August 12, 2011
As a new school year starts, public health and school officials are issuing their annual reminder to parents to make sure their children are up-to-date on their immunizations.
Some parents, however, will ignore the message. Compelled by any number of factors — their religious beliefs, medical evidence that their children can’t handle immunizations, concerns that the vaccines will cause more harm than good — they opt out of the recommended immunization schedule.
The percentage of opt-outs is small. In 2009, the national immunization rate for children ages 19 months to 35 months was at or above the 90 percent goal set by public health officials, according to the U.S. Centers for Disease Control and Prevention’s National Immunization Survey.
In the area’s largest school district, Colorado Springs School District 11, 3.6 percent of its 29,400 students — about 1,058 — have received exemptions. In Academy District 20, 9 percent of its 23,119 students received an opt-out based on one or more of the state’s three approved reasons for exemptions: medical, religious and personal.
But underlying the high vaccination rates are indications that a majority of parents have concerns about the safety and effectiveness of vaccines, and some health officials worry that could lead to a decline in immunizations which, in turn, could cause a rise in the diseases they’re meant to prevent.
CDC researchers found that only 23 percent of parents in a 2010 survey had no concerns about vaccinations. Though the analysts concluded that parents’ concerns don’t necessarily translate into a decision to opt out, they believe more needs to be done to address them.
Many public health officials believe the answer lies in better educating parents about vaccination testing and safety, and letting them know the problems that come from getting one of the diseases targeted by childhood vaccinations.
The Colorado Department of Public Health and Environment, coupled with the Children’s Immunization Coalition and the Vaccine Advisory Committee of Colorado, launched a website to do just that. Called Immunize for Good (immunizeforgood.com), the site examines the many questions and concerns surrounding vaccines, and attempts to separate “fact from fiction,” including the idea that vaccines cause autism.
“Parents who are on the fence, or who just don’t know, we’d like to give educational outreach to them,” said Margaret Huffman, community outreach program manager for the Colorado Immunization Program in the state health department. “The site talks about the benefits versus the risks, aluminum, natural immunity, the side effects — all the different questions they’ve been asking their pediatricians and family physicians for some time.”
Given the history of public response to vaccinations, however, these and other efforts still may not be enough to persuade every parent who opts out for anything other than religious beliefs or a medical condition that pre-empts a child from getting immunized.
An article for the New England Journal of Medicine earlier this year chronicles the ups and downs of public acceptance of immunizations. There was a “golden age” of acceptance in the 1940s, but “antivaccine thinking” took hold in the 1970s, and it’s persisted, the authors say, fueled by websites and TV reports that dish out inaccurate information.
The most publicized incident of a vaccine caught in the crossfire is the one to prevent measles, mumps and rubella. Before a vaccine was developed in the 1960s to combat measles, about 48,000 people were hospitalized each year with encephalitis, severe respiratory illness and other complications that resulted in 400 to 500 deaths, the CDC said. Most of the cases were in school-age children.
Then, in 1998, Dr. Andrew Wakefield conducted a study published by a British medical journal that linked the MMR vaccine to autism. His report sent vaccination rates tumbling in the United Kingdom. Measles cases soared, and many children were hospitalized. U.S. cases also have risen, driven primarily by unvaccinated people coming to the states from other countries and spreading it to unvaccinated locals.
Although the Wakefield study was debunked and Lancet retracted the article this year, some people hold fast to the belief that the vaccine causes autism. One Colorado Springs father who asked not to be identified because he didn’t want his family to be named said he’s convinced the vaccine caused his son to become autistic, because the child was fine up until he received the shot.
Health officials counter that it’s often just a matter of timing: Autism symptoms tend to show up around the age when children are receiving their first vaccines, but it doesn’t mean the shot caused the ailment.
“It’s unfortunate, because there are individuals — and I think they’re in the minority — but individuals who still hang onto the belief that vaccines cause autism, and they’re either not up to date, or not referencing legitimate, credible sources of information,” said Dr. Bernadette Albanese, medical director for El Paso County Public Health. “Study after study after study has been done. That data is published, that data is available from credible sources.”
It is true, however, that vaccinations can lead to serious, and sometimes fatal, reactions, but health officials say most side effects tend to be minor. Statistically, they say, children have a greater risk of coming down with serious health problems from the diseases themselves, not the vaccines.
