Offit on vaccine exemptions

Our colleague Paul Offit published an op-ed in the Wall Street Journal last week titled "Fatal Exemption" (Unfortunately, subscription is required for full access). In it, Offit notes the findings published in JAMA last month showing a significant increase in the number of vaccine exemptions and the corresponding increase in vaccine-preventable illnesses. The chief culprit, says Offit: the growing use of 'philosophical exemptions'. He writes, in part:

"When it comes to issues of public health and safety, we invariably have laws. Many of these laws are strictly enforced and immutable. We don't allow philosophical exemptions to restraining young children in car seats, to smoking in restaurants or to 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 will be forced to decide whether it is our inalienable right to catch and transmit potentially fatal infections."

Parents challenging school exclusion policies for unvaccinated

While vaccinations are required in every state in the U.S. as a condition of public school or day-care attendance, all allow for exemptions in certain circumstances, namely medical, religious, or philosophical reasons (or a combination thereof, depending on the state). However, most states warn that those exempted from vaccinations may be prohibited from attending school in the event of an outbreak. With the current mumps epidemic in the Midwest, this policy is being tested, with mixed results...

• In Kansas, 15-year old David Brockway was not permitted to attend school for 12 days after another student contracted mumps. Brockway's father, who had acquired a religious exemption for his son and signed a form acknowledging suspensions such as this were possible, protested the action to the school board and won, according to the Wichita Eagle. The compromise: Brockway's father had to sign a 'waiver' specific to mumps, calling into question whether the motivation for the school board's actions is a concern over public health and limiting the transmission of the virus or merely insulating itself against potential liability. Since it's acknowledged that those vaccinated are not 100% protected against mumps, the school board may have actually put themselves at greater legal risk, if other students get mumps as a result of Brockway being an ideal vector for transmission.

• In Edwardsville, MO, two students were escorted from school by police when they attempted to attend classes despite being prohibited from school because of not being vaccinated for mumps, the St. Louis Post-Dispatch reports. One parent is reportedly meeting with a lawyer over the matter.