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Parents who don't vaccinate their kids put us all at risk

Nguyen-PamelaPamela Nguyen is a resident physician in pediatrics at UCLA's Mattel Children's Hospital.
I have been thinking a lot about measles lately. In four years as a medical student and three years as a pediatric resident, I have never seen a case. As a result, all I know about the illness, I learned from textbooks. What scares me is that this soon may change. This spring, Los Angeles County saw it's first confirmed case of measles since 2006.

Measles is a serious public health threat. According to the Centers for Disease Control and Prevention, the disease remains the leading cause of vaccine-preventable deaths in children. In 2007, there were 197,000 measles deaths worldwide, 90 percent of them in children younger than 5. That is nearly 450 deaths every day.

A study published in the April issue of Pediatrics examined a 2008 measles outbreak in San Diego. The index case was a 7-year-old unvaccinated child who was exposed to the virus while abroad. This case resulted in 839 exposed persons, 11 actual cases (all in unvaccinated children) and the hospitalization of an infant too young to be vaccinated. In total, the outbreak cost the public more than $175,000, which would have covered the costs of measles vaccinations for almost 180,000 children.

And yet, many parents continue not to vaccinate their children. I see such children frequently. Last fall, when I entered an examination room, a 5-year-old patient loudly yelled "Get out!" Her mother apologized, then explained. "Sorry, she's never gotten S-H-O-T-S before."

Confused, I looked down at the chart to confirm that the patient was in for H1N1 and seasonal flu vaccines. Seeing that she was, I seized the opportunity to offer her catch-up vaccines as well, but her mother declined. She explained matter-of-factly that it was because the flu was "going around" whereas the other vaccine-preventable diseases, she said, were no longer a threat.

She went on to tell me that she was a lawyer who had grown up in a country where measles is still endemic. Since moving to the U.S., she had never known anyone to suffer from measles, but she did know several children who had autism. So, while she understood that vaccinations had not been definitively shown to cause autism, she felt that, here in America, the risk of autism was a bigger threat than that of vaccine-preventable diseases.

The parents in the San Diego outbreak also didn't vaccinate their children because they were afraid of autism. But exhaustive study has found no link between autism and vaccines. It's puzzling why well-educated, upper- and middle-income parents worry so much about a connection that doesn't exist while they ignore the very real risks of not vaccinating. Vaccine refusal is creating large reservoirs of susceptibility, primarily in private and charter schools that are generally free from state restrictions. I worry that we will soon see just how real that risk is. In addition to the case of measles, there also have been nine cases of mumps reported in L.A. County this year.

By choosing not to vaccinate, parents put not only their children but other peoples' children in harm's way. Immuno-compromised children, infants and pregnant women cannot be vaccinated, so they are put at increased risk when those who can be vaccinated are not.

As we saw in the recent H1N1 outbreak, it is often panic rather than education that moves a community to action. Not until parents saw children dying from swine flu did they move to vaccinate their children. Let's hope measles doesn't have to reach pandemic proportions again before we take notice. It is time to change our perspective and make the safety of all children our priority.

The first step is to demand stricter guidelines for personal-belief exemptions. Vaccinations should be mandatory for public school entry in all but the rarest of cases. The next step is to put pressure on private and charter schools to follow these same guidelines. It is selfish for parents who intentionally don't vaccinate to make other children vulnerable. We cannot afford to continue leaving the public's health in the hands of irresponsible parents.
This op-ed was originally published June 1 in the Los Angeles Times.

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