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High Rate of Vaccination Opt-Outs Raises Concern Among Local Physicians

Health-care professionals warn that choosing not to immunize because of personal beliefs puts the community as a whole at risk

At a time when the nation is worried about the spread of the Ebola virus, vaccine-preventable diseases in elementary schools pose a serious threat on the South Coast. 

Already, the Santa Barbara County Public Health Department has reported 85 cases of pertussis this year, with 36 of those occurring in schools.

Earlier this month, The Waldorf School experienced what medical professionals called an epidemic when five of its students came down with pertussis, commonly known as whooping cough.

The spread of whooping cough has been linked to a high rate of parents who choose to opt out of vaccinations. State law requires students to get vaccinated for everything from pertussis, measles and chicken pox to tetanus, mumps, rubella and diphtheria.

The reasons for the opt-outs vary.

Some people worry that there is a link between vaccinations and autism, a belief that has been led by some Hollywood celebrities such as Jenny McCarthy but has been scientifically disproven.

A 1998 study published in The Lancet, a medical journal, linked vaccines for measles-mumps-rubella with autism. The study sparked an anti-vaccination movement, but in 2010 the study was discredited when The Lancet retracted it, claiming the statements in the paper were false. Andrew Wakefield, the study's author, eventually lost his medical license.

Still, the remnants of the autism-vaccine link remain.

But most medical professionals warn that parents who skip vaccinations not only put their kids at risk, but the overall community.

"Vaccines are one of the great advancements in the history of medicine, and a leading reason why western countries have eradicated deadly pathogens such as smallpox and polio," said pediatrician Dr. Dan Brennan said.

Brennan said educating and requiring families to immunize their kids is the biggest issue of importance in the pediatric community. The Centers for Disease Control and Prevention has recently amplified its advocacy for childhood immunizations, saying that any slowdown in vaccinations could undo the work over years and cause deadly diseases to return. 

Doctors are pushing education on "herd immunity," the concept that 95 percent of the population must be vaccinated to ensure safety in the community.

"It's all about herd immunity," Brennan said. "When a population or school falls below a 95 percent immunization rate, we start to see the spread of vaccine preventable diseases. A small percentage of our patients are not medically able to receive vaccines or are too young to receive vaccines, so when a handful of otherwise healthy children/adults opt out of immunizing, they quickly bring us below the 95 percent threshold and we start to increase the risk of pertussis and measles outbreaks."

Waldorf in 2013 had an 87 percent rate of opt-out for vaccinations for kids entering kindergarten. The private school has about 125 students enrolled, and 50 of them are in the nursery through kindergarten grades, according to SantaBarbaraIndependentSchools.com.

The Waldorf School is not alone in having a high rate of vaccination opt-outs. Montecito Union School has a 27 percent personal exemption rate. El Montecito is at 42 percent, and Carpinteria Family School had a 50 percent opt-out rate for kindergartners in 2013.

In the North County, Santa Ynez Valley Family School in Los Olivos had a 31 percent personal-belief exemption last year, and Santa Ynez Valley Charter had a 20 percent opt-out rate. Trivium Charter School in Santa Maria had a 49 percent personal belief exemption rate.

For the 2013-14 school year, California has a statewide personal-belief exemption of 3.15 percent. In Santa Barbara County, the number is 4.72 percent, according to the California Department of Public Health.

In Santa Barbara, doctors have seen many cases of pertussis, while measles cases also have broken out in Orange County, Marin County, San Diego and other areas of the state.

Administrators with The Waldorf School did not return repeated calls from Noozhawk seeking comment.

Tammy Murphy, the superintendent for Montecito Union School, said a school nurse meets individually with parents who do not complete the immunizations to inform them of the health risks.

"I understand fully the concerns and questions being raised over vaccinations, specifically a growing trend of parents opting to not vaccinate their children, but the district is legally obligated to recognize and honor this parental right," Murphy said. "We work to monitor, through thoughtful observation, our children’s health in order to take good care of our students, and the overall health of our classrooms."

Stacia Lansman Kenet, a medical doctor who founded Pediatric Alternatives in Marin County, doesn't share the traditional scientific perspective on the importance of vaccines.

"I think we're just messing with nature, and we really don't know what we've created," she told Mother Jones magazine in March. "We've reduced or largely eliminated many infectious diseases. But in their place, we have an epidemic of chronic illnesses in children.

"The incidence of asthma, allergies, and autism spectrum disorders has dramatically increased since the 1990s. And the reason for this we don't know. But my concern is that vaccines have played a role."

Her practice has nearly 2,000 patients.

Paige Batson, manager of disease control and prevention for the Santa Barbara County Public Health Department, said it's important for people to know the widespread effects of nonvaccination.

"If people are choosing not to vaccinate, they are putting others at risk of contracting the disease," Batson said. "If that child is under 1 year old, you are putting that child at severe risk."

Batson said the county follows up with the doctors of patients who contract a vaccine-preventable disease. Families with a child under 1 year of age are at the greatest risk, Batson said, adding that "they are the ones who are going to have the bad outcomes."

Batson praised AB 2109, which went into effect in 2013, as a positive step toward 100 percent vaccination. The law requires that parents who want a personal exemption first speak to a health-care professional about the risks of vaccine-preventable diseases. 

She said that increasingly, doctors are choosing not to accept patients whose parents decide against vaccinations. 

"When we are part of a community, we all have a responsibility to do what is right for our kids and families, but we also have an obligation to do what is right for the health of our community," Dr. Brennan said. "Parents who are not immunizing need to understand that they are not only putting their own kids at risk, but our entire community's health at risk."

Dr. Christoph Le-Renard, a pediatric hospitalist at Santa Barbara Cottage Hospital, said people should understand that choosing not to vaccinate is not like choosing not to take an antibiotic. Not vaccinating puts other at risk.

Le-Renard recently saw a patient under 6 months old who came down with pertussis. The child, who was too young to get vaccinated, was in the hospital for a month. 

"It is typically someone who is not vaccinated who will travel and bring the illness back," Le-Renard said. "You will put other kids at risk. Children under 6 months are the ones at the most severe risk of death."

Le-Renard said parents frequently bring up autism when seeking a personal-belief exemption, but those concerns are unfounded.

"There has been no evidence that autism is called by vaccines," Le-Renard said. "It seems like high-income families may be thinking they are exempt from picking up these illnesses, but anyone can pick up these illnesses. It doesn't matter where you live."

Physicians said it will take work to educate and change the minds of the public.

"It's going to take a lot of effort to explain the concept of herd immunity, and to help parents realize that they can no longer pretend that there are enough people immunized around them that they can opt out of immunizing their own kids," Brennan said. "Physicians and other practitioners need to take the time to explain the importance of vaccines to parents instead of allowing them to quickly sign a release and get out of the office. It is a challenge, but a necessary challenge."

Check Your School

Visit the following websites to find out more about vaccination rates for individual schools:

» www.shotsforschool.org/

» www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx

Noozhawk staff writer Joshua Molina can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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