How are the cold and flu different?

Knowing the difference between the common cold and the flu can be crucial to your well-being — and that of your loved ones — this winter.

On Jan. 19, the Centers for Disease Control and Prevention (CDC) revealed that during the 2017 to 2018 flu season, there were 30 child deaths.

There have also been reports of adults who had the flu and died from complications.

Read on for a look at the two illnesses and how you can tell them apart.

Getting down to basics

“Because these two types of illnesses have similar symptoms, it can be difficult to tell the difference between them based on symptoms alone,” the CDC explains online. “In general, the flu is worse than the common cold, and symptoms are more common and intense.”

The agency notes that special testing may be performed early on to determine which illness you may have.

There’s also another point: The common cold is mainly caused by rhinoviruses, the Mayo Clinic says. The influenza virus, however, is responsible for causing the flu.


Common cold symptoms

Muscle aches, fevers, chills: the flu can be an unpleasant experience during chilly weather.  Here's what you need to know about seasonal influenza and how to prevent it.

Coughing, a runny nose, congestion and a sore throat are just some of the things patients with the common cold may experience, according to the Mayo Clinic. Others include sneezing and a minor headache or body aches.

“It’s usually harmless, although it might not feel that way,” the Mayo Clinic says of the common cold.

It notes that people usually recuperate within seven to 10 days, but recommends looking for treatment for certain health conditions, like when adults have a fever higher than 101.3 degrees Fahrenheit.


Flu symptoms

For one type of the virus, called Influenza A, the “classic” presentation of symptoms is a sudden onset, Dr. Neil Fishman, an infectious disease specialist and associate professor of medicine at the Hospital for the University of Pennsylvania, told Fox News.

People may first have a headache “more in the front of your head or behind your eyes,” with other symptoms being a fever of at least 103 degrees, chills, sweats and body aches.

Influenza B often is less severe and resembles the common cold, but there can be more serious cases, he noted.

People worried about the flu or who think they may have it should consult their physicians.

Fighting the opioid epidemic will require more court battles

Rate falls for second straight year; correspondent Ellison Barber looks at the numbers

New York City’s decision to file a lawsuit this week against eight big pharmaceutical corporations and distributors that ignited the nation’s raging opioid epidemic cannot bring back the hundreds of thousands of loved ones who have perished during this crisis.

But for families like my own that have suffered, it raises some hope that Big Pharma companies may yet be held responsible for their actions.

Unfortunately, accountability has been quite elusive since pill makers began flooding the market with prescription painkillers more than two decades ago.

As far back as 2001, Connecticut’s then-Attorney General (and now U.S. Senator) Richard Blumenthal sounded the warning cry about Oxycontin abuse, publicly urging manufacturer Purdue Pharma to take action to warn about the potential for addiction connected to the drug, which it aggressively marketed as “non-addictive.”

Three years later West Virginia became the first state to sue Purdue in a case that never went to trial and resulted in a $10 million settlement.

In 2007, Purdue finally pleaded guilty to misleading doctors and the public about Oxycontin’s potential for addiction and abuse, paying $600 million in fines and payments to settle the Justice Department case against the company.

By this time addictive pain pills, often snagged from unused bottles in family medicine cabinets, were as readily available as candy in the halls of the high school where my 16-year-old son Tommy, like many teens, was wrestling with his identity.

By 2010, pharmacies in Florida, where we were living, were selling more than 650 million oxycodone pills per year, with 93 of the top opioid-dispensing doctors in the U.S. operating in the state. (Oxycodone is the active ingredient in Oxycontin and is also an ingredient of other pain pills).

Then completely unaware of the word “opioid” or the deadly dagger Tommy was flirting with, my wife and I proceeded through our normal routine one Friday until our son didn’t come home after school.

When Tommy’s cellphone went straight to voicemail, we began a frantic and agonizing four-day search for him. We finally found him in a decrepit, abandoned building on the brink of overdose death. His drug of choice? Oxycontin.

Some 13 overdoses and nine years later, we’ve learned far more about the opioid crisis that we ever could have fathomed. About how easy it is to become addicted even after short-term use. How opioids rewire a person’s brain chemistry in ways that make overcoming the drug nearly impossible.

