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pertussis

Too many kids are not getting vaccinated

We let this happen, thanks to the fervor of a vocal minority.

The number of Texans who exempt their children from vaccination for non-medical reasons rose nearly 9 percent last school year, continuing a now 12-year-long trend that public health officials worry could eventually leave communities vulnerable to outbreaks of preventable diseases.

The new numbers represent a 19-fold increase since 2003, the first year that Texas law allowed parents to decline state immunization requirements for “reasons of conscience.” The number of such exemptions are still small, a little under 45,000 of the state’s roughly 5.5 million schoolchildren, but they’ve spiked from less than 3,000 that first year, according to the new state data.

“The trend is going in the wrong direction,” said Anna C. Dragsbaek, president and CEO of The Immunization Partnership, a pro-vaccine group. “It’s time for the community to step up and take action on this very troubling trend.”

Concern has picked up in recent years amid the re-emergence of diseases such as measles and whooping cough. A large measles outbreak last year, linked to an initial exposure at Disneyland in California, sparked particular distress.

Texas is one of 18 states that allows waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only two states – Mississippi and West Virginia – don’t grant exemptions from immunization requirements on religious grounds, and all states allow exemptions for medical conditions, such as a compromised immune system.

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Pushed by the Immunization Partnership, the 2015 Legislature considered a bill that would have required the Texas Department of State Health Services to post the exemption numbers of every school on its website.

Under the current law, the department is only required to post aggregate numbers for each school district.

The bill passed the House but died in the Senate. Dragsbaek, impressed at the traction the legislation got, said the partnership will push hard on behalf of any such bill again in 2017.

The bill to require school-specific information called for the inclusion of delinquency numbers, also a big problem. At HISD, for instance, more than 3 percent of children in 2015-2016 – who hadn’t obtained a conscientious exemption – had not received at least one of each vaccine by the district’s age-specified deadline. Enforcement of such deadlines is up to the principal.

“Eleven percent of HISD’s prekindergarten students hadn’t received their first dose of measles vaccine 90 days into the school year,” said Dr. Susan Wootton, a pediatrician at University of Texas Health Science Center at Houston who is leading an HISD task force on immunization delinquency. “That needs to be fixed. Nepal does better than that.”

Harris County’s overall conscientious exemption rate is still relatively low, just 0.62 percent, but it’s doubled in the last five years. So has Montgomery County’s, now 1.73 percent. Brazoria County has gone from 0.30 to 0.80. Gaines County in West Texas has the state’s highest conscientious exemption rate, nearly 5 percent.

That would be a worthwhile bill, but the real goal needs to be to eliminate the “personal belief” exemptions, which are an increasing threat to public health. Unfortunately, the pushback on that last session was ferocious, and that has emboldened the anti-vaxxers. I don’t know how much optimism I have about the school-specific information bill as a result. There are plenty of people who would like to see better vaccination laws, but the energy and organization is on the other side. It would help to get some leadership from, say, the Governor’s office, but he has none to offer, so the rest of us are on our own.

Anti-vaxxers gain ground in Texas

There’s a lesson in here that we need to learn.

On a Friday night little over a year ago, a Texas mother of three was attending a school dance when she got a text message that stopped her cold.

A state lawmaker from Dallas had filed legislation taking aim at a provision in state law that allows parents to opt their children out of school immunization requirements.

“I looked at that text and I just kind of was like, ‘Oh no he didn’t,’” said Jackie Schlegel-Polvado, who lives near Bastrop. “This is Texas. We believe in parental rights in Texas. Like, that is just a fundamental belief that most Texans have that parents make decisions for their children, not the state.”

It was an issue that directly affected Schlegel-Polvado and her family. Since 2007, she has been one of a small but growing number of parents in Texas who obtain “conscientious exemptions” from state vaccine requirements.

What was several worried parents exchanging text messages over the next few days turned into a Facebook group that within two weeks had more than 1,300 members, and then, ultimately, a political action committee.

