Outbreak raises vaccine exemption concerns

State health officials are concerned about the rising number of people seeking vaccination requirement exemptions.


An investigation has revealed a 7-month-old child recently was exposed to chickenpox at home by an older sibling who had a religious exemption from vaccination. That exposure led to an outbreak at a child care facility on the Kenai Peninsula.

The Alaska Section of Epidemiology (SOE) on Nov. 3, 2011 was notified of the outbreak, according to a March SOE bulletin.

"The issue is that the more people, children in the Kenai case, that haven't been vaccinated against a certain disease, the higher the risk of an outbreak and spread of the disease within a given setting," said Michael Cooper, SOE infectious disease program coordinator.

Health officials are working toward education so parents stop the trend of delaying or refusing vaccination. Certain religions will continue to disavow vaccines based on their beliefs.

State regulations require that all children in public and private schools, certified preschools and licensed child care facilities are immunized for various diseases -- mumps, polio and chickenpox among others -- unless the child is exempt for medical or religious reasons. An affidavit signed by the child's legal guardian is used to affirm that immunization conflicts with tenets and practices of their church.

Alaska had the highest immunization exemption rate in the U.S. for 2010-11, at nearly 9 percent, according to the Center for Disease Control.

The pool of unvaccinated children increases the risk of vaccine-preventable disease outbreaks in the state, said Gerri Yett, SOE immunization program director.

When a parent submits a religious exemption, it exempts the child from all vaccines. People may request the exemption because their child is behind on a particular vaccine, she said. In some cases, parents claim religious objections to avoid vaccines for their kids.

"Parents may have elected to do a religious exemption for that one dose (of chickenpox vaccine) even though the child is up to date on all other vaccines," she said.

This skepticism toward vaccines is causing outbreaks, she added.

"With vaccine hesitancy that we're seeing more and more of with parents, or delaying, we're starting to see an increase in the number of outbreaks," she said.

During last year's November incident, a total of three cases occurred due to the outbreak. The first two cases infected infants too young for vaccination, and the third case infected a child with a religious exemption, according to the bulletin.

People are not required to designate what religion they practice on state exemption forms. Yett said she believes people often are not discussing the decision with a medical doctor.

People can get a religious exemption without visiting a doctor, she said.

"The SOE is working with health care providers to be more vocal with parents, explaining that there are consequences to delaying or deferring vaccination, or even choosing to do an exemption," she said.

The Roman Catholic Church does not fall under the category of churches asserting all vaccines should be avoided, said the Rev. Steve Moore, Archdiocese of Anchorage chief operating officer, but some vaccines conflict with the Catholic Church's ethics.

"The one that is sometimes troubling for (Catholic) parents is the HPV vaccine, and also some vaccines which consist of fetal tissue," he said. "Those can be a problem."

HPV, the human papillomavirus, is transmitted through sexual contact. The CDC recommends boys and girls within an age range starting at 9 are vaccinated against the common sexually transmitted virus.

According to Catholic bioethics leaders, pursuing universal vaccinations for sexually transmitted viruses or diseases could have the unintended effect of setting up a false sense of security for boys and girls who are sexually active. Parents also are concerned they are sending the wrong message about pre-marital sex.

Another religion-based objection to vaccines is the presence of aborted fetal tissue.

But according the CDC, some vaccines, including a mumps vaccine, contain killed viruses. The virus is cultured in human cell-line cultures, and some of these cell lines originated from aborted fetal tissue. After processing, very little, if any, of that tissue remains in the vaccine.

Many other vaccines are produced in animal tissues. Christians may find conflict due to the tenet warning not to mix the blood of man with blood of animals.

Children should receive their first dose of chickenpox vaccine between 12 to 15 months of age, and their second dose between 4 to 6, according to the SOE.

"What we saw on the Kenai was unfortunate," Cooper said. "There were people who could not get the vaccine yet because of their age. They've lost some of the immunity they had from birth."

Other than the transmitted infections, three infants too young for vaccination were kept from the facility for 21 days.

Mississippi has lowest immunization exemption rate at 0.1 percent, according to the CDC.

"The states that have no religious exemptions and fewer medical exemptions found that they're having fewer problems with outbreaks of preventable diseases," Cooper said.

Jerzy Shedlock can be reached at jerzy.shedlock@peninsulaclarion.com.


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