Backlash builds on North Coast amid measles outbreak

For the sake of her 3-year-old, leukemia-stricken daughter, Yve Duran is appealing to her Sebastopol neighbors to reconsider their views against vaccinating their children against measles.

When two cases of measles were documented last month in Marin County, Duran took her younger daughter, Elliot, from preschool on the campus of a Sebastopol elementary school. Now she worries that Elliot - who is vaccinated but is more vulnerable due to her treatment for leukemia - will contract measles, one of the most contagious of all infectious diseases, in a park or at a grocery store. She sometimes puts a mask over the girl’s mouth and nose when they go out.

“There are children (like Elliot) in the community who are relying on the people around them to keep them safe,” Duran said. “It’s very real to me.”

Duran’s plea comes as the debate over state-mandated vaccinations reaches into presidential politics and into homes throughout Sonoma County and the greater North Coast. It has prompted a growing campaign - including new legislation - in favor of childhood vaccinations that health officials say are a critical public safety tool.

The measles outbreak that began in mid-December at Disneyland and has reached 107 cases statewide, spreading as far north as Marin County, has also prompted a vocal backlash against parents who do not vaccinate their children for various reasons, including personal and religious beliefs or overriding medical considerations.

Critics fault them as people who put their own interests above the public’s welfare, while their defenders, including Kentucky Sen. Rand Paul, a presumptive candidate for president, say the so-called anti-vaxxers are asserting their right to make critical decisions regarding their children.

Tara Howley of Sebastopol, whose two daughters are not immunized against measles, defended others who make the same choice.

Her daughters have autoimmune disorders that could cause an adverse reaction to the vaccine, she said.

“I actually think it’s healthy for children to get childhood diseases,” Howley said, thereby gaining lifetime immunity without the potentially negative side-effects of vaccines.

Other parents she knows who have steered away from vaccination are lawyers, physicians and other professionals who have studied the issue, she said.

“They’re not screwballs,” Howley said.

Sonoma County has for years had pockets of people who decline to vaccinate their kids. The latest state data, however, shows that as many as 36 schools from across the county have vaccination rates for measles below the level needed to protect the general population. At some schools, the vaccination rate for measles is half that level.

Local physicians say it’s likely only a matter of time before a measles case hits this year in Sonoma County, and health officials say they are worried about the prospect of the illness running rampant in schools and surrounding communities with low levels of vaccination.

“I am concerned there are clusters of people who choose not to vaccinate (their children),” said Dr. Karen Holbrook, the county’s deputy health officer.

Overall, Sonoma County public and private schools posted a 91.48 percent kindergarten immunization rate this year, just below the statewide rate of 92.55 percent.

The county rate is sufficient “to prevent widespread illness,” Holbrook said, adding that she would prefer to see a rate in the mid-90s.

Schools in western Sonoma County, particularly, rank among the lowest for measles vaccination rates. In Sebastopol and Occidental, for example, a total of four schools reported immunization rates of roughly 23 to 58 percent - far from the 90 percent threshold that indicates protection for the population at large, a concept known as “herd immunity.”

Sebastopol Independent Charter School, with 10 of 44 kindergartners immunized against measles, had the lowest rate - 22.7 percent - among 111 county schools included in a California Department of Public Health report on kindergartners who enrolled last fall.

Orchard View School, an independent study charter school in Sebastopol, had a 25 percent immunization rate; Live Oak Charter School in Petaluma reported a rate of 33.3 percent; SunRidge Charter School in Sebastopol recorded a rate of 38.6 percent; and Pathways Charter School in Rohnert Park had a rate of 50 percent.

Summerfield Waldorf School and Farm, a private school located west of Santa Rosa, had 57.8 percent immunization, and Harmony Elementary School in Occidental had the lowest rate among public, non-charter schools at 62.5 percent.

State law allows parents to opt out of vaccinating their children by filing a personal belief exemption, including a signed form from their physician. Exemptions also are granted for religious beliefs and medical reasons.

Holbrook said the measles outbreak is frustrating because the disease is preventable with the recommended two doses of vaccine between ages 1 and 6, which have a 97 percent effective rate.

The health officer said she understands the motivation of parents who opt out of vaccinations. “They are concerned about safety and they want what’s best for their kids,” she said.

But numerous studies have discounted the often-alleged link between the measles vaccine and autism, and serious side-effects from it are rare, Holbrook said. “The risk-benefit analysis easily supports vaccinations.”

A disease that used to kill 400 to 500 Americans every year, measles is now making an apparent comeback after being eliminated in the U.S. a half-century ago, following the introduction of a highly effective vaccine in the early 1960s.

Officials point to a dramatic spike in measles with 644 cases last year, after exceeding 100 cases only four times since 2001.

Public health officials point to studies that show a high rate of vaccination against measles serves to protect “isolated individuals” who lack immunity. At low levels, “you lose that protection,” Holbrook said, referring to the concept of a “free ride” for a minority of unvaccinated individuals, such as schoolchildren.

