By Paloma Esquivel and Sandra Poindexter
California parents are deciding against vaccinating their kindergarten-age children at twice the rate they did seven years ago, a fact public health experts said is contributing to the reemergence of measles across the state and may lead to outbreaks of other serious diseases.
The percentage of kindergartens in which at least 8 percent of students are not fully vaccinated because of personal beliefs has more than doubled, according to data on file with the state. That threshold is significant because communities must be immunized at a high rate to avoid widespread disease outbreaks. It is a concept known as herd immunity, and for measles and whooping cough at least 92 percent of kids need to be immune, experts say.
High vaccination levels in the U.S. have helped millions of children avoid serious diseases and saved tens of thousands a year from paralysis, birth defects and death, experts say. But the risk of infectious disease remains a concern. Recent measles cases, for example, were brought into the country by travelers and quickly spread to several unvaccinated individuals.
"Five days a week, (children are) in their small classroom," said Shannon Stokley, an epidemiologist at the National Center for Immunization and Respiratory Diseases, part of the Centers for Disease Control and Prevention. "That's the perfect conditions for spreading germs and spreading infections."
State law requires kindergartners to be vaccinated against measles, pertussis (whooping cough), polio, mumps, rubella, hepatitis B, chicken pox, diphtheria and tetanus.
Parents who say immunization is against their personal beliefs can get exemptions. Some opt out of all the mandatory shots, while others allow students to get select vaccinations. There are also temporary and medical exemptions.
That makes exact vaccination rates hard to assess. But the upward trend in belief exemptions is troubling to health experts. California is coping with a whooping cough epidemic and earlier this year experienced a cluster of measles outbreaks, in part because of insufficient vaccination.
The anti-vaccination movement is driven by parents who question the medical consensus that inoculations are safe. Some are concerned that vaccines could trigger autism _ a notion that has been thoroughly discredited by scientists.
Holly Blumhardt, a mother of three unvaccinated children (two of them attend Orange County public school), said her family believes in staying healthy "from the inside out." In her view, that means taking vitamin and mineral supplements, steering clear of genetically modified foods, getting regular chiropractic care and maintaining an "active lifestyle." "Most parents want to do the ... healthiest thing for their child," Blumhardt said. "It should be their choice."
An analysis of the state figures found that the growth in personal-belief exemptions was particularly prevalent at private schools: Nearly 1 in 4 of those kindergartens reported at least 8 percent of their students were exempt from at least one vaccine last fall because of personal belief. In 2007, that figure was just 1 in 10. The rate for public school kindergartners last fall also more than doubled, to 11 percent from 5 percent in 2007.
Overall, the rate of personal belief exemptions at California kindergartens with at least 10 students doubled to 3.1 percent last fall from 1.5 percent in 2007.
"I'm 65. I was born right on the edge of the polio epidemic," said Thomas Kaut, administrator at Montessori Children's House of Shady Oaks in Redding, a private school where 40 percent of kindergartners had non-medical waivers. "I still feel like it's a no-brainer. Some of these parents don't understand the severity of these diseases."
However, he said, the parents who choose his school are attracted to an alternative style of education, "so it makes sense that they might have different views about health."
Tammy Murphy, superintendent of the Montecito Union School District in Santa Barbara, said she tries to respect parents' decisions, while remaining mindful of risks to the school community.
"I don't think they make this decision out of a place of ignorance. It's one they've thought about deeply," said Murphy, whose district kindergartners had a 27.5 percent belief exemption rate last fall.
"They're reading all about this and making what they feel is the best-informed decision they can for their child."
At Santa Cruz Montessori in the small coastal community of Aptos, about 7 percent of kindergartners in 2007 got belief exemptions. Last fall, that rate was 22.6 percent.
Principal Kathy Rideout said the school has tried different approaches to encourage parents to immunize children. They asked a doctor to talk with fellow parents. They produced handouts emphasizing the importance of immunizations and asked parents seeking belief exemptions to get counseling from a health-care practitioner. A state law that went into effect this year made that a requirement.
But none of it made much difference, Rideout said. On average, about 13 percent of kindergartners had exemptions in the last five school years.
"My concern is not only for the health of the students here but also for the families that are members of the community," Rideout said. "We know that it can be very dangerous for pregnant women and young infants" who have not been immunized to visit the school. It could also be a problem if students at the school are not vaccinated for medical reasons.
Those who support the rights of parents to opt out, individual concerns trump community risk.
"It's only ethical for a person to decide what risk they are willing to take with their body," said Dawn Richardson of the National Vaccine Information Center, which argues for the right of parents to decide. The American Academy of Pediatrics, however, has said the group promotes unscientific approaches to vaccines. "No one group should demand that another group take a risk to benefit them, that's where it crosses the line," Richardson said.
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