Parents opting out of vaccines for kids

WASHINGTON, Nov. 13 (UPI) -- A growing number of parents across the United States are opting out of mandatory vaccination requirements for their children and health experts are concerned this could lead to outbreaks of deadly diseases such as measles, polio and whooping cough.

In all, nearly 38,000 children have been exempted from receiving the usual bout of childhood immunizations, according to figures from the Centers for Disease Control and Prevention in Atlanta. Also, the numbers appear to be increasing dramatically in several states, including Colorado, Oregon, Washington and Michigan.

The situation has become such a concern in some states that they have asked for assistance from the CDC.

"It's getting at the level that we're having concerns," Carol Stanwyck, an epidemiologist in CDC's immunization services division, told United Press International. She said the CDC has started to work with state public health agencies to determine the reasons for the increases.

State requirements for school enrollment generally mandate inoculations for diphtheria, whooping cough, tetanus, measles, mumps, rubella and polio. Some states have added chicken pox and hepatitis B. However, some children cannot be vaccinated for medical reasons, such as allergies to vaccine components, and nearly every state offers some type of exemption for religious or philosophical objections.

The reasons for the jump in exemptions are unclear, although Stanwyck said CDC expects to know more in about a year. A contributing factor appears to be an increasing concern among parents about the safety of vaccines. The available data do not specify parental reasons for opting out of vaccination requirements, but nearly half of the approximately 38,000 exempted children were granted their exemptions for religious reasons -- an approach often employed by parents who fear vaccines carry too many risks.

Though vaccines can cause minor side effects, most health professionals say the available scientific evidence is conclusive that the chances of serious complications are extremely rare. Moreover, the chances of developing serious complications from vaccines are much lower than the risks of severe illnesses and death from the diseases.

"The rates of parents that are taking non-medical exemptions to school immunization laws are increasing in many states and are probably increasing nationally," Dan Salmon of Johns Hopkins University's Institute for Vaccine Safety in Baltimore, told UPI. "This poses a greater risk of disease outbreaks and even poses risks to vaccinated children," he said.

Recent studies have found exempted children are up to 35 times more likely to contract measles and six times more likely to contract whooping cough than vaccinated children. For example, a study of measles and whooping cough cases in Colorado between 1987 and 1998 found schools that had higher rates of exemptions were more likely to experience outbreaks and at least 11 percent of vaccinated children who became infected with measles contracted it from an exempted student.

"It's not just that parents are only endangering their own kids," Dr. Anthony Robbins, professor of public health at Tufts University School of Medicine in Boston, told UPI. "Their decision results in reduced protection for every other kid in the community," said Robbins, who ran the National Vaccine Program during the Clinton administration.

Although vaccines help the body's immune system fight off diseases, they do not confer 100-percent protection. An important goal of vaccination lies in achieving a high level of immunization within a community -- otherwise known as herd immunity. This reduces the chance that any one person will contract a disease, which in turn reduces the likelihood of diseases being able to spread through a community.

Dr. Tom Pendergrass, a pediatrician at the University of Washington in Seattle and chair of the American Academy of Pediatricians' committee on state government affairs, said the increase in exemptions has put his own state at risk "for another big outbreak of whooping cough among infants," or even measles. In 2002, there were 575 cases of whooping cough, a three-fold increase from the previous year, Pendergrass told UPI.

Exemptions in Washington have increased from 3.4 percent of kindergarten-aged children five years ago to the current level of 4.1 percent -- or more than 2,400 children.

The increase "appears to be mainly due to philosophical and religious exemptions and not medical exemptions," Cindy Gleason, health educator for the immunization program at the Washington Department of Health in Olympia, told UPI.

In Colorado, which has the lowest vaccination coverage of any state, there has been a marked increase in exemption rates, jumping tenfold over the past 10 years, Dr. Ned Calonge, chief medical officer of the Colorado Department of Public Health and Environment in Denver, told UPI. The exemption rate increased from 0.3 percent of kindergartners to 3.0 percent, Calonge said.

"Although overall it has low impact, it is concerning that it's on the increase," he said.

In Oregon, the number of exemptions has doubled since 1999 and the bulk of this was due an increase in religious exemptions, Lorraine Duncan, immunization program manager in the state's Department of Human Services in Portland, told UPI.

In one Oregon town, Ashland, the rate of religious exemptions is a staggering 15 percent, Duncan said. "We're really worried about it," she added, noting the area currently is experiencing outbreaks of whooping cough.

Ashland is of particular concern because its location could facilitate spread of disease to other areas, including internationally, Duncan said. The city, which is close to the California border, is located on a major interstate highway, and it contains a university that enrolls many international students.

Michigan -- one of the states that has requested CDC's assistance -- has the largest exemption rate of any state --nearly six percent or more than 7,500 kindergarten-aged children.

"We've seen small increases over the past few years," T.J. Bucholz, director of communications for the Michigan Department of Community Health in Lansing, told UPI. "It concerns us," Bucholz said, noting the health department will be intensifying efforts in the next few months to communicate to parents the importance of vaccination for their children.

Other states with high exemption rates include Wisconsin with 5 percent or 176 cases, Nebraska with 4.5 percent or more than 1,000, and Alaska with 4 percent or 329.

The rate ranges from 1 percent to 2.8 percent for several other states, including Arizona, California, Idaho, Indiana, Maine, Minnesota, Montana, Pennsylvania, Rhode Island, Utah, Vermont and Wyoming.

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Steve Mitchell is UPI's Medical Correspondent. E-mail sciencemail@upi.com