Aug
Poverty, health fears leave kids unvaccinated
Local health officials say part of the problem is a high-profile court case that seemed to link vaccines to autism. In March, a federal ”vaccine court” approved paying an unspecified sum to the parents of Hannah Poling, 9, of Baltimore, who argued that her autism-like symptoms were caused by vaccines.
BY FRED TASKER at the Miami Herald
More than 10,000 students sought exemptions from required vaccinations last year in Miami-Dade, Broward and Monroe county schools, giving South Florida some of the highest noncompliance rates in the state.
And the percentage of South Florida children not having their shots when school starts is growing, according to Florida Department of Health records. Those records count only kindergartners and seventh graders, meaning the overall numbers are certainly higher.
With South Florida public schools starting Monday, local health officials say they hope things are going better this year but admit they have no way to know.
Doctors say childhood vaccinations are a crucial underpinning of public health, protecting against such serious diseases as mumps, measles, polio and meningitis.
”There’s a social contract here,” said Dr. Jeffrey Brosco, associate professor of pediatrics at the University of Miami School of Medicine. “If you get meningitis or polio you could die.”
Local health officials say part of the problem is a high-profile court case that seemed to link vaccines to autism. In March, a federal ”vaccine court” approved paying an unspecified sum to the parents of Hannah Poling, 9, of Baltimore, who argued that her autism-like symptoms were caused by vaccines.
”Not a day goes by without someone asking me if vaccines are safe,” Brosco said. “It’s increasing steadily over the past two years.”
DISINCENTIVES
South Florida has its own set of disincentives to getting vaccinated, from high poverty rates to language barriers to a transient population.
In Miami-Dade, too few public schools have nurses to encourage compliance, said Dr. Fermin Leguen, medical director of the Miami-Dade Health Department.
Only four Broward Health Department clinics give free vaccinations, said Dr. John Livengood, the health department’s epidemiologist. “We have trouble with poor children having lower vaccination rates. They’ve missed so many shots by the time they arrive for kindergarten that we can’t just give them a shot and bring them up to date.”
Monroe County’s transient, service-industry population means many students show up for school at all levels without required shots or documentation, said Steve Mason, nursing director of the county health department.
Beyond these practicalities looms the fear of a vaccine-autism connection.
Ellen Blackburn’s son, Aaron, 12, walked early, talked early and showed all the signs of a thriving 2-year-old at his Coconut Creek home. Then he received his measles-mumps-rubella shots.
Two weeks later: “He almost died. He had a high fever. He was delirious.”
His diagnosis: autism.
Susan Goldstein’s daughter, Stephanie, took the same shots at age 2 and later received the same diagnosis. Stephanie is 16 now and lives with her parents and 18-year-old brother, Alex, in Weston.
”I bathe her every night,” said Susan Goldstein. “She’s not independent and never will be.”
Parents recognize that most experts disagree with them. Every medical authority from the Centers for Disease Control and Prevention to the New England Journal of Medicine to the American Academy of Pediatrics says vaccines are safe.
”I don’t know if vaccines caused her autism,” said Goldstein, 50, “but I feel a great degree of guilt because I never read any toxicity studies before she got her shots.”
Blackburn has turned to Miami lawyer Elwood Lippincott Jr., to file suit in the federal vaccine court in Washington, arguing that Aaron’s vaccinations caused his autism.
”It’s not the vaccine itself, it’s the mercury-based preservative, thimerosal,” Lippincott said.
The CDC cites studies that say thimerosol, which has been in some vaccines since the 1930s, is not associated with autism. But it worked with manufacturers to remove it from school-required vaccines in 2001.
At a March news conference, CDC director Dr. Julie Gerberding said: “The weight of the evidence indicates that vaccines are not associated with autism. But CDC knows that some parents may still have concerns about this issue . . . so we will continue to study the role of vaccines.”
By law, students entering kindergarten in any Florida school are required to have 16 shots, with more required for higher grades.
The only exemptions are for religious or medical reasons. In theory, the immunization rate should be nearly 100 percent.
In Miami-Dade public and private schools, health department records say the immunization rate for 2007-08 was 90.8 percent for kindergartners and 83.5 percent for seventh-graders.
In Broward, the immunization rate was 90.9 percent for kindergartners and 91.8 percent for seventh graders.
In Monroe, the immunization rate was 88.6 percent for kindergartners and 77 percent for seventh-graders.
In fact, health officials in all three counties acknowledge they don’t know how many school children were unvaccinated. Most of those not vaccinated when school started last fall were in the ”temporary medical exemption” category. They had 30 days to clear up any medical problem and get vaccinations.
Health officials don’t know if they did.
”We didn’t have the personnel to follow up,” said the health department’s Leguen.
Last year, the department had nurses in only about 30 of Miami-Dade’s 392 schools, he said.
New programs funded by the Children’s Trust will put nurses in 100 schools this year, 150 next year — and with luck, in all schools by 2011.
SEVENTH GRADE
The problem is particularly acute among seventh graders. Miami-Dade, Broward and Monroe counties have some of the state’s highest percentages of seventh-graders in the ”temporary medical exemption” category.
Dade has 15.4 percent, Broward 7.3 percent and Monroe 20.1 percent. Most Florida counties have less than 1 percent.
With public concern growing, Florida’s legislators are taking steps.
Gov. Charlie Crist has created a Governor’s Task Force of Autism Spectrum Disorders — a panel of state leaders that will meet this fall to look into autism’s causes and treatments.
Outgoing Florida House Speaker Marco Rubio of Miami-Dade has called an ”Autism and Disability Summit” for Sept. 15-16 in Orlando to give input to Florida legislators.
State Sen. Jeremy Ring, D-Margate, said he is looking into sponsoring a bill regulating vaccinations. “We’re looking at a moral exemption to make it simpler for parents to opt out.”
Nineteen U.S. states have exemptions allowing parents to avoid vaccinating their children for moral or philosophical reasons. Florida parents can opt out only for religious or medical reasons.
”We have to be very careful,” Ring said. “I don’t say there should be no vaccinations. There’s a big difference between polio and chickenpox. Nobody wants a polio epidemic.”
Making it too easy to opt out is a bad idea, said Dr. David Tayloe Jr., president-elect of the American Academy of Pediatrics.
“The last time vaccination rates got too low in the country, in the 1980s, there was a measles epidemic, and 130 people died.”
