Is Outbreak at Disneyland an Opportunity to Examine Vaccine Exemption Laws?

Kids brought home more than Mickey Mouse ears at “The Happiest Place on Earth’’ over the winter break.

As of January 27, 88 people had contracted the measles as a result of an outbreak at Disneyland and Disney California Adventure, according to the California Department of Public Health. The majority got sick after spending time in the theme park between December 15 and 20. Others contracted the potentially fatal virus from friends and family who visited the theme parks.

Health officials said close to half of California’s 74 residents afflicted with the measles weren’t vaccinated. In addition to California, there are now 14 cases spread across Arizona, Utah, Oregon, Colorado, Nevada, Washington, and Mexico. In Northern California, more than 30 babies who were potentially exposed (and too young to have been vaccinated against the virus in the first place) have been placed in home isolation.

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Public health officials are attributing the spread of the virus to the clusters of unvaccinated residents in Orange County, where the theme parks are located. Unvaccinated children have been on the rise in California, where until recently parents were allowed to claim “personal belief exemptions’’ (also known as “philosophical exemptions’’) from public school immunization requirements. To try to curb this, at the beginning of 2014, California enacted a lawrequiring families to visit a doctor’s office and get a physician’s signature on their exemption forms.

Before the law changed, the number of philosophical exemptions had doubled over six years, and the latest data show the law hasn’t made much of an impact. In California’s 2014-2015 Head Start class, the first required to comply with the new law, 12,981 families filed personal belief exemptions (a slight reduction from 2.94 to 2.67 percent of the class). This may be because it is relatively easy to get out of the doctor signature requirement by claiming a religious exemption to medical treatment more broadly. And the law isn’t retroactive, so the children already admitted to schools without immunizations can stay unvaccinated.

A similar legislative vaccine debate is playing out in another popular tourism state with high exemption rates: Maine, also known as “America’s Vacationland.’’

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The number children in Maine who don’t get vaccinated has increased in the past decade to 3.9 percent, one of the highest exemption rates in the country according to the Maine Center for Disease Control and Prevention. Like California, Maine allows parents to use philosophical exemptions to get out of immunizing their children. That may change: In reaction to the latest stats, state legislators have proposed two bills targeting philosophical exemptions.

The first bill, presented by Rep. Ralph Tucker of Brunswick, proposes to get rid of philosophical exemptions entirely (and join the ranks of states like Massachusetts that only allow medical and religious exemptions). The second, sponsored by Rep. Richard Farnsworth of Portland, proposes a law similar to California’s: A doctor’s signature would be required for anyone requesting the exemption.

“The intent of the legislation is to basically make sure that families have appropriate information before they sign off. Right now they can sign off for whatever reason,’’ Farnsworth told Boston.com. “Because the internet and social media is filled with all kinds of garbage about vaccinations, I really think it’s valuable, for families sign off on it, that they have appropriate information, and we make sure they have the right information.’’

The rising population of unvaccinated children isn’t legislators’ only concern. Public health officials believe the state is vulnerable to an outbreak. Last summer, a whooping cough (pertussis) outbreak in Maine sickened at least 254 children, the CDC estimated. The majority of patients were between 7 and 19 years old. In 2012, 646 cases were reported statewide across all age groups. Advocates looking to change the policies around philosophical exemption rates are pointing to these outbreaks as a warning.

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“From a public health point of view, we absoluately have to increase our rate of immunizations in order to reduce the risk of transmission for early childhood diseases,’’ said Farnsworth. “We’ve already seen problems with whooping cough, measles, and mumps recently. It’s not fair to the general public to have kids who are running around with the potential to expose everybody … I would hope we would increase our immunization rate, but my primary concern is to make it so people have to visit a physician before they make this decision.’’

It’s not yet clear how Farnsworth’s bill will play out. As of mid-January, he said it hadn’t even left the revision committee, but he’s already facing criticism from families and other legislators.

“I don’t think the doctor should be in the position of being the parent of the parent,’’ Rep. Andrea Boland, of Sanford, told The Portland Press Herald. The argument is similar to what other critics are expressing, especially the families who regularly file philosophical exemptions.

Maine and California aren’t alone. While all 50 states require public school students to be immunized, 19 states still allow families to file philosophical exemptions. But their decisions don’t just affect those states’ residents. It wasn’t only California that was affected by the measles outbreak, and it isn’t only the kids whose parents chose not to vaccinate them who got sick.

It’s a small world, after all.

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June 18, 2019 | 8:55 AM