Mississippi is not exactly one of the USA’s highest ranked states for health issues. The state ranks 47th in public health. It ranks 47th in smoking. It ranks 47th in health care quality. At least it’s consistent! Other surveys put Mississippi dead last in healthcare qualitative measurements. Ironically, there’s one health care issue where the state does well – the lack of a Mississippi vaccine exemption for religion has been critical to the state having the highest vaccine uptake rate in the country.
This anomaly has got to be one of the most interesting stories in the vaccine world – the state’s vaccine uptake rates (see Note 1) for MMR (for measles, mumps and rubella), DTaP (for diphtheria, tetanus and whooping cough), and varicella (chickenpox) vaccines exceed 99.4%. This number far is far beyond the level necessary for the herd effect to protect all individuals in an area. All thanks to a lack of a Mississippi vaccine exemption for religious beliefs.
The high vaccine uptake rate breaks the irony meter for one other reason – Mississippi is one of the country’s most religious states. And the fact that the state does not allow religious exemptions for vaccination of young children seems like it is out of character for the state. Mississippi is one of only three states that disallow religious exemptions to vaccines (California and West Virginia being the other two). And the Mississippi vaccine exemption rules rely upon a simple piece of jurisprudence – parental duties trump parental rights.
As a result of this important concept, Mississippi vaccine exemption rules do not allow for a religious exemption. I know, it is difficult to wrap your mind around Mississippi in this story. But let’s find out why the state has led the way on stopping religious exemptions.
Continue reading “Mississippi vaccine exemption – no religion allowed”
During an address to Parliament on Tuesday, Édouard Philippe, who serves as prime minister under new liberal president Emmanuel Macron, stated that starting next year, France mandates vaccines for all children. It will mandate vaccines for young children that are unanimously recommended by health authorities starting next year.
Three vaccines, for diphtheria, tetanus and poliomyelitis, are already mandatory in France. Vaccines that would become compulsory under the new law would be pertussis, measles, mumps, and rubella (MMR) , hepatitis B, Haemophilus influenzae bacteria, pneumococcus and meningococcus C.
Phillipe said, in his speech, that “children are still dying of measles. In the homeland of [Louis] Pasteur that is not admissible.” Legendary scientist Pasteur is one of the founders of the field of bacteriology and invented vaccines for anthrax and rabies. Continue reading “France mandates vaccines – saving children from diseases”
One of the most successful pieces of vaccine legislation in recent years has been SB277 in California, which eliminated personal belief exemptions (PBE), that allowed a parent to exclude a child from immunization requirements for school based on the parent’s personal beliefs, including religious objections. These PBEs had been used and abused by anti-vaccine parents to exempt their school-aged children from most, if not all, vaccines.
Other than California, only West Virginia and Mississippi have such strict prohibitions on these PBEs that they are effectively not allowed as a method to refuse vaccines before a child enters school. But many other states are considering vaccine legislation that could improve vaccine uptake. Unfortunately, there are also states on the other side of the equation that are considering laws that reduce restrictions on personal belief exemptions.
The National Vaccine Information Center (NVIC), which seems to conflate “information” with misinformation about vaccines, claims that there are 134 vaccine bills being considered in 35 states. I wish!
I thought we would could take a look at current vaccine legislation being considered by various states that could potentially increase vaccine uptake in those states. Then we’ll take a look at those states pushing legislation that might decrease vaccine uptake. This should provide real information about what’s going on with these laws, instead of the alternative facts from the vaccine deniers at NVIC.
Continue reading “Vaccine legislation in the USA – a state by state analysis”
California SB277 makes immunization mandatory for children attending schools in the state by removing personal belief exemptions for vaccination. These personal belief exemptions were abused by parents in pockets of California, causing immunization rates in some communities to fall precipitously. California SB277 should correct that abuse. The new vaccine requirements should increase the vaccination rate, as long as someone doesn’t find some loophole to abuse the system, because anti-vaccine parents tend to be a resourceful group.
