Vaccine Waivers, Informed Consent and Public Health
Doubt and Denialism: Vaccine Myths Persist in the Face of Science
Facts are Facts
Health Officials to Consider Tightening Vaccine Exemptions
Whooping Cough Epidemic Exposes Holes in California's Immunization System
Sponsored
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Before 1963, about 3 to 4 million people got measles each year and an average of 450 people died, mostly children. After the vaccine became available, the number of measles cases dropped by 98%. (Image: CDC/ Cynthia S. 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(The image is colorized.) Bacteria cling to the cilia of the respiratory epithelial cells, paralyze cilia with toxins, and cause inflammation and dense mucus in the airways that induce coughing fits. Before a pertussis vaccine become available in the 1940s, pertussis was one of the most common childhood diseases and a major cause of death among children. Those who survive infection become immune to the disease, though public health officials think natural immunity, like vaccine-induced immunity, wears off. (Image: Energeo EU)","credit":null,"description":"Bordetella pertussis, the bacteria that causes pertussis (whooping cough) ","imgSizes":{"guest-author-32":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2012/08/Bordetella-pertussis-bacteria.feature-32x32.jpg","width":32,"height":32,"mimeType":"image/jpeg"},"guest-author-64":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2012/08/Bordetella-pertussis-bacteria.feature-64x64.jpg","width":64,"height":64,"mimeType":"image/jpeg"},"guest-author-96":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2012/08/Bordetella-pertussis-bacteria.feature-96x96.jpg","width":96,"height":96,"mimeType":"image/jpeg"},"guest-author-128":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2012/08/Bordetella-pertussis-bacteria.feature-128x128.jpg","width":128,"height":128,"mimeType":"image/jpeg"},"detail":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2012/08/Bordetella-pertussis-bacteria.feature-75x75.jpg","width":75,"height":75,"mimeType":"image/jpeg"},"kqedFullSize":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2012/08/Bordetella-pertussis-bacteria.feature.jpg","width":306,"height":172}},"fetchFailed":false,"isLoading":false},"quest_10190":{"type":"attachments","id":"quest_10190","meta":{"index":"attachments_1591205162","site":"quest","id":"10190","found":true},"title":"WildFire","publishDate":1288973432,"status":"inherit","parent":10188,"modified":1288973432,"caption":null,"credit":null,"description":"\u003cp class=\"attachment\">\u003ca href='http://www.kqed.org/quest/files/2010/11/WildFire.jpg' title='WildFire'>\u003cimg width=\"300\" height=\"199\" src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/11/WildFire.jpg\" class=\"attachment-medium\" alt=\"WildFire\" title=\"WildFire\" />\u003c/a>\u003c/p>","imgSizes":{"guest-author-32":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2010/11/WildFire1-32x32.jpg","width":32,"height":32,"mimeType":"image/jpeg"},"guest-author-64":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2010/11/WildFire1-64x64.jpg","width":64,"height":64,"mimeType":"image/jpeg"},"guest-author-96":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2010/11/WildFire1-96x96.jpg","width":96,"height":96,"mimeType":"image/jpeg"},"guest-author-128":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2010/11/WildFire1-128x128.jpg","width":128,"height":128,"mimeType":"image/jpeg"},"detail":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2010/11/WildFire1-75x75.jpg","width":75,"height":75,"mimeType":"image/jpeg"},"kqedFullSize":{"file":"https://ww2.kqed.org/app/uploads/sites/39/2010/11/WildFire1.jpg","width":300,"height":199}},"fetchFailed":false,"isLoading":false}},"audioPlayerReducer":{"postId":"stream_live"},"authorsReducer":{"dr-barry-starr":{"type":"authors","id":"6177","meta":{"index":"authors_1591205172","id":"6177","found":true},"name":"Dr. Barry Starr","firstName":"Dr. Barry","lastName":"Starr","slug":"dr-barry-starr","email":"bstarr@thetech.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Dr. Barry Starr (\u003ca href=\"https://twitter.com/geneticsboy\">@geneticsboy\u003c/a>) is a Geneticist-in-Residence at The Tech Museum of Innovation in San Jose, CA and runs their Stanford at The Tech program. The program is part of an ongoing collaboration between the \u003ca href=\"http://genetics.stanford.edu/\">Stanford Department of Genetics\u003c/a> and \u003ca href=\"http://www.thetech.org/\">The Tech Museum of Innovation\u003c/a>. Together these two partners created the \u003ca href=\"http://www.thetech.org/exhibits/permanent/index.php?sGalKey=gtwt&galKey=lt\">Genetics: Technology with a Twist\u003c/a> exhibition.\r\n\r\nYou can also see \u003ca href=\"https://ww2.kqed.org/science/author/dr-barry-starr/\">additional posts by Barry at KQED Science\u003c/a>, and read his \u003ca href=\"http://science.kqed.org/quest/author/dr-barry-starr/\">previous contributions\u003c/a> to \u003ca href=\"http://science.kqed.org/quest/\">QUEST\u003c/a>, a project dedicated to exploring the Science of Sustainability.","avatar":"https://secure.gravatar.com/avatar/4a5680e4c642ea0f0f3041af16018969?s=600&d=blank&r=g","twitter":"geneticsboy","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"science","roles":["author"]},{"site":"quest","roles":["subscriber"]}],"headData":{"title":"Dr. Barry Starr | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/4a5680e4c642ea0f0f3041af16018969?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/4a5680e4c642ea0f0f3041af16018969?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/dr-barry-starr"},"gabriela-quiros":{"type":"authors","id":"6186","meta":{"index":"authors_1591205172","id":"6186","found":true},"name":"Gabriela Quirós","firstName":"Gabriela","lastName":"Quirós","slug":"gabriela-quiros","email":"gquiros@kqed.org","display_author_email":false,"staff_mastheads":["science"],"title":"Video Producer and Reporter","bio":"Gabriela Quirós is a \u003cstrong>video producer and the coordinating producer for KQED's web science video series \u003ca href=\"https://www.kqed.org/deeplook\">Deep Look\u003c/a>\u003c/strong>. She joined KQED as a TV producer when its science series QUEST started in 2006 and has covered everything from Alzheimer’s to bee die-offs to dark energy.\r\n\r\nShe won a 2022 AAAS Kavli Science Journalism Award with a team of her Deep Look colleagues. She has won five regional Emmys as a video producer and has shared seven more as the coordinating producer of Deep Look. The episode she produced about \u003ca href=\"https://www.kqed.org/science/728086/how-mosquitoes-use-six-needles-to-suck-your-blood\">How Mosquitoes Use Six Needles to Suck Your Blood\u003c/a> won a Webby \"People's Voice\" award. She has also earned awards from the Jackson Hole Wildlife Film Festival, the Society of Professional Journalists and the Society of Environmental Journalists.\r\n\r\nHer videos for KQED have also aired on NOVA scienceNOW and the PBS NewsHour, and appeared on NPR.org.\r\n\r\nAs an independent filmmaker, she produced and directed the hour-long documentary \u003ca href=\"http://lpbp.org/beautiful-sin-qa-with-producer-gabriela-quiros/\">\u003cem>Beautiful Sin\u003c/em>\u003c/a>, about the surprising story of how Costa Rica became the only country in the world to outlaw in vitro fertilization. The film aired in 2015 on public television stations throughout the U.S., and in Costa Rica.\r\n\r\nShe started her journalism career as a newspaper reporter in Costa Rica, where she grew up. She won the National Science Journalism Award there for a series of articles about organic agriculture, and developed a life-long interest in health reporting. She moved to the Bay Area in 1996 to study documentary filmmaking at the University of California, Berkeley, where she received master’s degrees in journalism and Latin American studies.","avatar":"https://secure.gravatar.com/avatar/6d82c20152affd1b434c31a904c40809?s=600&d=blank&r=g","twitter":"gabrielaquirosr","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"science","roles":["editor"]},{"site":"quest","roles":["editor","ef_view_calendar","ef_view_story_budget"]}],"headData":{"title":"Gabriela Quirós | KQED","description":"Video Producer and Reporter","ogImgSrc":"https://secure.gravatar.com/avatar/6d82c20152affd1b434c31a904c40809?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/6d82c20152affd1b434c31a904c40809?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/gabriela-quiros"},"lizagross":{"type":"authors","id":"6322","meta":{"index":"authors_1591205172","id":"6322","found":true},"name":"Liza Gross","firstName":"Liza","lastName":"Gross","slug":"lizagross","email":"lizagross@gmail.com","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Liza Gross, an award-winning independent journalist and senior editor at the biomedical journal PLOS Biology, writes mostly about conservation and public and environmental health. She was a 2013 recipient of the NYU Reporting Award, a 2013 Dennis Hunt Health Journalism fellow and a 2015 USC Data Journalism fellow.\r\n\r\nRead her \u003ca href=\"http://science.kqed.org/quest/author/lizagross/\">previous contributions\u003c/a> to \u003ca href=\"science.kqed.org/quest/\">QUEST\u003c/a>, a project dedicated to exploring the Science of Sustainability.","avatar":"https://secure.gravatar.com/avatar/1f7d36efc78088d63466cef5f10c4c7a?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"stateofhealth","roles":["author"]},{"site":"science","roles":["author"]},{"site":"quest","roles":["subscriber"]}],"headData":{"title":"Liza Gross | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/1f7d36efc78088d63466cef5f10c4c7a?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/1f7d36efc78088d63466cef5f10c4c7a?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lizagross"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"quest_46104":{"type":"posts","id":"quest_46104","meta":{"index":"posts_1591205157","site":"quest","id":"46104","score":null,"sort":[1350486005000]},"guestAuthors":[],"slug":"vaccine-waivers-informed-consent-and-public-health","title":"Vaccine Waivers, Informed Consent and Public Health","publishDate":1350486005,"format":"aside","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cfigure id=\"attachment_46119\" class=\"wp-caption alignleft\" style=\"max-width: 450px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/10/17/vaccine-waivers-informed-consent-and-public-health/measles-micrograph-carousel/\" rel=\"attachment wp-att-46119\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/measles-micrograph-carousel-450x253.jpg\" alt=\"measles virus virion\" title=\"measles micrograph carousel\" width=\"450\" height=\"253\" class=\"size-medium wp-image-46119\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This electron micrograph image shows the structure of a single virus particle, or “virion,” of measles virus. Before 1963, about 3 to 4 million people got measles each year and an average of 450 people died, mostly children. After the vaccine became available, the number of measles cases dropped by 98%. (Image: CDC/ Cynthia S. Goldsmith; William Bellini, PhD) \u003c/figcaption>\u003c/figure>\n\u003cp>Gov. Jerry Brown has made it just a little bit harder for parents to refuse or skip vaccinations for their children. \u003c/p>\n\u003cp>By signing AB 2109 into law last month, Brown strengthened one of the nation's most permissive school immunization requirements. Under existing law, California parents could choose which vaccinations to reject simply by signing a form saying \u003ca href=\"http://www.cdph.ca.gov/pubsforms/forms/ctrldforms/pm286b.pdf\">“all or some immunizations are contrary to my beliefs.”\u003c/a>\u003c/p>\n\u003cp>Now, at least, their beliefs will need to be informed by actual science.\u003c/p>\n\u003cp>State laws require children entering private or public school to get immunized to reduce the risk of spreading infectious diseases to their classmates. All states allow medical exemptions for children with allergies, immunodeficiency or other conditions, and most allow exemptions on religious grounds.\u003c/p>\n\u003cp>California is one of 20 states that allow parents to opt out of laws requiring children to get vaccinated before they enter school simply because they choose not to. \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Costs of easy exemptions\u003c/strong>\u003cbr>\nIn California, personal belief exemption rates rose slowly between 1996 and 2007, from half a percent to 1.5 percent. But between 2008 and 2010, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22698009\">study published in the American Journal of Public Health\u003c/a> in August, the number of children with one or more personal belief exemptions increased by 25%. \u003c/p>\n\u003cp>That means more than 11,500 kids showed up in classrooms, playgrounds, and after-school activities without their vaccinations in 2010. Even more troubling, the number of kindergartners who attended schools with more than 20 exempted classmates more than doubled. Exempt children are clustering within the same schools, putting themselves—and their peers—at greater risk of an epidemic. \u003c/p>\n\u003cp>The San Francisco Bay Area has among the highest clustering of exemptions in the state, while Santa Cruz County ranks in the top 10 counties for all three measures analyzed: prevalence (proportion of students with exemptions), exposure (the likelihood a child would interact with an exempt classmate) and vulnerability (a measure of the risk of disease outbreak resulting from compromised herd immunity).\u003c/p>\n\u003cfigure id=\"attachment_46122\" class=\"wp-caption alignleft\" style=\"max-width: 329px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/10/17/vaccine-waivers-informed-consent-and-public-health/nigeria-cropped/\" rel=\"attachment wp-att-46122\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/nigeria-cropped-329x360.jpg\" alt=\"\" title=\"nigeria measles victim\" width=\"329\" height=\"360\" class=\"size-large wp-image-46122\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\"> This late 1960s photograph shows a Nigerian mother and her child, who was recovering from measles. The child’s skin is peeling as his measles infection heals. Measles victims in poor countries where other diseases are prevalent often require intensive nursing to avoid complications, including subsequent infections. (Image: CDC) \u003c/figcaption>\u003c/figure>\n\u003cp>The resurgence of vaccine-preventable diseases, from pertussis to measles, implicates exemptions in the outbreaks. But without data on the incidence of these vaccine-preventable diseases, says public health researcher Alison Buttenheim, “we can’t say for certain that more personal belief exemptions cause higher disease risk.”\u003c/p>\n\u003cp>Yet Buttenheim, an assistant professor at the University of Pennsylvania School of Nursing who led the study, says there’s one thing she knows for sure. “Parents who choose not to vaccinate are free-riders, relying on herd immunity maintained by those who do vaccinate to protect their children.”\u003c/p>\n\u003cp>Though Buttenheim didn’t have the data to study the link, \u003ca href=\"http://www.kdheks.gov/testimony/download/HB2094_Testimony_DCHunt_2012.pdf\">other studies\u003c/a> have found that exemptions tend to cluster geographically, increasing the risk of local disease outbreaks. \u003c/p>\n\u003cp>And in a recent study in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMc1209037\">New England Journal of Medicine\u003c/a>, states with looser exemption policies also had more cases of pertussis (or \"whooping cough\"), a bacterial infection that \u003ca href=\"http://www.cdc.gov/pertussis/outbreaks.html\">killed 10 infants in California\u003c/a> in 2010. (\u003ca href=\"http://www.whoopingcough.net/cough-child-muchwhooping.wav\">Anyone who thinks babies don't suffer from pertussis never heard this cough.\u003c/a>)\u003c/p>\n\u003cp>“Vaccine-preventable diseases are going to start in places where people are refusing,” says Roger Baxter, a physician, infectious disease expert and co-director of the Kaiser Permanente Vaccine Study Center in Oakland. “We have lots of evidence of that around the world. We’ve seen it. We know it will happen.” \u003c/p>\n\u003cp>That’s why some states are requiring parents to think through the risks of leaving their children—and their neighbors’ children—vulnerable to deadly pathogens by refusing some or all pediatric vaccinations.