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    Lack of Vaccines


    Title: More Oregon Parents Delaying Vaccines
    Date: June 19, 2012
    Source: CNN

    Abstract: Nearly 10% of parents in Oregon are limiting their children to getting no more than one or two injections per visit to the pediatrician, according to a new study published in the medical journal Pediatrics Monday.  

    As a result, children are falling behind in getting recommended vaccines, which could leave them vulnerable.

    Researchers analyzed immunization records from 97,711 children born between 2003 and 2009 and found that parents in the greater Portland area choosing to restrict the number of shots their infants get during the first 9 months of life grew from 2.5% in 2006 to 9.5% in 2009.

    By limiting the number of injections, parents are choosing to deviate from the vaccine schedule recommended by the CDC, the American Academy of Pedictrics (AAP) and the American Academy of Family Physicians.

    Researchers say this study is the first to quantify how many babies are consistently getting vaccines on a delayed schedule.  Data about children who weren't getting any vaccines at all were not included in this report.

    Lead study author Steve Robison says he was surprised that the number of parents who are limiting vaccine injections was so high.

    Robison, an epidimiologist with the Oregon Health Authority, says some parents may be following recommended alternate vaccination schedules as suggested by Dr. Stephanie Cave or Dr. Robert Sears, who in 2001 and 2007 respectively began recommending that children only receive one vaccine per doctor's visits and delaying or avoiding some vaccines.

    Three years ago, Pediatrics published an article in which two researchers address what they call "The Problem With Dr. Bob's Alternative Vaccine Schedule." In it, they say stretching out when children get vaccines will "increase the time during which children are susceptible to vaccine-preventable diseases," resulting in fewer children who are protected, "with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases."

    Currently the CDC's Advisory Committee on Immunization Practices (ACIP)  recommends children get multiple vaccines at their 2, 4, 6 and 12 months well-baby visits.

    The study authors found many parents weren't actually sticking to the Sears or Cave schedule either, suggesting "parents are unable to accommodate the extra visits needed to space out vaccinations according to alternative schedules because parents are customizing their own schedules."

    The study found that babies on the delayed vaccine schedule received on average only six vaccination injections during four doctor's visits, compared to about 10 vaccinations over three visits when parents allowed for the regular schedule to be followed.

    "It may be appealing to follow an alternate schedule, but it's too easy fall behind on shots, and it's really hard to catch up once you're behind," Robison says.

    As more vaccines have been developed and added to the schedule, so has the fear among some parents that instead of preventing illness, these drugs are causing children to get sick, particularly since controversial British physician Dr. Andrew Wakefield suggested there was a link between the measles-mumps-rubella vaccine and autism in a discredited study.

    The CDC does not endorse any alternate vaccine schedules.

    "There's no evidence whatsoever that that getting multiple antigens is bad," says and Dr. Paul Cieslak, medical director for the Immunization program for the Oregon Health Authority and a recent member of the CDC's Advisory Committee on Immunization Practices, which has been developing the recommended vaccine schedule since 1995. Antigens are bacteria or viruses that help a child build up immunity.

    Cieslak says there's a reason for how the CDC and AAP endorsed vaccination schedule is set up: "The schedule is a balance between when you need vaccines and practical considerations like when is a child likely to visit a doctor."

    Cieslak, who was not involved in the study, explains that if you follow Sears' schedule, for example, you have to take your child to the pediatrician nine or 10 times during the first year of life. He says for many parents it's hard enough to get to the five recommended appointments on the well-baby schedule.

    He is aware that some parents fear having their child exposed to too many antigens at one time. But he also reminds them that when a child is crawling on the floor or eating his or her first mouthful of dirt – which will happen – the child is exposed to hundreds of bacteria and bugs, which the immune system has to deal with.

    Cieslak also points out that vaccinations according to the CDC/ACIP schedule are recommended precisely at the time when infants are at highest risk of serious illness. "If you get pertussis during infancy... [babies] cough and cough and cough, and when they're coughing so much they can't get a breath because you only exhale when you cough."

    He says in Oregon about about 50% of infants with pertussis land in the hospital and occasionally there's even a death.

    Cieslak applauds the vast majority of parents who are following the schedule as recommended. To them he says: "Good job! You're getting your kids immunized and helping to protect the kid next door as well" (CNN, 2012)

    Title: Rising Number Of Connecticut Kids Exempted From Vaccines
    Date: September 4, 2012
    Source: Fox News

    Abstract: An increasing number of Connecticut students are being exempted from vaccinations as parents cite allergic reactions or religious prohibitions.

