Whooping Cough on the Rise Among Children Whose Parents Refused the Vaccine

Researchers in Colorado recently published a paper in the medical journal Pediatrics that received some attention from the press and, as a consequence, the public (J. M. Glanz, D. L. McClure, D. J. Magid, et al, “Parental Refusal of Pertussis Vaccination Is Associated with an Increased Risk of Pertussis Infection in Children,” Pediatrics (2009) 123: 1445-1451). The study examined the incidence of whooping cough (pertussis) in children whose parents had chosen not to vaccinate them; the results were concerning.

Vaccines are recommended by the Centers for Disease Control and Prevention (CDC) and professional societies, such as the American Academy of Pediatrics. But these organizations can’t enforce their recommendations; only states can do that—usually when children enter day-care centers and elementary schools—in the form of mandates. State vaccine mandates have been on the books since the early 1900s; but aggressive enforcement of them didn’t occur until much later, born from tragedy.  

In 1963 the first measles vaccine was introduced in the United States. Measles is a highly contagious disease that can infect the lungs causing fatal pneumonia or the brain causing encephalitis. Before the measles vaccine, measles caused 100,000 American children to be hospitalized and 3,000 to die every year. In the early 1970s, public health officials found that states that enforced vaccine mandates had rates of measles that were 50 percent lower than states that didn’t enforce them. As a consequence of this outbreak, all states worked toward requiring children to get vaccines.

But not all children are subject to these mandates. All fifty states have medical exemptions to vaccines, such as a serious allergy to a vaccine component. Forty-eight states also have religious exemptions. And twenty-one states have philosophical exemptions; in some states these exemptions are easy to obtain, by simply signing your name at the bottom of a form; and in others they’re much harder, requiring notarization, annual renewal, a signature from a local health official, or a personally written letter from a parent.

The Pediatrics study examined the relationship between vaccine exemptions and rates of disease. The authors found that children whose parents had chosen not to vaccinate them were 23-fold more likely to catch pertussis—a disease that causes inflammation of the windpipe and breathing tubes, pneumonia and, in about twenty-five infants every year, death—than vaccinated children.

The finding that lower immunization rates caused higher rates of disease shouldn’t be surprising. In 1991 a massive epidemic of measles in Philadelphia centered on a group that chose not to immunize its children; as a consequence nine children died from measles. In the late 1990s, severe outbreaks of pertussis occurred in Colorado and Washington among children whose parents feared pertussis vaccine. In 2008 the United States witnessed a nationwide measles epidemic greater than anything seen in more than a decade; the outbreak occurred almost exclusively in children whose parents had chosen not to vaccinate them. More recently, things have only gotten worse. In the past few months six children in the Philadelphia area got meningitis caused by a bacterium called Haemophilus influenzae type b—a disease for which a vaccine has been routinely recommended for almost 20 years. None of these children were vaccinated and three died from the infection. Died because their parents had chosen not to vaccinate them.  

Some would argue that philosophical exemptions are a necessary pop-off valve for a society that requires children to be injected with biological agents for the common good. But as anti-vaccine activists continue to push more states to allow for easy philosophical exemptions one thing is clear, more and more children will suffer and occasionally die from vaccine preventable diseases.

When it comes to issues of public health and safety we invariably have laws. Many of these laws are strictly enforced and immutable. For example, we don’t allow philosophical exemptions to restraining young children in car seats or smoking in restaurants or stopping at stop signs. And the notion of requiring vaccines for school entry, while it seems to tear at the very heart of a country founded on the basis of individual rights and freedoms, saves lives. Given the increasing number of states allowing philosophical exemptions to vaccines, at some point we are going to be forced to decide whether it is our inalienable right to catch and transmit potentially fatal infections.