Texans For Vaccine Choice’s mission, according to Schlegel-Polvado, is to guard parents’ rights to opt out of vaccine requirements — whether that means targeting legislators who seek to close non-medical exemptions or pushing for policies that otherwise protect parents who choose not to vaccinate, like preventing physicians from excluding them from their practices.

In this year’s primary elections, that meant going after state Rep. Jason Villalba, the Dallas Republican who filed the bill.

“The animus that was leveled against me for that was very surprising to me,” said Villalba, who ultimately won his race. “These people, they literally said it to my face — they hate me. That was troubling. Because I get it, they care about their children — but I care about my children too, and the children of the community.”

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State law requires that children at all public and private schools have 10 different immunizations, including for tetanus, measles and pertussis, the bacterial disease known as whooping cough. Generally, children must receive those vaccines by the time they are in kindergarten, though they receive others, like for hepatitis B, in later grades.

If parents wish to opt out of school immunization requirements, they must file a what’s known as a “conscientious exemption” form with their child’s school at the start of the year. All but two states — West Virginia and Mississippi — grant exemptions from school immunization requirements on religious grounds. Texas is among 18 that also waive requirements because of personal beliefs, according to the National Conference of State Legislatures.

Under Villalba’s initial measure, Texas would have only allowed students to receive exemptions for medical reasons, such as an allergic reaction or in instances where a weakened immune system could cause health complications.

Pediatricians — many of whom have watched with dismay as the number of parents choosing not to vaccinate their children has climbed — widely support the elimination of non-medical exemptions to immunization requirements.

[…]

During the 2015 legislative session, Villalba said he quickly became acquainted with the passion of the anti-vaccine movement’s supporters, many of whom believe the undue influence of pharmaceutical companies has led to an overabundance of immunization requirements that come at the expense of children’s health.

“This is a group that is very dedicated, very organized; this issue is very important to them,” he said.

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For now, the new organization’s strength appears to lie in its mobilizing abilities. A February campaign finance report showed just over $1,000 in contributions. And while its members made their presence felt in Villalba’s race, he still managed to win with 55 percent of the vote.

But Villalba said that without the engagement of the group, he would have expected his margin of victory to be larger.

It also may have accomplished a broader goal. The lawmaker said that for the 2017 legislative session, he does not plan to re-file his bill narrowing exemptions to the state’s vaccine requirements.

“I’m not interested in a suicide mission on this issue,” he said. “I sense — and this is unfortunate — the only way a bill like this gets any traction is an even worse large-scale outbreak, between now and session. Short of that I just don’t think there is going to be the appetite to do this bill.”

See here for some background. The lesson here is that intensity matters. A group of people that care passionately about a single issue and organizes around it can often get what they want in our political system, even if they’re a distinct minority. These anti-vaxxers are but one example; I’m sure you can think of many others. The number of unvaccinated children in Texas schools is still fairly small, less than one percent of the total, but it’s grown by more than ten times since 2004. This kind of idiocy is the reason why measles has made a big comeback in the US and around the world after being declared eradicated. I can’t blame Rep. Villalba, who was left hanging by Greg Abbott, for not wanting to deal with this crap next session. If the rest of us want someone else to pick up the ball on this, we’re going to need to make at least as much noise about it as these dangerous fanatics have done. Complaining about them is easy. Doing something about it is hard. It’s up to us.

Fighting pertussis

Sure hope these folks can make a lot of progress in their work.

Of the more than 30,000 children hospitalized with pertussis in the United States each year, 10 to 20 will die. Worldwide, pertussis infects more than 16 million and causes nearly 200,000 deaths a year.

“We need to come up with some therapeutic options,” [Dr. Mary Healy, a pediatric infectious disease specialist with Texas Children’s Hospital and Baylor College of Medicine] said. “We have very little to offer.”

That soon could change. Last month, a research team led by scientists from the University of Texas at Austin reported progress developing antibodies that could be used to combat pertussis infections in those too young to be vaccinated.

