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MISTAKING THE ENEMY: With safety concerns about vaccines on the rise, more and more parents are refusing to immunize their children. Have they forgotten about diphtheria?
Five-year-old Carlo Schmidt gets ready for his kindergarten vaccines at
the office of Dr. Ted Humphry in Arcata. Photo by Bob Doran.





She had read a lot about vaccinations even before becoming pregnant with

her daughter. Why subject a tiny body to a barrage of foreign substances when some children appear to be harmed by them? she wondered.

Her decision: no shots for her newborn.

Four years later, the little girl contracted pertussis -- as have at least 29 other Humboldt County residents, mostly children, since 1999. The symptoms typically include coughing spasms punctuated by a desperate intake of breath -- the "whoop" that gives the disease its common name, whooping cough. Many children cough so hard they throw up. Some turn blue. Infants are especially vulnerable to the disease, which can be fatal.

"It was a constant, 24-hour-a-day ordeal," said the mother, who asked that her name not be used. "It's such an intense cough. It's frightening. And it took all summer from when she got it in June, two months of complete care," before she was well again.

Nevertheless, the mother said she did not regret her decision to skip the vaccines.

"She'll go the rest of her life without that illness, and that's something that immunizations can't give you," she said. "What doesn't kill you makes you stronger."

A disturbing trend

Like many other states, California requires children to be immunized against a variety of diseases when they enter kindergarten. Most Humboldt kids -- about 89 percent as of last year -- do get the shots.

But a growing number of parents here and throughout the country are questioning the wisdom of vaccinating their children. They believe the risks, which some say include everything from febrile seizures to mercury poisoning to death, outweigh the benefits. They believe that the immunizations don't do what they're supposed to do, and that the shots are just pushed on children so that drug companies can rake in profits.

State law has for decades allowed parents to claim exemptions to the immunization requirement simply by signing a form saying they're "contrary to my beliefs." The "personal belief exemption," as it is called, may be claimed for any reason, be it religious or philosophical. (Christian Scientists, who practice faith healing, pushed legislatures throughout the country to institute the exemptions beginning in the 1950s.)

Since 1996, the number of parents who have taken the exemption in Humboldt County has doubled, from 2 percent to 4.2 percent of the 1,488 incoming kindergartners in 2002. For younger children, those in child care centers, the "exempted" children make up nearly 10 percent of the total.

Ready for School?

Polio (IPV) -- 3 doses
Diphtheria, tetanus and pertussis (DPT or DTaP) -- 4 doses
Measles, mumps and rubella (MMR) -- 2 doses
Hepatitis B -- 3 doses
Varicella (chicken pox) -- 1 dose*

*Requirement waived if child has had the disease.
Haemophilus influenzae type b (Hib) vaccine required for child care and preschool centers.
The trend has public health officials worried.

"I am concerned about the high number of personal belief exemptions in our area," said Susan Wardrip, a registered nurse and immunization coordinator for the county's public health branch. "There is a perception that the risk of the vaccine is more substantial than the risk of the disease. I think it's a lack of education about what these diseases can do.

"This is a time when people don't lose children in this country. It's the price of success. You eradicate the disease and then people think it's not a problem anymore. But you go back a generation or two, or you go to a country where they still have these diseases, and they line up to get these vaccines."

Celia Woodfill, an epidemiologist with the immunization branch of the state Department of Health Services, agreed. "The community hasn't seen vaccine-preventable diseases in so long they forget how horrible they really are."

Diphtheria, for example, was among the top three causes of death for children under 15 before the vaccine was licensed in the 1940s. It causes a thick membrane to grow over the throat, which can spread down the airway and lead to breathing problems, paralysis and heart failure. Diphtheria kills one out of every 10 people who get it.

And it hasn't been wiped out: When the Berlin Wall crumbled in 1991, so did the former Soviet Union's public health care system. Immunizations took a nosedive, and, since then, more than 150,000 cases of diphtheria and 5,000 deaths have been reported.

Fearing vaccines

Zoli Gaudin-Martin and Kelly GaudinSo why do some people shun vaccines?

Kelly Gaudin, a 42-year-old single mother in Arcata, [photo at right] said that when she was a child growing up in Florida, no one thought twice about vaccines. "This was as common as your navel," she said, pointing to a shot mark on her upper left arm. "Everybody had one."

But when she moved to Humboldt County from the Bay Area five years ago, she decided "there were legitimate questions that needed to be asked" about immunizations. She talked to other parents, to a local doctor. She read Mothering magazine and got information from the Internet. What she found out was that some children's bodies appear to react badly to the shots. A federal program called the Vaccine Adverse Event Reporting System has received more than 123,000 reports of negative reactions after immunizations since 1990 -- 15 percent of which were classified as serious. (Many of those, researchers say, may have occurred coincidentally after the shots, rather than having been caused by them.) Reactions range from pain and swelling in the area of the shot to fever, convulsions and shock.

