Health Officials to Consider Tightening Vaccine Exemptions
Whooping Cough Epidemic Exposes Holes in California's Immunization System
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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"}},"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_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":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Health Officials to Consider Tightening Vaccine Exemptions","datePublished":"2010-10-13T21:31:48.000Z","dateModified":"2010-10-13T21:31:48.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"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":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Whooping Cough Epidemic Exposes Holes in California's Immunization System","datePublished":"2010-07-29T01:37:55.000Z","dateModified":"2010-07-29T01:37:55.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"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. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? 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. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. 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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