When there’s a stoplight that turns red late at night when there is no other traffic around, most people will stop anyway just because it’s a simple rule and a safe practice.
Some, however, will not, and the more people that break a simple rule, the more dangerous it becomes for the whole community.
That’s the way many pediatricians are looking at the issue of vaccinations among children as a potential measles outbreak continues to make its way eastward from the West Coast, where the outbreak began several months ago in California’s Disneyland theme park.
The situation in California brought the issue of vaccinations back into the national spotlight, as Disneyland officials advised those not vaccinated for measles to avoid the fun park. At the same time, the accompanying outbreak seemed to multiply fastest in communities where there were high rates of parents who had opted not to vaccinate – a trend that grew very popular in the 1990s and has continued to draw adherents. The situation, in whole, has caused many communities to look at what their vaccination rates are – especially amongst their youngest children in the schools – and to examine the health science behind vaccinations.
“It’s a dicey issue right now,” said Chelsea Supt. Mary Bourque. “On a federal level, there are rules and regulations, but there is also free choice and religious considerations. As a society, we do recognize there is tension here – that tension between free choice versus what’s best for the group. That’s what we’re going to wrestle with when it comes to vaccinations in the next few years in our country. We really need more guidance from the federal government. At the same time, where does the individual’s choice infringe and put the collective population in danger? That’s the very heart of this issue.”
Such questions are, indeed, at the center of the debate.
Vaccination rates began to sink in the 1990s when a study in the United Kingdom purported to link vaccinations with autism. The study was highly publicized and caused many parents in Europe and the United States to re-think vaccinating their children, resulting in scores and scores of children not getting the usual childhood vaccinations for diseases like the measles, diphtheria and polio.
“That study has been completely debunked,” said Dr. Lorky Libaridian, a pediatrician at a Cambridge Health Alliance (CHA) practice in Revere and an instructor at Harvard Medical School. “There have been tests after tests that have been conducted and that have proven there is no link. That said, there’s been an anti-vaccination campaign and people who are against using vaccinations that’s been going on for while. That has never stopped since the late 1990s.”
Now, with a measles outbreak at hand, Libaridian said that pediatricians are thinking about what these diseases are and how to spot and treat early.
“We’re definitely watching it as it moves eastward,” she said. “A lot of us have never seen measles because it was eliminated through vaccinations. We have to brush up on it. It could easily get here. It takes just one person. We’re not on red alert, but we’re watching it.”
One thing that worries pediatricians and school officials is what is called the vaccination threshold. That term refers to an idea that if a certain percentage of the overall community is vaccinated, then that protects those who are not vaccinated.
Libaridian said it’s become known as the “herd community.”
“There is something known as the herd community,” she said. “What that means is that we don’t have to vaccinate every single person, but there is a minimum threshold of the community you need vaccinated because those who are vaccinated end up protected those who aren’t…By everyone else getting vaccinated, it’s around an 88 to 94 percent threshold for measles, it protects the entire community. When the vaccination rate numbers dip below that minimum threshold, that’s the thing we worry about.”
She said that’s where the late-night stoplight analogy comes into play.
“The best prevention for measles is vaccination,” he said. “When we vaccinate ourselves and others, it’s helping the community. The things we do don’t always have a benefit for just ourselves. It is like stopping at a red light when no one is around. We do that because it is a simple rule for safety and if people didn’t stop, it would make things more dangerous. The more people who choose not to obey a simple rule, the more dangerous they are for everyone.”
In Everett, Revere, and Chelsea, vaccination rates from a state Department of Public Health (DPH) annual survey of kindergarten students for last year, 2013-2014, are very high – which is good news for doctors and school officials.
In Everett, most elementary schools are in the high-80s or mid-90s in rates for kindergartners. Everett Supt. Fred Foresteire said the success in Everett comes from a partnership with Everett’s Board of Health.
“Our rates are a combination of the Board of Health and the way we enroll our students,” he said. “No one gets enrolled in the Everett Public Schools without verifying things with our Parent Information Center (PIC). The medical records are part of that process. Every student’s medical records get checked by the nurse at the Board of Health.
“It’s critical we stay on top of this,” the continued. “I think it’s the right thing. It protects everybody – the children and everyone else. We’re growing so fast in Everett and people are coming from all over the world and it’s just critical we make sure everyone is vaccinated.”
Revere proved to have the most outstanding rates around, with nearly every school at 100 percent for all vaccines monitored – which includes vaccinations for diphtheria, chickenpox, polio, hepatitis B, measles and others.
Only one school in Revere, the Garfield School, had lower rates, and that was because there were a few families that requested exemptions for religious reasons. Still, the rates for that school were in the high 90s.
“For the most part, that’s due to our Parent Information Center (PIC) and the fact that we have a nurse there a lot,” said Revere Supt. Paul Dakin. “She’s a great benefit for some parents who don’t have their kids immunized. Immunizations now are very controversial topics. In some ways, it’s coming down to a moral decision as well as a health decision. If I were doing it all over with my kids, I can’t see not immunizing. The instruction going on with our nurses and our parents is valuable for us.”
Chelsea Supt. Bourque said her district’s rates are also the product of a partnership – Chelsea’s being with the Mass General Hospital’s large clinic in Chelsea.
“I really do think the reason we’re so high on vaccination rates is due to our partnership with MGH,” she said. “Having MGH right here in Chelsea and the MGH Clinic in Chelsea High School helps as well.”
Chelsea reports rates for only one school – the Silber Early Learning Center where kindergarten classes are held.
In Boston, many of its schools showed in the DPH survey to be far below the state averages and much lower than the believed thresholds for healthy “herd community” protections.
In Charlestown and the North End, for example, some rates were in the 60 percent range, and many were in the 70s.
However, a spokesperson for the Boston Public Schools (BPS) explained that actual rates are much higher.
She said the rates for 2013-2014 appear low because the district eliminated the job of the person who was charged with entering vaccination data. Without that job being filled, said the spokesperson, only part of the data was entered, resulting in what appears to be very low rates.
“For sure, that’s a large part of the pie,” said Denise Snyder of BPS. “We know we’re struggling to get the data into a database. I would say, for sure, we’re getting more students vaccinated than we have reported in our data.”
Snyder said Boston schools do mandate vaccinations at the time of registration.
Libaridian said parents need to get complete information before making the decision not to vaccinate. She said she welcomes questions from her patients about vaccinating their children. She said she respects those who choose not to do so, and just asks that anyone considering such a decision consult their pediatrician.
“There’s so much misinformation in the media that it can be very overwhelming for parents,” she said. “You get all kinds of information that isn’t correct. You also get celebrities saying things that aren’t true and what they’re saying is actually dangerous.”
Meanwhile, she said that she always makes a case for vaccination and believes that parents should believe in their safety.
“Vaccinations are very, very safe and effective,” she said. “Diseases we know are out there and this protects from serious illness and death. Measles can cause death…The risks are next to none. The risk of death for measles is 1-3 per 1,000. Why not prevent it? Even for other illnesses. I grew up in a time when kids got chickenpox. Kids don’t get chickenpox anymore because of the vaccine. It doesn’t have to happen.”