\u003c/p>\n\u003cp>Last year, \u003ca href=\"http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Exemptions.aspx\">Washington\u003c/a> (and just last month \u003ca href=\"http://www.leg.state.vt.us/docs/2012/Acts/ACT157.pdf\">Vermont\u003c/a>) passed laws requiring parents to have a health care professional certify that they received information regarding the risks of immunization, as well as the risks of exposing their family and community to potentially deadly diseases by forgoing immunization. \u003c/p>\n\u003cp>Under California's new law, starting January 2014, parents seeking personal belief exemptions must do the same. \u003c/p>\n\u003cp>The bill, sponsored by state Assemblyman Richard Pan (D-Sacramento), a pediatrician and director of the UC Davis Pediatric Residency Program, is little more than an \u003ca href=\"http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/informed-consent.page\">informed consent law\u003c/a>. Anytime you undergo a medical procedure, your doctor is required by law to counsel you on its risks and benefits. The bill requires the same counseling for parents who want to avoid vaccination.\u003c/p>\n\u003cp>In signing the bill, Brown noted that those “whose religious beliefs preclude vaccinations” don’t need a health care practitioner’s signature. Until the new law takes effect, the state’s philosophical and personal belief exemptions cover religious objections, and parents’ signatures are sufficient in either case. \u003c/p>\n\u003cp>\u003cstrong>The myth of 100% safety\u003c/strong>\u003cbr>\nBut for Baxter, vaccine refusal has veered into religion, with people obsessed with “uber-protection” and vaccine safety. “There’s nothing in this world that’s 100 percent safe,” he says. \u003c/p>\n\u003cp>“With vaccines, we expect some reactions like fevers or sore arms. But for serious adverse events, where we might expect 1 in 1,000 for most medications, if we see 1 in 100,000 for vaccines, we think it’s too much. Yet many people are worried about things that happen as rarely as 1 in a million. The benefits of vaccines far outweigh that.”\u003c/p>\n\u003cp>There’s a 1 to 2 in a million risk that the measles-controlling MMR vaccine will cause a serious adverse reaction like encephalitis or pneumonia. By contrast, \u003ca href=\"http://www.cdc.gov/measles/about/overview.html\">1 to 2 of every 1,000 measles cases\u003c/a> ends in death. \u003c/p>\n\u003cp>Just as no vaccine is 100% safe, no vaccine is 100% effective. That’s why the concept of \u003ca href=\"http://www.historyofvaccines.org/content/herd-immunity-0\">“herd immunity”\u003c/a> is so important. When vaccination rates in a community reach a certain threshold (85% to 95% depending on the contagiousness of the disease), then those who can’t get vaccinated—because they’re too young, on immune-suppressing treatments like chemotherapy, or their immune system didn’t respond to the vaccine—are still protected. \u003c/p>\n\u003cp>But herd immunity relies on high-compliance with recommended pediatric vaccination schedules. \u003c/p>\n\u003cp>An the trouble is, you’re not likely to know if your child’s vaccination didn’t offer full protection until he comes home sick after going to school, soccer practice, or a play date with unvaccinated peers.\u003c/p>\n\u003cp>\u003cstrong>Opportunistic pathogens\u003c/strong>\u003cbr>\nIn February 2010, the SF Department of Public Health \u003ca href=\"http://www.sfbaypeds.com/storage/post-files/SFDPH_Measles%20Health%20Alert.2010.2.22.final.pdf\">issued a health alert\u003c/a> about a measles outbreak. How it started is unclear. But two years earlier, 11 cases of measles in San Diego were traced to a seven-year-old unvaccinated boy who had traveled to Switzerland with his parents and came home with the measles. Within 19 days, he had infected his two siblings, five classmates, and four children—including three infants who were too young to be vaccinated—at his pediatrician’s office. One of the infants had to be hospitalized for severe dehydration, which can be fatal for babies. \u003c/p>\n\u003cp>The child who started the epidemic went to a school where 36 of 376 children—nearly 1 in 10—had personal belief exemptions.\u003c/p>\n\u003cp>That’s why some doctors have decided not to see families who shun vaccination. Some regularly treat very sick children and don’t want to risk exposing them to infections that could cause complications and even death. But most doctors that Baxter works with see the informed consent law as an opportunity to explain the risks to parents who didn’t really understand them. \u003c/p>\n\u003cfigure id=\"attachment_46142\" class=\"wp-caption alignleft\" style=\"max-width: 614px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/10/17/vaccine-waivers-informed-consent-and-public-health/rubella-poster-smaller2/\" rel=\"attachment wp-att-46142\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/rubella-poster-smaller2-614x360.jpg\" alt=\"rubella vaccine poster\" title=\"rubella poster\" width=\"614\" height=\"360\" class=\"size-large wp-image-46142\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Typically a mild childhood illness, rubella (also known as “German measles”) can pose a serious threat to the developing fetus if the mother is infected during pregnancy. More than 20,000 babies were born with congenital rubella syndrome (CRS) during an outbreak in 1964-65, before the US vaccine was licensed in 1969. CRS can cause diverse symptoms ranging from deafness to seizures, encephalitis, and developmental delays. (Image: CDC)\u003c/figcaption>\u003c/figure>\n\u003cp>Before Brown signed the bill, anti-vaccination activists led by ex-SNL cast member Rob Schneider fought against the bill on the grounds of parental rights, child safety, and a \u003ca href=\"http://scienceblogs.com/insolence/2012/06/29/makin-copies-of-antivaccine-nonsense-against-california-bill-ab-2019/\">list of myths too numerous\u003c/a> to go into here. Incredibly, Sacramento-based TV News Channel 10 \u003ca href=\"http://www.news10.net/video/1824491466001/1/Rob-Schneider-discusses-his-stance-on-AB-2109-with-News10\">gave Schneider 11 minutes\u003c/a> to spread his misinformation. He was joined by die-hard anti-vaccination activist Dawn Winkler and Tony Amador, a candidate for the Assembly seat held by the author of AB 2109, Richard Pan. \u003c/p>\n\u003cp>Activists like Winkler and Schneider tell people that vaccines are dangerous and parents should have the right to decide what’s best for their children. What’s really dangerous, though, is giving people like Schneider — who have little grasp of the facts about vaccines, immunology, or public health — a platform to spread their misinformed beliefs. Infectious disease experts know what Schneider can't seem to grasp. Infectious pathogens are remarkably adaptable and will readily exploit any weaknesses in herd immunity to make a roaring comeback.\u003c/p>\n\u003cp>In 2008, a pertussis outbreak at an El Sobrante Waldorf school forced public health officials to close the school temporarily. According to data filed with the California Department of Public Health, 68% of children attending that school have personal belief exemptions on file this year. Only 6% of children there are fully vaccinated. \u003c/p>\n\u003cp>The San Francisco Waldorf School isn't far behind, with personal belief exemptions for 59% of children, leaving 22% of students without all their vaccinations. At the Greenwood School in Mill Valley, where 79% of students have personal belief exemptions, only 2% of children are fully vaccinated. \u003c/p>\n\u003cp>It’s bad enough that people who don’t want to vaccinate are putting they own children at risk, Baxter says. “But they’re also putting their children’s friends at risk, they’re putting little babies who are too young to be vaccinated at risk, they’re putting immune-compromised kids at risk, and they’re putting their classmates at risk.”\u003c/p>\n\u003cp>People shouldn’t lull themselves into complacency thinking that high vaccination rates in general will protect their kids. “If there’s a pertussis outbreak,” Baxter says, “it’s going to start in schools with high personal exemption rates. Same with measles, varicella, any vaccine-preventable disease. They’re going to start in places where people are refusing.”\u003c/p>\n\u003cp>Parents have the right to ask school administrators to disclose the exemption rates at their child’s school. You can also go to the California Department of Public Health’s web site to find each school’s exemption rates. \u003c/p>\n\u003cp>It would be a good thing if parents refused to send their kids to schools with high exemption rates, Baxter says, rather than choosing schools where “parental rights” are viewed as more important than public health. \u003c/p>\n\u003cp>In the end, he adds, it takes a mandate to bring vaccinations up to the levels that can protect people from these diseases. “It’s the only thing that works because people are busy, or lazy—or have weird ideas.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Or, in too many cases, they're getting medical advice from the likes of Rob Schneider instead of a doctor.\u003c/p>\n\n","blocks":[],"excerpt":"Starting in 2014, California will require parents to see a health practitioner to learn the risks and benefits of vaccination before opting out of the state's immunization requirements. Public health officials hope that when parents learn the difference between science-based evidence and the uninformed myths so prevalent online and in the mainstream media, they'll decide to protect their children from the real risks of infectious disease, rather than worry about unfounded theoretical risks. ","status":"publish","parent":0,"modified":1351578670,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":39,"wordCount":2009},"headData":{"title":"Vaccine Waivers, Informed Consent and Public Health | KQED","description":"Starting in 2014, California will require parents to see a health practitioner to learn the risks and benefits of vaccination before opting out of the state's immunization requirements. Public health officials hope that when parents learn the difference between science-based evidence and the uninformed myths so prevalent online and in the mainstream media, they'll decide to protect their children from the real risks of infectious disease, rather than worry about unfounded theoretical risks. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"46104 http://science.kqed.org/quest/?p=46104","disqusUrl":"https://ww2.kqed.org/quest/2012/10/17/vaccine-waivers-informed-consent-and-public-health/","disqusTitle":"Vaccine Waivers, Informed Consent and Public Health","path":"/quest/46104/vaccine-waivers-informed-consent-and-public-health","audioUrl":"http://www.whoopingcough.net/cough-child-muchwhooping.wav","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_46119\" class=\"wp-caption alignleft\" style=\"max-width: 450px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/10/17/vaccine-waivers-informed-consent-and-public-health/measles-micrograph-carousel/\" rel=\"attachment wp-att-46119\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/measles-micrograph-carousel-450x253.jpg\" alt=\"measles virus virion\" title=\"measles micrograph carousel\" width=\"450\" height=\"253\" class=\"size-medium wp-image-46119\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This electron micrograph image shows the structure of a single virus particle, or “virion,” of measles virus. Before 1963, about 3 to 4 million people got measles each year and an average of 450 people died, mostly children. After the vaccine became available, the number of measles cases dropped by 98%. (Image: CDC/ Cynthia S. Goldsmith; William Bellini, PhD) \u003c/figcaption>\u003c/figure>\n\u003cp>Gov. Jerry Brown has made it just a little bit harder for parents to refuse or skip vaccinations for their children. \u003c/p>\n\u003cp>By signing AB 2109 into law last month, Brown strengthened one of the nation's most permissive school immunization requirements. Under existing law, California parents could choose which vaccinations to reject simply by signing a form saying \u003ca href=\"http://www.cdph.ca.gov/pubsforms/forms/ctrldforms/pm286b.pdf\">“all or some immunizations are contrary to my beliefs.”\u003c/a>\u003c/p>\n\u003cp>Now, at least, their beliefs will need to be informed by actual science.\u003c/p>\n\u003cp>State laws require children entering private or public school to get immunized to reduce the risk of spreading infectious diseases to their classmates. All states allow medical exemptions for children with allergies, immunodeficiency or other conditions, and most allow exemptions on religious grounds.\u003c/p>\n\u003cp>California is one of 20 states that allow parents to opt out of laws requiring children to get vaccinated before they enter school simply because they choose not to. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Costs of easy exemptions\u003c/strong>\u003cbr>\nIn California, personal belief exemption rates rose slowly between 1996 and 2007, from half a percent to 1.5 percent. But between 2008 and 2010, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22698009\">study published in the American Journal of Public Health\u003c/a> in August, the number of children with one or more personal belief exemptions increased by 25%. \u003c/p>\n\u003cp>That means more than 11,500 kids showed up in classrooms, playgrounds, and after-school activities without their vaccinations in 2010. Even more troubling, the number of kindergartners who attended schools with more than 20 exempted classmates more than doubled. Exempt children are clustering within the same schools, putting themselves—and their peers—at greater risk of an epidemic. \u003c/p>\n\u003cp>The San Francisco Bay Area has among the highest clustering of exemptions in the state, while Santa Cruz County ranks in the top 10 counties for all three measures analyzed: prevalence (proportion of students with exemptions), exposure (the likelihood a child would interact with an exempt classmate) and vulnerability (a measure of the risk of disease outbreak resulting from compromised herd immunity).\u003c/p>\n\u003cfigure id=\"attachment_46122\" class=\"wp-caption alignleft\" style=\"max-width: 329px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/10/17/vaccine-waivers-informed-consent-and-public-health/nigeria-cropped/\" rel=\"attachment wp-att-46122\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/nigeria-cropped-329x360.jpg\" alt=\"\" title=\"nigeria measles victim\" width=\"329\" height=\"360\" class=\"size-large wp-image-46122\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\"> This late 1960s photograph shows a Nigerian mother and her child, who was recovering from measles. The child’s skin is peeling as his measles infection heals. Measles victims in poor countries where other diseases are prevalent often require intensive nursing to avoid complications, including subsequent infections. (Image: CDC) \u003c/figcaption>\u003c/figure>\n\u003cp>The resurgence of vaccine-preventable diseases, from pertussis to measles, implicates exemptions in the outbreaks. But without data on the incidence of these vaccine-preventable diseases, says public health researcher Alison Buttenheim, “we can’t say for certain that more personal belief exemptions cause higher disease risk.”\u003c/p>\n\u003cp>Yet Buttenheim, an assistant professor at the University of Pennsylvania School of Nursing who led the study, says there’s one thing she knows for sure. “Parents who choose not to vaccinate are free-riders, relying on herd immunity maintained by those who do vaccinate to protect their children.”\u003c/p>\n\u003cp>Though Buttenheim didn’t have the data to study the link, \u003ca href=\"http://www.kdheks.gov/testimony/download/HB2094_Testimony_DCHunt_2012.pdf\">other studies\u003c/a> have found that exemptions tend to cluster geographically, increasing the risk of local disease outbreaks. \u003c/p>\n\u003cp>And in a recent study in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMc1209037\">New England Journal of Medicine\u003c/a>, states with looser exemption policies also had more cases of pertussis (or \"whooping cough\"), a bacterial infection that \u003ca href=\"http://www.cdc.gov/pertussis/outbreaks.html\">killed 10 infants in California\u003c/a> in 2010. (\u003ca href=\"http://www.whoopingcough.net/cough-child-muchwhooping.wav\">Anyone who thinks babies don't suffer from pertussis never heard this cough.\u003c/a>)\u003c/p>\n\u003cp>“Vaccine-preventable diseases are going to start in places where people are refusing,” says Roger Baxter, a physician, infectious disease expert and co-director of the Kaiser Permanente Vaccine Study Center in Oakland. “We have lots of evidence of that around the world. We’ve seen it. We know it will happen.” \u003c/p>\n\u003cp>That’s why some states are requiring parents to think through the risks of leaving their children—and their neighbors’ children—vulnerable to deadly pathogens by refusing some or all pediatric vaccinations.