By Michelle Andrews

When Rep. Michele Bachmann (R-Minn.) recently suggested that the human papillomavirus vaccine — recommended for girls and young women to protect against cervical cancer — was dangerous and might cause mental retardation, the American Academy of Pediatrics pushed back hard. The AAP, which represents 60,000 pediatricians, issued a statement saying the claim had “absolutely no scientific validity.”

Bachmann’s is only the latest attack on vaccine safety, as anyone knows who has tracked the persistent and discredited claims that vaccines cause autism, among other problems.

Public-health experts insist that childhood immunizations are safe, but widespread misinformation by self-described safety advocates and others is one reason pediatricians frequently find themselves fielding questions from anxious parents.

When repeated efforts to educate parents fail, some pediatricians are now taking action: They’re refusing to treat children unless their parents agree to have them vaccinated according to guidelines set by the Centers for Disease Control and Prevention.

Pediatricians who go this route say they’re concerned about more than the health of the children. They’re also worried about other patients in the waiting room, some of them too young to be immunized or with health problems that compromise their immune systems. Unvaccinated children put those kids at risk.

“It’s my job to do the very best we can with patients in this practice,” says Dr. Harry Miller, a pediatrician with Four Seasons Pediatrics in Clifton Park, N.Y., whose practice stopped treating unvaccinated children last year. “Exposing that small percent who don’t vaccinate to those who do is a disservice.”

Most parents have supported the decision, he says, which was spurred in part by a rise in the number of the practice’s parents who refused immunizations. That number was very small, and those who felt strongly about avoiding all vaccines — about 0.5 percent of the families — have left the practice.

The AAP doesn’t think doctors should take such a hard line. “Over time, parents may be willing to reconsider previous vaccine refusals,” says the group’s policy statement.

More From This Series: Insuring Your Health

When vaccination rates fall below roughly 80 or 90 percent, a population loses the benefit of “herd immunity,” which protects even those who can’t be vaccinated or for whom the vaccine didn’t work, experts say.

According to the CDC, vaccination rates for children ages 19 to 35 months were at or above 90 percent for many illnesses, including polio; measles, mumps and rubella (MMR); and hepatitis B. Fewer than 1 percent of children received no vaccines. Vaccination rates for teens are significantly lower but increasing, the CDC found.

Although overall refusal rates may be low, they vary widely by location. In Washington state, for example, the rate of nonmedical exemptions from school vaccination requirements was 6 percent in 2007, with one county recording a 27 percent refusal rate.

Under the Affordable Care Act, starting last fall vaccines that are recommended by the CDC’s Advisory Committee on Immunization Practices must be provided at no chargeto people in new health plans.

Melissa Henriksen says she would be thrilled to encounter a doctor who took a proactive stance on vaccines, but the Charlottesville practice where she takes her 5-year-old daughter, Jaya, has no such requirement.

Noting that there was a recent measles outbreak in the city, she says, “I feel like these parents don’t get it: It is your own decision [whether to vaccinate], but there is a consequence for your community.”

An assistant professor of biology at the University of Virginia, Henriksen conducts cancer research using human cells. She occasionally has encountered undergrads who wanted to work in her lab but hadn’t been immunized against hepatitis B, which they might contract working with the cells. When she suggests getting the shot, they decline, often citing their parents’ concern about vaccinations.

States require that children be vaccinated before attending school, but in 2008, 48 states allowed parents to sidestep the requirement for religious reasons, and 21 states permitted exemptions for philosophical or personal reasons, according to a studypublished in the New England Journal of Medicine. (All states permit exemptions for medical reasons.)

Parents may have concerns about vaccines, says Douglas Diekema, a professor of pediatrics at the University of Washington School of Medicine. But in general, “they don’t have a strong philosophical objection.”

And that’s where the AAP thinks pediatricians can make a difference: by addressing parents’ concerns and educating them about the importance of vaccines. Ideally, that will convince them to go forward.

But even if it doesn’t, pediatricians shouldn’t turn them away, says the AAP. “If the goal is to get children vaccinated, you don’t accomplish that by asking them to leave the practice,” says Diekema, the lead author of the AAP policy statement.

Nor is Diekema persuaded by the waiting-room argument: “Presumably these kids will get treated somewhere,” he says. “Maybe you’re keeping your own waiting room clean, but you’re not preventing the spread of disease.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Although children can be exempted from the school vaccination requirements for medical, religious or personal reasons, obtaining a certificate of exemption has become more difficult under a new law that went into effect July 22nd.

