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immunizations

Our vaccination rates are down, too

I wish I had a snappy intro for this, but I just don’t.

The summer months are typically the busiest of the year in Dr. Kenya Parks’ office, a steady flow of parents trotting in their little ones to receive immunizations required for school attendance.

But the numbers are way down this year, one more casualty of the COVID-19 pandemic.

“It’s quite noticeable,” said Parks, a pediatrician with UTHealth and UT Physicians, the practice of doctors at the University of Texas’ McGovern Medical School in Houston. “Parents who usually pack our offices around now instead are putting off or canceling or just not showing up for appointments. They’re scared.”

Such fear is a primary reason for an average 44 percent drop in the number of doses administered in the Texas Vaccines for Children program during the early months of the pandemic, according to a new state report. The trend puts Texas at risk of vaccine-preventable disease outbreaks, a potential disaster when school starts up.

The drop is particularly high for immunizations for measles — 55 percent — the highly infectious disease declared eradicated in the United States 20 years ago but now experiencing a resurgence. The drop in doses administered is slightly higher in the Houston area, site of a measles outbreak in 2019 and identified in a study the same year as one of the nation’s hot spots, vulnerable to an even bigger outbreak.

The overall Texas trend is concerning because the state’s vaccination rates were bad even before the pandemic. The state last year failed to meet minimal national goals for eight of 11 immunizations and barely squeaked by for the three it did meet.

“It’s like we got an F in eight classes and a D- in three, and now things are getting worse, when we can least afford it,” said Allison Winnike, president of the Immunization Partnership, a Houston-based vaccine advocacy organization. “That’s why it’s crucial parents call their pediatricians, get their kids in for their vaccinations if they’re not up to date.”

The good news, if you want to call it that, is that this doesn’t seem to be the result of changing attitudes about vaccinations. It’s about fear of the virus, which is something we can be a bit more hopeful will change in the not-too-distant future. But this is also a real risk factor for reopening schools, which I haven’t seen any official acknowledgement of. Risking a COVID-19 outbreak to force in-person school at a predetermined date is bad enough. Risking a measles outbreak on top of that is even worse. You can blame the parents if you want for the decisions they’ve made – I for one would be more compassionate, but you do you – but that doesn’t change the fact that this is a thing that will need to be dealt with, and that’s likely going to require some time. Are Greg Abbott and the TEA even thinking about this?

Anti-vaxxers gonna anti-vaxx

Every step of the way, they are an obstacle to public health.

The Texas group that lobbies against vaccine mandates is now launching a campaign against COVID-19 contact tracing, the public health measure used for decades around the world to contain disease spread.

Texans for Vaccine Choice this week called on its members to contact Gov. Greg Abbott and let him know they “do not wish to be monitored or surveilled for any reason” in response to a new state program hiring and training workers to identify people who’ve come into close contact with those who recently tested positive for the coronavirus. Such people are then asked to quarantine until testing shows they don’t have the disease.

“The government should stop thinking its job is to keep everyone healthy and instead focus on protecting our rights,” says a post on the organization’s website. “We here at TFVC will remain vigilant as our government expands greatly and the threats to our members grow.”

The campaign drew an immediate rebuke from Dr. Peter Hotez, the Baylor College of Medicine infectious disease specialist who has led public health’s fight against the anti-vaccine movement, which he holds responsible for the resurgence of vaccine-preventable diseases such as measles and whooping cough.

Thanks to the movement’s efforts, some 60,000 Texas parents currently obtain non-medical exemptions for school vaccines, some 25 times higher than 2003, the first year such exemptions were allowed. A 2018 study by Hotez found Houston and three other Texas cities rank among the 15 metropolitan “Shotspots” of such exemptions.

“Awful to see the #antivax lobby in Texas now going the extra measure to halt #COVID-19 prevention,” Hotez tweeted Tuesday in reply to a Texans for Vaccine Choice tweet alerting people to the campaign. “In the name of fake ‘health freedoms’ slogans, they aspire to land thousands of Texans in our hospitals and ICUs.”

John Wittman, a spokesman for Abbott, noted that a contact tracing program was part of the guidelines laid out by President Donald Trump in order to reopen the state and has been used in Texas and the country for decades. He said the program is “completely voluntary” and that the state health department has “taken steps to ensure it protects individuals’ liberty and privacy.”

