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Seeing POD People? It’s No Sci-Fi Film
By ARIEL KAMINER
NYTimes
3/1/10
PODs are the sleeper cells of public health, assuming a different shape and observing different local mores each time a crisis emerges. When hepatitis A was diagnosed in a bartender at the Manhattan nightclub Socialista two years ago, POD people were on hand to vaccinate patrons, including some guests at Ashton Kutcher’s birthday party. In the case of a bioterrorism attack, they might turn up in your neighborhood dispensing anthrax antidote. On Feb. 18, they were in Anshe Sfard Hall in the Borough Park section of Brooklyn, rolling up the sleeves of Hasidic Jews. That’s a long way from Ashton Kutcher.
I entered the hall on the left, with the other women; men entered on the right. With stacks of gold-braided chairs in the corner and a divider to keep the sexes apart, the Anshe Sfard POD — short for Point of Distribution — could have been the day-before photo of an Orthodox wedding. Instead, it was the front line against one of the city’s more surprising outbreaks in years.
It started last year, when some children at a Jewish summer camp in the Catskills came down with mumps, one of those childhood diseases that were supposed to have been consigned to history. They brought it back home to the Hasidic enclaves in Borough Park, Crown Heights and Williamsburg. By last month, there were more than 900 cases, and more adults were getting sick.
Time to activate the PODs.
Mumps is not generally fatal, though it is painful and can cause deafness or infertility. In neighborhoods where families might have a dozen children, and young men spend long days together in yeshivas or synagogues, it spreads fast. But business was slow at Anshe Sfard, so Sheila Palevsky and Elissa Levine, two of the sharp, funny members of the POD team, were keeping each other amused with tales of former postings.
Hasidic Jews may be more inclined to visit their own doctors than to discuss bodily functions with strangers. (“When did you last go to the mikvah?” Ms. Levine asked while taking my medical history, referring to the ritual bath that many observant Jewish women visit after menstruating. I thought the euphemism was very sweet.) As for the antivaccine movement, its echoes are rare in these parts, but they ring out with a strong local accent. “Jews trust the Almighty, not vaccines,” one commenter wrote on the site of The Yeshiva World, an online newspaper, in a mix of Hebrew and English. On a Crown Heights Web site, someone else wrote, “I wish that folks would have as much faith and confidence in God as they do in doctors and scientists.”
But there is another reason things look different here: This outbreak has written a new chapter in epidemiological history.
The standard prescription is two doses of the M.M.R. (measles, mumps, rubella) vaccine in childhood. That’s what most of the patients in Brooklyn had gotten, and it didn’t help them. Which has led medical professionals to reconsider some long-held notions about mumps in particular and communicable diseases in general.
“People that have measurable antibodies to mumps, which I was always taught meant you were immune, we found are getting the disease,” said Dr. Edward Chapnick, director of infectious diseases at Maimonides Medical Center. “And two vaccines, which we always thought had a very high effectiveness at preventing this, turns out to have a 75 to 80 percent effectiveness.”
The Department of Health still recommends two shots, but many doctors in the area — including Dr. Eli Rosen, a pediatrician who said he had treated 200 to 300 mumps cases so far — now favor three vaccinations, as do other private doctors in the area. “It appears that two vaccines are not effective in the vast majority of cases,” Dr. Rosen said. “Is this going to be a pattern we’ll see as we go out in vaccine years?” And, he added, would other vaccines also lose their effectiveness over time?
As a child I probably got my two M.M.R. shots, but who remembers. Everyone I spoke to assured me that so long as I wasn’t pregnant and did not have an immune disorder, there was no downside to an extra shot. But what’s the chance I would really need it? I don’t hang out in Brooklyn yeshivas.
In a city where people live so close to one another, it’s baffling that an outbreak could stay confined to a specific population, even an insular population. But that’s the paradox of city life, on an epidemiological scale: We are simultaneously a teeming megalopolis and a collection of little villages (or offices or apartment buildings), each with its own public health profile.
Still, a cluster of cases has already been documented in Orthodox and Hasidic neighborhoods of Westchester County. Unless that outbreak is halted, entropy will eventually win out.
So at the Quality Health Center in Williamsburg, which has reported hundreds of suspected cases, I decided to roll my sleeve up. Turns out it’s not just a fear of needles that makes little kids cry; the shot really did smart.
To distract me, Dov Landa, a physician assistant, shared the story of a 40-year-old Hasidic woman who had brought her large family in the day before. When it was her turn to get vaccinated, Mr. Landa, following protocol, asked if she was pregnant. The woman laughed. “I haven’t been pregnant in 10 years,” she said. He tested her anyway, just to be sure. And so it was that he got to tell her the happy news. Mazel tov.