S199 Briefing Sheet

The CDC Recommended Vaccine Schedule is not the same as The Vermont School Attendance Required Vaccine Schedule! (VSARVS) When Vermont Health Commissioner Dr. Harry Chen was quoted in the Burlington Free Press on January 16, 2012 lamenting: “…only 60 percent of Vermont's young people have had full doses of all 14 recommended immunizations”
http://www.burlingtonfreepress.com/article/20120116/NEWS03/201160307/Vermont-lawmakers-try-boost-vaccination-rates

Dr. Chen was not talking about the Vermont school requirements! Dr. Chen was talking about the CDC “Dream” schedule, and using an incredibly restrictive CDC National Immunization Survey (NIS) statistic. This statistic is so arbitrary that a child fully compliant with Vermont laws is considered “unvaccinated”. NIS surveys statistically “throw out” children who do not have a vaccine by certain milestone ages, even if they catch up later, or are missing even a single dose of a 5 dose series. Vermont children have 98% compliance for the Vermont School Attendance Required Vaccine Schedule. (While the varicella/chicken pox vaccination rate is only
88%, an additional 10% of children have natural immunity gained from having had the disease. ). See attachment 3: Health–Vermont Immunization Summary Sheet 2010/2011.

All Public Health Objectives are exceeded with 98% vaccination rates. The title of the article Dr. Chen was quoted in is “Vermont lawmakers try to boost vaccination rates”. Boost them to what? From 98% to 99%? There is no abuse of the Philosophical Exemption. The vaccines with low uptake Dr. Chen would like to see increased do not require an exemption because they are not required. Changing the exemption rule will have no effect on them. If the intent is to boost those rates another action is needed. The Vermont School Attendance Required Vaccine Schedule requires 9 vaccines for K-12 attendance (not 14). They are Polio, MMR (measles, mumps, rubella combo), DTaP (Diptheria, Tetanus Pertussis combo), Hepatitis B, and Varicella (Chicken Pox). Children 0 to 5 years old that are enrolled in a state licensed daycare or pre-school have the additional

requirement of PCV and Hib.
Vaccine Schedule.

See attachment 1, the Vermont School Attendance Required

The Vermont Department of Health measures and publishes the K-12 vaccination rates for the VSARVS annually. The report for 2010/2011 is attachment 3. Students who don’t have their records in order or are in the process of catching up any missed doses by the annual report cutoff date (December 31 of each year), but who do vaccinate are classified “Temporarily Exempt”. Students with a “Philosophical Exemption” do not necessarily opt out of all vaccines. Students who are opting out of any single dose of any of the required vaccines will have an Exemption on file for that dose. For example a child who has all of the traditional vaccines but whose parents don’t agree with the recent addition of Chicken Pox (Varicella), will show up in both places on the form: as vaccinated for MMR, Polio, DTaP, and Hepatitis B categories; and also as an Exemption due to the missing Chicken Pox. This explains why in the charts below, the total of the rates for Philosophical Exemptions and Temporary Exemptions, when added to the Vaccination rate for Polio, DTaP, MMR, or Hep B exceeds 100%. The Varicella / Chicken Pox vaccination rate looks lower because it is a recent addition and any child who has naturally contracted chicken pox does not require the vaccination as he has a naturally acquired immunity.

Health—Vermont Immunization Summary Sheet 2010/2011
Grade Temp Ex Phil Ex Polio MMR Hep B DTaP Varicella

Kinder 7th

10.44% 12.96%*

5.08% 2.43%

91.89% 91.28% 95.49% 91.55% 98.55% 98.72% 98.27% 98.25%*

88.38%^ 88.62%^

*A 5th dose of DTaP is a 7th grade requirement, the Temp Ex rate is students without documentation or late for their last of 5 doses. Percentage calculated using the FY08 chart listing all grades showing DTaP & Tdap to be consistently within .5% of the other “core” vaccines, so the real rate is 98.25% +or- .5. Parents who do Polio, MMR, & Hep B don’t skip Tdap. ^ Chicken Pox is still circulating; children who have had the infection do not require the vaccination. See attachment 3 for full summary report.

Health—Vermont Immunization Summary Sheet 2007/2008
Grade Temp Ex Phil Ex Polio MMR Hep B DTaP Varicella

Kinder 7th

5.95%* 2.06% 1.03%* 1.03%

95.99% 92.28% N/a 97.36% Not Req 98.85% 98.48% 97.11% 98.55% Not Req

*Note the lower Temporary Exemption rates in this year, resulting in higher documented rates. See attachment 4 for full summary report.

