Parents PACK Newsletter

December 2006

Parents Pack Newsletter

Possessing, Accessing and Communicating Knowledge About Vaccines

In this issue:

• Feature Article: Editorial Regarding Disease Rates and Exemptions
• Spotlight: Two New Web Sites Provide Information About Autism
• Did You Know?. . .Acellular Pertussis Vaccine
• Ask the VEC - Multiple Doses of Vaccines

Feature Article: Editorial Regarding Disease Rates and Exemptions

The following editorial was written in response to a paper that appeared last month in the Journal of the American Medical Association. In the paper, Omer and colleagues found an association between rates of pertussis and the ease of obtaining exemptions.

Last month the Journal of the American Medical Association (JAMA) published a study that received little attention from the press and, as a consequence, the public. The study examined the incidence of whooping cough (pertussis) in children whose parents had chosen not to vaccinate them; the results were concerning.

Vaccines are recommended by the Centers for Disease Control and Prevention (CDC) and professional societies, such as the American Academy of Pediatrics. But these organizations can't enforce their recommendations; only states can do that—-usually when children enter day-care centers and elementary schools-—in the form of mandates. State vaccine mandates have been on the books since the early 1900s; but aggressive enforcement of them didn't occur until much later, born from tragedy.

In 1963 the first measles vaccine was introduced in the United States. Measles is a highly contagious disease that can infect the lungs causing fatal pneumonia or the brain causing encephalitis. Before the measles vaccine, measles caused 100,000 American children to be hospitalized and 3,000 to die every year. In the early 1970s, public health officials found that states with vaccine mandates had rates of measles that were 50 percent lower than states without mandates. As a consequence, all states worked toward requiring children to get vaccines. Now every state has some form of vaccine mandates.

But not all children are subject to these mandates. All fifty states have medical exemptions to vaccines, such as a serious allergy to a vaccine component. Forty-eight states also have religious exemptions; Amish groups, for example, traditionally reject vaccines, believing that clean living and a healthy diet are all that are needed to avoid vaccine-preventable diseases. And twenty states have philosophical exemptions; in some states these exemptions are easy to obtain, by simply signing your name at the bottom of a form; and in others they're much harder, requiring notarization, annual renewal, a signature from a local health official, or a personally written letter from a parent.

The JAMA study examined the relationship between vaccine exemptions and rates of disease. The authors found that between 1991 and 2004 the percentage of children whose parents had chosen to exempt them from vaccines increased by 6 percent per year, resulting in a 2.5-fold increase. This increase occurred almost solely in states where philosophical exemptions were easy to obtain. Worse, states with easy-to-obtain philosophical exemptions had twice as many children suffering from pertussis—-a disease that causes inflammation of the windpipe and breathing tubes, pneumonia and, in about twenty infants every year, death—than states with hard-to-obtain philosophical exemptions.

The finding that lower immunization rates caused higher rates of disease shouldn't be surprising. In 1991 a massive epidemic of measles in Philadelphia centered on a group that chose not to immunize its children; as a consequence nine children died from measles. In the late 1990s, severe outbreaks of pertussis occurred in Colorado and Washington among children whose parents feared pertussis vaccine. And in 2005 a 17-year-old unvaccinated girl, unknowingly having brought measles back with her from Romania, attended a church gathering of 500 people in Indiana and caused the largest outbreak of measles in the United States in ten years; an outbreak that was limited to children whose parents had chosen not to vaccinate them. These events showed that for contagious diseases like measles and pertussis it's hard for unvaccinated children to successfully hide among herds of vaccinated children.

Some would argue that philosophical exemptions are a necessary pop-off valve for a society that requires children to be injected with biological agents for the common good. But as anti-vaccine activists continue to push more states to allow for easy philosophical exemptions one thing is clear, more and more children will suffer and occasionally die from vaccine preventable diseases.

When it comes to issues of public health and safety we invariably have laws. Many of these laws are strictly enforced and immutable. For example, we don't allow philosophical exemptions to restraining young children in car seats or smoking in restaurants or stopping at stop signs. And the notion of requiring vaccines for school entry, while it seems to tear at the very heart of a country founded on the basis of individual rights and freedoms, saves lives. Given the increasing number of states allowing philosophical exemptions to vaccines, at some point we are going to be forced to decide whether it is our inalienable right to catch and transmit potentially fatal infections.

S. B. Omer, W. K. Y. Pan, et. al. "Nonmedical Exemptions to School Immunization Requirements" JAMA 2006; 296, 14, pp.1757-1763.

Paul A. Offit, MD is the director of the Vaccine Education Center at The Children's Hospital of Philadelphia.

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Spotlight: Two New Web Sites Provide Information About Autism

Two new web sites provide accurate information about autism for parents and others. Healing Thresholds was created to connect parents to scientific and health information about autism as quickly and efficiently as possible. Its Web site is www.healingthresholds.com.

The second is a page on a web site devoted to education and disorders. It has an informative page on autism at www.k12academics.com/autism.htm. Please take a few moments to visit both sites.

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Did you know?. . . Acellular Pertussis Vaccine

Acellular refers to a more purified version of the pertussis bacteria in the current vaccine. Because the older vaccine caused a number of side effects, including inconsolable crying, the bacterial proteins were subjected to additional purifications. With purer preparations of proteins, the vaccine causes less side effects; however, it still provides protection from whooping cough.

Ask the VEC — Multiple Doses of Vaccines

Q. Why are some vaccines given as a single dose and others as multiple doses?

A. Vaccines may be given multiple times for a few reasons. First, some vaccines are given more than once so that a greater number of people can be protected against the disease. For example, when adults get the chickenpox vaccine, 78 of 100 will be protected after one dose, but that number rises to 99 of 100 after the second dose. Since the additional dose is not harmful and provides extra protection even in first-dose responders, everyone is recommended to get the second dose. Second, some vaccines provide a low level of protection after a single dose, but additional doses provide a greater response, so that individuals are better protected. This is true of the vaccine for Haemophilus infleunzae type b or Hib. Another reason for multiple doses is that immune responses last longer after more than one dose of some vaccines. The pertussis vaccine is an example of this. Finally, some vaccines protect against agents that change often enough that older versions would not offer protection. The influenza vaccine is an extreme example of this, requiring new versions every year.

Send us your comments

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