Immunization of Infants

Since we are having a baby next month, we are thinking of immunizations along with other baby-related topics. So I was surprised to find out that some people like us don’t vaccinate their children.

Struggling, inner-city parents are more likely to neglect to completely vaccinate their children, while parents who refuse to vaccinate at all tend to be white and well-off, U.S. researchers reported Tuesday.

[…]In 2001, only an estimated 62.8 percent of all children aged 19 to 35 months were fully vaccinated, Philip Smith and colleagues at the Centers for Disease Control and Prevention’s National Immunization Program found.

More than 2 million children or 36.9 percent of toddlers were not fully vaccinated in 2001, and 17,000 children or 0.3 percent were not vaccinated at all, Smith’s team wrote in Tuesday’s issue of the journal Pediatrics.

[…]Several studies have shown two barriers to full vaccination — a lack of adequate medical care and affluent, educated people who question the need to vaccinate their children.

“Among parents of unvaccinated children, 47.5 percent expressed concerns regarding safety, compared with 5.1 percent of parents with undervaccinated children,” the researchers wrote.

And those who refuse vaccines often do not trust doctors.

“Among parents of unvaccinated children, 70.9 percent said that a doctor was not influential in shaping their vaccination decisions for their children, compared with 22.9 percent among undervaccinated children,” the researchers said.

Of the children not vaccinated, 57 percent were boys.

“In response to concerns about the perceived risk of autism resulting from vaccinations, parents might have avoided having their sons vaccinated at a higher rate than their daughters, as a result of knowing that they have risk factors for autism and knowing that the rate of autism is 4 times greater for boys than for girls,” the researchers wrote.

Last month, the Institute of Medicine reported that a panel of experts could find no evidence that vaccines cause autism, but groups that question vaccine safety vowed to continue to fight to prove a link.

Here are the conclusions from the abstract of the paper.

Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding $75,000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children. Unvaccinated children were more likely to be male than female. Annually, ~17,000 children were unvaccinated. The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan. States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children.

There is lot of interesting data in the paper itself.

Among all children 19 to 35 months of age, an estimated 36.9% were undervaccinated. In the undervaccinated group, children were most frequently NUTD on varicella vaccine (23.5%), diphtheria, tetanus, and acellular pertussis vaccine (18.2%), hepatitis B vaccine (11.2%), and polio vaccine (11.0%).

[…]Compared with fully vaccinated children, unvaccinated children were […] more likely to live in a household with ≥4 children than in a household in which he/she was the only child.

[…]Estimated rates [of unvaccinated children] ranged from a low of 60 per 100,000 (Rhode Island) to 1125 per 100,000 (Utah). Among the 10 states with the highest estimated rates per 100,000 children 19 to 35 months of age, 7 were western states (Utah, Montana, Oregon, Colorado, Washington, Alaska, and Idaho).

Other states in the top 10 were Oklahoma, Maine, and Vermont.

The counties with the largest numbers of unvaccinated children were Los Angeles, CA, and Detroit, MI (including Wayne, Oakland, and Macomb Counties). The remaining counties among the 20 with the greatest numbers of unvaccinated children included the cities of Chicago, IL, Pittsburgh, PA, Dallas, TX, Houston, TX, Oklahoma City, OK, and Grand Rapids, MI. Also included among those counties were Westchester County, NY, and Lancaster County, PA. New York City was not among the 50 areas with the greatest estimated numbers of children with no vaccine doses.

[…]In 2000—2001, all states allowed exemptions for medical reasons, 48 for religious reasons, and 17 for philosophical reasons.

I understand medical reasons. I don’t agree with religious reasons for skipping vaccines but that is still understandable. But what really is a philosophical reason to expose your child to these killer diseases?

Razib probably won’t be surprised with this next bit of data.

12.3% of all children attending public schools and 18.8% of children attending day care in Ashland, Oregon, in 2002 claimed exemptions from mandatory vaccination laws, compared with 2.4% for the entire state that year.

Fear of autism does seem to affect vaccination decisions.

Siblings in families in which there was an autistic child were 3 times more likely to be unvaccinated, compared with siblings in families in which there was a child with attention-deficit/hyperactivity disorder.

MedPundit had a reminder we all need.

Before immunizations were routine, pediatric wards were full of children in iron lungs who couldn’t breathe on their own thanks to polio. When I was in training, older physicians used to tell horror stories of children gasping for their last breaths as pertussis (whooping cough) closed up their airways, and there was nothing they could do to stop it. Measles used to be a significant cause of blindness and deafness. Congenital rubella caused all sorts of birth defects. The success of the immunization programs against these highly communicable diseases have wiped them from our collective memory. Now, the vaccines seem worse to many than the diseases. (Same as smallpox, no?)

The people who don’t vaccinate their children are relying on the benefit of the majority who do immunize. However, any regional concentration of unvaccinated people can be quite dangerous as disease can spread quite easily there. MedPundit and Foreign Dispatches have pointed out about a Nigerian state’s recent campaign against polio vaccination.

Coming from the developing world, I am quite familiar (much more so than an average American I think) with the threat of diseases like polio, measles and whooping cough, etc. I remember campaigns in Pakistan to vaccinate children and eradicate these diseases as I was growing up. Even smallpox was not eradicated in Pakistan until I was 4 years old. I still have the smallpox vaccine scar on my arm.