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Sue Gimpel and Lisa Dubois are both mothers of three.

They want what?s best for their children, which is why one mom will be vaccinating her children against the swine flu virus and the other mom will not.

Their decisions illustrate the concerns many parents have about the vaccine for swine flu, also known as H1N1, and about vaccinations in general.

In the North Bay, which has some of the highest rates of non-immunized children in California, the swine flu vaccine taps into fears that such inoculations pose health risks beyond the disease for which it is being administered.

Public health and school officials are ramping up their outreach efforts to counter such concerns, asserting that declining to vaccinate a child could expose them to swine flu and even the risk of dying.

Those risks were underscored in August when a 14-year-old El Molino High School student from Graton died after becoming ill with swine flu. He was the sixth Sonoma County resident to die after contracting the disease.

Dubois, who lives in Hidden Valley Lake in Lake County, said she will be giving her youngest ? Isabella, 6, and Zachary, 5 ? the swine flu vaccination just as she has given them flu shots every year that they were available. The kids also are fully immunized against childhood diseases such as measles.

?Anything can go wrong with any kind of shot,? said Dubois, an administrative assistant in a realty firm. ?But if my pediatrician, who I?ve been with for 17 years, says this is what?s best for the kids, then we go for it.?

Dr. Fred Brewer, a pediatrician with Sutter Medical Group of the Redwoods, said many parents had been comfortable skipping yearly flu shots for their kids in the belief?that the odds of?contracting the disease were relatively low.

That?s changed, he said, with?predictions that as much as 60 percent of the U.S. population could contract the flu this year. ?They say, ?Let?s get the shot,?? he said.

Brewer, whose diagnosis of swine flu in a 10-year-old?boy was confirmed by test results on Monday, said he tells parents the vaccine is safe.

?If you could avoid being sick for a week ... with a shot, would you do it?" he asked rhetorically.

But Gimpel, a full-time Sebastopol mom, said she won?t give the vaccine to her two youngest, 15-year-old Tori and 10-year-old Jake, fearing it poses more risk than the actual flu virus.

?I feel that I?m exposing them to a potentially fatal disease or chronic illness by giving them the vaccination,? she said. ?We all take our chances in life and there are many risks, but to actually impose it (the vaccine) is very different.?

Gimpel?s son is a student at Sebastopol Independent Charter School, where 75 percent of kindergartners last fall were exempted by their parents from receiving vaccinations. That?s second in Sonoma County to Sunridge Charter, also in Sebastopol, and nearly 40 times greater than the statewide exemption rate of 1.9 percent.

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 0.6 points over the same period.

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

Gimpel?s children never have had a vaccination other than getting shots for tetanus. She said all three got chicken pox and the entire family, with the exception of her husband, Ralph, came down with whooping cough in 2000. But otherwise, she said the kids have been relatively healthy.

She said the choice not to vaccinate comes down to her concern that such inoculations contain ?toxins? that stress a person?s immune system and can result in chronic disease, such as multiple sclerosis, chronic fatigue syndrome or autism.

She said public health officials ?still haven?t gotten to the source of these illnesses, and yet we continue to inject our babies with known neuropathogens. We have to wake up here.?

Many studies have, however, debunked an alleged link between autism and the measles, mumps and rubella vaccine reported in 1998. Much of the concern with that vaccine centered on the preservative thimerosol, which has not been a part of the formulation since 2001.

Complicating matters for both vaccine skeptics and supporters is the fact some formulations of the swine flu vaccine are expected to contain a small amount of thimerosol to prevent contamination during manufacture and shipment.

Dr. Mark Netherda, deputy county public health officer, said officials with the federal Centers for Disease Control and Prevention told him in a conference call last week that there should be enough thimerosol-free flu vaccines available for all children under 3 and pregnant women.

Netherda said that, with or without thimerosol, he considers vaccines to be safe.

?I?m a parent, too,? he said. ?People worry about vaccines, but they are like seat belts. You, the parent, have the complete ability to control this life-saving measure.?

Skeptics of the swine flu vaccine also raise alarm over adjuvants that can be used in the formulation to boost potency. While this translates into fewer shots for individuals and increased vaccine supplies, some worry that such substances can cause an autoimmune disease, such as rheumatoid arthritis, in which the immune system attacks the body?s own tissues.

To address such concerns, federal officials have decided against using swine flu vaccines with adjuvants.

That doesn?t satisfy Gimpel, who said if one of her children was to become ill from a vaccine, the government would not help.

?Doctors and public health may say, ?Yes,? but who takes care of the child who is sick and dies? Who repairs that?

?It?s the parent,? she said.

School officials are caught in the middle of the debate, wanting to prevent flu outbreaks on campus while remaining sensitive to parents? ? and perhaps their own ? concerns about vaccines.

Susan Olson, executive director at Sebastopol Independent school, said her staff is taking measures to try to limit the flu on campus, including asking kids to wash their hands more often and asking their parents to keep them home if they become sick.

She said it?s not her place to recommend whether children should be vaccinated, however. ?I?m an educator, not a doctor,? she said.

Public health officials say they are concerned about a higher risk for an outbreak of swine flu on campuses where fewer students are vaccinated. But Olson said she?s not overly worried.

?We have two campuses of 260 kids,? she said. ?It?s not like we have thousands of kids squooshed together in an auditorium every week. So I?m not really worried about contagion more than usual.?

Other school officials apparently are more concerned, judging by the number of parents who?ve been requested to get clearance notes from a health professional before an ill child is allowed to return to school.

Such requests have been pouring into public health clinics in Petaluma and southwest Santa Rosa, prompting county schools chief Carl Wong to send a message to all 179 principals and 40 superintendents telling them there is no legal basis for the notes and urging administrators to follow previously released guidelines for dealing with the flu.

These include asking parents to not bring their kids back to school until they have been fever-free for at least 24 hours.

Wong said administrators will monitor absenteeism rates as the flu season unfolds for evidence of any major outbreaks. He said there was no significant increase in absenteeism at El Molino after the death of the 14-year-old, who officials said had underlying health problems in addition to the swine flu.

?We are all becoming better educated,? Wong said. ?We are now understanding that the H1N1 virus is so pervasive that it?s going to be comparable to the general flu, and that the way we address it is no different than the flu season in previous years.?

Wong said he supports any prevention measure that includes vaccinations, but that he ?respects? a parent?s decision to forgo the shots.

Netherda said the swine flu vaccine is being formulated like other flu vaccines that have been safely used for decades, and that each year the seasonal flu vaccine is modified to include what infectious-disease specialists predict will be the three most dominant strains of flu circulating in the coming flu season.

Although the 2009 version of the swine flu virus is new, Netherda said it has the same basic structure and biology as other flu viruses.

?There is no reason to believe that a vaccine made from this virus will cause more problems than other flu vaccines, which have been shown, year after year, to be effective and safe,? he said.

Health officials say what?s different this year is that children, young adults and pregnant women who catch the new flu run a greater risk than the elderly of developing complications ? a reversal from previous seasons and hence the reason why prevention efforts include a ramped-up focus on kids.

?I?m certain we?ll have more deaths,? Netherda said. ?Whether those will be in children or not we don?t know.?

It?s a risk Dubois believes warrants giving her kids the vaccination.

?You hope that they?re not sorry when it?s too late,? she said of parents who forgo the shots. ?They have their beliefs. We have ours.?

You can reach Staff Writer Derek J. Moore at 521-5336 or derek.moore@pressdemocrat.com.

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