Donald G. McNeil Jr.

His daughter Kathryn Polak said the cause was heart failure. Polak lived in Golden, Colorado.

In an era when foreign aid is largely based on charity, Polak (pronounced POLE-ack) instead advocated training people to earn livings by selling their neighbors basic necessities like clean water, charcoal, a ride in a donkey cart or enough electricity to charge a cellphone.

Although the nonprofit companies he created did accept donations, their purpose was to help poor people make money. His target market was the 700 million people around the world surviving on less than $2 a day, and he traveled all over the world seeking them out.

Before embarking on any project, Polak would interview dozens of villagers.

“I’ve interviewed over 3,000 families,” he said in 2011. “I spend about six hours a day with each one — walking with them through their fields, asking them what they had for breakfast, how far their kids walk to school, what they feed their dog, what all their sources of income are. This is not rocket science. Any businessman knows this: You’ve got to talk to your customers.”

His most successful project was in foot-powered treadle pumps to pull water out of the ground. Beginning in 1982, he sold millions for about $25 each in Bangladesh and India, he said. The company he created for the project, iDE for International Development Enterprises, now operates in Asia, Africa and Latin America.

The cost included the mechanism, which could be built in a local welding shop, and drilling the well. Polak’s organization trained thousands of welders and drillers. The customers — small farmers — supplied the foot power and long bamboo handles for the pumps, the device resembling a crude elliptical trainer.

To sell them, Polak ran a publicity campaign: a singing, dancing Bollywood-style movie about a couple that could not marry because her father could not afford a dowry. But once he bought a pump and could grow vegetables in the dry season, when they fetch more money, love triumphed.

“OK, somewhat cheesy,” Polak admitted, “but we bought a van with a video setup and took it to villages. A typical open-air audience was 2,000 to 5,000 people.”

By contrast, he said, the World Bank was subsidizing expensive diesel pumps that drew enough water to cover 40 acres. They were handed out by government agents, who could be bribed, he said, and the richest landowner would thus become “a waterlord,” who could drain the aquifer supplying everyone else’s wells and then charge them for water.

“It was very destructive to social justice,” Polak said.

Another franchise company he started in India was Spring Health, which uses battery power to convert salt into chlorine. The bleach is used to disinfect local water, which is then sold door-to-door in refillable containers.

Franchisees get caps and shirts with distinctive blue raindrops, and street theater troupes help uneducated people make the connection between dirty water and diarrhea, which sickens millions of children every day and, when chronic, can leave them mentally and physically stunted.

Polak wrote two books about his ideas and experiences, “Out of Poverty” in 2008 and, with Mal Warwick, “The Business Solution to Poverty” in 2013.

In 2007, he helped arrange an exhibit, Design for the Other 90 Percent, at the Cooper-Hewitt National Design Museum in Manhattan. It displayed the kind of simple products he endorsed: drip-irrigation systems, inexpensive eyeglasses and 20-gallon plastic water containers in the shape of a wheel that could be rolled instead of carried on the head.

Polak was born in Prachatice, in what was then Czechoslovakia, on Sept. 3, 1933, to Hugo and Marta (Baum) Polak. His father was a fruit-tree nurseryman, his mother a librarian. Six years later, fleeing the Nazis, the family ended up in the small town of Millgrove in Ontario with the help of a synagogue in nearby Hamilton.

Their first home had no electricity or running water, and Paul and his brother attended a one-room school. He later attended medical school at Western Ontario University and did his psychiatric residency at the University of Colorado.

At a student party, he was brewing beer in a washing machine — a money-saving measure — when he met Agnes M. Potter. They were engaged six days later, his daughter Kathryn said, and were married for 59 years. His other survivors include two more daughters, Amy Schefer and Laura Polak, and two grandchildren.

Polak practiced psychiatry in the Denver area for 23 years and, for extra income, bought and managed small apartment buildings, drilled for oil and invented an oil-well pump jack. By 1981, he could afford to think about giving up medicine and focusing on real estate.