    The Connecticut Post reports  that according to the state Department of Public Health, 1,056 children entering kindergarten and seventh grade last year received exemptions. That's up by 127 percent increase from 2003, when the state recorded 465 such exemptions.

    Vaccination coverage in Connecticut still remains high, with more than 97 percent receiving various vaccinations.

    A medical exemption excuses a child due to an allergic, pediatric cancer or HIV or other immune disorders.

    State health officials say 111 cases of pertussis -- a contagious bacterial disease -- have been reported this year and that the state could reach a 10-year high. Last year, there were 68 cases (Fox News, 2012). 

    Title: 15 States Lag On Vaccinating Tots For Measles, Mumps And Rubella
    Date: September 6, 2012
    Source: Fox News

    Abstract: The percentage of U.S. toddlers who receive the vaccine for measles, mumps and rubella (MMR) remains above the target of 90 percent, according to a new report from the Centers for Disease Control and Prevention (CDC). However, there are 15 states where lower percentages of 1- to 3-year-olds receive this vaccine, the report said.

    Additionally, the national rates of children this age receiving the vaccines against hepatitis B, poliovirus and varicella (chickenpox)  are above the target of 90 percent, the report said.

    However, coverage varies by state and local areas, and "low vaccination coverage is a concern, especially for extremely transmissible diseases like measles ," the researchers said in a statement.

    The 15 states that fell short of the 90 percent target for the MMR vaccine  were Arizona (86.7 percent), Colorado (88.4 percent), Idaho (89.5 percent), Iowa (86.7 percent), Michigan (87.6 percent), Mississippi (89.6 percent), Missouri (88.2 percent), Montana (87.8 percent), South Carolina (89.3 percent), South Dakota (89.2 percent), Utah (88.8 percent), Virginia (89 percent), Washington (89.3 percent), West Virginia (85.8 percent) and Wyoming (85.6 percent).

    For many vaccines, lower rates of coverage were seen in children whose families live below the poverty line, according to the report.

    Only two states — Nebraska and Hawaii — met the 90 percent target for the DTaP vaccine, which protects against diphtheria, tuberculosis and pertussis (also called whooping cough ), according to the report. Most states had coverage rates between 80 and 90 percent for this vaccine, which is administered in a series of four injections. The national coverage rate was 84.6 percent.

    The report is based on the data gathered during the CDC's 2011 National Immunization Survey. Researchers interviewed parents of 19,500 children born between January 2008 and May 2010, and followed up with the children's doctors to obtain their immunization records. The results were weighted to be nationally representative.

    Between 2010 and 2011, there were increases in the percentages of children who received several vaccines, with the biggest increase — from 66.8 percent to 80.4 percent — coming in those who received the full series of shots for the Hib vaccine, which protects against one type of bacterial meningitis . There were also increases in the rates of children receiving the vaccines against hepatitis B and A, and rotavirus.

    National coverage has remained stable since the mid-1990s for the MMR vaccine, the DTaP vaccine, the varicella vaccine and poliovirus vaccine, according to the report.

    Vaccines have had a substantial effect on the rates of diseases, the CDC said. Since the introduction of the hepatitis A vaccine, the rate of the disease has dropped 93 percent compared with the pre-vaccine rate. Hospitalizations for rotavirus infections in infants and young children have decreased from 66 percent to 89 percent, and the rate of pneumonia in children under age 5 caused by streptococcus bacteria has decreased by 99 percent by 2007.

    Less than 1 percent of toddlers received no vaccines, according to the report (Fox News, 2012).

    Title: California Parents With Kids In Private Schools More Likely To Opt Out Of Vaccines
    Date: September 9, 2012
    Source:
    Fox News

    Abstract: Parents who send their children to private schools in California are much more likely to opt out of immunizations than their public school counterparts, an Associated Press analysis has found, and not even the recent re-emergence of whooping cough has halted the downward trajectory of vaccinations among these students.

    The state surveys all schools with at least 10 kindergartners to determine how many have all the recommended immunizations. The AP analyzed that data and found the percentage of children in private schools who forego some or all vaccinations is more than two times greater than in public schools.

    More troubling to public health officials is that the rate of children entering private schools without all of their shots jumped by 10 percent last year, while the opt-out figures held steady in public schools for the first time since 2004.