California joined two other states, West Virginia and Mississippi, with the most stringent requirements for vaccination for children before they can enter school. West Virginia State Law does not allow for non-medical exemptions to immunization requirements. Mississippi only allows medical exemptions (as does California), which allows parents to request an exemption for their child if there is a medical condition that contraindicates a vaccine. All three states require physician certification of medical exemptions.
Interestingly, West Virginia legislators strengthened vaccination laws in 2015 by extending vaccination requirements to preschoolers. And it created the position of state Immunization Officer, who is responsible for ruling on the validity of requested medical exemptions in an unbiased manner. Maybe California could implement such a position.
The results of these strict enforcement of exemptions are significant reduction in incidence of diseases. For example, Mississippi has not had a case of measles since 1992, and West Virginia since 2009. On the other hand, there was a relatively large measles outbreak at Disneyland in 2015, where 134 individuals (mostly Californians, though residents of six other states and two countries) were infected with the disease.
The drop in disease rates in California will be much more apparent in California, which has 9 million children in school, compared to 737 thousand in Mississippi and 382 thousand in West Virginia. Diseases like chickenpox and measles are highly infectious, so high immunization rates should block any spread of the disease
California SB277 became effective on July 1, 2016, so this is the first school year where the mandatory vaccine requirements were in place. Unfortunately, because of that prior abuse of personal belief exemptions in California, there are still communities at risk for vaccine preventable diseases.
A measles outbreak in the Orthodox Jewish community in parts of Los Angeles struck 20 individuals. And when county health officers started tracking down the 2000 people who were in contact with measles patients, they found that over 10% of them were not vaccinated.
A recent mumps outbreak in Los Angeles has stricken seven adult males who lacked vaccination to the disease (usually from the MMR vaccine). And last month, there was an outbreak of mumps amongst college students in Southern California. Hopefully, as we increase the vaccine uptake in California, the risk of these type of outbreaks will become lower and lower.
Unfortunately, there is a loophole (I told you) in the California SB277 – the medical exemption only requires a letter from a physician, and it’s not further scrutinized as is done in West Virginia. And because there are numerous anti-vaccine doctors who ignore real science for their beliefs, there appears to be a growing cottage industry forming to make medical exemptions somewhat easily available.
According to the garrulous Orac, it seems that medical exemptions are for sale. Orac mentions a Dr. Tara Zandvliet, who charges $120 per child for medical exemptions for vaccines. She describes what constitutes a valid, in her opinion, medical exemption for vaccines:
Hyper immune conditions
Including, but not limited to:
- Allergies to food, bee stings, medicines that include hives/swelling/wheezing (hay fever does not count)
Including, but not limited to:
- Ulcerative Colitis
- Mixed connective tissue
- Hashimoto or Graves thyroid (not regular low thyroid)
- Antiphospholipid antibody
- Multiple Sclerosis
- Rheumatoid arthritis (not old age or overuse arthritis)
- Type 1 diabetes (child type)
- Eosinophilic esophagitis
- Documented autoimmune only – not suspected autoimmune such as fibromyalgia, chronic fatigue, Lyme or endometriosis. Those will not qualify.
Including, but not limited to:
- Multiple myeloma
Including, but not limited to:
- Documented diseases only. Not “getting sick a lot”.
Genetic conditions associated with worse outcomes
- Studies are still pending, but include MTHFR, Some HLA subtypes.
- Vaccine reactions must be related to the vaccine within about a week, and must be immediate and not caused by anything else. These reactions include but are not limited to:
- Leg swelling causing hospitalization
- Difficulty breathing
- Encephalitis, including high-pitched cry and developmental regression
- Severe lethargy
- Fevers over 103
- Bad reactions do NOT include fevers under 103, sore leg, cranky, getting sick a lot after, getting asthma after, having allergies after vaccination.
