Childhood Vaccinations: A Prickly Issue

 

For the majority of Connecticut parents, the risk of a child contracting a life-threatening—yet completely preventable—disease is simply not worth taking.

Indeed, the state’s vaccination-compliance rate for children entering kindergarten is more than 97 percent. That’s even higher than the median rate of 94 percent nationally, as reported last month (in an Aug. 1 report) by the Centers for Disease Control and Prevention (CDC).

Still, the number of children who were exempted by their parents from the law has risen slightly but steadily over the last few years—from .8 percent in 2006, to 1.7 percent in 2013.
Their numbers may be few, but parents who oppose vaccinations are passionate in their convictions. And although the anti-vaccine movement of the late ’90s (see box on page 39) has lost considerable momentum, there is still concern in some circles that vaccinations may do more harm than good.

It’s a polarizing issue.

Because no vaccine is foolproof (according to the CDC, most routine vaccines produce immunity about 90 to 100 percent of the time), some parents in the pro-vaccine camp fear that their children may be infected by kids who haven’t been vaccinated.

“The whole thing makes me crazy. I am not into vaccinations at all,” says Kim, a mother of three who lives in a small town in the Connecticut Valley. “Because it is such an ugly topic,” and she fears her children may be ostracized, she asked not to be identified. “I don’t push my views on anyone, and I don’t like anyone pushing their views on me,” she adds.
When her first child was born nine years ago, Kim followed the letter of the law and brought him in for all of his early-childhood vaccinations. But by the time he was ready for kindergarten, she’d started questioning both the efficacy and safety of the required shots.

“I started doing my own research, I learned what was in the vaccines and read studies linking them to all sorts of illnesses—I just didn’t buy what the doctor was telling me,” she says. When she questioned the efficacy of the MMR vaccine during a measles outbreak that affected vaccinated children in New York, her doctor told her “nothing is guaranteed.” In the end, it was the sheer number of shots that put Kim over the edge. “When I refused to let them give my younger daughter six shots in one day, I got kicked out of the pediatrician’s office,” she says. She found a more “holistic” physician, and by filing a religious exemption with the Connecticut Department of Public Health (DPH), she joined the ranks of parents whose kids don’t get vaccinated but are permitted to attend public schools anyway.
 

 

Getting an exemption in Connecticut is surprisingly easy. A medical exemption for any number of reasons—allergic reactions to the vaccine, pediatric cancer, immune disorders—simply requires a written statement from a physician. Exemptions based on religion, which are granted much more frequently, and often used as a pretext, require only that a parent or guardian give the school nurse a signed note (which is then filed with the DPH) stating that the family’s religious beliefs prohibit vaccinations. These exemptions are not checked or challenged.

The increase in exemptions is worth noting, but not alarming, according to Kathy Kudish, vaccine coordinator and supervising epidemiologist with the DPH. “A number under 2 percent is relatively insignificant,” she says. “We’re just keeping our eye on it.”

“We know that the vast majority of children [in the U.S.] are having some vaccines,” says Shannon Stokely, an associate director with the Immunization Services Division of the CDC. “Exemptions don’t necessarily mean a child has never had any vaccines. They may have just missed one dose. We can’t distinguish between children having none or just a few.”

Laura George of Seymour is a school psychologist and mother who says that at first she was “on the fence” and skeptical of the state’s vaccine regimen with her first two children. “I read the news and worried there might be a risk, but then I took a close look at the studies [that pointed to ill effects from vaccines] and wasn’t convinced they were valid,” George says. “I think the research was flawed, and I know it’s important to get your information from multiple sources. So when my third child was born, my husband and I agreed it was more important to protect her.” George has kept up with all of her kids’ vaccinations since then because she says she trusts her instincts, and perhaps more importantly, her doctor.
Most physicians maintain that vaccinations are safe and an important part of protecting a child’s overall health. “It can be challenging. We have to weigh [concern about the risks] against the seriousness of getting a disease,” says Vasanth Kainkaryam, an internist and pediatrician at Hartford Hospital.

He advises parents hesitant to have their kids vaccinated to “learn about the diseases they prevent, what we’re trying to do with the vaccine and why we’re asking you to do this in the first place. Sometimes it helps to step away from the shot part of it.”

Stepping as far away from the process as possible is a divorced mother from Trumbull whose children asked that the family not be named. Her ex doesn’t share her views, so she worries that her decision not to vaccinate may present legal or custodial issues. “Vaccines are an emotional topic, especially when children become ill and the parents believe the vaccine is responsible,” she says. Years ago, keenly observant of her babies’ health following their vaccines, she began charting their ear infections, eating habits and periods of listlessness. She didn’t like the patterns that emerged. It prompted her to take a close look at what went into the vaccines her doctor was recommending, and she ultimately decided they were “mostly toxic” and not beneficial to her children’s health and well-being. She stopped vaccinating her children almost a decade ago, with no regrets.

