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VT S.199 & HB.527 Information
VT S.199 & HB.527 Information
Kindergarten
50% 40% 30% 20% 10% 0% Dtap Polio MMR Hep-B Varicella Exempt Exempt Exempt Medical Rel. Phil. Prov Admit Prov Admit No Rec
7th Grade
The current ACIP schedule requires 39 injections and two oral doses. This is not the VT School Sched.
These are the Vermont K-12 Reqd Shots. 98%+ of Vermont 7th Graders Comply. Kindergartners are given 12 months after first enrollment to comply, called Provisional Admittance, but even so over 91% start school with these shots.
Pre-K have no requirements unless they are in a state licensed day-care or pre-school.
When Dr. Chen says only 65% of Vermont children are Fully Immunized for 14 vaccine preventable infections, he means they have every indicated vaccine on this list, by a milestone age. For example the first dose of HepB within 24 hours of birthon some surveys that child is not fully immunized even if he catches up later. Any infant 6 months or older who does not get an annual flu shot every year is not fully immunized, and is part of falling vaccination rates.
There is no wholesale abandonment of the traditional vaccines. Parents are considering if their personal situation warrants a vaccine for Diarrhea. Rotavirus is dangerous in third world countries but very treatable in the USA. HepA is not casually contagious but transmitted by fecal oral transmission, and prevented by proper hygiene. Chicken Pox was considered a routine childhood illness, and was not even a state reportable infection until after the vaccine was created.
When the VT DOH is talking about Low Rates, they mean under 35 month old toddlers getting all, or some combination of the shots on the list by certain age milestones. They are not talking about the VT school Vaccine schedule.
Vermont law does not dictate a dosing schedule. Vermont law only requires that vaccines be received prior to enrollment in Kindergarten,
(or licensed daycare or pre-school)
^ Chicken Pox is still circulating, children who have had the infection do not require the vaccination. Chicken Pox is a recent addition to the schedule and it is also the most commonly exempted. * A 5th dose of tdap is a 7th grade requirement, the Provisional {Prov} Ex rate is students without documentation or late for their last of 5 doses. Percentage calculated using the FY08 chart listing all grades showing DtaP & tdap to be consistently within .5% of the other core vaccines, so the real rate is 98.25% +or.5. Parents who do Polio, MMR, & Hep B dont skip tdap. ** Students who are missing as little as one dose of a vaccine on the schedule require a "Provisional Admittance" to be enrolled in school. This report closes December 31 of each year, 9 months before the Provisional Admittance time period expires. V. Provisional Admittance- These kids will have missing vaccines within 12 months (2) A student may be admitted to school provisionally if a health care provider indicates a student is in the process of complying with all immunization requirements. Such provisional admission shall be for a reasonable length of time but shall not exceed one year.
http://healthvermont.gov/regs/documents/imm_regulations.pdf
Kindergarten
50% 40% 30% 20% 10% 0% Dtap Polio MMR Hep-B Varicella Exempt Exempt Exempt Medical Rel. Phil. Prov Admit Prov Admit No Rec
7th Grade
Less than 1% of children avoid all vaccines. Most exemptions are for Chicken PoxAlmost NO exemptions are for all shots The double paperwork requirement of both vaccination records and exemption forms for children that are opting out of a shot make for confusing statistics. The exemption rate only measures the number of children with a form on file, it does not mean they are unvaccinated. A child with all of the core, traditional vaccines- DTaP, MMR, Polio, will show up as both vaccinated, yet also as exempt for the Varicella or Hep B. Vermont children have no vaccine requirements prior to Kindergarten, (unless enrolled in a daycare or pre-school). In recognition of this fact they are allowed to start school with a temporary Provisional exemption lasting up to one year to come into compliance.
14% 10% 8% 6%
VT 7th Grade 2.43% PE
Percent of Students
12%
4% 2% 0%
'10-11
'00-01
'01-0 2
'0 2-03
'03-04
'04-05
'05-06
'06-07
'07-08
'08-09
'0 9-10
Surveyed
Is Vermont at Risk?
This map full of red dots is misleading. The small enrollment size of many schools in Vermont leads to deceptive percentages. The state average of philosophical exemptions is only 5.08%.
