To immunize or not?

A declining level of vaccinations among Sonoma County children worries public health officials who say the risk of a serious outbreak of an infectious disease is growing — and must be stopped.

The county’s rate of student exemption from the federal standard for childhood vaccinations is six times higher than the national rate and three times higher than the state average. And the gap is widening rapidly.

But some parents and physicians are challenging the federal standard, which prescribes about 35 doses of 14 different vaccines in the first 18 months, contending it may not be the best medicine.

The tension over a medical decision that all parents must make while their children are in diapers also reflects an underlying conflict between individual rights versus state regulation at a time when both medical technology and government policy are increasingly challenged.

“It was a heart-wrenching decision,” said Patricia Bernard of Sebastopol, who chose to forgo all vaccinations for her daughter, Brigitte, now 11.

The issue is charged on both sides.

“We are turning back the clock to a time when children did not have protection,” said Dr. Mary Maddux-Gonzalez, Sonoma County’s public health officer. “We have to reverse this trend.”

Some physicians, however, are sympathetic to their patients’ concerns about repeatedly dosing infants with vaccines against measles, mumps, whooping cough, diphtheria, influenza and other diseases.

“There are people in our community who think vaccines are poison,” said Dr. Tory Davis, a family practice doctor in Occidental.

Davis believes vaccines are safe but said the dosing schedule can be extended, with some inoculations postponed, at “almost no risk.”

The percentage of fully immunized students entering Sonoma County kindergarten classes has steadily dipped from 91.6 percent in 2002 to 87.7 percent last fall, according to state records. The statewide average is down by only 0.6 points over the same period.

Roughly half of this year’s kindergartners who are not fully vaccinated have exemptions that cover all diseases. The other half are missing some vaccinations.

The county’s nearly 4-point drop in the vaccination rate might seem small, but officials say it comes close to the level — about 85 percent — at which “herd immunization,” the safety in numbers from widespread inoculation, breaks down.

In nine county school districts, six of them in the west county, the percentage of fully immunized kindergartners is below 80 percent, a Public Health Department analysis said. The figures exclude private schools.

At six North Bay schools, all charter or private schools, more than half the families had received exemptions from the required vaccination regimen. Such concentrations of partially immunized or unimmunized students pose “a significant risk of an outbreak of a vaccine-preventable disease,” Maddux-Gonzalez said.

State law allows parents, by merely signing a waiver form, to gain exemption from the vaccinations required to enter kindergarten at public and private schools.

At Sunridge Charter School in Sebastopol, 25 out of 33 kindergartners, or 76 percent, had exemptions last fall, the highest rate in the North Bay — and fifth highest in the state.

Brigitte Bernard is a fifth-grader at Sunridge, and her mother said she’s not concerned about an elevated risk of disease there.

“It seemed like I would be putting her at more risk to immunize her,” Patricia Bernard said she concluded after researching immunization. “I believe in free choice, especially when it comes to the health of our children.”

A healthy diet, mostly vegetarian and organic with minimal refined sugar, and healthy lifestyle — her daughter doesn’t surf the Internet, play video games or watch TV — are the best defense against disease, Bernard said.

Nonetheless, Bernard said it’s tough to buck the mainstream, with the government and medical establishment backing immunization, compounded by criticism from relatives who said she was “putting my daughter’s life in danger.”

Public health officials cite an outbreak of 12 measles cases last year in San Diego, triggered by an unvaccinated 7-year-old boy who acquired the disease on a trip to Switzerland. Eight of the 11 other infected children were unvaccinated due to exemptions.

Measles is making a comeback, Maddux-Gonzalez noted, with an average of 63 cases a year nationwide from 2000 to 2007, followed by 131 cases in the first seven months of 2008. A child died of whooping cough in Sonoma County in 2007: Davis called that disease — a nuisance for adults but often deadly to infants under six months — a “huge threat in our community.”

Two widely publicized objections to immunization have been eliminated, Maddux-Gonzalez said. An alleged link between autism and the measles, mumps and rubella vaccine reported in 1998 has been debunked, and mercury has been removed from all pediatric immunizations, except some flu vaccines, she said.

Mark Rice, Sunridge director, said he shares the public health concern about a possible outbreak of disease. “But the choice not to inoculate is entirely a parent’s,” he said in an e-mail message.

Carl Wong, county schools superintendent, said he is disturbed by the trend to avoid or delay immunizations for children who spend school days close together, an environment ripe for transmitting communicable disease.

