"I'm very much against vaccination for any reason," said Michelle Monteleone of Cumming. "My children have already had their shots, and the damage has been done. But if I were to have another baby, I would make different choices."

Monteleone's 4-year-old daughter, Maria, began developing signs of autism shortly after receiving her fourth DTaP (diphtheria-tetanus-pertussis) shot at the age of 13 months.

"I don't think it's coincidental," said Monteleone. "She was speaking words at nine months. But over the course of six months after getting that shot, she steadily deteriorated and lost all ability to communicate."

Reports surfaced in the mid-1990s about a possible link between autism and vaccines, particularly the MMR (measles-mumps-rubella). But after an extensive review of the research, the National Academy of Sciences concluded in 2001 that there was no causal relationship.

Monteleone, however, disagrees. "I'm not saying it's the reason for every child that's autistic," she said.

"But some children have more sensitive immune systems, and they can't handle vaccinations."

Nationally, about 1 percent of parents choose not to immunize. Janie Dalton, clinical coordinator for District 2 Public Health in Gainesville, is concerned that the practice could become widespread.

"People read things on the Internet and they panic," she said. "I got a call from one mother who was so worried, she said she would move to another state if she couldn't get an exemption in Georgia."

Georgia law requires children to be vaccinated in order to attend school or day care. But under certain circumstances, the requirement can be waived.

All 50 states offer a medical exemption for children with weak immune systems or who are allergic to vaccines.

Seventeen states allow an exemption for personal or philosophical reasons. Georgia isn't one of them, but parents get around that obstacle by claiming a religious exemption, available in all states except Arkansas, Mississippi and West Virginia.

In some states, the parent must be able to prove that they belong to a religion, such as the Christian Scientists, that rejects medical care. But in Georgia, all parents have to do is write out a statement and have it notarized.

The statement is kept on file at the child's school. Mamie Coker, health services coordinator for Hall County Schools, said there is no central database for those records, and the number of exemptions varies widely.

"I checked with a couple of schools and found that Spout Springs Elementary had one medical and two religious, while North Hall Middle had no medical and five religious," she said.

Gainesville pediatrician James Gilbert said parents who decide not to vaccinate usually research their decision carefully, and they often prefer alternative methods of health care, such as chiropractic.

"If I think the problem is ignorance and the parent is just afraid, I try to persuade them (to vaccinate)," he said. "But if it's an educated parent making an informed decision, I support them. The pool of people who are immunized is so large that you're pretty safe even if you don't get your shots."

Curtis Allen, spokesman for the National Immunization Program at the Centers for Disease Control and Prevention, said as long as 85 to 90 percent of the population is vaccinated, there is a "herd immunity."

"But if vaccine coverage were to fall, those diseases would return," he said, citing cases in Britain, Sweden and Japan, where attempts to cut back on vaccinations resulted in massive epidemics.

"In a way, we're victims of our success," he said. "Parents have not seen these diseases, therefore they're not concerned."

Clarkesville resident Beth Greene does know about disease; she's a nurse at Northeast Georgia Medical Center. But after her daughter, Alyssa, had a near-fatal reaction to a DTaP booster two years ago, she's convinced that vaccines pose a danger.

"I would rather take the risk of disease than the risk of death from vaccination," she said.

According to the CDC, one out of every 200 children who contract pertussis (whooping cough) will die, but there has never been a proven case in which a child died from the vaccine.

Monteleone thinks families should research the pros and cons and decide what's right for them.

"I'm not telling my friends, 'Don't vaccinate,'" she said. "Just know that you have a choice. And if your pediatrician insists, find another doctor."

E-mail: dgilbert@gainesvilletimes.com