We also learned about how the stigma carried by the word “heroin” kept this growing problem in the shadows for so long, causing families to suffer in silence for fear of what their neighbors might think, and causing many Americans to mistakenly brush off opioid addiction as a skid row problem and not something that would affect them.

As our son continued to struggle through the vicious cycle of relapse, detox, recovery and repeat, we began to understand the scope of the problem. We count ourselves among the lucky ones, because Tommy has survived and is now doing well.

But we have no illusions that this will ever be over, because as any person who has overcome addiction can attest, it is a lifelong “one day at a time” challenge.

Today’s opioid epidemic can reach any family. It is an equal opportunity destroyer that strikes rural, suburban and urban communities, poor, middle-class and wealthy families – with no regard for race, age or gender.

Last year alone the opioid epidemic claimed more American lives than we lost during the Vietnam War. Nearly 100 people die every single day from either heroin or prescription pill overdose. And that’s just the statistics that are reported. The real toll is certainly higher.

Meanwhile, pharmaceutical companies continue to profit from this national tragedy. Since its record settlement in 2007, Purdue has continued to rake in billions of dollars from the sale of its homerun drug Oxycontin, vaulting the company’s family owners onto the Forbes Wealthiest Families in America list.

For those of us who are battle weary from the front lines of the crisis, it is small solace that some prominent Big Pharma actors might once again be found liable.

New York City joins a growing list of cities, counties and states that are suing to bring drug companies to justice in a move reminiscent of Big Tobacco lawsuits years ago. But the politics of greed that have allowed this infection to fester for so many years already make us skeptical that this time will be different.

Since Purdue’s huge settlement, Big Pharma has fought back in a big way, significantly increasing their lobbying efforts at the federal and state levels. According to The Associated Press and the Center for Public Integrity, Purdue, other pain pill producers, and their related nonprofit associations spent nearly $900 million on lobbying and political contributions between 2006 and 20015.

The amount spent by the industry’s influence machine is eight times more than the powerful gun lobby spent during the same time period. If anyone wonders how the opioid train rolled down the tracks for so long while politicians or regulatory officials looked the other way, the answers can be found in political spending records.

Similar to the speeches and press conferences that promise to end the opioid crisis, the pledges to make “Big Pharma pay for what they’ve done” will do little to change realities on the ground, at least for years to come. Even if settlements or further restrictions are achieved, it will be too little and too late for most American families coping with opioid addiction.

At least awareness has been heightened by the spate of new lawsuits. Anything we can do to further drag the problem out of the shadows and into the light is an important first step toward education and prevention. It’s hard to battle something that so many don’t even understand.

Sadly, the talk continues to far outpace the walk on the issue of opioid addiction. Most of our public leaders and government officials simply continue to scratch their heads about what to do next.

Until we can go move beyond the headline-grabbing promises to fight this epidemic and pursue the legitimate actions and resources needed to make a dent in it, don’t expect much to change.

Why feminists want Mila Kunis to turn down a Harvard award

A Harvard University theater group with an all-male cast is under fire from those who say it should allow women onstage — and they’re asking Mila Kunis to take up their cause.

On campus and off, detractors are calling on the Hasty Pudding troupe to start casting women and to update sexist portrayals of women. Amid the debate, some are calling on Kunis to reconsider her acceptance of the group’s Woman of the Year award on Thursday to protest the exclusion.

“It would be a wonderful thing for her to not accept this award, to say this is gender inequality,” said Liz Kantor, a senior studying molecular and cellular biology, who auditioned for this year’s show. “There are women on campus who are more than willing to take advantage of these opportunities, yet they’re still being excluded.”

Hasty Pudding is known for bawdy comedic revues that feature men in drag playing female characters, a longstanding tradition in the group, which says it was formed in 1795.

But more recently, women have sought acting roles in the student-written parodies, which are shown in Massachusetts, New York and Bermuda and have helped launch careers for former students ranging from Jack Lemmon to Broadway composer Larry O’Keefe.

Kantor is among about 20 women who auditioned for this year’s show as a form of protest, an idea started by two women in 2015. Each year, the women have promptly been cut.

Women can instead take behind-the-scenes jobs, including writing the shows or working on the business staff or technical crew, the group says on its website.

The group has been criticized for its all-male cast before, including in a 2016 petition from dozens of former members who urged it to accept women.

