By Ginger Ogle and Tracey Taylor
“The vaccine controversy today is one of the most important public health crises we face in America.” So said Michael Willrich, associate professor of history at Brandeis University and author of the new book, Pox: An American History, speaking on NPR’s Fresh Air on April 5.
Willrich was not referring to smallpox, the subject of his book, but rather to the ongoing nationwide debate, among parents in particular, as to whether to give children immunizations, in particular the DTaP or Tdap vaccination which protects against Pertussis (whooping cough), Tetanus and Diphtheria.
Immunization rates have been steadily dropping in California and elsewhere. Those who oppose vaccinations are often concerned that the risks of perceived adverse events following immunization outweigh the benefits of preventing common diseases. Subsequently discredited research has also played a significant part in affecting attitudes to immunizations. A 1998 paper in the British medical journal The Lancet, which claimed a connection between the measles, mumps, rubella (MMR) vaccine and autism, prompted declining vaccination rates. The article’s author, Dr Andrew Wakefield, was subsequently found guilty of serious professional misconduct and, in 2011, the research was declared fraudulent in the British Medical Journal.
California is experiencing a whooping cough epidemic. In 2010, there were more cases than in any year since 1947. According to the California Department of Public Health, last year California had 9,477 cases of whooping cough, far higher than previous years, with 10 deaths. There were fewer than 1,000 cases a year in the 1970s, ’80s, ’90s and most of the 2000s. Berkeley reported 18 cases of whooping cough last year, and Alameda County as a whole had 422 cases.
Daxle, who lives in Oakland does not get her her 15-month-year-old daughter vaccinated. “I believe that vaccines are mostly effective at preventing certain strains of certain diseases, but not nearly as effective as we are led to believe,” she said. “Side effects are under reported, as doctors are reluctant to attribute adverse reactions to vaccines. If my child were in a situation [like group daycare] where she was exposed to a high level of disease, I would consider getting her some of the vaccines, but she isn’t. I believe that it is much more important to focus on building her immune system through proper nutrition.”
Whooping cough is a bacterial disease that usually peaks in late summer. It is extremely contagious and can last for months, with coughing that is severe enough to crack ribs, break blood vessels and require hospitalization. It can be deadly for babies and young children. There were 10 deaths from whooping cough in California last year –all of these were babies younger than two months, too young to be vaccinated fully.
The DTaP or Tdap (Pertussis, Tetanus, Diphtheria) vaccination which protects against whooping cough first became widely available in the 1940s. Babies must have three doses between two and six months. A total of five doses are needed by kindergarten, and a booster at age 11.
Because of the current epidemic, the California Department of Public Health is now recommending that adults be vaccinated if they are healthcare workers, work with babies, or are women of childbearing age, including pregnant women. Beginning next fall, all middle school and high school students in California will need to provide proof of the Tdap vaccine.
Pamela Hyde, who lives in Berkeley, experienced Pertussis first-hand when her husband, Julian, contracted it recently and then passed it on unwittingly to their one-year-old son. “It started as a head cold with a lingering cough, and then got worse and worse,” she said. “Frankly it was really scary. The coughing was so bad that his eyes would roll back and he passed out at least three times because of the strength of it.” The couple’s pediatrician diagnosed Julian. Their son, who was nearly through with his immunizations, only contracted a mild case.
“I’ve done a lot of homework on this issue and there is a lot of data to support immunizations,” said Hyde. “This is not like a new pesticide for which we don’t have much data. The science does not connect vaccinations to the issues parents are concerned about. This is not something to mess around with. Pertussis kills small children — and it’s not so pretty for adults.”
In California, schools are required to collect immunization records from entering kindergarteners showing that they have been vaccinated for childhood diseases such as polio, pertussis, diphtheria, and tetanus. However, parents can file a Personal Beliefs Exemption (PBE) instead, a pre-printed form that requires only a signature, saying that vaccinations conflict with their personal beliefs.
California is one of the few states that allows such easily obtained non-medical exemptions. States with easy procedures for opting out of vaccinations had a 90% higher incidence of pertussis, according to a 2006 research study at the Center for Disease Control (CDC).
A California Watch article in June 2010 found that “seven of the 12 California counties with the highest whooping cough rates also have above average rates of kindergarten students showing up to school with ‘personal-belief’ vaccine waivers”.
Marin County had 345 whooping cough cases last year, the highest per-capita rate in the state, and its rate of PBEs is more than twice the state average.
Unfortunately, while affluent counties in California tend to have the highest opt-out rates, nearly all the pertussis deaths last year were in very poor Hispanic populations where medical care is lacking, and parents are less likely to have been vaccinated as babies themselves.
