SIOUX CITY | Bailey Boettcher wailed when a nurse poked a syringe filled with the measles, mumps and rubella (MMR) vaccine into the 12-month-old's chubby thigh as she lay on an exam table at Prairie Pediatrics. Her mom, Beth Boettcher, planted a kiss on her forehead to comfort her.
The momentary discomfort Bailey endured will protect her from serious diseases that could damage her brain, claim her hearing and sight and ultimately take her life.
All 50 states have legislation that requires specific vaccines for children. The idea behind vaccination is creating "herd immunity," a situation in which the majority of the population is immune to diseases such as measles, mumps and pertussis. A high vaccination rate protects infants and those who can't be vaccinated due to medical conditions.
"I just always thought that vaccines were a good thing. I feel they keep our kids healthier and keep others' kids healthier," Beth Boettcher said.
Data shows a growing number of parents seem to disagree, opting out of vaccination. Vaccine exemptions are on the rise in a number of states, including Iowa, with religious exemptions outpacing medical exemptions by far.
All state laws grant vaccine exemptions to children for medical reasons, and only three states -- West Virginia, Mississippi and California -- offer no religious or philosophical exemptions, according to information from the National Conference of State Legislatures.
Currently, Iowa parents may forgo vaccinations for their children for medical or religious reasons. During the 2015-2016 school year, the state, which had a vaccination rate of 98.76 percent, recorded 8,733 total exemptions for students in grades K-12. Seventy-seven percent of those exemptions were religious exemptions.
Source: Iowa Department of Public Health
Woodbury County tallied 52 vaccine exemptions during the 2002-2003 school year. Since then, the number of exemptions has steadily increased over the years, reaching a high of 183 exemptions last school year. Of those exemptions, 135 were religious exemptions and 48 were medical exemptions.
Sergeant Bluff-Luton Elementary School led the way in Woodbury County in 2015-2016 with 99.74 percent of its students having valid vaccine certificates, while West Middle School had the lowest vaccination rate at 85.79 percent -- well below the county's vaccination rate of 98.64 percent.
Tyler Brock, Siouxland District Health Department deputy director, said populations that have low vaccination rates are at increased risk for outbreaks.
Since Aug. 1, Iowa has tallied 181 cases of mumps -- 105 of those cases were reported in Dubuque County. No cases were reported in Woodbury County during that time period. Woodbury County had one case of mumps in March 2016, which was its first case in six years.
Mumps, a disease that causes swollen and tender salivary glands, is typically preventable through vaccination. Rare but serious complications can occur with mumps, including sterility, deafness and meningitis -- an inflammation of the lining around the brain and spinal cord.
"Any time there are diseases that are preventable that we're not preventing, it's concerning for public health," Brock said. "It runs the risk of taxing public health resources when we have outbreaks caused by vaccine-preventable diseases. It also places at risk some of our most vulnerable -- young infants who are too young to be vaccinated."
DEBUNKED CLAIM PERSISTS
Steven Joyce, an internist and pediatrician at Mercy Medical Center, said rumors perpetuated on social media factor into some parents' decisions to forgo vaccination altogether or delay or spread out vaccines. The debunked assertion that the MMR vaccine causes autism is one of the most common.
The Journal reached out to locals who oppose vaccination or disagree with recommended vaccine schedules. They didn't respond to requests for comment or declined to be interviewed.
"There's never been a link of significant harm from a vaccine, especially autism," Joyce said. "The only study ever published that linked vaccines with autism was a falsified study, and that investigator was reprimanded."
That investigator was Andrew Wakefield.
Although the British gastrointestinal surgeon's paper, which was published in the medical journal The Lancent in 1998, was retracted, and he was subsequently barred from practicing medicine, his discredited claim that the MMR vaccine causes autism persists.
President Donald Trump met with Wakefield in August during his campaign. Then Wakefield was spotted at one of Trump's inaugural balls. Trump has expressed skepticism about the vaccine schedule in various tweets over the years.
On Sept. 4, 2014 he tweeted, "I'm not against vaccinations for your children, I'm against them in 1 massive dose.Spread them out over a period of time & autism will drop!"
