California measles outbreak highlights Marin vaccination dilemma
By Janis Mara
Posted: 01/31/2015 03:50:21 PM PST 5 Comments
Rhett Krawitt, a 6-year-old in remission from leukemia, just wants to be a regular kid. But Marin County's low vaccination rate threatens the Corte Madera child's recovery.
Krawitt can't be vaccinated because his immune system is compromised, and he can't count on others for protection. And the youngster is not alone.
"There are hundreds of kids in the Bay Area with life-threatening illnesses who cannot be immunized. Babies are at risk. A lot of people are at risk. This goes beyond my child," said Carl Krawitt, Rhett's father.
This year, 6.45 percent of Marin's kindergartners are not fully vaccinated against communicable diseases — with some schools showing rates of 50 percent or more, according to the state Department of Public Health. The county has long had the Bay Area's highest rate of "personal belief exemptions," allowing parents to lawfully send kids to school without all required vaccinations against diseases like measles, polio or whooping cough.
Last week, two unvaccinated children became the first reported measles cases in Marin after being exposed to the disease as part of the Disneyland outbreak, according to county public health officials. There had not been a case of measles in Marin since 2001, officials said. On Friday, there were 91 confirmed cases statewide.
"Getting vaccinated is a social responsibility," said Dr. Matthew Willis, the public health officer for Marin County. "Generally we like to see 90 percent of the children vaccinated to help ensure that the disease would not spread rapidly in that community.
"Many of the schools are flirting with that level of immunity necessary for what we call herd immunity," Willis said. "Herd immunity is when a certain percentage of the community is protected and diseases don't have the opportunity to establish a foothold, and this is how we protect each other by choosing to be vaccinated."
High opt-out rates
At Greenwood School in Mill Valley, 61 percent of the kindergartners are partially or completely unvaccinated, according to state figures. At San Geronimo Valley Elementary in San Geronimo, 58 percent of the kindergarten children are partially or completely unvaccinated. Half the children at the New Village School in Sausalito are in the same boat, according to the health department.
"If all but one of the children at a school are vaccinated and someone with measles comes by to drop off a package, the likelihood that the carrier would encounter someone susceptible would be low," Willis said.
Carl Krawitt plays with son Rhett, 6, in the backyard of their Corte Madera home on Wednesday. He is in remission from leukemia, and therefore cannot be vaccinated. (Alan Dep — Marin Independent Journal)
"Whereas if half of the children are unvaccinated, it's much more likely the disease would be transmitted to someone who would become ill and transfer it to someone else, and soon you have a full outbreak of the disease."
This is especially important for children like Rhett Krawitt, said Dr. Robert Goldsby, a pediatric oncologist at the University of California at San Francisco who is Rhett's physician.
If such a child were to get measles, "it might delay their cancer therapy," Goldsby said. "That might impact their overall chance of getting rid of their cancer."
An analogy for this social compact would be the rules of the road. When everyone stops at a four-way stop, no one gets hurt. Even if one maverick floors it and burns through the intersection, it's likely no harm will be done. But the more people who refuse to adhere to the agreement, the more likely it is that there will be a crash.
Opposing views
A Marin chiropractor doesn't see it that way.
"There is so much falsehood there," said Corte Madera chiropractor Donald Harte.
"Children are not cows. They are not part of a herd. Most of the kids getting measles are vaccinated," Harte said, referring to cases in California. Asked how many of those children were vaccinated, Harte said he did not know.
According to the state Department of Public Health, Harte is wrong. Of the California measles cases reported last week in which vaccination status was known, 80 percent weren't vaccinated, according to Dr. Gil Chavez, state epidemiologist.
"The whole concept of vaccination is wrong. Measles is not a deadly disease. When I was a kid, everybody got measles, mumps or chicken pox, and nobody died," said Harte, who is 64.
In fact, measles killed an average of 432 people and infected 500,000 each year between 1958 and 1962, according to the U.S. Centers for Disease Control; the disease still kills two out of every 1,000 infected. As late as 1999, one child a week died in the United States as a result of complications from chicken pox, the center reported.
