Illinois Issues: A Call For Immunization

Dr. Kemia Sarraf's support for vaccinations became much fiercer when her son, Joseph, was diagnosed with leukemia three years ago. Joseph, 15, is considered to be immunocompromised because of his chemotherapy treatments.

"He has an immune system that just doesn't work right," says Sarraf. "Despite having been fully vaccinated as a child, the cancer compromises his ability to mount an appropriate immune response to the common cold, frankly, let alone to the measles or the flu."

As cases of the measles popped up across the country, and in Illinois, Sarraf made sure everyone in close contact with Joseph was not only vaccinated as a child, but revaccinated. She, her husband and three other sons received extra doses of the measles, mumps and rubella (MMR) vaccine.

"Measles is incredibly infectious," says Sarraf who is also a doctor at HSHS St. John's Hospital in Springfield. "Ninety-five percent of a population has to be vaccinated against the measles to achieve what we call herd immunity."

Herd immunity is the threshold of a population that needs to be immune so a disease is stable and does not easily spread. Recent trends show a slight uptick in vaccine-preventable diseases across the country. For example, documentation shows measles appeared to be eliminated from the U.S. in 2000. Since then, however, a resurgence of the disease seems to be present with the number of cases wavering from double digits to triple digits in the past decade. 

In 2015, the entire country experienced a large outbreak of measles that spread across multiple states, including in Cook County, where the disease hit a daycare center infecting around a dozen infants.

"What we saw in that outbreak were that a number of the individuals that contracted measles, 12 of them were under the age of one and were thus not able to be vaccinated," says Dr. Nirav Shah, the director of the Illinois Public Health Department.

The Centers for Disease Control and Prevention says the majority of people who get measles are unvaccinated. Illinois allows exemptions to families with medical or religious objections. However, in 2015, Gov. Bruce Rauner tightened the requirements specifically for religious exemptions in an effort to reduce the number of unvaccinated children.

The law required families to complete a certificate explaining their choice and also include the signature of a doctor showing they were counseled on the risks of forgoing vaccines. What Illinois does not allow is an objection based on a moral issue or fear of vaccines. Nineteen states in the United States do allow personal belief exemptions.

In some cases, the fear of vaccines derives from a 1998 report by British gastroenterologist Andrew Wakefield. He published a study that linked the Measles Mumps and Rubella (MMR) vaccine to autism. That study has since been retracted and although there is an increase in the rate of autism diagnoses, health professionals say it's simply because of increased awareness.

Photo Credit: SIU School of Medicine

"Unequivocally and without a doubt there is no link between vaccinations and autism," says Dr. Craig Batterman, an associate professor of pediatrics at SIU School of Medicine. "That's been proven again and again and again."

Preliminary reports show Illinois has not experienced any measles outbreaks since 2015. But there have been yearly outbreaks of mumps, pertussis (whooping cough) and varicella (chicken pox). Reports show whooping cough is the most common vaccine-preventable disease. According to the Illinois Department of Public Health, preliminary reports show there were 11 whooping cough outbreaks across the state in 2017.

There were 27 outbreaks in 2015 and 32 in 2016, according to the department. However, Shah says that's not necessarily considered a trend or a "comeback" for the disease and it's important to look further into the past. "If you take that view to compare where we are today to where we were in the 60s or 70s or 80s, what you see is a dramatic difference," he says.

Still, some medical professionals have serious concerns about parents questioning whether and how to vaccinate their children. Batterman says he isn't seeing a large influx of individuals choosing not to vaccinate, but he still has concerns about herd immunity being compromised.

"Besides smallpox, nothing has been eradicated," says Batterman. "(The diseases are) all there. They're out there just poised and waiting. If we allow this trend to continue of more people opting out of vaccines, you're going to see more epidemics - large scale disease. In the end, it's not going to be people getting sick. People are going to die from this."

Even as health professionals champion the effectiveness and necessity of vaccines, the ongoing vaccine debate highlights a possible disconnect in communication between the medical community and parents.