\u003c/p>\n\u003cp>Last year, \u003ca href=\"http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Exemptions.aspx\">Washington\u003c/a> (and just last month \u003ca href=\"http://www.leg.state.vt.us/docs/2012/Acts/ACT157.pdf\">Vermont\u003c/a>) passed laws requiring parents to have a health care professional certify that they received information regarding the risks of immunization, as well as the risks of exposing their family and community to potentially deadly diseases by forgoing immunization. \u003c/p>\n\u003cp>Under California's new law, starting January 2014, parents seeking personal belief exemptions must do the same. \u003c/p>\n\u003cp>The bill, sponsored by state Assemblyman Richard Pan (D-Sacramento), a pediatrician and director of the UC Davis Pediatric Residency Program, is little more than an \u003ca href=\"http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/informed-consent.page\">informed consent law\u003c/a>. Anytime you undergo a medical procedure, your doctor is required by law to counsel you on its risks and benefits. The bill requires the same counseling for parents who want to avoid vaccination.\u003c/p>\n\u003cp>In signing the bill, Brown noted that those “whose religious beliefs preclude vaccinations” don’t need a health care practitioner’s signature. Until the new law takes effect, the state’s philosophical and personal belief exemptions cover religious objections, and parents’ signatures are sufficient in either case. \u003c/p>\n\u003cp>\u003cstrong>The myth of 100% safety\u003c/strong>\u003cbr>\nBut for Baxter, vaccine refusal has veered into religion, with people obsessed with “uber-protection” and vaccine safety. “There’s nothing in this world that’s 100 percent safe,” he says. \u003c/p>\n\u003cp>“With vaccines, we expect some reactions like fevers or sore arms. But for serious adverse events, where we might expect 1 in 1,000 for most medications, if we see 1 in 100,000 for vaccines, we think it’s too much. Yet many people are worried about things that happen as rarely as 1 in a million. The benefits of vaccines far outweigh that.”\u003c/p>\n\u003cp>There’s a 1 to 2 in a million risk that the measles-controlling MMR vaccine will cause a serious adverse reaction like encephalitis or pneumonia. By contrast, \u003ca href=\"http://www.cdc.gov/measles/about/overview.html\">1 to 2 of every 1,000 measles cases\u003c/a> ends in death. \u003c/p>\n\u003cp>Just as no vaccine is 100% safe, no vaccine is 100% effective. That’s why the concept of \u003ca href=\"http://www.historyofvaccines.org/content/herd-immunity-0\">“herd immunity”\u003c/a> is so important. When vaccination rates in a community reach a certain threshold (85% to 95% depending on the contagiousness of the disease), then those who can’t get vaccinated—because they’re too young, on immune-suppressing treatments like chemotherapy, or their immune system didn’t respond to the vaccine—are still protected. \u003c/p>\n\u003cp>But herd immunity relies on high-compliance with recommended pediatric vaccination schedules. \u003c/p>\n\u003cp>An the trouble is, you’re not likely to know if your child’s vaccination didn’t offer full protection until he comes home sick after going to school, soccer practice, or a play date with unvaccinated peers.\u003c/p>\n\u003cp>\u003cstrong>Opportunistic pathogens\u003c/strong>\u003cbr>\nIn February 2010, the SF Department of Public Health \u003ca href=\"http://www.sfbaypeds.com/storage/post-files/SFDPH_Measles%20Health%20Alert.2010.2.22.final.pdf\">issued a health alert\u003c/a> about a measles outbreak. How it started is unclear. But two years earlier, 11 cases of measles in San Diego were traced to a seven-year-old unvaccinated boy who had traveled to Switzerland with his parents and came home with the measles. Within 19 days, he had infected his two siblings, five classmates, and four children—including three infants who were too young to be vaccinated—at his pediatrician’s office. One of the infants had to be hospitalized for severe dehydration, which can be fatal for babies. \u003c/p>\n\u003cp>The child who started the epidemic went to a school where 36 of 376 children—nearly 1 in 10—had personal belief exemptions.\u003c/p>\n\u003cp>That’s why some doctors have decided not to see families who shun vaccination. Some regularly treat very sick children and don’t want to risk exposing them to infections that could cause complications and even death. But most doctors that Baxter works with see the informed consent law as an opportunity to explain the risks to parents who didn’t really understand them. \u003c/p>\n\u003cfigure id=\"attachment_46142\" class=\"wp-caption alignleft\" style=\"max-width: 614px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/10/17/vaccine-waivers-informed-consent-and-public-health/rubella-poster-smaller2/\" rel=\"attachment wp-att-46142\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/rubella-poster-smaller2-614x360.jpg\" alt=\"rubella vaccine poster\" title=\"rubella poster\" width=\"614\" height=\"360\" class=\"size-large wp-image-46142\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Typically a mild childhood illness, rubella (also known as “German measles”) can pose a serious threat to the developing fetus if the mother is infected during pregnancy. More than 20,000 babies were born with congenital rubella syndrome (CRS) during an outbreak in 1964-65, before the US vaccine was licensed in 1969. CRS can cause diverse symptoms ranging from deafness to seizures, encephalitis, and developmental delays. (Image: CDC)\u003c/figcaption>\u003c/figure>\n\u003cp>Before Brown signed the bill, anti-vaccination activists led by ex-SNL cast member Rob Schneider fought against the bill on the grounds of parental rights, child safety, and a \u003ca href=\"http://scienceblogs.com/insolence/2012/06/29/makin-copies-of-antivaccine-nonsense-against-california-bill-ab-2019/\">list of myths too numerous\u003c/a> to go into here. Incredibly, Sacramento-based TV News Channel 10 \u003ca href=\"http://www.news10.net/video/1824491466001/1/Rob-Schneider-discusses-his-stance-on-AB-2109-with-News10\">gave Schneider 11 minutes\u003c/a> to spread his misinformation. He was joined by die-hard anti-vaccination activist Dawn Winkler and Tony Amador, a candidate for the Assembly seat held by the author of AB 2109, Richard Pan. \u003c/p>\n\u003cp>Activists like Winkler and Schneider tell people that vaccines are dangerous and parents should have the right to decide what’s best for their children. What’s really dangerous, though, is giving people like Schneider — who have little grasp of the facts about vaccines, immunology, or public health — a platform to spread their misinformed beliefs. Infectious disease experts know what Schneider can't seem to grasp. Infectious pathogens are remarkably adaptable and will readily exploit any weaknesses in herd immunity to make a roaring comeback.\u003c/p>\n\u003cp>In 2008, a pertussis outbreak at an El Sobrante Waldorf school forced public health officials to close the school temporarily. According to data filed with the California Department of Public Health, 68% of children attending that school have personal belief exemptions on file this year. Only 6% of children there are fully vaccinated. \u003c/p>\n\u003cp>The San Francisco Waldorf School isn't far behind, with personal belief exemptions for 59% of children, leaving 22% of students without all their vaccinations. At the Greenwood School in Mill Valley, where 79% of students have personal belief exemptions, only 2% of children are fully vaccinated. \u003c/p>\n\u003cp>It’s bad enough that people who don’t want to vaccinate are putting they own children at risk, Baxter says. “But they’re also putting their children’s friends at risk, they’re putting little babies who are too young to be vaccinated at risk, they’re putting immune-compromised kids at risk, and they’re putting their classmates at risk.”\u003c/p>\n\u003cp>People shouldn’t lull themselves into complacency thinking that high vaccination rates in general will protect their kids. “If there’s a pertussis outbreak,” Baxter says, “it’s going to start in schools with high personal exemption rates. Same with measles, varicella, any vaccine-preventable disease. They’re going to start in places where people are refusing.”\u003c/p>\n\u003cp>Parents have the right to ask school administrators to disclose the exemption rates at their child’s school. You can also go to the California Department of Public Health’s web site to find each school’s exemption rates. \u003c/p>\n\u003cp>It would be a good thing if parents refused to send their kids to schools with high exemption rates, Baxter says, rather than choosing schools where “parental rights” are viewed as more important than public health. \u003c/p>\n\u003cp>In the end, he adds, it takes a mandate to bring vaccinations up to the levels that can protect people from these diseases. “It’s the only thing that works because people are busy, or lazy—or have weird ideas.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Or, in too many cases, they're getting medical advice from the likes of Rob Schneider instead of a doctor.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/46104/vaccine-waivers-informed-consent-and-public-health","authors":["6322"],"categories":["quest_4","quest_12"],"tags":["quest_11538","quest_13201","quest_11537","quest_2163","quest_13202","quest_3054","quest_3056"],"featImg":"quest_46119","label":"quest"},"quest_42176":{"type":"posts","id":"quest_42176","meta":{"index":"posts_1591205157","site":"quest","id":"42176","score":null,"sort":[1344438037000]},"guestAuthors":[],"slug":"doubt-and-denialism-vaccine-myths-persist-in-the-face-of-science","title":"Doubt and Denialism: Vaccine Myths Persist in the Face of Science","publishDate":1344438037,"format":"standard","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cp>As a science journalist, I’m often confronted with the unsettling fact that a sizable portion of my audience rejects what scientists know is true.\u003c/p>\n\u003cp>Take two classic cases, climate change and evolution. Even though \u003ca href=\"http://environment.yale.edu/climate/files/Climate-Beliefs-March-2012.pdf\">two-thirds of Americans believe global warming is happening\u003c/a> (up 3% from last year), less than half think we’re to blame. Just 15% of Americans believe humans evolved over millions of years from archaic species, \u003ca href=\"http://www.gallup.com/poll/155003/Hold-Creationist-View-Human-Origins.aspx\">while 46% think God created us pretty much as-is\u003c/a> sometime within the past 10,000 years. That’s right, 46%—a figure that’s barely budged since Gallup started asking the question 30 years ago.\u003c/p>\n\u003cp>But it’s yet another evidence-impervious belief that I find most troubling. Last year, a Harris Interactive/HealthDay poll found that \u003ca href=\"http://www.harrisinteractive.com/newsroom/pressreleases/tabid/446/mid/1506/articleid/674/ctl/readcustom%20default/default.aspx\">18% of Americans think vaccines cause autism\u003c/a>—a theory that has no basis in scientific reality, doesn’t even have a plausible biological basis, and has been knocked down more times than a metal duck in a shooting gallery. (Nearly a third aren’t sure if there’s any connection, while just over half think none exists.)\u003c/p>\n\u003cp>The blithe rejection of scientific knowledge in favor of, well, fantasy has become so common that it now has a name: “denialism.”\u003c/p>\n\u003cp>Denialism can take many forms, but most scholars agree that simply raising doubt about an issue can undercut the legitimacy of an entire corpus of scientific evidence in the public’s mind. And \u003ca href=\"http://www.lastwordonnothing.com/2012/04/25/the-impasse-when-the-truth-wins-assumption-fails/\">tactics for raising doubt\u003c/a> abound. Those identified by infectious disease experts in a \u003ca href=\"http://eurpub.oxfordjournals.org/content/19/1/2.full\">2009 commentary\u003c/a> include charges of conspiracy—for example, accusing vaccine advocates of profiting from the “vaccine-industrial complex”—and creating impossible expectations of what science can do—“absolute proof” that vaccines are safe, most recently raised by one-time “Saturday Night Live” cut-up Rob Schneider in a \u003ca href=\"http://www.huffingtonpost.com/2012/07/01/rob-schneider-links-autism-vaccines_n_1641922.html\">bizarre interview\u003c/a>. I must point out that in \u003ca href=\"http://blogs.plos.org/thepanicvirus/2012/07/18/apparently-rob-schneider-thinks-all-caps-is-a-substitute-for-having-a-clue-a-lower-cased-fact-based-rebuttal/\">peddling his vaccine-autism insanity\u003c/a>, Schneider noted that autism was “nearly unheard of in the 1930s.” No joke. I guess he didn’t realize the syndrome wasn’t described until 1943.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Opportunistic Pathogens\u003c/strong>\u003cbr>\nIn a way, that 18% still believe vaccines cause autism shows progress—down from 25% just two years ago. But unlike the idea that humans spontaneously appeared through an act of God, believing against all evidence that vaccines cause autism (or ill-defined harm) can have dangerous consequences.\u003c/p>\n\u003cp>Last month, CDC officials reported more than 18,000 cases of whooping cough (or pertussis) across the country—a rate of infection they hadn’t seen so early in the year since 1959. So far, nine babies have died.\u003c/p>\n\u003cp>California had its own epidemic in 2010, with more than 9,100 cases and 10 infant deaths.\u003c/p>\n\u003cp>Pertussis is a vaccine-preventable disease. But prevention depends on public compliance. And people like Schneider who doubt vaccine safety tend to consider their children’s vaccinations optional. In the 2011 poll, 86% of doubters opted out of some or all of their kids’ scheduled shots. That’s why some blame vaccine skeptics for the current epidemic. With just 84% of toddlers fully vaccinated, it’s likely skeptics play some role.\u003c/p>\n\u003cp>But CDC officials aren’t sure what’s behind the epidemic, or why even vaccinated teenagers are getting sick. It’s possible that the \u003ca href=\"http://www.wired.com/wiredscience/2012/08/pertussis-vax-effectiveness/\">vaccine isn’t as effective as researchers hoped\u003c/a> or has been \u003ca href=\"http://www.pbs.org/newshour/bb/health/jan-june11/pledge_03-16.html\">targeting the wrong pathogen strains\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_42266\" class=\"wp-caption alignleft\" style=\"max-width: 296px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/08/08/doubt-and-denialism-vaccine-myths-persist-in-the-face-of-science/polio_vaccine_poster/\" rel=\"attachment wp-att-42266\">\u003cimg class=\"size-large wp-image-42266\" title=\"Polio_vaccine_poster\" src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/08/Polio_vaccine_poster-296x360.jpg\" alt=\"polio vaccine poster\" width=\"296\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The CDC’s national symbol of public health, the \"Wellbee\", appears in this 1963 poster to encourage the public to get the oral polio vaccine. (Image: CDC/ Mary Hilpertshauser)\u003c/figcaption>\u003c/figure>\n\u003cp>What officials do know is that \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a1.htm\">unvaccinated kids are eight times as likely to get pertussis as vaccinated kids\u003c/a>. And when vaccinated kids do contract the disease, it’s much milder, doesn’t last as long, and tends to be less infectious.\u003c/p>\n\u003cp>That’s why public officials are \u003ca href=\"http://blogs.plos.org/bodypolitic/2012/07/26/a-forgotten-but-crucial-cause-for-the-pertussis-epidemic/\">urging adults, especially pregnant women, to get boosters\u003c/a> to protect children still too young to be fully vaccinated. Kids get the first of five pertussis shots (plus a later booster) at 2 months. Most pertussis deaths claim children younger than 3 months old. Nine of the 10 children who died in California during the 2010 outbreak were under 8 weeks old.\u003c/p>\n\u003cp>\u003cstrong>Separating Fears from Facts\u003c/strong>\u003cbr>\nAll this weighed heavily on my mind last week, when I \u003ca href=\"http://blogs.plos.org/biologue/2012/07/31/could-vaccines-breed-super-virulent-malaria/\">wrote about new research\u003c/a> that could conceivably feed vaccine doubts. \u003ca href=\"http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1001368\">The study\u003c/a>, a fascinating investigation of experimental evolution in lab mice, found that vaccines can favor the evolution of more virulent malaria parasites.\u003c/p>\n\u003cp>Vicki Barclay (a postdoc in evolutionary biologist \u003ca href=\"http://www.youtube.com/watch?v=cvXc9aMF6CA\">Andrew Read\u003c/a>’s group at Penn State University) vaccinated mice with a malaria protein found in several vaccines now in clinical trials. She mimicked natural disease transmission by using needles instead of mosquitoes and letting parasites grow in one mouse before infecting the next one. (She did the same thing with unvaccinated mice.) Parasites that evolved in immunized mice caused more severe disease symptoms than those that evolved in unvaccinated mice.