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Children's Health

Whooping Cough Outbreaks Tied to Parents Shunning Vaccines

Study finds that areas with high rates of nonmedical vaccine exemptions also had high number of cases

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Omer and his team reviewed data on vaccine exemptions from school data, and they geographically coded that information to the census tract level. They then did the same thing with data on whooping cough cases.

The investigators found 39 clusters for high nonmedical exemption rates and two statistically significant clusters of whooping cough cases. Census tracts within a high nonmedical exemption cluster were 2.5 times more likely to be in a whooping cough cluster than areas without high exemption rates.

The risk of whooping cough was 20 percent higher inside a vaccine exemption cluster than outside of one, according to the study.

In California, whooping cough clusters and nonmedical exemption clusters were associated with a lower population density, lower average family size, fewer minorities, higher percentage of high school graduates, higher average household incomes and a lower percentage of families living in poverty, the study found.

"There was some nice analysis from the CDC years ago that people who refuse vaccines tend to be higher in socioeconomic status," added Omer.

An expert not involved with the study agreed with that analysis.

"The irony is that normally people with lower socioeconomic status have an increased risk of infectious diseases, but with vaccine-preventable infectious diseases, the risk is higher for those higher in socioeconomic status," noted Dr. Kenneth Bromberg, director of The Vaccine Research Center and chairman of pediatrics at The Brooklyn Hospital Center in New York City.

Some who seek these exemptions argue that it's a personal decision that only they can make for their family. But, Omer and Bromberg both expressed concern because the decision not to vaccinate is likely putting others at risk for infection.

"We live in a free society, but infectious diseases are different from other phenomenon. Someone else's behavior can affect my child or loved one, or me," noted Omer.

"If a parent gets their child vaccinated and that particular vaccine has an 80 percent efficacy rate, that means that even if you don't account for waning protection after vaccination, there's still a one-in-five chance that child can be at risk of being infected. But, the odds are lower if everyone in the community is vaccinated," Omer explained.

"It's personal freedom versus public health," Bromberg said. "We can't always do everything we want in a society. And the issue is more complicated than what was addressed in this article. There are immune-compromised people, and people who receive their vaccines as recommended. By not getting vaccinated, they're putting immune-compromised people at an even greater risk and putting normally healthy people at risk, too," said Bromberg.

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