Vaccination holdouts a disparate mix of rural, populous counties

As word of California’s measles outbreak spread to even remote Mariposa County, health officer Robert Ryder tried to capitalize on the alarming news by reaching out to families whose children weren’t fully vaccinated.

There were 137 kindergartners in his county — a Sierra foothills community that includes Yosemite National Park — who were missing at least one measles vaccine. Ryder sent public health officials armed with vaccine shots to schools and day care centers and other places where children and families congregated.

“We made it very accessible, and, of course, it was free. We tried to make parents an offer they couldn’t refuse,” said Ryder, a longtime infectious disease physician. But only 14 children were vaccinated. Most parents just didn’t show up, Ryder said. “It was very disappointing.”

Much of the public focus on vaccination efforts has been on places like Marin County, which is often held up as a hub of anti-vaccination sentiment in the state, and not entirely without merit. But there are many smaller, more rural counties like Mariposa that have much poorer rates of childhood immunization.

In Nevada County, north of Lake Tahoe, more than 20 percent of children start school with personal belief exemptions, which allow them to enter kindergarten without being fully immunized; the state average is 2.5 percent. The overall vaccination rate in that county is 73 percent — the worst in the state.

Three other counties, including Mariposa, have kindergarten immunization rates under 80 percent, meaning 20 percent of children or more are not wholly vaccinated for one reason or another. In Mariposa, more than 14 percent of children are under-vaccinated due to personal belief exemptions.

High rural opt-out rates

Even Bay Area neighbor Santa Cruz County — which isn’t exactly rural — has higher opt-out rates than Marin. In both counties, the overall immunization rate is about 84 percent. But in Santa Cruz, more than 9 percent of kindergartners have personal belief exemptions, compared with 6 percent in Marin. The remaining children are “conditional entrants,” which means their parents intend to get them vaccinated but haven’t completed the full immunization schedule.

“When you look at rankings, sometimes you want to be in the top 10. This is one of the times when you don’t,” said Dr. Lisa Hernandez, Santa Cruz County health officer. “We do have higher personal belief exemptions than our neighbors. It’s a challenge for us.”

What unites the parents in these disparate counties isn’t clear, even to public health experts like Ryder and Hernandez who are working to figure out how to improve vaccination rates in their own communities and statewide.

Cause of measles outbreak

A study published last Monday found that “substandard vaccination” is probably to blame for the measles that started at two Disney theme parks in December breaking out in the rest of California and several other states. The paper, which was authored by scientists from Harvard and two other Boston-area research institutions, was the first to demonstrate a strong link between under-vaccinated populations and the Disney outbreak.

The outbreak is winding down now. The state reported 133 cases as of Friday, with no new cases in a week. Public health officials will consider the outbreak over when 42 days have passed — that would be April 17 — with no new cases.

Now, as they begin to catch their breath from weeks of reporting and investigation, public health experts are trying to understand the doubt and fear that have led so many people to reject what was once a well-accepted and even welcomed medical intervention. Rates of personal belief exemption have climbed dramatically in several counties over the past decade or two, and it’s not clear what’s going to halt that movement.

Autism myth persists

Two years ago, Marin County conducted a survey asking parents why they decided not to vaccinate. Parents cited concerns about their children getting too many shots over too short a period of time as their primary worry, followed by doubts about the safety of newer vaccines. They said they were “unsure” whether vaccines could cause autism — a claim, long debunked, that’s held firm since a single study noting a possible ink was published in the 1990s.

That one study often is blamed for much if not all of the vaccine resistance still reported in the United States. But Sharon Kaufman, a UCSF medical anthropologist, said the issue also is tied deeply to major cultural and societal shifts that have happened over the past two decades.

Americans are much less trustful of government and major corporations, especially so-called Big Pharma, than they once were. Parents have seen medical science shift and change course over time — solid facts about diet and nutrition change from year to year, and drugs once deemed safe are pulled from the market.

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