Living Without Vaccinations

By Dorsey Griffith
Sacramento Bee Medical Writer
Sunday, Dec. 2, 2001

They are as lively and rosy-cheeked as any 5- and 6-year-old girls, their long, blond hair gleaming in the sun as they swing upside down from the monkey bars at the playground.

But Skyla and Iris Foxfoot are not like most 5- and 6-year-olds in America.  The Nevada County children have not been immunized against childhood diseases such as measles, chicken pox and haemophilus meningitis.  "I think they are healthier for it," said their mother, Cindy Foxfoot, a licensed midwife. "I think their immune systems are stronger for it."

Foxfoot and her husband are among a relatively large number of parents in rural Nevada County who, based on personal beliefs, have chosen to exempt their children from vaccinations otherwise required by state law.  In California, people can exercise that option simply by signing the back of a school immunization record.

Last year, California had its highest rate of "personal beliefs exemptions" in 20 years, at just more than three-quarters of a percent of all entering kindergartners, or about 4,000 children.  Even so, Nevada County stands out.  Last year, the Sierra foothills county had the highest rate of exempted kindergartners and the second-highest rate of exempted seventh-graders in California.  More than 6 percent, or 54 out of 848 kindergartners, were exempted, and more than 11 percent, or 126 out of 1,130 seventh-graders.  Statewide, just over 1 percent of seventh-graders were exempt last year.

Nevada County's exemption rates are unusual even among the state's rural counties.  Tehama County, which has nearly the same number of entering kindergartners, had a 1.3 percent exemption rate last year; Yuba, with just over 1,000 entering kindergartners, had a 1 percent rate.

According to many in Nevada County, the difference has a lot to do with the character of the place and its people. Many residents have adopted "holistic" lifestyles, educating their children at home, eating organic foods and preferring natural remedies to pharmaceuticals for what ails them.

"To me, (worrying about these diseases) is not what life is about," said the mother of a 2-year-old boy who has not had his shots, "because I have the knowledge of using herbs, I live in a community where alternative health is supported, and I have a close group of other parents who don't vaccinate."

Since the beginning of the last century, vaccinating children against potentially deadly or disabling diseases has been a widely accepted medical practice.  The eradication of smallpox through worldwide vaccination campaigns is hailed as one of the greatest public health triumphs of the last century.  The polio vaccine, introduced in 1962, is claimed to have eliminated the disease from the Western Hemisphere.

But in recent years, vaccinations once considered routine have come under attack, mainly from parent groups.  The trend stems, in part, from a growing interest in holistic medicine.  But with so many diseases under control, some parents also feel freer to weigh the potentially dangerous side effects vaccines can pose.  "Because of our success in immunizations, we have lost our memory of how bad these diseases really are," said Dr. Natalie Smith, chief of the immunization branch of the state Department of Health Services.

Californians have been able to opt out of childhood vaccination programs since the early 1970s.  California is among 22 states that offer personal-belief or religious exemptions in addition to medical exemptions.

Efforts to establish exemption programs in New Jersey and Texas were defeated in recent years.  In Iowa, on the other hand, the state Legislature recently killed an attempt by health officials to end religious exemptions.

Perhaps the most high-profile debate involving vaccines stems from suspicions linking measles, mumps and rubella vaccine to autism.  Many parents of autistic children say their children seemed normal until soon after the first inoculation, typically given between 12 and 18 months of age.

Last year, Congress' Committee on Government Reform held lengthy hearings to explore the possible link.  The committee chairman, Congressman Dan Burton, R-Ind., told the story of his own grandson who was diagnosed with autism soon after getting immunized, and called for more research.  Because of increasing concerns, the federal government has asked the National Institute of Medicine to set up a committee to analyze theories about immunization safety concerns.

Meanwhile, the 20-year-old National Vaccine Information Center, a parent-led safety organization, has called for a congressional investigation into the nation's mass vaccination program.  They argue that not enough is known about the potential harm vaccines may cause to justify routine immunization of every child.

"We believe the one-size-fits-all approach does not acknowledge biodiversity," said Barbara Loe Fisher, co-founder and president of the center.  The center played a role in the Food and Drug Administration decision in 1996 to develop a safer vaccine against pertussis, or whooping cough.

Over time, concerns have been raised about possible links between
inoculations and a range of conditions, including juvenile diabetes, asthma, attention deficit disorder, and sudden infant death syndrome.

