SO MANY SHOTS

The measles outbreak that originated at Disneyland in December 2014 prompted elected officials to author legislation that would require children be vaccinated to enter school. On June 20, 2015, Gov. Jerry Brown signed SB 1277, known as the NO SHOT. NO DAYCARE. NO SCHOOL. EVERY CHILD. EVERY VACCINE. Most of the vaccines are given during infancy. Parents rely on the advice of their pediatricians, specifically as to which vaccinations are given and when they are to be administered.
But parents worry. So many vaccinations in one visit. Is it safe? Will it overwhelm my baby’s immune system? Can’t we spread them out? Do we really need all of them? After all, most of the illnesses for which there are immunizations have nearly disappeared from the American health picture. The list of dreaded diseases that essentially no longer threaten vaccinated children includes, but is not limited to, mumps, measles, rubella, pertussis (whooping cough), diphtheria, tetanus, influenza, chicken pox, Haemophilus influenza type B (HIB), hepatitis A, hepatitis B, human papillomavirus (HPV), meningococcal disease, pneumococcal disease, polio and retrovirus.
The answers seem obvious until the parent sees the volume of shots waiting at the pediatrician’s office, all of which will be going into the child during a single visit. So much medicine in such a small body. Some parents are concerned that it just isn’t safe. But according to the American Academy of Pediatrics, it is not only safe in nearly all cases, it confers a reassuring absence of childhood diseases that were once justifiably feared.
This year in California, whether to have a child participate in the vaccine program is no longer optional. It is mandatory if a child is going to attend public or private school.
The new state law went into effect on July 1 requiring every child attending public school, private school or child care to be certified as fully vaccinated. There are narrow exceptions to participation that are strictly medical and must be verified by a detailed letter from the doctor.

A WORD FROM THE M.D. Dr. Robert Levin of the Ventura County Medical Center puts vaccinations in perspective In December 2014, a measles outbreak at Disneyland that was traced back to Ventura County caused quite a scare for parents and state legislators. The outbreak prompted the bill SB 1277, requiring parents to vaccinate their children or they would not be able to enroll their children in schools or day care, private or public, with very limited medical exemptions to permit any kind of absention. The law was signed in June 2015 and then went into effect this July for the 2016-17 school year. Dr. Robert Levin of the Ventura County Medical Center spoke to the VCReporter about the new law and how it has impacted local parents and children. What are parents’ primary concerns over the new state mandate for children to be vaccinated for school? From May this year to the beginning of school, we would get two to three calls a day from parents, mostly objecting to the state law — previously parents who took personal exemptions. They were expressing objections in having to do them. Sometimes they said they would pull kids out of school. Whether true or not, we were just there to answer their questions. Now we are only getting maybe one to two a week in the last six weeks. Have you seen a rush of parents coming in to have their children vaccinated in the last several months? Every year, in these last three months, we see a rush or a spike coming in for immunizations, but I can’t say there was a noticeable difference this year. Do you know the number of children who are not vaccinated for school? That’s a hard question to answer. Some schools have a vaccination rate of 99.6 percent and some are 54 percent. Overall, this year, there is about 2 percent to 4 percent who are not vaccinated coming into this. What passes for medical exemptions in particular? Parents or guardians can only get exemptions from a licensed M.D., not nurse practitioners, not school nurses, not naturopathics. . . . A medical exemption would be something that would affect their ability to get an immunization, such as an immunodeficiency that would prevent live vaccinations — the MMR is a live vaccine. Other things might be an allergy. That would only tend to limit them; most vaccinations don’t have well-known allergens. Besides the Disneyland measles outbreak in December 2014, what else have you seen that could have been prevented if people, children had been vaccinated? We have pertussis (whooping cough) outbreaks every two years. The other thing: How do you convince people to get a vaccine when vaccinations have done an incredibly good job preventing them (diseases)? We have never seen some of them. The only one vaccination to stop is smallpox. We still see polio — it was a common sight [in the U.S.] 60 years ago but it’s still seen in other countries. Mumps is not such a terrible disease, but it causes a lot of sterility. I see couples who want to conceive but one had mumps and they can’t. There is not a single vaccine that isn’t protecting us from something that isn’t injurious or causes death. by Michael Sullivan