The red dots on this map represent 71 individual schools with Kindergarten classes that have a greater than 6% Philosophical Exemption Rate. A single child with a Chicken Pox Philosophical Exemption in a school with 16 Kindergartners results in a 6% plus exemption rate. Two children with a Chicken Pox Philosophical Exemption in a school with 32 Kindergartners results in a 6% plus exemption rate
360 Children out of 6,695 Kindergartners have a Philosophical Exemption on file. There are 273 schools offering Kindergarten with enrollments from 1 to 130.
One of these red dots is Brookfield Elementary, which in 2010/11 had a single 13 student Kindergarten class. All of the 13 children are fully vaccinated for DTaP, Polio, MMR, and Hep B. 12 of the 13 are vaccinated for Chicken Pox, with 1 student requiring a Philosophical Exemption to opt out. Because of the way VT DOH measures exemptions, this school has a 7.7% Philosophical Exemption Rate. In 2007 this school would have had a 0% exemption rate, because Chicken Pox was not a requirement until 2008. Is one child not receiving a Chicken Pox shot, which was not a requirement prior 2008, a threat to Public Health?
Another red dot is Sudbury Country, a school with a 33.33% Philosophical Exemption Rate! Sudbury has 3 Kindergarten students. All 3 are fully vaccinated for DTaP, Polio, MMR and Hep B. Only 2 of the 3 are vaccinated for Chicken Pox, with 1 student using a Philosophical Exemption, resulting in the schools 33.33% Philosophical Exemption rate. In 2007 this school would have had a 0% exemption rate, because Chicken Pox was not a requirement until 2008.
Is this really an honest representation of this issue by VT DOH? Does using percentages in populations this low properly communicate the impact of Philosophical exemptions on the vaccination rates? This is the second misleading map recently produced. VT DOH submitted a map to the Senate committee that used the temporary, Provisional Exemption rate, which is double the Philosophical Exemption rate, and implied without clarification that it was the Philosophical Exemption Rate.
This subject is much more nuanced than Exemptions equal unvaccinated children. Consider North Bennington Grade School: 13 of 14 have DTaP, Polio, MMR, and HepB; 11 of 14 have Chicken Pox, and 7 have Philosophical exemptions. That means 3 Chicken Pox exemptions, and one exemption each for the DTaP, Polio, MMR, & HepB vaccines.
DTap Met
Polio Met
MMR Met
Hep-B Met
Varicella Met
Exempt Medical
Prov Admit
26
26
26
27
25
0.1
0.0
0.2
Average Percentage
27
24 88.7%
24 87.8%
24 87.6%
25 91.3%
23 83.7%
0.3 0.9%
0.0 0.1%
3 12.6%
3 10.3%
0.4 0.0%
27
26 97.4%
26 96.0%
25 92.2%
0.1 0.2%
0.0 0.1%
0.5 2.0%
2 6.1%
Average Percentage
22
21 93.5%
20 90.7%
20 88.9%
0.1 0.3%
0.0 0.0%
2 9.3%
0.8 3.8%
Adding Chicken Pox in 2008/2009 more than doubled the number of schools with 6% exemptions
50
45
50
50
50
45
0.1
0.1
40
36 89.2%
39 96.8%
39 96.8%
38 95.4%
36 89.8%
0.0 0.1%
0.0 0.0%
4 9.0%
3.0 7.5%
0.0 0.1%
72
66 91.3%
71 98.3%
71 98.4%
70 97.7%
65 89.4%
0.2 0.3%
0.1 0.1%
3 3.8%
8 10.5%
0 0.1%
33
29 87.5%
33 98.9%
33 99.4%
33 99.2%
29 87.3%
0.1 0.3%
0.1 0.3%
0.0 0.0%
6 17.2%
0 0.2%
Over 98% of 7th graders have 4 of 4 DTaP. There is a TDaP booster scheduled in 7th grade, and the report closes on December 31, before all students get the booster. Notice the schools with 0% Philosophical Exemptions share the gap, and have 17.2% Provisional Admittance while the kids catch up.
Is a Parent Unscientific or Irrational for Using a Philosophical Exemption to Modify the Schedule?