This is a ridiculous list. Children with type 1 diabetes, for example, are more susceptible to and more at risk of complications from vaccine preventable diseases. If Dr. Zandvliet had any idea about diabetes, she would be strongly recommending vaccines for those children. Ironically, the only treatment for type 1 diabetes is 3-4 times daily injections of insulin, whose package insert (pdf) would make any anti-vaxxer faint – vaccines should be a walk in the park for any child with diabetes. And should be required.
Dr. Zandvliet also states that MTHFR gene mutation is a risk factor for vaccines. But that’s simply not true, and no reliable source says that this gene mutation is a serious contraindication for vaccines.
Furthermore, her list of vaccine reactions actually may or may not be related to vaccines. The whole list is dependent upon parental memory and post hoc logical fallacies.
Finally, as Orac points out, the actual list of real contraindications for vaccines is rather limited – severe allergic reaction to the vaccine or its components, which will be obvious to anyone, is the major one. But I suppose, to get the vaccine medical exemption, people will try to make that claim. And because California relies upon the word of the physician rather than an independent, unbiased party, like West Virginia’s Immunization officer, there will be no way to dismiss this problem.
But there is some good news. Late last year, the California Medical Board started actions to pull the license of Dr. Robert Sears, a notorious anti-vaccine physician, who wrote a medical exemption for a 2 year old child. In a post in CityWatch, Bob Gelfand wrote:
The charges against Sears cannot help but create a stultifying effect on pediatricians who have been merchandising themselves as anti-vaccine practitioners, and on those who have been considering doing so. They are all thinking things through very carefully at the moment. The upside to writing slightly spurious vaccine exemptions is to build one’s medical practice and to gain the gratitude of anti-vaccine parents. The downside is the possible loss of one’s career.
By the way, continuing a narrative that bothers me about the anti-vaccine movement, it feels like only white privileged types are going to be able to get these “for sale” medical exemptions. Dr. Sears practices in a swanky part of Southern California, and caters to wealthy parents. Of course, Dr. Zandvliet charges $120 for her “services” in providing medical exemptions. I’ve seen numerous other “ads” from physicians in the expensive areas of California saying that they’ll consider writing medical exemptions for children.
The problem with this industry is that it has a negative impact on the California SB277 – the law may not be as effective as we want, although I’ve got a feeling that a lot of people who used personal belief exemptions are not going to be bothered by trying to find a pediatrician to write an exemption, once their own physician says, “NO!”
As long as California SB277 increases the uptake rate for childhood vaccines, despite the exemption industry, the overall effect should be strongly positive. But we all await data from California on the exemption rate and vaccination rate – as I always say, it’s the evidence that matters, and hopefully we’ll get some good evidence soon.
The California vaccine exemption bill – SB 277, which essentially eliminates all vaccine personal belief exemptions for children to be vaccines prior to attending schools in the state – was signed into law today by Governor Jerry Brown (D).
The SB 277 vaccine exemption bill was sponsored by California Senator Richard Pan MD and by Ben Allen, of Santa Monica. The bill was introduced after a outbreak of measles in December at Disneyland sickened 136 Californians. It passed quickly through both houses of the California Legislature.
The law applies to students attending any public or private school in the state, so parents who choose not to vaccinate children for non-medical reasons would need to make other arrangements for their child’s education. Now, only valid medical exemptions, such as known allergies and other medical conditions, approved by a physician, will be allowed an exemption to vaccination.
Governor Brown also reiterated, while signing the bill, that “while requiring that school children be vaccinated, the law explicitly provides an exception when a physician believes that circumstances – in the judgment and sound discretion of the physician – so warrant.”
There is some evidence that the medical exemption has been abused by parents who do not want their children vaccinated with cooperation of like minded physicians. This does worry me, since there are pediatricians who “advertise” their services in signing these forms.
Notwithstanding my concern, this makes California one of the three toughest states for vaccinations, along with Mississippi and West Virginia. And that is good news indeed.
