by Tara Haelle, DXS contributor
The past few weeks have seen big
news for vaccines. A bill related to vaccine exemptions was signed into law, a
court ruled against a parent’s refusal to vaccinate and a recent study points
out the value of vaccinating a household — especially mom — to protect a young
infant from pertussis (whooping cough).
The latest news is that Governor
Jerry Brown in California signed a bill last Sunday that had been sitting on his desk
since September 6 and was the target of a number of rallies by parents who
didn’t want to see it pass. Among those fighting the bill was Dr. Bob Sears, who says he walks a middle ground with
vaccine policy but in reality tends to flirt with those who fear vaccines and
rely on misinformation. Although some parents claimed the bill took away their
right to choose whether their children get vaccinated, it actually just ensures
they get good medical information before they make that choice.
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| Photo by Dave Gostisha at sxc.hu. |
The bill-now-law, AB 2109, proposed
by a pediatrician, requires parents to get a statement signed by a health care
practitioner that the parents/guardians have received accurate, evidence-based information
about the risks and benefits of vaccines before they can use a personal belief
exemption to prevent their children from being vaccinated. This law is a
tremendous triumph both for informed consent in medical decisions and for the
public health of children in California, which saw a considerable outbreak of pertussis
(whooping cough) in 2010. Washington state passed a similar law last year
and saw 25 percent drop in exemptions filed. Other states are considering
similar laws in a nationwide overall shift toward
strengthening exemption requirements.
Why are these laws so important? In
short, they kill two birds with one stone: They make it more difficult for
parents to casually opt out of vaccines on philosophical grounds (as opposed to
religious or medical reasons), and they require parents who want to opt out to
at least hear out a pediatrician on accurate information about the actual risks
(which do exist) and benefits (there are so many) of immunizations. Parents who
are determined not to vaccinate their children can still refuse, but many
parents who might have signed those forms out of convenience — it can be easier
to sign than to get to the doctor’s office for the shot — will now at least
hear the impact a decision not to vaccinate can have on the community. (Hopefully, they go to a health care
practitioner other than Dr. Sears, whose stances have gradually been moving
further and further toward unscientific and misinformation of those who oppose
vaccines.)
It’s also particularly notable that California and Washington are
the most recent states to tighten opt-out procedures for parents because they
are home to some of the more recent
pertussis outbreaks. More on that in a moment.
First, a bit of background on
vaccine exemptions: Only 20 states have personal belief exemptions, and until last
year, eight of these simply require nothing more than a parent signature. Now
that number is down to six. (Other types of requirements for philosophical
exemptions include writing out your reasons for exemption, requiring the forms
to be notarized, requiring education on the risks/benefits, direct involvement
from the state or local health department or renewals.)
All states have medical exemptions
for patients who have auto-immune disorders, have proof that their bodies do
not respond to immunization, have documented allergic reactions or have other
circumstances which make it too risky for them to be immunized. In fact, these
are the very people that the rest of the population protects through herd
immunity when vaccination rates are up where they should be. All but two states
have religious exemptions (Mississippi and West Virginia are the exceptions).
And that brings us to some less
covered but still significant news about one state’s ruling on a particular
case involving religious exemption. Last week, the U.S. district court in Ohio
ruled that one woman’s claim of religious objection was insufficient for her
children to be exempted from being vaccinated. Read the whole story here. To be fair, this is a complex case
involving far more than vaccines; the mother is clearly neglectful and the
overall situation is pretty crappy. However, the fact that the court found “the
mere assertion of a religious belief ... does not automatically trigger First
Amendment protections,” and that “it has long been recognized that local
authorities may constitutionally mandate vaccinations” is significant in a
state that offers both religious and personal belief exemptions.
Because of the danger to public health
when clusters of kids are not vaccinated, my personal opinion on this issue is
that “personal belief” exemptions should not be offered in any state, and
religious exemptions should be extremely difficult to get, if they are offered
at all (which may be the best overall route). Some cite the Amish, Mennonite
and Christian Scientists, though actually the majority
of Amish children, at least, are vaccinated, and it doesn’t appear that any
Amish
objections to vaccines are for religious reasons. Christian Scientists have
successfully been convicted of neglect in other incidents
where their children died from inadequate medical care, though
their religion is the only one I’m aware of that vaccination actually,
explicitly violates.
The constitutionality of religious exemptions is dubious as
well. At the very least, however, anyone seeking any exemption should certainly
to see a doctor first to be sure they have accurate information and not simply
what they have seen online or heard at the playground. Those who absolutely
will not vaccinate in states without exemptions may also opt to home school or
send their children to private schools that don’t have requirements. But considering
the increasing rates of measles and the increasing epidemics of
pertussis, the need for high vaccination coverage in communities is more
important than ever.