“But, instead of trying to become a Bill Gates or a Donald Trump, I came to the realization that, beyond having enough money to cover my basic living expenses, the marginal value of accumulating more wealth was not really useful,” he told an interviewer this year.

Shortly afterward, a friend working with the United Nations High Commission for Refugees invited him to Somalia, where he quizzed inhabitants of a resettlement camp about how they lived.

Seeing that transportation for water and wood was a major problem, he worked with local blacksmiths to repurpose parts scavenged from derelict cars.

“We built 500 donkey carts and sold them to the refugees for $450 each,” he said.

The commission’s model, however, was charity, “so we had to fight the establishment,” he said. But many refugees had connections from whom they could borrow money, repaying the loans by carrying goods for others.

Earlier this year, Polak described a new project he was working on: carbonizing mesquite chips and bamboo in motorized kilns made from chains of 55-gallon drums to see which made the best charcoal. He hoped to form a partnership with Mahindra, an Indian car and tractor maker, to encourage using renewable invasive plants instead of coal in rural stoves.

“We’re going to keep the whole system under $25,000,” said Stephan Reckie, who said Polak had made him the successor chief executive of Transform Energy, the company pursing the project. “It’s quicker than making charcoal the traditional way. We capture the off-gasses and reuse them, and we’re looking at a lot of employment for local people.”

This article originally appeared in

Paul Polak, Entrepreneur for Those Living on $2 a Day, Dies at 86

Dr. Paul Polak, a former psychiatrist who became an entrepreneur and an inventor with a focus on helping the world’s poorest people create profitable small businesses, died Oct. 10 in Denver. He was 86.

TSAKANE, South Africa — When Tsholofelo Msimango joined a clinical trial of new tuberculosis drugs, she was 20 years old and weighed just 57 pounds.

Stricken with a deadly strain of tuberculosis, Msimango was terrified. She was to be transferred to Sizwe Tropical Diseases Hospital in Johannesburg. The nurses in the township here told her that it was far away and infested with vervet monkeys.

“I cried the whole way in the ambulance,” she recently recalled. “They said I would live with monkeys and the sisters there were not nice and the food was bad and there was no way I would come back. They told my parents to fix the insurance because I would die.”

Five years later, Msimango, who became the trial’s fifth enrolled patient, is now tuberculosis-free. She is healthy at 103 pounds, and has a young son.

The trial she joined, nicknamed Nix-TB, is small — it has enrolled only 109 patients. But experts are already calling the preliminary results groundbreaking. The three-drug regimen tested on Msimango has shown a 90% success rate against a deadly plague: extensively drug-resistant tuberculosis, better known as XDR-TB.

On Wednesday, the Food and Drug Administration effectively endorsed the Nix-TB regimen by approving the last of its three drugs, pretomanid, for XDR-TB patients as long as it is used with the other two previously approved ones, bedaquiline and linezolid.

Usually, the World Health Organization eventually adopts approvals made by the FDA or its European counterpart, meaning the regimen could soon come into use worldwide.

Tuberculosis has now surpassed AIDS as the world’s leading infectious cause of death, and the XDR strain is the ultimate in lethality. It is resistant to all four families of antibiotics typically used to fight the disease.

Only a tiny fraction of the 10 million people infected by TB each year get the XDR strain, but very few of those who do survive it.

There are about 30,000 cases in more than 100 countries. Three-quarters of those patients die before they even receive a diagnosis, experts believe, and among those who get typical treatment, the cure rate is only 34%.

The treatment itself is extraordinarily difficult. A typical regimen in South Africa requires up to 40 daily pills, taken for up to two years. Other countries rely on even older regimens that include daily injections of antibiotics that can have devastating side effects, including deafness, kidney failure and psychosis.

But the new regimen tested in Nix-TB requires only five pills a day for a mere six months. Its three drugs are not without side effects, but most are manageable, according to the doctors running the trial.

