Epidemic Revives Vaccine Debate Health Workers Fight Fear, Complacency As Well As Pertussis

The region’s whooping cough epidemic has killed an infant, swamped medical laboratories, and sent hundreds of people to health clinics and pharmacies.

The epidemic also has drawn attention to Idaho’s low immunization rates and revived an emotional debate over whether vaccines work.

When Spokane mother Rhonda Fiskland heard about the death of a 2-month-old Post Falls boy two weeks ago, she thought of her own baby’s bout with pertussis, or whooping cough, in January.

She remembered lying on the floor, crying with helplessness, as her baby coughed and coughed.

“It’s a night I’ll never forget,” Fiskland said. “I was told the reason she got pertussis was because so many people are not immunizing their children.

“It frightens me, because my little girl could have died.”

In Coeur d’Alene, Cathy Weston wondered whether the Post Falls baby who died in late March was breast-fed. Weston, a midwife and former Deaconess Medical Center nurse, distrusts vaccines, and made the decision long ago to do everything in her power to raise healthy children without immunizations.

She’s a strong believer in breast-feeding and good nutrition - based on unprocessed, organic power to raise healthy children without immunizations.

She’s a strong believer in breast-feeding and good nutrition - based on unprocessed, organic foods - as the key to a healthy immune system.

Her decision was personal and not one she would suggest to everyone.

“I don’t want to be a pompous jerk and say ‘neener, neener,’ but I am one of those people who looks over my kids like a hawk,” she said. “If one of my kids got sick and died, that would be my responsibility.”

When Phyllis Albee heard about the recent death, it hit hard. She coordinates Panhandle Health District’s immunization programs.

“That was just devastating to all of us, because we know that’s something that might have been prevented,” she said, adding that the parents were not negligent. “I believe the community has a responsibility here.”

That responsibility, she and other health officials said, is to achieve the highest immunization rates possible to protect everyone from disease.

The whooping cough epidemic comes on the eve of National Immunization Week, which started this weekend.

The health district’s Board of Health is appointing a task force to address the problem of low immunization rates. Idaho’s 1995 rate, 66 percent, was the lowest in the nation.

Dr. Richard McLandress, a family physician in Coeur d’Alene, is heading the task force. He believes he knows what the problem is.

“It’s real simple,” McLandress said. “Parents have lost their discipline … and they’re bamboozled by misinformation.”

Among the reasons that parents fail to immunize their children are:

Forgetfulness and inconvenience. The Panhandle Health District claims 98 percent of children get their first shot, but only 61 percent get the whole series. Some may lack a “medical home,” a consistent source of medical care from a particular doctor or nurse.

Concerns over the safety and effectiveness of vaccines. Those fears are fueled by media reports, publications and organizations that focus on adverse reactions and uncertain long-term effects.

Religious beliefs. Christian Science, for instance, teaches that immunity lies in understanding and trusting God’s laws.

Medical conditions. Some children cannot tolerate vaccines because of allergies or other medical conditions.

Health care providers say most people intend to immunize their children, but just fall off the schedule one way or another.

When 2-year-old Kaylee Hatch came down with a cough last week, her father brought her into Panhandle Health District fearing whooping cough.

Greg Hatch thought she might have caught pertussis during a recent trip to McDonald’s.

“There were a bunch of kids there,” Hatch said. “We didn’t know who they were.”

The nurse attending Kaylee found she wasn’t up to date on her vaccinations, and ushered her into a clinic room for her shots.

“We call this a missed opportunity,” she said.

Beth Parsons, Coeur d’Alene, took advantage of her daughter’s missed opportunity. First the baby had a cold, and then an ear infection, which led to delays in her vaccinations.

By the time the doctor would vaccinate, Parsons wouldn’t allow it. She’d read so much material about the down sides of immunization that she decided against it.

“The body has its natural immunity,” she said. “When you start putting things in your systems that are man-made, you’re going to pay a price.”

In Idaho, 1-1/2 percent of parents whose children attend public school choose not to immunize them for religious, medical or personal reasons. North Idaho has the highest rate of exemptions to the public school immunization requirements at 2-1/2 percent.

