Datestamp: 12/03/2011

Vaccine avoidance hits new state high

Public health officials worry about preventable outbreaks

An increasing number of Oregon's children are entering kindergarten without being fully immunized, Oregon Health Authority numbers show. Since the 20012002 school year, the rate of parents claiming nonmedical exemptions for children entering school has risen steadily, reaching 5.6 percent last school year. That number hasn't dipped once in the past decade. And while the majority of parents are sticking with the national immunization schedule, vaccination rates dipping below the goal of at least 95 percent worries public health officials. "That is a number of concern," said Stacy de Assis Matthews, school law coordinator for Oregon Immunization Program. "When we fall below that number, we do get concerned we'll see these diseases again." She's talking about measles, meningococcal disease and polio illnesses that still exist but have faded in Americans' consciousness. Oregon is among the states with the highest exemption rates. Alaska had the highest exemption rate in 201011, at nearly 9 percent, according to an Associated Press analysis. Colorado's rate was 7 percent, Minnesota 6.5 percent, Vermont and Washington 6 percent. The nonmedical exemption process is easy in Oregon. Parents simply sign a religious exemption statement, then check the vaccines they're opting out of, de Assis Matthews said. For the purpose of immunization requirements, Oregon defines religion as "any system of beliefs, practices or ethical values." Marion and Polk counties are among the lower end of exemption rates in the state, at 3.4 percent and 3.7 percent respectively. In Multnomah County, the exemption rate is 7.1 percent and 8.4 percent in Lane County. Josephine County topped the list last school year with a 12.7 percent religious exemption rate.

Vaccine avoidance hits new state high

Reasons for parents' choosing exemption vary. Some are concerned their babies are too young for the shots while others dislike the sheer number that are required. Others worry that the vaccines can do more harm than good. But those in the medical field say the consequences of low vaccination rates are tangible and dangerous. So far this year, 205 measles cases have broken out in the U.S., including three in Oregon, de Assis Matthews said. "This is a disease that is vaccinepreventable and can be really serious," she said "Once in a while, kids die because of measles. We haven't seen hardly any cases in years and years." Last school year, parents of 1,548 Marion County children claimed religious exemptions, according to the health department. Marion County health officer Dr. Karen Landers said the public health system has several layers of protection against disease transmission, starting with the school immunization law. If a disease occurs in the community, public health officials instruct those who aren't fully vaccinated to stay home. But even that system isn't foolproof, as transmission already may have occurred before someone is diagnosed of a vaccinepreventable disease. For example, Landers said, chicken pox and whooping cough are both highly contagious before the symptoms show. As of Nov. 25, 844 SalemKeizer School District students have religious exemptions, representing 2 percent of the student body. The number of exemptions in the district has been increasing, said Eric Richards, student services coordinator. Richards said each building in the district has an immunization recorder who is the point person regarding vaccinations. When parents choose to exempt, they are given a brochure with information on the risks, responsibilities and rights of those who actively choose not to fully immunize their children. The brochure also notes that the local public health authority has the right to exclude inadequately vaccinated children from school and child care in case of a disease occurrence. Richards said while the district is interested in students' protection against disease, it can do little beyond provide information, because parents have a right to sign a religious exemption. "There needs to be a balance," de Assis Matthews said. "Immunizations are an individual choice, and it protects the individual child. But it's also a community issue." She added that young babies and people who can't be immunized because of allergies or medical conditions are highly vulnerable if their community does not have a high vaccination rate. It's not clear whether children with religious exemptions have received no shots or some shots, but studies have shown that exemptions to all vaccines are less common. When parents are seeking an alternative vaccination schedule, healthcare providers could play a important role.

Vaccine avoidance hits new state high

Dr. Lara Knudsen, a family physician with Willamette Health Partners, said it's ideal for parents to abide by the recommended vaccine schedule. But if parents want to alter their children's schedule, she works with the family to come to an agreement, she said. "Not because there's a medical or scientific basis but in an effort to come up with a plan that parents feel comfortable with," Knudsen said. "I think our role as physicians is to provide as much information as we can and collaborate with those parents." The Oregon Health Authority for the first time is collecting more specific data on exemptions, including separating those who opt out of all vaccinations versus those who are selectively immunized, de Assis Matthews said. The data, which will be available May 2012, will help public health officials determine which particular vaccines are being exempted and which communities might be at high risk for an outbreak. OHA will provide the information to local health departments to use in educational campaigns, de Assis Matthews said. syoo@StatesmanJournal.com, (503) 3996673 or follow at Twitter.com/syoo. Vaccine List Recommended Immunizations for children from birth to 6 years old Chicken pox Diphtheria Hib HepA HepB Flu Measles Mumps Pertussis Polio Pneumococcal Rotavirus Rubella Tetanus DTaP is a combination vaccine that protects against diphtheria, tetanus and pertussis. Vaccine avoidance hits new state high 3

MMR is a combination vaccine that protects against measles, mumps and rubella. Source: Centers for Disease Control and Prevention Caption: A child watches anxiously as he receives one of the recommended vaccines. statesman Journal file Section: Page one Page: 1A Byline: Saerom Yoo Source: From:

Vaccine avoidance hits new state high