Linezolid was approved in 2000 and bedaquiline in 2012. Some drug-access groups had opposed pretomanid’s approval, saying it needed further testing. Other TB experts argued that the situation is still so desperate that risks had to be taken.

Dr. Gerald Friedland, one of the discoverers of XDR-TB and now an emeritus professor at Yale’s medical school, called Nix “a wonderful trial” that could revolutionize treatment: “If this works as well as it seems to, we need to do this now.”

A killer appears

News that tuberculosis had evolved a terrifying new strain first broke in 2006, when doctors at a global AIDS conference learned of a doomed group of tuberculosis patients in Tugela Ferry, a rural South African town.

Of the 53 patients in whom the strain had been detected, 52 were dead — most within a month of diagnosis. They were relatively young: The median age was 35.

Many of them had never been treated for TB before, meaning they had caught the drug-resistant strain from others and had not developed it by failing to take their drugs. Several were health workers who were assumed to have caught it from patients.

Within months, South Africa realized it had cases of the deadly infection in 40 hospitals. Alarmed, World Health Organization officials called for worldwide testing.

The results showed that 28 countries, including the United States, had the deadly strain, XDR-TB, and that two-thirds of the cases were in China, India and Russia. It took far longer to determine how widespread it was in Africa, because most countries there could not do the sophisticated testing.

HIV, the virus that causes AIDS, helped drive the epidemic. Anyone infected with it is 25 times as likely to get TB, according to the WHO. But many victims, including Msimango, catch this type of TB without ever having HIV.

In the early years, XDR-TB was a death sentence. Doctors tried every drug they could think of, from those used to treat leprosy to those for urinary tract infections.

“From 2007 to 2014, we threw the kitchen sink at it,’’ said Dr. Francesca Conradie, a researcher at the University of the Witwatersrand, Johannesburg, and director of the Nix trial.

The death rate was about 80%. Sometimes the drugs killed patients. In other cases, patients died because they could not tolerate the drugs and stopped taking them.

Tuberculosis germs burrow deep into the lungs and barricade themselves inside clumps of dead cells. Breaking those nodules apart and killing all the bacteria inside requires taking drugs for months.

Nearly all antibiotics cause nausea and diarrhea. But some, especially the injections, are far tougher. “I had a patient who tried to commit suicide because of the tinnitus — ringing in his ears,” said Dr. Pauline Howell, a tuberculosis researcher who runs the Nix trial at Sizwe.

“Some get hallucinations,” Howell said. “I had one patient who tried to cut open his skin because he thought bugs were crawling under it. I’ve had patients who became wheelchair-bound because of the vertigo.”

Patients can go deaf over a weekend, she said, or the nerves in their feet and hands can wither until they can no longer walk or cook. Some develop disrupted cardiac rhythms, which can trigger heart attacks.

Msimango, too, veered close to death because the drugs were too much for her.

When she was 19, she said, she caught drug-resistant TB from another young woman — the temporarily homeless daughter of a friend of her mother.

Her mother had generously taken in the young woman and had told her daughter to share her bed, a common arrangement in the tiny houses of townships like Tsakane. “A few weeks after she left, I started coughing,” Msimango said.

“She had not told us that she had drug-resistant TB and had defaulted,” she added, using a common term for dropping out of treatment.

At first, Msimango got her injections at a hospital and took her pills under her mother’s watchful eye. But they made her feel so awful that she secretly spat them out, stuffing them between the sofa cushions when her mother wasn’t looking.

After she defaulted twice herself, she was transferred to Sizwe, terrified that she would die alone.

No masks, no doctors

Although it lies in South Africa’s largest city, Sizwe does host monkeys, along with feral peacocks and the occasional mongoose. It has long been on the front lines of South Africa’s protracted battle against tuberculosis.

The hospital sits on an isolated hilltop 10 miles from downtown. The British built it in 1895 as Rietfontein Hospital to house victims of contagious diseases like leprosy, smallpox and syphilis.

