Has your child had the latest booster shot for (Tdap) whooping cough? If not, there is still time before the school year begins. A new state law requires all students entering seventh grade and beyond to show proof that they are up to date on their pertussis (whooping cough) booster. An outbreak last year killed 10 infants in California. As with all state vaccination requirements for students, parents can opt out from giving their children the booster. (All states require vaccines for public school. Only two states, West Virginia and Mississippi have no opt-out escape clause. Other states have variations on what California has. The law is California Health & Safety Code section 120365 (2006).)

Another required vaccine is the MMR, which stands for measles, mumps and rubella. We are in the midst of a measles outbreak, the likes which has not been seen in this country since 1996. According to the Centers for Disease Control, the total number of measles cases for 2011 was 156 at the end of June. California had 15 confirmed cases of measles although none were reported in Ventura County.

2There is a growing controversy about the safety and efficacy of these vaccines and an increasingly vocal minority is demanding the right to opt out of vaccinating their children in states that do not have such a policy. There appear to be three main reasons for this: parents are still concerned that the MMR vaccine can trigger autism, parents are concerned that their children are receiving too many vaccines spaced too closely together, and many parents do not believe there is a need for the vaccinations. The incidence of vaccine-preventable diseases is so low that they are no longer perceived as dangerous. Since an entire generation has passed since these illnesses were ubiquitous, most of today’s parents of young children have never seen the terrifying onset of polio or a child made deaf from mumps or dying from pneumonia caused by measles. These once-common illnesses are now considered to be inconsequential, yet those same parents likely benefited from being inoculated when they were children.

The movement to opt out of vaccinating children is relatively new and is often related to the now-disreputable paper written and published in 1998 by Dr. Andrew Wakefield. A British physician, Wakefield speculated that the MMR vaccine could possibly be related to the upsurge in autism cases. The most recent report from the CDC that said one out of every 101 children will be autistic.

Wakefield’s paper was withdrawn from the medical journal, his methods were dismissed as fraudulent, and Wakefield lost his license to practice medicine in England.  In the U.S., the courts have consistently ruled against parents claiming their children’s autism was caused by MMR vaccine. Nevertheless, the anti-vax movement continues to point to Wakefield’s paper as revealing a legitimate connection between the MMR vaccine and autism.

For those children just beginning kindergarten, parents must show proof that their child is entirely up to date on all of the vaccines. Although most parents are compliant with the law, the goal of reaching 95 percent by the year 2020 remains elusive for public health officials.

In some pockets of Ventura County, it appears that school administrators and parents are barely trying to comply with the law and do not seem to take the importance of mass vaccination very seriously. Would you send your fully vaccinated child to a school where you knew that only 27 percent of their classmates were likewise vaccinated? How about only 18 percent? Or 17 percent?

Those are the official numbers of vaccinated kindergarteners at the respective schools of Honey Tree Early Childhood Care in Thousand Oaks, Montessori School of Ojai, and Oak Grove School in Ojai.

(See sidebar for the Ventura County schools that have the best and the worst rates of vaccination.)

tThe California law requiring vaccinations allows for three types of waivers in which parents may opt out of vaccinating their children. The religious waiver is rarely used. The medical waiver is determined by a physician. And the philosophy waiver is for parents who, without being required to even name a reason, merely need to state in an affidavit that they don’t believe in vaccinating their children. You will never know which child sitting next to your kid may be completely unvaccinated. For families with infants at home or family members with compromised immune systems, such as cancer patients or those with HIV, a low compliance rate can be terrifying.

Prevention of a measles outbreak requires an extremely high compliance rate to achieve “herd immunity,” which is the only protection available for those who cannot be vaccinated. Measles is so highly infectious that 92-95 percent of the population must be immune to the virus. Only then will the virus disappear for want of a susceptible host.

At least eight Ventura County public and private schools with kindergarten fall beneath 60 percent compliance.

According to Dr. Robert Levin, Ventura County director of Public Health, “These are the schools where we have the potential to see major outbreaks with high degrees of serious illness and death from vaccine-preventable diseases. The number of people choosing not to vaccinate their child continues to increase. This leaves more of our children to both catch the disease and to pass it on to other unprotected children.”

The Centers for Disease Control has a target of 95 percent vaccination coverage for all kindergarten children for polio, diphtheria/tetanus/pertussis, measles/mumps/rubella, hepatitis B and varicella (chickenpox).

