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Immunization concerns

More than a quarter of Ashland parents choose not to vaccinate their children, and the government wants to know why.

The Centers for Disease Control and Prevention is holding a community meeting Jan. 10 in Ashland to help its Immunization Safety Office prioritize vaccine safety studies beginning in the next five years.

Ashland joins Indianapolis and Birmingham, Ala., as three U.S. cities the CDC is tapping to solicit the public's concerns about vaccines.

"I think what's important about this is it's the government coming out and asking people's opinions, asking their advice, asking them to help set policy," said pediatrician Ben Schwartz, a senior scientific advisor in the Department of Health and Human Services' National Vaccine Program.

Ashland was chosen partly for its high rates of unvaccinated children, Schwartz said.

"We wanted to learn from people who had more concerns about vaccines," he said.

The CDC held the Birmingham meeting Dec. 13 and will hold the Indianapolis meeting Jan. 17 before the National Vaccine Advisory Committee's Vaccine Safety Working Group convenes in Washington, D.C., Feb. 4 to hear the results.

Ashland's meeting will take place Saturday, Jan. 10, from 9 a.m. to 4 p.m. at the Ashland Middle School commons. Registration and a continental breakfast begin at 8 a.m. and lunch and refreshments will be provided.

Attendees must live within the city limits and be at the meeting all day. Participants qualify for a $50 stipend, which Schwartz said is a "reflection of how we value people's time" and is also aimed at recruiting a cross-section of the community.

The CDC hopes for about 75 attendees, and people must register in advance by calling facilitator The Keystone Center at (800) 219-6670 or going online to www.keystone.org/registration/ashland. For more information, including a link to the draft scientific research agenda, go to www.hhs.gov/nvpo/nvac/publicengagement.html.

High rates

While Birmingham and Indianapolis are more representative of typical communities, Ashland stands out with its "substantially higher" rates of unvaccinated children, Schwartz said.

Oregon requires schoolchildren to be vaccinated against 11 diseases, but parents can opt out by signing a religious exemption, which defines religion as "any system of beliefs, practices or ethical values."

Statewide, 3.7 percent of kindergarteners had exemptions in 2007, while 28.1 percent of Ashland kindergarteners were exempt, according to numbers provided by the Jackson County Health Department.

Ashland's numbers get even higher when broken down by school.

For 2007, 66.7 percent of students at Willow Wind Community Learning Center were exempt, while 65.9 percent of Siskiyou School students and 45.7 percent of John Muir Elementary students had exemptions, according to reports submitted to the health department.

At Walker Elementary, 23.4 percent of students had exemptions, while 15. 3 percent of Bellview students and 14.8 percent of Helman students were exempt.

Belinda Brown, Ashland's school nurse coordinator, said the numbers can be somewhat misleading because if a parent signs a religious exemption for one vaccination but follows the remaining requirements, the child is counted as an exemption.

Regardless, the numbers are still high, "and they're higher than we want them to be," Brown said.

A variety of reasons contribute to the high exemption rates, Brown said.

A small group faces barriers to vaccinating, such as not knowing where to get the shots or lacking money or transportation, but the school works hard to help parents overcome these obstacles, she said.

Some parents are adamantly opposed to immunizations for personal or religious reasons, Brown said, and many are worried about vaccine safety.

It's important to respect parents' choices, but the number of exempt students is troublesome, Brown said.

"It's been an area of concern for the school district and the community at large, and we've been thinking of ways to improve that," Superintendent Juli Di Chiro said at the Dec. 8 school board meeting.

If there were an outbreak of a vaccine-preventable disease, unvaccinated students would have to stay home until it passed. Meanwhile, the school district would be required to provide five hours of one-on-one tutoring each week to every quarantined student, Di Chiro said.

When parents want to sign an exemption, the school tries to make sure they understand the risks of not vaccinating, Brown said.

"It's our job to make sure everyone has the information they need," she said.