\u003c/p>\n\u003cp>Inevitably, some will misconstrue these results to confirm their belief that vaccines aren’t safe. Except the findings don’t say anything about vaccine safety. They show that, from a pathogen’s point of view, medical technologies act like any other selective pressure. We spend billions to develop the most powerful drugs science can muster only to discover we’re outnumbered, outgunned, and outmaneuvered. Millions of years of evolution have endowed pathogens with survival strategies we’ve yet to imagine.\u003c/p>\n\u003cp>Lest you delude yourself into thinking we humans have an edge in this evolutionary battle, consider this: Scientists have managed to wipe out just one human pathogen. Ever. After Edward Jenner discovered a smallpox vaccine in 1798, it took nearly 200 years and an all-out international effort to eradicate this disfiguring disease.\u003c/p>\n\u003cp>As Read and Barclay’s study shows, when you try to kill pathogens, they fight back. And when vaccines don’t destroy all the parasites (like the \u003ca href=\"http://www.sciencenews.org/view/generic/id/335354/title/Malaria_vaccine_yields_protection\">malaria vaccine now in clinical trials)\u003c/a> or fail to provide lifelong immunity (like the pertussis vaccine), the survivors can evolve. And they might come back even stronger.\u003c/p>\n\u003cp>I know that most people who shun government vaccine schedules \u003ca href=\"http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1000114\">have their children’s best interests at heart\u003c/a>. Some truly worry that vaccines may somehow cause irreversible damage to their child—and if it happened, how could they ever forgive themselves?\u003c/p>\n\u003cp>But anyone who chooses not to vaccinate their kids is missing something critical: the pathogens vaccine researchers are trying so desperately to control are formidable opponents. And though scientists still have a lot to learn about how pathogens adapt to our efforts to control them, they’re sure of this much: vaccines aren’t the enemy.\u003c/p>\n\u003cp>Vaccines rarely provide 100% protection. But they’re the state-of-the-art defense against infectious disease.\u003c/p>\n\u003cp>What’s more, if vaccine-preventable diseases like pertussis become more virulent, and there’s \u003ca href=\"http://wwwnc.cdc.gov/eid/article/15/8/pdfs/08-1511.pdf\">some evidence that this may be true\u003c/a>, those who refuse vaccination will have little recourse when their kids—or their neighbors’ kids—take ill.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Public health officials often say that parents who reject vaccination will realize they’ve made a terrible mistake only when these once rare childhood diseases, long controlled by vaccination, return, with tragic consequences. Why on earth would anyone want to help a deadly agent hell-bent on survival get the upper hand?\u003c/p>\n\n","blocks":[],"excerpt":"Many people continue to doubt the evidence for climate change, evolution, and vaccine safety, even though the scientific consensus on these issues is rock solid. Among the most troubling evidence-resistant theories is the long-debunked yet persistent myth that vaccines cause autism—a completely unfounded belief--leading to general doubts about vaccine safety, with dangerous public health consequences.\r\n\r\n\r\n","status":"publish","parent":0,"modified":1478825957,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1278},"headData":{"title":"Doubt and Denialism: Vaccine Myths Persist in the Face of Science | KQED","description":"Many people continue to doubt the evidence for climate change, evolution, and vaccine safety, even though the scientific consensus on these issues is rock solid. Among the most troubling evidence-resistant theories is the long-debunked yet persistent myth that vaccines cause autism—a completely unfounded belief--leading to general doubts about vaccine safety, with dangerous public health consequences.\r\n\r\n\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"42176 http://science.kqed.org/quest/?p=42176","disqusUrl":"https://ww2.kqed.org/quest/2012/08/08/doubt-and-denialism-vaccine-myths-persist-in-the-face-of-science/","disqusTitle":"Doubt and Denialism: Vaccine Myths Persist in the Face of Science","path":"/quest/42176/doubt-and-denialism-vaccine-myths-persist-in-the-face-of-science","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>As a science journalist, I’m often confronted with the unsettling fact that a sizable portion of my audience rejects what scientists know is true.\u003c/p>\n\u003cp>Take two classic cases, climate change and evolution. Even though \u003ca href=\"http://environment.yale.edu/climate/files/Climate-Beliefs-March-2012.pdf\">two-thirds of Americans believe global warming is happening\u003c/a> (up 3% from last year), less than half think we’re to blame. Just 15% of Americans believe humans evolved over millions of years from archaic species, \u003ca href=\"http://www.gallup.com/poll/155003/Hold-Creationist-View-Human-Origins.aspx\">while 46% think God created us pretty much as-is\u003c/a> sometime within the past 10,000 years. That’s right, 46%—a figure that’s barely budged since Gallup started asking the question 30 years ago.\u003c/p>\n\u003cp>But it’s yet another evidence-impervious belief that I find most troubling. Last year, a Harris Interactive/HealthDay poll found that \u003ca href=\"http://www.harrisinteractive.com/newsroom/pressreleases/tabid/446/mid/1506/articleid/674/ctl/readcustom%20default/default.aspx\">18% of Americans think vaccines cause autism\u003c/a>—a theory that has no basis in scientific reality, doesn’t even have a plausible biological basis, and has been knocked down more times than a metal duck in a shooting gallery. (Nearly a third aren’t sure if there’s any connection, while just over half think none exists.)\u003c/p>\n\u003cp>The blithe rejection of scientific knowledge in favor of, well, fantasy has become so common that it now has a name: “denialism.”\u003c/p>\n\u003cp>Denialism can take many forms, but most scholars agree that simply raising doubt about an issue can undercut the legitimacy of an entire corpus of scientific evidence in the public’s mind. And \u003ca href=\"http://www.lastwordonnothing.com/2012/04/25/the-impasse-when-the-truth-wins-assumption-fails/\">tactics for raising doubt\u003c/a> abound. Those identified by infectious disease experts in a \u003ca href=\"http://eurpub.oxfordjournals.org/content/19/1/2.full\">2009 commentary\u003c/a> include charges of conspiracy—for example, accusing vaccine advocates of profiting from the “vaccine-industrial complex”—and creating impossible expectations of what science can do—“absolute proof” that vaccines are safe, most recently raised by one-time “Saturday Night Live” cut-up Rob Schneider in a \u003ca href=\"http://www.huffingtonpost.com/2012/07/01/rob-schneider-links-autism-vaccines_n_1641922.html\">bizarre interview\u003c/a>. I must point out that in \u003ca href=\"http://blogs.plos.org/thepanicvirus/2012/07/18/apparently-rob-schneider-thinks-all-caps-is-a-substitute-for-having-a-clue-a-lower-cased-fact-based-rebuttal/\">peddling his vaccine-autism insanity\u003c/a>, Schneider noted that autism was “nearly unheard of in the 1930s.” No joke. I guess he didn’t realize the syndrome wasn’t described until 1943.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Opportunistic Pathogens\u003c/strong>\u003cbr>\nIn a way, that 18% still believe vaccines cause autism shows progress—down from 25% just two years ago. But unlike the idea that humans spontaneously appeared through an act of God, believing against all evidence that vaccines cause autism (or ill-defined harm) can have dangerous consequences.\u003c/p>\n\u003cp>Last month, CDC officials reported more than 18,000 cases of whooping cough (or pertussis) across the country—a rate of infection they hadn’t seen so early in the year since 1959. So far, nine babies have died.\u003c/p>\n\u003cp>California had its own epidemic in 2010, with more than 9,100 cases and 10 infant deaths.\u003c/p>\n\u003cp>Pertussis is a vaccine-preventable disease. But prevention depends on public compliance. And people like Schneider who doubt vaccine safety tend to consider their children’s vaccinations optional. In the 2011 poll, 86% of doubters opted out of some or all of their kids’ scheduled shots. That’s why some blame vaccine skeptics for the current epidemic. With just 84% of toddlers fully vaccinated, it’s likely skeptics play some role.\u003c/p>\n\u003cp>But CDC officials aren’t sure what’s behind the epidemic, or why even vaccinated teenagers are getting sick. It’s possible that the \u003ca href=\"http://www.wired.com/wiredscience/2012/08/pertussis-vax-effectiveness/\">vaccine isn’t as effective as researchers hoped\u003c/a> or has been \u003ca href=\"http://www.pbs.org/newshour/bb/health/jan-june11/pledge_03-16.html\">targeting the wrong pathogen strains\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_42266\" class=\"wp-caption alignleft\" style=\"max-width: 296px\">\u003ca href=\"http://ww2.kqed.org/quest/2012/08/08/doubt-and-denialism-vaccine-myths-persist-in-the-face-of-science/polio_vaccine_poster/\" rel=\"attachment wp-att-42266\">\u003cimg class=\"size-large wp-image-42266\" title=\"Polio_vaccine_poster\" src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/08/Polio_vaccine_poster-296x360.jpg\" alt=\"polio vaccine poster\" width=\"296\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The CDC’s national symbol of public health, the \"Wellbee\", appears in this 1963 poster to encourage the public to get the oral polio vaccine. (Image: CDC/ Mary Hilpertshauser)\u003c/figcaption>\u003c/figure>\n\u003cp>What officials do know is that \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a1.htm\">unvaccinated kids are eight times as likely to get pertussis as vaccinated kids\u003c/a>. And when vaccinated kids do contract the disease, it’s much milder, doesn’t last as long, and tends to be less infectious.\u003c/p>\n\u003cp>That’s why public officials are \u003ca href=\"http://blogs.plos.org/bodypolitic/2012/07/26/a-forgotten-but-crucial-cause-for-the-pertussis-epidemic/\">urging adults, especially pregnant women, to get boosters\u003c/a> to protect children still too young to be fully vaccinated. Kids get the first of five pertussis shots (plus a later booster) at 2 months. Most pertussis deaths claim children younger than 3 months old. Nine of the 10 children who died in California during the 2010 outbreak were under 8 weeks old.\u003c/p>\n\u003cp>\u003cstrong>Separating Fears from Facts\u003c/strong>\u003cbr>\nAll this weighed heavily on my mind last week, when I \u003ca href=\"http://blogs.plos.org/biologue/2012/07/31/could-vaccines-breed-super-virulent-malaria/\">wrote about new research\u003c/a> that could conceivably feed vaccine doubts. \u003ca href=\"http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1001368\">The study\u003c/a>, a fascinating investigation of experimental evolution in lab mice, found that vaccines can favor the evolution of more virulent malaria parasites.\u003c/p>\n\u003cp>Vicki Barclay (a postdoc in evolutionary biologist \u003ca href=\"http://www.youtube.com/watch?v=cvXc9aMF6CA\">Andrew Read\u003c/a>’s group at Penn State University) vaccinated mice with a malaria protein found in several vaccines now in clinical trials. She mimicked natural disease transmission by using needles instead of mosquitoes and letting parasites grow in one mouse before infecting the next one. (She did the same thing with unvaccinated mice.) Parasites that evolved in immunized mice caused more severe disease symptoms than those that evolved in unvaccinated mice.\u003c/p>\n\u003cp>Inevitably, some will misconstrue these results to confirm their belief that vaccines aren’t safe. Except the findings don’t say anything about vaccine safety. They show that, from a pathogen’s point of view, medical technologies act like any other selective pressure. We spend billions to develop the most powerful drugs science can muster only to discover we’re outnumbered, outgunned, and outmaneuvered. Millions of years of evolution have endowed pathogens with survival strategies we’ve yet to imagine.\u003c/p>\n\u003cp>Lest you delude yourself into thinking we humans have an edge in this evolutionary battle, consider this: Scientists have managed to wipe out just one human pathogen. Ever. After Edward Jenner discovered a smallpox vaccine in 1798, it took nearly 200 years and an all-out international effort to eradicate this disfiguring disease.\u003c/p>\n\u003cp>As Read and Barclay’s study shows, when you try to kill pathogens, they fight back. And when vaccines don’t destroy all the parasites (like the \u003ca href=\"http://www.sciencenews.org/view/generic/id/335354/title/Malaria_vaccine_yields_protection\">malaria vaccine now in clinical trials)\u003c/a> or fail to provide lifelong immunity (like the pertussis vaccine), the survivors can evolve. And they might come back even stronger.\u003c/p>\n\u003cp>I know that most people who shun government vaccine schedules \u003ca href=\"http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1000114\">have their children’s best interests at heart\u003c/a>. Some truly worry that vaccines may somehow cause irreversible damage to their child—and if it happened, how could they ever forgive themselves?\u003c/p>\n\u003cp>But anyone who chooses not to vaccinate their kids is missing something critical: the pathogens vaccine researchers are trying so desperately to control are formidable opponents. And though scientists still have a lot to learn about how pathogens adapt to our efforts to control them, they’re sure of this much: vaccines aren’t the enemy.\u003c/p>\n\u003cp>Vaccines rarely provide 100% protection. But they’re the state-of-the-art defense against infectious disease.\u003c/p>\n\u003cp>What’s more, if vaccine-preventable diseases like pertussis become more virulent, and there’s \u003ca href=\"http://wwwnc.cdc.gov/eid/article/15/8/pdfs/08-1511.pdf\">some evidence that this may be true\u003c/a>, those who refuse vaccination will have little recourse when their kids—or their neighbors’ kids—take ill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Public health officials often say that parents who reject vaccination will realize they’ve made a terrible mistake only when these once rare childhood diseases, long controlled by vaccination, return, with tragic consequences. Why on earth would anyone want to help a deadly agent hell-bent on survival get the upper hand?\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/42176/doubt-and-denialism-vaccine-myths-persist-in-the-face-of-science","authors":["6322"],"categories":["quest_4","quest_9","quest_12"],"tags":["quest_256","quest_11335","quest_2163","quest_13","quest_2532","quest_2538","quest_3054","quest_3056"],"featImg":"quest_42287","label":"quest"},"quest_10188":{"type":"posts","id":"quest_10188","meta":{"index":"posts_1591205157","site":"quest","id":"10188","score":null,"sort":[1289232525000]},"guestAuthors":[],"slug":"facts-are-facts","title":"Facts are Facts","publishDate":1289232525,"format":"standard","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cp>\u003cem>Everyone is entitled to his own opinion, but not his own facts.\u003c/em>\u003c/p>\n\u003cp>Daniel Patrick Moynihan\u003cbr>\n\u003cbr>\n\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/11/WildFire.jpg\" alt=\"\">\u003c/a>\u003cem>High numbers of vaccinated people act like a fire break\u003cbr>that keeps a disease from spreading.\u003c/em>\u003c/span>\u003c/p>\n\u003cp>Because anyone can write anything on the web, it can be hard to know what is fact and what is not. I wrote about this in my last \u003ca href=\"http://ww2.kqed.org/quest/2010/10/25/tracing-bad-and-dangerous-internet-science/\">blog\u003c/a>. And this issue has become alarmingly apparent in a discussion going on in a recent QUEST \u003ca href=\"http://ww2.kqed.org/quest/2010/10/13/health-officials-to-consider-tightening-vaccine-exemptions/\">blog about vaccinations\u003c/a>.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>In the comments section of this blog, someone writes that herd immunity is a complete myth. This is wrong. Herd immunity is real and actually makes perfect sense.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Obviously for a disease to spread, it has to go from one person to another (either directly or indirectly). A man with measles on a deserted island won’t spread it to anyone because there is no one else who can catch it. Same thing with an infected man in the midst of a group of people immune to the disease.\u003c/p>\n\u003cp>If we start adding people to the island, then it can spread. And if we put the man with the measles into a group of susceptible people, then it will flare up into a bona fide epidemic (think America when the first Europeans landed).\u003c/p>\n\u003cp>Now imagine a city where most of the people are immune. If the man with the measles goes there, odds are he won’t meet anyone susceptible. When he gets better, the disease will disappear. This is herd immunity.\u003c/p>\n\u003cp>Basically the immune people shield the susceptible ones from the disease. They act as sort of a fire break that keeps the epidemic from spreading. Perfectly reasonable idea.