“That action puts other children at risk,” Wong said, referring to the exemptions.

He and Maddux-Gonzalez advocate a change in the vaccination waiver law, perhaps requiring parents to take a class before gaining the exemption to ensure it is “more of an informed decision.”

Dr. Carlisle Holland, a Sebastopol osteopath, defended parental choice. “Vaccination is not benign,” he said, describing it as “an insult to the immune system” intended to strengthen its resistance to disease.

“I don’t think that parents who refuse vaccinations altogether are crazy,” he said.

Generally, Holland said, families and physicians should determine which vaccinations each child needs and when they should be administered. “Trying to make one size fit all (through the standard inoculation schedule) is lousy medicine,” he said.

Dr. Mark Netherda, deputy county public health officer, rejected the idea that people can pick and chose the vaccinations they want.

“You wouldn’t wear a seat belt half of the time,” he said.

Davis, whose Occidental Area Health Center practice includes plenty of vaccination skeptics and opponents, said she tries to meet them halfway.

“Maybe it’s misinformed, maybe it differs from the western medical model, but it doesn’t help to ostracize these people,” she said. “You’re not going to win people over just by telling them they’re wrong.”

You can reach Staff Writer Guy Kovner at 521-5457 or guy.kovner@pressdemocrat.com.

Of the 10 school districts in Sonoma County with the lowest kindergarten vaccination rates, eight are in the west county. Percentage figures represent kindergartners who have received all their required vaccinations.

Twin Hills Union Elementary, 55.66%

Sebastopol Union Elementary, 58.93%

Harmony Union Elementary, 67.65%

West Side Union Elementary, 68.12%

Gravenstein Union Elementary, 71.92%

Liberty Elementary, 73.17%

Windsor Unified, 76.11%

Guerneville Elementary, 77.88%

Forestville Union Elementary, 79.46%

Two Rock Union Elementary, 84.04%

Petaluma City Elementary, 86.26%

Geyserville Unified, 88%

Dunham Elementary, 88.89%

Oak Grove Union Elementary, 89.10%

Wilmar Union Elementary, 89.66%

Cinnabar Elementary, 89.69%

Santa Rosa Elementary, 89.73%

Bennett Valley Union Elementary, 91.71%

Mark West Union Elementary, 91.74%

Healdsburg Unified, 92.45%

Rincon Valley Union Elementary, 92.60%

Bellevue Union Elementary, 92.68%

Sonoma Valley Unified, 93.68%

Roseland Elementary, 94.08%

Piner-Olivet Union Elementary, 94.49%

Waugh Elementary, 95.52%

Cloverdale Unified, 95.70%

Wright Elementary, 96.15%

Cotati-Rohnert Park Unified, 96.54%

Old Adobe Union Elementary, 97.82%

These are the 20 schools in Sonoma County with the highest number of kindergartners last fall whose parents had received exemptions from all vaccination requirements. Statewide, 1.9 percent of kindergartners had been exempted.

Sunridge Charter, Sebastopol, 25 of 33 kindergartners —76%

Sebastopol Independent Charter, Sebastopol, 33 of 44 —75%

Orchard View, Sebastopol, 8 of 12 —67%

Summerfield Waldorf, Santa Rosa, 17 of 31 —55%

Village Charter, Santa Rosa, 9 of 17 —53%

Pathways Charter, Santa Rosa, 12 of 28 —43%

California Virtual Academy At Sonoma, Petaluma, — 19 of 45 —42%

Live Oak Charter, Petaluma, 21 of 55 —38%

Harmony Elementary, Occidental, 8 of 25 —32%

Forestville Elementary, Forestville, 10 of 37,27%

West Side Elementary, Healdsburg, 6 of 24 —25%

Apple Blossom, Sebastopol, 19 of 78 —24%

Pine Crest Elementary, Sebastopol, 4 of 21 —19%

Brush Creek Montessori, Santa Rosa, 2 of 11 —18%

Woodland Star Charter, Sonoma, 6 of 34 —18%

Santa Rosa Charter School for the Arts, Santa Rosa, 7 of 41 —17%

Guerneville Elementary, Guerneville, 6 of 42 —14%

Park Side Elementary, Sebastopol, 8 of 59 —14%

Windsor Christian Schools, Windsor, 3 of 28 —11%

Oak Grove Elementary, Sebastopol, 5 of 48 —10%

Alexander Valley Elementary, Healdsburg, 2 of 22 —9%