Petaluma, CA, USA. Tuesday, August 13, 2019._ Marisela Alcala of Sonoma took her two month old son, Mason McKinnon to the Petaluma Health Center where they gave the infant a checkup and he was vaccinated. Changes to California’s current vaccination law would make it more difficult for parents to use medical exemptions to avoid immunizing their children before enrolling them in school. Senate Bill 276 is making its way through the Legislature and is expected to be signed by Gov. Gavin Newsom. (CRISSY PASCUAL/ARGUS-COURIER STAFF)

Back to school poses vaccine dilemma for some Petaluma families

Pockets of Petaluma have low vaccine rates as the state attempts to ban most exemptions.

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Marisela Alcala leaned down so she was inches from her son’s face. She tapped his nose and gently rubbed his cheeks to distract him as the injections went into his legs in rapid succession.

The Sonoma resident’s 2-month-old, Mason McKinnon, was receiving five different immunizations on a recent morning at the Petaluma Health Center. One was done orally to prevent rotavirus infections, but others like the Hib, pneumococcal and a combination vaccine of DTaP, polio and Hepatitis B required needles.

Ensuring her son’s health at such a vulnerable age makes these types of painful doctor’s visits a necessary evil, Alcala said. She wants her two young children to play outside carefree and stay enrolled in public schools so they develop strong social skills.

“There’s people that don’t believe in vaccines, and I think that’s crazy,” she said. “With the (measles) and stuff, when all that was going around, why would you put other people at risk just because they don’t believe in it? I don’t know, I’d rather get all my kids vaccinated.”

With school underway citywide, families across Petaluma have been rushing to their doctors to make sure their children are fully vaccinated, an aspect of the back-to-school process becoming increasingly more regulated as lawmakers continue to bolster immunization policies.

But a government effort to require so-called “anti-vaxxers” to vaccinate their children has many parents in Petaluma fearful of an agenda they believe is eroding civil liberties as the contentious debate over vaccinations persists.

Others, however, welcome the new laws, and view the low immunization rates at some schools as a public health risk that could make Petaluma vulnerable to an outbreak of an infectious disease.

Preventable illnesses like measles, which the U.S. declared eliminated in 2000, have made a comeback this year. According to the Centers for Disease Control and Prevention, over 1,200 measles cases have been reported, the most since 1992 and more than eight of the last nine years combined.

Before widespread use of the vaccine, measles caused over 2 million deaths annually, according to the World Health Organization. In 2017, it killed approximately 110,000 worldwide, and most were children under 5 years old.

Every school in California is required to provide its immunization records to the state during the fall. Out of 17 Petaluma schools that have an enrollment higher than 20 students, the percentage of students entering kindergarten with all of their vaccines was roughly 89% for the 2018-19 school year.

Medical experts say herd immunity, the term for a population’s resistance against the spread of a contagious disease, is typically established when vaccination rates are between 92% and 95%. When herd immunity is in place, those that can’t get vaccines due to compromising health conditions are protected.

Only six schools met the 95% threshold to qualify as a fully vaccinated institution last year, and none of those were west of Highway 101, which geographically splits Petaluma. The lowest immunization rate of 45% belonged to Live Oak Charter School, a Waldorf-inspired academy located at the Sonoma-Marin Fairgrounds.

Where things stand today

The vaccine debate is a testy subject where widespread anecdotes, endless Internet material and growing questions about western medicine have made a dent in immunization rates over the last two decades.

Many in the anti-vaccination movement argue that vaccines are unnecessary, ineffective or dangerous.

Immunization Rates at Petaluma Schools

SAFEST (95% or higher)

Corona Creek Elementary

La Tercera Elementary

Miwok Valley Elementary Charter

Penngrove Elementary

River Montessori Elementary Charter

Sonoma Mountain Elementary

MODERATELY VULNERABLE (90-94.9%)

Grant Elementary 91%

Loma Vista Immersion Academy 93%

Old Adobe Elementary Charter 93%

McDowell Elementary 90%

McNear Elementary 92%

Meadow Elementary 92%

MORE VULNERABLE (80-89.9%)

Cinnabar Charter 80%

Mary Collins Charter School at Cherry Valley 84%

McKinley Elementary 88%

Valley Vista Elementary 89%

MOST VULNERABLE (Less than 80%)

Live Oak Charter School 45%

*The school data provided to the state is based on reporting in the fall, and may change during the school year. To view an interactive map where you can search vaccination rates by zip code, click here.

