Shots, or not? Doctors assert need for childhood vaccines as some parents raise questions, seek exemptions

http://seattletimes.nwsource.com/html/healthscience/134399903_vaccination05.html

Tuesday, February 05, 2002 - 12:18 a.m. Pacific

Shots, or not? Doctors assert need for childhood vaccines as some parents raise questions, seek exemptions

By Judith Blake
Seattle Times staff reporter

MICHELLE KUMATA / THE SEATTLE TIMES

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The latest on vaccinations

It has been a rite of passage for American babies for decades: getting vaccinated to fend off disease.

Yet today, while the vast majority of children still receive the shots, more parents are asking questions or seeking exemptions from required immunizations. The year-to-year rise in exemptions is tiny, say Washington state health officials, but it has been trending upward for several years.

"(The increase) has been seen in Seattle and King County and in many major metropolitan areas around the country," said Dr. Edward Marcuse, associate medical director at Children's Hospital & Regional Medical Center.

Whether the cause is reduced access to health care linked to a slumping economy or growing consumer hesitancy about vaccination safety is unclear, he said. But he worries it's the latter — and thinks that's unjustified.

A combined vaccine for measles, mumps and rubella has stirred many of the questions, with some parents concerned about its safety — concern fueled, in part, by an ongoing MMR debate in Great Britain. More about that later.

Yet Marcuse and virtually all mainstream health agencies and organizations say this and other recommended immunizations are not only safe but essential to the health of nearly everyone. Strong advocates include the federal Centers for Disease Control and Prevention, the American Academy of Pediatrics and the American Society of Family Physicians.

The medical establishment acknowledges that vaccinations are not perfect, but says that both severe adverse reactions and instances of diseases occurring in spite of vaccination are quite rare. New improved versions of vaccinations, which seek to reduce reactions, are regularly introduced (see accompanying story).

In Washington and elsewhere, officials are pushing for even higher rates of immunization against sometimes-killer diseases such as polio, diphtheria, pertussis (whooping cough) and tetanus that ravaged vast populations in the days before immunization.

Vaccination against these, plus measles, mumps, rubella and hepatitis B, is required in Washington before a child enrolls in school or a day-care center.

In addition, the American Academy of Pediatrics recommends immunization against varicella (chicken pox) and pneumococcus (pneumonia) for all children.

"We can't rest on our laurels," despite relatively high vaccination rates among Americans, said Ros Aarthun, assessment coordinator for the immunization program of the Washington state Department of Health.

Any decrease in those rates, she said, erodes "herd immunity": society's group protection from disease.

Aarthun said exemptions sought by Washington parents for seven of the eight required immunizations rose from 2.7 percent of all kids entering school in the 1997-98 school year to 3.4 percent in 2000-2001. (The eighth vaccine, hepatitis B, is surveyed separately, but the statistics are problematic.)

The exemption numbers probably are imprecise, for various reasons, Aarthun said, and the year-to-year increases may also be too small to be statistically significant. Yet she said the general direction merits concern.

"We see that the trend is going up," she said. "There is something going on."

In neighboring Oregon, officials said last spring's exemption rate rose to 2.7 percent after hovering at around 1 percent for the past decade.

Exemption hot spots included Jackson County (Ashland), where an estimated 12 percent of children got religious exemptions, according to an Associated Press report. At one school, exemptions have hit 34 percent, the report said.

In Washington, parents can get exemptions on religious, medical or philosophical grounds. "The door is wide open," said Aarthun.

In both Washington and Oregon, however, immunization rates for children at age 2 beat the national average of 77.6 percent in 2000. Washington averaged 78.7 percent and Oregon, 80.3 percent.

Children can also receive the shots after age 2, potentially raising compliance rates, though public-health officials urge early vaccination for early protection.

Rising exemption requests for school-age children in Washington appear related at least partly to the MMR debate, Aarthun said. Some local doctors say more parents are asking about it, and a clutch of Web sites — some fervently anti-vaccination — keep the controversy bubbling.

At issue is a claim that the combined measles/mumps/rubella vaccine may help cause autism in children. The claim arose largely from a 1998 British study that suggested the MMR vaccine can trigger inflammatory bowel disease, which some researchers believe may be linked to autism in certain cases. It's a hot issue in Britain, hitting hard at immunization compliance.

Some parents, there and here, have concluded it would be safer to give children separate vaccines against the three diseases, and Seattle pediatrician Dr. Mark Greenfield said he's had a few requests for this.

"We believe parents should have the choice" of getting the immunizations separately, said Barbara Fisher, president of the National Vaccine Information Center. The consumer group, which often takes a negative stand on various vaccines, believes MMR is one factor contributing to the rise of autism.

However, a spokeswoman for Merck & Co., the sole manufacturer of MMR, said the company is no longer producing the three vaccines separately and has no plans to do so because major health organizations support a single vaccine.

Giving the immunizations separately, says the American Academy of Pediatrics, would subject babies to more shots. Also, the shots would need to be given on separate dates, adding to parents' inconvenience and probably reducing immunization rates, the organization says.

In any case, the Centers for Disease Control, the Institute of Medicine and other major medical agencies and organizations say other studies have found no evidence of a link between the combined MMR vaccine and autism. The British study claiming such a link was too small (12 children), says the CDC, and used no control group for comparison.

Also, in at least four of the 12 children, behavior problems preceded any symptoms of bowel disease, making it unlikely that either bowel disease or the MMR vaccine triggered the autism, says the CDC.

However, there's no absolute proof that MMR and autism couldn't be connected in some cases, says the CDC, and research continues.

Aarthun said that if she had young children today, she'd probably do "a lot of reading" before making immunization decisions. But in the long run, she's certain she would come down on the side of getting the shots.

"Statistically, the risk of making my child vulnerable to diseases we know really exist would outweigh (the far lower risk) of any safety questions about vaccination."

Where to get information

These resources can provide more information about vaccinations. The first three are strongly pro-immunization, though they also list side effects of various vaccines. The fourth organization frequently voices strong reservations about vaccines.

• Washington state Department of Health: 206-236-3595; Immunization Home Page: www.doh.wa.gov/cfh/immunize

• American Academy of Pediatrics: 847-434-4000; www.aap.org

• Centers for Disease Control and Prevention: www.cdc.gov

• National Vaccine Information Center (a consumer group): www.909shot.com

Judith Blake can be reached at 206-464-2349 or jblake@seattletimes.com..

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.