Anti-vaccine movement grows in many states

ATLANTA — A rising number of parents in more than half of states are opting out of school shots for their kids. And in eight states, more than 1 in 20 public school kindergartners do not get all the vaccines required for attendance, an Associated Press analysis found.

That has health officials worried about possible new outbreaks of diseases that were all but stamped out.

The AP analysis found that more than half of states have seen at least a slight rise in the rate of exemptions over the past five years. States with the highest exemption rates are in the West and Upper Midwest and include Washington.

It’s “really gotten much worse,” said Mary Selecky, secretary of health for Washington state, where 6 percent of public school parents have opted out.

Rules for exemptions vary by state and can include medical, religious or philosophical reasons.

Parents’ reasons for skipping the shots vary. Some doubt that vaccines are essential. Others fear that vaccines carry their own risks. And some find it easier to check a box opting out than to get the shots.

Still others are ambivalent, believing in older vaccines but questioning newer shots against, say, chickenpox.

The number of shots is also giving some parents pause. By the time most children are 6, they will have been stuck with a needle about two dozen times – with many of those shots given in infancy. The cumulative effect of all those shots has not been studied enough, some parents say.

“Many of the vaccines are unnecessary, and public health officials don’t honestly know” the effects of giving so many vaccines to such small children, said Jennifer Margulis, a mother of four and parenting book author in Ashland, Ore., which has unusually high vaccination exemption rates.

But few serious problems have turned up over years of vaccinations, and several studies have shown no link between vaccines and autism, a theory from the 1990s that has been widely discredited.

To be sure, childhood vaccination rates remain high overall, at 90 percent or better for several vaccines, including those for polio, measles, hepatitis B and chickenpox. In many states, exemptions are filed for fewer than 1 percent of children entering school for the first time.

Health officials have not identified an exemption threshold that would likely lead to outbreaks. But they worry when some states have exemption rates beyond 5 percent. The average state exemption rate has been estimated at less than half that.

Even more troubling are pockets in some states where exemption rates are much higher. In some rural counties in northeast Washington, for example, vaccination exemption rates in recent years have been above 20 percent and even as high as 50 percent.

“Vaccine refusers tend to cluster,” said Saad Omer, an Emory University epidemiologist who has done extensive research on the issue.

Parents who let their kids skip some vaccines put others at risk, health officials say. Because no vaccine is completely effective, if an outbreak begins in an unvaccinated group of children, a vaccinated child may still be at some risk of getting sick.

Studies have found that measles has suddenly re-emerged in some communities with higher exemption rates. Vaccinated kids are sometimes among the cases, or children too young to be vaccinated.

And measles isn’t the only risk. Last year, California had more than 2,100 whooping cough cases, and 10 infants died. Only one had received a first dose of vaccine.

“Your child’s risk of getting disease depends on what your neighbors do,” Omer said.

While it seems unlikely that diseases like polio and diphtheria could make a comeback in the U.S., immunization expert Dr. Lance Rodewald says it’s not impossible.

“Polio can come back. China was polio-free for two decades, and just this year, they were infected from Pakistan. And there is a big outbreak of polio in China now. The same could happen here,” Rodewald, of the federal Centers for Disease Control and Prevention, said in an email.

Commonly required vaccines Most people don’t think about polio and diphtheria these days v those diseases have been stamped out in the United States, largely because of vaccines.

But a growing number of parents are seeking exemptions so their children don’t have to get those vaccinations and others required by most states for kids to attend school.

Here’s a rundown of the diseases the most commonly required vaccines help prevent:

 • Polio, a paralyzing, sometimes deadly disease once seen in terrifying outbreaks, now occurring in only a few developing countries.

 • Measles, a once-common illness that causes a rash and in rare cases can be fatal. In recent years, fewer than 100 cases were seen, but that number has at least doubled this year in the U.S.

 • Mumps, a usually mild disease known for swelling the salivary glands, sometimes leading to more severe complications such as deafness or miscarriage. Nearly 2,500 cases were reported last year.

 • Rubella, or German measles, causes a rash but can trigger birth defects if acquired by a pregnant woman. Only a handful of cases are reported in the U.S. each year.

 • Pertussis, or whooping cough, a highly contagious disease that can cause violent coughing in children. Nearly 20,000 cases were reported in 2010, an unusually bad year with several infant deaths.

 • Tetanus, or lockjaw, can cause tightening of the muscles that prevents a victim from swallowing. Only a couple dozen cases have been seen in the U.S. in recent years.

 • Diphtheria, a bacterial illness that can lead to neck swelling and even death. Kids are at the greatest risk, but no confirmed case has been reported in the U.S. since 2003.

 • Hepatitis B, a viral infection that attacks the liver and can lead to liver failure or death. About 2,700 cases were reported last year.