    Public health officials believe that an immunization rate of at least 90 percent in all communities, including schools, is critical to minimizing the potential for a disease outbreak. About 15 percent of the 1,650 private schools surveyed by the state failed to reach that threshold, compared with 5 percent of public schools.

    There were 110 private schools statewide where more than half the kindergartners skipped some or all of their shots, according to AP's analysis, with Highland Hall Waldorf School in Northridge -- where 84 percent opted out -- topping the list.

    Parents cite a variety of reasons for not immunizing their children, among them: religious values, concerns the shots themselves could cause illness and a belief that allowing children to get sick helps them to build a stronger immune system. Likewise, there's no single explanation that accounts for why so many more parents who send their children to private schools apparently share a suspicion of immunizations.

    Saad Omer, a professor of global health at Emory University in Atlanta who has studied vaccine refusal in private schools, surmised more private school parents are wealthy and have the time to spread five shots over a series of years and stay home should their child get an illness like chickenpox. Neal Halsey, a professor of pediatric infectious diseases at the Johns Hopkins University, said parents who choose private schools are likely to be more skeptical of state requirements and recommendations.

    Bibi Reber, whose children attend the Waldorf-inspired Greenwood School in Mill Valley, had her children vaccinated only for what she sees as the deadliest diseases. Greenwood has a 79 percent opt-out rate among its kindergartners.

    "I don't think dirt or getting sick makes you a weak person; your immune system needs to work with things," said Reber, whose children attend the Greenwood School in the San Francisco Bay area town of Mill Valley. "We certainly don't want to go back to having polio, but on the other hand, I don't think we need to eradicate all the childhood diseases.

    Public health officials say that, regardless of why parents choose not to vaccinate their children, the result is the same: an increased risk of an outbreak of whooping cough or other communicable diseases.

    "We're very concerned that those schools are places where disease can spread quite rapidly through the school and into the community, should it get introduced," said Dr. Robert Schechter, medical officer with the Immunization Branch of the California Department of Public Health.

    That's what prompted the Legislature to approve a bill requiring parents to discuss vaccinations with a pediatricians or a school nurse before they can opt-out. Gov. Jerry Brown has until the end of September to sign or veto it.

    State Assemblyman Richard Pan, a pediatrician, who sponsored the bill, said he believes private school parents are more apt to mistakenly believe that the vaccinations themselves could be more dangerous than the diseases.

    "In private school, these are people who have money, who are upper middle-class, and they are going on the Internet and seeing information and misinformation," said Pan, D-Sacramento.

    Increasing immunization rates for this population is critical to controlling the outbreak of diseases, he said. "Have you ever seen a child cough themselves to death? It's not pleasant," he said.

    Those who choose not to vaccinate their children see the legislation as meddlesome and unnecessary.

    "It's making an extra appointment and paying extra money to go in there and essentially get permission to do what I feel is right for my family," said Dawn Kelly, who sends her unvaccinated 5-year-old son and partially vaccinated 9-year-old son to Monarch Christian School in the Los Angeles area.

    Like many parents who refuse some or all immunization shots, Kelly worries her children's immune system could be overwhelmed by getting too many vaccines at once.

    Melani Gold Friedman, president of the parent association at Highland Hall Waldorf School, is concerned with what the legislation means for families who normally consult with acupuncturists, holistic healers or other alternative practitioners.

    "The bill has an assumption that everyone's seeing one particular kind of doctor, but the people who are opting out, chances are they're not seeing that kind of doctor," she said.

    Vaccination opt-out rates nationwide have been creeping up since the mid-2000s, spurred in part by the belief the battery of vaccinations routinely given to infants could lead to autism. Several major studies have discredited that idea.

    Parents are allowed to forego vaccines for philosophical reasons in California and 19 other states. Of those, only Washington requires parents to consult with a physician. And, in California, there's no difference between private and public schools when it comes to what's required for parents to opt out -- they simply sign a document. The state recommends that kindergarteners receive five vaccine progressions, including protections against Polio, Hepatitis B and Measles.

    Politicians and public health experts across the nation are focusing more attention on childhood immunizations, driven by a re-emergence of diseases like whooping cough. The U.S. is in the midst of what could be its worst year for that disease in more than five decades, with nearly 25,000 cases and 13 deaths.

    After whooping cough reached epidemic levels in California in 2010, the state took action, embarking on a public information campaign and increasing the availability of vaccines. A law was passed requiring booster shots for older students.