There are certainly questions to be raised about the state’s contact tracing plan, though those questions should mostly be about competence and cronyism. I can sort of see the rationale behind the anti-vaxx movement, if I squint and do some deep-breathing exercises. The point of contact tracing is to find and notify people who may have come into contact with a person who has tested positive for COVID-19. I’m really hard-pressed to see what the problem is with that, beyond the usual tinfoil-hat paranoia about RFID chips, UPC codes, and our precious bodily fluids. We already know we have a long fight ahead over an eventual coronavirus vaccine, which is now a partisan issue as well as another thing for these people to froth about. The rest of us need to recognize this for what it is, which is a direct threat to our health. What are you going to do about that, Governor?

Measles, schmeasles

Eh, no biggie.

With U.S. measles cases this year reaching historic levels since being practically eradicated nearly 20 years ago, a host of bills targeting vaccination policies in Texas don’t appear to be gaining traction in the Legislature.

The U.S. Centers for Disease Control and Prevention has confirmed 704 cases of the measles in 22 states so far this year, the most of any year since 1994. Fifteen of those cases have been in Texas, the Texas Department of State Health Services said.

Considering the scope of the crisis, Rekha Lakshmanan, policy director for the Immunization Partnership, a group devoted to eradicating vaccine-preventable diseases, said lawmakers this session are missing an important opportunity to pass what she called “common-sense immunization laws,” among them bills aimed at increasing data transparency.

Notable among those measures are Senate Bill 329, filed by Sen. Kel Seliger, R-Amarillo, which would require the Department of State Health Services to publish the immunization opt-out rates for individual public schools. Currently, the health department is only required to post this information for districts as a whole and private schools. Another, House Bill 1966 by Rep. Gene Wu, D-Houston, would empower child care facilities to list their immunization opt-out rates for parents who are interested.

Vaccine advocates say making this data available would help parents choose the best place to send their children, particularly if the children have compromised immune systems and can’t be vaccinated.

“If you cannot vaccinate your child, then you need to place them in a child care facility with children who are vaccinated, I think, for the obvious reason that you know those children would not spread it to your child if there is a contagion that goes through the population,” Wu said of his legislation.

Opponents say the information does not reflect the overall health of a facility and could lead to kids being discriminated against for not being vaccinated, even though names would not be published.

Lawmakers heard testimony on both bills in committee hearings last week but did not vote on either. Next week is the deadline for the House to advance bills. The Senate has until May 22.

See here, here, and here for some background. This story was from the weekend, so please note that the House deadline for voting out bills is tonight at midnight. After that, it’s Senate bills or attaching amendments if your bill died in committee. The anti-vaxxers complaints do not move me. I see this as a matter of giving parents the information they need to make good choices. If that means that preschools and child care facilities are less inclined to take kids whose parents chose not to vaccinate them because it’s bad for their business, well, that should tell you something.

Also, too:

Amid a record-breaking national outbreak of measles, the number of Texans who exempt their children from vaccination for non-medical reasons took another big leap this past school year.

The number increased 14 percent in 2018-2019, continuing a 15-year-long trend that public health officials worry is leaving communities vulnerable to the resurgence of preventable diseases such as measles, which has been confirmed this year in 23 states, including Texas. The number of measles cases this year is the largest since 1994.

“Seeing non-medical exemptions increase again on a double-digit scale should create outrage for everyone,” Allison Winnike, president and CEO of the Houston-based Immunization Partnership, said in a statement. “It’s time for Texans to take action.”

Porfirio Villarreal, public information officer for the Houston health department, added that it’s “disappointing to see yet another rise in the number of parents opting out of life-saving vaccines, mostly due to the vast amount of misinformation on the internet and social media channels.”

The number of exemptions are still small, 64,176, but they represent a roughly 2,000 percent increase since 2003, when the state began allowing parents to decline immunization requirements for reasons of conscience. There were about 3,000 in 2003-2004, and a little under 57,000 in 2017-2018.

[…]

Texas is one of 17 states that allow waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only three states — California, Mississippi and West Virginia — don’t grant exemptions on religious grants. All 50 states allow exemptions for medical conditions, such as a compromised immune system.

Of course, tightening up the rules for exemptions is not on the table at all. The report that produced this data breaks it down by school district but – as we know – not by individual school. I don’t even know what else to say.

There’s only one solution to the anti-vax crisis

They have to be beaten at the ballot box. There’s no other way.

On the South steps of the Texas Capitol, state Rep. Briscoe Cain prayed that the children standing beside him would not be mocked for their parents’ decision not to vaccinate them.

