- Associated Press - Wednesday, December 24, 2014

BLOOMINGTON, Ind. (AP) - By the time most Indiana children reach the age of 10, they have been subjected to a battery of immunizations designed to protect them - and those around them - from illnesses that once were a scourge of childhood such as polio, diphtheria and pertussis.

State law requires children in public and accredited private schools to receive immunizations under a schedule set by the Indiana State Board of Health. However, parents can request a medical or religious exemption.

Statewide, nearly 73 percent of adolescents age 13 to 17 have received the required immunizations, which places Indiana seventh among the states, according to information gathered for America’s Health Rankings by the United Health Foundation. The immunization rate of children in Indiana is 68.5 percent, 33rd best in the nation, according to the 2014 health rankings.

While compliance is high, it is not universal. Concern about the safety of vaccines for children, fueled by media reports of vaccine-suspected injuries and high profile activists like actress Jenny McCarthy, have led some parents to refuse vaccinations or to deviate from the schedule imposed by the state.

Immunization information for the Monroe County Community School Corp. shows that some of the district’s poorest elementary schools have the highest rates of compliance. Conversely, those with the lowest compliance rates have some of the district’s lowest rates of poverty.

At 99 percent, Fairview Elementary School has the highest rate of compliance of any school in the district. Fairview has a free and reduced-price lunch rate of nearly 90 percent, according to the Department of Education’s Compass website. Students qualify for free or reduced-price lunch based on family size and income.

At the opposite end of the spectrum is University Elementary School, with only 72 percent of students compliant. About 30 percent of students at University Elementary are enrolled in the free or reduced-price lunch program.

Tessa Schilling, director of health services at MCCSC, said one reason for University’s low rate is that it serves families who come to Bloomington from foreign countries to work or study at Indiana University. She said different countries have different immunization requirements, and certain immunizations have to be spaced out.

“If there’s a 30-day wait before the next series, and we see that a lot, they’re still counted as noncompliant,” she told The Herald-Times (http://bit.ly/138XHQC ).

An Oct. 6 Time magazine article suggests the high number of families at the elementary school with ties to Indiana University may very well be the reason for its low rate of compliance, but not because of where those families come from.

Vaccination refusals tend to be a phenomenon of the wealthier, better educated, politically bluer parts of the country, such as the northeast, Pacific Coast and pockets around major universities, according to the article. There are some outliers, but there seems to be a correlation between poverty and compliance among elementary schools in the Monroe County Community School Corp.

When the corporation’s elementary schools are ordered from most to least compliant, the free and reduced price lunch percentage among the top half of schools is about 54 percent. The average for the bottom half is about 32 percent.

Local pediatrician Scot Moore said in an email he hasn’t found well-educated, middle- and upper-class families to be more likely to refuse vaccinations or deviate from the recommended schedule, but he has seen an uptick overall.

The reason, he said, is misinformation regarding the effectiveness and possible side effects of vaccinations.

“Although Internet sites and prominent spokespeople sound convincing when discussing autism, seizures and other complications, there is no science to support these claims,” Moore said in the email.

That lack of scientific study is part of what makes people like Karmen Wagler skeptical about vaccinations.

Wagler is a nurse and a volunteer with the Indiana Coalition for Vaccination Choice. She said many of the people associated with the Coalition are also health care workers.

“The main reason we came together is because we’ve seen firsthand the damage of vaccines,” she said.

That statement seems to fly in the face of conventional wisdom about vaccinations. Moore said in an email that decades of study and millions of children receiving immunizations according to the recommended schedule have proved claims of adverse side effects to be untrue. Wagler, however, points to the National Vaccine Injury Compensation Program as evidence to the contrary.

According to the Centers for Disease Control’s website, in the mid-1970s several lawsuits were filed against vaccine manufacturers and health care providers by people who believed they had been injured by the diphtheria, pertussis, tetanus vaccine, often shortened to DPT.

“Damages were awarded despite the lack of scientific evidence to support the injury claims,” according to the CDC website.

As a result of the decisions, prices soared and some vaccine manufacturers halted production. A vaccine shortage ensued and public health officials became concerned about the return of epidemic disease. In response, Congress passed the National Childhood Vaccine Injury Act of 1986.

Among other things, the act created the National Vaccine Injury Compensation Program to compensate those injured by vaccines on a “no fault” basis, according to the CDC’s website. Since the first claims were filed in 1989, more than $2.8 billion in compensation awards have been paid to petitioners.

“That was a huge red flag for me,” Wagler said. “If they’re so safe, why do we need to provide liability protection?”

Ed Kraus is a clinical professor of law at Chicago-Kent Law School. He supervises a clinic that represents people injured by vaccines.

“Vaccines are capable of doing tremendous amounts of good,” he said, “but we have to also be aware of situations where people have been injured.”