Any increases in the Philosophical Exemption rate from 2007/2008 can easily be explained by the adding of the Varicella / Chicken Pox Vaccine requirement to the schedule.

How much higher than 98% is a reasonable expectation in an entire statewide population? The recent Pertussis infections are unrelated to the Philosophical Exemption. First, as documented above, these infections are occurring in a 98% vaccinated population, which is evidence of vaccine failure, not lack of coverage. This is not unique to Vermont, and is happening worldwide. Scientists are investigating several explanations. One is that a strain of Pertussis has mutated so that the vaccine no longer suppresses it, as described in attachment 5, the article REGION: Two-thirds of local pertussis cases were vaccinated, data show: Expert says whopping cough mutating, becoming more infectious, published in the California periodical North County Times. Another recent discovery is that the Pertussis vaccine appears to wear off in as little as 3 years, as detailed in the attachment 6, the WebMD article
Pertussis Vaccine May Not Give Long-Term Protection.

Misdiagnosis is common, as there are other conditions that have the same symptoms as Pertussis but are not Pertussis, as detailed in attachment 7, the NY Times article Faith in Quick Test Leads to Epidemic That Wasn’t. Any Pertussis case that is not lab-confirmed is suspect. It has also been documented that Vaccinated children may be asymptomatic reservoirs for infection, as illustrated in attachment 8, the article Pertussis
Infection in Fully Vaccinated Children in Day-Care Centers, Israel published in the CDC Journal Emerging Infectious Diseases.

In Summary, as the near 100% Vermont School Attendance Required Vaccine Schedule rates demonstrate, this legislation is not needed, and therefore of little utility as the maximum potential increase is only 1%. The State of Vermont is in one of the most trying economic periods of recent memory. Is it responsible government for the proponents of these bills to tie up the legislature’s time, energy, and valuable funding to address a nonexistent problem? Please do the right thing and preserve parent’s rights. Fail these Bills and keep using a system that is working.

Attachments:
1. Vermont School Attendance Required Vaccine Schedule
http://www.healthvermont.gov/hc/imm/documents/vt_schedule_kids.pdf

2. CDC Recommended Schedule 0-6 & 7-18
http://www.cdc.gov/vaccines/spec-grps/infants/downloads/parent-ver-sch-0-6yrs.pdf http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf

3. Health—Vermont Immunization Summary Sheet 2010/2011
http://healthvermont.gov/hc/imm/documents/school_nurse_report_immunization_data_2010-2011.xls

4. Health—Vermont Immunization Summary Sheet 2007/2008
www.healthvermont.gov/local/school/documents/FY08DistributionCopyVtSNR-ImmunizationDataRevised9-11-08.xls

5. REGION: Two-thirds of local pertussis cases were vaccinated, data show: Expert says whopping cough mutating, becoming more infectious, a Dec 15, 2010 article in the North County Times, a periodical serving North San Diego and Southwest Riverside Counties in California.
http://www.nctimes.com/news/local/sdcounty/article_1e57b3db-8302-5313-99b3-f15d48b8829f.html

6. Medscape.com WebMD Health News article of September 20, 2011: Pertussis Vaccine May Not Give Long-Term Protection
http://www.medscape.com/viewarticle/750210

7. NY Times Article of Jan 22, 2007 Faith in Quick Test Leads to Epidemic That Wasn’t
http://www.nytimes.com/2007/01/22/health/22whoop.htm

8. Article in CDC Journal Emerging Infectious Diseases, Vol. 6, No. 5, SeptemberOctober 2000, pp. 526-529: Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel
http://wwwnc.cdc.gov/eid/article/6/5/00-0512_article.htm

Not Required By Vermont

Not Vermont Required

Not K-12 Required

High Vaccination rates with Philosophical Exemption in place shows there is no abuse

Provisional Admittance is students with incomplete documentation

High Vaccination rates with Philosophical Exemption in place shows there is no abuse

School Vaccine Survey Report 2007-2008

Grade Kinder First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Tenth Eleventh Twelveth Ungraded Total