Students on Hasty Pudding’s executive board, which is led by a woman and includes several female members, declined to comment for this article. Overall, about half the 50 students involved with the group are women.

The troupe’s all-male cast took cues from the Shakespearean era, when men played all roles. Harvard itself admitted only male undergraduates until a partial merger with Radcliffe College in 1977.

The Man and Woman of the Year awards precede the kickoff of the annual revue, which includes more than 30 performances in February and March.

Kunis, whose credits include “That ’70s Show” and “Black Swan,” has spoken out sharply against sexism in entertainment, including in a defiant 2016 essay . She did not respond to a request for comment.

Others recently named Woman of the Year by the group include Octavia Spencer and Amy Poehler, who cracked a biting joke about the group’s exclusion of women when she accepted the honor in 2015.

“You know it’s time for a change when the Augusta National Golf Club has lapped you in terms of being progressive,” Poehler said, referring the Georgia club’s 2012 decision to admit women.

Some critics are also challenging the portrayal of women in the revues, which have featured characters with names like “Donna My Knees” and “Sheila Rowsya.”

“It just magnifies the misogyny that men are portraying these characters,” said Kantor, of West Nyack, New York. “They’re usually just the most blatant stereotypes you could think of.”

Hasty Pudding stated as a social club, taking its name from the porridge members brought to meetings. The school recognizes Hasty Pudding as a student group but doesn’t necessarily endorse its views, a school spokesman said. Officials declined to comment specifically on its casting policies.

But the administration has been working to curb campus groups that exclude members based on gender, including secretive all-male groups known on campus as “final clubs.”

Students who join single-gender social groups, for example, are banned from taking campus leadership positions, but Hasty Pudding is considered an arts group, not a social group, and isn’t subject to the rule.

Women who have pushed for a place in the cast say students are split. Some say women in drag wouldn’t be as funny, and some say the all-male cast is a tradition that should be protected.

But freshman Elle Shaheen, a theater major who auditioned for the cast, said the group is missing an opportunity to update its attitudes.

“This issue is not necessarily just about women. It’s about theater being all-inclusive,” said Shaheen, 18, of Portsmouth, New Hampshire. “I plan on continuing to fight for it, and I’ll audition next year, and the year after that.”

Breakup may have motivated Texas high school shooting, alleged gunman had violent past

A recent breakup may have pushed a student with a history of aggressive actions to shoot and seriously injure a 15-year-old girl in the cafeteria of their Texas high school on Monday, officials said.

Multiple students and a parent told FOX4 News the 16-year-old suspected gunman at Italy High School was in a relationship with the victim, but the pair had recently broken up. The students and parent told FOX4 the teenager was very upset about the breakup.

“I did know that the guy that was shooting was mad at the girl because she had left him for somebody else,”  Danaisia McCowan told FOX4. “So he shot at one guy and missed him, and then he shot at her.”

The suspect, whose name has not yet been released by police, appeared in court Wednesday after being charged with two counts of aggravated assault with a deadly weapon. The judge ordered the 16-year-old to remain in juvenile detention on the grounds that he is a danger to himself and others and does not have adequate supervision. He will undergo a psychological evaluation before his next detention hearing on Feb. 7, according to FOX4.

In this photo from video by KDFW Fox4, law enforcement personnel gather outside the high school in Italy, Texas, following an active shooter incident at the school Monday morning, Jan. 22, 2018. Sheriff's officials said a boy who is a student at the school was taken into custody. (KDFW Fox4 via AP)

Law enforcement personnel gather outside the high school in Italy, Texas, following an active shooter incident.  (FOX4)

The 16-year-old’s parents were in court, along with the victim’s mother but cameras were not allowed because he is a juvenile, FOX 4 reported. The suspect’s name and mugshot also will not be released.  Officials have not yet announced if the case will remain in juvenile court, or whether prosecutors will charge him as an adult.

Ellis County sheriff’s Sgt. Joe Fitzgerald told the Associated Press officials would inquire about any dating history involving the two as part of the investigation. Fitzgerald also said officials know where the handgun used in the shooting was obtained, but declined to publicly reveal that information.

The 15-year-old girl who was wounded in the gunfire is in “good spirits,” Italy Independent School District Superintendent Lee Joffre said Tuesday after making a visit at a Dallas hospital.

