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Correction to This Article
A Jan. 9 Health article incorrectly said that mercury was once used as preservative for the vaccine known as MMR, which is used for measles, mumps and rubella. The vaccine did not contain mercury.
A Shot of Urgency In Md.'s Vaccine Debate

By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, January 9, 2007

When vexed parents ask Greg Reed why their children must be vaccinated against chickenpox and hepatitis B -- a question he has fielded in the past week as more than 20,000 Maryland middle and high school students failed to meet the state's Jan. 2 immunization deadline and some were barred from school -- he cites the case of a 32-year-old Maryland man who died several years ago after contracting chickenpox from his young daughter.

"We tell parents every year that about 100 people die from chickenpox" in the United States, said Reed, program manager for the Maryland Center for Immunization, a branch of the state health department. Vaccination, he said, will "provide protection for a lifetime."

While most of the focus has been on the logistics of enforcing Maryland's latest vaccination deadline for students in grades six through nine, public health officials say that the medical reasons for the requirement imposed by the state legislature have received scant attention.

Contrary to popular belief that chickenpox is a mild illness, Reed and other health officials say, it is impossible for doctors to predict who will suffer serious complications, the risk of which increases with age. The most dreaded includes necrotizing fasciitis, the so-called "flesh-eating bacteria," which can be fatal.

"Every doctor who has seen a case of this hopes never to see one again," said physician Deborah Wexler, executive director of the Immunization Action Coalition, a nonprofit Minnesota group that provides informational materials about vaccines to doctors and works closely with the federal Centers for Disease Control and Prevention.

"People who don't vaccinate their children are putting them at risk, as well as kids who can't be vaccinated" because they have cancer or other medical problems, Wexler said. "This is about protecting yourself and protecting your community."

Once accepted without question as a parental responsibility, immunization has lost the urgency that used to propel it, Wexler and others say, in part because mass vaccination has been so successful.

Most parents have never seen or heard of children who went blind from measles, deaf from mumps or suffered overwhelming infection from other childhood diseases such as haemophilus influenza.

Some of the skepticism about the need to vaccinate is attributable to what many health officials say are persistent unsubstantiated myths about childhood vaccines that circulate on the Internet: that the dangers of vaccines outweigh their benefits, that they cause autism and other serious ailments or that they encourage promiscuity.

Much of the controversy has swirled around mercury, which was once used as a preservative for the vaccine against measles, mumps and rubella known as the MMR.

In 19 states, lawmakers have made it easier in recent years for parents to opt out of vaccinations based on a "personal belief exemption" that in some states may be obtained simply by signing a waiver. (In the District, Maryland and Virginia, exemptions are permitted for religious or medical reasons, such as a severe allergy to a vaccine component.)

"The MMR controversy did a lot of damage and made people scared of vaccines," Wexler said.

A study by public health researchers from Johns Hopkins, published in the Journal of the American Medical Association in October, found that states that permitted personal belief exemptions had significantly higher rates of pertussis infection than those that did not allow them.

Several years ago when Maryland began requiring the chickenpox vaccine for entry into kindergarten and elementary school, some parents were misinformed that the shot contained tissue from aborted fetuses, recalled Donna Mazyck, a school health services specialist for the state. (The District requires chickenpox and hepatitis B shots for all students, while Virginia requires hepatitis B shots for all and chickenpox vaccinations for those born after Dec. 31, 1996.)

This time, Mazyck said, the reason for spotty compliance has a much more prosaic cause: Parents have said they had too little time and too much else to do.

"I think this is one of the many things on the plates of parents and guardians," she added.

Mazyck and Reed emphasize that the required vaccines are safe and highly effective and that side effects tend to be mild and temporary. The most common is soreness at the injection site that lasts a few days and occurs in about 20 percent of children who receive the chickenpox vaccine, according to Wexler.

"The risks are very small," she said, adding that the same is true of the hepatitis B vaccine, which has been administered to about 100 million Americans since 1991.

The risks are far greater for the those who aren't immunized, she said.

Chickenpox, she noted, is a highly contagious disease that is spread through the air. Those who have had the disease, which includes the vast majority of older teenagers and adults, do not need the vaccine, which has been administered to newborns since 1995.

The hepatitis B vaccine is especially important for teenagers, according to health officials.

The virus is spread by exposure to blood or body fluids from an infected person through drug use, sex, tattooing or during childbirth or contact sports.

The disease is common in developing countries. It typically causes an illness that can last several weeks and produces symptoms including fever, nausea and yellowing of the skin or eyes.

In about 10 percent of cases, sufferers develop a chronic lifelong infection that can remain dormant for years. These patients can spread the disease and are at greater risk for permanent liver damage, including the development of liver cancer, which is fatal.

When it is unclear whether a child has been properly immunized against hepatitis B or has had a physician-documented case of chickenpox, Reed said, officials are recommending revaccination. "That's the most expedient course," he said. "We want to ensure they are protected." ยท

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