Not enough Bay Area kids vaccinated, docs say Childhood vaccinations

Two months-old Santana Brown, center, receives his first rotavirus vaccination at the Bayview Child Health Center on Thursday, July 30, 2009. About 77 percent of San Francisco children are up to date on their immunizations, which leaves thousands of kids vulnerable to diseases such as whooping cough and measles that are uncommon in the United States, in many cases due to parents' reluctance to immunize their children and some just don't have access to a regular pediatrician who can keep kids up to date. less Two months-old Santana Brown, center, receives his first rotavirus vaccination at the Bayview Child Health Center on Thursday, July 30, 2009. About 77 percent of San Francisco children are up to date on their ... more Photo: Stephen Lam, The Chronicle Photo: Stephen Lam, The Chronicle Image 1 of / 4 Caption Close Not enough Bay Area kids vaccinated, docs say 1 / 4 Back to Gallery

Too many children are under-vaccinated in the Bay Area, leaving them vulnerable to illnesses that were once thought nearly eradicated and making it easier for some diseases to get a foothold in communities and spread, public health experts say.

Vaccination rates have climbed over the past 10 years, aided by the creation of immunization registries that help doctors track children's shots and public information campaigns to convince parents that vaccines are safe and necessary. But vaccines are still a controversial topic for many parents, who fear potential side effects from immunization or don't like the idea of giving their infants a dozen or more shots.

In some communities, families are widely taking advantage of laws that allow them to exempt their children from mandatory immunizations. These laws allow parents to shield their children from inoculations for personal reasons. In 2008, Marin County had one of the highest exemption rates in the state - 6.3 percent, compared to 2 percent statewide - and at one San Francisco private school, the exemption rate is 54 percent.

"Our rates are definitely too low," said Dr. Susan Fernyak, director of communicable disease control and prevention at the San Francisco Department of Public Health. "We don't have these diseases killing our children that we had a century ago, and people have really lost sight of that."

Childhood immunizations are important, first, to protect the individual and, second, to develop "herd immunity" - vaccinating a large enough group that an infectious disease is unable to spread and eventually disappears, say public health experts.

Since the first vaccines became available, diseases like polio and smallpox have disappeared in the United States. Pertussis, or whooping cough, still infects thousands of people every year and measles shows up in small outbreaks from time to time, but rates of both have fallen off dramatically.

Increased risk of disease

That's in the United States, but many diseases are still active in other parts of the world. Today's air travel makes it easier for them to spread globally. In February, three people in San Francisco came down with the measles - an adult who was infected while in Europe, and two children who had not been vaccinated.

"People don't realize these diseases are still out there," said Dr. Nadine Burke, medical director of the Bayview Child Health Center. "Vaccines are the single most important way to protect children today. I am not a person who likes to scare people, but you don't want to see pertussis in a baby."

Public health experts recommend that children be vaccinated for nine diseases by age 2, and a 10th vaccine for chicken pox by age 5. All but chicken pox require multiple doses and at least one booster.

About 77 percent of the 2-year-olds in San Francisco are up to date on their vaccines. Statewide, about 76 percent of children are fully vaccinated by age 2. Both of those rates fall far short of federal mandates that the vaccination rate should be 90 percent by 2010.

The rates improve for kindergarteners, who are required to be vaccinated unless parents ask for an exemption, which can be granted for medical reasons or unspecified personal reasons. In the Bay Area, six of nine counties have rates above 90 percent.

Many young children are under-vaccinated for logistical or financial reasons - they come from low-income families with no health insurance, for example, or their parents have moved a lot and the children haven't had one doctor to keep track of their immunizations.

Public health experts are attempting to take care of those children through clinics that provide free immunizations. The state has developed an immunization registry that keeps tabs on children who repeatedly change doctors.

Worried parents

But there's a third set of children, those with parents who choose not to vaccinate their children. Much of the reluctance is the result of long-held and widely publicized beliefs about a connection between vaccines and autism - ideas that have been repeatedly disproved by researchers.

Other parents worry that their baby's immune system isn't strong enough for so many vaccines, or fear that some of the newer vaccines haven't yet been proved safe. Doctors dispute these concerns, but many say they understand why parents are worried and will work with them to develop individualized vaccine schedules. Doctors can allow parents to delay vaccines until children are older, for example, or opt out of specific vaccines they're concerned about.

It's not an ideal answer, said Dr. Gena Lewis, a pediatrician at Children's Hospital Oakland. But if it's a choice between late vaccination and no vaccination at all, doctors prefer that children get at least some protection.

"We're willing to work with people," Lewis said. "We'd rather have them get a few at a time than not have any."