Protest in NJ over flu vaccine requirement

This Associated Press story on a protest yesterday in Trenton, NJ, regarding the state's expanded childhood immunization requirements has been distributed widely throughout the media. (It even earned a coveted place on the website of the widely-visited Drudge Report.)

The newly-enacted state requirements in New Jersey -- available here and effective as of this past September 1 -- include, among other vaccinations, that all children between 6-59 months attending day-care or preschool be vaccinated annually against influenza. This requirement mirrors the CDC recommendation for influenza vaccination, (which was recently expanded through age 18). New Jersey is the first state in the nation to require influenza vaccination in this population, a policy that has been widely supported by medical and public health organizations in the state and nationwide.

According the media coverage of the protest, those in attendance support a bill introduced in the state legislature that would allow the variously-termed 'philosophical,' 'personal-belief', or 'conscientious' exemptions to state vaccine requirements, available in approximately 20 states but not currently permitted in New Jersey. (Presently, only medical and religious exemptions are allowed in the state.)

The Newark Star-Ledger also sent reporters to cover the event, as did the Camden (NJ) Courier-Post. The Star-Ledger published an editorial arguing against the personal-belief exemption bill.

Perspectives on vaccine safety, exemptions, and autism links

Tuesday's Washington Post included a story about religious and other non-medical exemptions to state vaccine requirements. The article, "Faith lets some kids skip shots," examines the increase in personal belief exemptions by parents to forgo vaccination and its implications on disease rates as seen by the medical community. Interviewed for the story were Paul Offit, Saad Omer, and Barbara Loe Fisher.

This piece appears a few weeks after the cover story of Time magazine titled "The Truth about Vaccines." The story detailed the ongoing worries about alleged links between MMR or other vaccines with increases in autism rates and the response of the medical community to these concerns. Of particular note is the reporter's discussion of research using genetics and genomics to understand individual responses to vaccination. The story included a useful diagram (.pdf) tracing the recent increase in measles cases in the U.S., an increase suspected of being linked to trends in exemptions.

The Time cover story was likely motivated -- at least in part -- by the case of Hannah Poling which received significant attention this spring. In March, CDC acknowledged that vaccines Poling had received had exacerbated an underlying genetic condition related to mitochondria (a cellular component) leading to symptoms resembling those of autism. The case has been viewed by proponents of the vaccine-autism link as a 'smoking gun,' but CDC officials and others have noted that Poling's diagnosis and condition are exceptional and do not speak to a more general connection between vaccines and autism. The case was the subject of a commentary in the New England Journal of Medicine last month by Paul Offit that focused on the confusion surrounding many aspects of the decision.

Finally, returning to exemptions and their consequences, the New York Times' Ethicist column -- an often light-hearted Q&A on ethical dilemmas -- featured this question last weekend:

"My daughter’s play group consists of children ranging in age from infancy to 4 years old. One mother revealed that she does not vaccinate her son. After much frank but cordial discussion and opinions from pediatricians — some thought she endangered our vaccinated kids; others did not — she felt pressured to leave the group. Did the group behave ethically?"

Based on pediatricians' opinions that the unvaccinated child did not pose a significant threat to her vaccinated playmates (a view that is not held by all in the medical community), 'The Ethicist' concludes that the other parents were wrong to exclude the unvaccinated child.

"Science Progress" on Vaccine Policy

Our colleague Jonathan Moreno, also a Senior Fellow at the Center for American Progress, directs a project there on science and technology policy called "Science Progress." The project, consisting thus far of a web magazine and blog, celebrates its inaugural print edition this Friday. Last month, it published an interview with Dr. Saad Omer of Johns Hopkins, best known for his work on non-medical exemptions to vaccine requirements.

An excerpt from the interview:

SP: What do you think is most important for people who are both working in the public health community, people who are policymakers, people who might be hearing about this issue, and for parents to take away from this whole conversation in the public sphere at the moment?

Omer: One thing that people should realize is that we know that vaccines have some side effects. And we should acknowledge that, everyone who is involved. However, the risk and benefit calculus for all vaccines that are out there, based on our current knowledge, heavily favors not only getting your child vaccinated, but also getting them vaccinated according to the specified schedule.

Roundup: Exemption rates, Health-care workers, and Shingles

Some stories and perspectives in the news of late:

• "Parents claim religion to avoid vaccines for kids: Vaccination fears fuel increase in exemptions sought, AP finds" -- This AP story published late last week received significant attention in newspapers around the country. The key finding of their analysis is this: "From 2003 to 2007, religious exemptions for kindergartners increased, in some cases doubled or tripled, in 20 of the 28 states that allow only medical or religious exemptions, the AP found." The story includes reaction from Paul Offit, Barbara Loe Fisher, and others.

• "Inoculate thyself" -- This op-ed in the New York Times, written by an epidemiologist at the New York City Health Department, raises yet another alarm over low influenza vaccination rates among health care providers. The author argues that hospital accreditation and federal funding should be tied to improving staff vaccination rates, and until then, patients should refuse care from physicians and nurses who have not been vaccinated.

• "A vaccine as an option to keep shingles at bay" -- Also from the New York Times, this story from early October introduces readers to shingles, its treatment, and prevention options, namely, the potential benefits of Zostavax. The piece feels more like an informational article from WebMD than a story published in the nation's most respected newspaper, but a useful overview regardless.
  

Offit on vaccine exemptions

Our colleague Paul Offit published an op-ed in the Wall Street Journal last week titled "Fatal Exemption" (Unfortunately, subscription is required for full access). In it, Offit notes the findings published in JAMA last month showing a significant increase in the number of vaccine exemptions and the corresponding increase in vaccine-preventable illnesses. The chief culprit, says Offit: the growing use of 'philosophical exemptions'. He writes, in part:

"When it comes to issues of public health and safety, we invariably have laws. Many of these laws are strictly enforced and immutable. We don't allow philosophical exemptions to restraining young children in car seats, to smoking in restaurants or to stopping at stop signs. And the notion of requiring vaccines for school entry, while it seems to tear at the very heart of a country founded on the basis of individual rights and freedoms, saves lives. Given the increasing number of states allowing philosophical exemptions to vaccines, at some point we will be forced to decide whether it is our inalienable right to catch and transmit potentially fatal infections."

Parents challenging school exclusion policies for unvaccinated

While vaccinations are required in every state in the U.S. as a condition of public school or day-care attendance, all allow for exemptions in certain circumstances, namely medical, religious, or philosophical reasons (or a combination thereof, depending on the state). However, most states warn that those exempted from vaccinations may be prohibited from attending school in the event of an outbreak. With the current mumps epidemic in the Midwest, this policy is being tested, with mixed results...

• In Kansas, 15-year old David Brockway was not permitted to attend school for 12 days after another student contracted mumps. Brockway's father, who had acquired a religious exemption for his son and signed a form acknowledging suspensions such as this were possible, protested the action to the school board and won, according to the Wichita Eagle. The compromise: Brockway's father had to sign a 'waiver' specific to mumps, calling into question whether the motivation for the school board's actions is a concern over public health and limiting the transmission of the virus or merely insulating itself against potential liability. Since it's acknowledged that those vaccinated are not 100% protected against mumps, the school board may have actually put themselves at greater legal risk, if other students get mumps as a result of Brockway being an ideal vector for transmission.

• In Edwardsville, MO, two students were escorted from school by police when they attempted to attend classes despite being prohibited from school because of not being vaccinated for mumps, the St. Louis Post-Dispatch reports. One parent is reportedly meeting with a lawyer over the matter.