Other Voices: What a personal belief exemption means for public health
Immunizations are a vital protection for you, your family and community. Without a fully immunized population, infectious diseases that are preventable can, do, and will break out and cause an outbreak of disease. Depending on which disease and who is infected, the results can be relatively minor or can cause permanent disability or death.
For example, pertussis (chickenpox) is considered by many to be a relatively minor disease, but if you are younger, older, or otherwise compromised by a chronic disease or immunity (cancer, chemotherapy, HIV/AIDS, on steroids, or diabetic, for example), it can be fatal. In fact, we have had one fatality due to pertussis in recent months in Nevada County.
Once you have had pertussis, you are now able to come down with shingles, a very debilitating disease which can lead to complications and death. However, if you or your children are properly immunized, the risk of contracting pertussis is very small and the risk for shingles is virtually nonexistent.
Should you decide to enroll your children in school and to sign a personal belief exemption, you are putting your child and anyone he or she comes into contact with at risk. Please consider the following, which are your responsibilities by signing the personal belief exemption form.
1. “Measles, Mumps, Rubella, Chickenpox, Pertussis, Diphtheria, Polio, Haemophilus Influenza type B, Hepatitis A, and Hepatitis B are infectious to others and are avoidable through immunization.” This means that an infected person, even without symptoms, can transmit the infection to other children, who might not be able to be vaccinated because of an allergy or other sensitivity, and to adults who also may not be fully immunized, including older folks in long-term care facilities.
2. “Please educate yourself to the symptoms and possible complications that can arise from a vaccine-preventable disease. Information for parents about these diseases may be found at the National Immunization Program site http://www.cdc.gov/nip or by calling the Nevada County Public Health Department (530) 265-1450.” We are here to help you, schools and school nurses be better informed about the risks and complications of these diseases. We can also provide all childhood immunizations as well as adult immunizations. Annually we hold several influenza immunization clinics throughout the county.
3. “These diseases have many symptoms that require close monitoring and care in order that complications are minimized. It is essential to have a plan of care, coordinated with your health care provider, to act upon the mildest to most severe symptoms of the disease.” Please educate yourself about what complications to look for. Measles can cause meningitis and death relatively quickly. Hepatitis B in a child can cause a chronic carrier state that can result in cirrhosis of the liver, hepatocellular (liver) cancer, and an early death.
4. “The school or school nurse is responsible for maintaining a list of the school children who have a parent-signed exemption to immunization for medical, religious, or personal belief. This list allows the school nurse to quickly identify any child who is at risk of exposure to a vaccine-preventable disease.” During an outbreak at your child’s school, children who are not immunized will be excluded from school to prevent them from becoming infected and to prevent continued transmission to others, including school, religious institutions, play groups, and others.
5. “An unimmunized child who will be excluded from school by the County Health Officer when a vaccine preventable disease is identified in the school. The ill child will also be excluded from school.” If the outbreak is large enough, entire classrooms or the entire school will be closed.
6. “When a child is excluded from school it is the responsibility of the parent or guardian to keep the child isolated from the public at large to prevent spread of infection to the community.” You will need to make arrangements on your own to care for any sick or excluded children, and older children will not be allowed to go to work. The isolation timeframe is determined by the County Public Health Officer. Isolation requires that the exposed or ill child not leave home unless for medical care.
7. “Vaccine preventable diseases are considered Reportable Communicable Diseases under the Health and Safety Codes of California. A Public Health Nurse will contact you to investigate the disease. Be prepared to provide information to the investigator. This information is confidential.” We must follow up on communicable disease reports to help prevent the infection from spreading to others. In some cases we will provide a protective antibiotic, in others the protective vaccine. We do not share personal information regarding our patients/clients with others, and only those within the Public Health Department have access to this confidential information.
8. “The parent or guardian is also at risk of contracting any of these diseases when exposed to an ill child. If unimmunized, the parent or guardian may also be considered exposed and incubating the disease, since this may continue the cycle of infection to others. This in turn requires that the parent or guardian to remain in isolation from the community through the incubation period.” If your child brings home an infectious disease and you are not immunized or cannot show evidence of having had the disease, you, too, may be physically isolated in your home.
9. “The child who is exposed to the disease may be offered preventive medication or immunization to prevent the disease from occurring – either may keep the child from being excluded from school.” Your child will be excluded from school during the incubation period of the disease during an outbreak unless you and your child follow the prescribed response as noted above.
I know that all parents want what is best for their children, and I guarantee you that we in the Public Health Department want the same. However, we have over 98,000 “patients,” and one of our primary jobs is to protect the entire public’s health.
The above guidelines, which you will be asked to sign when you enroll your kindergartner and choose to take advantage of the personal belief exemption, is only one of the ways we try to prevent disease and to promote health. Please visit our Web site http://www.mynevadacounty.com and look for the Public Health Department, for other ways we work to protect you and your loved ones.
Dr. Joe Iser is the director of public health and public health officer for the Nevada County Human Services Agency.
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