Vaccinations: Bane for Some, Benefit for Many

COURT HOUSE – When parents register their children for pre-school and kindergarten, one of the requirements is an updated immunization record. Many parents and most doctors think vaccinations outweigh the risks. For some parents, it’s not so black and white.
“We try to educate parents on the vaccine, the diseases it prevents and why it’s important to have your child vaccinated,” said Dr. James Petrucci, a pediatrician with Rainbow Pediatrics, which has offices in Cape May County. “Sometimes we have hesitancy by the parents, but we really try to work with them and provide education about the safety and effectiveness of vaccines.”
Outbreaks such as the measles outbreak which took place in Disneyland, Calif., earlier this year, receive much media attention, according to Petrucci, but follow up coverage doesn’t always match. “Some things you read are not always true, so it’s important to talk about the disease and the possible vaccine effects with your doctor.
“In order to protect against communicable diseases, we advocate parents vaccinate their children,” he added. “However, a parent does have the right to refuse vaccinations for their child for religious or medical reasons.”
Across New Jersey, the Department of Health reported that for the 2013-14 school year, about 9,000 students skipped vaccinations based on religious grounds, one of two reasons for receiving an exemption from the state requirement.
About 1,600 received exemptions based on medical reasons. Cape May County reported 90 students, or about 2 percent, received religious exemptions for the same period.
“Of 700 students, we have about 10 religious exemptions,” said Nancy Polt, school nurse at Middle Township Elementary No. 1. The school includes pre-kindergarten through second grade.
Registration for Middle Township Elementary No. 1 School took place May 4-8, and Polt said “we follow the law” when it comes to immunization requirements and exemptions. “The Center for Disease Control and Prevention (CDC) does not make these laws lightly. We also work closely with the county health department, such as reporting the number of flu cases, on a weekly basis.”
New Jersey’s immunization requirements are in accordance with the American Academy of Pediatricians (AAP), the American Academy of Family Physicians (AAFP) and the CDC/Advisory Committee on Immunization Practices (ACIP). The state establishes the minimum vaccine requirements – in this case, against communicable diseases – for childcare centers, pre-school and school entry and attendance. In some instances, the state’s requirements differ from the CDC/ACIP’s schedule.
Over her 20 years as a school nurse, Polt has seen many changes occur in the vaccination requirements and recommendations. “A couple of years ago, we saw an increase in requests for exemptions because the CDC required pre-schoolers to receive a flu shot. Many parents did not want to give their child the shot and doctors were not willing to give a medical exemption. So we saw an increase in requests for religious exemptions.”
Only medical and religious exemptions are recognized by New Jersey. According to the state Department of Health, medical exemptions must indicate a specific period of time in which the child can not receive a specific vaccine. Reasons for the specific situation that the vaccine can’t be used because it would be harmful to the patient must be enumerated by the ACIP and AAP. Although reviewed, they may not necessarily be updated annually. If the medical condition permits, the child must obtain the vaccine once the time period expires.
Religious exemptions, on the other hand, do not have to be updated yearly according to the state Department of Health. “Religious exemptions are not the same as philosophical, moral or conscientous exemptions,” according to the department’s website.
The request does not have to include the name of the religion. “The persons charged with implementing the rule should not question whether the parents’ professed religious statement or stated belief is reasonable, acceptable, sincere and bona fide,” according to the website. “In practice, if the written statement contains the word religion or religious, the statement should be accepted and the exemption granted.”
“Things died down a bit after we had a couple of bad flu seasons,” Polt added, referring to the increase in requests for immunization exemptions, “after parents saw how sick their children got with the flu.
“Sometimes we see a medical exemption for pertussis,” she noted, “but that’s usually because there were documented severe reactions.” (Pertussis is a contagious infection of the respiratory system characterized by a severe “whooping” cough. It’s one of the first vaccines given to a child.)
“We live in a small world, where traveling is so easy so we need to be sure kids are protected,” said Petrucci, a pediatrician since 2008. “Sometimes it’s a tricky discussion.”
The vaccination schedule, as endorsed by the CDC, AAP and AAFP, is designed to protect children according to Petrucci. Some vaccinations are required, while others are recommended.
“For example, we have more and more discussions about the vaccine for the human papilloma virus (HPV), which is designed for children from 9-26 years of age,” Petrucci said. “We start discussing it at yearly well checks early on as it is a recommended vaccine. We always have a discussion about it.
“Sometimes parents think that because they don’t see the disease anymore, there’s no need to be vaccinated against it,” he continued. “But the reason we don’t see it anymore is because we had the vaccination and we were able to control the disease.”
One of those diseases which has been virtually eliminated in the U.S. is polio. “Parents were scared of the polio epidemic that occurred each summer in the 1950s,” according to The Children’s Hospital of Philadelphia (CHOP) website. “Parents kept their children away from swimming pools, sent them to stay with relatives in the country and clamored for an understanding of the spread of polio. They waited for a vaccine, sending dimes to the White House to help the cause. When licensed in 1955, the country celebrated Jonas Salk, the vaccine inventor, as a hero.”