“It is an amazing demonstration of her strength that she was able to survive this,” he told reporters.


While officials have not officially released the name of the girl, an off-duty Dallas firefighter is being credited with helping to save her life.

In this photo from video by KDFW Fox4, law enforcement personnel gather outside the high school in Italy, Texas, following an active shooter incident at the school Monday morning, Jan. 22, 2018. Sheriff's officials said a boy who is a student at the school was taken into custody. (KDFW Fox4 via AP)

Authorities believe a breakup may have motivated a shooting at the high school in Italy, Texas.  (FOX4)

Capt. Charles Hyles told FOX4 News his kids go to the high school, and when he heard what happened Monday he ran inside the school to help. That’s when he found the girl shot four times on the ground in the cafeteria.

“She was saying, please don’t let her die. We told her we would not let her die,” Hyles said. “I felt a special bond with her. When she made me promise she wasn’t going to die, I needed to follow up on my promise that I would see her at the hospital.”

Noelle Jones suffered injuries that “range from a bullet lodged in her neck, another removed from her abdomen to a foot of unrepairable small intestine having to be removed,” according to a GoFundMe page set up to help her family with medical expenses.

Fellow students said the shooter had a violent history, and one parent told FOX4 she had complained to school administrators after the same boy threw scissors at her daughter in anger.

Cassie Shook, a 17-year-old junior at the school, told the AP she was angry when she learned who the suspect was because she’d complained about the boy at least twice to school officials, including to a vice principal.

“This could have been avoidable,” she said. “There were so many signs.”


Shook said she first went to school officials after the boy allegedly made a “hit list” in eighth grade and her name was on it. Then last year, the boy got angry during a class and threw a pair of scissors at her friend and later threw a computer against a wall, she said.

Joffre has repeatedly said that he can’t comment on disciplinary actions involving students. He says that the district “adheres to regulations established by the Texas Education Agency.”

“I have confidence that our administration always addresses the Texas education code appropriately,” he said.

In his statement Tuesday to parents and the community, Joffre said he understands they have “many questions and concerns.” At a news conference Tuesday afternoon at a church that lasted less than five minutes, Joffre said he’d like to help “possibly address some of the concerns” about “conversations and speculation regarding student discipline.”

Philadelphia aims to be first US city to host safe injection sites

Discarded syringes are seen in an open-air heroin market that has thrived for decades outside the heart of Philadelphia, July 31, 2017.

Philadelphia wants to become the first U.S. city to permit medically supervised drug injection sites as a way to combat the opioid epidemic, officials said Tuesday.

The city is seeking outside operators to establish at least one such site in the city, in a move met with both support and criticism.

Philadelphia has the highest opioid death rate of any large U.S. city. That mortality rate has been increasing, as more than 1,200 people fatally overdosed in Philadelphia in 2017 — one-third more than in 2016.

President Donald Trump declared the U.S. opioid crisis a public health emergency nearly three months ago.

In safe injection sites, people can shoot up under supervision of a doctor or nurse who can administer an overdose antidote if necessary.

The Philadelphia Inquirer called the city’s plan the “most radical step yet” against the opioid crisis.

Dr. Thomas Farley, public health commissioner, told the Inquirer that “we are facing an epidemic of historic proportions.” He said the sites could be “a life-saving strategy and a pathway to treatment.”

“No one here condones or supports illegal drug use in any way,” Farley said. “We want people saddled with drug addiction to get help.”

No U.S. city has established such a site, though Seattle has set aside $1.3 million to create a safe injection site there. Injection sites are operating in Canada and Europe.

Philadelphia officials visited Seattle and safe injection sites in Vancouver, where Farley said they have reduced overdose deaths, the spread of diseases like HIV and hepatitis C, and created safer neighborhoods that are free of used-needle litter.

The city officials concluded that a single site in the city would save 25 to 75 lives a year and millions of dollars in hospital costs and public funds, at the same reduce public injection of drugs, the Inquirer reported.

Rate falls for second straight year; correspondent Ellison Barber looks at the numbers

Councilwoman Helen Gym said the decision was “bold, brave, and lifesaving.”

Mayor Jim Kenney wasn’t at the news conference, but Farley said the Democrat supports the recommendation.

