August marks National Immunization Awareness Month, sponsored by the Centers for Disease Control and Prevention and serves as a good reminder for parents to have their children vaccinated, especially in the wake of the new law, Senate Bill 277, that strengthened immunization requirements and eliminated exemptions previously allowed for personal or religious beliefs. The bill was signed by Gov. Jerry Brown in 2015 and went into effect July 1, 2016 and applies to all children before entering kindergarten.
Sonoma County has a particularly low rate of vaccinated children in comparison to the rest of the state. As of the most recent school year, about a dozen schools in the county are still ranked as “most vulnerable” by the California Department of Public Health (CDPH), with less than 80 percent of students fully vaccinated. Nevertheless, those numbers are going up as SB 277 has gone into effect. According to the immunization branch of CDPH, the proportion of students attending kindergarten in the state in 2017-2018 who have received all required vaccines is 95.1 percent, a 4.7 percentage point increase over the three years since 2014-2015.
“We have definitely seen an uptick in parents coming in to vaccinate their children for school since the passing of this law,” says Dr. Angela Zarate, MD, Pediatrician at Kaiser Pediatrics in Santa Rosa.
However, medical exemptions are also on the rise as parents who previously could forego vaccines for their children based on personal beliefs are seeking ways to skirt the law.
According to Dr. Gary Green, MD, Chief of Infectious Diseases at Santa Rosa Kaiser Medical Center, there is a “perfect storm” of reasons why parents, especially in certain pockets of the county, are choosing not to vaccinate.
“Some parents think normal vaccines are not effective or can be dangerous,” says Green. “In a way we are a product of our own success. We don’t see a lot of these diseases anymore and they are not in our social consciousness. Because we don’t see children dying with these diseases we have lost understanding of how dangerous some of these infectious diseases are.”
Until a disease is completely wiped out; however, the public can still be at risk and pandemics can happen again.
There is also a lot of misinformation being circulated about presumed dangers of vaccines. Green recalls a study being released in Great Britain that linked autism to a measles vaccine. The organization was shown to have falsified data, were brought up on criminal charges and retracted their study, but the damage had already been done in terms of making parents wary of what was being put into their children’s bodies.
Some pediatricians have noticed a change in reasons over the years for not vaccinating their children.
“I have been a practicing pediatrician for 14 years now,” says Zarate. “It seems the reasoning has actually changed over the years. Years ago, caregivers who would refuse vaccines would have a distinct reason, such as a strong religious code that was against medications, vaccines, or blood products; personal beliefs about keeping things holistic in the early months; or sometimes misinformation about the contents or side effect of a vaccine, learned from celebrity authored books, circles of friends, or family members. I have found in recent years, with the veritable explosion of social media, that many young parents now come in and tell me they think they will refuse vaccines, or follow an
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alternate schedule of vaccination, because they feel pressured to do so by the confusing amount of information on social media. They admit to me that they aren’t even sure why they are doing this. It’s almost becoming the ‘in’ thing to do. This is very concerning to us as pediatricians as a whole.”
“There is also a general mistrust of government organizations and the science community,” says Green. “There is an element of mistrust of any organizational body that makes legislation. If the government wants to make sure all children are vaccinated before 7th grade, people wonder if there is a hidden agenda or other underlying reason that would put their children at unnecessary risk. There is a fearfulness in society related to policy.”
There are some children that indeed cannot be vaccinated; namely those with weakened immune systems due to other diseases, or those that have been found to have a severe documented allergy to a vaccine. Because there are people in our society that cannot be vaccinated, not vaccinating those that can be puts those who are most vulnerable, including already sick children or infants too young to be vaccinated, at risk.
“Really, for the vast majority of healthy children, vaccines are safe and highly recommended,” says Zarate. “For a board-certified practicing pediatrician like myself, I only encounter a few cases per year, amongst many hundreds, that may have a true medical exemption preventing them from being fully vaccinated. Usually, they are children with rare diseases or childhood cancers, whose medical therapies temporarily prevent them from taking a few select vaccines.”
In addition, today we live in a truly global society. Having people visit here from all over the world, including from countries with low vaccination rates, or having U.S. residents returning to the states from abroad and have visited a crowded area can have dangerous implications. Such was the case a couple years ago when a measles outbreak occurred at Disneyland in Southern California, affecting dozens.
Green asserts that the fear of vaccines is unfounded. While vaccines 30 to 40 years ago may not have been as safe, today they are more effective and safer than ever.
According to the Sonoma County Public Health Department, by transitional kindergarten and up to six years old children should have received four doses of the polio vaccination, five doses of vaccines for Diphtheria, Tetanus and Pertussis (often referred to as DTAP), two doses of Measles, Mumps and Rubella (MMR), three doses of Hepatitis B and one dose of the Varicella vaccine. By elementary or secondary school (7 to 17-year- old), schools require another four doses of polio, three doses of DTAP, one more dose of MMR, one dose of Varicella for 7 to 12-year-olds and two doses of Varicella for 13 to 17-year-olds. In addition, new 7th grade admission requirements include one dose of Tdap and two doses of MMR or any measles-containing vaccine.
Child care centers, day nurseries, nursery schools, family day care homes and development centers also have immunization requirements, starting with two to three months old with polio, DTaP, Hib and Hepatitis B. Every few months additional vaccination requirements are added, until most children have met the child care requirements by around age 15-18 months.
“For an infant in the first year of life, the primary series which contains DTAP, Hepatitis B, Polio, Hib, Pneumococcal, and Rotavirus protection are key,” says Zarate. “Depending on the facility, these can be administered separately, or as combination vaccines, which lessen the amount of injections required. These are given at the 2, 4, and 6 month well visits.”
From a pediatrics standpoint and as a parent himself, Green reminds parents to set a good example.
“Parents model for their children a way of life,” says Green. “We model behaviors, social awareness and overall health. It is very important to show good health habits and vaccination habits and ensure we [as adults] are also up to date with our vaccinations.”
Concerned parents are encouraged to visit non-biased sites for more information on vaccines such as CDC.gov and Shotsforschool.org which offers specific lists of what is currently required for entrance to California schools at various age levels. In addition, there exists an iPhone app called Vaccines On The Go: What You Should Know (by the Children’s Hospital of Philadelphia) which is free on the app store and lists each vaccine, safety, and the ingredients in each vaccine vial.
“Immunizations save lives,” reminds Zarate. “Prior to the advent of many of the vaccines available today, there were simply more community outbreaks of contagious diseases, more hospitalizations for severe childhood illnesses and more childhood deaths. The immunizations we have available today are safe, effective, and trusted by us, the doctors who take care of your children. I believe vaccinating your child is one of the best steps a caregiver can take in being an advocate for health and safety in their young lives.”