"Sure, the statistics show that it's rare for your child to have [a bad] reaction, but for some number it's real," Gaudin said. "I wouldn't forgive myself if something like that happened to my child."

Her daughter, Zoli Gaudin-Dalton [in photo at right], will turn 5 next month. Gaudin first considered skipping the immunizations altogether, then heard about a Humboldt friend whose son came down with pertussis. "I realized that it was here and present and posed a danger. Out of fear, I decided to go ahead" and get the pertussis vaccine, as well as the haemophilus influenzae type b, or Hib, when Zoli was 3 months old, she said. Those were repeated at 7 months. Zoli has received no other shots.

"I feel confident in my decision not to follow through with the immunization schedule," Gaudin said. "We do everything we can to stay healthy."

If there were an outbreak of one of the vaccine-preventable diseases in the school where she'll enter kindergarten this year, Zoli would, by state law, be kept out until she got the shot -- or until the threat to her health was over, which could be weeks.

"I'm willing to take Zoli out of school if that's what's required," Gaudin said. If she got the measles? "We would get through that. I trust the integrity of our organism, of our body. Allowing nature to have a certain amount of latitude is OK with me."

Myth or Fact?

CONCERN: The MMR vaccine can cause autism.

A major 2002 study involving over a half million children showed no difference in autism levels between those who received the vaccine and those who didn't.

CONCERN: The pertussis vaccine doesn't work for all children.

True, pertussis is one of the less effective vaccines. But children who get the vaccine will get much less sick with less chance of complications if they also get the disease.

with mercury, which some believe may contribute to autism and other neurological disorders.

Thimerosal's use as a vaccine preservative has been discontinued. While no serious harmful effects had been reported, there was some concern that mercury blood levels in children were approaching safety limits. Most, but not all, routine vaccines in the U.S. contain no thimerosal.

Vaccines aren't necessary because the diseases have been wiped out.

Vaccines themselves are responsible for the low rates of disease. But some diseases are still common in other parts of the world and can migrate. And low immunization rates in the U.S. and elsewhere have caused cases to multiply.

CONCERN: It is risky to subject a child's body to so many antigens.

Children are exposed to foreign antigens every day. A cold exposes her to four to 10 antigens; a case of strep throat, 25 to 50.

Sources: U.S. Centers for Disease Control, New England Journal of
Medicine, Humboldt County Public Health.

Worries about mercury

A quick Web search on immunizations is enough to make any parent leery.

Site after site is filled with frightening stories: infants who died following their immunizations, children whose autism was allegedly caused by a vaccine, accusations of money-grubbing pharmaceutical companies. One site offers a video to help parents "understand why vaccines are essentially loaded guns aimed at your child's body."

One particular concern has focused on the mercury content in vaccines. A mercury-containing preservative called thimerosal was added to some vaccines beginning in the 1930s. A number of parents whose children developed neurological conditions, including autism, suggested that mercury was the culprit. The fact that more and more vaccines were added to the "required" list for schools only increased some parents' anxiety. Even some in the medical establishment expressed concern that the additional vaccines were producing concentrations of mercury in children's blood that were approaching safety limits.

While emphasizing that the "large risks of not vaccinating children far outweigh the unknown and probably much smaller risk, if any, of cumulative exposure to thimerosal-containing vaccines over the first six months of life," the American Academy of Pediatrics and the U.S. Public Health Service issued a statement in 1999 urging that "thimerosal-containing vaccines should be removed as soon as possible" because "any potential risk is of concern." Today, thimerosal is either nonexistent or present in only trace amounts in vaccines.

To Dr. Ted Humphry, a pediatrician who has worked in Arcata for 26 years, most of what parents find on the anti-vaccine Web sites is bogus. "The vast majority of [the Web sites] are based in weak science," he said. "Some of the claims they have made have eventually been disproven, such as the link between MMR [measles-mumps-rubella vaccine] and autism." He cited a study that was published last November involving all Danish children born from 1991 to 1998 -- more than a half million. Those who had received the MMR vaccine were no more likely to have autism than those who had not. "That's pretty conclusive for my money," Humphry said.

"I spend a lot of time talking about immunizations and I know the literature," he said. When parents have questions, he asks if they want to talk. "If they say no, the discussion's over. I don't agree with their not immunizing their children, but then I don't agree with a lot of things parents do. Sometimes they change their minds; most of the time they don't."