It is true that the pertussis
vaccine is not as effective as the old one used to be, something I wrote about a few weeks ago. It’s also true that
pertussis peaks every five years or so, but even taking into account the peaks,
the overall rate of cases has been steadily
on the move upward. Dr. Offit, the chief of the Division of Infectious
Disease at Children’s Hospital of Philadelphia and a very vocal advocate of
vaccines, said he believes that parents’ refusals to vaccinate are playing
their own small part in the increase.
“The major contributor is waning
immunity. The minor contributor is the choice not vaccinate,” he said. He noted
that there are researchers working on the problem, as this Nature article notes (paywall), including attempts
to make a better vaccine with more adjuvants, the additives that enhance the
body’s immune response to a vaccine. While vaccinated children and adults have
been high among the numbers of those getting whooping cough, getting the
vaccine remains among the best ways to reduce your risk of contracting it — or
of having less rough of a time with it if you do get it. Dr. Offit also pointed
out that pregnant women in particular should be sure they get their booster.
Which brings us to the study
published last week that relates to the most important reason to get
vaccinated, at least from the perspective of preventing deaths — to protect the
babies who are too young for the vaccine but most likely to contract it and die
from it.
The study, published in the journal Epidemiology last week, looked at how
frequently pertussis was transmitted to others within the same household and
how effective “cocooning” is. Cocooning is vaccinating all the household
members who can get the vaccine for the purpose of protecting young babies who
can’t yet be vaccinated for the disease.
They found that transmission rates
within the home are high, especially for mothers passing the illness on to
their children. Therefore, making sure all pregnant women are vaccinated before
their baby arrives would, according to their calculations, cut the risk in half
that a baby would contract pertussis. The evidence for sibling vaccination,
though weaker, still points to the value of overall cocooning: “Vaccination of
siblings is less effective in preventing transmission within the household, but
may be as effective overall because siblings more often introduce an infection
in the household.”
Indeed, this year, siblings’
bringing home the disease appears more likely than ever in the states
experiencing big outbreaks this year. Just how bad are the numbers? Well, 2010
was the last five-year peak, which totaled 27,550 cases. It’s currently
September of 2012, and the numbers last reported to the CDC were at 29,834, and
that doesn’t even include over 3,700 cases in Minnesota that haven’t been officially
reported to the CDC yet. These numbers, which include 14 deaths (primarily of
babies under 3 months), may very well end up doubling the 2011
total of 18,719 if they continue at the current rate through the end of the
year. It’s the biggest pertussis outbreak since 1959.
Not surprisingly, the majority of
the states leading in pertussis cases are also among those that offer personal
belief exemptions. Washington, despite their new law, is sitting at 4,190 cases, quadrupling their 2011 count of
965. This is the state where 7.6 percent of parents opted for exemptions (among
all grade levels, not just kindergarten) in 2008-09, more than four times the
national rate of about 1.5 percent. Minnesota and Wisconsin have similarly high
rates and both have personal belief exemptions. The most recent numbers out of Minnesota are 3,748 — they had just 661
cases last year. Wisconsin is leading the nation with 4,640 cases, up from
1,192 in 2011, at last report in the Sept. 28 Morbidity and Mortality Weekly Report (pdf) at the CDC.
But the increases are being seen
across the nation, as this CDC map shows. Texas (1,287 cases to date this year),
Pennsylvania (1,428 cases) and Colorado (897 cases, though they averaged 158
over the past four years) are among other states with personal belief
exemptions (though the Texas one has significant restrictions and hoops to jump
through). But it’s clear the decreased effectiveness of the vaccine is playing
the biggest role, especially in places like Iowa (1,168 cases) and New York
(2,107), neither of which offer personal belief exemptions.
Again, though, a less effective
vaccine does not mean a worthless vaccine. It still offers 85 percent
protection when you get the shot or the booster, and even as it loses some
effectiveness as the years go by, you’re far less likely to have a severe case
if you do get the disease. And you’re protecting those around you, including
the babies who have only been here a few months and are the most susceptible to catching and dying from the disease.
Bottom line — it’s worth it to get
the shot, and to make sure your kids do too.
Opinions expressed in this article do not either necessarily reflect or conflict with those of the DXS editorial team or contributors.
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[Tara Haelle (www.tarahaelle.com) is a health and science writer and a photojournalist based in Peoria, IL after years as a Texan, where she earned her undergraduate degrees and MA in journalism at UT-Austin. She’s the mental health editor for dailyRx.com in addition to reporting on pediatrics, vaccines, sleep, parenting, prenatal care and obesity. Her blog, Red Wine & Apple Sauce, focuses on health and science news for moms, and you can follow her on Twitter at @health_reporter and @tarasue. She’s also swum with 9 different species of sharks, climbed Kilimanjaro and backpacked in over 40 countries, but that was in the years of B.C. (Before Children). She finds that two-year-olds are tougher to tussle with than tiger sharks.]
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