In western Sonoma County, the concentration of low measles immunization rates has Yve Duran worried because her daughter is “relying on folks around her for her immunity.”

Elliot’s risk is heightened by the chemotherapy treatment for her leukemia, which will last almost three years, crushing her body’s natural defenses - and the protection from her first measles vaccination - leaving her more vulnerable to both the disease and its complications, such an pneumonia and encephalitis, which can result in brain damage, hearing loss, mental retardation and death.

Yve Duran removed her daughter from a preschool on the campus of Apple Blossom School in Sebastopol, which has an 82.9 percent immunization rate, but left her older daughter, Roan, 5, at the school.

Apple Blossom is in the same district - Twin Hills Union - as Orchard View and SunRidge, which posted two of the county’s four lowest immunization rates.

Barbara Bickford, the Twin Hills superintendent, said she is concerned by those rates. “We prefer to have as many of our children immunized as possible,” she said.

Orchard View and SunRidge serve families “that are looking for alternatives to traditional elementary school programs,” she said. If parents submit the appropriate paperwork for a personal belief exemption, the district is required by law to enroll their children, Bickford said.

Chris Topham, executive director at Sebastopol Independent Charter School, said the school is neutral on the vaccination issue. “We’re really silent about it,” he said, noting that both of his children were vaccinated following the recommendation of their doctor.

Stephen Collins, superintendent of the Harmony Union School District in Occidental, said west county folks have “an independent view of the need for vaccinations.”

Collins said he personally believes vaccinations are important and supports a state law introduced last week that would repeal the personal belief exemption.

A Press Democrat online survey last week found that 64 percent of 683 respondents favor mandatory vaccinations for all children, 22 percent think it should be up to parents and 13 percent said only some vaccines should be mandatory. The survey was conducted on the newspaper’s website.

Students entering California public and private schools must be immunized against measles as well as polio, diphtheria, tetanus, pertussis (whooping cough), mumps, rubella, hepatitis B and varicella (chickenpox).

Howley, whose daughters attend the Sebastopol Independent Charter School, said she is not opposed to vaccines per se. After consulting several physicians over the girls’ autoimmune disorders, Howley said they jointly “had to make a really hard decision not to vaccinate.”

Both girls had whooping cough and “came through it just fine,” Howley said last week on the downtown Sebastopol campus. If a measles case occurred at school, Howley said she would keep her daughters at home, if warranted.

School and public health officials can together order unvaccinated kids to stay home for up to 21 days in the event of a measles exposure at their school.

Rebecca McLeod-Waldo, another Sebastopol Independent Charter School parent, said her four children have all the required vaccinations except for varicella.

“I believe in the herd immunity,” said McLeod-Waldo, a nurse-midwife. “I think there are people out there who can’t get vaccinated and are compromised. I feel a duty to help protect them.”

The choice is a “tough one” for parents, she said, also suggesting that some opposition to vaccinations is based on “anecdotes, not science.”

“Go to an old cemetery from the 1800s and tell me what you see,” McLeod-Waldo said. “Rows of gravestones for kids who died in epidemics.”

In the North Bay region, Sonoma County had the third-highest measles immunization rate, trailing Napa at 94.74 percent and Lake at 92.19 percent. Marin County’s rate for current kindergartners is 88.03 percent, followed by Mendocino at 83.38 percent.

Nevada County is the lowest statewide, at 73.54 percent. The county had just 628 enrolling kindergartners last fall, according to the state report.

Among Sonoma County schools, 21 - nearly one in five - reported 100 percent measles vaccination, including all four schools in the Roseland School District with a combined total of 318 kindergartners.

“I don’t have an answer,” Roseland Superintendent Amy Jones-Kerr said, when asked about the reason for the perfect numbers. The district makes no special effort in that regard, she said.

“I guess our families are just doing what they feel is right for the child,” Jones-Kerr said. Roseland district’s student body is 91 percent Latino, compared with 43 percent countywide.

Also in the 100 percent group was Sonoma Country Day School, which charges $21,950 annual tuition for elementary grades, with 30 percent of students receiving tuition assistance, according to the school’s website.

Dr. Fred Drach, an infectious disease specialist with Annadel Medical Group in Santa Rosa, said measles “probably will” reach Sonoma County. “All it would take is someone coming into west county with active measles,” he said.

Drach said there is no good reason to avoid the vaccine, except for people whose immune systems are compromised, for example by leukemia or an organ transplant.

Last year’s spike in measles nationwide, followed by the Disneyland-based outbreak in California, could be a warning that the once-prevalent disease - which sickened 500,000 and killed nearly 500 people a year in the 1950s - could be “rearing its head” due to low vaccination levels in some areas, Drach said.

The vaccine was introduced in 1963, and in 2000 measles was eliminated in the United States, meaning it was no longer circulating in the population here.

But the nation remains vulnerable to the measles virus brought in by visitors or by Americans who have traveled abroad. Worldwide, about 20 million people a year get measles and 146,000 die, an average of 17 deaths an hour, according to the Centers for Disease Control and Prevention.

News Researcher Janet Balicki contributed to this report.

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