OC’s Top School Nurse on the Wisdom of Vaccinating Kids


Pamela Kahn, the Department of Education's Health & Wellness Coordinator, is working with school nurses to comply with the state's stricter immunization requirements. (Photo by: Rayna Jensen)

A new state law will make it more difficult for parents to opt out of vaccinating their children, which will particularly affect communities in South Orange County, where the opt-out rates are high.

Pamela Kahn of the Orange County Department of Education is tracking the law’s implementation, which takes effect next January. Kahn is a nurse, public health expert and the department’s liaison to school nurses, who are required to report the number of parents requesting vaccination exemptions for their children.

Kahn is a staunch advocate for vaccination and explains in an interview with Voice of OC what the law is designed to accomplish and why she and other health officials believe it necessary.

Q: How will exemption work under the new law?

A: What the law is going to require is that parents who elect to sign a personal belief exemption (PBE) must first be given information regarding the risks that go along with not having a vaccine. There will have to be a signature where the parent says, “I have been informed of risks and have elected to sign the PBE.”

Q: How did the exemption work before?

A: Before, parents would walk in to schools and say, “I don’t want to have my kids to have a vaccine” and sign what is known as the blue form [California School Immunization Record], and it was done. There was no extra step of giving education about possible consequences.

Q: And what are the consequences of going without a vaccine?

A: The primary risk is, of course, contracting the illness. Many of these vaccine-preventable illnesses can have severe health consequences. The secondary risk is the possible exclusion of their child from school for an extended length of time. Should we have an outbreak of a certain vaccine-preventable disease at a school, county health officials could come in and say that all children who have not had the vaccine need to be excluded from school during the run of this disease. This exclusion period could last from one to six weeks or possibly even longer.

Q: Some might argue that the new law won’t change any minds. What was the goal?

A: I think the intent of the law was to provide people with an education. Parents might not realize their child could be excluded from school and not be sure why there’s a new vaccine. If we have a chance to explain that an illness has reached epidemic proportions and that babies are at risk of dying, they may say, “I didn’t realize that.”

Also we as school nurses sometimes see parents who have never signed a PBE in the past, but if the child is behind on his shots or a new one is required, the parent will suddenly say, “I don’t believe in these.” Sometimes we are unsure if it’s a true philosophical opposition or a matter of convenience.

Q: Who is most vulnerable to communicable diseases?

A: We always worry about babies under 6 months who have not been fully immunized. Also with the flu, we worry about our elderly population.

Q: Are poorer people and minorities more vulnerable to fatalities from communicable diseases?

A: It’s difficult to say. Remember that in 2010, we had 10 infant deaths from whooping cough in the state of California. I believe that all 10 were Hispanic babies. I don’t know their socioeconomic status. We don’t really know why that was.

Q: What are the rates of exemptions in Orange County?

A: I have data from the Orange County Health Care Agency for 2010 for the percent of kindergarteners with PBEs by school district. The highest ones, between 5.3 and 7.7 percent, were Capistrano Unified, Laguna Beach Unified and Huntington Beach City. The lowest included Santa Ana Unified, Garden Grove Unified and Anaheim City.

Q: Is the main objection autism?

A: We don’t ask parents why they are filling out the exemption … but yes, from what we’ve heard — though again, that’s totally anecdotal.

Q: Are there also people who delay some vaccinations out of concern for autism as well?

A: Some parents, even if they’re not opposed to vaccines, are trying to space the immunizations apart a little more. There are alternate schedules that some pediatricians use.

Q: What are the health consequences of delaying vaccines?

A: The vaccine schedule is recommended by ACIP [federal Advisory Committee on Immunization Practices]. It was created to provide maximum response at the earliest time in life. We want to see parents get their children vaccinated as soon as safely possible, and there’s a lot of science around the issue of what is the best age to give a child a vaccine. By delaying it you just don’t give them that immune response until later on in life.

Q: Can you address the fear that vaccines cause or are linked to autism?

A: Dozens of studies have been published in peer-reviewed journals, and none have shown a link between immunization and the rise in autism levels. Mercury had been pinpointed as a cause of autism, but it has not been used in vaccines since 2001. And yet we’ve still seen the rate of autism rise. There’s no credible — and that is a subjective term — study that has shown this tie-in.

Q: But there are all sorts of claims about the relationship of vaccines to autism.

A: We say this over and over: Parents need to be careful about the resources they choose to consult. We can find anything we want to on the Internet. Some of the information out there is not evidence-based.

Q: And the famous article alleging a connection that was in a British medical journal [The Lancet] was retracted.

A: The Lancet has retracted that article. The author, Dr. [Andrew] Wakefield, lost his license. It was a totally noncredible study.

Q: Is an epidemic of a communicable disease a realistic possibility in Orange County?

A: A few years ago, France had an outbreak of 9,000 cases of measles that were proven to be related to lower vaccine rates. San Diego had an outbreak of measles. It was traced to a child who had traveled overseas, was not fully immunized and then brought it back, only a few years ago.

Q: The herd immunity — the percentage within a population who need to be vaccinated to avoid outbreak — is slipping in Orange County. Can you say more about that?

A: As we see, particularly in the districts we mentioned, the herd immunity level is dropping below critical level. It is a distinct possibility and becoming a probability we’ll see an onset of vaccine-preventable diseases. The sad thing is — and this is true of medical interns and residents — some medical professionals have not even seen these diseases.

We’ve become blase about them; we don’t fear them like we should. We used to lose children to chicken pox and saw mass staff infections that resulted in amputations. We’ve become complacent.

Q: Do you consider the Tdap booster, which was required of California teens in 2011, proof that vaccines can reduce outbreaks of diseases?

A: That was evidence. As a direct result of implementation of Tdap [for whooping cough], we had no deaths last year in California, and 2011 marked a drop-off in rates.

Amy DePaul is a freelance writer and lecturer in the UC Irvine literary journalism program. You can reach her directly at depaula@uci.edu

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