Many of the cases the clinic handles involve adults with injuries such as shoulder or chronic regional pain syndrome from flu shots. Others are severely damaged neurologically, he said. Some are afflicted with Guillain-Barre Syndrome, a disorder in which the body’s immune system attacks part of the peripheral nervous system, or chronic inflammatory demyelinating polyneuropathy, a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms.

In children, complaints involve seizure disorders, brain injuries and acute disseminated encephalomyelitis, but that’s rare, Kraus said. There are also young adults with different kinds of injuries from the human papillomavirus or HPV vaccine, sold under the brand name Gardisil, he said.

In general, these complications tend to affect people with immune issues or sensitivities to medications or children with mitochondrial disorders or dysfunction, Kraus said. The most famous Vaccine Injury Compensation Program claim involved a child with an unknown mitochondrial disorder.

At 19 months old, Hannah Poling received five vaccines for nine diseases in one day, according to several news outlets. At the time, Poling was interactive, playful and communicative. Soon after she developed fever, seizures and severe health problems.

Eight years later, the government conceded vaccines aggravated a cell disorder nobody knew Hannah had, leaving her with permanent brain damage and autism-like symptoms. The Vaccine Injury Compensation Program awarded Hannah’s family $1.5 million for her care, lost earnings, pain and suffering in one year, according to a Sept. 10, 2010, CBS news article. In addition to the first year’s payments, Hannah’s family was expected to receive more than $500,000 per year for her care. It was believed total compensation could amount to $20 million over Poling’s lifetime, according to the CBS article.

Paul Offit, chief of the division of infectious diseases and the director of the vaccines prevention education center at the Children’s Hospital of Philadelphia, criticized the decision in the Poling case in a piece for the New England Journal of Medicine. He wrote the Vaccination Injury Compensation Program has, in recent years, “turned its back on science.”

Offit, who is a co-inventor and co-holder of a patent on the rotavirus vaccine RotaTeq, from which he and his institution receive royalties, wrote that while it is clear natural infections can make things worse for people with condition’s like Poling’s, no clear evidence exists that vaccines can do the same thing.

Kraus and Wagler, however, feel like there’s a reason that evidence doesn’t exist.

“It’s difficult to prove a vaccine caused injury,” Kraus said. “The science is not as well developed as you would want.”

The reason, he said, is because there’s not a huge incentive to fund research in that area.

“A lot of funding comes from the pharmaceutical industry,” Kraus said. “They’re not interested in funding research that looks at vaccination safety. It’s not to their benefit.”

Looking at it from a public health perspective, the government wants to promote vaccinations for the greater good and that tends to be their focus, he said. Parents, however, need to make the best decision they can for their child’s health.

“For many, that’s on the recommended schedule, but for others, it’s to skip certain ones,” he said. “The idea that the only rational, moral choice is to give a child all the recommended vaccines on the recommended schedule is not fair.”

Wagler has felt that criticism and she’s heard the comparisons to Jenny McCarthy, the actress and former Playboy model who claimed vaccines caused autism in her son. McCarthy’s activism on the subject has made her the butt of jokes, including the tongue-and-cheek Pigasus Award from the James Randi Educational Foundation granted for contributions to pseudoscience.

“People call Jenny McCarthy nuts,” Wagler said.

She’s not saying McCarthy is right, but Wagler does think people should be aware of what’s in vaccines and what possible risks those ingredients may pose before allowing them to be injected into their children.

“We’re not a bunch of wackos. We don’t want diseases back,” she said. “We want people to be able to make an informed choice. It’s a medical risk.”

Of course, not vaccinating children also poses a risk.

Moore, the local pediatrician, warns against deviating from the recommended schedule.

“Families choosing to alter the typical schedule are experimenting with their own child,” he wrote in an email. “There are no studies looking at side effects or protection from alternate regimens.”

What people like Kraus find objectionable is a one-size-fits-all vaccination policy.

“We need to work toward which person is more likely to have an adverse reaction,” he said. “We need to tailor the program more effectively to eliminate or reduce the number of injuries.”

Getting an exemption

While it appears governments and health organizations are satisfied with that one-size-fits-all system, a growing number of families in the MCCSC have figured out how to take matters into their own hands.

Schilling, the director of health services at MCCSC, said the biggest reason for noncompliance with the recommended vaccination schedule has changed.

“It used to be because people weren’t getting it done, but now it’s they don’t want to,” she said.

The state of Indiana requires students in public schools and accredited private schools to adhere to the Indiana State Department of Health School Immunization Requirements. Unlike some states, Indiana does not allow families to file a philosophical exemption. It does, however, allow medical and religious exemptions.

The Indiana Department of Education has a specific form for medical exemptions that requires a physician’s signature. The religious exemption, however, is much less formal.

A religious exemption can be as simple as a signed, hand-written note saying a parent or guardian objects to vaccination for their child due to religious beliefs. No further explanation is necessary, Schilling said.

“It’s a one sentence piece of paper,” she said. “You can’t take it any further.”

___

Information from: The Herald Times, http://www.heraldtimesonline.com

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