\u003c/p>\n\u003cp>Of course, it is possible that even though this makes sense it doesn’t actually happen in the real world. I decided to look back at the literature and see if there are any real examples of herd immunity out there. There are lots of them. Here are two. \u003c/p>\n\u003cp>More than a hundred years ago, scientists were noting that not everyone had to be vaccinated against smallpox to stop an epidemic in its tracks*. Scientists also noticed that when they were wiping out smallpox, not everyone needed to be vaccinated to have the disease disappear. In many places, it was enough if 80% of the population could be vaccinated and revaccinated in a 4-5 year period. So smallpox definitely provides evidence for herd immunity. \u003c/p>\n\u003cp>A common argument against statistics like these is that the decrease in disease came not from vaccines but from better hygiene. To try to counter this argument, I decided to look at mumps.\u003c/p>\n\u003cp>A mumps vaccine wasn’t really widely available in the U.S. until 1968. Here is a quote from a really thorough review \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8174658\">article \u003c/a>from 1993 in the journal \u003cem>Epidemiological Review\u003c/em> : \u003c/p>\n\u003cp>\u003cem>\"Mumps notifications have now fallen by more than 95 percent since the introduction of vaccination. Given that vaccine uptake has only recently reached that level among school entrants, that uptake among preschoolers is far below that level, and that mumps vaccine efficacy is probably below 90 percent, this decline in incidence is appreciably greater than would be predicted by direct protection alone. Assuming that the decline in reported cases reflects incidence and not a decline in notification efficiency, then this is evidence for indirect protection of susceptibles by herd immunity.\"\u003cbr>\n\u003c/em>\u003c/p>\n\u003cp>Since mumps vaccinations didn’t start until 1968, it is pretty unlikely that its decrease has been due to better sewers and washing our hands more thoroughly. No, this is a direct result of vaccines and herd immunity. \u003c/p>\n\u003cp>In fact the whooping cough epidemic can be explained by herd immunity too. It isn’t that not enough people are vaccinated (at least not yet). Instead, it is that the vaccine has worn off for older kids increasing the number of susceptible people. We now have too few people to have a solid fire break and so flare ups of whooping cough are starting to happen.\u003c/p>\n\u003cp>So despite what you might read on the web (including in the comments section of this blog), herd immunity is real. There is an overwhelming amount of data out there to support the idea that it protects us from the diseases that used to sweep through our population. Herd immunity is a fact and therefore real whether you believe in it or not.\u003c/p>\n\u003cp>\u003cem>*Farr W. Second annual report of the Registrar-General of Births, Deaths and Marriages of England and Wales, 1840.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> 37.7749295 -122.4194155\u003c/p>\n\n","blocks":[],"excerpt":"Despite what you might read on the web (including in the comments section of this blog), herd immunity is real. There is an overwhelming amount of data out there to support the idea that it protects us from the diseases that used to sweep through our population. Herd immunity is a fact and therefore real whether you believe in it or not.","status":"publish","parent":0,"modified":1289232525,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":756},"headData":{"title":"Facts are Facts | KQED","description":"Despite what you might read on the web (including in the comments section of this blog), herd immunity is real. There is an overwhelming amount of data out there to support the idea that it protects us from the diseases that used to sweep through our population. Herd immunity is a fact and therefore real whether you believe in it or not.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"10188 http://www.kqed.org/quest/blog/2010/11/08/facts-are-facts/","disqusUrl":"https://ww2.kqed.org/quest/2010/11/08/facts-are-facts/","disqusTitle":"Facts are Facts","path":"/quest/10188/facts-are-facts","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Everyone is entitled to his own opinion, but not his own facts.\u003c/em>\u003c/p>\n\u003cp>Daniel Patrick Moynihan\u003cbr>\n\u003cbr>\n\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/11/WildFire.jpg\" alt=\"\">\u003c/a>\u003cem>High numbers of vaccinated people act like a fire break\u003cbr>that keeps a disease from spreading.\u003c/em>\u003c/span>\u003c/p>\n\u003cp>Because anyone can write anything on the web, it can be hard to know what is fact and what is not. I wrote about this in my last \u003ca href=\"http://ww2.kqed.org/quest/2010/10/25/tracing-bad-and-dangerous-internet-science/\">blog\u003c/a>. And this issue has become alarmingly apparent in a discussion going on in a recent QUEST \u003ca href=\"http://ww2.kqed.org/quest/2010/10/13/health-officials-to-consider-tightening-vaccine-exemptions/\">blog about vaccinations\u003c/a>.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>In the comments section of this blog, someone writes that herd immunity is a complete myth. This is wrong. Herd immunity is real and actually makes perfect sense.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Obviously for a disease to spread, it has to go from one person to another (either directly or indirectly). A man with measles on a deserted island won’t spread it to anyone because there is no one else who can catch it. Same thing with an infected man in the midst of a group of people immune to the disease.\u003c/p>\n\u003cp>If we start adding people to the island, then it can spread. And if we put the man with the measles into a group of susceptible people, then it will flare up into a bona fide epidemic (think America when the first Europeans landed).\u003c/p>\n\u003cp>Now imagine a city where most of the people are immune. If the man with the measles goes there, odds are he won’t meet anyone susceptible. When he gets better, the disease will disappear. This is herd immunity.\u003c/p>\n\u003cp>Basically the immune people shield the susceptible ones from the disease. They act as sort of a fire break that keeps the epidemic from spreading. Perfectly reasonable idea.\u003c/p>\n\u003cp>Of course, it is possible that even though this makes sense it doesn’t actually happen in the real world. I decided to look back at the literature and see if there are any real examples of herd immunity out there. There are lots of them. Here are two. \u003c/p>\n\u003cp>More than a hundred years ago, scientists were noting that not everyone had to be vaccinated against smallpox to stop an epidemic in its tracks*. Scientists also noticed that when they were wiping out smallpox, not everyone needed to be vaccinated to have the disease disappear. In many places, it was enough if 80% of the population could be vaccinated and revaccinated in a 4-5 year period. So smallpox definitely provides evidence for herd immunity. \u003c/p>\n\u003cp>A common argument against statistics like these is that the decrease in disease came not from vaccines but from better hygiene. To try to counter this argument, I decided to look at mumps.\u003c/p>\n\u003cp>A mumps vaccine wasn’t really widely available in the U.S. until 1968. Here is a quote from a really thorough review \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8174658\">article \u003c/a>from 1993 in the journal \u003cem>Epidemiological Review\u003c/em> : \u003c/p>\n\u003cp>\u003cem>\"Mumps notifications have now fallen by more than 95 percent since the introduction of vaccination. Given that vaccine uptake has only recently reached that level among school entrants, that uptake among preschoolers is far below that level, and that mumps vaccine efficacy is probably below 90 percent, this decline in incidence is appreciably greater than would be predicted by direct protection alone. Assuming that the decline in reported cases reflects incidence and not a decline in notification efficiency, then this is evidence for indirect protection of susceptibles by herd immunity.\"\u003cbr>\n\u003c/em>\u003c/p>\n\u003cp>Since mumps vaccinations didn’t start until 1968, it is pretty unlikely that its decrease has been due to better sewers and washing our hands more thoroughly. No, this is a direct result of vaccines and herd immunity. \u003c/p>\n\u003cp>In fact the whooping cough epidemic can be explained by herd immunity too. It isn’t that not enough people are vaccinated (at least not yet). Instead, it is that the vaccine has worn off for older kids increasing the number of susceptible people. We now have too few people to have a solid fire break and so flare ups of whooping cough are starting to happen.\u003c/p>\n\u003cp>So despite what you might read on the web (including in the comments section of this blog), herd immunity is real. There is an overwhelming amount of data out there to support the idea that it protects us from the diseases that used to sweep through our population. Herd immunity is a fact and therefore real whether you believe in it or not.\u003c/p>\n\u003cp>\u003cem>*Farr W. Second annual report of the Registrar-General of Births, Deaths and Marriages of England and Wales, 1840.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> 37.7749295 -122.4194155\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/10188/facts-are-facts","authors":["6177"],"categories":["quest_4"],"tags":["quest_1356","quest_2163","quest_3054","quest_3055","quest_3147","quest_3152"],"featImg":"quest_10190","label":"quest"},"quest_9409":{"type":"posts","id":"quest_9409","meta":{"index":"posts_1591205157","site":"quest","id":"9409","score":null,"sort":[1287005508000]},"guestAuthors":[],"slug":"health-officials-to-consider-tightening-vaccine-exemptions","title":"Health Officials to Consider Tightening Vaccine Exemptions","publishDate":1287005508,"format":"standard","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/CDC_free_photo_9395_resized.jpg\" alt=\"\">\u003c/a>\u003cem>Public health officials in the Bay Area are concerned that not enough children are starting kindergarten with all their immunizations. (Credit: CDC/ Judy Schmidt)\u003c/em>\u003c/span>\u003c/p>\n\u003cp>\u003cem>Reported for \u003ca href=\"http://www.kqed.org/news/\">KQEDnews.org\u003c/a>\u003c/em>\u003c/p>\n\u003cp>Concerned by the steady increase in the number of children who are starting kindergarten without proof of updated vaccinations, public health officials in the Bay Area will meet in November to look into the possibility of tightening the system that allows parents to opt out from mandatory immunizations. \u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Six percent of the state’s kindergartens – up from 2 percent a decade ago – have so many unvaccinated children that public health officials consider them “sites of concentrated vaccine-preventable disease risk,” according to a 2009 report by the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\">California Department of Public Health\u003c/a>. At these schools, more than 10 percent of the students were exempted from providing proof that they’re up to date with all their vaccines. \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Ten percent may seem like a small number, but it’s enough to “put a school at risk of an outbreak of a vaccine-preventable disease if the disease was introduced,” said Dr. Robert Schechter, chief of the immunization branch of the state Department of Public Health, located in Richmond. \u003c/p>\n\u003cp>The issue is of increasing concern to medical leaders in California, where a whooping cough outbreak this year has made more than 5,000 people sick and resulted in the deaths of nine babies. \u003c/p>\n\u003cp>“Increases in the numbers of children whose parents choose not to immunize them are concerning,” said Kathleen Harriman, an epidemiologist with the department’s immunization branch. “In Europe, it was a drop in childhood immunization rates that allowed previously controlled diseases to become endemic again.” \u003c/p>\n\u003cp>Officials strive to keep immunization rates high enough to confer “herd immunity,” or “community immunity,” to the population. Herd immunity occurs when the vaccination of a portion of the population provides protection to unvaccinated people. \u003c/p>\n\u003cp>Depending on the disease and the community in which it might occur, in order for unvaccinated people to be protected against communicable diseases, approximately 75 to 95 percent of the population has to be vaccinated against them, medical experts say. \u003c/p>\n\u003cp>“For example, the level of vaccine coverage necessary to retain herd immunity to measles, a vaccine preventable disease that has recently caused outbreaks in schools, is estimated to be 83 percent to 94 percent,” said Schechter. \u003c/p>\n\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.vaccinesafety.edu/cc-exem.htm\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Map-of-states-by-exemption_formatted_resized.gif\" alt=\"\">\u003c/a>\u003cem>The 20 states that appear in green - California among them - allow parents to get a personal belief exemption for their child. The states highlighted in pink allow parents to opt out of vaccination only for religious reasons. (Credit: \u003ca href=\"http://www.vaccinesafety.edu/\">Institute for Vaccine Safety, Johns Hopkins University\u003c/a>). \u003ca href=\"http://www.vaccinesafety.edu/cc-exem.htm\">Enlarge this map.\u003c/a>\u003c/em>\u003c/span> \u003c/p>\n\u003cp>California is one of 20 states that allow parents to opt out from providing proof that their children have received mandatory vaccinations by stating that they are philosophically opposed to their child being vaccinated. \u003c/p>\n\u003cp>All states except for Mississippi and West Virginia allow parents to opt out because of their religious beliefs. And every state allows for children who have a medical reason to opt out. \u003c/p>\n\u003cp>In California, children starting kindergarten must show proof that they have had five doses of the whooping cough vaccine, four of the polio, three of the hepatitis B, two of the combined measles-mumps-rubella and one of the chickenpox vaccine, or that they have been sick with the chickenpox instead.\u003c/p>\n\u003cp>California’s vaccine exemption system is among the easiest in the country, said Dr. Saad Omer, of the Emory Vaccine Center at Emory University in Atlanta, who has compared exemptions around the country. California law requires only that a parent sign a form called a personal belief affidavit – also known as a personal belief exemption – stating that immunizations are contrary to his or her beliefs. \u003c/p>\n\u003cp>In total, 10,280 kindergartners in California had personal belief exemptions in 2009. That’s 2 percent of all the state’s kindergartners. \u003c/p>\n\u003cp>Omer found that in states where getting an exemption is easy, such as in California, the rate of whooping cough was at least 50 percent higher than in states that made it more difficult for parents to opt out. \u003c/p>\n\u003cp>“It’s not just an abstract legal requirement,” Omer said. “It has an impact on disease rates.”\u003c/p>\n\u003cp>California is in the midst of a whooping cough epidemic that has made roughly 5,300 people sick in 2010 – the most cases reported in 60 years. Nine people have died, all of them babies. Eight of them were under two months of age, too young to be vaccinated against the disease. The ninth baby had received the first dose of the vaccine two weeks before getting sick, according to the California Department of Public Health. \u003c/p>\n\u003cp>Whooping cough is the common name for pertussis, a bacterial respiratory infection that causes a persistent, fitful cough that can be life-threatening for infants. Highly infectious, it gets its name from the characteristic “whoop” sound that happens as people gasp for breath, although many babies under six months of age don’t develop the whoop. \u003c/p>\n\u003cp>In California, some counties where the rates of personal exemptions are high have suffered more cases of whooping cough. In Marin, for example, 7 percent of kindergarten students had personal exemptions – the highest rate in the Bay Area. The county has been particularly hard hit by whooping cough, with more than 300 cases so far this year. But other counties that have been hard hit by the disease, such as the Central California county of Madera, don’t have particularly high rates of vaccine exemptions, said Catherine Martin, executive director of the \u003ca href=\"http://immunizeca.org/index.pacq\">California Immunization Coalition\u003c/a>, a non-profit group in Sacramento.