MMR Vaccination Requirement in California Public Schools

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Measles is a highly contagious respiratory virus that is spread through the air. Widespread use of the MMR vaccine led to a reduction of measles cases by more than 99%, and the disease deemed eliminated in the United States in the year 2000. The CDC recommends two doses of this vaccine are needed for complete protection. Children should be given the first dose of the MMR vaccine at 12 to 15 months of age. The second dose can be given 4 weeks later, but is usually given before the start of kindergarten at 4 to 6 years of age. However, from January 1 through May 23, 2014, a total of 288 confirmed measles cases have been reported to CDC, which is the highest yearly total since elimination. 85% of the nationwide cases that had measles, and were unvaccinated, declined vaccination due to religious, philosophical, or personal objections.

Since 2000, when measles was declared eliminated in the United States, the number of cases per year in California has ranged from 4-40 cases. During the first 5 months of 2014, California has the second highest state total with 60 confirmed cases. California currently allows medical, religious, and philosophical exemptions for the MMR vaccine upon enrollment to kindergarten. The philosophical exemption use has increased over the past 5 years to 2.9% of all enrolling kindergarten students. Eliminating religious and philosophical exemptions would increase the number of vaccinated children enrolling in kindergarten. A policy that would stifle current and future measles outbreaks would be to only allow medical exemptions. Dr. Paul Offit, Chief of Infectious Diseases and Director of the Vaccine Education Center at Children’s Hospital of Philadelphia, explained the benefits of vaccination during a recent appearance on the Colbert Report.

Paul Offit on Colbert Report

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7 Responses to “MMR Vaccination Requirement in California Public Schools”

  1. ebasili1 Says:

    Dr. Offit does an amazing job explaining the advantages of vaccination on Colbert! Both entertaining and accurate. I love the point he makes about the public not remembering how scary some of these vaccine preventable diseases can be, precisely because vaccinations have worked so effectively.

    Regarding your stance to eliminate both religious and philosophical exemptions for school-aged children, I wonder how much public support such a policy change would garner. I can see conservative Californians up in arms and quoting the Constitution’s First Amendment right to religious freedom. I wonder if there would be a way to engage religious leaders and promote vaccination through those channels. To counter philosophical exemptions, it seems like publishing more scientific papers about vaccine safety is not impressing the public. What other tools do we have at our disposal to fight misinformation? As the cases of measles continue rising, truly it seems that the aftermath of Andrew Wakefield’s false claims is tragic.

    Nice post 🙂

  2. sarahmarshall2014 Says:

    I understand why eliminating philosophical and religious exemptions to childhood vaccination is contentious. Many Americans cherish the right to make unhealthy decisions. However, I do favor mandatory vaccinations for children unless medical contraindications exist. Children should not live at the mercy of their parent’s poor decision-making – the state has a well-established duty to protect children and the general public. We have helmet laws, seat belt laws, and substance use laws that restrict freedom in order to protect health. I believe the government can act in the best interest of the people, especially children, and that children cannot be put on a sacrificial alter to uphold unjustified beliefs of the parents. Vaccinations cause no more discomfort than wearing a seat belt or helmet, in my experience. Requiring vaccinations for children makes absolute sense.

  3. cvshirley Says:

    Thank you for a very interesting post. While I agree that a policy change of this nature would continue to spark public controversy surrounding this topic, my opinion is that this dangerous trend in refusing vaccinations will continue without an intervention at the policy level. As one the previous comment pointed out, the published evidence disputing the negative effects has had little impression on those opposing vaccinations. I think this leaves policy makers and experts in the field to enforce policy change that will protect children and the general public. While Americans thrive on their right choose, I do not think that parents, in fact, have the right to choose to withhold life saving therapies from their children or their children’s classmates.

  4. sfung4 Says:

    I agree with you that childhood vaccination schedule is important to adhere to, and it should be reinforced at both federal (CDC) and state level. Through childhood vaccinations, we’ve been able to eradicate or significantly reduce the burden of many vaccine preventable diseases. Childhood vaccination coverage has always been around 75-85%. The remaining percentage are parents either low in SES or hold extreme views against vaccination as a way to defend for their rights in making personal health decisions for their child. Adhering to federal and state mandates in receiving recommended vaccines without receiving sufficient disease and vaccine product educations makes them feel that an unknown and far removed entity (CDC or state health department) is making personal healthcare decisions for them, while this “CDC” certainly does not have their child’s best interest at heart. Moms are constantly in a guardian role for their child, especially for the vulnerable infants, so polices and mandates are perceived to be a way of taking away their rights to make healthcare decisions for their child. Therefore, using more policies to coerce away their rights to file for religious and philosophical exemptions will be ineffective in increasing childhood vaccination rate. Instead, we should motivate and mobilize pediatricians, the policy managers, to partner with parents at personal level, so that they feel that vaccination decisions are made with their child’s best interests at heart. The parents in low SES are also much less compliant to the vaccine schedules due to lack of insurance, lack of necessary primary health care for their child, unreliable means of transportation, and transient job situation. Sadly, we still see many private practices, driven by business bottom lines, turned away people with no insurance or with public insurance. Therefore federal program like Vaccines For Child from the CDC, must be better utilized in both public and private channels (clinic offices, public health departments, even pharmacy), so that the underserved can have equal access to vaccinations.

  5. carabarnes Says:

    I completely agree with ebasili1 on the statement that Andrew Wakefield’s false claims have led to tragic public perceptions of vaccines. The utterly incorrect claims linking vaccines to autism has done more to damage the reputation of science and the public’s belief in data than almost any other scientific scandal. However, I do not think mandating vaccination for school entry is the solution, or at least all of the solution. I think there would be significant push back from parents on the requirement and that would only worse the public perception of vaccines. Rather, part of the solution must come from scientists themselves. Simply pushing scientific papers and data on the public has not helped, as scientists (of which I am one) have not communicated the message effectively. Scientific literature and data is written in a way for other scientists to understand, rather than the general public, and scientists do themselves and the science a disservice when they do not tailor their message and communicate it in a way that resonates with the public. I think part of the solution to breaking the cycle of vaccine misperceptions is through appropriately tailored messages about vaccines.

  6. drkhaira Says:

    There have been a number of attempts by the California legislature to institute policy change in regards to vaccination refusal. Most recently Assemblyman Dr. Richard Pan authored a bill that became law mandating parents refusing vaccines for their children to obtain medical counselling from a board certified pediatrician or family practitioner prior to kindergarten.

    http://www.cnn.com/2012/06/04/health/california-vaccination-opt-out/

    I disagree with a few statements made by sfung4. First, as a pediatrician in California I’ve encountered parental refusal of vaccinations on a daily basis. Low SES or extreme views are not the predominant background of parents that refuse vaccines. In fact the vast majority of parents are intelligent and have made their decision thoughtfully. Second, ‘mobilizing’ or ‘motivating’ pediatricians as ‘policy makers’ is short sighted. Pediatricians cannot mandate or coerce, we don’t have that power. We are partners with parents, and can only make recommendations. My persuasive attempts has been refined over my 20 years of practice. Despite my attempts I have rarely changed parents minds while spending precious time on lost causes. Finally, the reasons associated with parental vaccine refusal are relatively simple. Parents point out that if the disease isn’t a threat why should they have their child receive the inoculation? That logic is sound, and there is very little a clinician can elucidate to the contrary. A threat, is only a threat if its outside your door.

    As draconian as it may sound it is that fear that will motivate parents otherwise. Education, placing unrealistic expectations on clinicians, and counselling will never work. Regrettably, when parents fear that usually results in action. In 2011, my flu vaccine rates shot up to 94%, and my stocks ran dry within 45 days during the first H1N1 scare. We can thank the media, and the internet for drumming up that compliance rate. Perhaps prevention resources would be better spent on that tactical route.

  7. megsullivan16 Says:

    As a pediatrician, I spend a lot of time discussing vaccines with my patients and like to think these conversations are very important. However, as drkhaira correctly points out, the education piece surrounding the decision to vaccinate is complex.

    There was a recent article published in Pediatrics that looked at 4 different methods of educating parents on the MMR vaccine and found that none of the strategies increased a parent’s plan to vaccinate. In some instances, the probability of vaccination actually decreased.

    http://pediatrics.aappublications.org/content/early/2014/02/25/peds.2013-2365

    That is not to say that we shouldn’t keep having these conversations about the benefits of vaccines and risks of not vaccinating, but we have to be sure our strategies aren’t actually backfiring.

    I agree with ebasili1 that eliminating the exemptions in California would be difficult. I do think the law mentioned by drkhaira requiring medical counseling and signature is a step in the right direction

    (http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_2101-2150/ab_2109_bill_20120831_enrolled.pdf)

    I am curious to see the data on what effect it has on immunization prevalence.

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