In contrast, critics have argued the sites may undermine prevention and treatment and cause safety concerns.

Pennsylvania House Speaker Mike Turzai, who is running for the Republican nomination to challenge Democratic Gov. Tom Wolf, called Philadelphia’s safe injection plan misguided and a violation of federal law.

It’s unclear how the federal government would respond if Philadelphia gets a safe-injection site. The U.S. Department of Justice declined to comment on the plan.

Meanwhile, the city hopes to hear from operators interested in setting up the injection sites, as locations are to be determined, the Inquirer reported.

Do e-cigarettes help or harm? Report says not clear yet

Vaping with e-cigarettes that contain nicotine can be addictive according to a new study by the National Academies of Sciences, Engineering and Medicine.

Electronic cigarettes could be a boon to public health or a major liability, depending on whether they help Americans quit smoking or encourage more young people to try traditional cigarettes, a new report concludes.

The report issued Tuesday wrestles with the potential benefits and harms of the vapor-emitting devices which have been sold in the U.S. for more than a decade. But those effects may not be known for decades, in part, because of how slowly illnesses caused by smoking emerge.

“In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern,” said David Eaton, of the University of Washington, who headed the National Academies of Sciences, Engineering and Medicine committee that studied the issue. “In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

There are no long-term studies on the health consequences of e-cigarettes and little consensus on whether they are effective in helping smokers quit, according to the report requested by the Food and Drug Administration.

The experts found “substantial” evidence that young people who use e-cigarettes are more likely to try cigarettes. On the other hand, experts found only “limited evidence” that cigarettes are effective tools to help adult smokers quit.

The committee’s review of more than 800 studies yielded many findings that were largely in line with prior assessments by other researchers. For instance, the panel found “conclusive evidence” that most e-cigarettes contain numerous chemicals that can be toxic. However, there was equally strong evidence that e-cigarettes contain fewer toxicants and at lower levels than regular cigarettes.

E-cigarettes have been sold in the U.S. since at least 2007. Most devices heat a liquid nicotine solution into vapor and have been promoted to smokers as a less dangerous alternative since they don’t have all the chemicals, tar or smoke of regular cigarettes. E-cigarettes and similar vaping devices have grown into a $4 billion-dollar U.S. industry with thousands of varieties of flavors and customizable products available in specialty shops and online.

The FDA gained authority to regulate the devices in 2016 after years of pushback from the industry. But last year the agency said it would delay the deadline for manufacturers to submit their devices for review until 2022. The decision was blasted by anti-smoking advocates who say some e-cigarette manufacturers target kids with candy and fruit flavors.

The FDA has signaled its intention to begin pushing U.S. consumers away from traditional cigarettes toward alternative products, such as e-cigarettes. The regulatory delay was intended, in part, to give companies more time to research their products.

FDA Commissioner Scott Gottlieb called the link between e-cigarette use and trying smoking in young people “troubling.”

“We need to put novel products like e-cigarettes through an appropriate series of regulatory gates to fully evaluate their risks and maximize their potential benefits,” he said in a statement.

Some other key takeaways and questions from the report:

— Chemicals in e-cigarette vapor, such as formaldehyde, are capable of damaging DNA in humans. However, it’s unclear if the chemicals exist at levels high enough to cause cancer.

— Switching completely from traditional cigarettes to e-cigarettes significantly reduces exposure to numerous cancer-causing chemicals.

— E-cigarettes can sometimes explode causing burns and injuries. The risk of such accidents is higher with devices that are stored improperly or contain low-quality batteries.

— There is substantial evidence that e-cigarette vapor contains traces of metal, possibly due to the metallic coils used to heat liquid that the devices vaporize.

Taco Bell employee assaults manager with hot burrito

A Taco Bell employee became outraged over having to work the morning shift and retaliated against his supervisor by whipping a hot burrito at her.

An angry employee at a South Carolina Taco Bell threw a hot burrito at his supervisor following an argument, a Spartanburg Police Department report says.

On Monday, a supervisor at the restaurant said the employee got angry over having to work the morning shift.

The supervisor said she told the employee to “stop being a crybaby” after he got into several verbal disputes with other coworkers, the report said.