\u003c/p>\n\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/2010/10/California-map-with-exemption-rates_blackbackgd.png\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/California-map-with-exemption-rates_blackbackgd_resized.png\" alt=\"\">\u003c/a>\u003cem>This map shows the rate of personal belief exemptions in California counties in 2009. (Credit: California Department of Public Health) \u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/2010/10/California-map-with-exemption-rates_blackbackgd.png\">Enlarge this map. \u003c/a>\u003c/em>\u003c/span>\u003c/p>\n\u003cp>In Marin, two private schools have the county’s highest rates of personal belief exemptions. At the Marin Waldorf School, in San Rafael, 31 of the 49 kindergartners had personal belief exemptions in 2009, a rate of 63 percent. So did eight of the 19 kindergartners at Mill Valley’s Greenwood School. \u003c/p>\n\u003cp>Among Marin’s public school districts, the two schools with the largest number of kindergartners with personal belief exemptions are in the \u003ca href=\"http://www.rossvalleyschools.org/\">Ross Valley School District\u003c/a>. At Brookside Elementary, 15 out of 126 kindergartners have exemptions this year, a rate of 12 percent, and at Manor Elementary, 16 kindergartners – or 25 percent of the school’s 58 kindergartners – have exemptions. \u003c/p>\n\u003cp>“I think it is very easy for parents to sign the waiver,” said the school district’s nurse, Laurel Yrun. \u003c/p>\n\u003cp>As for why Marin County parents seem more likely to sign a waiver than parents in other California counties, she said, “It’s a good question. We’re a wealthy county; this is a community of fairly well-educated people, probably with good access to medical care. It’s interesting. I don’t know.” \u003c/p>\n\u003cp>Yrun said most of the parents who are signing exemptions in her district are doing so because they have opted not to give their children a particular vaccine. Only a minority of parents are opting out of vaccines altogether, she said. The most popular vaccine to skip in her district is the hepatitis B, followed by polio and the measles-mumps-rubella, she said. The whooping cough vaccine was the least likely to be skipped in her district, she said. \u003c/p>\n\u003cp>Nonetheless, the district was hard hit by whooping cough during the past school year. In Marin, only 87 percent of kindergartners had been vaccinated against whooping cough in 2009, compared to 93 percent statewide.\u003c/p>\n\u003cp>The California Department of Public Health hasn’t studied the characteristics of the parents who obtain exemptions. But research by Omer and his colleagues in Colorado, Massachusetts, Missouri and Washington confirms Yrun’s experience. They found that only 25 percent of exempted children didn’t receive any vaccines at all. \u003c/p>\n\u003cp>In the case of whooping cough, other factors in addition to personal belief exemptions have contributed to the epidemic in California, said Martin, of the California Immunization Coalition. For example, immunity to the bacterium that causes the disease wanes over time, so a large number of teenagers and adults are currently unprotected.\u003c/p>\n\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Doses-of-the-Tdap-pertussis-booster-shot_resized.jpg\" alt=\"\">\u003c/a>\u003cem>A whooping cough booster shot will become mandatory for middle schoolers in July 2011. (Credit: Gabriela Quiros)\u003c/em>\u003c/span>\u003c/p>\n\u003cp>Children receive the fifth dose of the DTap vaccine that protects against whooping cough at age four or five. But by the time they’re 10 or 11, they need a booster shot called Tdap, which only became available in 2005. In September, Gov. Arnold Schwarzenegger signed into law an update to the health code that will require schools to check that children starting middle school have received the Tdap booster shot, starting in July of 2011. \u003c/p>\n\u003cp>Public health officials in the Bay Area have been concerned about the increase in the number of parents choosing to opt out of mandatory vaccinations since before this year’s whooping cough epidemic. They trace the change to what Emory University’s Omer refers to as “the Wakefield affair.” \u003c/p>\n\u003cp>In 1998, English doctor Andrew Wakefield published a study of 12 children linking the measles-mumps-rubella vaccine to autism. The paper caused rates of vaccination to fall and cases of measles to climb in the United Kingdom. Wakefield’s research has since been discredited. In February, the medical journal the Lancet retracted his paper, saying that its authors had made false claims about how the study was conducted.\u003c/p>\n\u003cp>Nonetheless, the paper’s effects are still being felt, said nurse Yrun. \u003c/p>\n\u003cp>“That’s been refuted, but once it’s been out in the media, parents hang onto it,” she said. \u003c/p>\n\u003cp>Concerns were also raised about thimerosal, a mercury derivative used as a preservative in some pediatric vaccines. It was eliminated in the United States from all but some flu vaccines in 2001. And numerous studies have found no connection between thimerosal and autism, the most recent of which was a Centers for Disease Control paper published in September. \u003c/p>\n\u003cp>“While we still need to find out the cause of autism, it seems quite clear that vaccinations are not one of them,” said Dr. Robert Benjamin, public health officer of Alameda County. \u003c/p>\n\u003cp>Benjamin is one of the public health officers who will be attending a meeting organized by the California Immunization Coalition in mid-November. The meeting will bring together a small group of private doctors, public health officials and representatives of medical associations interested in discussing possible changes to the personal belief exemptions, said the coalition’s Catherine Martin.\u003c/p>\n\u003cp>Benjamin said that in Alameda County, 11 percent of the people who have contracted pertussis had a personal belief exemption. \u003c/p>\n\u003cp>“While it doesn’t sound like a large percentage, it’s significant not only in that these kids are acquiring pertussis, but they’re also transmitting it,” he said. “This is where the personal belief exemption is an individual decision which has large societal and community ramifications.” \u003c/p>\n\u003cp>Benjamin said he would like to change the exemption’s wording so that it makes parents reflect on the impact their decision might have on the community. Or he would like to make it more difficult to obtain. \u003c/p>\n\u003cp>After studying personal belief exemptions around the country, Emory University’s Omer has come up with a guideline for those designing exemptions. \u003c/p>\n\u003cp>“It shouldn’t be easier to have your child exempted than to have your child immunized,” he said. \u003c/p>\n\u003cp>Omer has found that replacing a pre-printed form with a letter crafted by the parents in which they explain why they want the exemption could be an effective way to curtail the number of exemptions. Some states even require the letter to be notarized. A counseling session, viewing a video, or visiting the health department are some of the educational measures that have also been effective, he said. His team didn’t study the language of the exemptions in detail, he said. So he said he couldn’t comment on whether adding new wording to California’s form might help. \u003c/p>\n\u003cp>When the California group meets, the biggest challenge they might face is deciding who should be given the job of educating parents, if an educational component is agreed upon as the solution.\u003c/p>\n\u003cp>“To be honest, everybody is challenged budget-wise and everyone wants others to do the job,” said the immunization coalition’s Martin. “Some may feel it’s the schools’ job to educate the parents. Other people believe it’s the doctors’ and public health departments’ job. But the doctors and health departments are feeling stressed because of reimbursements and budgets.” \u003c/p>\n\u003cp>In fact, the state Legislature, facing record deficits, reduced the budget of the Department of Public Health’s infectious disease branch immunization program by $18 million last week, Martin said. \u003c/p>\n\u003cp>In Marin County, nurse Yrun said she’s curious to see how the efforts to change the exemptions system will pan out. \u003c/p>\n\u003cp>“It’s a huge issue to tackle,” she said. “Even though they’re a minority (parents who exempt their children), they have some pretty strong beliefs.”\u003c/p>\n\u003cp>But the whooping cough epidemic has raised concern among parents who are giving their children all their vaccines. \u003c/p>\n\u003cp>“Some people in the district were very angry,” she said. “We had parents calling and asking what the district was doing about the un-immunized children. I reassured them that the county is trying to reduce it. The public health department has gone out and had physicians talk to parents. But when you have events like that you usually have the people who believe in vaccinations who show up. The department has advertisements, they have a campaign – they’re using cows to depict herd immunity. It’s just now starting.” \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To find out how many children might be under-vaccinated at your school, download the \u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/2010/10/Immunization-Status-of-Kindergarten-Schools-20091.pdf\">2009 Immunization Status of Kindergarten Students in California\u003c/a> \u003ci>(.pdf, 676 KB)\u003c/i>.\u003c/p>\n\u003cp>Watch our QUEST story about Northern California researchers searching for \u003ca href=\"http://ww2.kqed.org/quest/video/autism-searching-for-causes\">the causes of autism\u003c/a>. \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> 38.5815719 -121.4943996\u003c/p>\n\n","blocks":[],"excerpt":"Concerned by the increase in the number of children who are starting kindergarten without all their vaccines, public health officials in the Bay Area will look into the possibility of tightening the system that allows parents to opt out from mandatory immunizations.","status":"publish","parent":0,"modified":1287005508,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":59,"wordCount":2423},"headData":{"title":"Health Officials to Consider Tightening Vaccine Exemptions | KQED","description":"Concerned by the increase in the number of children who are starting kindergarten without all their vaccines, public health officials in the Bay Area will look into the possibility of tightening the system that allows parents to opt out from mandatory immunizations.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"9409 http://www.kqed.org/quest/blog/2010/10/13/health-officials-to-consider-tightening-vaccine-exemptions/","disqusUrl":"https://ww2.kqed.org/quest/2010/10/13/health-officials-to-consider-tightening-vaccine-exemptions/","disqusTitle":"Health Officials to Consider Tightening Vaccine Exemptions","path":"/quest/9409/health-officials-to-consider-tightening-vaccine-exemptions","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/CDC_free_photo_9395_resized.jpg\" alt=\"\">\u003c/a>\u003cem>Public health officials in the Bay Area are concerned that not enough children are starting kindergarten with all their immunizations. (Credit: CDC/ Judy Schmidt)\u003c/em>\u003c/span>\u003c/p>\n\u003cp>\u003cem>Reported for \u003ca href=\"http://www.kqed.org/news/\">KQEDnews.org\u003c/a>\u003c/em>\u003c/p>\n\u003cp>Concerned by the steady increase in the number of children who are starting kindergarten without proof of updated vaccinations, public health officials in the Bay Area will meet in November to look into the possibility of tightening the system that allows parents to opt out from mandatory immunizations. \u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Six percent of the state’s kindergartens – up from 2 percent a decade ago – have so many unvaccinated children that public health officials consider them “sites of concentrated vaccine-preventable disease risk,” according to a 2009 report by the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\">California Department of Public Health\u003c/a>. At these schools, more than 10 percent of the students were exempted from providing proof that they’re up to date with all their vaccines. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ten percent may seem like a small number, but it’s enough to “put a school at risk of an outbreak of a vaccine-preventable disease if the disease was introduced,” said Dr. Robert Schechter, chief of the immunization branch of the state Department of Public Health, located in Richmond. \u003c/p>\n\u003cp>The issue is of increasing concern to medical leaders in California, where a whooping cough outbreak this year has made more than 5,000 people sick and resulted in the deaths of nine babies. \u003c/p>\n\u003cp>“Increases in the numbers of children whose parents choose not to immunize them are concerning,” said Kathleen Harriman, an epidemiologist with the department’s immunization branch. “In Europe, it was a drop in childhood immunization rates that allowed previously controlled diseases to become endemic again.” \u003c/p>\n\u003cp>Officials strive to keep immunization rates high enough to confer “herd immunity,” or “community immunity,” to the population. Herd immunity occurs when the vaccination of a portion of the population provides protection to unvaccinated people. \u003c/p>\n\u003cp>Depending on the disease and the community in which it might occur, in order for unvaccinated people to be protected against communicable diseases, approximately 75 to 95 percent of the population has to be vaccinated against them, medical experts say. \u003c/p>\n\u003cp>“For example, the level of vaccine coverage necessary to retain herd immunity to measles, a vaccine preventable disease that has recently caused outbreaks in schools, is estimated to be 83 percent to 94 percent,” said Schechter. \u003c/p>\n\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.vaccinesafety.edu/cc-exem.htm\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Map-of-states-by-exemption_formatted_resized.gif\" alt=\"\">\u003c/a>\u003cem>The 20 states that appear in green - California among them - allow parents to get a personal belief exemption for their child. The states highlighted in pink allow parents to opt out of vaccination only for religious reasons. (Credit: \u003ca href=\"http://www.vaccinesafety.edu/\">Institute for Vaccine Safety, Johns Hopkins University\u003c/a>). \u003ca href=\"http://www.vaccinesafety.edu/cc-exem.htm\">Enlarge this map.\u003c/a>\u003c/em>\u003c/span> \u003c/p>\n\u003cp>California is one of 20 states that allow parents to opt out from providing proof that their children have received mandatory vaccinations by stating that they are philosophically opposed to their child being vaccinated. \u003c/p>\n\u003cp>All states except for Mississippi and West Virginia allow parents to opt out because of their religious beliefs. And every state allows for children who have a medical reason to opt out. \u003c/p>\n\u003cp>In California, children starting kindergarten must show proof that they have had five doses of the whooping cough vaccine, four of the polio, three of the hepatitis B, two of the combined measles-mumps-rubella and one of the chickenpox vaccine, or that they have been sick with the chickenpox instead.\u003c/p>\n\u003cp>California’s vaccine exemption system is among the easiest in the country, said Dr. Saad Omer, of the Emory Vaccine Center at Emory University in Atlanta, who has compared exemptions around the country. California law requires only that a parent sign a form called a personal belief affidavit – also known as a personal belief exemption – stating that immunizations are contrary to his or her beliefs. \u003c/p>\n\u003cp>In total, 10,280 kindergartners in California had personal belief exemptions in 2009. That’s 2 percent of all the state’s kindergartners. \u003c/p>\n\u003cp>Omer found that in states where getting an exemption is easy, such as in California, the rate of whooping cough was at least 50 percent higher than in states that made it more difficult for parents to opt out. \u003c/p>\n\u003cp>“It’s not just an abstract legal requirement,” Omer said. “It has an impact on disease rates.”\u003c/p>\n\u003cp>California is in the midst of a whooping cough epidemic that has made roughly 5,300 people sick in 2010 – the most cases reported in 60 years. Nine people have died, all of them babies. Eight of them were under two months of age, too young to be vaccinated against the disease. The ninth baby had received the first dose of the vaccine two weeks before getting sick, according to the California Department of Public Health. \u003c/p>\n\u003cp>Whooping cough is the common name for pertussis, a bacterial respiratory infection that causes a persistent, fitful cough that can be life-threatening for infants. Highly infectious, it gets its name from the characteristic “whoop” sound that happens as people gasp for breath, although many babies under six months of age don’t develop the whoop. \u003c/p>\n\u003cp>In California, some counties where the rates of personal exemptions are high have suffered more cases of whooping cough. In Marin, for example, 7 percent of kindergarten students had personal exemptions – the highest rate in the Bay Area. The county has been particularly hard hit by whooping cough, with more than 300 cases so far this year. But other counties that have been hard hit by the disease, such as the Central California county of Madera, don’t have particularly high rates of vaccine exemptions, said Catherine Martin, executive director of the \u003ca href=\"http://immunizeca.org/index.pacq\">California Immunization Coalition\u003c/a>, a non-profit group in Sacramento.