Audra Parker, a Colorado Springs mother of three teenagers and board president of the Autism & Asperger Connections support group, sided with the health officials when she decided to get her children vaccinated.
“There’s a large group of people who believe that immunization is preferable to having their child die from a curable disease,” said Parker, who emphasized that she was speaking for herself, not the organization. “Yeah, my kid has autism. It’s not the end of the world, but by not vaccinating, you’re risking contracting a disease that could be the end of the world. You have to choose.”
Albanese and other medical experts believe some parents aren’t aware of the risk from the diseases because, paradoxically, vaccines have lowered the number of cases to the point where they don’t see the problems they cause.
“They’re not seeing the disease, and how horrible pertussis can be in a 4-week-old baby in an ICU who can’t catch its breath because it’s coughing so hard,” Albanese said. “They’re not seeing someone get measles pneumonia. They’re not seeing the disease because vaccinations have been so successful. It’s almost a false sense of security.”
Barbara Loe Fisher also believes parents need to better educate themselves about vaccinations, but she’s coming from a different perspective than the public health community. Fisher, co-founder and president of the National Vaccine Information Center, said she’s not against vaccinations per se, and her children have received several — but not all — of them. But one of her four kids is learning disabled, which she blames on a diphtheria-pertussis-tetanus shot.
“Everybody knows somebody today who was healthy, got vaccinated and is not healthy,” she said. “People’s real-life experience is becoming disconnected from what health authorities tell them.”
She said immunizations should not be given on a one-size-fits-all schedule, because children have different genetic and biological makeups. She also notes that a national program created in 1986 to compensate families whose children were harmed by vaccines has awarded about $2 billion, indicating that the shots are not 100 percent safe.
And she questions why the number of children diagnosed with chronic diseases or disabilities, as well as the number of infant deaths, has risen along with the number of recommended shots. It begs for more research, she contends.
“We believe the science is not adequate to answer the question, ‘Has the use of multiple vaccines ... had a negative effect on long-term good health?’”
Public health officials say the science is there, from the safety of vaccinations to the immunization schedule itself. The schedule is put together by the Advisory Committee on Immunization Practices, which meets three times a year and is made up of medical professionals and researchers from across the U.S.
“They’re not going to make a recommendation like this in a cavalier fashion,” said CDC spokesman Jeffrey Dimond.
Fisher decries what she calls the “demonization” of parents who question the safety of vaccines and the science behind them, but by and large, public health officials seem less interested in criticism and more interested in winning the holdouts over with more education on vetted research that address their concerns.
“I would think we’d all be remiss if we say, ‘Just blithely do it,’ and not acknowledge that a parent will have concerns about their child and vaccinations,” CDC spokesman Jeffrey Dimond said. “That’s a healthy sign of good parenting.”
THE DISCUSSION ON FACEBOOK
The Gazette asked whether people have exempted their children from vaccinations, and why. Here are some of the responses:
• “Select immunizations opted out, and others at delayed intervals. ... I think some (I repeat, some) immunizations are excessive and the large quantity that are given with no regard to general health, cold/sickeness, during the time they insist on giving immunizations. After spending much time looking into this, I opted out of flu and chicken pox of any kind, and delayed the intervals of the vaccines I did let him get.”
• “My kids are immunized, but I had to comment. It ticks me off that one idiot who made false claims many years ago (about vaccines and an autism link) could cause so much damage. I’m curious to see if people are still using that as a reason not to immunize, or if there’s some other reason.”
• “I think I can totally be on board with not giving your kid 20 shots at once. That would freak me out. ... But to avoid things that we have not had in our country for god knows how long and now we do again kinda makes me wonder. I don’t want whooping cough or meningitis or various other things that first world countries have managed not to get forever.”
• “It bothers me that people don’t get immunized as I am allergic to the whooping cough vaccine. I worry every single time I hear there is a breakout. My kids have had every single immunization, including flu and chilcken pox, without any problems whatsoever.”
• “The way vaccinations are given is outrageous! The infants are given 3-4 shots of a cocktail of vaccinations mixed together! All at once.”
• “Chemicals are added to vaccines! Most notably is thimerosal, which contains mercury! Mercury poisoning is very similar to autism.” (For the record, the CDC reports that thimerosal hasn’t been included in childhood vaccines since 2001, and that studies have shown it to be safe. It is used in flu vaccines. -- The Gazette)