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SIDEBAR:

GRANTING IMMUNITY

Not all naturopaths oppose immunization.

Dr. Paul Lewis has little respect for health-care specialists who advocate against immunizations. "Quacks with a capital Q," is how he describes them.

Though some alternative health-care providers are firmly in the anti-immunization camp, most interviewed by WW take a more moderate approach.

Naturopathic physician Laurie Marzell, for example, sees immunization as a natural process. She, like many other naturopaths, administers routine immunization shots.

Edwin Hofmann-Smith, another naturopath, immunizes most of his pediatric patients, but waits until they are 3 or 4 months old, instead of 2 months. He also gives them one inoculation at a time instead of several in one day. "If there is an adverse reaction," he explains, "we know which vaccine the child reacted to."

Mark Stengler, another naturopathic physician, says homeopathic remedies can lessen the likelihood of undesired immunization side effects such as fever, fussiness or lethargy. Stengler, who chose not to immunize his own child, also says that homeopathic vaccinations are available; they are similar to conventional inoculants, he says, but are more dilute than routine shots. These vaccines, however, do not meet state health department immunization requirements.

 --TB

Context:

The number of children entering Oregon schools without immunizations ranges from none in Klamath County to nearly 6.5 percent in Coos County. In Multnomah County, 1.24 percent of kindergartners enter schools with philosophical or religious waivers.
 

There is a 1-in-2.5 million chance of contracting paralytic polio from the oral polio vaccine. The injected, inactivated polio vaccine carries no such risk, but is less effective in preventing the disease.
 

Chickenpox, while serious in teens, does not have dire consequences in most young children. Because of this, some pediatricians are not recommending the new varicella vaccine for their young patients.

This fall Judith Boothby sent her 9-year-old son off to school at Atkinson Elementary in Southeast Portland. He had the requisite backpack and new sneakers, but he didn't have all of his immunization shots.

That's not because his parents forgot. Rather, they are convinced that their fourth-grader is better off without some of his state-mandated shots. And thanks to Oregon's liberal waiver policy, he and approximately 5,000 other metropolitan area students are currently in classrooms without immunizations.

Although the number of non-immunized students in Oregon (about 1 percent) has remained steady over the years, local health providers say that as naturopaths and herbologists gain credibility, parents are increasingly questioning traditional immunizations and looking for alternatives. This skeptical attitude toward immunizations comes as the Oregon Health Division is moving in the other direction, filing new rules this month that increase the number of inoculations required for entry into schools and state-licensed day care.

Some parents see the question of immunization as one of personal choice. Many health-care professionals, however, argue that parents who forgo immunizations are endangering other kids and undermining efforts to wipe out diseases.

"One percent sounds like a low number," says Dr. Paul Lewis, a pediatric infectious disease specialist at Oregon Health Sciences University, "but it is a lot of kids."

Oregon began requiring immunizations for kindergartners in 1982. Inoculations, usually given beginning at 2 months, offer protection from serious illness, boosting the body's ability to fight potentially deadly viruses. An inoculation usually contains a cocktail of inactive viruses, giving the body a chance to recognize and build up antibodies against them following the injection. Oregon children are required to be immunized against six diseases: measles, mumps, rubella, polio, tetanus and diphtheria.

All but four states grant waivers for parents who object to inoculations on religious grounds. But Oregon is one of just 16 states that also allows waivers for philosophical reasons. That means, in practical terms, anyone wanting a waiver in Oregon can get one.

Those filing waivers do so for a variety of reasons. One Portland mother, for example, says she believes the World Health Organization, a body that studies global health issues, is tainting inoculations to keep the world population down. More typical are concerns that childhood immunization shots weaken the body's immune system and wreak havoc on our natural defenses. "We need to have these diseases to strengthen our immune system," says Boothby.

Some claim that immunization shots are more dangerous than the diseases they are meant to protect us against, attributing autism, attention deficit disorders, dyslexia, allergies and cancer to immunization shots. Inoculations are accused of causing epilepsy, sleeping and eating disorders, asthma, Sudden Infant Death Syndrome and impulsive violence. "We have to decide if we want to cope with the side effects of the diseases, or the side effects of the immunizations," says Boothby.

Scientific studies, however, do not find a causal relationship between immunizations and most of the serious side effects they are accused of triggering. SIDS cases, for example, are currently declining, while immunizations are increasing.

That's not to say immunizations are risk-free. Immunizations improve all the time, but many still have side effects. Kids may be feverish and fussy after being inoculated. In some cases, they may even develop some of the symptoms of the disease they're being vaccinated against. Lethargy and convulsions occur at a rate of approximately 1 per 1,750 doses of DTP (diphtheria/tetanus/pertussis) vaccine administered.

While parents may see that as a huge risk, the danger in not vaccinating is greater. Seizures accompanying pertussis, or whooping cough, occur at a rate of 1 per 25 to 1 per 200 cases. And pertussis can cause more than seizures. Carla Wester's daughter contracted whooping cough before her immunization series began. Wester, a Portland homemaker, remembers her daughter, who dropped to her birth weight, coughing until she turned blue. "It was extremely scary," she says. "She was near dead when we went to the hospital."

 To Lewis, the advantages far outweigh the risks--not only for individual children, but for society as a whole. He calls the advent of vaccines "the greatest advance in medicine since clean water."

Immunizations have two benefits. First, they provide protection for an individual. Second, they have the potential to make vaccinations unnecessary in the future. A national immunization campaign is credited with eradicating smallpox and polio. In theory, other diseases could also be wiped out if almost everyone was immunized against them for a period of time.

In keeping with that philosophy, all 50 states require vaccinations for entry into schools. In Oregon, new rules filed this month will add hepatitis B, chickenpox and a second dose of measles vaccines to the list of immunizations required before or by the 2000-2001 school year.

If immunizations are a way to wipe out diseases, the state's liberal waiver policy seems suspect. Last year, in the tri-county area, there were an estimated 5,000 students without immunizations, according to the health office of the Multnomah County Education Service District.

The number of unimmunized children is troubling because immunizations are not 100 percent effective. In the case of an outbreak, even some people who have been vaccinated could contract the disease, and disease outbreaks are more likely to occur when immunization rates drop. A 1991 measles outbreak in Philadelphia, for example, afflicted 1,500 children after immunization compliance decreased. Nine of those children died.

Despite such sobering statistics, no one WW spoke to is advocating mandatory immunization shots in Oregon. Pediatrician Gale Rydell favors education over regulation. "We can't force people to [immunize]," she says. "But I tell my patients who don't want to immunize, 'Let me tell you a little about the diseases.'"

Dr. Lewis agrees. "I don't want to force, but convince, people to immunize their kids," he says.