Source: California Department of Public Health

But research shows that, as a whole, they are effective in eliminating preventable and sometimes deadly diseases, and any alleged links to disorders like autism have been debunked and discredited.

Under California law, students are required to get 17 doses of six different immunizations in a typical K-12 track – specifically polio, DTap, Hepatitis B, MMR (measles-mumps-rubella) and chickenpox.

The only way to avoid vaccines and keep a child enrolled in school is to have a doctor-provided medical exemption. Previously, California families could use a personal belief exemption, but a 2016 law ended that practice.

Personal belief exemptions already in place were grandfathered in under the rule change, but without a valid medical exemption, those students will have to catch up once they reach 7th grade.

Dr. Jessica Rhodes, a family physician at the Petaluma Health Center, said their staff strongly recommends getting all the required immunizations, but acknowledged it can be a challenge when parents come in with hesitations.

“I think a lot of that comes from the Internet and access to information that all of us have now,” she said. “I think previously people would come to the doctor’s office and that would be the one recommendation about things like this. But now people look in a lot of different places for just advice about their health.”

According to a 2017 survey by the CDC, the percentage of children that have received no vaccines has more than quadrupled from 2001 to 2015.

Even though the overall increase is fractional, reaching 1.3% for children born in 2015, health officials remain worried that trend might continue without policy intervention, and could have greater impacts in larger populations.

The tidal shift on measles, for example, has led to 65 reported cases in California as of last week, and an outbreak remains active in the Los Angeles area.

No cases have been reported in Sonoma County, but a few residents requested testing after experiencing some symptoms, said Dr. Celeste Philip, an officer with the county’s Public Health Division.

According to the state’s annual immunization assessment, Sonoma County had the sixth-highest percentage of kindergarten medical exemptions in 2018-19, and a local task force of healthcare professionals is attempting to identify why parents opt-out of vaccinations so the county’s Department of Health Services can improve its messaging and possibly change opinions.

Philip pointed out that when there’s a deadly outbreak of a virus like Ebola, the efforts to find a vaccine are universally supported. But when it comes to the diseases that modern medicine has all but conquered, the sentiment changes.

“In that context, there’s a lot support for it,” Philip said. “But in the tried and true vaccines, because we’ve successfully prevented them, people forget there can be bad health outcomes and even death. It’s that balance between of keeping it relevant to people that’s difficult.”

What local anti-vaxxers say

Many parents that pursue vaccine exemptions don’t make the decision lightly.

One Petaluma mother, who requested anonymity to protect her family’s privacy, has two children ages 10 and 8 with chronic illnesses, and both are enrolled at local schools with vaccine exemptions. The youngest, a girl, has been diagnosed with Crohn’s disease, but for the oldest, a boy, his situation is much more complicated.

For the first few years, the son received all his required vaccines, the mom said, but when her daughter was diagnosed with the debilitating bowel ailment, she delayed both of their schedules as a precautionary measure since the disease can show up in siblings.

Her son never developed Crohn’s, but about four years ago, he began getting chronically ill, showing symptoms like body aches, high fever, swollen tonsils, and a sustained low appetite for 3-5 days “like clockwork” every month, she said.

Test after test came back negative, and doctors struggled to figure out what was wrong. Last year the symptoms peaked, she said, keeping the son homebound for five months.

Flustered and short on answers, eventually she was steered toward alternative practitioners and Lyme literate doctors that specialize in treating a bacterial infection caused by tick bites, which had become the prevailing theory but was never officially diagnosed by traditional doctors.

Through alternative treatments, his symptoms subsided and he found normalcy again. But, each of the alternative practitioners opposed vaccines, and since they gave her son relief, she was more inclined to listen.

