Hundreds of thousands of children are going to school this fall without protection from deadly diseases.
More parents are deciding not to vaccinate their children against mumps, measles, rubella, polio and other dangerous diseases. The parents are refusing to vaccinate because of concerns that the vaccinations themselves are harmful, or because of the growing cost and complexity of getting the shots.
A Scripps Howard News Service review of incomplete surveys submitted to the federal Centers for Disease Control and Prevention shows at least 135,000 children (out of about 4 million new students) started kindergarten last fall exempt from vaccine requirements. In some states, one in 10 children did not get vaccinated, and in some communities 30 percent of the children were unprotected.
The same CDC survey system reported that at least 76,000 middle school students around the country started the last school year with exemptions that allowed them to be incompletely vaccinated.
The surveys are incomplete because not all school districts in all states file complete reports to CDC.
Even so, experts who track the surveys say the number of exemptions has expanded from fewer than 1 percent to at least 2 percent or 3 percent of students in many states.
More worrisome was a CDC report issued in April that found more than one in four toddlers under age 2 are not being vaccinated as recommended, mostly due to doses being missed rather than no shots at all.
"I'm afraid those numbers may more accurately reflect what's happening with the vaccination of young children,'' said Dr. Paul Offit, chief of infectious diseases and head of the vaccine institute at Children's Hospital in Philadelphia. "It's unlikely that many will catch up before they enter school, and with exemptions so easily granted, they don't have to."
Referring to the protection of the entire population, Offit says he's afraid "we've already dropped below the level of vaccine coverage where herd immunity exists for some diseases. At some point, we're going to be forced to decide whether it is an inalienable right to catch and transmit potentially fatal infections."
A Scripps Howard News Service poll found that 56 percent of Americans think parents should be able to exempt their children from vaccinations for "philosophical reasons."
A series of measles outbreaks through July represented the greatest surge of the disease in this country in more than a decade. It has infected at least 131 people in 15 states and underscores the danger posed by pockets of unvaccinated people, the CDC says. Most of them, 112, were not vaccinated, and of the 95 eligible for vaccination by age and medical status, 63 had not gotten shots because of religious or philosophical beliefs.
Seventeen of the victims picked up the disease overseas, but the rest were infected in the United States. "That's what's so concerning to us,'' said Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Disease. "Measles is imported into this country all the time, but this year, we've seen it spread to much larger groups of unvaccinated people —as many as 30 in one group of home-schooled children in Illinois — than we've had in recent years.''
Saad Omer, assistant professor at Emory University's School of Public Health in Atlanta and several other leading vaccine researchers reported two years ago that in states that more readily grant exemptions, not only are more children opted out, but the rate of pertussis, or whooping cough, infections are 50 percent higher in those states.
Omer and others warn the unvaccinated can put not only others who haven't gotten shots at risk of exposure, but even some who think they're immune.
"Most first-line vaccines are about 85 to 95 percent effective, so even those who have done the right thing by getting vaccinated on time have a 10 to 20 percent chance they're still unprotected,'' Omer said. "So if I'm one of those people, what are the consequences of people around me not doing the right thing? It puts me in a great deal of danger."
In all but two states, parents can obtain exemption from mandatory school vaccinations if they declare immunization contrary to their religious beliefs. Twenty states also allow exemptions based on "personal belief" or philosophical objection to vaccines. Every state allows children to be excused from vaccine requirements if a doctor finds the shots might jeopardize their health.
But public health officials say unvaccinated children — and some unvaccinated adults — are at the center of increasingly frequent outbreaks of illnesses that most doctors have studied in books but never seen.
That's how Kelly Lacek's youngest son, Matthew, came to be something of a celebrity patient at Pittsburgh's Children's Hospital two years ago, at age three. Few doctors there had ever seen a child infected by the bacteria Haemophilus Influenzae Type B. Before Hib vaccine for infants was introduced in 1990, the disease struck down 20,000 American children a year and killed 600.
Matthew "got so sick, so fast. He was hunched over and couldn't breathe (the infection often causes severe swelling in the throat),'' Lacek recalled. "We took him to our local emergency room and they were treating him like it was an asthma attack. But this one young doctor asked me if he'd been vaccinated. I said no and within seconds he realized how life-threatening Matthew's condition really was. He saved his life.''
Looking back, Lacek considers how she came to doubt vaccines for her kids. With her firstborn, Ashley, "I didn't think twice about shots, but then we started hearing about the autism concerns and it seemed like I was surrounded by friends with children getting diagnosed with those conditions."
Working as registrar at the private school her children attend in Monroeville, Pa., "I saw so many cards come through stating the mother wanted a religious exemption from vaccination."
Her second child, Stephen, had gotten his first "baby shots,'' but when Lacek asked her pediatrician if she could prove to her there was no mercury in the vaccines, "she couldn't and I said, okay, we're not doing it. I got a religious exemption for him and Matthew when he was born."
Today, all the Lacek kids are fully vaccinated. Kelly Lacek is part of a national network called Parents of Kids with Infectious Diseases, urging families to immunize.
"I think making people aware of real-life stories like ours, letting them know that these killer diseases vaccines are meant to prevent are still out there, helps put the risks in a different light,'' Lacek said.
Mary-Clayton Enderlein of Mill Creek, Wash., was in her early 30s when she became infected with pertussis from a baby whose family did not immunize. She was also 9-months pregnant with her second son, Colin.
Although she'd been vaccinated, her immunity had worn down. She thought she had a respiratory infection when Colin was born, but "I gave him pertussis with my first kiss." Her son was sick for many weeks, but survived and is now finishing high school.
"I still have friends that don't immunize and I understand their reasons, but you need to balance those fears with social responsibility,'' Enderlein said. "I worry at some point we're going to hit some critical mass of unvaccinated kids and see an epidemic that's a lot more compelling than the possibility of adverse reactions to vaccines."