In the past, a parent or guardian could obtain a certificate allowing a child to enter school without the required vaccinations simply by signing a form.

Under the new law, parents must get information from their health care provider about immunizations. The health care provider must then sign a Certificate of Exemption form for most types of exemptions.

But health officials warn that vaccination are advisable especially after recent outbreaks of vaccine-preventable diseases such as whooping cough and measles.

All recommended vaccines for children under 19 are provided at no-cost through Washington’s Childhood Vaccine Program, Department of Health officials note.

Health care providers may charge an office visit or administration fee, but this can also be waived for those who cannot pay.

To learn more:

• For information about the form and the new law (www.doh.wa.gov/cfh/Immunize/default.htm).

• For help finding a health care provider or an immunization clinic, go to the Department of Healths health agency locator (www.doh.wa.gov/LHJMap/LHJMap.htm) or the WithinReach (www.withinreachwa.org)

• Or call the Family Health Hotline at 1-800-322-2588.

According to the new report, kindergarten coverage in Washington State for required vaccines (including polio, whooping cough, measles, hepatitis B, and chickenpox) ranged from 88 percent to 93 percent, below the state and national goal of  95 percent or higher for all vaccines.

One reason for Washington’s poor showing, health officials said, is that the state’s high vaccine exemption rate, with 6.2 percent of children entering kindergarten having been opted out of one or more vaccines by their parents — the highest exemption rate in the nation.

Other states with high opt-out rates were Oregon (5.4 percent) and Vermont (5.8 percent).

All told, vaccine exemptions were obtained for 5,015 kindergarteners in Washington State.

Until this year, obtaining an exemption in Washington state was relatively easy. All a parent or guardian had to do is sign a certificate to exempt a child from one or more vaccines and the child could enter school unvaccinated.

According to the CDC, almost all of the exemptions in Washington were for non-medical reasons, such as philosophical or religious objections to vaccinations.

Concern over the state’s low vaccination rate and recent outbreaks of vaccine-preventable diseases such as pertussis and measles prompted the State Legislature to pass a new law to make obtaining an exemption a bit harder.

Under new rules that go into effect July 22, parents or guardians who want to exempt their child from school or child care immunization requirements must first get information from a licensed health care provider about the benefits and risks of vaccinations.

The health provider must then sign a form or letter confirming that the parent got this information and the form must be turned in to the school or child care.

Washington state health officials hope the new requirements will encourage more parents to have their children fully immunized and reduce the number of “convenience” exemptions, when parents turn in the exemption form rather than spend time gathering up the child’s immunization records.

The Washington State Department of Health notes:

• All recommended vaccines for kids under 19 are provided at no cost through the state’s Childhood Vaccine Program. Health care providers can charge an office visit or administration fee; this may be waived for those who are unable to pay.

• School nurses have access to Washington’s CHILD Profile Immunization Registry and can help parents turn in complete and accurate immunization records.

To learn more:

• For help finding a health care provider or an immunization clinic, contact the local health agency (www.doh.wa.gov/LHJMap/LHJMap.htm) in your community or call the Family Health Hotline at 1-800-322-2588.

• More read about the exemption rules go to www.doh.wa.gov/cfh/Immunize/schools/default.htm.

• For more about childhood immunizations in general go to: www.doh.wa.gov/cfh/Immunize.

Pneumonia and shingles vaccines are preventive-care essentials for older adults, and meningitis and tetanus shots are now college rites of passage.

Even the vaccines of childhood—measles, mumps and rubella, and whooping cough—are recommended for adults who missed out in their younger years.

Photo: James Gathany/CDC

Adult vaccinations should be part of all preventive care, but they are especially critical for people with chronic diseases such as diabetes, since flu and other illnesses can make routine medications less effective, throw off health goals such as stable blood sugar, and reduce a person’s ability to care for herself.

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Editor’s Note: Washington State health officials are urging adults and children to be vaccinated against whooping cough so that they don’t spread the infection to vulnerable children. To learn more read: Adults, teens urged to get whooping cough vaccine.

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For America’s growing population of older adults, vaccinations may head off potentially deadly disease complications—a bout of influenza leading to a trip to the hospital for pneumonia, for example.

Vaccinations can also be a good way to establish your medical home with a primary care provider, as a non-critical visit where you can discuss other preventive health goals and maybe ask questions about minor symptoms in a less urgent setting.