The polio virus destroys the nervous system, causing paralysis. According to the website, it is extremely rare in the U.S. because of the vaccine. However, it is common in other countries so the CHOP website states the polio vaccination is still recommended.
Vaccines are not an invention of modern medicine, as Edward Jenner invented a method to protect against smallpox in 1796. According to The CHOP website, “the method involved taking material from a blister of someone infected with cowpox and inoculating it into someone else’s skin, called arm-to-arm inoculation. By the late 1940s, scientific knowledge had developed enough so large-scale vaccine production was possible and disease control efforts could begin in earnest.”
The next routinely recommended vaccines were developed during the early 20th century. These included the vaccines to protect against pertussis (1914), diptheria (1926) and tetanus (1938). These three were combined in 1948 and given as a DPT vaccine.
Today, children could receive as many as 24 shots by the time they are two years of age, including five in one visit according to CHOP.
Many children do not have adverse reactions to a vaccination, beyond what Petrucci called “typical signs such as crankiness or a low-grade fever.”
Several people who responded to two Facebook requests by the Herald asking for people to “go on the record to tell their story” about whether children should be vaccinated before being allowed into school, told stories about their children having reactions to a vaccine, and/or obtaining a religious exemption. They were not, however, willing to go on their record with their names. Most of the 60 responses were along the lines that “students should not be allowed to attend school unvaccinated.”
“I have not broken any laws, I am practicing my legal right,” the Court House mother wrote in an email. “Perhaps you could include a paragraph explaining the fear that a parent has in regards to using a real name. Could you imagine how many of my son’s friends’ parents would refuse to allow him to sleep over at their homes based on an article in the newspaper? I will not do that to my son. I will not do that just because people choose to stay uneducated…It (telling my story using my real name) opens a personal can of worms that no family wants to ever see.”
According to Kevin Thomas, Cape May County Health Department public health coordinator, parents are counseled prior to their children receiving immunizations.
“Children’s clinics are done for well children monthly by appointment only,” he explained, “and the guardian or parent is pre-counseled on the general health of the child followed by a list of immunizations they are due according to their age and vaccination status. The parents are given Vaccine Information Statements on each of the vaccines ordered and they have the opportunity to ask both the nurse and/or physician questions about the vaccinations.”
For adults, Thomas said they would contact the Health Department to set up an appointment to be vaccinated on whatever vaccines they are seeking. They also receive a Vaccine Information Statement and are given the opportunity to ask questions.
“Parents and adults are informed and educated about the vaccines through the Vaccine Information Statement and through question-and-answer opportunities,” he stressed. “The patient waiting room also has many fact sheets and brochures on various vaccines.”
Influenza vaccines are started annually in the fall and the Health Department holds several clinics including the annual drive-through clinic. Information is provided through press releases about influenza and about the schedules of the clinics.
“We also receive calls from the public from time to time inquiring about vaccinations,” Thomas added. “The Health Department provides information and answers these questions.”
The Health Department encourages that people receive all recommended vaccines based on the Advisory Committee on Immunization Practices, which is a division of the CDC.
“We have concerns about students who are not vaccinated within the county,” Thomas said. “This poses a potential problem in an outbreak, for example. Those children unvaccinated may be susceptible, as well as other children who cannot receive vaccines, such as children receiving chemotherapy or having other immune system problems.”
By February 2015, according to the state Department of Health, more than 100 cases of measles had been diagnosed in the U.S., more than the number of cases diagnosed in 2012, and more than 2014, when more cases were diagnosed in the U.S. than in any other year in the past two decades.
If there is an outbreak of a communicable disease for which a child is not vaccinated, Polt said they will ask that the unvaccinated child stay out of school, in accordance with state law.
“Next year the requirements for a religious exemption are getting stricter,” Polt said. “You used to be able to just write a note about how the vaccinations impacted your beliefs. Next year, we have been notified that the state is becoming stricter, however, we are still waiting for the details.”
A bill that would make it more difficult for parents in New Jersey to cite religion as a reason for preventing their children from vaccinations cleared the second legislative committee in early March. The Assembly bill (A1931) would require parents to obtain a notarized letter explaining “the nature of the person’s religious tenet or practice that is implicated by the vaccination and how the administration of the vaccine would violate, contradict or otherwise be inconsistent with that tenet or practice.”
The statement also must show the tenet “is consistently held by the person,” and is not merely “an expression of that person’s political, sociological, philosophical or moral views, or concerns related to the safety of efficacy of the vaccination.”
Parents would also have to include in the statement they “understand the risks and benefits of the vaccination to the student and the public health and acknowledge the student may be excluded from attendance” by the state health commissioner in the event of an outbreak of a communicable disease, according to the bill.
If the bill is approved, schools would be prohibited from allowing an exemption unless these new requirements are followed.
To contact Karen Knight, email kknight@cmcherald.com.