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Shawn Vestal: Pertussis epidemic a reminder that vaccination is crucial

My son got whooping cough last year.

He didn’t whoop much. He didn’t miss much school. It wasn’t a big deal.

But he had a lot of company in that brief and minor misery. More than 4,900 cases of pertussis were reported in Washington state in 2012. The largest rate of infection was among infants, who cannot be vaccinated against the disease. One infant’s death was attributed to the disease.

It was a genuine epidemic, and it was helped along, in part, by people who chose not to vaccinate their kids.

That was the bad news regarding vaccine-preventable disease in Washington state last year. The good news was this: Fewer people chose not to vaccinate their kids than the previous year. Which was better than the year before. Which was better than the year before …

“I think it’s really clear that we are making progress,” said Becky Linn, immunization outreach coordinator for the Spokane Regional Health District. “We still have work to do.”

Washington remains one of the most vaccine-averse corners of the country. In the 2009-10 school year, we had the highest rate in the nation of parents seeking exemptions to school vaccination requirements. At 6.1 percent, we were more than triple the national average; Spokane County was worse, at 8.7 percent. Since then, the rate has slowly declined both statewide and in Spokane County, partly because health officials went on the offensive against “vaccine hesitancy.”

It’s still high, though.

For the 2012-13 school year, 6.1 percent of Spokane County kindergartners had exemptions of some kind; statewide, the figure was 4.5 percent.

It’s likely that the bad news of 2012 – the pertussis epidemic – contributed to the good news by reminding people what can happen when a fast-spreading disease takes hold.

“When you have something like an epidemic of pertussis, it’s really quite apparent what the risk is,” said Michele Roberts, immunization program communications manager for the state Department of Health.

Vaccine hesitancy flourishes when it’s easy to forget how important they are. When we forget about the luxury of not having polio, or measles or diphtheria epidemics. When we can no longer remember the prospect of thousands of kids dying every single year from infectious diseases.

When people don’t get their kids vaccinated, they’re in effect making a choice for the rest of us by reducing our “herd immunity” and allowing diseases a chance to sneak in and take hold.

Take the whooping cough epidemic. Because the pertussis vaccine is effective but imperfect, herd immunity is an important barrier to widespread outbreaks. The more friendly human hosts who exist for the disease – which spreads easily and rapidly – the farther into the population it can reach. So a vaccinated kid – like, say, mine – can end up with a mild case of it. Or infants, who cannot be vaccinated, might get a worse case of it. They might die. As one did last year, remember.

Vaccine hesitancy takes different forms. Some people have religious and personal objections. Some have medical conflicts. Some buy into conspiracy-minded fear-mongering about vaccines, such as the celebrity-abetted and scientifically discounted claims of a link to autism. Health officials say that a lot of it stems from convenience: Until 2011, it was easy to simply claim a personal exemption when registering your child for school.

The law was changed to require doctors to counsel patients about the risks and rewards of vaccines before they sign off on an exemption. Linn said that has helped encourage doctors to be thorough in discussing vaccination with parents and has led parents to ask more questions of their doctors.

“One question being asked of the providers is, ‘Well, do you vaccinate your kids?’ and the provider says, ‘Absolutely, my kids are vaccinated,’ ” she said.

So far, the new law seems to have nudged the rate of exemptions downward a bit – but the overall downward trajectory was already in place. Both Linn and Roberts say the key to that has been an aggressive overall effort, a willingness to use a wide range of tactics to educate the public, to communicate with concerned parents and to target programs toward niches.

An example is an effort starting this fall to target vaccine hesitancy among Russian immigrants, Linn said. It’s part of a joint effort with a Seattle organization and will involve some focus groups starting in the fall. A pilot program, also set to start this fall, will attempt to improve the quality and reliability of vaccine data in local schools.

The Department of Health recently released a detailed report on vaccination rates for the just-concluded school year. It shows a general increase in the vaccinated populations of the state’s kids. But there are still lots of pockets of the community and the state where vaccination levels are alarmingly low. Rural school districts all over Eastern Washington have exemption rates of 10 percent or greater. And the figures themselves only cover public-school kids; the vaccination rates in the rest of the population remain a mystery.

Health officials see it as a never-ending challenge.

“There are kids every day who are not getting their vaccinations,” Roberts said. “And it’s putting our communities at risk.”

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