But for adults without a regular doctor, immunizations are one of the few preventive care tools widely available through public clinics, drugstores and community vaccination drives.

Who Gets What?

Let’s start with the flu. Seasonal influenza vaccinations are a must for all adults, since the major strain of flu changes from year to year.

No one likes to get the flu, but for some, catching it means more than a bad week in bed. Nancy Nally has lupus with complications that include seizures.

“The only seizure that I have had since starting medication was because I was running a fever from having the flu,” says the 38-year old mother. “The fever, although not extremely high, was enough to cause a seizure despite the anti-seizure medications that I take.”

Nally also gets the annual shot to reduce the chance that her elementary school daughter, who has autism, will get sick.

It’s enough of a reason for television producer John Z. Wetmore as well: “I have elderly relatives who could be in serious trouble if I caught the flu and passed it on to them,” he said.

Another vaccination recommended for all adults is the tetanus shot, which should be given every ten years. Margaret Lewin, M.D., medical director of Cinergy Health and a vaccination expert, recommends more frequent tetanus shots for her patients who rock-climb or enjoy other sports where skin-penetrating injuries are common.

“If they get the shot every five years, we might be able to save them a trip to the emergency room,” she explains.

Annual pneumonia vaccinations are important for those 65 and older, along with people who have underlying heart, lung or immune disorders.

For adults over 60, Dr. Lewin also recommends a shingles vaccine. Shingles is caused by a reactivated chicken pox virus, and can be “devastatingly painful,” she says. “It’s never very hard to talk someone into getting a shot for shingles, if they know someone who has had the disease.”

Some vaccines are recommended mostly to special groups of adults. College students and soldiers bunking in dorms and barracks should receive meningitis vaccinations, since the close- quarters living makes them prone to potentially deadly outbreaks.

Hepatitis B vaccines are recommended for all sexually active adults, emergency personnel, health care workers and those who work with small children. The new vaccine against cervical cancer is now widely offered to young girls and women. And international travelers may need to get shots for yellow fever, typhoid, hepatitis A and polio, depending on their destination.

One of the newest frontiers in adult immunizations is also the oldest—the alphabet soup of childhood vaccinations such as Tdap and MMR that protect against diphtheria, whooping cough, measles, mumps and rubella. If you never received these vaccinations as a child, or even if you did, it might be worth another…ahem…shot.

“Most people are not aware that childhood vaccines and boosters may lose effectiveness by the time adults reach 30 years of age,” Dr. Kaminetsky says. A simple blood test can determine whether your body still has antibodies against these diseases.

In some places where childhood vaccinations are spotty, diseases like whooping cough are “back with a vengeance,” Lewin said. “I’ve seen adults with horrendous coughs that last six to eight weeks.”

The vaccine for another formerly widespread childhood disease—chicken pox, or varicella—has been available only since 1995, so many adults may have missed out.

The disease has worse symptoms in adults than in children, and can be very dangerous for pregnant women

Why Won’t You Get Vaccinated?

I don’t like needles.

Amy Baxter is a pain researcher and CEO of MMJ Labs, a company that markets a device to reduce the pain of injections.

The product was developed with mostly children in mind, but she says “needlephobia” is also “a big deal” among adults.

Varicella (Chickenpox) Virus

She works in an emergency department, “so I’d be crazy not to get my shots,” she says. “In a geriatric population, who you think would be over it by then, 3 to 6 percent cite needlephobia as their reason for not getting their flu shots.”

The shot will make me sick.

Pulmonologist and lung disease expert Dr. Mark Williams says this is the most common objection he hears when he brings up flu immunizations with his patients. “They say, ‘Every time I get the flu shot I get sick.’ Some people might get a mild, flu-like reaction, but you don’t really get flu from a flu shot.”

Lewin agrees, saying the shots are safe for the majority of people with normal immune systems. “Most vaccines are dead, dead, dead, and you can’t catch the disease from them.”

Lewin and Williams say they don’t hear as many concerns about the safety of vaccines and their additives from their adult patients, a common and controversial concern with childhood vaccines.

“But it’s important for providers to educate,” said Williams “There have been huge, well-done studies that have discounted most of the speculation of vaccine safety. We need to talk about data and facts rather than conjecture.”

I can’t afford these vaccines.

Williams works in a veterans’ hospital, where, he says, “We think of vaccinations as sort of another vital sign, along with taking your temperature and blood pressure when you come in.”