Mohandas K. Gandhi volunteered there during a 1904 bubonic plague outbreak, and Archbishop Desmond Tutu was a tuberculosis patient there in his youth.

Although Sizwe still has its 19th-century style — the grounds are a jigsaw puzzle of tin-roofed, one-story barracks — the TB explosion of the last 25 years has forced changes.

In 1996, with the AIDS epidemic raging, the WHO announced that South Africa had the world’s worst tuberculosis epidemic: 350 cases per 100,000 citizens.

That finding shocked the government, which had been using outdated approaches against the disease. Diagnoses were made by X-ray, which are less accurate than sputum tests, and doctors hospitalized every patient.

I visited shortly after the 1996 announcement, and the situation inside Rietfontein was unnerving. In the men’s ward, dozens of TB patients lay on cots only 2 feet apart; those with drug-resistant strains slept next to patients with more common strains. No one wore a mask, and no doctor was on duty.

During the day, the transom windows were open to let in fresh air. But at night, the patients shut them and turned up the heat. (Johannesburg sits at a higher elevation than Denver, so nights get chilly.) The room became a deadly incubator.

A return visit this month showed that far more than the name had changed (Sizwe means “nation” in Zulu).

The former men’s ward is now a mostly empty meeting hall. Patients with TB that is not drug-resistant are treated at home, and even those with partially drug-resistant strains are usually hospitalized only briefly.

The XDR-TB patients rest in a ward atop the hill, and golf carts transport those too weak to walk. Each patient has a separate room and bathroom, hookups for oxygen and lung suction, a TV and big windows and a door to the lawn outside.

The building has a negative-pressure air system, but it keeps breaking down, so the policy is to keep all the doors and windows open as much as possible, said Dr. Rianna Louw, the hospital’s chief executive.

Patients can work in the garden, play pool or foosball, and take classes in sewing, beading or other crafts that might help them earn a living when they get out.

But the months of isolation needed for treatment can be tough. “Our children are scattered, they are falling apart!” a patient who gave her name only as Samantha shouted at a group-therapy session that turned into an airing of grievances.

“The father of my kids is in prison,” she said. “My firstborn son is arrested for robbing people in the street. That would not happen if I was home!”

The counselor interrupted to say: “We understand your frustration. But if we discharge you, we are taking a risk. You are not healthy. You can still expose people to your disease. That’s why you will stay a minimum of four months.”

A rush to approval?

The regimen successfully tested at Sizwe is called BPaL, shorthand for the three drugs it comprises: bedaquiline, pretomanid and linezolid.

The BPaL regimen is “bold, because it’s three killer drugs instead of two killers plus some supportive ones,” Howell said.

Most regimens, she explained, rely on two harsh drugs that can destroy bacterial walls and include others that have fewer side effects but only stop TB bacteria from multiplying.

But even the new treatment poses hazards. Short-term use of linezolid against severe hospital infections causes few problems, but use for many weeks against TB can kill nerves in the feet, making it hard to walk, or can suppress the bone marrow where blood cells are made. (To find the ideal linezolid dose, the Nix investigators have started a new trial, ZeNix.)

The FDA approved bedaquiline in 2012 for use against multi-drug resistant TB (the XDR strain is an even deadlier subset), and in 2015 the WHO followed suit.

Until Wednesday, pretomanid was in dispute, although in June an FDA advisory committee voted 14-4 to approve it.

Some advocacy groups argued at the time that the drug had been too little tested.

“Pretomanid looks like a promising drug, but it’s being rushed forward, and we don’t want to see the FDA lower the bar for approval,” Lindsay McKenna, co-director of the tuberculosis project at the Treatment Action Group, an advocacy organization, said in July.

Her organization and others had asked the FDA to first demand two of the most rigorous tests: a head-to-head comparison of pretomanid against delamanid, a related drug, and a randomized clinical trial in thousands of patients of the Nix regimen versus another used by the WHO.

Delamanid also works against XDR-TB but has serious disadvantages, Howell said. It requires two daily doses, and they must be taken an hour apart from any other drug.

