There are a very few good reasons not to vaccinate -- for example, if your child has cancer or is recovering from chemotherapy. If you are not vaccinating because of misguided fears of autism, or beliefs that vaccinations are dangerous, or beliefs that vaccines "weaken the immune system", shame on you. You are letting your fears and beliefs put other people at risk, who have no idea that your children may endanger their health or well-being.
You are putting other people's health at risk, especially infants under 12 months (the earliest recommended age for the measles-mumps-rubella inoculation) and those susceptible for other reasons. Your child is contagious four days before the rash appears.
Vaccinations prevent disease. No medical procedure is without risk, but in the case of vaccination, the risks are vanishingly small, and the benefit to your child and your child's community are immense. Update: Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States.
The current measles outbreak in San Diego was sparked by an unvaccinated 7 year old child who acquired the disease in Switzerland, and so far has infected two infants too young to be vaccinated. The infants both acquired the highly-contagious disease by being at the Children's Clinic in La Jolla at the same time as the virus-shedding 7-year-old.
One infant (the 10 month old) is hospitalized. The other infant travelled to Hawaii on February 9 with its parents (exposing hundreds of people on the airplane) before being diagnosed and quarantined in Hawaii.
The 10-month-old attends Baldwin Academy; the infants' program is closed until February 26, and others at Baldwin Academy who are not vaccinated must also stay at home until February 26.
Today, there are a total of eleven cases: seven at San Diego Cooperative charter (three siblings and four classmates), the two infants, and two others (age and vaccination status unknown).
Adults born between 1956 and 1970, even if vaccinated, are thought to have a higher risk of contracting measles than vaccinated individuals born later than 1970, as the form of the vaccine used from 1963 to 1969 was not as effective as the current version.
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At the beginning of the outbreak, nearly 10% of the student body were unvaccinated and were quarantined at home. Voice of San Diego reported on February 4:
34 unimmunized students at San Diego Cooperative Charter School (SDCC) are stuck at home, said principal Wendy Ranck-Buhr. The students can't come to school until Feb. 21, unless they get immunized against the illness.
By February 12, the 34 had dropped to 17, according to a bulletin from SDCC.
UPI reported that up to 50 children are quarantined, including the Baldwin Academy students, the SDCC students, and unvaccinated students at the Murray Callan Swim School (which has classes for infants as young as three months).
You parents who were so afraid of vaccination -- how do you feel about the illnesses your fear caused? How about the financial hardship for parents whose children are excluded from school? If I were a parent in the infant program at the Baldwin Academy, I'd be furious. I am sure that the Baldwin Academy isn't rebating tuition for the weeks the infant program is closed -- the parents of those infants are either suffering financial loss by staying home from work, or paying double for child care.
An unrelated case in Hawaii is an adult woman who was exposed in Italy, and showed symptoms on her return to her home. Her age and vaccination status was not reported. However, she took care to isolate herself and probably has not exposed any further people to risk of the disease.
Vaccines were the greatest public health achievement of the 20th century," said Steve Dettwyler, director of DPH's Immunization Program. "As we entered the 21st Century, immunization rates had reached record highs in the United States. We are striving to maintain those levels to prevent outbreaks of diseases such as measles, mumps, rubella and diphtheria." The Centers for Disease Control and Prevention (CDC) offers four examples of vaccine success to illustrate the importance of continued vigilance in obtaining childhood immunizations:
- Polio - Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States, leaving thousands of children in braces, crutches, wheelchairs and iron lungs. Though virtually eradicated here, polio still exists around the world. In 1994, wild poliovirus was imported to Canada from India, but high vaccination levels prevented it from spreading. If immunization rates fall in the United States, children could be exposed to imported strains of this deadly virus.
- Measles - Prior to introduction of the measles vaccine, there were approximately 3-4 million cases each year, and 450 deaths annually between 1953-63. Widespread use of the vaccine has led to a greater than 99 percent reduction in the rate of measles infection in the United States. However, in the late 1980s, immunization rates against measles dropped, leading to 100,000 cases of the disease and more than 100 deaths.
- Rubella (German Measles) - In 1964-65, before rubella immunization was used routinely in the United States, a rubella epidemic resulted in 11,000 miscarriages, 2,000 neonatal deaths and 20,000 infants born deaf, blind or mentally retarded. In 1998, only 19 pregnant women contracted rubella.
- Mumps - Before the mumps vaccine was introduced, this viral disease was a major cause of deafness in children. About 212,000 cases occurred in 1964. After vaccine licensure in 1967, reports of mumps decreased rapidly, though a resurgence in 1987 led to 12,848 reported cases. Since 1989, incidence has again dropped, with a total of 606 cases reported in 1998. Mumps is easily spread among unvaccinated persons and would quickly return if immunization rates drop.
California does mandate vaccinations for school attendance, but the exemptions are easy to get. The quote is from the article "Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies With Pertussis Incidence"
For example, California offers a personal belief exemption whereby the parent simply signs a prewritten statement on the school immunization form. This personal belief exemption is available to anyone regardless of the nature of their beliefs (religious or philosophical) and it is easier to claim this exemption than to complete the school immunization form that requires a health care clinician to obtain the child's medical record and transcribe the dates of vaccine administration.
The article concluded that:
Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.
- Voice of San Diego.org February 4 2008
- Sign-on San Diego February 11 2008
- Sign-on San Diego February 12 2008
- Sign-on San Diego February 16 2008
- KITV News, Hawaii, February 16 2008
- CDC: Vaccines and Immunizations
- National Network for Immunization Information: Measles
- Publc Health of Seattle and King County: Measles Information
- Dr. Razavi's Good To Know Blog: Measles in Adults
- Measles Outbreak in A Community With Very Low Coverage, the Netherlands
- Journal Watch of Infections Diseases: Outbreaks in the US--Why?
- NPR: Boston Outbreak Shows Risk Even to the Vaccinated
- Boston.com Measles Outbreak Shows a Global Threat June 10 2006
- NEJM: Implications of a 2005 Measles Outbreak in Indiana for Sustained Elimination of Measles in the United States August 3 2006
- JAMA: Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies With Pertussis Incidence October 11, 2006
- Ed-Data: San Diego Cooperative Charter School
- San Diego Cooperative Charter School
- Roush, S., Murphy, T.V., and the Vaccine-Preventable Disease Table Working Group (2007) Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA. 2007;298(18):2155-2163.