Her argument against vaccinations includes concerns about ethical research and a push by the pharmaceutical industry to market unnecessary drugs; she feels vindicated by experience since her children have never been healthier. “Most of us trust our doctors, and most doctors have never taken the time to do the research,” she says. “They just follow the guidelines they’ve been given . . . until something bad happens and they can easily connect the dots.”

But Kainkaryam says he’s seen what happens when unvaccinated children get sick—and it isn’t pretty. “We see it when things get bad,” he says, “when a pediatric patient in the ICU dies from pertussis, for example.” Of all preventable diseases, cases of pertussis, aka whooping cough, are of most concern to health-care professionals. A highly contagious bacterial disease, pertussis leads to severe coughing that causes children to make a distinctive whooping sound as they gasp for air. Complications include respiratory ailments, and in rare cases, especially among children under 2, it can be fatal. There were 183 cases in Connecticut last year, “more than we’ve seen in over a decade,” says Kudish at the DPH. “Luckily, we had no fatalities. Other parts of the country experienced worse than we did. But we had concerns. We try to control it where we can, following up with kids who have not been vaccinated.”
 

 

The consequences must be part of the discussion, says Kainkaryam. “We have to bring that out up-front.”

Meanwhile, the DPH is ramping up its efforts to eventually reach 100-percent compliance. The Connecticut Vaccine Program has played an important role in keeping the state’s vaccination numbers up thus far. The program provides vaccines to doctors for enrolled children up to age 18. Expanded in January of this year, the program covers 14 of the 16 required vaccines—at no cost. “Our goal has always been to provide all vaccines and all doses,” says Kudish. “We hope to get there soon.”
 

Current Vaccine Requirements

The list of immunization requirements for children enrolled in Connecticut public schools is long and complex. The following vaccinations are required of children entering kindergarten:

  • DTaP. Prevents diphtheria, tetanus, and pertussis. At least four doses, with  the last given on or after the 4th birthday.
  • Polio. At least three doses, the last given on or after the 4th birthday.
  • MMR. Prevents measles, mumps and rubella. Two doses separated by at least 28 days, with first dose given on or after the 1st birthday.
  • Hepatitis B. Three doses, with the last dose on or after 24 weeks of age.
  • Varicella. Prevents chicken pox. Two doses separated by at least three months, with the first dose on or after the 1st birthday; or upon verification of disease.
  • Hib. Prevents pneumonia, epiglottitis and bacterial meningitis. One dose on or around the 1st birth­day.
  • Pneumococcal. One dose on or after the 1st birthday for children under five.
  • Hepatitis A. Two doses given six months apart, with the first dose on or after the 1st birthday.

For details on all immunizations and doses required through grade 12, visit ct.gov/dph.
 

The Autism Scare

Many who fear serious side effects of the MMR vaccine point to the work of Andrew Wakefield, a former British surgeon. In 1998, he published a study linking autism to the vaccination that prevents measles, mumps and rubella. The news started a furor among parents and prompted a movement against vaccinations both here and abroad. Following the study’s publication, rates of children going unvaccinated doubled in Connecticut and New York. In New Jersey, they rose by 800 percent.

Wakefield’s work was later roundly discredited by the medical community in the U.K., the American Academy of Pediatrics, the American Medical Association, the Centers for Disease Control and Prevention, and researchers around the world. The British Medical Journal  branded the study an “elaborate fraud,” but the damage had been done. To this day, many believe the autism link is credible. The scare — and its debunking— are the subject of The Panic Virus: A True Story of Medicine, Science, and Fear by Seth Mnookin (Simon & Schuster).
 

We’ve Come a Long Way  and Yet . . .

It was recently reported that the number of teenage girls in the U.S. who have been vaccinated against human papillomavirus (HPV) has lagged since 2012. HPV is a sexually transmitted infection that can cause cervical cancer. Just over half of all girls aged 13 to 17 have received one dose of HPV vaccine and only a third have received all three recommended doses, according to the Centers for Disease Control. Since the vaccine was introduced in 2005, legislators in 41 states and the District of Columbia have proposed legislation to require, fund or educate the public about the HPV vaccine; Connecticut is not among them. Twenty-two states have enacted such legislation.

 

Childhood Vaccinations: A Prickly Issue

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