As measles hits Marin, Reed parents’ vaccine pleas gain national attention
With son’s system too weak for immunization, family says those who opt out their own kids risk others’ lives
Editor’s note: This article first appeared in the Feb. 4, 2015, edition of The Ark. It earned first place for Best Writing and for Coverage of Education in the California Newspaper Publishers Association’s 2015 Better Newspapers Contest, and first place for Best Health Story and second place for Best Education/Literacy Story in the Nationa Newspaper Association’s 2016 Better Newspapers Contest.
By KEVIN HESSEL and DEIRDRE McCROHAN
Reed Elementary School last week became the new center of a national conversation about parents who don’t vaccinate their children, just days before the seven-state Disneyland measles outbreak landed in Marin.
East Corte Madera’s Carl Krawitt, whose son, Rhett, is recovering from leukemia, contacted Reed Union School District Superintendent Steven Herzog — and then KQED — to protest parents putting his own son at risk and to urge the district to bar unvaccinated children from coming to school. The Jan. 26 news report, crossposted on NPR’s website, sparked national interest from newspapers and other media outlets like the New York Times.
Rhett, who turns 7 on Feb. 6, was diagnosed with acute lymphoblastic leukemia in 2010, at age 2½, and underwent treatment for 3½ years. He was the Leukemia & Lymphoma Society’s Boy of the Year for the organization’s Greater Bay Area chapter in 2013 and was featured in The Ark’s pages last May, just three months after his last treatment.
His immune system is still recovering, and he can’t be vaccinated.
Instead, Rhett must rely on what’s called community or herd immunity — a principle in which a critical segment of a population’s immunization against contagious diseases can limit the opportunity for the disease to spread.
A breakdown in the vaccination rate means a breakdown in that herd immunity. For parents like Krawitt, Marin’s personal-belief exemption rate from required school immunizations can be unsettling: Some 7.5 percent of Reed Union School District kindergartners entered the 2014–2015 school year with exemptions, compared with 6.5 percent for Marin County and just 2.5 percent statewide, according to county and state public health department records.
Just 86.4 percent of incoming Reed Union kindergartners were considered to be adequately vaccinated for MMR — measles, mumps and rubella — or 127 of 147 students, compared with 97.6 percent at St. Hilary School, 92 percent at Strawberry Point Elementary School, 88 percent for all Marin schools and 92.6 percent statewide. Those figures include students who cannot be vaccinated for reasons beyond the personal-belief exemption.
Herzog reported that, across all grade levels, the overall exemption rate within the three-school Reed district is 3.5 percent — 54 of the district’s 1,563 children — still well higher than the state average; statistics were not immediately available for the district’s overall vaccination rate for MMR.
Outbreak in Marin
While Krawitt may have intended to kickstart a conversation, the threat suddenly became more real Jan. 29 when the Marin Department of Health and Human Services confirmed two cases of measles among unvaccinated siblings — the county’s first cases since 2001, according to Public Health Officer Dr. Matthew Willis.
The siblings, who were reportedly exposed as part of the Disneyland outbreak — which, as of The Ark’s press time, now includes 59 of California’s 92 total cases since Jan. 1 — do not attend public schools and do not live in Southern Marin.
Nevertheless, the Marin measles cases brought into sharp relief Krawitt’s demand and the threat that unvaccinated children pose to those who can’t be vaccinated for legitimate medical reasons.
“We’re not talking about ignorant people who don’t believe in global warming,” Krawitt said of the parents who decline to vaccinate their kids. “These are intelligent people. We just need to educate them.”
Krawitt says he’s always believed that unvaccinated children should not be allowed in the classroom, and that he first told the school of his concerns when Rhett was entering kindergarten at Reed Elementary last school year.
This school year, as daughter Annesley began the third grade at Bel Aire Elementary School and Rhett entered first grade, Krawitt went to a parents’ meeting and says he was “dismayed when the school principal lectured the parents about how dangerous peanut allergy was and how we could endanger children’s lives by allowing our children to bring nuts to school.”
“I raised the issue of immunization, and she dismissed me by saying the district couldn’t do anything,” Krawitt said. He raised the issue again in November after a chickenpox outbreak.
“Then, when the measles (outbreak) came up, I took a much harder line,” Krawitt said. That’s when he and his wife, Jodi, contacted Herzog and KQED. “I sent the email to solidify our position, and it worked because it went viral.”
Herzog confirmed to Krawitt that the principal was right: For now, the district’s hands are tied.
“I would like all my parents to vaccinate their children, but California law allows parents to decline to have their children vaccinated,” he said in an interview.
