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Mandate Education Before Vaccine Opt-Out, Colorado Task Force Says

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A Colorado task force assembled to explore the state's unusually high rates of parents who opt their children out of vaccines for personal or religious reasons recommended this week requiring education and counseling before allowing families to claim such exemptions.

It's a problem many states are tackling, particularly those with permissive rules for claiming personal exemptions from vaccines necessary for enrollment in a public school or a licensed child-care program. Nationally, there's been a recent spike in measles cases, with 175 confirmed cases so far this year, Centers for Disease Control and Prevention Director Thomas Frieden said last week:

"Really what we're seeing with the measles cases in  this country is a combination of two things. First, continued spread and, in some cases, resurgence of measles around the world, reminding us that we are all connected by the air we breathe. And second, it is not a failure of the  vaccine, it's a failure to vaccinate. So around 90 percent of the people who have had measles in this country were either not—were not vaccinated either because they refused, or [they were] not vaccinated on time."

Decisions to opt out have been tied to a variety of factors, and some have attributed the rise to unproven theories that vaccines contribute to autism. Public health officials have widely criticized those notions.

In Colorado, families can choose not to get their children one or all of a required series of vaccinations if they cite a medical, religious, or personal belief, the task force report said:

"Currently, [personal belief exemptions] are the primary reason for exemption in our state, with Colorado having among the highest rates of [personal belief exemptions] in the nation. For the 2012-2013 school year, 4.3 percent of kindergarteners were not fully vaccinated upon school entry due to exemptions. Of the 4.3 percent of children exempted, 93 percent of those claimed a personal belief exemption.The remaining exemptions claimed were for medical or religious reasons. This equates to almost 3,000 kindergarteners entering schools each year who are unimmunized against one or more ... for vaccine preventable diseases (VPD).

The ease of obtaining [personal belief exemptions] may play a role in the high rates of VPD. In states like Colorado, where parental signature alone is sufficient to claim an exemption, the incidence of pertussis (whooping cough) was 41 percent higher than in states with more restrictive methods.

Furthermore, states that permit exemptions with such ease are associated with higher rates of exemptions in schools  and, within states; schools that have higher rates of exemptions may be associated with higher disease rates."

The group didn't question parents' right to exempt their children, but stakeholders who met with the task force were concerned that parents might claim personal exemptions because it was an inconvenience to get children vaccinated, rather than out a true sense of personal convication. They also said some parents might not understand the risk to public health created by lower vaccination rates. The group set out to determine how to involve parents and schools in accountability and public education about the issue.

A majority of stakeholders said Colorado should require education or counseling prior to claiming a personal belief exemption and that the state should publish the immunization and exemption rates by schools and licensed child-care facilities.

Ideas that got "high levels of support" from stakeholders were adding a requirement for annual renewal of the personal belief exemption and requiring a medical or provider signature for the personal belief exemption, the report said.

Every state allows for medical exemptions for vaccine requirements, and most have religious exemptions, according to the National Conference of State Legislatures, but many do not have philosophical or personal exemptions, or they have more restrictive requirements for allowing parents to opt their children out. 

Photo: Nurses Fatima Guillen, left, and Fran Wendt, right, give Kimberly Magdeleno, 4, a whooping cough booster shot as she is held by her mother, Claudia Solorio, at a health clinic in Tacoma, Wash., in May, 2012. -Ted S. Warren/AP-File

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