- Associated Press - Sunday, March 15, 2015

GREAT FALLS, Mont. (AP) - Posters in the waiting and exam rooms at Benefis Pediatrics encourage vaccination and warn of the dangers of the diseases they prevent. Decades after the vaccines for diseases like measles were first developed, they still pose a threat.

“We worry about the waiting room. I think that’s a realistic fear right now,” said pediatrician Deborah Garrity at Benefis Health System.

An outbreak at the Disneyland theme park in California in late December has led to 142 confirmed cases in seven states. None in Montana, but doctors continue to be concerned about the spread of the disease among unvaccinated children.

Garrity and her colleagues have seen very few cases of measles, a disease that was declared eradicated in the United States in 2000. They worry a case might come into the waiting room and infect other children before the providers there would be able to identify it.

“It’s not something we deal with,” she said.

As more and more parents opt not to vaccinate their children, providers become worried about outbreaks.

Garrity and family nurse practitioner Courtney Crouch often see patients whose parents either do not want to vaccinate them at all or who choose to deviate from the recommended vaccine schedule. Visiting with parents about their concerns about vaccines is a common occurrence, they said.

“Autism is still a big one,” Garrity said, referring to a now-refuted 1998 study that appeared in the British medical journal the Lancet that linked autism to the measles, mumps and rubella vaccine. The lead author of that study, Andrew Wakefield, was stripped of his medical license because of flaws in the study, and the Lancet retracted the article.

A study published this month in the Journal of the American Medical Association showed a heavy genetic influence on whether a baby develops autism.

Other parents worry their infant’s immune systems won’t be able to handle so many vaccinations at once. They instead may insist on an alternative schedule for their children. Garrity said that is ill-advised.

The CDC vaccine schedules that doctors follow has been studied and shown to be effective. The effectiveness of other vaccine schedules has not been researched, she pointed out.

“There’s research on why to give a vaccine and when mom’s immunity wanes and the kids need their own shot,” Crouch explained.

Mothers who breast feed and have immunity from disease can pass that immunity on to their very young children, but that wanes within months.

Benefis pediatricians have been trying to educate patients about the importance of vaccination, but some parents don’t want to hear it, Garrity told the Great Falls Tribune (https://gftrib.com/18sRUs7).

While most people choose to vaccinate their children, it’s upsetting to Garrity that some parents do not, making their children susceptible to contracting serious illness, she said.

“It comes up every week,” added Crouch.

A 2008 National Immunization Survey showed immunization rates in Montana for infants ages 19 to 35 months were some of the lowest in the country. The low rate was attributed both to vaccine hesitancy by parents and missed opportunities to immunize, according to a recent state Department of Public Health and Human Services report.

For infants of that age group, only about 87 percent are vaccinated against measles, according to a national survey performed by the Trust for America’s Health, a pro-vaccine group.

Jim Murphy, chief of the communicable disease bureau at DPHHS, said those survey numbers come with a margin of error of about 5.3 percent, but added that Montana could be doing better to vaccinate its children.

In 2008, Montana was 50th overall in childhood series and rose as high as 35th at one point. Now the state hovers around 40th, he said.

“We’ve made a lot of progress in the last couple years. Health departments and providers have done a great job reaching out to people,” Murphy said.

But Murphy said his department was “very concerned” about measles.

The low vaccination numbers are, for the most part, rectified by the time children go to a day care provider or reach school age and are required to have certain vaccinations.

According to a state survey of Montana’s 2013-2014 student immunization rates, only 2 percent of kindergartners, or 276 students, were enrolled in school conditionally, which means they are allowed to go to school so long as they are getting caught up on their vaccinations.

By second grade, the number is 111, or less than 1 percent of students.

Additionally, 94 percent of kindergartners had at least two doses of the MMR (measles, mumps and rubella) vaccine, with all the rest of the grades with at least 95 percent.

About 98 percent of schools responded to the survey, Murphy said.

According to Murphy, the low number is due in part to lack of access for people who live in rural areas.

“We have 22 to 23 counties where the only source of immunization is the county health department. So availability may be an issue for some folks,” he said.

Children can attend daycare and school if they are unvaccinated if they have medical or religious reasons for doing so. Statewide, less than one half of one percent of children qualify for the medical exemption.

“It’s incredibly rare,” said Garrity, the pediatrician.

But she added that for those few children who cannot be vaccinated, the herd immunity of the vaccinated population protects them from getting sick.

A little more than 2 percent of children in the state have religious exemptions. Counties that have the highest rate of religious exemptions are Golden Valley (6.5 percent), Lincoln (6 percent), Ravalli (6 percent), Sanders (5.7 percent) and Petroleum (5.7 percent). Cascade County’s religious exemption rate is 0.9 percent.

All Montana counties except two had less than 1 percent of students with a medical exemption. Park County has 1 percent and Treasure 2.7 percent claiming the exemption. Cascade County’s medical exemption rate is 0.1 percent.

Montana is one of the states that does not have a philosophical exemption. An attempt to insert that exemption into House Bill 158, which seeks to add the chicken pox, or varicella, vaccine to the list of required vaccines for children, was unsuccessful.

The bill, sponsored by Billings Democrat Margie MacDonald, passed the House 51 to 49 Thursday.

The bill also requires that children over the age of 7 receive a pertussis vaccine. According to the DPHHS immunization survey, students’ rate of vaccination is the lowest for pertussis, usually given as the Tdap, which also protects against diphtheria and tetanus. Overall, only 93 percent had received the booster.

That’s translated into increased pertussis in the state. Great Falls Public Schools experienced a pertussis outbreak during December and January, and it was not an isolated incident.

According to Murphy, Montana had the highest rate of pertussis in the nation in 2013, the most recent year that numbers are available

At Benefis Pediatrics, parents who choose not to vaccinate their children are asked to sign a form acknowledging they have been informed of the risks of not vaccinating their children.

They’re making some inroads. When the measles outbreak first occurred, a mother with three unvaccinated children brought them to Crouch and told her she wanted them all to be vaccinated.


Information from: Great Falls Tribune, https://www.greatfallstribune.com

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