The Center for Disease Control recommends a 90% immunization rate to protect an entire community. This means that even if 10% of a community cannot or does not vaccinate, everyone in the community is still protected.
How is Berkeley as a community doing in protecting its most vulnerable citizens — babies and children — from whooping cough? Last year, with 18 cases of whooping cough and based on a population of 102,743, Berkeley’s infection rate is worse than the state average of 4 infections per 100,000, but still much better than counties like Marin and San Luis Obispo, with 77 and 72 cases per 100,000 residents respectively.
However, a child’s chances of catching whooping cough may depend on which school she (or her older siblings) attend. Vaccination rates among Berkeley’s public and private schools vary considerably, from as low as 23% of kindergarten students at the Montessori Family School to 100% of kindergarteners at the School of the Madeleine and The Academy (see accompanying table). (Note that American International Montessori, Global Montessori, Growing Light Montessori, St. Joseph the Worker, Shu Ren, and Walden School are not included because schools that have fewer than 10 kindergarteners are not included in the CDPH database.)
A database at the California Department of Public Health, Immunization Status of Kindergarten Students, reveals this disparity. This database records vaccination rates for 2010 for all schools in California that have 10 or more kindergarten students.
Some of the Berkeley schools shown in the table above reported a higher rate for the DTP vaccine alone. For example, although only 66% of Washington students are up to date on all vaccinations, 79% of them are up to date on DTP. At Oxford, only 78% of all students have been fully vaccinated, but 90% have received the DTP.
This database also includes information about the number of children at each school with Personal Belief Exemptions on file. None of the public schools in Berkeley reported more than four children with PBEs, a rate of 0-4% at all schools except Oxford, which has an 8% PBE rate.
So the schools with lower immunization rates cannot be explained by PBE filings. The PBE rates at private schools range between 0 and 23%, but as is the case at public schools, there is still a sizable contingent of students who are neither fully vaccinated nor exempt via a PBE. For instance, 29% of Berkwood Hedge students have a PBE on file, but 47% of the students are not fully vaccinated. Likewise, at Montessori Family School, 77% of students are not fully vaccinated but only 23% of students have filed a PBE.
The question for a community is how one person’s decision not to vaccinate will impact other members of that community. Norma Arceo, a spokesperson for the CDPH, said: “Different diseases have different thresholds of community immunity or ‘herd immunity’. The higher the proportion of persons who are immune, the lower the likelihood that a susceptible person will come into contact with an infectious person. Promoting vaccination to stop the spread of vaccine-preventable diseases, such as measles and rubella, is one of our top priorities. We encourage vaccination for all preventable diseases.”
Most pediatricians recommend immunizations, and many don’t accept non-immunized patients. One that does is the Bayside Medical Group in Berkeley. “Bayside is often cited on the Berkeley Parents Network as a pediatric practice which accepts non-immunized patients, which is true – yet this acceptance is not because we don’t think vaccination is important,” wrote two of the pediatricians at Bayside, Paula Brinkley, MD and Katya Gerwein, MD, in a letter to BPN. “On the contrary, all of the pediatricians in our practice believe strongly in the value of vaccination, but we want to care for all children, even if their parents hold different beliefs about vaccines than we do.”
The doctors said they have seen several serious cases of pertussis among their patients in recent months. “Yet it continues to be challenging to convince some parents to vaccinate and protect their children against this serious disease,” they conclude.
Meanwhile, Pamela Hyde said: “I’m very much a ‘to each his/her own’ type of parent, and fully support everyone doing what works for their family. But the vaccination question stands outside that realm – this is not a decision on par with toilet training or discipline principles, which would only mildly impact one’s immediate community. This is potentially life and death for not just the playgroup, but the largest community grouping we all participate in.”
Update, 04.27.11: The Montessori Family School got in touch to say that their latest figures for vaccinated kindergarteners are higher than the 2010 figures quoted in the table. “On behalf of the MFS staff, we want to thank you for your diligence in informing parents of the immunization rates for kindergartners in the Berkeley schools,” they write. “The MFS community is highly aware of the whooping cough epidemic in California and is working hard to keep our community safe. You should be aware that the immunization report that you refer to reflects our status in October 2010 and is not current. We have thirteen kindergartners at our Early Childhood campus in Berkeley. Three of our kindergartners have personal beliefs exemptions and ten are completely up-to-date on all immunization.”
Ginger Ogle is Director of Berkeley Parents Network where parts of this article first appeared. Find information on immunizing generally and rates of vaccinations in California schools on the CDPH website.