The work was led by Jessica Maynard, an associate professor of chemical engineering at UT, who previously had worked on an Ebola treatment

Pertussis is a bacterial infection that colonizes the lungs and secretes about 20 disease-causing compounds and toxins.

“We can’t really agree on which of them are the most important,” Maynard said. “But we think it’s the pertussis toxin, because it’s directly responsible for the increase in your white blood cell count.”

Those cells flood into the blood and can clog the lungs and other organs. Antibiotics can help clear the bacteria, but they do not affect the toxins that are doing all the damage. Researchers previously tried pulling various antibodies from vaccinated people and using those to treat infants, with little success.

Maynard’s team decided to focus on two antibodies that would bind tightly to the pertussis toxin and deactivate it. They cloned the antibodies to deliver them to infants in massive amounts.

“We’re really trying to go after the symptoms,” Maynard said.

In laboratory tests, the antibodies protected mice from being infected with pertussis, much like a vaccine. The researchers also tested the antibodies as a treatment in baboons that were sick with pertussis. The antibodies did not clear the bacteria, but they lowered white blood cell counts, speeding recovery.

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Widespread vaccination still is the key strategy in the United States for protecting infants.

The current vaccine is effective but imperfect. Immunity tends to wane after three years. And since the disease is less severe in older children and adults, siblings or parents of infants could be infected and not know it. They unknowingly can pass on the infection to vulnerable babies.

Public health experts advocate a strategy called cocooning, in which adults and adolescents who will be in contact with a baby get vaccinated at least two weeks earlier.

“Probably the most important thing you can do is vaccinate a pregnant woman in the third trimester of pregnancy,” Healy said. “The theory then is they won’t get pertussis and give it to the baby.”

You know how I feel about vaccinations. It’s more than a little scary to realize that I could have been a carrier and passed it on to one of my kids before they were old enough to be immunized. And while pertussis may be less severe in adults than in kids, it can still be really, really awful. So please, make sure your vaccinations are up to date. And send some happy thoughts to Dr. Maynard and her team.

Pertussis

Not good.

State health officials warn that Texas is on track to see the highest number of whooping cough cases it has registered in 50 years if occurrences of the disease continue at the current rate.

As of this week, Texas has reported 1,670 cases of pertussis, better known as whooping cough, to the Centers for Disease Control and Prevention. The Texas Department of State Health Services stresses that the disease is serious, especially in young children.

Two whooping cough deaths have been reported this year in the state – children too young to be vaccinated, according to the department’s website. Thirteen percent of the whooping cough cases have required hospitalizations, with almost all of them involving infants younger than 1 year old.

Babies are especially vulnerable to the infection because they don’t have full protection against it until they’re 6 months old, when they receive the last of three shots.

Dr. Robert Lapus, pediatric emergency services director at Children’s Memorial Hermann Hospital, said two infants suffering from whooping cough recently were admitted to the hospital. Both were younger than 6 months.

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The disease was common, with hundreds of thousands of cases reported annually, until the 1940s when the vaccine was introduced. For about 25 years, fewer than 5,000 cases were reported annually in the United States. The numbers started to climb again in the 1990s.

The Centers for Disease Control reports there were 159 whooping cough deaths in the United States from 2004 to 2011. Almost all the deaths – 141 of the 159 – were babies younger than 3 months old.

More than 41,000 cases were reported across the country in 2012, with 18 deaths. In Texas, there were 2,218 cases, with 159 in Harris County, 32 in Montgomery County, 12 in Fort Bend County and 10 in Galveston County.

As the story notes, low vaccination rates and higher infection rates are a national problem. As that CDC link suggests, the Affordable Care Act ought to help, since more people will be able to get primary care, which of course includes vaccinations. The bottom line is that we all need to be aware of these things. The vaccinations we got as kids don’t last forever. It’s a good idea to check and see what shots you may need now.