Health Officials: Marin Parents Opting Out of Vaccines Put Community at Risk

By Thuy Vu

In Marin County, health experts are alarmed at a trend concerning childhood immunizations and the parallel rise of at least one disease that may be related. They're seeing a steady rise in the number of Marin parents who choose not to have their children vaccinated, and they now fear the numbers are high enough to threaten the health of the broader community.

California law requires that before children can enter kindergarten, they must be vaccinated for nine diseases, including chickenpox, measles and pertussis (better known as whooping cough). But parents can get around the law by filing a personal belief exemption, a short, signed statement that vaccines are against their personal beliefs.

In Marin, personal belief exemptions have doubled over the past decade to nearly 8 percent, the highest opt-out rate in the Bay Area and one of the highest in the state. Meanwhile, in April and May of this year, county public health officials reported a significant rise in pertussis cases. (Whooping cough cases have been on the rise in California and across the country; as of the end of June, Marin had reported more cases than almost any other county in the state.)

At many schools in the county, vaccination levels are now below what's needed for herd immunity.

"Herd immunity is an important concept because we need to have 85 to 95 percent of children in a community vaccinated in order to protect the community," said Dr. Nelson Branco of Tamalpais Pediatrics. "When the herd immunity is low, we start to see outbreaks."

Dr. Branco finds the opt-out trend so troubling that he decided to take a stand last spring. His office refuses to see patients who don't get the MMR shot for measles, mumps and rubella by age two.

Playing with fire

"Measles is dangerous. Infants under one can't be immunized for measles," Dr. Branco said. "In the 2008 outbreak in San Diego, there were 11 children who were ill with measles. Four of them were exposed in their doctors' waiting room. We didn't want that happening in our waiting room."

Tamalpais Pediatrics has about 8,000 patients. After the new policy was put in place, 20 families left Dr. Branco's practice. Many of them went to Pediatric Alternatives, which accepts families that don't want to get all of the standard vaccinations.

"We get a lot of families that come to us that want to vaccinate, but they're really concerned about the fact that they might have to give five or even six vaccines to their 2-month-old," said Pediatric Alternatives' Dr. Sarabenet Sequeira.

Dr. Sequeira says she believes most immunizations offer far more benefits than risks.

This fall, county health officials sent a survey to 3,000 parents of kindergarteners asking about their feelings on vaccines. They're hoping the results will help them better understand why parents opt out.

They're also hoping a new law in January will help reverse the trend by requiring parents to consult with a health care provider before asking for a personal belief exemption.

Even under that law, however, parents can sidestep the consultation by claiming a religious exemption.

Marin County's Public Health Officer, Dr. Matt Willis, recalls how he came very close to shutting down a school to unvaccinated children toward the end of the last school year after a pertussis outbreak made 100 students ill.

"We know that the same ingredients that caused the outbreak at the end of last year are present at the beginning of this year," Dr. Willis said. "It's partly because we have so many parents who are opting out of vaccines" on behalf of their children.

So far this year, the county has seen 140 cases of whooping cough. The problem extends well beyond Marin, as in 2010, more Californians came down with whooping cough than in any year since 1947. Ten babies died.

The video above is from the premiere episode of KQED NEWSROOM, a weekly news magazine program on television, radio and online, featuring Thuy Vu and Scott Shafer. Tune in to KQED Public Television 9 on Friday, Oct. 18, at 8 p.m. to watch the entire show. Listen to a rebroadcast at KQED Public Radio 88.5 FM on Sunday, Oct. 20, at 6 p.m.