Some parents opt out of vaccinations altogether, while others are using a delayed schedule to fulfill vaccine requirements. They say it's not necessarily because they question the importance of vaccinations but because they don't agree with the timing suggested by the CDC. Oftentimes, babies will receive multiple shots for various diseases in one visit. Parents on a delayed schedule may choose to only administer one shot per visit to determine whether there were any adverse reactions to a specific vaccine.

One of those moms is Brianne Shaffer, who lives in Illinois. Her 1-year-old twins were born two months premature. She and her husband decided to immediately delay all vaccines because her children were born early.

"We didn't do any vaccinations until at least two months," says Shaffer. "It's a big overload on a baby's developing immune system."

Shaffer says her husband tends to be "pro-vaccine" whereas she considers herself to be "pro-research." Shaffer points to Dr. Bob Sears, who wrote "The Vaccine Book," which discusses a flexible vaccine schedule. Dr. Sears' website attempts to bridge the gap between parents who have vaccine concerns and the medical community. "The bottom line is that more and more parents want options," the website reads. "If we don't provide them with options they are comfortable with, more parents will opt out of vaccines altogether."

Shaffer says she respects the doctors who allow parents to make choices they believe is best for their children, but finding a doctor who allows her to veer from the CDC's vaccination schedule was not easy.

The CDC's basic immunization schedule currently calls for children to receive vaccinations for 14 types of diseases, including a yearly flu shot, while Illinois law requires vaccinations for 12 diseases. Some vaccinations combine doses, such as the MMR vaccine. However, children must receive multiple doses of vaccines before they are considered immune. For example, children must receive four doses of the poliomyelitis (polio) shot before they reach kindergarten.

Photo Credit: Centers for Disease Control and Prevention

Illinois allows schools to accept children on a delayed or staggered immunization schedule, with guidelines. The rules at Ball-Chatham district in Chatham say the timeline must be written and signed off on by the physician and school nurse.

"If they choose to delay whatever vaccine it is, say it's the MMR vaccine … they have to provide a date they will secure their vaccine by," says Jen Mogren, a nurse at Glenwood Elementary in Chatham. Parents are then bound by that schedule, and they would have until those dates to get the vaccines completed and submit proof of immunization turned into the school district.

Photo Credit: Mary Cullen/NPR Illinois

"If we would have an outbreak of say MMR at that time, that child would be removed from the school until such a time that we talk with the health department and the child's doctor to return them safely to school," says Mogren.  

But, Dr. Doug Carlson, chief of pediatrics with SIU School of Medicine, says a delayed schedule is actually more harmful to your child. "Giving lower doses spread out over time makes children vulnerable over time for a longer period of time," says Carlson. "Thus, increasing the risk of infection in those children and significantly increasing the risk of infection in a population of children if that child gets infected."

Even in the Shaffer case, where the twins were born prematurely, Carlson says there is no evidence that suggests spreading out vaccines is effective, especially for other children who may be too young to receive a shot or others who have compromised immune systems and cannot receive vaccines at all.

Current legislation requires schools in Illinois to be in compliance with the rules and regulations for vaccines laid out by the Illinois Department of Public Health. Melaney Arnold with the IDPH says if a child has not received the vaccinations by deadline, evidence is needed to show the vaccines will be administered. Children may be on a “catch-up” or delayed schedule due to minimum time intervals between doses. It’s up to each school to monitor that schedule.

Photo Credit: Kemia Sarraf

Sarraf, the physician whose son was diagnosed with cancer, says, as a mother, she understands why parents choose not to vaccinate or to pick an alternate schedule. She says the anti-vaccination movement has tapped into a primal instinct for any mother: fear.

"Anti-vax parents don't come in and say they would love a dose of measles in (their) family," says Sarraf. "They do it because they have been convinced there is something to fear from that shot. There isn't. We're fearing the wrong thing. We need to be fearing the disease."

Sarraf says although medicine has not successfully eradicated infectious, deadly diseases, it has eradicated everyone's memory of them.

"There's a difference between a belief and knowledge. Those are two separate things," says Sarraf. "(We) know that vaccines save lives, that vaccines prevent devastating consequences from illness, that vaccines save children."

Illinois Issues is in-depth reporting and analysis that takes you beyond the headlines to provide a deeper understanding of our state. Illinois Issues is produced by NPR Illinois in Springfield.