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Opting Out: Community Immunity and the Choice to Vaccinate

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(Nevada City, CA)
Monday, August 29, 2011

Jump to pertussis immunization maps

Dr. Karen Milman fingers paperwork of public health data in her Grass Valley office. She's the Nevada County Public Health officer.

MILMAN: It's my job and my moral belief that I should do everything possible to keep everyone in this county healthy, so it's hard when things seem to be stacked against you.

This small county in the sierra foothills poses a big challenge to Milman. It has the lowest immunization rates in the state of California.  

Last year, only 73% of children entering kindergarten in the county were fully immunized. In some cases parents were unable to get the shots for their kids. But 17% opted out of vaccination claiming an exemption based on personal belief. As a result, Milman says Nevada county doesn't have 'community immunity.'

MILMAN: I'm very concerned about this. We don't have the community protection or enough people who are either immune or who have sufficient immune resistance to prevent a disease from spreading. So should someone come into this county with an infectious disease, such as measles - as we've seen across the whole country - there are a high number of people who are likely to get the disease.


Public health officials strive for 90% immunity just to prevent the spread of disease.  Nevada County doesn't have that level. Milman says outbreaks of pertussis occur every other year. But that doesn't concern Thea Blair.  

BLAIR: I don't doubt that vaccinations can infer immunity. But I think there are other ways of gaining immunity.

Blair opted her teenager out of this year's whooping cough booster shot law.

BLAIR: I'm not afraid of childhood diseases. I'm not afraid of fevers. My son is 16 and my daughter is 9, and they've never been to the doctor on account of illness.

Blair adds that her kids have never had vaccinations, with the exception of tetanus, when her son almost clipped his finger off as a toddler. They've never had antibiotics either.

BLAIR: So we have made a choice based on the observation that our children have healthy immunities, they appear to be just fine. So we're not going to mess with it. If there was another indication, we would go with that.

(sound of Thea Blair walking around in garden)

Blair shows me her vegetable garden and livestock. Her family lives on an acre of farmland in Nevada City. She says a harmonious home life, drinking raw milk and organic food, and reducing stress helps build immunity.

(sound of Thea Blair walking around in garden)

Blair also has concerns about vaccine ingredients, although she admits the concerns aren't substantiated by mainstream medicine. Still a look at the CDC website does show some surprising additives to vaccines, such as formaldehyde and monkey kidney tissue.

Whether a healthy lifestyle is enough to protect her kids from whooping cough, Blair doesn't know. But she says she's grateful the state gives her choice in how to care for her children.

BLAIR: ...That I can sign the back of that form, and take a waiver. And everybody has that choice.

But, that personal choice is not something that Dr. Karen Milman says serves the community.  She says the county has outbreaks of vaccine preventable illness every year. Ironically, Milman says, that's in part due to the local culture being concerned about health.

MIlLMAN: People come here and want what's best for their child. They want everything possible that's best for their child. They want to live in a rural community that's safe, good education, and in their perception, they fear vaccines. 

Nevada County isn't the only place with high numbers of personal belief exemptions from immunization. Parents of almost 12,000 kindergartners statewide chose to opt out last year. And the numbers are rising.

0829 Maps Final

To find out more information about school immunization rates, you can download this table from the California Department of Public Health website.

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