A WORD FROM THE M.D.
Dr. Robert Levin of the Ventura County Medical Center puts vaccinations in perspective
In December 2014, a measles outbreak at Disneyland that was traced back to Ventura County caused quite a scare for parents and state legislators. The outbreak prompted the bill SB 1277, requiring parents to vaccinate their children or they would not be able to enroll their children in schools or day care, private or public, with very limited medical exemptions to permit any kind of absention. The law was signed in June 2015 and then went into effect this July for the 2016-17 school year. Dr. Robert Levin of the Ventura County Medical Center spoke to the VCReporter about the new law and how it has impacted local parents and children.
What are parents’ primary concerns over the new state mandate for children to be vaccinated for school?
From May this year to the beginning of school, we would get two to three calls a day from parents, mostly objecting to the state law — previously parents who took personal exemptions. They were expressing objections in having to do them. Sometimes they said they would pull kids out of school. Whether true or not, we were just there to answer their questions. Now we are only getting maybe one to two a week
in the last six weeks.
Have you seen a rush of parents coming in to have their children vaccinated in the last several months?
Every year, in these last three months, we see a rush or a spike coming in for immunizations, but I can’t say there was a noticeable difference this year.
Do you know the number of children who are not vaccinated for school?
That’s a hard question to answer. Some schools have a vaccination rate of 99.6 percent and some are 54 percent. Overall, this year, there is about 2 percent to 4 percent who are not vaccinated coming into this.
What passes for medical exemptions in particular?
Parents or guardians can only get exemptions from a licensed M.D., not nurse practitioners, not school nurses, not naturopathics. . . . A medical exemption would be something that would affect their ability to get an immunization, such as an immunodeficiency that would prevent live vaccinations — the MMR is a live vaccine. Other things might be an allergy. That would only tend to limit them; most vaccinations don’t have well-known allergens.
Besides the Disneyland measles outbreak in December 2014, what else have you seen that could have been prevented if people, children had been vaccinated?
We have pertussis (whooping cough) outbreaks every two years. The other thing: How do you convince people to get a vaccine when vaccinations have done an incredibly good job preventing them (diseases)? We have never seen some of them. The only one vaccination to stop is smallpox. We still see polio — it was a common sight [in the U.S.] 60 years ago but it’s still seen in other countries. Mumps is not such a terrible disease, but it causes a lot of sterility. I see couples who want to conceive but one had mumps and they can’t. There is not a single vaccine that isn’t protecting us from something that isn’t injurious or causes death.
by Michael Sullivan

WHAT ABOUT MY RIGHTS AS A PARENT?

Many parents insist they have rights regarding the welfare and safety of their children, and they are correct. Some parents fear the injection of so many products into their children at such a young age. They claim it is their right not to have chemicals injected into their children or, alternately, to vaccinate only on an extended schedule.
“Parents have a right to control the upbringing of their children, but it is not absolute,” said Erwin Chemerinsky, dean of the School of Law at University of California, Irvine. “Courts have all said that there is a compelling interest in making sure that children are vaccinated to protect them and others. Every court in the country has upheld compulsory vaccination laws, even without any exception for religion or a parent’s conscience. The parent’s claim does not have legitimacy here.” 

Actor Jim Carrey and other celebrities passionately disagree. According to his Twitter account, Carrey told his 14 million followers that he believes there is a link between the MMR vaccine (measles, mumps, rubella) and autism. Carrey said he is pro-vaccine although he is also anti-neurotoxin.
He said that the vaccine ingredients thimerosal and mercury can harm a child. The Centers for Disease Control reports that U.S. vaccines contain neither ingredient. When Carrey was dating celebrity Jenny McCarthy, it was determined that her son was autistic. Carrey believes it was caused by the MMR vaccine.
The popularity of this belief is based on a debunked theory from Dr. Andrew Wakefield whose fraudulent research paper claimed that the MMR vaccine caused autism. This, culled from a group of 12 children whose parents had been paid by Wakefield for their children to participate in the study. It was easily disproven but the celebrity of McCarthy and Carrey gave it more public exposure than would have otherwise been the case.
Immunizations have been an important part of modern medicine for the past century. Parents were thrilled not to be burdened by the threat of a list of dangerous diseases that, until the vaccines, stalked every child. In what has been a major step forward in public health, these vaccines have been successful.
According to recent studies, a major reason that many vaccine-resistant parents say they refuse to participate is that they do not believe a real threat exists. They look around and they don’t see measles, mumps and other preventable illnesses. Today’s young parents, however, did not get the measles precisely because they were protected by the MMR vaccine. These parents believe they are doing something positive by letting other
parents decide for themselves. But, as Chemerinsky pointed out, the courts say that public health, which benefits from mass vaccinations, is the overriding goal.