“Conventional medicine is sort of shutting their doors on us,” she said. “‘We’ll be here when you need us,’ but never really doing anything. Meanwhile, I’m seeing these alternative doctors and my son is getting better.”

Another Petaluma mother, a nurse at an intensive care unit who also requested anonymity, was concerned and unsure when her two young children were being aggressively scheduled for vaccines. She felt her physicians were pressuring her every visit.

Eventually, through her own extensive research, she felt comfortable avoiding immunizations – and their pediatrician – altogether.

She believes the medical community has been brainwashed on the issue, often ignoring the negative reactions and responses that arise after a child gets vaccinated, or when an adult gets a flu shot, which she sometimes sees at the ICU.

“I think they have a whole agenda,” she said. “It’s a big moneymaker for the pharmaceutical industry. They’re making millions and millions off vaccines. There’s tons being tested and trialed now.”

Both mothers said they pay extra attention to any health notices at school, and have their own systems for responding whenever there’s an illness going around.

They expressed fears over the latest legislative proposal, Senate Bill 276, which would grant greater state oversight for doctors that provide five or more medical exemptions, as well as schools that have immunization rates less than 95%.

Their biggest concern is that it may have a chilling effect, forcing doctors to avoid medical exemptions entirely.

Lawmakers, on the other hand, believe the system has been abused. Since personal belief releases were banned three years ago, new figures shows that medical exemptions have quadrupled in California, and more than 100 schools have exemption rates 10% or higher.

Despite strong opposition from anti-vaxxers, the bill cleared several key hurdles earlier this summer, and is currently navigating an Assembly appropriations committee. Gov. Gavin Newsom has already agreed to sign it if it reaches his desk.

“I’m terrified because I’m absolutely stuck,” said the mother of the two chronically ill children. “And this isn’t just me. There’s so many other families I know personally that are going through something similar.”

While acknowledging there are legitimate concerns like an adverse reaction or an immunodeficiency that prevents some children from getting vaccinated, Rhodes, the Petaluma physician, sees opting out as a freedom made available because of just how effective immunizations have been over the last century.

“I think sometimes some of the hesitancy about some of the vaccines quite frankly come from a place of privilege, and that we live in a society now where a lot of these diseases aren’t here anymore because of the vaccines,” Rhodes said. “So a lot of people haven’t had children suffer from them or loved ones suffer from them, so we don’t really know how severe they are.

“Now we’re more concerned about a reaction to a vaccine or a component to a vaccine rather than thinking about the severity of the illness we’re trying to protect the kid against.”

Low rate at Live Oak

If there’s a pattern in Sonoma County, Philip said it’s that independent charter schools tend to have higher exemption rates than standardized public schools. In Petaluma, it’s about even.

Mary Collins School at Cherry Valley had 84% of its kindergarteners vaccinated last year. Cinnabar Charter had 80%. The exceptions were Miwok Valley, River Montessori and Old Adobe Elementary, which reported 95%, 95% and 93%, respectively.

With 45%, Live Oak has one of the lowest vaccination rates in California, but school officials said they operate within state law, and enforce immunization requirements for students that aren’t exempt.

Live Oak office manager Kim Anderson said the school sends out a summer packet every year that includes information on vaccination requirements. After that, it’s up to the parents to decide how they want to comply – and if they don’t, they miss school.

“We don’t counsel or coach. It’s not our place to,” she said. “That’s for the medical profession. We just need to implement the law. It can be uncomfortable, but that’s our role.”

When students get sick and miss school, Anderson said they try to probe and find out more information. If it’s contagious, they’ll put out a notice, let the community know which class it’s in, and implement any necessary protocols to isolate it, she said.

Under health department guidelines for an outbreak, for vaccine-exempt students, that could mean staying home.

First-year Executive Director Justin Tomola, the former principal of Brooks Elementary School in Windsor, described Live Oak’s values as old-fashioned, using a more holistic approach to child development.

