School nurses in Orange County are preparing for a new state law that will make it harder for parents to opt out of vaccinating their children.

At a conference in Orange last week, some 80 school nurses met with local health officials at Children’s Hospital of Orange County or CHOC to learn about their role in the law, which takes effect in January. The law requires parents who forego vaccination to receive information on the health consequences of doing so.

The law authorizes school nurses to provide the information to parents, since proof of vaccinations is normally required for admission to school. In the past, parents merely signed a card exempting their children and filed it with school officials.

Exemptions are believed to be responsible for a return of communicable diseases such as whooping cough, which killed 10 children in California in 2010, the highest number since 1947.

“We’ve been growing in our exemptions,” said Dr. Marc Lerner, medical officer of the Orange County Department of Education. “It will be interesting to see in a year if new exemption requirements affect vaccination rates.” States that have instituted more rigorous exemption processes have seen a decline in opting out, Lerner told participants at the workshop.

One reason parents opt out, according to Dr. Jasjit Singh, a pediatric infectious disease specialist at CHOC, is that many communicable illnesses seem abstract and unlikely.

“You’re never going to see a case of diphtheria, but everyone knows a kid in the neighborhood who has autism,” she said.

Autism was a common reason why parents refrained from vaccinating their children in recent years, though numerous scientific studies in the U.S. and other nations have not shown a connection. A 1998 article in a British medical journal popularized the connection but was later retracted, and the author lost his physician’s license, Singh said.

Recently, the Orange County Health Care Agency conducted focus groups of parents in the county who resist vaccines. The agency learned that most parents no longer link vaccines to autism; instead, they are more concerned about autoimmune diseases and additives used in the vaccines. Some parents also believe vaccines are no longer necessary and their children are not at risk.

But Singh countered, “There are very real risks when you don’t immunize your child.”

Experts at last week’s meeting with school nurses said that it’s important to address parents’ concerns about vaccination. For example, some parents worry that vaccinations will overwhelm their children’s immune systems.

But Singh said that even though the number of required vaccines has increased over the years, the number of antigens — that is, toxins in the vaccine provoking an immune response — have been reduced from thousands to single digits.

Similarly, school nurses should acknowledge that vaccination is not foolproof, she said, which is why immunization efforts work better when everyone complies with the policy. And while contracting an illness is sometimes a more reliable way to prevent future infection, parents looking to vaccinate their child naturally by subjecting him or her to the illness are taking a big risk, she said.

“Natural immunity is only good if you live to have it,” Singh said.

She also said that parents seeking to protect their children by eliminating or reducing the number of vaccines need to know that the health hazards of not vaccinating are far greater.

Orange County has seen drop-offs in the number of children immunized in recent years. According to data from the Health Care Agency, the people who opt out of vaccinating tend to be wealthier, white residents.

Consider Capistrano Unified School District, which consistently shows lower percentages of vaccinated students than other districts in the county. For example, the average percentage of kindergarteners in the district who have completed the second round of the measles, mumps and rubella vaccine is 77 percent.

That figure falls short of the level of immunization recommended to prevent an outbreak of measles, mumps or rubella, which is at least 83 percent, said Dr. David Nunez, family health medical director at the agency.

“Some of the school districts are far below that protected level,” Nunez said. “What that suggests is that if there was a case of measles in some of these communities, it might spread rapidly throughout the community.”

Nunez said that an outbreak of measles can occur when an unvaccinated student returns from traveling abroad. Severe cases of measles can result in encephalitis and permanent brain damage, he said.

At last week’s workshop, school nurses learned that the new law will allow officials to remove unvaccinated students from a school if they are believed to have been exposed to certain communicable illnesses. The new law will apply to both private and public schools and child care facilities.

Amy DePaul is a Voice of OC contributing writer and lecturer in the UC Irvine literary journalism program. You can reach her directly at

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