    Yet the opt-out rate continued climbing in private schools. It's more than doubled since 2004, to 2,228 kindergartners in last year's state survey. While the overall rate of full immunization among kindergarteners hovers around 91 percent, places where the opt-out rate is greater could pose a risk for outbreak.

    In 2008, East Bay Waldorf School in El Sobrante closed temporarily after whooping cough sickened more than a dozen students, eight of them kindergartners. The San Francisco Bay Area school had a vaccination rate of less than 50 percent.

    State health officials are tracking the divergence of opt-out rates in private and public schools, but are not planning any studies or outreach efforts targeting this pupil population. The state is conducting a general education campaign to boost vaccinate rates.

    The AP analysis found 20 of the 25 California private schools with the highest opt-out rates are "Waldorf schools," a loose association of institutions founded on the teachings of 19th-century philosopher Rudolf Steiner. He favored a holistic approach to education and medicine and thought childhood illnesses could be beneficial.

    Officials at these schools would not comment about Pan's bill but say they trust parents to make the best decisions for their children's health.

    "Parents who are brave enough to say, `No, that's not the right thing,' should be supported," said Patrice Maynard, spokeswoman for the Association of Waldorf Schools of North America (Fox News, 2012).

    Title: Non-Medical Vaccination Opt-Outs On The Rise
    Date: September 19, 2012
    Source:
    ABC News

    Abstract: An increasing number of parents are getting state approval to allow their children to opt out of school-mandated vaccinations for non-medical reasons, according to a new analysis published Wednesday.

    Dr. Saad Omer, author of the correspondence published in the New England Journal of Medicine, warned that this trend is leaving large populations of children at risk for developing potentially deadly illnesses that haven't been seen in the United States in many years.

    "Rates of exemption are substantially higher today than several years ago," said Omer, assistant professor of global health, epidemiology and pediatrics at Emory University in Atlanta. "Previously, rates were only rising in states with easy exemption policies, but now they are even rising in states that make it more difficult."

    Exemption policies vary from state to state and can range from not allowing any nonmedical exemptions to allowing opt-outs for religious or philosophical reasons. Some states make it very difficult to get approval for exemptions by requiring notarized letters from clergymen, letters written by parents with specific wording, or completion of standardized forms that can only be obtained from special locations such as health departments. Others make it very simple to skip vaccinations: Parents need only check a box on a short, standardized form.

    Omer and his colleagues analyzed data compiled by the U.S. Centers for Disease Control and Prevention on vaccination exemption rates for school years 2005 to 2011. They compared vaccine opt-out rates in each state to the ease with which exemptions could be obtained.

    They found that parents were 2.5 times more likely to opt out in states that permit philosophical reasons compared with states that require religious objections. They were also more than two times more likely to opt out in states with easy exemption processes.

    In most cases, fears among parents over vaccines -- many of them unfounded -- may be at play.

    "The CDC and health departments are doing a good job of increasing vaccine coverage," Omer said. "Therefore, rates of vaccine-preventable disease are going down substantially. Parents aren't seeing the actual diseases, so when they hear about real or perceived adverse effects of vaccines, their perception of the risks versus benefits is shifted."

    Dr. William Schaffner, chair of preventive medicine at Vanderbilt University, agreed.

    "Parents are just more skeptical about benefits of vaccines," he said. "Most young parents today have never seen a case of polio or measles, and they didn't learn about the seriousness of these diseases and importance of the vaccinations in school."

    Schaffner added that he finds it interesting that some states do not allow exemptions while others "really oblige parents wishing to opt out."

    Past research has shown, though, that in states with a substantial proportion of unimmunized or incompletely immunized children, many kids are susceptible to these classic diseases. A 2006 study showed a 50 percent higher incidence of pertussis -- commonly known as whooping cough -- in states where it is easier to get exemptions. There have been similar findings with respect to measles.

    Schaffner said he is very concerned that unvaccinated children who go abroad will bring back diseases, such as measles, that are still a major problem in other parts of the world. Not only will they suffer, but they will spread the illnesses to children who are unable to be vaccinated for medical reasons.

    Schaffner said that part of the solution to the problem is that "states with easier process need to tighten up." However, he said, this is not a fool-proof approach. He said some research has shown an increase in medical exemptions in states that have tightened up their policies -- suggesting that parents are pressuring doctors to give medical exemptions. He encourages doctor to not let themselves be "brow-beaten into providing dubious excuses" (ABC News, 2012)