Some pediatricians, including Dr. Bob Sears, author of The Vaccine Book, feel that parents should have a right to refuse to vaccinate their children and still be allowed to send their children to public or private schools. Sears believes that parents should also have the right to space out the vaccinations as opposed to maintaining the schedule created by the CDC and the American Academy of Pediatricians.

“I think every parent in every state should have the right to opt out,” Sears said in an interview. “That’s because vaccines carry a very small risk of causing a serious, and even fatal, reaction. In my opinion, the government does not have the right to force parents to give their child a medical treatment that carries such a risk. I know the diseases carry risk as well, but I think parents should have the right to choose.”

3The U.S. Supreme Court has ruled on just such an issue. The 1922 case of Zucht v. King looked at the issue of school admission without required vaccinations. The court held the vaccination ordinances “confer not arbitrary power, but only that broad discretion required for the protection of public health.”

Still not satisfied that this mandate by some states was constitutional, the requirement for the hepatitis B vaccine was challenged in Arkansas in 2002. The court held that even though such an illness was not a clear and present danger compared to other illnesses, the 1922 ruling covered any vaccination that “has a real and substantial relation to the protection of the public health and the public safety.”

When the vaccination laws were challenged based on the First Amendment’s guarantee of religious freedom, the courts determined that, in practicing their religion, individuals may not engage in activities that violate or threaten important social interests.

And under the Fourteenth Amendment, which guarantees due process, the courts balance the rights of individuals against the state interests.

Barbara Loe Fisher is the founder of the National Vaccine Information Center (NVIC) and published a short statement this past Independence Day on the website Age of Autism. Fisher is strongly against the way children are vaccinated in this country, despite a disclaimer on her website claiming neutrality on the issue.

“Today there is no greater threat to liberty in America than the government enforced use of pharmaceutical products such as vaccines sold by corporations for profit that can both harm individuals and fail to work at all,” Fisher posted on her website. “The large gaps in the knowledge about the damage that repeated vaccination from day of birth throughout life could be doing to our brains and immune systems, have turned current vaccine laws into a forced, uncontrolled scientific experiment on the American population.”

Expressing the opposite view, Levin said he has very strong personal feelings about parents who choose to leave their children unvaccinated. “I don’t think people should have the right to opt out of a vaccine unless there is a medical reason. People don’t have a right to drive a car without a driver’s license. When you drive, you put other people’s lives at risk as well as your own. When you go out into society unimmunized, you do the same thing.”

Internationally, there is a massive outbreak of measles underway in Kenya and Ethiopia. According to the United Nations, Ethiopia has seen more than 17,500 cases of measles and 114 deaths so far this year. The World Health Organization said among Somali children at a refugee camp in Kenya have seen 462 cases of measles, which caused 11 deaths.

In Europe, measles outbreaks have been reported in 33 countries and tens of thousands of people have been infected, according to the CDC.

The measles outbreak in France this year demonstrates how quickly the measles can spread in an under-immunized environment. So far, there have been 12,500 cases of measles and six deaths. This, in a country with a fully immunized rate of only 60 percent. Some communities in Great Britain have a measles immunization rate of only 32 percent.

Measles is different from many other vaccine-preventable diseases, according to Levin. “Measles is one of the more infectious of the communicable diseases, and therefore, very high levels of population immunity are needed to control it,” he said.

Levin said several cases of vaccine-preventable illnesses have been recorded this year in Ventura County. There have been more than 200 cases of pertussis, 47 cases of hepatitis B, two cases of hepatitis A, two cases of meningococcal disease, two cases of mumps and one case of chickenpox where the patient was hospitalized.

“These were preventable,” Levin said.

When people use the term “measles,” they sometimes confuse three different viruses that present similar symptoms but are completely unrelated. Measles is the most serious of the three viruses.

Before the vaccine was available in 1963, there were three to four million cases every year. USA Today reported that measles used to kill 3,000-5,000 Americans a year. After the vaccine was introduced, deaths from measles dropped by 99 percent.

Measles has a specific set of symptoms that start to appear 10-14 days after exposure: a low fever that continues to climb quite high, even up to 105 degrees, followed by a runny nose, cough and conjunctivitis. Usually two to four days later, a rash appears at the hairline, spreads to the face and neck and finally all the way to the hands and feet. Often, a couple of days before the rash begins, tiny blue-white spots, called Koplik spots, appear.

