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News, Health, Opinion, Government

On Gratuitous Sentence & The Public Health?

Thomas B. Elias, Columnist
Santa Monica Mirror Archives
Thomas B. Elias, Columnist

Posted Nov. 24, 2013, 6:46 am

Tom Elias / Mirror Columnist

Imagine a California where polio becomes a threat to children’s health again, as it was before the 1950s, when first the Salk vaccine and later the even more effective Sabin formula threw this dreaded and crippling disease into dormancy.

Or a California where dozens of kids die every year from pertussis, better known as whooping cough for the gasping “whoop” afflicted children often make after coughing. And more.

There’s a possibility – slim, but still there – that a single sentence in one of Gov. Jerry Brown’s signing messages on an unpublicized 2012 law could open these kinds of Pandora’s boxes, at least for children of parents who want to avoid vaccinating them.

The law, passed as Assembly Bill 2109, was intended to do the reverse. It requires documentation when the value of vaccinations to children and the community at large is explained to parents or guardians not planning to vaccinate their kids. It reiterates previous rules requiring persons opting out due to religious belief to get a signed statement from a doctor, nurse or physician’s assistant saying they’ve been told the benefits of vaccination. And it says parents must file one written statement of their beliefs and another attesting to receipt of information about vaccination.

The idea was to improve vaccination rates and benefits by making doubly sure everyone is fully informed. But Brown stuck one wild-card sentence into his signing message, where no signing message was required.

“I will direct the Department (of Public Health) to allow for a separate religious exemption on the form,” he said, adding that “in this way, people whose religious beliefs preclude vaccinations will not be required to seek a health practitioner’s signature.”

Brown, thus, ordered a weaker approach than mandated by the law he had just signed. The Department of Public Health issued a new exemption form embodying this in October.

From now on, any parent or guardian who doesn’t feel like getting his or her child vaccinated for polio, diphtheria, measles, rubella, mumps or pertussis has an easy out. A box on the new form even lets parents claim their religion precludes seeking medical advice.

The vaccinations are normally required to register kids in various levels of public school, with pertussis shots before seventh grade coming at the most advanced age on the list.

It’s a lot easier to check off a box than it would be to follow even the old rules, which the 2012 law aimed to beef up.

That box on the new form stunned some health advocates, since it is neither mentioned nor authorized by law or regulation. It led to speculation about why Brown ordered that “separate religious exemption” on the new form.

Diana Dooley, state Health and Human Services secretary, asserted the governor’s order “does not countermand the law.” She refused to explain how that can be, when the law provides for no easy out like Brown ordered.

Added another Brown spokesman, “The governor believes that vaccinations are profoundly important and a major public health benefit. This law is intended to strongly encourage people to take full advantage of vaccinations. We've also taken into account fundamental First Amendment religious freedoms through an extremely narrow exemption.”

It all spurs fear in public health advocates mindful of the fact that California has seen thousands of whooping cough cases over the last few years, more than 9,000 in 2010 alone. In that year, 10 children died from the disease, but strong vaccination drives in the next two years reduced later tolls. Who knows what could happen with the easy exemption Brown calls “narrow?”

What’s known is that a Johns Hopkins University study found the heaviest concentrations of 2010 pertussis cases came where the most religious exemptions were filed. (http://pediatrics.aappublications.org/content/early/2013/09/24/peds.2013-0878.abstract)

Which means that barriers to parents and guardians opting their charges out strictly for convenience really do aid public health.

It will be some time before anyone can assess the effects of the new form and its dicey box, but one thing for sure: The state will now do less than it has for decades to suppress pernicious diseases that formerly caused huge health problems.

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Comments

Nov. 26, 2013, 7:59:34 pm

Stephanie Ettner said...

Whooping cough vaccine may not halt spread of illness Mike Stobbe , The Associated Press Nov. 25, 2013 at 5:41 PM ET The whooping cough vaccine may keep people from getting sick, but it doesn't prevent them from spreading the illness to others, research suggests. A government study offers a new theory on why the whooping cough vaccine doesn't seem to be working as well as expected. The research suggests that while the vaccine may keep people from getting sick, it doesn't prevent them from spreading whooping cough — also known as pertussis — to others. "It could explain the increase in pertussis that we're seeing in the U.S.," said one of the researchers, Tod Merkel of the Food and Drug Administration. Whooping cough is a highly contagious disease that can strike people of any age but is most dangerous to children. It was once common, causing hundreds of thousands of illnesses annually and thousands of deaths. But after a vaccine was introduced in the 1940s, cases dropped to fewer than 5,000 a year. The vaccine was replaced in the 1990s because of side effects that included pain and swelling from the shot and fever. The newer vaccine is part of routine childhood vaccinations as well as adult booster shots. But cases have rebounded. Last year was the nation's worst year for whooping cough in six decades — U.S. health officials received reports of more than 48,000 cases, including 18 deaths. This year hasn't been half as bad — about 20,000 reported illnesses, including six deaths so far. Whooping cough ebbs and flows in cycles, so experts aren't surprised to see cases recede. But 20,000 can still be seen as a lot when a widely used vaccine is supposed to protect the public. Some studies have concluded the newer vaccine doesn't last as long as the old one. But the study by Merkel and his colleagues offers a new wrinkle. Their research used baboons, considered the most human-like model for studying whooping cough. Baboons at ages 2, 4 and 6 months were vaccinated and then exposed to whooping cough at 7 months — when vaccine protection would be new and strong. The baboons didn't get sick, but they had high levels of bacteria in their respiratory system for five weeks — which suggest they were contagious for about that long. Some baboons given the old vaccine had low levels after only two weeks. That's a big deal finding because it was thought that people only spread the disease when they had coughs and other symptoms, said Dr. Erik Hewlett, a University of Virginia whooping cough researcher who was not involved in the FDA study but has collaborated with Merkel. Health officials have sought to protect small children by vaccinating the people who are in contact with them such as grandparents and baby sitters — a strategy called "cocooning." But that may not work as well as hoped if infected people who don't show any symptoms can still spread it, the research suggests. "This is a whole new way of thinking of the problem," Hewlett said. Still, cocooning is better than nothing. An infected person with a cough is probably spreading more germs that someone who spreads it through talking or exhaling, said the FDA's Merkel. The study was published Monday in the journal Proceedings of the National Academy of Sciences. Versions of the vaccine are made by two companies — Sanofi Pasteur and GlaxoSmithKline. A GSK spokesman said the company didn't have enough information on the study to comment. Sanofi said in a statement that it's not clear how well the findings translate to humans, and that many factors may contribute to recent surges in whooping cough. It also said the research contains "valuable information" and points to areas for further study. © 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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