\u003c/p>\n\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/2010/10/California-map-with-exemption-rates_blackbackgd.png\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/California-map-with-exemption-rates_blackbackgd_resized.png\" alt=\"\">\u003c/a>\u003cem>This map shows the rate of personal belief exemptions in California counties in 2009. (Credit: California Department of Public Health) \u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/2010/10/California-map-with-exemption-rates_blackbackgd.png\">Enlarge this map. \u003c/a>\u003c/em>\u003c/span>\u003c/p>\n\u003cp>In Marin, two private schools have the county’s highest rates of personal belief exemptions. At the Marin Waldorf School, in San Rafael, 31 of the 49 kindergartners had personal belief exemptions in 2009, a rate of 63 percent. So did eight of the 19 kindergartners at Mill Valley’s Greenwood School. \u003c/p>\n\u003cp>Among Marin’s public school districts, the two schools with the largest number of kindergartners with personal belief exemptions are in the \u003ca href=\"http://www.rossvalleyschools.org/\">Ross Valley School District\u003c/a>. At Brookside Elementary, 15 out of 126 kindergartners have exemptions this year, a rate of 12 percent, and at Manor Elementary, 16 kindergartners – or 25 percent of the school’s 58 kindergartners – have exemptions. \u003c/p>\n\u003cp>“I think it is very easy for parents to sign the waiver,” said the school district’s nurse, Laurel Yrun. \u003c/p>\n\u003cp>As for why Marin County parents seem more likely to sign a waiver than parents in other California counties, she said, “It’s a good question. We’re a wealthy county; this is a community of fairly well-educated people, probably with good access to medical care. It’s interesting. I don’t know.” \u003c/p>\n\u003cp>Yrun said most of the parents who are signing exemptions in her district are doing so because they have opted not to give their children a particular vaccine. Only a minority of parents are opting out of vaccines altogether, she said. The most popular vaccine to skip in her district is the hepatitis B, followed by polio and the measles-mumps-rubella, she said. The whooping cough vaccine was the least likely to be skipped in her district, she said. \u003c/p>\n\u003cp>Nonetheless, the district was hard hit by whooping cough during the past school year. In Marin, only 87 percent of kindergartners had been vaccinated against whooping cough in 2009, compared to 93 percent statewide.\u003c/p>\n\u003cp>The California Department of Public Health hasn’t studied the characteristics of the parents who obtain exemptions. But research by Omer and his colleagues in Colorado, Massachusetts, Missouri and Washington confirms Yrun’s experience. They found that only 25 percent of exempted children didn’t receive any vaccines at all. \u003c/p>\n\u003cp>In the case of whooping cough, other factors in addition to personal belief exemptions have contributed to the epidemic in California, said Martin, of the California Immunization Coalition. For example, immunity to the bacterium that causes the disease wanes over time, so a large number of teenagers and adults are currently unprotected.\u003c/p>\n\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Doses-of-the-Tdap-pertussis-booster-shot_resized.jpg\" alt=\"\">\u003c/a>\u003cem>A whooping cough booster shot will become mandatory for middle schoolers in July 2011. (Credit: Gabriela Quiros)\u003c/em>\u003c/span>\u003c/p>\n\u003cp>Children receive the fifth dose of the DTap vaccine that protects against whooping cough at age four or five. But by the time they’re 10 or 11, they need a booster shot called Tdap, which only became available in 2005. In September, Gov. Arnold Schwarzenegger signed into law an update to the health code that will require schools to check that children starting middle school have received the Tdap booster shot, starting in July of 2011. \u003c/p>\n\u003cp>Public health officials in the Bay Area have been concerned about the increase in the number of parents choosing to opt out of mandatory vaccinations since before this year’s whooping cough epidemic. They trace the change to what Emory University’s Omer refers to as “the Wakefield affair.” \u003c/p>\n\u003cp>In 1998, English doctor Andrew Wakefield published a study of 12 children linking the measles-mumps-rubella vaccine to autism. The paper caused rates of vaccination to fall and cases of measles to climb in the United Kingdom. Wakefield’s research has since been discredited. In February, the medical journal the Lancet retracted his paper, saying that its authors had made false claims about how the study was conducted.\u003c/p>\n\u003cp>Nonetheless, the paper’s effects are still being felt, said nurse Yrun. \u003c/p>\n\u003cp>“That’s been refuted, but once it’s been out in the media, parents hang onto it,” she said. \u003c/p>\n\u003cp>Concerns were also raised about thimerosal, a mercury derivative used as a preservative in some pediatric vaccines. It was eliminated in the United States from all but some flu vaccines in 2001. And numerous studies have found no connection between thimerosal and autism, the most recent of which was a Centers for Disease Control paper published in September. \u003c/p>\n\u003cp>“While we still need to find out the cause of autism, it seems quite clear that vaccinations are not one of them,” said Dr. Robert Benjamin, public health officer of Alameda County. \u003c/p>\n\u003cp>Benjamin is one of the public health officers who will be attending a meeting organized by the California Immunization Coalition in mid-November. The meeting will bring together a small group of private doctors, public health officials and representatives of medical associations interested in discussing possible changes to the personal belief exemptions, said the coalition’s Catherine Martin.\u003c/p>\n\u003cp>Benjamin said that in Alameda County, 11 percent of the people who have contracted pertussis had a personal belief exemption. \u003c/p>\n\u003cp>“While it doesn’t sound like a large percentage, it’s significant not only in that these kids are acquiring pertussis, but they’re also transmitting it,” he said. “This is where the personal belief exemption is an individual decision which has large societal and community ramifications.” \u003c/p>\n\u003cp>Benjamin said he would like to change the exemption’s wording so that it makes parents reflect on the impact their decision might have on the community. Or he would like to make it more difficult to obtain. \u003c/p>\n\u003cp>After studying personal belief exemptions around the country, Emory University’s Omer has come up with a guideline for those designing exemptions. \u003c/p>\n\u003cp>“It shouldn’t be easier to have your child exempted than to have your child immunized,” he said. \u003c/p>\n\u003cp>Omer has found that replacing a pre-printed form with a letter crafted by the parents in which they explain why they want the exemption could be an effective way to curtail the number of exemptions. Some states even require the letter to be notarized. A counseling session, viewing a video, or visiting the health department are some of the educational measures that have also been effective, he said. His team didn’t study the language of the exemptions in detail, he said. So he said he couldn’t comment on whether adding new wording to California’s form might help. \u003c/p>\n\u003cp>When the California group meets, the biggest challenge they might face is deciding who should be given the job of educating parents, if an educational component is agreed upon as the solution.\u003c/p>\n\u003cp>“To be honest, everybody is challenged budget-wise and everyone wants others to do the job,” said the immunization coalition’s Martin. “Some may feel it’s the schools’ job to educate the parents. Other people believe it’s the doctors’ and public health departments’ job. But the doctors and health departments are feeling stressed because of reimbursements and budgets.” \u003c/p>\n\u003cp>In fact, the state Legislature, facing record deficits, reduced the budget of the Department of Public Health’s infectious disease branch immunization program by $18 million last week, Martin said. \u003c/p>\n\u003cp>In Marin County, nurse Yrun said she’s curious to see how the efforts to change the exemptions system will pan out. \u003c/p>\n\u003cp>“It’s a huge issue to tackle,” she said. “Even though they’re a minority (parents who exempt their children), they have some pretty strong beliefs.”\u003c/p>\n\u003cp>But the whooping cough epidemic has raised concern among parents who are giving their children all their vaccines. \u003c/p>\n\u003cp>“Some people in the district were very angry,” she said. “We had parents calling and asking what the district was doing about the un-immunized children. I reassured them that the county is trying to reduce it. The public health department has gone out and had physicians talk to parents. But when you have events like that you usually have the people who believe in vaccinations who show up. The department has advertisements, they have a campaign – they’re using cows to depict herd immunity. It’s just now starting.” \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To find out how many children might be under-vaccinated at your school, download the \u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/2010/10/Immunization-Status-of-Kindergarten-Schools-20091.pdf\">2009 Immunization Status of Kindergarten Students in California\u003c/a> \u003ci>(.pdf, 676 KB)\u003c/i>.\u003c/p>\n\u003cp>Watch our QUEST story about Northern California researchers searching for \u003ca href=\"http://ww2.kqed.org/quest/video/autism-searching-for-causes\">the causes of autism\u003c/a>. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp> 38.5815719 -121.4943996\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/9409/health-officials-to-consider-tightening-vaccine-exemptions","authors":["6186"],"categories":["quest_12"],"tags":["quest_256","quest_1452","quest_13203","quest_2163","quest_3055","quest_3147"],"label":"quest"},"quest_6889":{"type":"posts","id":"quest_6889","meta":{"index":"posts_1591205157","site":"quest","id":"6889","score":null,"sort":[1280367475000]},"guestAuthors":[],"slug":"whooping-cough-epidemic-exposes-holes-in-californias-immunization-system","title":"Whooping Cough Epidemic Exposes Holes in California's Immunization System","publishDate":1280367475,"format":"standard","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Neal-Snider-34-got-his-whooping-cough-vaccine-at-San-Franciscos-Adult-Immunization-and-Travel-Clinic-on-Wednesday_resized.jpg\" alt=\"\">\u003c/a>\u003cem>Neal Snider, 34, got his whooping cough vaccine at San Francisco's Adult Immunization and Travel Clinic on Wednesday. His wife is seven months pregnant. Credit: Gabriela Quiros\u003c/em>\u003c/span>\u003c/p>\n\u003cp>\u003cem>Reported for \u003ca href=\"http://www.kqed.org/news/\">KQEDnews.org\u003c/a>\u003c/em>\u003c/p>\n\u003cp>The whooping cough epidemic that has killed six babies and made an estimated 1,500 people sick in California this year is exposing holes in the state’s immunization system, which leaders in the public health community are now racing to patch.\u003c/p>\n\u003cp>Last month, the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\">California Department of Public Health\u003c/a> declared whooping cough an epidemic. Public health officials are urging anyone who has contact with children under the age of one to get a whooping cough booster shot called Tdap.\u003c/p>\n\u003cp>“California is the worst state for whooping cough,” said Andrew Resignato, director of the \u003ca href=\"http://www.sfimmunize.org/\">San Francisco Immunization Coalition\u003c/a>, a partnership of state agencies, community groups and medical organizations.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The state saw a five-fold increase in the number of reported cases of whooping cough in the first half of 2010, compared to the same period last year.\u003c/p>\n\u003cp>Whooping cough is the common name for pertussis, a bacterial respiratory infection that causes a persistent, fitful cough that can be life-threatening for infants. Highly infectious, it gets its name from the characteristic \u003ca href=\"http://www.pkids.org/dis_pert_stsop.php\">“whoop” sound\u003c/a> that happens as people gasp for breath. But the name might be misleading. Many babies under six months of age who contract pertussis don’t develop the whoop, said Dr. Stephen Parodi, chair of infectious disease for Kaiser Permanente Northern California.\u003c/p>\n\u003cp>\u003cstrong>Booster shot advised\u003c/strong>\u003c/p>\n\u003cp>Health care providers should be able to provide their patients with the Tdap booster shot, which is covered by insurance, said Amy Pine, director of the Communicable Disease Prevention Unit at San Francisco’s Public Health Department. And those who lack insurance can get the shot through their county public health department, either for a small fee or for free.\u003c/p>\n\u003cp>At the \u003ca href=\"http://www.sfcdcp.org/aitc.html\">Adult Immunization and Travel Clinic\u003c/a> at San Francisco’s Department of Public Health, almost 500 people have received the Tdap shot in July. That’s twice as many as did in July of 2009, said Pam Axelson, the clinic’s nurse manager.\u003c/p>\n\u003cp>“We’re getting a good response,” she said.\u003c/p>\n\u003cp>Elsie and William Leal dropped by for their shot because their daughter is six weeks away from giving birth to their sixth grandchild, a boy.\u003c/p>\n\u003cp>\u003cspan class=\"right\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Elsie-Leal-got-her-whooping-cough-booster-shot-at-San-Franciscos-Adult-Immunization-and-Travel-Clinic_resized3.jpg\" alt=\"\">\u003c/a>\u003cem>Elsie Leal got the booster shot to protect her soon-to-be-born grandson. Credit: Gabriela Quiros\u003c/em>\u003c/span>\u003c/p>\n\u003cp>“We want to make sure that we don’t give him anything,” said Elsie Leal. Everyone in their family, from their 25-year-old grandson to their 3-year-old granddaughter is in the process of updating their pertussis immunization. “Anyone who wants to see the baby is going to get it,” she said.\u003c/p>\n\u003cp>This is the response public health officials are hoping for. Though pertussis affects both adults and children, infants under six months are the most at risk for infection and death, due to the fact that they are not yet fully immune to the disease. Babies receive immunizations against pertussis, which are called DTaP, at two, four and six months, then again between 15 and 18 months. Infants aren’t fully immune until they have received the first three doses.\u003c/p>\n\u003cp>“We try to promote the concept of cocooning,” said Amy Pine, of San Francisco’s Public Health Department. “This is vaccinating anyone around a child who’s too young to be vaccinated.”\u003c/p>\n\u003cp>The state is recommending that anyone older than age seven receive the booster shot. Health providers are giving priority to pregnant women and women who have just given birth, as well as the people in contact with children under one or pregnant women. They’re also prioritizing health care workers.\u003c/p>\n\u003cp>Interviews with people getting the shot Wednesday show that information on the epidemic hasn’t yet reached all health providers. Leal said it took her a week to find a place that would give her the Tdap. She said that both her obstetrician and her primary care doctor refused to immunize her.\u003c/p>\n\u003cp>So did the pharmacy near her house in Dolores Heights, which told her that the shot is only for people under 64. Leal is 72. Nurse Axelson said that the booster shot also is safe for people over 64. She added that Leal’s doctors’ refusal to give her the booster shot might be related to the fact that ordering vaccines is a time-consuming process for doctors’ offices, involving significant paperwork.\u003c/p>\n\u003cp>The state Department of Public Health doesn’t track the number of adults who are immunized against pertussis, said Ralph Montano, spokesman with the department. But it does track the number of kindergartners who have received their shots. He said that 98 percent of children entering kindergarten in California have been immunized.\u003c/p>\n\u003cp>Statewide, about 43 percent of adolescents have been immunized against whooping cough, according to the U.S. Centers for Disease Control.