Faulty links and new laws
Personal-belief exemptions ballooned shortly after a 1998 report in the Lancet, a medical journal, that suggested a link between vaccines — specifically the MMR vaccine — and autism. The report was widely criticized at the time within the scientific community, was later found fraudulent and was retracted in 2010, while the lead researcher was barred from practicing medicine; the organizations Autism Speaks and the Autism Science Foundation both acknowledge the current findings and recommend children be vaccinated.
Yet personal-belief exemptions continued to grow statewide, when the rate peaked at 3.15 percent in 2013–2014, a year after Marin hit its high of 7.83 percent. Those figures are up from 2000’s rate of 0.77 percent and 2.48 percent, respectively.
The new decline in California, and in Marin, may be directly related to a new state law, effective Jan. 1, 2014, that requires a health-care practitioner provide parents seeking the exemption with information about the benefits and risks of immunizations and the risks of vaccine-preventable diseases.
When parents learn the facts — the measles vaccine, for instance, is 99 percent effective, and that there is no link between vaccines and autism — “more choose to immunize their children,” Willis said.
In addition, more pediatricians won’t accept or are dropping patients whose parents refuse to have their children vaccinated without a sound medical basis. To protect the doctors, the American Academy of Pediatrics advises doctors who retain such patients advise them of the risks of refusing vaccinations, document the refusal by having them read and sign a “Refusal to Vaccinate” form in the presence of a witness and place a copy in the patient’s medical record.
Herzog, who is retiring from the district at the end of this term to return to his family home in Colorado, said it surprised him when he came to the district in 2010 to find out that so many children didn’t have vaccinations, because this district sits in such a well-educated community.
While Herzog says he can’t violate state law by barring unvaccinated children from school, the county has the power to override that law for the public’s health and safety.
But it hasn’t come to that yet.
“If there were any evidence of school-based exposures, we immediately would put our exposure plan into place and mandate that unvaccinated students stay home from school for the recommended period” of 21 days, Willis said.
A life-threatening disease
Measles is one of the most contagious viral diseases on the planet, with a transmission rate of some 90 percent to those with no immunity, and typically begins with fever, cough, runny nose and red eyes, according to the California Department of Public Health. Within a few days, a red rash appears, usually first on the face and then spreading downward to the rest of the body.
According to the Centers for Disease Control and Prevention, measles-related ear infections that can cause permanent hearing loss occur in one in 10 kids. As many as one in 20 kids contracts pneumonia, the leading cause of death from measles in young children. One of every 1,000 children can develop encephalitis, brain swelling that can leave children deaf or mentally disabled. And one to two in 1,000 children will die from the disease.
The two-shot series of vaccines is typically given at ages 12–15 months, then at 4–6 years old.
In a Jan. 29 press briefing, Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, said the Disneyland outbreak has contributed to producing as many measles cases in January as the center usually sees in a year — some 102 total confirmed cases in 14 states.
Since 2002, the annual number of confirmed cases nationwide has only exceeded 100 four times. Last year, an outlier, there were 644 cases; most were related to a massive outbreak among unvaccinated Amish communities in Ohio.
“This worries me, and I want to do everything possible to prevent measles from getting a foothold in the United States and becoming endemic again,” Schuchat said.
She said the outbreak was not a problem with the measles vaccine not working, but a problem of the measles vaccine not being used. Some 2.6 million people died from the measles each year worldwide before the vaccination was widespread, a figure that’s been reduced to 145,000 per year — mostly in areas where there’s little access to the vaccine.
“I want to make sure that parents who think that measles is gone and haven’t made sure that they or their children are vaccinated are aware that measles is still around and it can be serious,” Schuchat said.
Since he has spoken up in the press, Krawitt said he and his wife have received a positive response from other community members and other parents in the school.
“Now we’ve forced those people to rethink the risk,” Krawitt said. “We’re forcing the conversation, and it’s that group that I hope will listen and be more rational and think more of science and not theories that have been debunked.
“Just because you have those beliefs doesn’t mean you’re entitled to impose them on others, when your actions have a (negative) impact on all those other people. You’re putting other people in danger.”
Kevin Hessel is The Ark’s executive editor. Deirdre McCrohan has reported on Tiburon local government and community issues for more than 25 years. Reach her at 415–944–4634.
Those who believe that they have developed measles should report the case immediately to the Marin County Public Health Office by phone at 415–473–7805 or, after hours, to the health office duty officer at 415–472–0911. Those with suspected cases of measles should stay at home until at least four days after rash onset or until cleared by Marin Health and Human Services.
Measles in Marin: arkn.ws/marinmeasles
Marin immunization program: marinhhs.org/immunization-program
California immunization-level reports: arkn.ws/ca_immunizations
California measles cases: arkn.ws/ca_measles
CDC measles information and statistics: cdc.gov/measles