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Although California pbaded tough legislation in 2016 banning "personal belief" exemptions for child immunization, some parents may turn to unethical doctors to circumvent the new law.
And a new study reveals that this could fuel new and dangerous measles outbreaks in that state.
Mandated by law
In a report on one of these outbreaks in early 2018, "the six unvaccinated measles patients all had parents who had chosen not to vaccinate them during their childhood," noted researchers led by Dr. George Han, Department of Public Health, Santa Clara County, California. San Jose, California.
The outbreak began with an unvaccinated 15-year-old boy who had contracted measles during a trip to Britain and brought it back to California. The disease quickly spreads to others through contacts in schools, screening activities and a tutoring center.
The outbreak would not have occurred if the children concerned had received the vaccines prescribed by law, said Han's team.
This law was pbaded because large groups of "anti-vaxx" parents refused to vaccinate their children, allowing outbreaks of measles and whooping cough to reappear in this state.
However, "medical exemptions for reasons determined by individual doctors" are still allowed in the state, said Han and his colleagues.
Practice contrary to the ethic
Thus, in some cases, parents pay doctors to write fake medical exemption notes. In fact, a study published in October in the newspaper pediatrics found that the rate of medical exemptions in California had increased by 250% in the two years following the ban on personal exemptions by the state.
It is possible that this unethical practice may have played a role in the measles epidemic described in the new report.
"Interviews with local health authorities suggest that some students without contraindications to vaccination have benefited from medical exemptions," noted Han's team. They reported that two of the children infected with the outbreak had "received large identical medical exemptions for all vaccines from a doctor located several hundred kilometers from the patient's home."
Paediatricians who reviewed the report quickly condemned this practice.
"I find it unreasonable that doctors are trying to take advantage of parents' fears," said Dr. Sophia Jan, director of pediatrics at Cohen Children's Medical Center, in New Hyde Park, New York . "Although California has made the right decisions by removing exemptions from personal beliefs about immunization, parents who fear vaccines clearly find a way around the law."
Dr. Michael Grosso is chair of the Pediatric Council of Huntington Hospital of Northwell Health in Huntington, NY. He endorsed Jan's comments, adding that "disciplinary action by state regulators is reasonable" for doctors who sell fraudulent medical exemptions to parents.
Movement "anti-vaxxer"
Measles is a highly contagious and, in rare cases, fatal infection thought to be virtually eliminated from the United States due to widespread vaccination of children with measles-mumps-rubella vaccine (MMR).
But that was before the recent rise of the "anti-vaxxer" movement: parents who share the mistaken belief that routine childhood vaccines are somehow related to serious developmental disorders such as autism . No such relationship has ever been supported by rigorous scientific research.
Nevertheless, the anti-vaxx movement is extended. Alarmed by recent outbreaks of measles and whooping cough in areas of high anti-vaccination sensitivity, some states (including California) have been quick to enact legislation banning exceptions to personal beliefs.
With this, the number of medical exemptions issued has increased.
According to Jan, "there are very few medical reasons why a child can not receive vaccines". Having a child with a suppressed immune system is one, but "it is clear that there is no report indicating that there is a growing epidemic of children with an immune system deleted, "she said.
And as more and more children are not vaccinated, measles has the opportunity to make a comeback, Grosso said.
Characteristic of rich and educated
"According to the US Centers for Disease Control and Prevention, 159 measles cases have already been reported in 10 states in 2019," he said. "This is a remarkable recovery compared to the last two years: in 2017, there had been only 120 cases, and the following year, 372".
"If the current rate were maintained for the rest of the year, our country would have recorded nearly 1,000 cases," Grosso said. "The most important variable of this equation is the number of unimmunized children."
He also noted that "under-vaccination in the United States is not a characteristic of poor communities, but rich and educated people". In many cases, said Grosso, highly educated parents convinced themselves that they knew more than doctors and the scientific community.
"There is not a single way to talk about vaccine safety with parents," Grosso said. For example, "a number of studies have shown that highlighting the serious nature of diseases such as measles forces some parents less likely to accept the vaccine, "he said.
In the meantime, measles remains a very real threat, as current outbreaks in anti-vaxx hot spots in Oregon, New York and other places are raging.
"This virus is very contagious," Grosso said. "The simple fact of being in a room where a person recently infected with measles could transmit the infection.And it is serious: complications include pneumonia, brain infections and death. "
The snapshot of the epidemic in California is published in the CDC newspaper Weekly report on morbidity and mortality.
Image credit: iStock
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