Human Services.

His team also is enhancing the usual mosquito testing, checking not just for West Nile virus that regularly spreads in the U.S. but for viruses more common in other countries like dengue and chikungunya.

Public health officials have been preparing for months, said Philadelphia’s Raval-Nelson, including with mock emergency drills and communications with counterparts around the country.

“I don’t want to send a message that there’s one key thing,” she said. “We have the frameworks in place to carry out what we need to.”

Neergaard writes for the Associated Press.

WASHINGTON — President Trump on Friday gave his endorsement to a January study by the Department of Health and Human Services that calls for cutting the number of vaccines recommended for every American child.

An executive order from Trump directs federal agencies to align their policies behind the study, which recommended an overhaul long called for by Health Secretary Robert F. Kennedy Jr. The study found that the United States recommends more childhood vaccines than many peer nations.

The Trump administration previously moved to narrow the number of recommended childhood vaccines in response to the report, but the move was blocked by a federal judge in Massachusetts. The administration is appealing the decision.

The study recommends vaccinating all children against 11 diseases. Several others would be recommended only for high-risk groups or when doctors recommend them in what’s called “shared decision-making.” That includes vaccines for flu, rotavirus, hepatitis A, hepatitis B, some forms of meningitis and RSV.

Trump’s order adds weight behind the study at a time when the administration had appeared to be trying to shift focus away from Kennedy’s more contentious vaccine policies and toward topics with more widespread support among medical professionals, such as healthful eating.

The order directs the Centers for Disease Control and Prevention to review the study and “take any appropriate steps” to update its vaccine recommendations. It says the CDC should “provide maximum flexibility to parents and doctors” and directs agencies to make sure all actions, regulations and funding are aligned with the study.

The order adds that any changes should ensure that Americans retain their current access to vaccines.

States, not the federal government, have the authority to require vaccinations for schoolchildren. While CDC requirements often influence those state regulations, some states have begun creating their own alliances to counter the Trump administration’s guidance on vaccines.

Trump directed the Department of Health and Human Services to carry out the study in December.

Kennedy is a longtime activist against vaccines and has sought ways to inject his skepticism about the shots into national guidance, running counter to the overwhelming consensus of medical experts. Last year, he announced the CDC would no longer recommend COVID-19 vaccines for healthy children and pregnant women, though public health experts said they saw no new data to justify the change.

Last June, he fired a 17-member CDC vaccine advisory committee and later installed several of his own replacements, including vaccine skeptics.

The January report found that vaccine recommendations for American children had increased in recent decades. It also highlighted countries where no vaccines are required to attend school.

Binkley writes for the Associated Press.

This remote island was once a thriving town – but now all that remains are ruins.

Hidden away in a far-flung Scottish archipelago lie the remains of a once-bustling settlement, deserted by all who called it home. The island of Hirta in the Outer Hebrides was occupied for 2,000 years, but during the 1930s, its final inhabitants evacuated due to health concerns.

It’s so isolated that it’s often omitted from maps altogether and can only be reached by boat – weather permitting.

It’s one of 40 islands in the St Kilda archipelago and now hosts the world’s largest gannet colony alongside some of the biggest puffin populations. During its inhabited years, islanders depended heavily on these seabirds – not merely for sustenance but for commerce.

They traded every component of the birds from feather to flesh.

Today, the population has vanished but a handful of military structures remain scattered across the island, overshadowing the crumbling stone cottages that once housed the community.

The structures line what was formerly Hirta’s main thoroughfare – now occupied solely by sheep, reports the Express.

Existence there was extraordinarily harsh, with severe weather conditions and scarce resources available.

To stay warm throughout the lengthy winters, inhabitants would bring livestock inside their basic stone dwellings and allow the waste from cattle and sheep to serve as insulation.

At its height in 1851, Hirta was inhabited by 112 people but this number rapidly dwindled over subsequent years.

Medical provision on the island had always been severely restricted, and as visitors began arriving on the isolated outpost as tourists, they introduced unfamiliar illnesses that the islanders were poorly prepared to combat.

During the 1930s, following the death of a young woman from appendicitis and pneumonia — conditions that might have been treatable on the mainland — the inhabitants of Hirta took the difficult decision to abandon the island.

The residents were evacuated by vessel in August that year and transported to mainland Scotland.

Following their local custom, islanders left a plate of oats and an open bible in every dwelling before stepping aboard the ship.

The final surviving former inhabitant of St Kilda, who was eight years old when the island was evacuated, passed away in 2016.

Bill Cassidy’s roles as a lawmaker, a doctor and a political candidate will collide on Wednesday as he questions Health Secretary Robert F. Kennedy Jr. in two high-stakes Senate hearings.

The Louisiana Republican chairs one of the Senate committees that oversees Kennedy’s department and sits on another, giving him two chances to interrogate the secretary about his plans for an agency responsible for public health programs and research. As a doctor, Cassidy has clashed with Kennedy’s anti-vaccine ideas even though he provided crucial support for the health secretary’s nomination last year.

At the same time, Cassidy is fighting for his political future in next month’s primary in Louisiana, where President Trump has endorsed one of his opponents in an unusual attempt to oust a sitting senator from his own party.

