US measles outbreak raises questions about Sonoma County vaccination rates

Nineteen years after it was thought to be eradicated in this country, measles is making a comeback. Last week, the Centers for Disease Control and Prevention released a bombshell: The number of confirmed measles cases in the first three months of 2019 - 387 - exceeded by 15 the total number of cases nationwide the previous year.

While 17 of those cases this year were in California, none were reported in Sonoma County, though county health centers have been put on alert and are on the lookout for patients exhibiting symptoms of the highly contagious airborne disease.

“We've tested more than a few (patients) to rule out measles, and are following individuals that have been exposed to known cases,” said Dr. Karen Holbrook, the county's interim health officer.

Measles or no, parts of the county are renowned in infectious disease circles for other reasons. They are home to parents who mistrust mainstream medicine and still resist getting their young children vaccinated for measles and other diseases. A state health department list of the top 10 schools last year with the most unvaccinated kindergartners included four from Sonoma County.

And health experts are now so alarmed that the World Health Organization included “vaccine hesitancy” on its list of this year's “Top Ten Threats To Global Health.”

“How could that even be on that list?” said an incredulous Dr. Brian Prystowsky, a Santa Rosa pediatrician who considers it a “moral obligation” to vaccinate himself and his children. “I mean, it's 2019.”

States begin to take action

Four years ago, after an eight-state measles outbreak was spawned in Disneyland, California passed a law that made it the third state - after Mississippi and West Virginia - to ban the practice of citing personal or religious beliefs to secure a vaccine exemption for public and private school students.

It didn't take long for anti- vaccination California parents to use another loophole: finding a doctor - not necessarily a pediatrician, but any licensed physician - willing to exempt a child from having to get shots for a broad range of medical reasons.

“A medical exemption in itself is not a bad thing - if a child needs it,” said Catherine Flores-Martin of the California Immunization Coalition. “But there are some doctors writing hundreds of them.”

Local schools top list

Topping that list of the 10 California schools with students carrying the most exemptions from vaccinations is the Sebastopol Independent Charter School, with 58% of its kindergartners excused from shots. Checking in at No. 3 is SunRidge Charter School in Sebastopol, with 51%. Also making the top 10: No. 4 Live Oak Charter School in Petaluma at 43%, and the ninth-ranked Summerfield Waldorf School and Farm in Santa Rosa, at 35%.

Compare those figures to what Holbrook said for many years was the percentage of kindergartners statewide with vaccine exemptions: two-tenths of 1%.

“The infuriating part,” said Prystowsky, the Santa Rosa pediatrician with the Sutter Pacific Medical Foundation, “is that there are a few rogue physicians unethically administering medical exemptions for money. They've made a business of circumventing the law.”

Bills take on exemptions

That's likely to become much harder in the not-so-distant future. State Sen. Richard Pan, D-Sacramento, also a pediatrician, is the author of the state's 2015 vaccination law, which led to a spike in what he has called “fake medical exemptions.”

To remedy that, on March 26, Pan introduced a follow-up bill that would take medical exemptions out of the hands of individual doctors. If and when the bill becomes law, each exemption application would need to be reviewed by the state's public health department. If enacted, the measure likely won't take effect for another year or two.

Meanwhile, Prystowsky doesn't blame the directors of the local schools with large numbers of unvaccinated students. “It's not their fault. If a parent brings in a medical exemption, they're obligated to honor it,” the doctor said.

“I'm honestly not sure what they're basing their decisions on” to vaccinate or not, said Chris Topham, director of the Sebastopol Independent Charter school, “because we've been advised by legal counsel to stay out of that. It's a personal, medical decision. It's not for the school to bring an opinion. Just follow the law.”

Unforeseen consequences

The personal parental decision to not vaccinate a child, however, can have consequences beyond one's personal sphere.

“If there's an outbreak at school,” said Peter Hotez, a renowned infectious disease expert at the Baylor College of Medicine in Houston, “the way it takes off is that kids bring it home to their younger siblings, who may not be old enough to be vaccinated. And they're the ones who end up in the hospital.”

Once a community's collective or “herd immunity” dips under a certain threshold, that population becomes susceptible to an outbreak of a contagious disease like measles, medical experts said. When a large percentage of that community isn't vaccinated, said Holbrook, that can lay the groundwork for an outbreak “that hits not only those who choose not to be vaccinated, but those unable to be vaccinated” - because they're too young, elderly or immune-compromised.

That rings a loud bell for Lynda Hopkins, a Sonoma County supervisor with a daughter at Topham's Sebastopol charter school, which recently had a minor outbreak of pertussis, or whooping cough.

Even though her daughter was vaccinated, a doctor advised Hopkins to put the girl on a course of antibiotics to prevent her from bringing the pertussis home to her 3-month-old brother.

While that brush with whooping cough was too close for her comfort, Hopkins sees both sides of the issue.

“When you're a parent, your kid is also your life,” she said. “So when you perceive a threat, whether it's the threat of unvaccinated children causing you or your baby to get sick, or whether it's someone taking away what you see as a critical decision- making process as a parent, it's going to spark a lot of passion. And fear.”

Vaccine-hesitant parents

Hopkins represents west county, which includes both the Sebastopol Independent Charter and SunRidge schools, and the area has long been a hotbed of anti-vaccination sentiment.

“It's Northern California,” said Kalen Wood, director of the SunRidge school. “We have parents who are holistic, alternative practicioners, acupuncturists, homeopathists. There are a lot of ways to look at medical care.

“They're concerned about preservatives and mercury in the serum,” she said, speaking on behalf of those vaccine-hesitant parents. “Some have expressed that belief that vaccinations should be a choice, not something dictated” by the government.

Many SunRidge parents are alarmed, Wood said, by the sheer number of childhood vaccinations required, and the fact that the shots go directly into the bloodstream, “bypassing the body's natural immunity protocols.”

Barbara Young, a marriage and family therapist in Healdsburg, dates her vaccine hesitancy to a long-ago conversation with her son's pediatrician. She'd read on a drug company's website that her history of epilepsy might increase her son's chance of suffering a seizure, if he received a certain vaccination.

Yes, that's true, her doctor said. “I said, ‘Why wouldn't you ask me that? Why wouldn't you screen for that?' And she told me, ‘If I ask questions that reduce the rates of vaccinations, I could get kicked out of the American Academy of Pediatrics.'?”

After that, “I realized I need to do all this research myself, and figure out the risk to my child. Because he's the one who's going to suffer, nobody else.”

Her son, now 9, does get some inoculations. He just didn't start them until he was 3 years old, rather than when he was an infant, as mainstream medical experts recommend.

“And never two vaccines at a time,” she said. Nor will he get his shots for Hepatitis B, or the sexually transmitted human papilloma virus, until he's much older.

“Do I think vaccines have helped prevent epidemics? I know they have,” Young said. “Do I think the companies that make them don't get enough oversight? I believe that, too.”

Staff Writer Austin Murphy can be reached at 707-521-5214 or austin.murphy@pressdemocrat.com.