Studying the reasons

Information is key for Kaitlin Newman, Shauna Gargus and Joel Carrick, nursing seniors at Oregon Health and Sciences University who are studying Ashland's high exemption rates and how to bring the numbers down.

They have contacted community leaders and school administrators and designed an informational pamphlet, and they talked about their project at the Dec. 8 school board meeting.

Besides running the risk of contracting a serious disease, unvaccinated children also jeopardize others, the students said.

When large segments of a population are not vaccinated, it causes a drop in protection provided by immunizations, a loss of "herd immunity," the students said.

For instance, the elderly and newborn babies are susceptible to pertussis (whooping cough), said Jim Shames, the medical director for Jackson County's Health and Human Services and adviser to the students.

Until the baby is old enough to be vaccinated for pertussis, its only protection is for people around it to be immunized, he said.

"It really takes a community to protect a child," Shames said.

Some children can't be vaccinated for medical reasons, and people with cancer, AIDS and other illnesses that compromise the immune system are also susceptible to catching vaccine-preventable diseases, said OHSU nursing instructor Linda Brown.

Immunizations have largely eradicated many diseases — such as mumps, polio and measles — in the United States, so people don't see their devastating effects and don't think they need to vaccinate, the students said.

But as a tourist town with visitors from around the world — including places where these diseases still exist, Ashland is especially susceptible for an outbreak, the students said.

Many parents choose not to vaccinate because of concerns about reactions to immunizations, but serious reactions are rare, the students said.

"The most common reaction to a vaccine is a sore arm," Gargus said.

Some concerns, like the possible link between vaccines and autism, are unsubstantiated, the students said.

"There's a lot of fears that parents have that a lot of people believe but aren't scientifically proven to be linked to the vaccine," Carrick said.

Parents don't always give equal concern to the complications from the diseases the vaccines aim to prevent, Linda Brown said.

"There's a balance between the risks of disease and the risks of side effects," Shames said.

As a parent, it can be hard to know if you're doing the right thing, Linda Brown said. "And so many of the families in Ashland are very concerned about trying to do the right thing," she said.

A parent's view

Julie Freed is one of those parents.

For her, doing the right thing was not vaccinating.

After a "huge amount of research," Freed, a homeopathic and nutritional consultant, chose to abstain from immunizations for her daughter.

Arianna Marshank, now an eighth-grader at the Siskiyou School, has been vaccinated for tetanus, but has not received the other recommended childhood immunizations.

Freed has signed the religious exemption and has never had any trouble getting her daughter into classes or camps, she said.

Her decision to not vaccinate had a lot to do with the timing of the shots and the amount of them, as well as the potential for side effects, Freed said.

"It's more just the safety aspect and the respect for the immune system developing on its own and not inundating it with chemicals," Freed said.

The amount of vaccines recommended for young children is a challenge to an undeveloped immune system, she said. In addition to the preservatives and chemicals in the vaccines, some of them don't seem necessary at such a young age, she added.

She has also seen adverse reactions to vaccines.

Although nothing has been proven, links suggest that vaccines may cause learning disabilities, autism and SIDS, Freed said. Complicating the issue, there's evidence on both sides to argue for and against vaccinations, she added.

"We don't know. We don't know what these chemicals do to our bodies," Freed said.

Now that her daughter's immune system has developed and she's healthy and strong, feeding her wholesome, organic food and making sure she gets fresh air and exercise "are my choices at keeping illness at bay," Freed said.

Her friends span the range of vaccination theory, with some not vaccinating at all, some who selectively vaccinate, some who don't adhere to the vaccination schedule and some who follow all the recommendations, Freed said.

It comes down to personal choice, and it's important to make an educated decision, she said.

Freed is not opposed to vaccines, but "I do feel like people feel like they don't have a choice," she said.

Whichever option parents pick, it's not an easy decision, Freed said.

"I'm not going to lie. I've had sleepless nights," she said. "We all worry about our kids and are concerned about our kids. And we all want to do what's best for our children."

Kira Rubenthaler can be reached at 482-3456 ext. 225 or krubenthaler@dailytidings.com.