New system
In the interest of avoiding such tragedies, Marin's health department, which confirmed two measles cases last week in related children who had not been vaccinated, has put a system in place to cope with infections. On Tuesday, the public health officer sent a letter to parents and guardians of Marin schoolchildren notifying them of the new system.
"If your child is unvaccinated or cannot provide laboratory confirmation of immunity and there is a case (of measles) in their school, they will be excluded from attending school for 21 days to protect themselves and to limit further spread of disease," Willis said in the letter. Since infection in the two current measles cases occurred outside the county and the children were isolated and will remain so for several weeks, unvaccinated children were not barred from attending school in this case.
Under the law, any case of measles diagnosed by health practitioners must be reported to the Marin County Department of Health and Human Services.
Now, when such a report is made, the department will phone the parents immediately and inform them that their child can't come to school for 21 days, the length of time it takes for the disease to run its course, Willis said.
"We have sent (Willis') message home to people," said Archie Douglas, the head of school for Greenwood, a private institution.
Addressing the issue of his school's 61 percent opt-out rate, "Out of 42 early childhood and kindergarten students at Greenwood, 16 of them have some level of personal belief exemption, and that is where the 61 percent figure came from," Douglas said.
"Twenty-six of the 42 students are fully vaccinated," Douglas said. For the measles, mumps and rubella vaccine, Douglas said, "we have a 74 percent vaccination rate."
Douglas said he and his staff are not urging parents to get children vaccinated.
'Not anti-vaccine'
"We're not anti-vaccine," Douglas said. "As an independent school, we don't think it's our right to force parents into a particular decision when the state is not requiring it." The school has a total of 130 students and encompasses preschool through eighth grade.
Two Greenwood parents said the 61 percent opt-out rate for the school is misleading.
"When it was time for my kids to start school, we rushed to get the vaccines all done. I realized I was behind, so I filled out a personal belief exemption form," said Rachel Hebert. "We're not anti-vaxers."
"I understand how important it is to vaccinate," said Jennifer Jerde of Mill Valley. "My sister works for the Centers for Disease Control.
"I didn't do them all at once. I spread them over a period of time," Jerde said. "There are vaccines I didn't do. I skipped the one related to sexually transmitted disease."
San Geronimo is also broadcasting the health department letter, said Laura Shain, the school's principal. Of the 100 students at San Geronimo, 58 have personal exemptions, Shain said.
The percentage of those students who have had the measles, mumps and rubella vaccine is 38 percent, Shain said.
"We have not urged our parents (who opted out) to reconsider their decisions," she said. "We have to be careful that we don't start giving heath recommendations. I would want to make sure that it was legal before we did that."
Representatives of New Village School did not answer messages by press time.
Willis' letter was distributed Wednesday to all school districts and private/independent schools, said Mary Jane Burke, Marin County superintendent of schools.
"We have been working with public health and will take swift action as recommended by Dr. Willis," Burke said.
"It is my hope that the families of children who are not vaccinated will work with their doctors in order to provide the immunizations, which are so important to the health of their children and other peoples' children," Burke said. "Please immunize your children now for the safety of all."
personal-believe exemptions
Highest rates of personal-belief exemptions from vaccinations among Marin kindergartens:
1. Greenwood School, Mill Valley: 61 percent
2. San Geronimo Valley Elementary: 58 percent
3. The New Village School, Sausalito: 50 percent
4. Bolinas-Stinson Elementary: 36 percent
5. Marin Waldorf School, San Rafael: 35 percent
6. Manor Elementary, Fairfax: 27 percent
7. San Domenico Primary, San Anselmo: 22 percent
8. Mark Day School, San Rafael: 18 percent
9. Brookside Elementary, San Anselmo: 14 percent
10. Novato Charter School: 14 percent
11. Marin Primary & Middle School, Larkspur: 14 percent
12. Edna Maguire Elementary, Mill Valley: 12 percent
13. Wade Thomas Elementary, San Anselmo: 10 percent
Source: California Department of Public Health
http://www.marinij.com/marinnews/ci_27433455/california-measles-outbreak-highlights-marin-vaccination-dilemma |
