Vaccines and Preventable Diseases:
Fatal Exemption: Relationship Between Vaccine Exemptions and Rates of Disease
Dr. Paul Offit's Commentary as published in Wall Street Journal
January 29, 2007
On January 20, the Wall Street Journal published a commentary written by Paul A. Offit, MD, director, Vaccine Education Center, and chief, Division of Infectious Diseases, Children's Hospital of Philadelphia (CHOP). The commentary originally appeared in the December 2006 issue of the email newsletter Parents Pack, which is a publication of the Vaccine Education Center.
Dr. Offit's commentary discusses the findings presented in a paper published in the Journal of the American Medical Association (JAMA) on October 11, 2006. The commentary as printed in Parents Pack is reprinted below in its entirety.
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Last month [October 2006] the Journal of the American Medical Association (JAMA) published a study that received little attention from the press and, as a consequence, the public. The study examined the incidence of whooping cough (pertussis) in children whose parents had chosen not to vaccinate them; the results were concerning.
Vaccines are recommended by the Centers for Disease Control and Prevention (CDC) and professional societies, such as the American Academy of Pediatrics. But these organizations can't enforce their recommendations; only states can do that—usually when children enter day care centers and elementary schools—in the form of mandates. State vaccine mandates have been on the books since the early 1900s; but aggressive enforcement of them didn't occur until much later, born from tragedy.
In 1963 the first measles vaccine was introduced in the United States. Measles is a highly contagious disease that can infect the lungs causing fatal pneumonia, or the brain causing encephalitis. Before the measles vaccine, measles caused 100,000 American children to be hospitalized and 3,000 to die every year. In the early 1970s, public health officials found that states with vaccine mandates had rates of measles that were 50 percent lower than states without mandates. As a consequence, all states worked toward requiring children to get vaccines. Now every state has some form of vaccine mandates.
But not all children are subject to these mandates. All fifty states have medical exemptions to vaccines, such as a serious allergy to a vaccine component. Forty-eight states also have religious exemptions; Amish groups, for example, traditionally reject vaccines, believing that clean living and a healthy diet are all that are needed to avoid vaccine-preventable diseases. And twenty states have philosophical exemptions; in some states these exemptions are easy to obtain, by simply signing your name at the bottom of a form; and in others they're much harder, requiring notarization, annual renewal, a signature from a local health official, or a personally written letter from a parent.
The JAMA study examined the relationship between vaccine exemptions and rates of disease. The authors found that between 1991 and 2004 the percentage of children whose parents had chosen to exempt them from vaccines increased by 6 percent per year, resulting in a 2.5-fold increase. This increase occurred almost solely in states where philosophical exemptions were easy to obtain. Worse, states with easy-to-obtain philosophical exemptions had twice as many children suffering from pertussis—a disease that causes inflammation of the windpipe and breathing tubes, pneumonia and, in about twenty infants every year, death—than states with hard-to-obtain philosophical exemptions.
The finding that lower immunization rates caused higher rates of disease shouldn't be surprising. In 1991 a massive epidemic of measles in Philadelphia centered on a group that chose not to immunize its children; as a consequence nine children died from measles. In the late 1990s, severe outbreaks of pertussis occurred in Colorado and Washington among children whose parents feared pertussis vaccine. And in 2005 a 17-year-old unvaccinated girl, unknowingly having brought measles back with her from Romania, attended a church gathering of 500 people in Indiana and caused the largest outbreak of measles in the United States in ten years; an outbreak that was limited to children whose parents had chosen not to vaccinate them. These events showed that for contagious diseases like measles and pertussis it's hard for unvaccinated children to successfully hide among herds of vaccinated children.
Some would argue that philosophical exemptions are a necessary pop-off valve for a society that requires children to be injected with biological agents for the common good. But as anti-vaccine activists continue to push more states to allow for easy philosophical exemptions one thing is clear, more and more children will suffer and occasionally die from vaccine preventable diseases.
When it comes to issues of public health and safety we invariably have laws. Many of these laws are strictly enforced and immutable. For example, we don't allow philosophical exemptions to restraining young children in car seats or smoking in restaurants or stopping at stop signs. And the notion of requiring vaccines for school entry, while it seems to tear at the very heart of a country founded on the basis of individual rights and freedoms, saves lives. Given the increasing number of states allowing philosophical exemptions to vaccines, at some point we are going to be forced to decide whether it is our inalienable right to catch and transmit potentially fatal infections.
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To access Dr. Offit's article from Parents Pack, go to:
www.chop.edu/consumer/jsp/division/generic.jsp?id=85382 (exit)
NOTE: Dr. Offit's Wall Street Journal commentary, titled "Fatal
Exemption," is available to the paper's online subscribers at www.wsj.com (exit)
To access the abstract of the JAMA article ("Nonmedical Exemptions to School Immunization Requirements: Secular trends and association of state policies with pertussis incidence"), go to: http://jama.ama-assn.org/cgi/content/abstract/296/14/1757 (exit)
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Content last reviewed on June 6, 2007
Content Source: National Center for Immunization and Respiratory Diseases