The following slides detail the increase in Febrile seizure risk, and Febrile emergency room visits associated with various combinations of the MMR and Chicken Pox Vaccine, and the Flu and PCV13 Vaccines. A Febrile seizure is a fever so high that it interrupts neurological function. According to the AAP Practice Parameter: The neurodiagnostic evaluation of the child with a first simple febrile seizure Pediatrics Vol. 97 No. 5 May 1, 1996 pp. 769 -772
A lumbar puncture should be strongly considered in a child younger than 12 months and should be considered in children between 12 and 18 months of age.
This spinal tap is to rule out bacterial meningitis.
Beyond the general unpleasantness of an infant requiring a spinal tap is that every interface with an emergency room is the risk of contracting a difficult to treat hospital acquired infection, or the adverse reaction to a therapeutic treatment. For example an unknown sensitivity or allergy to an anaesthetic, antibiotic, or other drug prescribed to treat the condition.
The United Kingdom does not recommend universal Chicken Pox vaccination.
Studies showed that the incidence of severe complications in children following chickenpox was less than 1 per 100,000 children and ataxia was the complication in less than a quarter of these cases.. In summary, the available research says that in children acute cerebellar ataxia may follow chicken pox and other viral infections and whilst there is some variability in the time it takes, complete recovery does occur. There is no specific therapy indicated.
The following slides look at seizure rates of the MMR alone, the VZV Chicken Pox alone, the MMR and Chicken Pox in separate injections in the same visit, and using the MMRV Pro-Quad 4 in 1 Combo injection
Excess Chicken Pox Vaccine Seizures Over MMR Alone Which vaccine would you choose for your child? Keeping the MMR and delaying or skipping the Chicken Pox dramatically reduces the possibility of a febrile seizure without affecting Public Health.
Influenza Vaccine, PCV13, and Febrile Seizures Both influenza vaccine and PCV13 can
cause fever Some children with fever may have a febrile seizure most common in children 12-23 months of age VSD data (2011) indicate about 1 febrile seizure for every 2,225 children who receive both vaccines ACIP recommends both vaccines be given at the same visit if indicated
36
What is unscientific or unreasonable about a parent doing everything they can to reduce the risk of discomfort and injury to their child? Isnt that a parents primary responsibility?
The previous slides show that a parent can cut the seizure risk to their child by half simply though product selection and using the MMR and a separate Chicken Pox shot, versus the MMRV combo shot. A parent can then again achieve another significant risk reduction by either delaying, or opting out of, the Chicken Pox vaccine. Chicken Pox was not even a requirement until 2008. According to the British UK Health Service a normal child has a less than 1/100k chance of a serious complication from Chicken Pox. This compares to a 12 to 24/100k seizure risk increase adding the Chicken Pox to an MMR visit or using the MMRV. Some parents are wondering what was the criteria to make Chicken Pox a requirement? The U.S. stands alone in recommending universal Chicken Pox vaccination. Was there a public outcry by parents requesting this vaccine? This medical, scientific documentation illustrates that there are very rational, reasonable, and fact-based reasons to modify the schedule to any individual childs or family's needs. While it is a given that the majority of children may tolerate the vaccine schedule without incidence, it is a irrefutable fact that some children experience catastrophic harm. Just like some kids can eat peanut butter, while for others it is a life-threatening substance.
Why the Preservation of the Philosophical Exemption is critical to the continuing excellent health of Vermont citizens
The previous slides document that it is a scientific, statistical fact that vaccine associated seizures are occurring in Vermont children. All of the Vaccine Information Sheets list a seizure as a contra-indication for further doses of that vaccine. About 7,000 Vermont children receive their first MMR, MMR+V, or MMRV vaccination every year. We know with scientific, statistical certainty that these vaccinations alone are resulting in some 2 to 5 or more seizures annually, depending on which combination of vaccines is administered. The PCV & Flu = 3 seizures. Yet even with this type of documentation it is almost impossible to get a Health Care Provider to concede that any adverse event following a vaccination is, or even could be, caused by or related to the vaccination. Ask Vermont DOH how many confirmed vaccine associated seizures are reported to them every year? If the number is zero, is that because Vermont is somehow magically protected from this medically confirmed phenomenon, or is it because of an inability or unwillingness by Health Care Providers to identify that a drug they administer is the cause of an Adverse Event?