Medical experts say there is no firm evidence to support such claims.  They say all vaccines carry some risks, but only for a fraction of the population.  According to the federal Centers for Disease Control and Prevention, for example, serious allergic reactions that can result in brain damage occur in fewer than one in 1 million children who get the diphtheria, tetanus and pertussis vaccine, and the measles, mumps and rubella vaccine.

Dr. Bruce Gellin, executive director of the National Network for Immunization Information, an organization that promotes vaccination education, said vaccines today are safer than ever.  "We have the best system in the world to assure they are as safe as they can absolutely be," he said.  "But no medical product is 100 percent safe."

Gellin points out that the dangers posed by vaccine-preventable diseases are much higher than the risks posed by the vaccines. Measles, for example, kills one in 500 children.  One in 1,000 will get encephalitis from measles.  Beyond concerns about safety, many parents believe the relatively new immunizations against diseases such as chicken pox and hepatitis B are unnecessary for young children:  They survived chicken pox, they figure, so why wouldn't their children?  And they argue that small children are hardly at risk for hepatitis B, which is spread through sexual contact and injection drug use.

"Parents want to have choices," Fisher said.  What troubles disease-prevention experts about the trend is the potential erosion of what is known as herd immunity, in which immunized kids serve as a protective barrier for kids who aren't.

Smith calls it the "free-rider effect," and says herd immunity only works to prevent outbreaks when enough children are fully immunized.  Children who haven't had their shots are more likely to get sick themselves, and spread infectious diseases to infants and other children who haven't been immunized.  They also pose a threat to adults and children who have been immunized, but for whom the vaccines were not 100 percent effective.

In 1998, Foxfoot said, her daughters contracted pertussis, a potentially dangerous disease preventable with the DTAP (diphtheria, tetanus, pertussis) vaccine typically given at 15 months.  The bacterial disease, which in about 9 percent of cases leads to pneumonia and, more rarely, seizures and brain disorders, is particularly dangerous to infants.  Worldwide, 30,000 people die each year from pertussis, according to the CDC.

The Foxfoot girls became sick along with several other unimmunized children who live or attend alternative schools in the scenic hills along the North San Juan Ridge in the far northwestern corner of the county.

Foxfoot said that when her daughters became ill, they developed the telltale cough with a whoop as they tried to catch their breath.  She kept the girls at home for nearly six weeks while they recuperated, as required by law for unimmunized children with vaccine-preventable diseases.  She also isolated them from older adults -- including her own parents -- and anyone who hadn't been immunized against the disease.

Foxfoot put her children on a diet without dairy and wheat products, and made sure they consumed plenty of clear broth to reduce the mucous that she said exacerbated the coughing.  They recovered fully.

"I was never worried for their lives," she said.  "They were strong and healthy."

Her children, whom she educates at home, remain healthy; neither has had an ear infection and neither has ever seen a primary-care physician, she said.

Feeding the immunization debate on both sides are numerous Internet sites devised to support one or the other side.  The Web site for Thinktwice Global Vaccine Institute, for example, provides personal stories about adverse reactions to vaccines and allows readers to post questions about immunizations, which are answered by the people who run the site.

The Immunization Action Coalition site does the opposite, providing horror stories from parents whose children contracted vaccine-preventable diseases.

Kris Jessen-Mather is a pediatric nurse practitioner in the Nevada County town of Grass Valley.  Many of her patients are the children of parents who are opposed to vaccination. It is her practice to listen to their concerns, then try to convince them of the importance of immunization.  "I just try and educate them," she said.  "But I can't make a parent immunize."

Not all parents want to talk about immunization with medical practitioners.  Foxfoot, for example, said she based her decision on her own research, which included articles in Mothering magazine, a periodical dedicated to "natural parenting" and books such as The Immunization Decision, What Every Parent Should Know, by a practitioner of homeopathic medicine.

Like others who do not immunize their children, Foxfoot has come to believe that the immune systems of infants are not ready to process the increasing number of vaccines now recommended.  Foxfoot cannot explain why that would be true, but she is satisfied with her understanding of the process.  Most important, she said, is that she takes her decision not to immunize seriously, and feels prepared to deal with the medical consequences.

"If you're not going to educate yourself, and know the diseases and symptoms and how to treat them," she said, "maybe you should vaccinate."

Nevada County health officials are aware of their high exemption rates and have made it a goal to increase immunization rates by 20 percent by the end of 2004.  School officials say they plan to operate a van to bring shots and vaccination education to rural communities where the immunization rates are especially low.

Even with additional support, Christina Garner, the county immunization coordinator, knows it could be an uphill battle with the parents who refuse to immunize.  "They are very educated on what they believe," she said.

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