INDIANAPOLIS — Indiana has a better chance than many states of avoiding widespread outbreaks of measles and other vaccine-preventable illnesses like the one that has hit California, says a public health and legal expert at Indiana University-Purdue University Indianapolis.
That’s because Indiana has stricter requirements than those states regarding children receiving mandatory vaccines as a condition of entry to child care and elementary school, said Ross D. Silverman, a professor of health policy and management at the IU Richard M. Fairbanks School of Public Health. Silverman also holds a secondary appointment as professor of public health and law at the Indiana University Robert H. McKinney School of Law.
The outbreak of measles in California is that state’s worst in 15 years, according to public health officials. The majority of those infected were not vaccinated against the disease.
In an article published Jan. 20 in the Journal of the American Medical Association, Silverman and a co-author said that during 2014, numerous communities across the United States were affected by significant, largely avoidable outbreaks of vaccine-preventable illnesses, such as measles, mumps and pertussis. These outbreaks have been associated with increasing numbers of families actively declining immunizations for their children.
According to Silverman, all states allow medical exemptions for children’s vaccinations, and all states, except Mississippi and West Virginia, offer parents the right to seek exemption from school vaccination requirements on the grounds that vaccination violates family religious beliefs. But 20 states go further when it comes to vaccination exemptions. These states, like California, offer broader grounds, allowing parents to opt their children out of vaccination requirements for philosophical or moral reasons.
Indiana does not permit exemptions for philosophical reasons, Silverman said. States like California with philosophical exemptions have higher rates of vaccine-preventable illnesses. In 2013, the Centers for Disease Control and Prevention reported that more than 17,000 California kindergartners received philosophical exemptions from state vaccine requirements (more than 3 percent of all children entering school), while approximately 730 (under 1 percent) of Indiana kindergartners received religious exemptions.
In addition to types of allowable exemptions, four other factors can be assessed to determine the protective strength of a state’s childhood vaccination exemption law:
• The population and entities within the state to which the law in question applies. • The documentation and filing processes by which individuals submit exemption applications. • The review process for exemption applications. • The availability of appeals and applicable penalties.
In addition to offering the narrower religious exemption, Indiana offers significant protection through the state law’s application to public and private schools, the requirement that those seeking exemption file such requests annually, as well as its robust state immunization registry. “Indiana has a new requirement going into effect this year that all health care providers enter complete immunization records for everyone under the age of 19 into the state’s immunization registry database,” Silverman said. “This will further strengthen the state’s ability to identify vulnerable populations and protect against outbreaks. And of course, increased local and state funding for public health departments and programs would augment prevention and protection efforts, while saving Hoosiers from the high costs of treatment and disease outbreak containment.”
Much has been done within the United States to reduce the rates of vaccine-preventable illnesses. Measles, for example, was considered eradicated. But the disease has come back, Silverman said.
“Outbreaks of measles now occur when unvaccinated people exposed to measles during travel abroad return home and come in contact with more unvaccinated populations here,” Silverman said. “Measles is one of the most contagious diseases around. If an infected person comes into contact with 10 unprotected people, 9 of those 10 will get measles. A growing number of people today are vulnerable because they have immune deficiencies, and a small population are vulnerable because, for whatever reason, the vaccine did not take.
“But the most worrisome and fastest-growing vulnerable population are those who choose not to get their children vaccinated, and that’s the population in which we’ve been seeing a surge of cases like measles and whooping cough nationwide in the last few years.”
Local communities that are most susceptible to triggering wider vaccine-preventable illness outbreaks following a single exposure are those in which people who have declined vaccinations cluster geographically, often in particular schools, religious institutions and communities, Silverman said.
“Vaccinations are the key to prevent such an outbreak,” Silverman said. “They protect the individual child from contracting serious and highly contagious diseases and help stop their spread.”