Pretomanid — which is named for Pretoria — is not owned by a drug company but by the TB Alliance, a nonprofit based in New York that is seeking new treatments.

Dr. Mel Spigelman, the alliance’s president, had argued that a full clinical trial would be both impractical and unethical.

“Put yourself in a patient’s position,” he said. “Offered a choice between three drugs with a 90% cure rate, and 20 or more with less chance of cure — who would consent to be randomized?”

Such a trial would cost $30 million and take five more years, he added: “That’s a very poor use of scarce resources.”

Dr. Mario Raviglione, who ran the WHO’s tuberculosis programs for 14 years and is on the TB Alliance’s board, said he had found the opposition from activist groups “disturbing.”

“I’m used to public calls by activists for rapid approval to provide new options,” he said. “I’m not used to calls against a new drug. It’s like we’re forgetting that we’re facing a lethal disease.”

‘There is no survival here’

Innocent Makamu, 32, was facing two years in the hospital when he chose to join the Nix trial in 2017.

Like Msimango, he also had caught drug-resistant TB from a roommate. A plumber, he had shared a room at a distant construction site with a carpenter.

“He was too much on the bottle,” Makamu said. “He kept defaulting.”

Soon afterward, he began feeling tired and lost his appetite. Doctors at the hospital near his home diagnosed tuberculosis, and put him on 29 daily pills and a daily injection.

“It was deep in my bum,” he said. “I couldn’t sit properly. It hurt every day.”

At the hospital, he watched two other inpatients wither and die because they could not stick to the regimen. “I thought, ‘Oh, there is no survival here.’”

Then further tests showed that he had full-blown XDR-TB. He was transferred to Sizwe and offered a spot in the Nix trial.

Some patients there who were on the standard 40-pill regimens discouraged him. “They said, ‘They are using you as guinea pigs,’” he said. “Even the nurses thought that.”

But he found the possibility of taking only five pills for six months very tempting, and so he volunteered. Within a month, he could tell it was working.

“Then the patients who called us ‘guinea pigs’ — they wished they had taken the research pills,” he said.

This article originally appeared in <a href="https://www.nytimes.com/2019/08/14/health/tuberculosis-xdr-tb-cure.html" id="46a26a8d-23b6-30c2-aef2-9a2a69f41f6c">The New York Times</a>.

Scientists Discover a Cure for the Deadliest Strain of Tuberculosis

(Global Health)

The new implant, by the drug company Merck, was tested in just a dozen subjects for 12 weeks. But experts were quite excited at its potential to revolutionize the long battle against HIV.

The research was described on Tuesday at an international AIDS conference in Mexico City.

New HIV prevention methods are desperately needed. About 75 million people have contracted the lethal virus since the AIDS epidemic began. Even now, about 1.7 million people are infected each year — despite decades of promotion of condoms and abstinence, and years of efforts to get people to take a daily pill that prevents infection.

“If — and I’m emphasizing if — if it pans out in a larger trial that it delivers a level of drug that’s protective for a year, that would be a game-changer,” said Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Disease and a leading expert on AIDS.

Dr. Robert M. Grant, a researcher at the University of California, San Francisco, who led the landmark 2010 trial that proved that a daily pill could thwart HIV, said he had expected a breakthrough based on the powerful new drug used in the implant.

The device “seems ideal in many respects,” he added. “It can be removed if there are side effects or HIV infection.”

Merck’s innovation is to deliver its new antiretroviral drug, islatravir, with a proven technology long used for birth control: a matchstick-sized plastic rod inserted just under the skin of the upper arm that slowly releases tiny doses of the medication.

Many people at risk of HIV infection, particularly women in Africa, are desperate for prevention methods that are easier to use, and easier to conceal, than a bottle of pills.

According to UNAIDS, more than 6,000 young women under age 24 are infected every week, and 80% of infected teenagers in Africa are girls.

African girls are often victims of rape or pressured into sex with older men in return for food, clothes or cash.