Measles can turn deadly if, in rare cases, the patient develops swelling of the brain called encephalitis. Pneumonia is another complication of measles that can also kill. In fact, a persistent rubeola (measles) infection can cause SSPE (subacute sclerosing panencephalitis), a condition in which the nerves and brain tissue degenerate. SSPE can sometimes hit the patient many years after the original measles infection. There is no cure for measles and the only recommended treatment is acetaminophen.

You’ve probably heard of the “German measles” and wondered if it was the same as the measles. No, it is actually a virus called rubella. This virus is milder than rubeola and has an incubation period of close to three weeks. Symptoms include swollen glands around the neck, a red, bumpy rash, a mild fever and muscle aches. Although a rare case of rubella encephalitis is possible, it is not the most dangerous aspect of the virus.

For pregnant women, exposure to rubella can be devastating for the fetus if it occurs in the third to fourth month of pregnancy. Congenital rubella can cause severe birth defects such as blindness from microphthalmia (small nonfunctional eyes), severe heart defects, deafness and serious neurological problems.

Finally, there is a virus called roseola, sometimes called sixth disease. The incubation period is five to 10 days after exposure. A child may initially have a runny nose, sore throat and eye redness. The virus then causes a sudden and very high fever, sometimes reaching 105 degrees. The fever quickly drops and a rash appears on the trunk (back and front part of the body below the chest) then spreads to the neck, face and limbs. The entire course of roseola lasts three to seven days. It is also referred to as the three day measles.

No cure exists and the only treatment is acetaminophen. Febrile seizures are the most common complication although, rarely, it can lead to aseptic meningitis (extremely dangerous) or encephalitis.

The severity of the risk of measles is seen in different ways, depending on the point of view of the person evaluating the risk. Levin took into account the fact that many parents who refuse to give their children the MMR vaccine out of a misplaced fear of autism, also often forgo other vaccinations.

Levin said the danger reaches far beyond that one unvaccinated child. “Anti-vaccine parents should be reminded that measles and pertussis and other vaccine-preventable diseases can cause severe illness and even death. If enough parents stop vaccinating their children, outbreaks of previously controlled diseases, like measles, will occur.”

In June, one passenger from Europe who flew to the U.S. for a vacation caused an enormous amount of chaos. A 43-year-old Italian man with measles flew from Brussels, Belgium, to New York City. From there, he flew to Rochester, N.Y., and then on to Chicago. From O’Hare Airport, he flew to San Diego where he infected Terminal One at Lindbergh Field and then rented a car from Avis after taking a shuttle to the facility. This man, who had never been vaccinated, finally developed symptoms and visited an urgent care center in Encinitas. Everyone who shared the air within two hours of this man’s presence all along the way was exposed to measles. This is the extremely contagious nature of measles.

Dr. Sears views the recent measles cases in the U.S. in a different light. “Unfortunately, some infants who are too young to be vaccinated end up catching (measles) from unvaccinated kids, but there haven’t been any fatalities in the U.S. from measles in over 10 years, so these cases pass without consequence.”

There is no denying that the rate of autism in all of its forms has been rising dramatically. Only recently have researchers started to dig for answers about the cause of what was an extremely rare condition just three decades ago. During the mid-20th century, the medical community often blamed the mothers for causing autism in their children by being too cold, disconnected or unresponsive to their children’s needs. Poor parenting seemed to explain the syndrome.

Two new and possibly related theories about the causes of autism have just been published. In one study by Stanford University and University of California, San Francisco, researchers compared nearly 200 sets of twins where at least one of the twins had autism. Genetics had been the prime suspect but this study found the opposite. The researchers said that environment accounted for a whopping 62 percent of the cases, compared to 38 percent caused by genetics.

Another study by the Autism Research Program at Kaiser Permanente looked at more than 1,800 children. It found that mothers who had taken antidepressants, specifically the SSRI (selective serotonin reuptake inhibitor) type, in the year before giving birth were twice as likely to have a child with autism. Pregnant women who were prescribed antidepressants during their first trimester were nearly four times as likely to have a child with autism. Some common SSRI antidepressants are Prozac, Paxil and Zoloft.

Doctors urge women who are now or soon intend to become pregnant to continue to take their prescriptions and to see their doctors about future choices.