Washington ranked 41st in the United States for overall vaccination rates at 71.2 percent in 2006, according to the latest statistics from the Center for Disease Control and Prevention.
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RECOMMENDED READING
The Vaccination Book: Making the Right Choice for Your Child, by Robert Sears, Sears Parenting Library, October 2007.
Do Vaccines Cause That? A Guide for Evaluating Vaccine Safety Concerns, by Martin G. Myers, M.D., and Diego Pineda. Ordering information at www.dovaccinescausethat.com/.
Vaccines: What You Should Know, 3rd edition, by Paul A. Offit, M.D., and Louis M. Bell, M.D., Simon & Schuster, March 2003.
Plain Talk About Childhood Immunizations, Public Health – Seattle & King County and Snohomish Health District. Available free from Within Reach at 1-800-322-2588 voice or 1-800-833-6388 TTY, and from Washington State Department of Health at 360-664-2929 fax only, or online at www.metrokc.gov/health/immunization/childimmunity.htm.
ORGANIZATIONS
National Network for Immunization Information Vaccine safety and general vaccine information, www.immunizationinfo.org
Public Health – Seattle & King County Immunization Program, Immunization Program: 206-296-4774 Vaccine Distribution Program: 206-296-4782 Communicable Disease Hotline: 206-296-4949 www.metrokc.gov/health/immunization
CDC (Centers for Disease Control and Prevention), Phone consultation: 1-800-CDC-INFO (800-232-4636) National Immunization Program e-mail: nipinfo@cdc.gov National Center for Immunization and Respiratory Diseases: www.cdc.gov/vaccines
Most health care providers say it’s the right thing to do, but Washington has some of the lowest immunization rates in the nation.
By Dana Thompson
As the start of a new school year approaches, Seattle-area parents have a checklist of things their children need for the coming year, depending on the school and grade. One of the things on that list is updated immunization records. State law requires that all students entering public school be current on certain vaccinations. If a child has not been vaccinated, or has received some but not all of the state’s required vaccinations, parents have to sign a letter of exemption.
Generally, by the time our kids have reached school age, most of us have long ago made choices regarding immunization based on our personal beliefs and experience, which can make providing the necessary paperwork for school seem like a bothersome chore.
But when our kids go to school, they become part of a greater community and thus are exposed to a larger germ pool. This is why state and federal health officials include immunization as an important element of a child’s readiness for school. The consensus among public health and medical professionals – advice that some skeptics still question – is that vaccinating your children is the best thing to do.
Weeding through the information about vaccinations, however, can be daunting, leaving many of us scared and distrustful. The sheer number of vaccinations required – about 16 doses by kindergarten – is overwhelming. We’re asked to give our newborns multiple shots that hurt, may cause small reactions, and in very rare cases, major reactions or death. We hear compelling stories of perfectly normal children who develop autism after receiving vaccinations. One theory raises the possibility of an underlying genetic disorder, such as mitochondrial disorder, being triggered by vaccinations.
But how do we know if our child is the one with the rare underlying disorder? And although continued scientific studies so far have failed to show any direct cause between vaccinations and autism or other immunological problems, there is still enough anecdotal evidence to put fear and questions into our hearts as parents. Even if the odds of serious complications from a vaccine are statistically lower than complications from the actual disease, if our child is the one with the bad reaction, the odds don’t matter much.
Most health professionals can empathize with this dilemma and have struggled, themselves, trying to figure out what’s best for their children. “When I took my newborn daughter to the doctor’s office to get her DTaP, I cried all the way there and home,” says Betsy Hubbard, immunization and clinical practice supervisor for Public Health – Seattle & King County. “I’d spent almost my entire career in immunizations – I’m a believer of vaccinations – and yet I was still afraid she would be that one in a million who had a serious complication.”
Dr. Douglas S. Diekema, education director at the Treuman Katz Center for Pediatric Bioethics and professor of pediatrics at the University of Washington, says there are two ethical aspects to the decision about whether to vaccinate your child.
“First, parents have a moral obligation to do what is best for their children. While most health care providers and parents believe it is in the best interest of a child to be vaccinated, not all parents agree,” Diekema says.
“However, as citizens and members of a community, we also have a duty not to put others in harm’s way. When a parent chooses not to vaccinate a child, it not only puts the child at risk of contracting preventable, and often serious disease, but it also puts others in the community at risk because that child can infect other individuals.”
Part of the issue is numbers. For a community to be safe from outbreaks of a preventable disease, the majority of the population needs to have immunity protection against that disease. Referred to as “herd immunity,” this principle is essential in keeping contagious diseases at bay and protecting vulnerable people in society who can’t be immunized. Although variable by disease, Diekema says individual vaccination rates in a community need to remain above 90 percent to 95 percent to keep isolated cases of a disease from getting a foothold. Once vaccination rates for a particular disease drop below 90 percent, small outbreaks occur, and below 70 percent, communities see large outbreaks that have the potential to become epidemics.