\u003c/p>\n\u003cp>\u003cstrong>Closing the immunization gap\u003c/strong>\u003c/p>\n\u003cp>Immunity against pertussis wears out with time, said Kaiser Permanente's Stephen Parodi. Children should get another shot between 4 and 6, and then another one at 11. Adults who haven’t received a booster shot should get one, and research is ongoing as to how long the immunity provided by that shot will last, he said.\u003c/p>\n\u003cp>Until the Tdap booster shot was developed in 2005, adolescents and adults didn’t have a way to keep up their immunity against the disease. Now that the booster shot exists, public health leaders are looking for a way to make sure that adolescents receive it. Most states have established a mandate for adolescents to get the shot around the time they enter 6th or 7th grade. California is one of 11 states that have no such mandate.\u003c/p>\n\u003cp>California Assemblyman Juan Arambula, I-Fresno, is sponsoring \u003ca href=\"http://www.assembly.ca.gov/acs/acsframeset2text.htm\">a bill\u003c/a> that would change that, by eliminating the age limits now set by the state Health and Safety Code. The code now says that public health officials can only compel children to get vaccinated against pertussis before they turn seven.\u003c/p>\n\u003cp>The measure, AB 354, passed the Assembly by a vote of 74-2 in May and is awaiting a vote in the state Senate. [UPDATE: Governor Schwarzenegger signed the bill into law on Sept. 29. Starting in July 2011, children entering grades 7 through 12 will have to show proof that they received a whooping cough booster. As of July 2012, only children entering 7th grade will have to get the booster shot.]\u003c/p>\n\u003cp>\u003cstrong>Disease misdiagnosed\u003c/strong>\u003c/p>\n\u003cp>Health officials are concerned that doctors might be misdiagnosing the disease. In all six deaths this year, health providers who saw the babies misdiagnosed the disease.\u003c/p>\n\u003cp>A seven-week-old girl who died in Los Angeles County earlier this month was misdiagnosed by her doctor three times and by emergency care personnel twice, according to a summary of her case distributed to public health leaders by the state Department of Public Health.\u003c/p>\n\u003cp>“People don’t recognize it,” said Resignato. Doctors may confuse pertussis with an upper respiratory infection, bronchitis, allergies, or a cough caused by asthma, he said.\u003c/p>\n\u003cp>Initially, pertussis can look like a common cold, causing a runny nose and maybe an achy, sore throat, said Parodi. That is followed by what he described as an annoying cough that typically lasts two weeks, but can last up to six weeks. The cough can be so bad that it causes patients to pass out or throw up.\u003c/p>\n\u003cp>“This can be a particular problem for little children,” said Parodi. “They can have trouble with breathing. This is what gets people to the hospital.”\u003c/p>\n\u003cp>The disease is treated with antibiotics. Patients are contagious from when they become ill until three weeks afterward. If they receive treatment, they will no longer be contagious after five days of antibiotics. The recovery period can take six to 14 weeks from when the patient first got sick.\u003c/p>\n\u003cp>“That’s another good reason to get vaccinated,” said Parodi. “Who wants to be sick for three months?”\u003c/p>\n\u003cp>\u003cstrong>Latinos disproportionately affected\u003c/strong>\u003c/p>\n\u003cp>Latino babies under six months are getting infected at a much higher rate than other babies that age. According to the state Department of Public Health, Latino babies under six months old have a rate of infection of 94 per 100,000 babies – twice the rate of African-American babies and almost three times the rate of white babies.\u003c/p>\n\u003cp>All of the four baby girls and two baby boys who have died from pertussis this year were Latino and hadn’t yet turned two months old. Three of them lived in Los Angeles County, and one each in San Bernardino, Fresno and Stanislaus counties.\u003c/p>\n\u003cp>Public health officials said Latino newborns might be at a higher risk for infection because they live with extended families, which puts them in contact with more people. Latinos in California are also under-immunized, said pediatrician Jaime Ruiz, from the \u003ca href=\"http://www.mnhc.org/\">Mission Neighborhood Health Center \u003c/a>in San Francisco.\u003c/p>\n\u003cp>“The Latino population isn’t always aware that there are clinics where they can get vaccines for free, if they qualify by income,” said Ruiz. “And if they are migrant farm workers, they are moving around.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> 37.7749295 -122.4194155\u003c/p>\n\n","blocks":[],"excerpt":"The whooping cough epidemic that has killed six babies and made an estimated 1,500 people sick in California this year is exposing holes in the state’s immunization system, which leaders in the public health community are now racing to patch.","status":"publish","parent":0,"modified":1280367475,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":42,"wordCount":1578},"headData":{"title":"Whooping Cough Epidemic Exposes Holes in California's Immunization System | KQED","description":"The whooping cough epidemic that has killed six babies and made an estimated 1,500 people sick in California this year is exposing holes in the state’s immunization system, which leaders in the public health community are now racing to patch.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"6889 http://www.kqed.org/quest/blog/2010/07/28/whooping-cough-epidemic-exposes-holes-in-californias-immunization-system/","disqusUrl":"https://ww2.kqed.org/quest/2010/07/28/whooping-cough-epidemic-exposes-holes-in-californias-immunization-system/","disqusTitle":"Whooping Cough Epidemic Exposes Holes in California's Immunization System","path":"/quest/6889/whooping-cough-epidemic-exposes-holes-in-californias-immunization-system","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Neal-Snider-34-got-his-whooping-cough-vaccine-at-San-Franciscos-Adult-Immunization-and-Travel-Clinic-on-Wednesday_resized.jpg\" alt=\"\">\u003c/a>\u003cem>Neal Snider, 34, got his whooping cough vaccine at San Francisco's Adult Immunization and Travel Clinic on Wednesday. His wife is seven months pregnant. Credit: Gabriela Quiros\u003c/em>\u003c/span>\u003c/p>\n\u003cp>\u003cem>Reported for \u003ca href=\"http://www.kqed.org/news/\">KQEDnews.org\u003c/a>\u003c/em>\u003c/p>\n\u003cp>The whooping cough epidemic that has killed six babies and made an estimated 1,500 people sick in California this year is exposing holes in the state’s immunization system, which leaders in the public health community are now racing to patch.\u003c/p>\n\u003cp>Last month, the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\">California Department of Public Health\u003c/a> declared whooping cough an epidemic. Public health officials are urging anyone who has contact with children under the age of one to get a whooping cough booster shot called Tdap.\u003c/p>\n\u003cp>“California is the worst state for whooping cough,” said Andrew Resignato, director of the \u003ca href=\"http://www.sfimmunize.org/\">San Francisco Immunization Coalition\u003c/a>, a partnership of state agencies, community groups and medical organizations.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The state saw a five-fold increase in the number of reported cases of whooping cough in the first half of 2010, compared to the same period last year.\u003c/p>\n\u003cp>Whooping cough is the common name for pertussis, a bacterial respiratory infection that causes a persistent, fitful cough that can be life-threatening for infants. Highly infectious, it gets its name from the characteristic \u003ca href=\"http://www.pkids.org/dis_pert_stsop.php\">“whoop” sound\u003c/a> that happens as people gasp for breath. But the name might be misleading. Many babies under six months of age who contract pertussis don’t develop the whoop, said Dr. Stephen Parodi, chair of infectious disease for Kaiser Permanente Northern California.\u003c/p>\n\u003cp>\u003cstrong>Booster shot advised\u003c/strong>\u003c/p>\n\u003cp>Health care providers should be able to provide their patients with the Tdap booster shot, which is covered by insurance, said Amy Pine, director of the Communicable Disease Prevention Unit at San Francisco’s Public Health Department. And those who lack insurance can get the shot through their county public health department, either for a small fee or for free.\u003c/p>\n\u003cp>At the \u003ca href=\"http://www.sfcdcp.org/aitc.html\">Adult Immunization and Travel Clinic\u003c/a> at San Francisco’s Department of Public Health, almost 500 people have received the Tdap shot in July. That’s twice as many as did in July of 2009, said Pam Axelson, the clinic’s nurse manager.\u003c/p>\n\u003cp>“We’re getting a good response,” she said.\u003c/p>\n\u003cp>Elsie and William Leal dropped by for their shot because their daughter is six weeks away from giving birth to their sixth grandchild, a boy.\u003c/p>\n\u003cp>\u003cspan class=\"right\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2010/10/Elsie-Leal-got-her-whooping-cough-booster-shot-at-San-Franciscos-Adult-Immunization-and-Travel-Clinic_resized3.jpg\" alt=\"\">\u003c/a>\u003cem>Elsie Leal got the booster shot to protect her soon-to-be-born grandson. Credit: Gabriela Quiros\u003c/em>\u003c/span>\u003c/p>\n\u003cp>“We want to make sure that we don’t give him anything,” said Elsie Leal. Everyone in their family, from their 25-year-old grandson to their 3-year-old granddaughter is in the process of updating their pertussis immunization. “Anyone who wants to see the baby is going to get it,” she said.\u003c/p>\n\u003cp>This is the response public health officials are hoping for. Though pertussis affects both adults and children, infants under six months are the most at risk for infection and death, due to the fact that they are not yet fully immune to the disease. Babies receive immunizations against pertussis, which are called DTaP, at two, four and six months, then again between 15 and 18 months. Infants aren’t fully immune until they have received the first three doses.\u003c/p>\n\u003cp>“We try to promote the concept of cocooning,” said Amy Pine, of San Francisco’s Public Health Department. “This is vaccinating anyone around a child who’s too young to be vaccinated.”\u003c/p>\n\u003cp>The state is recommending that anyone older than age seven receive the booster shot. Health providers are giving priority to pregnant women and women who have just given birth, as well as the people in contact with children under one or pregnant women. They’re also prioritizing health care workers.\u003c/p>\n\u003cp>Interviews with people getting the shot Wednesday show that information on the epidemic hasn’t yet reached all health providers. Leal said it took her a week to find a place that would give her the Tdap. She said that both her obstetrician and her primary care doctor refused to immunize her.\u003c/p>\n\u003cp>So did the pharmacy near her house in Dolores Heights, which told her that the shot is only for people under 64. Leal is 72. Nurse Axelson said that the booster shot also is safe for people over 64. She added that Leal’s doctors’ refusal to give her the booster shot might be related to the fact that ordering vaccines is a time-consuming process for doctors’ offices, involving significant paperwork.\u003c/p>\n\u003cp>The state Department of Public Health doesn’t track the number of adults who are immunized against pertussis, said Ralph Montano, spokesman with the department. But it does track the number of kindergartners who have received their shots. He said that 98 percent of children entering kindergarten in California have been immunized.\u003c/p>\n\u003cp>Statewide, about 43 percent of adolescents have been immunized against whooping cough, according to the U.S. Centers for Disease Control.\u003c/p>\n\u003cp>\u003cstrong>Closing the immunization gap\u003c/strong>\u003c/p>\n\u003cp>Immunity against pertussis wears out with time, said Kaiser Permanente's Stephen Parodi. Children should get another shot between 4 and 6, and then another one at 11. Adults who haven’t received a booster shot should get one, and research is ongoing as to how long the immunity provided by that shot will last, he said.\u003c/p>\n\u003cp>Until the Tdap booster shot was developed in 2005, adolescents and adults didn’t have a way to keep up their immunity against the disease. Now that the booster shot exists, public health leaders are looking for a way to make sure that adolescents receive it. Most states have established a mandate for adolescents to get the shot around the time they enter 6th or 7th grade. California is one of 11 states that have no such mandate.\u003c/p>\n\u003cp>California Assemblyman Juan Arambula, I-Fresno, is sponsoring \u003ca href=\"http://www.assembly.ca.gov/acs/acsframeset2text.htm\">a bill\u003c/a> that would change that, by eliminating the age limits now set by the state Health and Safety Code. The code now says that public health officials can only compel children to get vaccinated against pertussis before they turn seven.\u003c/p>\n\u003cp>The measure, AB 354, passed the Assembly by a vote of 74-2 in May and is awaiting a vote in the state Senate. [UPDATE: Governor Schwarzenegger signed the bill into law on Sept. 29. Starting in July 2011, children entering grades 7 through 12 will have to show proof that they received a whooping cough booster. As of July 2012, only children entering 7th grade will have to get the booster shot.]\u003c/p>\n\u003cp>\u003cstrong>Disease misdiagnosed\u003c/strong>\u003c/p>\n\u003cp>Health officials are concerned that doctors might be misdiagnosing the disease. In all six deaths this year, health providers who saw the babies misdiagnosed the disease.\u003c/p>\n\u003cp>A seven-week-old girl who died in Los Angeles County earlier this month was misdiagnosed by her doctor three times and by emergency care personnel twice, according to a summary of her case distributed to public health leaders by the state Department of Public Health.\u003c/p>\n\u003cp>“People don’t recognize it,” said Resignato. Doctors may confuse pertussis with an upper respiratory infection, bronchitis, allergies, or a cough caused by asthma, he said.\u003c/p>\n\u003cp>Initially, pertussis can look like a common cold, causing a runny nose and maybe an achy, sore throat, said Parodi. That is followed by what he described as an annoying cough that typically lasts two weeks, but can last up to six weeks. The cough can be so bad that it causes patients to pass out or throw up.\u003c/p>\n\u003cp>“This can be a particular problem for little children,” said Parodi. “They can have trouble with breathing. This is what gets people to the hospital.”\u003c/p>\n\u003cp>The disease is treated with antibiotics. Patients are contagious from when they become ill until three weeks afterward. If they receive treatment, they will no longer be contagious after five days of antibiotics. The recovery period can take six to 14 weeks from when the patient first got sick.\u003c/p>\n\u003cp>“That’s another good reason to get vaccinated,” said Parodi. “Who wants to be sick for three months?”\u003c/p>\n\u003cp>\u003cstrong>Latinos disproportionately affected\u003c/strong>\u003c/p>\n\u003cp>Latino babies under six months are getting infected at a much higher rate than other babies that age. According to the state Department of Public Health, Latino babies under six months old have a rate of infection of 94 per 100,000 babies – twice the rate of African-American babies and almost three times the rate of white babies.\u003c/p>\n\u003cp>All of the four baby girls and two baby boys who have died from pertussis this year were Latino and hadn’t yet turned two months old. Three of them lived in Los Angeles County, and one each in San Bernardino, Fresno and Stanislaus counties.\u003c/p>\n\u003cp>Public health officials said Latino newborns might be at a higher risk for infection because they live with extended families, which puts them in contact with more people. Latinos in California are also under-immunized, said pediatrician Jaime Ruiz, from the \u003ca href=\"http://www.mnhc.org/\">Mission Neighborhood Health Center \u003c/a>in San Francisco.\u003c/p>\n\u003cp>“The Latino population isn’t always aware that there are clinics where they can get vaccines for free, if they qualify by income,” said Ruiz. “And if they are migrant farm workers, they are moving around.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp> 37.7749295 -122.4194155\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/6889/whooping-cough-epidemic-exposes-holes-in-californias-immunization-system","authors":["6186"],"categories":["quest_12"],"tags":["quest_1011","quest_1452","quest_3351","quest_13203","quest_2163","quest_3055","quest_3147"],"label":"quest"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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