Iowa schools see more unvaccinated children

Iowa schools continue to see increasing numbers of unvaccinated children, even as fears about vaccine safety recede from the headlines.

Parents obtained vaccination exemptions for 7,967 Iowa children in the 2012-13 school year, more than triple the number from 12 years earlier, state officials said. That number represents less than 2 percent of all Iowa children, but public-health leaders worry about the continuing increase.

Experts warn that unvaccinated children can catch dangerous diseases and spread them to kids who can't be vaccinated or whose shots failed to provide full protection.For an example of what can happen, experts point to the hundreds of children sickened nationally during this year's surge of measles, which spread from unvaccinated children in Ohio.

Students in some schools are much more likely than others to go without some or all recommended vaccinations. In Des Moines, for example, some schools have less than 1 percent of students lacking vaccinations, while others have more than 10 percent.

Rick Kozin, Polk County's public-health director, said some parents apparently believe their children can skip vaccinations because most of their kids' classmates have received the shots. The parents figure there would be little chance of encountering the viruses or bacteria that the vaccinations target, he said.

Kozin said such parents might not realize that many other families are making the same calculation, which could open up a school to a disease outbreak. "I don't think some of these parents see the risk they're taking with their kids' health," he said.

Iowa requires children to have vaccinations against eight diseases before entering school. The number of shots varies, depending on which vaccines are combined. But for most children, the total is about 16 shots before they start kindergarten.

State law allows two kinds of exemptions. The first is a medical exemption, which must be signed by a health care professional. Public-health experts have few qualms with those. They recognize some children have legitimate reasons to avoid vaccinations, such as allergies. Fewer than a third of Iowa's vaccination exemptions are due to medical reasons.

The rest are classified as religious exemptions, which only requires parents to sign a statement saying immunization conflicts with "a genuine and sincere religious belief, and that the belief is in fact religious, and not based merely on philosophical, scientific, moral, personal, or medical opposition to immunizations."

Public-health leaders say it's extremely rare for an organized religion to bar vaccinations. But as government officials, they're not going to interrogate people on questions of faith.

"We could make it part of our religion if we had to in a bind," chuckled a West Des Moines woman who hasn't vaccinated her four children.

The woman did not want her name published because she did not want to get crosswise with public-health officials. She's already had enough problems with several physicians, who have declined to continue treating her children because they are unvaccinated.

The woman is wary of vaccines because of information she has read about purported dangers of preservatives. She contends if she keeps her children well-nourished, clean and otherwise healthy, they could safely fend off bouts of diseases such as measles, whooping cough and chickenpox.

"I feel like I'm equipped to treat them in a safer way than filling them with all these vaccines," she said.

The West Des Moines mom, who home-schools her children, was not surprised to hear that home-schooled kids tend to be the most likely to go without some or all recommended vaccines. Home-schooling parents tend to be people who do their own research and make up their own minds, the woman said.

In West Des Moines, 37 percent of home-schooled children are not fully vaccinated, records show. In Des Moines, that figure is 16 percent.

The schools data suggest that many unvaccinated kids come from relatively well-off families. For example, 12 percent of students at Des Moines' Cowles Montessori School were not fully vaccinated last year. Only 18 percent of Cowles' students come from families that qualify for free- or reduced-price lunches, compared to 70 percent districtwide.

Des Moines schools spokeswoman Amanda Lewis said district leaders are aware of such statistics, which are mainly due to families' use of Iowa's religious exemption.

"We certainly hope that parents in our district or anywhere in Iowa do not abuse this exemption, as it is relatively easy to obtain and impossible to confirm," she wrote in an email to the Register. "The district strongly believes that the immunization of students is an important public health issue that impacts the well-being of our students as much as any other safety measure we take in our schools."

A national expert said vaccination skeptics tend to be relatively prosperous people who have time and inclination to read reams of material about possible dangers facing their families. "We live in a world where people are far more motivated by fear than by reason," said Dr. Paul Offit, a pediatrics professor at Children's Hospital of Philadelphia.

Offit, who helped develop a rotavirus vaccine, is a national advocate for vaccinations. He said people often underestimate the danger from diseases that rarely surface in the United States. "Vaccines are a victim of their own success," he said.

The odds are slight for any single American child to be critically injured or killed because he or she isn't vaccinated. But it does happen, Offit said, and serious complications can strike children who had been healthy.

"It's a game of Russian roulette, except there are maybe 100,000 empty chambers," he said. "But why put a gun to your kid's head at all?"

The U.S. this year has been dealing with its largest measles outbreak in decades. The main outbreak, centered in Ohio, got a foothold in Amish communities where children were unvaccinated, officials have said.

Measles has sickened nearly 600 people in 21 states this year. The virus is extremely infectious, and doctors say that despite its relatively benign image in some people's minds, measles can cause brain damage and death.

America and Europe went through a wave of anxiety about vaccines in the past 20 years because of concerns that shots were causing young children to become autistic. Public-health officials have campaigned to put those fears to rest. They felt vindicated a few years ago when a British author who led the original study linking the measles vaccine to autism was denounced as a fraud by his co-authors.

Sunny Pamperin of Des Moines has heard theories about vaccine dangers, but they have not dissuaded her from having her two children vaccinated.

Pamperin smiled last week over the fact that one of the main vaccination critics is Jenny McCarthy, an actress and Playboy model who has contended that a vaccination caused her son's autism. Pamperin would prefer to take her pediatrician's opinion, which is that vaccines' protection vastly outweighs their risk. "I just can't see how a mother wouldn't want to protect their kids from these diseases," she said. "If my kids got sick with measles or polio or something, I'd just be devastated."

Pamperin brought her son, Elias Wayman, 4, in for a checkup last week with Dr. Nathan Boonstra, a pediatrician at Blank Children's Hospital. Elias was due for two shots, and his mother's main concern was his anxiety over the brief pain. She knows that some parents believe it's safer to spread vaccinations out instead of combining numerous vaccines into one or two shots. But she said Elias' fear of more shots would outweigh that theory.

Boonstra advised her that combination shots can slightly raise the risk of fever, which can occasionally cause seizures. But he said even the seizures tend not to be dangerous.

Boonstra won an award last year from the federal Centers for Disease Control and Prevention for his work promoting vaccinations. He understands why some parents are worried by what they hear from others or read online. He encourages them to raise concerns, and he said doctors need to take time to fully discuss the issue with parents.

Boonstra hopes it won't take a major outbreak of a dangerous disease to persuade some parents to vaccinate their children. He believes fears are starting to ebb, but he expects to hear questions for years to come.

"It's not easy to un-scare people once they've been scared," he said.

Vaccination laws

Nineteen U.S. states allow parents to opt out of vaccinations for their children by saying they have personal opposition to the shots.

Iowa is a bit stricter. It doesn't allow parents to opt out for personal reasons. However, it does allow families to opt out by stating they have religious objections to vaccination. The parents' signatures must be notarized, but they do not have to produce any specifics about the religious belief they're citing.

Only Mississippi and West Virginia don't allow exemptions for religious or personal beliefs, according to the Immunization Action Coalition, a national group based in Minnesota.

Iowa tends to rank well in national vaccination reports. For example, a 2012 report from the federal Centers for Disease Control and Prevention said more than 93 percent of Iowa toddlers had received shots for measles, mumps and rubella. The national average was 91 percent. More than 88 percent of Iowa toddlers had received shots for diphtheria, tetanus and pertussis, compared with less than 83 percent nationally.