Another study released Tuesday at the same conference reinforced the extreme vulnerability of young African women.

In it, 427 women and teenage girls in South Africa and Zimbabwe were given Truvada pills, the form of so-called preexposure prophylaxis to prevent HIV infection, also called PrEP, used in the United States.

They were repeatedly reminded to take the pills every day, but after one year, blood tests showed that less than a third were still taking any pills. Only 9% of the women and girls took them frequently enough to have protective levels of the drug in their bloodstreams.

The study’s authors are still interviewing participants about why they failed to comply. But women in Africa often say they cannot keep HIV drugs at home because they fear being accused by family, neighbors and lovers of being immoral or of having HIV. Some fear being threatened or beaten.

(Clinical trials among women in Africa often fail, or produce hard-to-interpret results, because some participants sign up but rarely use the interventions being tested. In interviews afterward, some have admitted to joining only because the trials offer free medical care and modest payments for participating.)

The drug used in the new implants is islatravir (pronounced IZ-lah-trah-veer), which until last week was known as EFdA or MK-8591. It is the first in a new class of drugs called nucleoside reverse transcriptase translocation inhibitors, which block movement of the enzyme responsible for cloning the virus’ DNA so that it can infect new cells.

Islatravir has “some remarkable attributes,” said Dr. Roy D. Baynes, Merck’s chief medical officer.

It is 10 times as potent as any previous HIV drug, he said, so tiny amounts are effective, which lowers the risk of side effects. The drug lingers in the body for a relatively long time — after five days, half of the dose remains — so it can be given less often that other HIV medications.

Unlike some HIV drugs, islatravir is absorbed into anal and genital tissues, which is where most infections start. And because it attacks a different step in the infection process, the drug appears not to give rise to viral strains with cross-resistance to other HIV drugs.

Other drug companies have recently reported success with other long-acting forms of HIV prevention. For example, injections of cabotegravir or rilpivirine deep into the buttocks have protected study participants for a month.

But monthly intramuscular injections are inconvenient and sometimes painful. And implants can be removed. The half-life of injectable cabotegravir, for example, is about 40 days. If a user develops a “breakthrough” HIV infection despite the injection, the lingering drug may drive the virus to mutate into a resistant form.

Although scientists are excited about the Merck implant’s possibilities, they warned that it still needs to prove itself.

The drug has protected rats and monkeys against multiple deliberate attempts to infect them, but human testing thus far has been only for safety: to see whether a handful of people could tolerate the implant for three months without dangerous side effects.

The assumption that the implant could protect against HIV for a year was arrived at by estimating how much drug is considered protective and how much the implant can hold. A real-world test will mean giving the implant to thousands of sexually active or drug-using men and women, and tracking how many get infected.

Such a trial will be long and expensive, said Mitchell J. Warren, executive director of AVAC, an advocacy group for HIV prevention.

Participants cannot just be given the implant and told to go out and have sex or inject drugs. Ethically, they must be offered the best prevention methods available, including oral PrEP, condoms, clean syringes and intensive counseling about safe sex or safe drug use.

That means many subjects must be followed for years to see if the implant works better than other methods.

Baynes, of Merck, declined to discuss how the next trial would be designed or to speculate on how long it would take. The company, he said, would consider testing in both the United States, where most HIV transmission is between gay men, and in Africa, where the virus is passed mostly between men and women.

He also declined to discuss the eventual cost, other than to say “we’re committed to responsible pricing.”

Price is a deeply contentious issue in PrEP. High hopes for a quick end to the AIDS epidemic raised by Grant’s 2010 study were dashed after relatively few Americans began taking Truvada — in part because Gilead, the patent-holder, raised the price to $20,000 a year and sued every generic competitor that tried to enter the market.

Other research groups have begun testing similar subdermal implants for HIV prevention, such as one that contains a new form of tenofovir, the main drug in Truvada.

High prices for prevention methods have been a constant disappointment, Grant said: “There is always a bright shiny new object with people asking, ‘Who cares what it costs?’”