But this isn’t always the case: “We’d like to get the shingles immunization, but our doctor does not give it,” said Linda Carlson, who works in marketing for a parenting magazine. “The only source for this expensive vaccine is drugstores. And our insurance provider will not cover shots given in the drugstore.”

For people who aren’t covered by a Medicare D prescription plan or private insurance, the one-time vaccine can cost between $200 and $300.

Not all insurance plans routinely cover adult vaccinations as part of preventive care, and some physicians may not carry certain vaccines if they don’t feel there will be a demand for them.

In some cases, as was illustrated by the H1N1 vaccination push in 2009, the vaccines themselves might be in short supply (although now, in 2010, there is an over-supply of H1N1 vaccine).

I can’t find these vaccines.

Patient assistant programs sponsored by some pharmaceutical companies provide free vaccines to low-income and uninsured patients, if the patients apply for the program through their physicians.

Other options include county health departments and vaccination drives sponsored by a pharmaceutical or drugstore chain. The national Immunization Action Coalition Web site (www.immunize.org) mostly aimed at health professionals, also contains “shot finder” searches.

It’s not that big of a deal.

Williams hears this one a lot, and he’s ready with his story. He missed his seasonal flu shot one year and “Boy, did I pay for it,” he says. “I had a severe case of influenza in February and ruptured a disc in my neck from coughing so hard.”

“People don’t realize how deadly this problem is,” he said. “We have 35,000 to 40,000 deaths each year from influenza and the bacterial pneumonia that can follow, and we believe this may be a gross underestimate.”

“I think that people who have seen people with these serious diseases like lockjaw, older people who knew someone who had shingles, know what they are getting vaccinated against,” said Lewin. “Most of us haven’t seen someone go deaf from measles, or infertile from mumps, or lose a pregnancy with German measles. We take for granted the protections we have.”

If you’re wondering whether your own vaccinations are up to date, the best place to start is with your primary care doctor.

Gather your medical records related to any vaccination you’ve had as a child or adult, and use those as a guide when you have the conversation with your physician.

Remember that any vaccinations you’ve received outside of your doctor’s office—a flu shot at the library, or a measles shot at school—won’t be part of your primary care record unless you carry or arrange to have this information sent to your physician.

Don’t forget to tell your doctor about any special circumstances that could affect your vaccination needs, including your work, your recreation, and your travel plans.

Recommended Vaccinations for Adults

The Advisory Committee on Immunization Practices, which provides guidance on vaccination for children and adults in the United States, publishes a regular update on adult immunization schedules and doses. Are you covered?

Check out the latest recommendations, including special information for international travelers, on the Centers for Disease Control and Prevention’s Vaccines and Immunizations Website.

Local Resources:

• Immunization Action Coalition of Washington: www.immunizewa.org‘

• Washington State Department of Health Immunization Program: www.doh.wa.gov/cfh/immunize

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Washington state children who have not been fully immunized have fallen ill in recent whooping cough and chickenpox outbreaks, they note.

School requirements for this fall

This fall, all students entering kindergarten through twelfth grade will be required to show proof of :

• three doses of hepatitis B vaccine,

• an age-appropriate series of diphtheria, tetanus, and pertussis-containing vaccines (DTaP, pediatric DT, adult Td, or Tdap) and polio vaccine,

• and two doses of MMR (measles, mumps, and rubella) vaccine.

For a complete list of the immunization schedule, visit: www.kingcounty.gov/health/immunization

Parents and guardians are advised to check with your clinic or health care provider to get the vaccines your child may need for school this fall and to bring your children’s shot records to all clinics, officials said.

Adults and teens need to make sure they’ve received their recommended immunizations as well, said said Betsy Hubbard, Public Health’s Immunization Supervisor.

“Whether you’re a parent or guardian enrolling your child in school, a student entering college, a health care worker, or an adult who likes to travel, you should be regularly checking to see if your immunization records are up to date,” Hubbard said.

Risks in not vaccinating

Although it is possible to ask for an exemption based on medical, religious or philosophical reasons, going without immunizations increases the risk of contracting vaccine-preventable diseases, which can be dangerous, health officials warned.

In addition, children who are not fully immunized may be excluded from attending school or childcare during an outbreak.

To exempt their child from receiving vaccines required for school entry, parents or legal guardians must complete and sign the separate Certificate of Exemption Status form.