Texas and other states that grant the parents of school-age children non-medical exemptions from vaccines are coming under scrutiny after this year’s measles outbreaks in the United States.
From Jan. 1 to June 6, 1,022 cases of measles were confirmed in 28 states, the greatest number of cases reported in the United States since 1992 and since measles was declared eliminated in 2000, according to the The Centers for Disease Control and Prevention. Of those cases, half occurred in an Orthodox Jewish community in Brooklyn, New York, where parents routinely opt out of vaccinations for their children because of religious beliefs.
In Texas and in 15 other states, parents can opt out of vaccinating their children for reasons of conscience or personal belief, including religious concerns. In all 50 states, children can be exempted from vaccinations for medical reasons, such as weakened immune systems or severe allergies.
New York legislators Thursday were set to overturn the exemption for religious beliefs in that state because of the Brooklyn outbreak. In California last year, a law allowing belief exemptions was abolished in response to an outbreak linked to Disneyland.
Unvaccinated children are especially at risk from measles, which can have very serious consequences, according to health officials.
One in every 20 children infected with measles gets pneumonia, the most common cause of death from measles in young children, according to the Mayo Clinic.
One in every 1,000 will develop encephalitis that can lead to convulsions that leave the child deaf or mentally impaired.
One or two of every 1,000 infected will die.
The concern is that with more non-medical exemptions allowed, lower overall vaccination rates could result in vaccine-preventable disease outbreaks, according to researchers at the Baylor College of Medicine.
In Galveston County, rates of kindergarteners entering school whose parents have opted out of vaccinations for non-medical reasons are generally on the increase, mirroring the state of Texas. Since the 2005-06 school year, rates of non-medical exemptions statewide have risen from 0.3 percent to 2.15 percent, according to data from the Texas Department of State Health Services.
In Galveston County, the Santa Fe Independent School District and the Clear Creek Independent School District have the highest non-medical exemption rates for kindergarteners with 3.95 percent and 2.58 percent.
Across Texas, 15 cases of measles have been reported in 2019 so far, six more than were reported in all of 2018. Five of those, reported early this year, were clustered in Harris, Montgomery and Galveston Counties.
The reasons for these increases can be explained by a number of factors, said Dr. Richard Rupp, professor of pediatrics at University of Texas Medical Branch and medical director of Teen Health Centers Inc. in Galveston Independent School District schools.
“If you think of kids not vaccinated as a group, you have to consider several things: kids not vaccinated for medical reasons, not a significant number; kids not vaccinated because their parents haven’t managed to get them vaccinated, probably the most significant number; and then you have people refusing to vaccinate for philosophical or religious reasons,” Rupp said. “The problem is that when you get enough of those together in one place, they can begin passing the disease.”
The problem of parents simply failing to get their children vaccinated can be dealt with at the school district level, Rupp said, and generally the stricter districts have the fewest unvaccinated students.
“Hitchcock, for example, has really been on top of it in the past,” Rupp said. Schools can regulate to some degree by being strict about not allowing children in schools without their shots, or being strict about time limits to get them.
The problem of non-medical exemptions for philosophical reasons is a tougher nut to crack, Rupp said. A battle back and forth between pro- and anti-vaccine people persists and exemptions to vaccination by parental choice continue to rise.
A popular anti-vaccine theory, that vaccines cause autism, has been disproven in multiple studies around the world, Rupp said. Another argument, that vaccines contain small amounts of damaging mercury as preservative, no longer applies because manufacturers have removed the questionable ingredient from their vaccines, he said.
“Now, the argument is that it’s a matter of personal choice,” Rupp said. “It’s about my kids, and I should have the right to choose. That’s the feeling among the vaccine community of where things have gone, and Americans are particularly sensitive about that. It’s fertile ground for them.”
Other factors figure in as well, such as the fact that a rising generation of physicians and young parents have never seen actual cases of the diseases children are vaccinated against.
“We don’t see kids get really sick any more with these diseases, and we don’t have a constant reminder that this is why we vaccinate,” Rupp said.
Parents who might be confused by the pro- and anti-vaccine debate and are vaccine hesitant sometimes go into one of his clinics for a conversation, Rupp said.
“They usually find it very reassuring, get their kids vaccinated and move on,” he said.
“It’s really up to parents. When they don’t vaccinate kids, they put other people’s kids at risk.”