Child with measles rash on face and body

Another Web site links Sudden Infant Death Syndrome to vaccines and alleges, "coroners don't check the immunization status of SIDS victims."

Not so, said Frank Jager, Humboldt County coroner. "That's one of the first things we check. It's part of the protocol we follow when we check on a child's death. Coroner's offices are mandated by state law" to follow that protocol, in effect since 1990, Jager said. "Most SIDS deaths occur between the ages of 2 and 4 months, and coincidentally that's when children are receiving vaccinations, too. There's no medical data that supports the conclusion that vaccines are causing the SIDS."

Putting others at risk

Opting out of the shots not only puts your own child at risk of disease; it can also threaten the community, health professionals said.

When a certain percentage -- some say 90 or 95 percent -- of a population is vaccinated against a disease, that group achieves what health officials call "herd immunity." The lower the vaccination rate, the more opportunities a disease has to catch hold and spread to those most vulnerable, including infants and immune-compromised children.

"A substantial minority of adults now question the need for immunization, citing a variety of reasons, from safety and value to cost for not being vaccinated," said David A. Neumann, executive director of the National Partnership for Immunization, in a written statement last month. Resulting disparities in coverage "threaten the health of our families and communities." [Mr. Neumann's position has been corrected from the error in the print edition]

Dr. Louis Z. Cooper put it more bluntly.

"The families that don't immunize their children are depending on other parents to do the right thing," said Cooper, interim director of the National Network for Immunization Information and professor of pediatrics at Columbia University. "That annoys me. It's kind of freeloading."

Child with tetanus seizuring

At 71, Cooper said he has spent more than 40 years working on vaccines and is "old enough to remember how bad these diseases were."

"I'm sure that some children are harmed by vaccines," Cooper continued. "There's nothing we do that some people are not harmed by." But when well-meaning parents surf the `net in search of answers to their medical questions, "They can't separate out the wheat from the chaff. Those of us who spend our whole lives on this, some of the issues are very complex. People who want to deviate from the guidelines . . . what they're really engaging in is uncontrolled experimentation without clear hypotheses, without controls, without informed consent."

The city of Boulder, Colo., is engaging in one such experiment. According to a story in last September's Atlantic Monthly, Boulder has the lowest school-wide vaccination rate in Colorado and one of the highest per capita rates of whooping cough in the United States. At one particular school, nearly half of the parents refused some or all shots for their kids. Others who came in contact with the students caught the virus during a resulting outbreak.

Parents who choose not to immunize their children may be taking more risks than they realize, even if they don't travel to foreign countries, said Jennifer Richmond, a public health nurse in charge of investigation and surveillance of communicable diseases for Humboldt County.

"Are they never going to let their kid go to a big city or ride on a subway?" she said. "Even in Humboldt County, there are foreign exchange students coming in. There are a lot of travelers going out from Humboldt and coming in to Humboldt. We really can't hide behind the Redwood Curtain any longer."

Wardrip, the county's immunization coordinator, said parents should think a generation ahead.

"One of the things that frightens me the most is parents who have not immunized their children and now their children are old enough to be parents," she said. Mothers who were not immunized as children can't pass along antibodies to their babies -- antibodies that help protect infants in their earliest days and months.

Person sneezing

And unvaccinated children are not only vulnerable themselves but may put others at risk. A child with rubella, or German measles, for instance, may suffer only mild symptoms. But the disease is spread easily, and the unborn children of pregnant women face the most grave consequences: A baby whose mother gets rubella in the early months of her pregnancy is at high risk for deafness, blindness, heart disease, brain damage and death.

Kristin Schmidt of McKinleyville said she felt good about vaccinating her 5-year-old son, Carlo, who got his kindergarten shots last week. "I'm very supportive of immunizations," she said. "If your child were to come down with one of those diseases, how would you ever forgive yourself? I think we have an obligation to the society at large to do our part to prevent these horrible diseases from cropping back up in the population."

polio ward with dozens of patients and nurses

`The questioning generation'

Of course, parents who refuse to immunize their children believe they are doing the right thing. One Eureka mother said she simply wanted to have "the healthiest child possible" and was concerned about side effects of the vaccines. She also asked that her name not be used; her parents would be upset if they knew of her decision, she said. "Their generation was so dependent on what the doctor said, and we're the questioning generation."

Humboldt County is, indeed, known for its "free thinkers," said Jacque Granstra, who has been a school nurse here for 33 years. "I'm not a typical Ken-and-Barbie type myself," she said. But she believes in vaccinations and emphasizes the positives.

Not everyone listens. "They just kind of want to do it their way."





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