Total Tetanus Tetanus Polio Polio MMR MMR Enrollment Met Not Met Met Not Met Met Not Met 6215 6051 164 5966 249 5735 480 97.36% 2.64% 95.99% 4.01% 92.28% 7.72% 6295 6170 125 6141 154 6070 225 98.01% 1.99% 97.55% 2.45% 96.43% 3.57% 6421 6328 93 6315 106 6271 150 98.55% 1.45% 98.35% 1.65% 97.66% 2.34% 6508 6405 103 6391 117 6351 157 98.42% 1.58% 98.20% 1.80% 97.59% 2.41% 6376 6287 89 6275 101 6244 132 98.60% 1.40% 98.42% 1.58% 97.93% 2.07% 6467 6375 92 6365 102 6331 136 98.58% 1.42% 98.42% 1.58% 97.90% 2.10% 6763 6644 119 6655 108 6646 117 98.24% 1.76% 98.40% 1.60% 98.27% 1.73% 7101 6998 103 7019 82 6993 108 98.55% 1.45% 98.85% 1.15% 98.48% 1.52% 7172 7066 106 7094 78 7075 97 98.52% 1.48% 98.91% 1.09% 98.65% 1.35% 7458 7119 339 7321 137 7318 140 95.45% 4.55% 98.16% 1.84% 98.12% 1.88% 7701 7155 546 7559 142 7539 162 92.91% 7.09% 98.16% 1.84% 97.90% 2.10% 7549 7200 349 7404 145 7414 135 95.38% 4.62% 98.08% 1.92% 98.21% 1.79% 7765 7482 283 7643 122 7630 135 96.36% 3.64% 98.43% 1.57% 98.26% 1.74% 41 39 2 38 3 31 10 95.12% 4.88% 92.68% 7.32% 75.61% 24.39% 89832 87319 2513 88186 1646 87648 2184

Hep-B (3)

6896 97.11% 6987 97.42% 7241 97.09% 7465 96.94% 7318 96.94% 7556 97.31% 37 90.24% 43500

Hep-B (1 Medical Religious Philiosophical or 2) Hep-B (0) Exempt Exempt Exempt Provisional 6215 15 5 128 370 100.00% 0.24% 0.08% 2.06% 5.95% 6295 13 7 136 89 100.00% 0.21% 0.11% 2.16% 1.41% 6421 21 8 102 35 100.00% 0.33% 0.12% 1.59% 0.55% 6508 21 10 112 33 100.00% 0.32% 0.15% 1.72% 0.51% 6376 13 10 97 27 100.00% 0.20% 0.16% 1.52% 0.42% 6467 12 8 109 21 100.00% 0.19% 0.12% 1.69% 0.32% 6763 11 6 101 50 100.00% 0.16% 0.09% 1.49% 0.74% 91 114 21 8 101 73 1.28% 1.61% 0.30% 0.11% 1.42% 1.03% 75 110 15 7 93 68 1.05% 1.53% 0.21% 0.10% 1.30% 0.95% 62 155 15 26 108 281 0.83% 2.08% 0.20% 0.35% 1.45% 3.77% 64 172 23 14 132 470 0.83% 2.23% 0.30% 0.18% 1.71% 6.10% 62 169 32 15 134 269 0.82% 2.24% 0.42% 0.20% 1.78% 3.56% 51 158 26 6 138 207 0.66% 2.03% 0.33% 0.08% 1.78% 2.67% 1 3 1 0 6 3 2.44% 7.32% 2.44% 0.00% 14.63% 7.32% 406 45926 239 130 1497 1996