As for what makes the school so attractive to families that have children exempt from vaccinations, Tomola said he wasn’t sure, and didn’t want to cast stereotypes on the community.

As a Waldorf-inspired school, Live Oak is built on the concept of “head, hearts, hands,” which is a focus on learning, community-building and project-based education, Tomola said.

If SB 276 becomes law, Live Oak and many other local charter schools will be subject to greater scrutiny by the state. Tomola said they would likely hold a public forum and help inform the community about any regulatory changes.

As he gets more embedded in the community, much of Tomola’s focus is on listening and learning the needs of everyone involved. If there’s aspects that need to change, it’s being willing to acknowledge and adopt them, he said.

One of my beliefs in terms of education is moving forward. We’re in this institution of learning, and as adults, if we don’t keep learning, then we’re kind of failing by not being an example.” — Live Oak Executive Director Justin Tomola

“One of my beliefs in terms of education is moving forward. We’re in this institution of learning, and as adults, if we don’t keep learning, then we’re kind of failing by not being an example,” Tomola said. “Learning is very vulnerable because it admits you don’t know something, and to admit you don’t know something is a risk because people will judge. We work hard at just acknowledging that learning is part of our growth in general.”

City’s two biggest districts

If there’s a key to establishing high vaccination rates, Old Adobe Union School District may have figured it out.

The majority of its five member schools fall within the fully-immunized range, specifically Sonoma Montain, Miwok Valley and La Tercera. Old Adobe and Loma Vista fall under the moderately vulnerable range of 90-94.9% vaccinated.

“I’m a big believer that in order to protect all of our students, we have certain obligations that we have to take care of that in that regard,” said Old Adobe Superintendent Craig Conte. “We are proud that our students – even the ones that can’t get immunizations – can come to school knowing they’ll be protected.”

Conte gave credit to District Nurse Laura Childress, who then gave credit to the secretaries and their relationships in the community. However, digitizing records for the first time when she came on board has definitely played a role, Childress said.

Even though the district advocates for getting vaccinated, she said she also understands when families have concerns, and encourages a kinder approach to what has steadily become one of the most combative issues among parents in the community.

“I don’t want to lecture people about it,” Childress said. “It’s a really personal thing and it’s really scary when a lot of the people who don’t want to get it done have a child or member of family that’s had a bad reaction. I try to be understanding and let them know what our guidelines are and why they’re there. We want to be sure that all kids are protected. But it doesn’t help to be aggressive with people about it.”

If full immunization is the goal, Petaluma City Schools, the city’s largest district, has some work to do.

Penngrove Elementary is the only school with its kindergarteners deemed fully vaccinated. The other seven primary schools fall under the moderately or more vulnerable (80-89.9%) category, with Live Oak as the outlier in the most vulnerable range.

Assistant Superintendent of Student Services Liz Chacon said safety is a top priority for the district, and targets a 100% immunization rate while knowing that there are numerous students with exemptions.

By using flyers, posters, personal letters and phone reminders, she described the district’s approach as an “extraordinary effort every year” to safeguard staff, students and their families.

“We aim to protect the health of our whole community, even though some individuals are unable to get vaccinations because of medical reasons or personal belief,” Chacon said in a statement. “We communicate the importance of vaccinations to all of our families.”

As state laws continue to shift around vaccination practices, immunization rates will likely increase at schools throughout California.

For the families in Petaluma that oppose vaccines, a difficult decision looms. If they comply, they act against their personal beliefs to ensure their children stay in school. If they don’t, the only option becomes homeschool, which could stunt social development.

And for the sake of Petaluma’s defense against deadly, preventable diseases, they might not get any say in that decision.

“We’re just trying to stay alive and as healthy as possible,” said the mother of the two chronically ill children. “That’s the thing that gets me about this pro, super 100% stance. It’s similar to the pro-life thing. This has to be a choice. Everybody has control over their own lives and their own choices. If you take that away, that’s (taking away) freedom.”

(Contact News Editor Yousef Baig at yousef.baig@arguscourier.com or 776-8461, and on Twitter @YousefBaig.)

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