It is in this context that the importance of the Philosophical Exemption becomes paramount for a parent to make the best health care decisions for his child.
The argument that the unvaccinated are a threat to the vaccinated has little merit.
Is it true that Everyone must be vaccinated because sometimes vaccines dont work?
It is a scientific fact that all vaccines have an efficacy failure rate. A certain percentage of people who receive the vaccine do not develop antibodies. That is why some vaccines require multiple doses, because one dose does not sufficiently induce antibody response in a majority of the population. Vaccine immunity can also wear off, unlike the permanent immunity from a naturally acquired infection. These are some of the reasons is why outbreaks occur in highly vaccinated populations. It is not the fault of the unvaccinated. Antibody response is something that is easily tested. As an alternative to forcing vaccination of those who dont desire it, the protection of a vaccinated person could be confirmed through testing, and then if the vaccine recipient has not developed antibodies he can receive another dose. This insures his protection, just like an American travelling in an under-vaccinated foreign country. It also respects the right of his fellow citizen to avoid an unwanted medical procedure.
Is it true that Everyone who can be vaccinated, must be, to protect those who cant be vaccinated?
Anyone who is so vulnerable that contracting a Vaccine Preventable Disease would be a life threat is also susceptible to a wide variety of other infections and conditions for which there are not vaccines. What level of risk may one citizen require of another to theoretically protect his personal interest? Previous slides demonstrate that the Chicken Pox vaccine has a greater risk profile than the contraction of the infection. Is it appropriate that Citizen A should expect Citizen B to involuntarily subject his child to a Chicken Pox vaccination with a risk greater than Citizen Bs child would experience by naturally contracting the infection, in order to theoretically protect Citizen As immune compromised child?
Is that reasonable?
Is requiring vaccination for school attendance equal to enforcing safeguards that prevent students from bringing weapons to school?
This is a flawed argument because the process by which weapons are kept out of school, student searches and metal detectors, do not pose a threat of physical harm to the students being screened. This analogy would only hold true if the metal detector failed in some way, on a regular basis, harming students so that 3 per 100 each year would require outpatient emergency room visits (analogous to the Fever visits in the VSD slide), and 1/1250 suffered a seizure requiring a hospital admission and spinal tap. What would the acceptable injury rate be if searching for weapons caused harm in those being screened?
Hepatitis B in Vermont
Hep B cases Acute Chronic >14 years age 2011 0 0 2010 2009 2008 2007 0 0 0 0 2 3 2 4
http://healthvermont.gov/pubs/IDB/
Hepatitis B is not spread through food, water, kitchen utensils, breastfeeding, kissing, coughing or sneezing
No
The US Department of Labor Occupational Health and Safety Administration, OSHA, does not support mandated influenza programs that do not include Personal and Philosophical Exemptions
State
New Hampshire Vermont Utah Massachusetts California Washington New Jersey New York Oregon Iowa Minnesota Maine Nevada New Mexico Hawaii
Immunization Rank*
2 22 47 5 40 39 45 41 27 17 24 36 49 44 29
Immunization Rank*
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
State
Connecticut New Hampshire Florida Rhode Island Massachusetts North Carolina North Dakota Tennessee Michigan Mississippi Alabama Nebraska Pennsylvania Georgia South Carolina
Vaccine vials with visible particles of charred shrink wrap evaded all quality control points and were only discovered by an astute Health Care Provider who noticed them when preparing to administer the vaccine. While it may be safe to inject burnt plastic into children, if Mercks Quality Control is incapable of detecting visible contaminants, what does that say about the ability to detect invisible viral, bacterial, and chemical potential pollutants?
Not every Injection intended to be a Vaccine is actually a Vaccine. Medication Errors are a measurable Healthcare occurrence.
Errors Excluded
Deaths from avoidable medical error more than double in past decade, investigation shows Preventable medical mistakes and infections are responsible for about 200,000 deaths in the U.S. each year The precise number of these deaths is still unknown because many states lack a standard or mandatory reporting system for injuries due to medical mistakes.
Kindergarten
50% 40% 30% 20% 10% 0% Dtap Polio MMR Hep-B Varicella Exempt Exempt Exempt Medical Rel. Phil. Prov Admit Prov Admit No Rec
7th Grade