REGION: Two-thirds of local pertussis cases were vaccinated, data show

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REGION: Two-thirds of local pertussis cases were vaccinated, data show
Expert says whopping cough mutating, becoming more infectious By JOANNE FARYON, KPBS, and KEVIN CROWE, Watchdog Institute | Posted: Wednesday, December 15, 2010 7:13 pm As California experiences its worst whooping cough outbreak in more than 60 years, health officials across the country trumpet vaccinations to protect against the disease. The number of cases of the disease in San Diego County this year has reached a record 1,046 as of mid-December and may triple the region's previous record by year's end, according to the county Department of Health and Human Services. Data collected from around this state and several others show that many people who have come down with whooping cough had been immunized. Reporters from KPBS and the Watchdog Institute, a nonprofit investigative center based at San Diego State University, collected and analyzed reports from areas with high rates of infection, and they traveled from Los Angeles to the Netherlands to find out why so many people are getting sick. Two of the world's most respected experts on the whooping cough, which is also known as pertussis, have very different views. Dr. James Cherry, a prominent researcher at UCLA, says increased awareness of whooping cough has led to more reports of it. However, Dr. Fritz Mooi, a well-known Dutch scientist who has been studying mutations of the pertussis bacteria for 15 years, said a more virulent strain of bacteria is contributing to outbreaks. KPBS and the institute have asked about the possibility of a more virulent whooping cough strain for months, and after rebuffing the inquiries last fall, the federal Centers for Disease Control and Prevention recently announced studies of the disease, and the bacteria causing it, in California and Ohio. Two members of the California study group said it was prompted by the increasing death toll and KPBS-institute inquiries. Officials from the CDC, the California Department of Public Health and two pertussis experts from UCLA held a conference call Oct. 13 to discuss studying whether a more virulent strain was responsible for infant deaths and is contributing to the current epidemic. That same day, whooping cough claimed the life of a San Diego newborn, its 10th victim in California. Dr. Jeff Miller, a scientist involved in the study at UCLA, said the possibility that the pertussis bacterium has mutated "is an important hypothesis to test." He added, "I wish we would have started it in 2005." Mooi said his research has been ignored by those who influence public policy on pertussis in the U.S. and beyond in part because they rely on vaccine makers to fund their meetings and research. There is little incentive for pharmaceutical companies to pursue a new vaccine because it would cost billions, he said. The circulation of a more virulent strain of pertussis could mean a new vaccine should be created. In their four-month investigation of the pertussis epidemic, KPBS and the institute found: -- For pertussis cases in which vaccination histories are known, between 44 and 83 percent were of people who had been immunized, according to data from nine California counties with high infection rates. In San Diego County, more than twothirds of the people in this group were up to date on their immunizations. -- Health officials in Ohio and Texas, two other states also experiencing whooping cough outbreaks, report that of all cases, 75 and 67.5 percent respectively, reported having received a pertussis vaccination. -- Today, the rate of the disease in some California counties is as high as 139 per 100,000, rivaling rates before vaccines were developed. -- Public officials around the world rely heavily on two groups of pertussis experts when setting vaccine policy relating to the disease. Both groups, and many of their members, receive money from the two leading manufacturers of pertussis vaccine.

http://www.nctimes.com/news/local/sdcounty/article_1e57b3db-8302-5313-99b3-f15d48b... 3/17/2011

REGION: Two-thirds of local pertussis cases were vaccinated, data show

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Pertussis is a highly contagious respiratory illness that may mimic a cold for the first 10 days. It then can produce a violent and persistent cough with a unique "whooping" sound. For adults, pertussis may only be a nuisance, like a bad cold. But to infants it can be deadly because they can't cough up what collects in their lungs and infections can spread. Vaccinations nearly wiped out whooping cough more than 30 years ago. But it has made a vengeful comeback in California and other highly vaccinated communities around the U.S. While public health officials and scientists agree that vaccines are still the best available tool against pertussis, they argue over how effective they are with time and in the face of a possible increase in virulence. Dr. Mark Horton, director of the California Department of Public Health, said health officials expect to see a certain percentage of people who have been vaccinated contracting whooping cough. He says no vaccine is 100 percent effective, and those who are immunized and getting sick are likely to be people for whom the vaccine did not work or whose immunity has waned. "That's no surprise to us," he said, "nor is it a reflection on the efficacy of the vaccine." Mooi, who heads the Pertussis Surveillance Project at the National Institute of Health in the Netherlands, said an epidemic in 1996 in his country gave the need for research more urgency. "And we found really a kind of new mutation in that bug," Mooi said. In tests, Mooi's lab found the mutated strain produced more toxins, which could make people sicker. 'Cocoon' didn't work At the Bryce home in Chula Vista, Marlon, who is 31 and a contract specialist at the Naval Medical Center, and Cindy, 27, wonder about the effectiveness of the vaccine. They discovered their newborn son, Matthew, had pertussis at only 23 days old, although everyone in the house had been vaccinated. Full family immunization, called cocooning, is universally recommended as the best protection for infants too young to be vaccinated. Marlon clearly remembers Cindy's call when she learned Matthew had whooping cough. "She was crying. ... The moment that I heard it, I immediately started thinking the worst. You've heard the news about the babies that have passed away. ... Why is this happening?" Marlon is soft-spoken and thoughtful when he talks about the experience, which was frightening, but ended with Matthew's full recovery. "The one thing I would want to know is, is the vaccine working? Is it as effective," he says. "I thought that if I did everything I was told to do that our sons would be protected." The bacterium that causes whooping cough was first identified in 1906, when the illness was a common cause of death in infants and young children. The discovery led to the first attempts at a vaccine, but it wasn't until the late 1940s, when the rate of disease was around 157 cases per 100,000, that scientists developed a vaccine effective enough to prevent pertussis. By 1970s, the pertussis infection rate had dropped to less than 1 per 100,000. But the vaccine, made of whole bacterial cells killed in labs, had side effects, such as prolonged crying spells in babies and seizures. By 1996, the FDA approved a new whooping cough vaccine ---- an acellular version, which uses only purified components of the disease-causing organism. It is considered safer than the whole cell vaccine and is the only one used in the U.S. today. Just as the vaccines were changing, health officials across the country were reporting increasing numbers of whooping cough cases. According to a CDC report, most of the children 4 years old and younger who got whooping cough nationwide between 1990 and 1996 were not fully immunized. That trend appears to have reversed in California's latest outbreak. Sick, despite inoculation