THE BIGGER PICTURE

When faced with vaccine-hesitant or vaccine-resistant parents, should the doctor dismiss them from the practice or continue to keep them on as patients? Doctors have recently been split, according to new reports in the journal Pediatrics. The American Academy of Pediatrics has, for the first time, declared its support for dismissing non-compliant patients.
The 2014 measles outbreak at Disneyland, which rendered 81 people sick with measles, is believed by doctors to have been the result of the failure of herd immunity, which had been undercut by the lower rate of vaccination. It was scary but had a positive effect. It proved what can actually happen when the vaccination rate drops too low to provide public protection.
Two surveys, from 2006 and 2013, illuminate changing attitudes of doctors on the best way to deal with vaccine-hesitant and vaccine-resistant patients. Even without the 2015 measles outbreak, by 2013 twice as many doctors dismissed vaccine-hesitant and vaccine-resistant families from their practices as they had in 2006. Also by 2013, nearly 90 percent of pediatricians in the survey said that at least one parent had asked to alter the vaccination schedule. A full 73 percent of parents who delayed or refused vaccinations did so, they said, because they believed the vaccines were unnecessary. They didn’t fear the measles or mumps or any of the vaccine-preventable diseases because immunizations had reduced the frequency of infection to near zero.
What most parents are not aware of is the number of people who would have become ill without the vaccines. These immunizations have prevented an estimated 322 million cases of illness, 21 million hospitalizations for Americans born between 1994 and 2013. This is according to the U.S. Centers for Disease Control and Prevention (CDC).

A LOOK AT LOCAL SCHOOLS

In Ventura County, different school districts are experiencing different reactions from the parents. At Moorpark Unified School District, Assistant Superintendent, Instructional Services, Donna Welch said that the district has implemented an extraordinary outreach program for parents — arming them with information.
“We’ve been telling parents from the very beginning, when they’ve come to register, more or less, no shots, no school,” Welch said. “This year we have a very careful list of all the students as they register if they didn’t have their updated immunizations. We made phone calls, we made a lot of effort, and no students were turned away from the first day of school.
“But if they didn’t have the immunizations even though we knew we had these little ones coming, we didn’t assign a teacher. All of the students, we had them all in by the first day. I attribute that to the new law because we were all on the same page. We are 100 percent. I guess that is a good thing.”
Dr. Michael Babb is the Superintendent of the Ventura Unified School District. He said the school nurses informed him that certain parents were coming to school armed with medical exemptions.
“Most families have been pleasant, worked well with us, although they are frustrated that they feel like they’re, from their point of view, losing their parents’ rights to make that decision,” Babb said. “There have been others who weren’t happy with the situation but most of them comply. Sometimes, too, the parents just don’t know. They said they didn’t have a clue that their kid needed more [vaccinations].”
Overall, in Ventura County, parents have been compliant for the most part.
There has been very little response from parents,” said Dave Schermer, communications manager from the Ventura County Office of Education. “The few objections we’ve heard of tend to be concentrated in more affluent areas such as the East County. Children who are not vaccinated are not able to attend school unless they have a medically necessary exemption from their physician.”

DIFFERENT VACCINES, DIFFERENT CONCERNS

One vaccine that is particularly unpopular is Gardasil, designed to prevent the HPV virus, which is most often transmitted through sexual contact. The HPV vaccine, however, is not a required vaccination, per California SB 1277. That vaccination is only currently required for school attendance as part of state law in Rhode Island, Virginia and Washington, D.C.
For those people who already have HPV, getting the HPV vaccine would still be beneficial, as there are various strains of HPV. The vaccine includes numerous strains, but 16 and 18 in particular are the most likely to become cervical cancer.
Dr. Robert Levin, medical director of the Ventura County Medical Center, said that while the HPV vaccine cannot prevent against a strain that a person has already contracted, it still serves to protect against other strains. Levin said that HPV is known to be the major cause of cervical cancer.
Many parents feel that Gardasil is unnecessary for their pre-pubescent children who have never been sexually active. Doctors, however, say that is a good time to administer the vaccine to be effective against future exposure; but according to the Centers for Disease Control and Prevention, young women can get HPV vaccine through age 26, and young men can get vaccinated through age 21.
For those parents who are forced to comply with pre-determined vaccination schedules when they would prefer to space out the vaccines as well as pick and choose which vaccines to administer, the American Academy of Pediatrics (AAP) has set a schedule that is both safe and assures the full vaccination of children. Doctors say the more the schedule is spread out, the more likely it is that some of the final vaccinations will be forgotten or ignored.
In a change of policy, the AAP is asking public health officials to eliminate all exemptions that are not medically necessary. Personal belief exemptions will no longer be acceptable. In order for herd immunity to be effective, nearly all people who can safely take the vaccines, must be vaccinated. Aside from a few states, however, the personal-belief exemption is still accepted. In certain pockets, it is popular, and herd immunity is difficult to maintain, risking the spread of infection to the most vulnerable. 

Michael Sullivan contributed additional reporting to this story.