While the majority of Washingtonians are vaccinated, the state still has one of the lowest overall immunization rates in the country. Based on 2006 statistics from the Centers for Disease Control and Prevention, the latest figures available, Washington ranks 41st in the United States for overall vaccination rates at 71.2 percent – a measure of children 19-35 months of age who are current on all 15 doses of the six vaccines the CDC recommends.
Twenty-one states, including Washington, allow “personal belief” vaccination exemptions for kids attending school or day care, while 48 states – all but Mississippi and West Virginia – allow religious exemptions, according to the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health.
In certain communities, “herd immunity” gets compromised because like-minded people tend to group together, leaving pockets of largely unimmunized people. Many areas around Washington state are seeing this played out – Grant County in Central Washington has been struggling since April with a measles outbreak in which 17 of the 19 cases are children who were not vaccinated. San Juan County, mainly Orcas Island, had around 70 cases of pertussis (whooping cough) this year, while Whidbey Island in Island County has been fighting an ongoing pertussis outbreak since June; Vashon Island also experiences frequent pertussis outbreaks. And in January, Spokane County experienced a significant outbreak of chicken pox.
“We live in a community where most people do vaccinate their children,” says Diekema, “and that fact makes it safer for other parents to not vaccinate their children. A parent who chooses not to vaccinate a child can do so without great risk only because other people have chosen to vaccinate. Take that fact away, and the choice to not vaccinate is no longer a reasonable or safe one.”
Decisions about immunization challenge our beliefs about individual responsibility vs. community responsibility, and what obligation we have toward the greater community when it comes to vaccinating our kids. This is especially true for those parents who believe vaccination is the wrong choice for their child, usually due to prior adverse reactions to a shot or fears about long-term impact to their child’s developing neurological system.
Our immunization decisions are further complicated by the fact that most of us have no experience with the dark side of these diseases. Most parents today never experienced the fear of polio or smallpox, although certainly our parents’ generation remembers. Most of us, if we had chicken pox, measles, or mumps, were mildly sick and moved on. Rubella is rarely dangerous to a child who has it, but poses a serious threat of deformity to unborn children whose mothers contract the disease.
“There is so little memory of what bad can happen,” says Diekema. “We forget the fact that people can die from measles, chicken pox or whooping cough.” Because we no longer see these diseases in large outbreaks, the risks associated with vaccination, especially the intangible risk to a child’s developing immune system, loom far larger for many of us than the risk posed by the disease itself.
This was true for Dawn Janow, a well-educated Bainbridge mother of two, who struggled with the need to vaccinate her newborns. “Blanket vaccination doesn’t make sense to me. I don’t see the need to plug a small, healthy, still-developing person full of shots, especially when we don’t live in a high-risk environment,” says Janow. “My kids weren’t going into day care and live in a healthy environment.”
Janow’s decision not to further vaccinate was clinched when her son, now 8, was 3 years old. After receiving the MMR and DTaP vaccines, he developed a severe local reaction with a rash. One of his legs swelled, with streaks reaching his groin. He ended up needing two rounds of antibiotics to fight the infection. At that point, Janow, who homeschools, felt the risk to her children from vaccinating was greater than their risk of contracting the disease or their risk to the community at large.
“Ultimately, my primary obligation is to my family, who is my first community,” says Janow, “and my secondary obligation is to the greater community.” Janow acknowledges it isn’t all or nothing, and that in certain situations vaccinations would make sense, especially now that her children are older and their immune systems more established. For instance, if traveling to a Third World country where polio or diphtheria are still rampant, or if a neighbor was ill and needed those around her to be risk-free, Janow would get her kids vaccinated.
For others, the choice to vaccinate comes easier. Sarah Brands, a mother of two in Ballard, had little trouble making up her mind. “I grew up in a medical family and felt vaccinating my kids was the best thing to do,” says Brands. “We did debate over the chicken pox vaccine but knew there could also be deaths from chicken pox so decided to go ahead and do it.”
Kimberly Kelly, a registered nurse and naturopathic doctor with practices in Seattle and Totem Lake, encourages parents to talk to their health care providers. “Generally, when parents come in to see me, they’ve read both the pros and cons of vaccination,” says Kelly. “They’re scared to vaccinate and scared not to and they don’t know which way to go.”
It’s important for parents to feel they have options and that vaccination isn’t all or nothing. Most health care providers will prioritize the vaccinations and work with you to develop an alternative immunization schedule that feels more reasonable. Some vaccines – like DTaP, HiB and PCV-7 – are extremely important at an early age because infants are most at risk of dying from the diseases they protect against. Other vaccines can often be delayed without much risk until the child is older. “Have the conversation,” says Kelly. “A health care provider can help you balance the immediate risk with later risk, and help you feel better about your choices.”
The main thing, according to Michele Roberts, health promotion and communication manager for the immunization program CHILD Profile at the Washington Department of Health, is to make sure your information regarding vaccinations is accurate. “Parents need to make sure they’re making an informed decision that’s right for them and their family,” says Roberts.
As parents, the best we can do is consider our sources, , talk to our health care providers and do what we believe is right.
Dana Thompson is a Bainbridge Island writer and mother of two. She found that consulting her children’s doctor and spreading out their immunizations did a lot to alleviate worries she had about vaccinations.
