CityView Magazine

disease. All but one of the patients with confirmed measles was unvaccinated or their vaccination status was unknown. Twenty of the children werenÕ t yet old enough to receive their first dose of the vaccine. And 23 were not vaccinated due to exemptions claimed for religious or personal beliefs. Why might people be opposed to immunization? Safety concerns and mistrust of Ò big governmentÓ and large pharmaceutical companies seem to be the two main reasons. There has been an alarming rise in the rate of autism and autism spectrum disorders, all since the era of more intensive immunizations. Autism is not usually diagnosed before 16 months of age, and by then children have received a long list of vaccines: three doses of Hepatitis B vaccine, three doses of DTaP, four doses of Hib, four doses of pneumococcal vaccine, three doses of IPV, their first MMR dose, their first varicella dose and now three doses of rotavirus vaccine. Are all of these immunizations necessary? Could there be unintended consequences that we are not yet aware of with all of these shots? Anything is possible, but there is a lot of good data that supports the safety of these immunizations. Does the MMR vaccine work perfectly? No. Vaccinated people still get measles. One dose of the vaccine, given between 12 and 15 months of age, is protective for 95 percent of children. After a second dose given at 4 to 6 years of age, the vaccine is greater than 99 percent but less than 100 percent effective in preventing infection. We rely on Ò herd immunityÓ for preventing outbreaks among those not yet vaccinated, including children younger than 15 months of age. How many people get exempted from vaccinations? In North Carolina, there are two valid reasons to get an exemption from immunization. The first is medical. If a licensed physician decides that an immunization is detrimental to a personÕ s health, that person is exempt. The second exemption is religious. No explanation is needed, and children may enroll in any type of school, college, university or facility without presenting a certificate of immunization. Patrice Baros, a registered nurse and a North Carolina school health team leader, told me that out of 53,000 students enrolled in Cumberland County schools, only 37 students claimed a religious exemption and only 33 students claimed medical exemptions. Ò We have a large military population,Ó Baros told me. Ò They are more familiar with vaccines and understand that vaccines are protective. This is life.Ó But in other cities and states, this isnÕ t always the case. In Oregon, the rate of vaccine exemption is 4 percent. A bill proposed this year in Florida would give that stateÕ s parents more leeway in making decisions about vaccinations. What advice do I give my patients? I tell them that the benefits of immunizations far outweigh the risks. I have a cousin with autism, and another with an autistic son. With such a history of autism, was I worried about immunizing my own children? Yes. Did they get all of the required immunizations? You bet.CV Dr. Lenny Salzberg teaches and sees patients at the Southern Regional Area Health Education Center. 56|June/July • 2009

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