“We ask that you strengthen these children … we ask that you shield them,” said Cain, R-Deer Park. “May government leaders never forget that parents know what is best for their children.”

On Thursday, more than 300 anti-vaccination advocates and their children rallied with Texans for Vaccine Choice to support bills filed by a handful of state lawmakers that would require doctors to provide families with both the “benefits and risks of immunization,” and make it easier to opt out.

“I walk these halls and I see … the fun they are poking at our children and our families, and it angers me,” said the group’s president, Jackie Schlegel, who said her daughter is disabled due to complications from a vaccine. “The time is now to stand up, to be here for your families, to be here for your children, the ones who do not have a voice.”

Statewide data shows a steady rise in children whose parents have claimed conscientious exemptions from vaccine requirements. In 2018, 76,665 individuals requested affidavits for the exemption, an 18.8-percent increase over 2017, and a 63.8-percent increase since 2014, according to the Texas Department of State Health Services.

As the movement grows, Texas has seen a series of outbreaks of infectious diseases that were thought to have been virtually eliminated in the U.S.

You can see what we’re up against. Measles are back, someone was walking around the Capitol with whooping cough, idiots are deliberately exposing their own children to chicken pox, it goes on and on. Reason, civic duty, compassion for the immunocompromised, nothing moves these people. The one thing we can do is throw the legislators who coddle them out of office. Diminish their power, and the rest takes care of itself. So, just as a reminder:

Jonathan Stickland, HD92, won in 2018 by a 49.8% to 47.4% margin, in a district where Beto O’Rourke got 48.3% of the vote.

Matt Krause, HD93, won in 2018 by a 53.9% to 46.1% margin, in a district where Beto O’Rourke got 48.2% of the vote.

Bill Zedler, HD96, won in 2018 by a 50.8% to 47.2% margin, in a district where Beto O’Rourke got 49.5% of the vote.

I wish I could make a case for Briscoe Cain’s vulnerability, but alas, he’s in one of the two most Republican districts in Harris County. Still, take those three out and you’ve really weakened the anti-vax core. You want to see fewer kids get easily preventable diseases in Texas? There’s your starting point.

The coming measles outbreak

I hope we’re wrong about this.

Peter Hotez used to worry mostly about vaccines for children in far-away places. An infectious diseases researcher at Baylor College of Medicine in Houston, Texas, Hotez is developing shots against diseases in poorer countries such as hookworm and schistosomiasis.

But now, Hotez is anxious about children much closer to home. The number of schoolchildren not vaccinated against childhood diseases in Texas is growing rapidly, which means that the state may see its first measles outbreaks in the winter or spring of 2018, Hotez predicted in a recent article in PLOS Medicine. Disgraced antivaccine physician Andrew Wakefield has set up shop in the Texan capital, Austin, and a political action committee (PAC) is putting pressure on legislators facing a slew of vaccine-related bills.

“Texas is now the center of the antivaxxer movement,” Hotez says. “There is a big fight coming,” adds Anna Dragsbaek of The Immunization Partnership, a nonprofit organization in Houston that advocates for vaccinations.

Texas still has one of the highest vaccination rates for childhood diseases overall, 97.4%, according to the U.S. Centers for Disease Control and Prevention. But the number of children not vaccinated because of their parents’ “personal beliefs”—as opposed to medical reasons—has risen from 2300 in 2003, when such exemptions were introduced, to more than 44,000 so far this year, according to numbers prepared by The Immunization Partnership based on Texas Department of State Health Services data. The actual number may be much higher because an estimated 300,000 Texan children are schooled at home, says Susan Wootton, an infectious disease pediatrician at the University of Texas in Houston; though the law requires these kids to be immunized too, parents don’t need to submit proof of vaccination.

Measles is an extremely contagious pathogen and often the first one to spread when vaccination rates dip below about 95%. The risk of outbreaks is even greater because unvaccinated children aren’t randomly distributed. In Gaines county in western Texas, for instance, the exemption rate is already 4.8%, and at one school in Austin, it’s 40%. “I would describe Texas as sitting on a ticking time bomb,” Wootton says.