I'm not against vaccinations for your children, I'm against them in 1 massive dose.Spread them out over a period of time & autism will drop!— Donald J. Trump (@realDonaldTrump) September 4, 2014
You have free articles remaining.
Patrick Beck, a pediatrician at Prairie Pediatrics, said there's no danger in giving multiple vaccines to children at once.
"There are studies that show that combining vaccinations boosts their immunity so they have a better response to multiple vaccines," he said.
After meeting with Trump at Trump Tower in January, Robert F. Kennedy Jr., a vaccine opponent, told the press that Trump asked him to head a commission that would study vaccines. The Trump administration has denied this.
The United States already has an advisory panel of medical and public health experts tasked with improving vaccine safety. The Advisory Committee on Immunization Practices develops recommendations on the use of vaccines.
Sean Peterson, clinical director for the Pier Center for Autism in Sioux City, said looking for a link between autism and vaccines would take away funding that could actually lead to an alternative treatment or cure for autism. He said studies have repeatedly shown that vaccines don't cause autism.
"To spend more money in that area versus looking at alternative theories that actually have some support and ground to stand on, we're wasting time and money and the resources of academicians across the world to have to debunk something that should've never been published in the first place," he said.
The Vaccine Adverse Event Reporting System, which is run by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration, collects information about adverse events that occur after the administration of vaccines.
Serious allergic reaction to the MMR vaccine occurs in less than 1 in a million doses, according to the CDC. Deafness, long-term seizure, coma or loss of consciousness and permanent brain damage are so rare that the nation's health protection agency said it's hard to tell whether these adverse events could be caused by the vaccine.
In the 21 years that he has been practicing medicine, Joyce said he has never witnessed any adverse events from vaccines. He said the side effects that his young patients have experienced have been limited to fever and injection site soreness.
Beck, who has been practicing medicine for 28 years, said his patients haven't experienced any adverse events either. However, he said he has seen how vaccine-preventable diseases have severely affected children who were too young to be immunized.
One of his patients, a 6-week-old infant, caught pertussis -- a highly contagious respiratory disease. The child spent 1-1/2 months on a ventilator. Another one of his young patients contracted meningitis. The child survived, but needed toes and fingers amputated and also developed visual problems.
To protect patients who are too young to be inoculated or who can't receive vaccines for medical reasons, Prairie Pediatrics has a policy of not accepting families into the practice who refuse vaccination.
The American Academy of Pediatrics doesn't support dismissing families who choose not to vaccinate outright, but instead encourages pediatricians to talk with parents to ensure they understand the complications that could occur from not vaccinating. Beck said parents who were initially against vaccination have changed their minds after talking with him.
If a bill that would make it easier for parents to avoid vaccination becomes Iowa law, Beck said he doesn't know if it would drive up the state's exemptions. He said it would likely lead more parents to question vaccination.
"It does create a lot more work for us to try to play down a lot of things that are out there that really have no basis, but again, that's our job," he said.
House File 7 sponsored by Ken Rizer, R-Cedar Rapids, would add a "personal conviction" exemption. If the bill passes, Iowa would join 18 other states that allow a philosophical exemption for those who object to immunizations because of personal, moral or other beliefs. Friday is a crucial day for the bill. The so-called funnel deadline narrows the list of bills eligible for passage this year.
Rizer didn't respond to a request for comment by press time about the origins of the bill or its traction in the legislature.
Joyce said he opposes a philosophical exemption, citing the reemergence of diseases like measles, which was declared eradicated in the United States in 2000. In 2014, the country experienced a record number of cases, 667 in 27 states. So far this year, 23 people from six states have contracted measles, according to the CDC.
Joyce said Americans seem to have forgotten the polio epidemic of 1952, which killed more than 3,000 people and left thousands of others disabled, or outbreaks of Haemophilus influenzae type B or Hib, which killed young children or significantly impaired them before a vaccine was introduced in 1992.
"Thanks to the Hib vaccine, I've never seen a case," he said. "The bottom line is that vaccines save lives."