This article originally appeared in <a href="https://www.nytimes.com/2019/07/23/health/hiv-aids-implant.html" id="1bfd8c3f-7a3d-3433-a897-c57d0a3c1325">The New York Times</a>.

In what could eventually become a milestone for HIV prevention, very preliminary tests of an implant containing a new drug suggest that it may protect against infection for a full year.

Someday, an Arm Implant May Prevent HIV Infection for a Year

Unlike some HIV drugs, islatravir is absorbed into anal and genital tissues, which is where most infections start.

The CDC emphasizes that children are the most important group to reach. Outbreaks spread rapidly in preschools and kindergartens, and young children often have infant siblings too young to get the vaccine.

But some adults, too, should consult with their doctors and consider getting the shot.

— Who is immune to measles?

The vast majority of adults in this country are immune, according to the CDC and other infectious disease experts. If adult Americans were not immune, the virus — which has been introduced from overseas every year since endemic circulation was eliminated in 2000 — would have spread widely before now.

But in the United States, outbreaks in the last 19 years have been largely confined to schools, churches, religious sects or other groups with low immunization rates.

Even the current tally of 704 confirmed cases is modest compared to recent outbreaks in some European countries. France had 2,913 cases last year, according to the World Health Organization; Italy had 2,686, and Britain had 953.

— Which adults should consider a booster shot?

Adults who lack “evidence of immunity,” as the CDC calls it, and are in any group with a slightly elevated risk of encountering the virus should consider getting a measles-mumps-rubella shot, the CDC says.

Those groups include health care workers, adults about to travel overseas, college students, and anyone living in a neighborhood or community now experiencing a measles outbreak.

— What is ‘evidence of immunity,’ and how do I get it?

Anyone born in the United States before 1957 is presumed to be immune, because virtually everyone caught measles back then. (Once you have endured a bout, you are almost always immune for life.)

Anyone whose medical records indicate that he or she had two doses of measles vaccine also is considered immune.

A doctor’s office can draw blood for an inexpensive test showing whether a patient has enough measles antibodies to be protected. Results are available in a few days.

— Who should avoid the MMR vaccine?

Pregnant women should not get the vaccine. But women who are thinking of getting pregnant and are not immune should have the shot at least one month before becoming pregnant.

Anyone with a life-threatening allergy to a vaccine ingredient or a weakened immune system should not get the shot. Nor should anyone with an immediate family member who has immune problems.

People with tuberculosis, with any condition that causes them to bleed or bruise easily, or who have recently received a blood transfusion or blood products — all should avoid the vaccine.

Anyone who has just had another vaccine should wait four weeks before getting the measles vaccine. Anyone who is moderately ill — with anything beyond a mild cold — should wait until he or she recovers.

— What about those born in the 1960s through 1980s? Was there a ‘bad vaccine’?

In 1963, two competing vaccines by Pfizer and Merck were introduced in the United States. The Pfizer vaccine contained virus “killed” with a formaldehyde-like chemical; the Merck shot contained a live but weakened virus.

The Pfizer vaccine (delivered in three doses) had virtually no side effects, but its protection waned quickly. The Merck one (a single shot) lasted much longer, but gave some children fever and a rash.

Other countries had rival products, and millions of children were vaccinated in trials testing various multidose combinations. In 1968, Merck produced a safer live vaccine, which eventually became the standard. It conferred about 93 percent protection in groups to whom it was given.

In 1989, medical authorities in the United States decided that was insufficient and recommended two doses — at roughly ages 1 and 5 — to boost overall protection to 97 percent.

If you were born in 1957 or later, and believe you were vaccinated but lack medical records detailing exactly which shot or shots you got — you are probably immune, especially if you were vaccinated after 1968. But the only way to be sure is to have a blood test.

Alternatively, you could just get another shot.

— Is it safe to have another measles shot even if you had them in childhood?