[…]

Meanwhile, a PAC named Texans for Vaccine Choice has sprung up after state Representative Jason Villalba, a Republican lawyer from Dallas, proposed scrapping nonmedical exemptions last year. (The Texas House of Representatives voted down the bill.) “While they do not have a whole lot of money, they have a lot of people that they can deploy to interfere in primary campaigns,” Dragsbaek says. “They made Villalba’s primary campaign very, very difficult.” Rebecca Hardy, director of state policies at Texans for Vaccine Choice, says the group is not trying to convince parents that vaccines are dangerous, but fighting for their right not to immunize their children. (It’s also helping them apply for exemptions.)

Though almost all U.S. states allow religious exemptions from vaccination, only 18 permit exemptions based on personal beliefs; with 27 million residents, Texas is the most populous one. Another hotbed of resistance to vaccines, California, stopped allowing “philosophical exemptions”—which covered religious and personal beliefs—this year, after a measles outbreak that sickened more than a hundred people. The change in legislation led some Californians opposing vaccines to move to Texas, Hotez says.

The Texas legislature is now pondering several bills that would help shore up vaccination. One would make it compulsory for parents to complete an online course before refusing vaccination; another would require them to discuss their decision with a doctor. The bill with the best chances may be one that would allow parents to know the immunization rates at their child’s school. “This does not infringe on anyone’s right to have an exemption, it simply allows parents who need to protect their children to have adequate information to do so,” Dragsbaek says. But Hardy says her PAC is opposed to even this bill: “If it’s truly about a parent’s right to know the health status of a campus, then why are we not proposing bills that would give the rates of HIV-positive kids on campus, or hepatitis B-positive kids?” she asks.

The problem, as I’ve noted before, is that the anti-vax forces are vocal and organized, which gives them a disproportionate amount of influence in the Lege. If you’re still mad about the November election (and you should be!) and you’re looking to Do Something to make our state a better place, organizing in favor of pro-vaccination candidates and officeholders, in all levels of government, would be a good way to channel that energy. Note this does not have to be strictly partisan – Rep. Villalba, who drew the wrath of the anti-vaxxers in 2015, is a Republican. But until there’s a countervailing force against the likes of Texans for Vaccine Choice, they’re going to gain all the ground. You can’t fight something with nothing, and the pro-vaccine forces have nothing right now.

Measles

Something we haven’t seen around here in awhile.

The Houston Area Health Alert Network sent an e-mail on Friday noting that an 11-month-old child, who attended the Cirque du Soleil performance at Sam Houston Race Park on March 20, developed fever the next day and a rash three days later. She later tested positive for the highly contagious virus.

The e-mail asked local health care providers to consider measles in patients presenting with a rash.

The baby is recovering, according to Kathy Barton, spokeswoman for the Houston health department.

Barton said health officials are aggressively investigating any contact the child may have had with at-risk people, but said the situation is nothing like it was in the late 1980s and early 1990s, when the city’s low child immunization rate — 11 percent — led to an outbreak that hospitalized one-third of confirmed cases.

Houston’s immunization rate is now 87 percent.

This was the first confirmed case since 2005. I think what caught my attention in this story is the unbelievably pathetic 11 percent child immunization rate from 20-25 years ago. How was it even possible to have been that bad not that long ago? That we’ve come that far since then is impressive, but I just can’t get over how far down we once were. I wish I could say we’ll never be there again, but with the brutal House budget decimating health and human services as it does, I’m not sure I can.

Free childhood immunizations available

Via email from the Houston Fire Department:

Get Your Child Ready For School With Free Immunizations from The Houston Fire Department and Blue Cross and Blue Shield

It takes more than school supplies to get your child ready for the new school year.

The Houston Fire Department and the Blue Cross Blue Shield Care Van have teamed up again in 2009 to offer free childhood immunizations at your neighborhood fire stations. This is the perfect time to get your child up-to-date on their immunizations for school and avoid the rush before school resumes after the summer. The immunizations are FREE. All you need to bring is your children, your identification and your children’s immunization records.

Immunization times are 4 p.m. -7 p.m.

Thursday, August 20 Fire Station 11 460 T. C. Jester

Thursday, September 3 Fire Station 29 4831 Galveston Road

Thursday, September 17 Fire Station 59 13925 S. Post Oak Road

Thursday, October 1 Fire Station 44 675 Maxey Road

Thursday, October 15 Fire Station 70 11410 Beamer Road

Thursday, November 5 Fire Station 76 7100 Cook Road

Thursday, November 19 Fire Station 32 8614 Tidwell Road

Visit the Houston Fire Department website at www.houstonfire.org for more information. Any questions? Contact the HFD Public Affairs office at 713-495-7900.