http://www.nctimes.com/news/local/sdcounty/article_1e57b3db-8302-5313-99b3-f15d48b... 3/17/2011

REGION: Two-thirds of local pertussis cases were vaccinated, data show

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KPBS and the Watchdog Institute requested information from 19 California counties most affected by pertussis. Nine counties supplied pertussis case information and vaccination history. In all but Stanislaus County, more than half the people sick with whooping cough had been immunized. As of the end of October, and in cases where immunization history was known, data showed: 83 percent of the people with whooping cough in Fresno had been vaccinated. In San Luis Obispo, 76 percent were up to date on their immunizations. In San Diego, 68 percent were up to date. Public health experts say the surge of the disease is cyclical, with increased diagnoses every two to five years. "And that tells us bordatella pertussis is circulating today exactly as it did in the prevaccine era," Cherry said. "The main reason is increased awareness," he explained. "People, particularly public health people, are much more aware, and that trickles down." Cherry and Netherlands scientist Mooi agree that immunity provided by vaccines wanes over time. But, they disagree over how long immunity lasts, and whether a mutated strain of pertussis is exploiting waning immunity. Package inserts included with the two most common pertussis vaccines in the U.S. state they are 85 percent effective. Cherry, who was involved in the efficacy studies when the vaccines were licensed by the FDA, estimated the efficacy is between 70 and 80 percent.

15 to 30% still susceptible after vaccination

Mooi said there's no way to know how effective the vaccines are because they haven't been tested against the new strain. "The vaccines have less efficacy than many people believe," he said. Better than nothing Public health agencies recommend five vaccine doses by age 6, and that adults get a booster every 10 years. The California Legislature passed a law in September requiring all children entering middle school to receive a pertussis booster. Cherry advocates booster shots. Mooi isn't so sure adult boosters are cost-effective. But both agree that the current vaccine offers the best protection against the disease, especially for families with an infant in the house. Mooi says money should be spent studying today's strains and making a vaccine that would work against them, Mooi said. "After all, every year we have a new flu vaccine, so, I think we should have something like that for bacterial vaccines, too," he said. Cherry believes a new, better vaccine is a long way off. "I think the likelihood of the logistics of getting a new vaccine right now in this country is almost impossible, because of the FDA rules and requirements," he said. "There's a lot of things you could do (to improve current vaccines), but to get it approved would cost billions of dollars." Freelancer reporter Roxana Popescu, Watchdog Institute intern Sandy Coronilla and KPBS intern Jessica Plautz contributed to this report. KPBS is the Public Broadcasting affiliate in San Diego. The Watchdog Institute is an independent nonprofit investigative journalism center. Both are based at San Diego State University.

http://www.nctimes.com/news/local/sdcounty/article_1e57b3db-8302-5313-99b3-f15d48b... 3/17/2011

Faith in Quick Test Leads to Epidemic That Wasn’t - New York Times

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http://www.nytimes.com/2007/01/22/health/22whoop.html?_r=1&pagewanted=print

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Faith in Quick Test Leads to Epidemic That Wasn’t - New York Times

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Faith in Quick Test Leads to Epidemic That Wasn’t - New York Times

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Faith in Quick Test Leads to Epidemic That Wasn’t - New York Times

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Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel

We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization’s case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.

The Study

Table. Clinical and laboratory profiles of children positive for Bordetella pertussis by polymerase chain reaction (PCR) in Israel

Conclusions

References