Yes. “If you don’t want to go through all the fandango of getting the test, it may be easier to just get the shot,” said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University Medical School. “There’s no downside to that alternative.”

— If adults rush to be vaccinated, will there be a vaccine shortage that leaves children vulnerable?

At the moment, there is no shortage of measles vaccine, according to the Food and Drug Administration. (There are shortages of vaccines for hepatitis B, shingles and yellow fever.)

Dr. Nancy Messonnier, director for immunization at the CDC, also said there was currently “a sufficient supply.”

In response to the current outbreak, Merck “has taken steps to increase U.S. supply of our MMR-II vaccine,” a company spokeswoman said.

If a shortage were to loom, the FDA could take steps to forestall it, including moving supplies around the country to cover spot shortages or permitting the import of equivalent products from countries that meet FDA standards.

This article originally appeared in <a href="https://www.nytimes.com/2019/04/30/health/adults-measles-vaccination.html" id="42c82cf4-aaf2-3aa1-ae61-558b0c476e33">The New York Times</a>.

Because of this year’s sharp increase in measles cases — which the Centers for Disease Control and Prevention has blamed a deliberate misinformation campaign by anti-vaccine activists for — many Americans are wondering whether they need to be vaccinated.

Should Adults Get a Measles Booster Shot?

The measles outbreak continues to spread in the United States, surpassing 700 cases this year, federal health officials said Monday. The virus has now been found in 22 states.

More than 500 of the 704 cases recorded as of Friday were in people who had not been vaccinated, the Centers for Disease Control and Prevention reported. Sixty-six people have been hospitalized.

About 400 of the cases have been found in New York City and its suburbs, mostly in Orthodox Jewish communities. That outbreak has spread to Detroit.

Los Angeles is now experiencing a fast-growing outbreak, and hundreds of university students who are thought to have been exposed and cannot prove that they have had their shots have been asked to quarantine themselves at home.

On Wednesday, the CDC said the number of cases had surpassed the previous high of 667, set in 2014. This year’s outbreak is the largest since the disease was declared eliminated in the United States in 2000. In 1994, there were 963 cases.

Elimination in 2000 meant measles virus was no longer circulating in the United States as it presumably had since European settlers first brought it to this hemisphere in the 15th or 16th century. Each year after 2000, a few cases arrived from overseas, either in immigrants or in returning tourists, but each outbreak was snuffed out.

More than 94% of American parents vaccinate their children against measles and other diseases, Dr. Robert Redfield, director of the CDC, said Monday.

His agency “is working to reach the small percentage of vaccine-hesitant individuals,” he said. “Vaccines are safe and do not cause autism."

About 100,000 children in this country under age 2 have not been vaccinated, he said, meaning they are vulnerable in this outbreak.

Some infants are not immunized because their parents avoid vaccination. Others cannot be protected either because they are allergic to components of the vaccine or are, for example, taking cancer or organ-transplant medications that suppress their immune systems.

“We must join together as a nation to once again eliminate measles,” Redfield said.

This year’s widespread outbreak was sparked by people infected with measles who have come into this country since last year, the CDC said. The measles strains detected were most frequently from Ukraine, Israel and the Philippines.

Communities have begun to take extraordinary measures to slow the infection rate and crack down on resistance to immunization.

New York City Mayor Bill de Blasio declared a state of emergency and threatened residents of four Brooklyn ZIP codes with $1,000 fines if they refused to vaccinate. City officials closed a yeshiva preschool for violating vaccination orders.

Rockland County, New York, the center of another outbreak, initially barred unvaccinated children from all indoor public places, including schools, malls, supermarkets, restaurants and houses of worship.

After a court blocked that order, the county instead barred from public spaces anyone who had measles symptoms or who had recently been exposed to the disease, threatening them with fines of up to $2,000 a day.

There have been no confirmed measles deaths in this country, but officials have said it is just a matter of time.

Even with modern medical care, the disease normally kills about 1 out of every 1,000 victims, according to the CDC.

Donald G. McNeil Jr.

Articles written by the author

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