How Cassidy handles the hearings could affect his chances at a pivotal moment of his reelection campaign and set the tone for how Congress oversees the nation’s health agenda at a time of rampant distrust and misinformation.

Cassidy hasn’t faced Kennedy in public since September. In the subsequent months, Kennedy has attempted a dramatic rollback of vaccine recommendations that, if not blocked by an ongoing lawsuit, could undermine protections against diseases like flu, hepatitis B and RSV.

After a backlash, Kennedy has also pivoted to spending more time talking about less controversial topics like healthy eating — albeit with his own spin, including sharing exaggerated claims that various ailments can be cured by diet alone.

Cassidy will have to decide on Wednesday whether to grill Kennedy on vaccines, an issue deeply important to him, or put their differences aside and prioritize loyalty to the Trump administration.

“He’s taken a risk showing any sort of resistance to RFK,” said Claire Leavitt, an assistant professor at Smith College who studies congressional oversight. “He may pay an electoral price for that.”

Cassidy has long advocated for vaccines

Cassidy has spent years walking a political tightrope. He’s one of the few Republican senators who voted to convict Trump during an impeachment trial after the Jan. 6, 2021, attack on the U.S. Capitol.

As a liver doctor, he advocated for babies to receive hepatitis B vaccines shortly after birth, a step that could have prevented the disease in his patients. But when Trump nominated Kennedy, a longtime anti-vaccine activist, Cassidy supported him. He did so after securing various commitments, including that Kennedy would work within the current vaccine approval and safety monitoring system and support the childhood vaccine schedule.

The vote for Kennedy did not appear to mollify Trump. The president endorsed U.S. Rep. Julia Letlow, one of Cassidy’s two primary opponents.

Cassidy also faces opposition from Kennedy’s allies in the “Make America Healthy Again” movement, a group that includes both anti-vaccine activists and a wide variety of other crusaders for health and the environment. The MAHA PAC, aligned with Kennedy, has pledged $1 million to Letlow’s campaign. While the organization hasn’t publicly said so, some have questioned whether the support is partly in retaliation against Cassidy for criticizing Kennedy’s vaccine policy agenda.

“I’m not really sure what MAHA’s beef is,” Cassidy told reporters earlier this month. “Let me point out that I am the reason that Robert F. Kennedy is now the secretary of HHS. He would not have gotten there otherwise.”

Cassidy argues that he has “strongly supported” the MAHA agenda, especially when it comes to the fight against ultraprocessed foods. However, the physician-turned-senator acknowledged that he and MAHA have “disagreed on vaccines.”

“We’ve seen, frankly, that I am right,” Cassidy added, pointing to recent measles-related deaths of children who were not vaccinated.

At a hearing in September, he slammed Kennedy’s decision to slash funding for mRNA vaccine development. He interrogated Kennedy over his attempt to replace members of a vaccine committee, suggesting the new members could have conflicts of interest. He also raised concerns that Kennedy’s vaccine policy decisions could be making it harder for Americans to get COVID-19 shots.

Later that month, Cassidy convened a hearing featuring former U.S. Centers for Disease Control and Prevention Director Susan Monarez, who was ousted by Kennedy less than a month into her tenure after they clashed over vaccine policy, and former CDC Chief Medical Officer Debra Houry, who resigned in August citing an erosion of science at the agency.

“I want to work with the president to fulfill his campaign promise to reform the CDC and Make America Healthy Again. The president says radical transparency is the way to do that,” Cassidy said at the time.

Experts say Cassidy’s vaccine stance might not hurt him

Political consultants said they expect Cassidy’s primary opponents, Letlow and Louisiana Treasurer John Fleming, to seize on any sound bites from Wednesday’s hearings that can make Cassidy seem at odds with the Trump administration.

But Dorit Reiss, a vaccine law expert at UC Law San Francisco, said the political risk of advocating for vaccines may not be as strong among Republicans as some people assume.

“He’s probably not alienating voters by focusing on the issue and calling it out,” she said.

Louisiana political consultant Mary-Patricia Wray said she thinks most diehard MAHA voters already know who they are voting for, and it’s probably not Cassidy.

Instead, she said, he may still be able to appeal to Democrats who switch their party registration to vote in the primary, as well as a wide swath of still-undecided Republican voters who care about the same health care affordability issues he advocates for every day in Congress.

“If I was advising Bill Cassidy, I would tell him your goal here is not to get out unscathed,” Wray said. “Your goal is to prove that your consistency on issues regarding public health is an asset in your campaign, not a detriment.”

Election outcome will shape future oversight of HHS

Also at stake if Cassidy doesn’t make it to November’s general election is what will happen to his responsibility to oversee the massive U.S. Department of Health and Human Services as the chair of the Senate Health, Education, Labor and Pensions committee.

Leavitt, the Smith College professor, said seniority typically plays the most important role in who chairs Senate committees. She said another Republican in today’s increasingly hyperpartisan Congress may not be as willing as Cassidy to check Kennedy’s power.

Reiss, the vaccine law expert, said she wishes Cassidy had done more hearings or introduced legislation to rein in Kennedy. And she said the senator bears the blame for allowing Kennedy to bring unfounded vaccine fears into the government in the first place.

“His original sin, of course, was voting for Kennedy at all,” Reiss said.

Swenson writes for the Associated Press. AP writer Sara Cline contributed to this report.