ESCAPE THE RASH Measles is on the rise, as 24 states now report new cases.
As an outbreak of measles courses through California, Sonoma County Health Officer Dr. Celeste Philip issued a warning and recommendation that parents immunize their school-age children against the highly contagious disease. Some Sonoma County public schools field immunization rates that are among the lowest in the state.
"I . . . write this letter to emphasize to parents and guardians the seriousness of this current measles outbreak and the potential impact to unvaccinated or under vaccinated children," says Philip in a note distributed to schools and parents yesterday.
As of the middle of May there have been 44 reported cases of measles in California and 750 nationwide this year, according to the Centers for Disease Control. That's the highest number of cases, reports Philip, "since measles was nearly eliminated in 2000."
The Bohemian reported on the letter from Philip last week on Bohemian.com and responses on social media were characteristic of this highly emotional debate pitting pro against anti-vaccination. One pro-vaccination Sonoma County reader said it was time to roll the vaccination truck into Sonoma County and get everyone up to date on their shots. An anti-vaccination readers said it was time to check those suspect numbers coming out of the CDC about the spike in measles this year.
In 2017, the state moved to rein in abuses over a "personal belief exemption" in the state vaccination law and Philip notes that since then, there's been a 94 percent rate of compliance with state law that requires vaccination as a condition of attending public school. But there are strong pockets of anti-vaccination resistance, including in Sonoma County.
None of the measles cases this year originated in Sonoma County, "but we are vulnerable," Philip writes, given that "in some (Sonoma) County schools less than half of students are up to date with the recommended vaccination schedule."
Any measles outbreak in Sonoma County will be met with swift action in the schools, Philip warns. "If your child is unvaccinated or cannot provide laboratory confirmation of measles immunity and there is a case in their school, they will likely be excluded from attending school for 21 days after their last exposure to the contagious individual. This exclusion helps protect the susceptible students and limits further spread of disease."
Online data indicates that Sonoma County is one of the least-compliant counties in the state, if not the country, when it comes to parents getting their children vaccinated. The state requires that children entering kindergarten be immunized against 10 communicable diseases, including for measles, mumps and rubella.
Those three are covered under the so-called "MMR" vaccine, which Philip says "has a long-established history of being safe and effective."
That view is not generally shared by an anti-vaccination community with a strong presence in Sonoma County. Here's how the immunization debate and changes in state law have played out in one Sonoma County school over the past few years: the Sebastopol Independent Charter elementary school had 45 students enrolled in 2017-18. That year, 35.5 percent of students were up to date in vaccinations; up from 26.67 percent the year previous. Fifty eight percent of the exemptions in 2017-18 were for medical reasons, up from 25 percent the year before. Before the personal belief exemption was curtailed, 38 percent of students were exempted in 2016-17 because of personal beliefs against vaccination held by the parents.
Those numbers are at odds with recent polling around vaccinations.
A Pew Research study from 2015 found widespread acceptance of vaccinations, as 68 percent of adults said childhood vaccinations should be required. Thirty percent said the choice ought to be the parents to make—and many of those respondents were young adults aged 18-29 who have no experience with, for example, the devastating effects of polio, which has largely been eradicated.
Philip's warning comes as the California legislature is considering closing a loophole in the state's childhood immunization law that came about after it curtailed the personal belief exemption in 2017. That effort was undertaken in response to a less-severe measles outbreak that year.
In closing one loophole, the state opened another: Now California's vaccination law permits medical exemptions for parents of children whose health might be impacted negatively by vaccinations. The exemptions are granted by a family health-care provider approved by the state to grant the exemption.
Critics say the loophole has been abused by parents who oppose vaccinating their kids, whether it's for medical or personal reasons.
A state senate bill this year would close the loophole in a bill sponsored by pro-vaccination legislator Richard Pan, who is both a senator and a pediatrician. He's been making the media rounds this month promoting SB 276, which would put the final decision about medical exemptions in the hand of the California Department of Public Health—and create a state registry of all children who have been granted medical exemptions.
As that bill works its way through committee, Sonoma County's health official Philip is urging that "unvaccinated or under-vaccinated children should be vaccinated as soon as possible through their healthcare provider so they will have protection, will not further spread illness and will not need to be absent from school."
She's supporting Pan's bill. "If passed it would send a clear message about the importance of vaccinations to keep individuals and communities healthy," says Philip via email, "and emphasize that vaccines are safe for the overwhelming majority of children and adults."
One of the most persistent critiques of vaccinations—and the driver of much of the debate about their efficacy and health risk—is that they cause or can contribute to autism. The autism-immunization debate continues apace, and one of its highest-profile proponents is Robert F. Kennedy Jr., founder of the organization Children's Health Defense (CHD).
Kennedy has compared a purported vaccine-driven rise in autism rates to the Holocaust, and noted in an interview that ran on the CHD site that "life for these children is an endless agonizing progression of twilight and terror. The tormenting gut aches, excruciating sensory sensitivities, the serial head banging and screaming, the isolation and perpetual joylessness. The entire family is permanently devastated."
State Sen. Pan, in turn, has been stressing his pro-vaxx viewpoint on behalf of public school children with severe health problems and/or auto-immune disorders—who can often only attend public school if everyone is also vaccinated, given the health risks they could face if one of their peers came down with the measles.