The employee then threw a hot burrito at the supervisor and broke his headset over his knee in a rage before throwing it on the ground where it broke into several pieces. He then stormed out of the Spartanburg, SC, Taco Bell.

The supervisor was left with melted cheese on her left arm, and down her left side and leg, WYFF reported.

Melted cheese was also found on the kitchen appliances.

The police were called to the restaurant for an assault complaint following the altercation.

According to the police report, warrants in the case will be pursued, but no arrests have been made so far.

In-N-Out Burger reveals managers make $160k on average

The burger chain was also given a 91 percent on Glassdoor from employees would recommend working at In-N-Out to a friend.

In-N-Out revealed the salary of its managers in a recent interview with the California Sun.

According to the report the fast food restaurant pays its restaurant managers on average more than $160,000, which is more than triple the fast food industry average.

Workers at the family-owned chain begin at $13 per hour, which is $2.50 above California’s current minimum wage. Employees can work their way up to get the coveted manager’s salary, and a college degree is not necessary.

Benefits also include health insurance, vision, 401K and dental plans.

KTVU reached out to In-N-Out Burger corporate who confirmed managers make on average $160,000, but they did not release additional details.

Employees seem to appreciate working for In-N-Out. On 91 percent of employees would recommend working at In-N-Out to a friend. One former employee wrote that it can be a bit fast paced and stressful at times but it’s “great pay, and you can move up fairly quickly.”

9 people hurt in volcano eruption near Japanese ski resort

At least nine people were injured after a Volcano erupted at a ski resort in Japan on Tuesday.

A volcanic eruption Tuesday injured at least nine people at a ski resort in central Japan, officials said.

One or two of the injured were on a gondola when the window was shattered by volcanic rocks, and the others were believed to have been hit by rocks while on the slopes, said Makoto Shinohara, an official in Kusatsu town.

Five people had broken bones, but none of the injuries were life-threatening.

The Japanese military said six soldiers who were among about 30 on ski training were buried by an avalanche, but they had all been pulled out of the snow.

The Japan Meteorological Agency said Mount Kusatsu-Shirane erupted around 10 a.m.

A rest house at the resort was hit by volcanic rocks, but the extent of damage was not known, resort official Yasuaki Morita said.

Aerial photographs showed a large swath of the snowy volcano covered by dark gray ash.

After girl’s killing, Pakistani women speak out on abuse

The brutal rape and killing of Zainab Ansari, a 7-year-old girl whose body was left in a garbage dump, has unleashed a wave of revulsion around Pakistan, revealing a string of child abductions and killings by a suspected serial predator and generating outrage at a culture of silence surrounding sexual abuse.

Zainab’s death has even given birth to a nascent Pakistani version of #me_too movement.

A number of prominent Pakistani women have come forward with their own stories of sexual assault, saying they want to change traditions that consider abuse as a mark of shame for the victim. Those traditions, they say, help predators get away with abuse and encourage an already corrupt police force to ignore such crimes.

Maheen Khan, a legendary Pakistani fashion designer, tweeted that she had been sexually abused as a child by an Islamic cleric who taught her the Quran. “I froze in fear day after day,” she tweeted. At 73, Khan has spoken publicly only once before of the abuse.

“We are now saying enough is enough. We should have woken up long ago,” she said in a telephone interview from her home in the southern city of Karachi. “I am ashamed to say it has taken this one little girl’s death.”

“What disturbs me the most is the silence when a little girl gets raped,” she said. “It has to do with the honor of family. Parents tell their daughters: ‘Don’t talk about it. Don’t tell anyone.’ Our silence is saying it is all right to sexually molest a child.”

The horror of Zainab’s killing was brought home for Pakistanis by a photo of her that went viral on social media, showing the smiling girl in her favorite bright pink coat, with a pink barrette holding back her hair. TV channels aired the photo alongside pictures of her lifeless body abandoned on a heap of garbage in her home city of Kasur.

Across Pakistan, thousands protested, condemning police inaction and blaming the government for failing to protect children.

“Whenever anybody saw her picture on social media or on electronic media everybody started weeping,” said Waqas Abid, a lawyer in Kasur who heads an activist group called the Good Thinkers Organization. “Everybody was self-motivated to come out from his or her house and ask for justice for Zainab.”