Washington’s statewide rate for exemptions is 2 percent.

Those statistics do not include people who choose to home-school their children.

Licensed day-care centers have similar requirements, and similar exceptions for people who choose not to vaccinate.

Coeur d’Alene day-care operator Iris Seigler said this year is the first that all 12 children at her day-care are current on vaccinations. Usually half of the parents decide against it, she said.

“I think it’s fear,” she said. “These are educated people in the community, very educated, who are choosing not to immunize their children.”

What once was an automatic rite of passage to toddlerhood now can be an emotional, controversial decision for parents.

McLandress said the problem started with “a scare” in the 1970s over adverse reactions from vaccines.

The worst reaction most children experience from immunization is a fever and soreness from the shot. But occasionally, the fever can trigger seizures and loss of consciousness, leading to other problems or, in rare cases, even death.

The polio vaccine itself is responsible for an estimated nine polio cases a year.

Because of such side-effects, several vaccine manufacturers were sued, and some quit the vaccine business, prompting Congress to establish the National Vaccine Injury Act of 1986. The act set up a fund for compensating victims of vaccine-related injuries and death.

Since 1988, 5,134 people have petitioned for compensation. Of those, the U.S. government awarded about 1,100 victims $756 million.

Despite the number of injuries, compensation program director Thomas Balbier had no qualms about vaccinating his own children.

“True, serious, vaccine-related events are extremely rare,” Balbier said. “With most of the claims, outside the polio claims, it’s never been proven as a matter of fact that the vaccine caused the injury.”

While admitting vaccines aren’t 100 percent safe, health officials emphasize the risks of not vaccinating.

Up to 10 seizures occur for every million diphtheria-tetanus-pertussis shots. But without the shot, one in 20 children would die from diphtheria, three in 100 would die from tetanus, and one in every 200 children would die from pertussis, according to the Centers for Disease Control and Prevention.

Immunization advocates say those who don’t vaccinate are putting the entire community at risk.

“The more people in the group who are immunized, the less risk you have to people who are susceptible,” Albee said. “Those children who haven’t had their shots are protected by those who have.”

Yet, the nation’s immunization program is considered by some to be a conspiracy to benefit big business.

Manfred Mueller, of the North Carolina-based Homeopathic Physicians Opposed to Vaccinations, said the pharmaceutical industry intentionally produces vaccines that can cause chronic disease.

“That’s good business,” Mueller said. Groups like his circulate books and articles that promote such claims.

“That’s almost psychotic,” McLandress said. “It’s so out of touch with reality. Its power feeds on fear.”

McLandress points out that the industry has responded to concerns about vaccines, and in the past year safer vaccines for pertussis and polio have entered the market.

Once health officials wipe out the pertussis epidemic, the battle for public trust will continue.

“A community needs to look at itself when something like this happens,” Albee said. “A decision to vaccinate is a parent’s decision, but low immunization rates are a community problem.”

, DataTimes ILLUSTRATION: Color Photo; Graphic: Immunization rates

MEMO: This sidebar appeared with the story: STATES HAVE CLEAR IMMUNIZATION REQUIREMENTS Both Washington and Idaho require immunizations for enrollment in public schools and licensed day-care facilities. In both states, parents may claim exceptions to any and all immunizations for religious, medical or personal reasons. Idaho schools require: Four or more doses of diphtheria, tetanus and pertussis (DPT) vaccines, unless fewer doses are medically recommended. Three or more doses of polio vaccine, unless fewer doses are medically recommended. One dose each of measles, mumps and rubella vaccine given after one year of age. Three doses of Hepatitis B vaccine if born on or after Nov. 22, 1991. Parents can provide proof of laboratory immunity in lieu of receiving any immunizations. Washington schools require children entering kindergarten through fifth grade to have: Three doses of Hepatitis B vaccine for kindergarten entry. Four doses of DPT, provided the last dose was on or after fourth birthday. Three doses of polio vaccine provided the last dose was on or after fourth birthday. One dose of live measles vaccine on or after first birthday. One dose each of mumps and rubella vaccine on or after first birthday. Washington also has specific immunization requirements for sixth through 12th-grade enrollment. -Susan Drumheller