Recently, there have been a few peer-reviewed articles published analyzing the effects of non-medical vaccines exemptions. There are usually two types of non-medical exemptions, philosophical, where the parents just don’t like vaccines because they’ve bought into the pseudoscience of vaccine denialism, or religious, where they use the cover of fake religions (only one tiny mainstream religion is opposed to vaccinations) to deny the huge health benefits of vaccinating their children. I reviewed one article that described that as a result of these exemptions, rates have increased quickly in whooping cough infections, is non-trivial disease. According to the Centers for Disease Control and Prevention, pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die.
Inconvenience (that is, the parents can’t be bothered to get their children immunized), bogus religious beliefs, and increased concerns, based on little actual evidence, about the risks of vaccination, are leading more US parents to refuse to vaccinate their children. A recent article, which investigated the rates of vaccination by state (while analyzing the ease of obtaining non-medical exemptions), showed that parents are increasingly able to refuse vaccination in states that have relatively simple procedures for immunization exemption. Some states, fearing a public health crisis, have responded by putting in place more burdensome procedures for parents of school-aged children to opt-out. Continue reading “Easy vaccine exemption rules lead to lower vaccination rates–shocking”
West Virginia isn’t frequently lumped together with the more progressive states in the country. But sometimes, there are surprises.
I admit that I keep up with all kinds of news articles dealing with vaccines and vaccinations; especially since the new health care reform tax credit was enacted. I read about new vaccines in development. I read about new vaccine technologies that might prevent autoimmune diseases, like Type 1 diabetes. And I read articles about vaccinations from community newspapers, like this story in a local West Virginia newspaper, where I’m reminded of how advanced West Virginia is, at least with respect to vaccines:
Beginning last year, and continuing every year after, older students entering the seventh and twelfth grade will have shot requirements that must be met before the start of the school year.
Seventh and twelfth grade students will not be allowed to attend school this fall without proof of these immunizations. It is important that once you receive the vaccines and the providers update your immunization record, that the school nurse is sent a copy of the vaccines for their records.
The Mason County Health Department recently sent out a reminder that seventh grade students must show proof of a booster dose of Tdap (tetanus, diphtheria, pertussis) vaccine and one dose of meningococcal/meningitis vaccine. Twelfth grade students also must show proof of a dose of Tdap (ususally obtained at age 11-12 years) plus at least one dose of meningococcal/meningitis vaccine after the age of 16 years. If the student received a meningococcal vaccine prior to the age of 16, a second meningococcal vaccine will be required for the twelfth grade. Continue reading “West Virginia occasionally gets it right”
The state of West Virginia (WV) has one of the toughest child vaccination regulations in the United States, not allowing any religious exemptions to vaccinations required before attending school. Only Mississippi has regulations this strict for allowable exemptions. Of course, as I have written, religious exemptions have been abused by vaccine deniers by creating “fake” religions so that parents’ antivaccination beliefs will be recognized by the state. In fact, only medical exemptions are accepted by the state (pdf), and their standards on who can meet the medical exemption are quite tough.
Continue reading “West Virginia tough on vaccine exemptions”
The Vermont Senate just passed a bill that will end the so-called “philosophical exemption” from requirements for students to receive vaccines before attending public schools. This exemption is used by the anti-vaccine lunatics to allow their children to attend schools without having the standard courses of vaccinations. Of course, these philosophical objections are almost always based on pseudoscientific beliefs rather than evidence. Continue reading “Vermont Senate passes bill to end philosophical exemptions from vaccinations”
In a report in Vaccine NewsDaily, seven states mulling legislation to skip mandatory immunizations, which would allow parents a “philosophical exemption” to mandatory vaccinations. In other words, this legislation would allow parents who listen to the anti-vaccination lunatics to refuse vaccines that prevent harm to their children, but worse yet harm to others who may not be immune to these infections.
[pullquote]measles cases in the nonexempt population increases significantly when exposed to an exemptor group[/pullquote] Continue reading “Seven states mulling legislation to skip mandatory immunizations”