The Senate’s Standing Committee on the Interior, which oversees policing, launched an inquiry this week into the sexual assaults in Kasur, as well as into another recent attack in another part of the country — the rape and killing of a 4-year-old named Asma, whose body was left in a field near her home in Kyhber Pukhtunkhwa, in northwestern Pakistan.

Kasur is a congested district of around 2.5 million people in eastern Pakistan, near the border with India. The city of Kasur is surrounded by brick kilns and tanneries and has hundreds of small factories making shoes and embroideries, all of which employ children — making them vulnerable to abuse. In 2015, an extensive child pornography ring was uncovered in the city; it had been flourishing for nearly a decade and involved nearly 250 children, some of whom were forced at gunpoint to have sex.

Zainab was snatched in early January as she walked to a Quran class. Her parents were away on pilgrimage in Saudi Arabia, and the girl and her two sisters and brother were watched over by her aunts and uncles who all live in the same house in an impoverished neighborhood of narrow lanes on the outskirts of the city.

“I told Zainab often to be careful,” her mother, Nusrat Ansari, said. Wrapped in a large shawl obscuring her face, she held Zainab’s photo, describing how she loved to play games with her cousins. Her favorite was hide and seek.

Her father, Mohammed Amin Ansari, denounced police for failing to warn residents about a serial killer in the city. “People don’t talk about sexual abuse,” he said.

It was only after the shock over Zainab that news emerged of other children abducted and raped in Kasur. Amid the uproar, police did testing on the victims and found the same DNA on eight of the children, all but one of whom was killed. Police now say they are hunting for a serial rapist-killer.

Among the eight victims was 5-year-old Ayesha. Her father, Mohammed Asif, said he pleaded with the police to find her after her abduction last year.

“They had no interest. They were more interested in keeping it quiet,” he told The Associated Press. Her body, showing signs of rape and torture, was found two days after her disappearance.

The sole survivor among the eight was a 6-year-old girl found by a homeless man rummaging through a garbage bin outside a vegetable market. She had been kidnapped for 15 hours, during which she was tortured. Cigarettes were put out on her feet and legs, and she suffered a serious head injury. Now at a hospital in the nearby city of Lahore, she can’t sit, hold up her head or speak, and her father Mohammad Ahsan, says all she does is cry.

Ahsan said his daughter’s attack was ignored in the media until Zainab’s killing.

Abid, the lawyer, said there have been at least 20 cases of children abducted, raped and killed over the past year in Kasur district. At his office, he showed the AP the police reports he has collected on 15 of the cases.

Among them were 7-year-old Laiba whose battered body was dumped in a partially constructed building; Imran, an 8-year-old boy whose body was stuffed in a plastic bag and dumped in a wheat field; 11-year-old Rehman Ali, found in stagnant water near a graveyard; 5-year-old Tehmina, abducted when she went to a nearby store to buy sweets; 7-year-old Sana, whose desperate father shouted her name from loudspeakers atop local mosques during his search for her; 11-year-old Fauzia, snatched from outside her home; and 7-year old Noor Fatima, her body found in a partially built house.

There were 4,139 cases of child sexual abuse reported in Pakistan in 2016, according to Sahil, an organization documenting child abuse in the country. It collects its figures by tracking reports in Pakistani media. But most cases go unreported, said Sahil’s executive director, Munizae Bano.

Zainab’s case, however, sparked a moment of openness. A number of well-known women hope that telling about their own experiences will prompt others to speak out.

Actress and child activist Nadia Jamil said anger and frustration at the silence prompted her to tweet about sexual abuse she suffered as a child.

“I just lost it when I went personal on social media, openly on social media,” she said.

Frieha Altaf, an events manager, model and actress who tweeted about abuse she suffered as a 6-year-old, said Zainab’s death is a catalyst to challenge shame and fear that silence victims and their parents.

“There is no stopping now,” she said. “For me, there is no stopping now.”

But Abid cautioned that change isn’t necessarily unstoppable. Frank language about sexual assault will likely bring a backlash from religious conservatives and many parents who oppose discussing sexual issues and hold tight to traditions that ban mixing of the sexes, consider girls responsible for the family “honor” and even forgive killing a girl who marries for love.

Ahsan and Asif, whose children were among the victims in Kasur, say their priority is to capture the serial predator.