Rules Revised

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shutterstock_181674491U.S. measles outbreak has caused some local day schools to alter policies.

In light of recent upticks in cases of measles and pertussis (whooping cough) throughout the United States, two of Detroit’s Jewish elementary day schools have revised their vaccination policies.

On Jan. 22, Steve Freedman, head of school at Hillel Day School of Metropolitan Detroit in Farmington Hills, sent an email to parents that said, “Hillel reserves the right to: exclude any child whose family has refused immunization, exclude any child who is not immunized against measles or pertussis and has been potentially exposed, for the duration of the incubation period.”

Freedman said Hillel would no longer accept a waiver from parents who don’t want to vaccinate their children because of religious or philosophical reasons.

Akiva recently implemented a similar policy, said Jordana Wolfson, chief administrative officer. In October, the school created an advisory committee of pediatricians and infectious disease doctors to review its vaccination policy.

“The board has accepted the recommendation of this committee, and Akiva will not accept vaccination waivers from families for religious or philosophical reasons,” said a Dec. 18 letter to parents signed by Wolfson, Head of School Rabbi Tzvi Klugerman and President Dan Mendelson.

Michigan law says a child can be exempt from immunization if a parent or guardian presents a written statement that they don’t want to vaccinate because of religious convictions or another objection.

As of Jan. 1, 2015, however, parents claiming an exemption must attend an educational program about vaccination at their local health department before a waiver is granted.

Michigan has one of the country’s highest rates of vaccination waivers — 5.9 percent of kindergarten students in 2014. Only Oregon, Idaho and Vermont had higher rates of unvaccinated kindergarteners, according to the Centers for Disease Control and Prevention (CDC).

Some parents seeking a “philosophical” waiver from the vaccination requirement think the risks of vaccines have been under-reported and the benefits of vaccines exaggerated.

“I strongly support parents’ right to decide whether to vaccinate their children,” said Kathy Erlich Simon, M.D., of Franklin, a pediatrician who practices in West Bloomfield.

“This decision must be made from knowledge of both the risks and the benefits of vaccines, rather than fear. I always tell parents there are risks either way and they will have to live with the consequences, so they need to do the research themselves and not just trust what they are told.

“Some of the most educated communities have the highest vaccine refusal rates, so to blame non-vaccination on ignorance is a lie.”

Steve Freedman

Skepticism about vaccines may also be connected to a broader cultural suspicion of the government at large and the medical and pharmaceutical professions.

Of another view is Dr. Beth Nadis, a pediatrician in West Bloomfield. “Vaccines save lives — period,” she said. “Overwhelming evidence supports their effectiveness as well as their safety.

“We are fortunate to have them to provide us the opportunity to protect ourselves and our loved ones.”

Her medical partner, pediatrician Dr. Seth Faber, agrees. “Unfortunately, a small but vocal minority has spread theories which have been repeatedly disproven,” he said. “These messages scare well-meaning people unnecessarily with regard to the benefits vaccines have provided our society.

“Vaccines protect individuals. They also protect those of us too small or too sick to vaccinate. As a community, we have the responsibility to protect each other; vaccinating children and adults provides a safe and effective opportunity to do so.”

As private schools, Hillel and Akiva are not obliged to accept religious or philosophical waivers.

Parents can also request a waiver on medical grounds for the rare instances when a health condition, such as leukemia or severe allergy, makes a child unable to take the vaccine. Akiva’s letter said the advisory committee would review such requests.

Measles Increasing
The CDC says measles was declared eradicated in the U.S. in 2000, after fewer than 60 cases were diagnosed, all arising from contact with international travelers.

Since then, an increasing number of parents have decided not to vaccinate their children, and as a result, the number of measles cases has increased, as has the number of pertussis cases.

Between January and the end of November last year, 610 cases of measles had been confirmed in 24 states.

Since then, more than 60 people have contracted measles, most of them after being exposed in December at Disneyland or Disney California Adventure Park, both in Anaheim.

Michigan’s first case of measles, in an Oakland County adult, was confirmed in late January and may be linked to Disneyland.

Nearly 10,000 cases of pertussis were reported in the U.S. in the first half of 2014, according to the CDC, a 24 percent increase over the same period the year before. California, the state with the highest number of cases, declared a pertussis epidemic.

Vaccines are effective because of a concept called “herd immunity.” When a certain majority of the population is immunized, the disease will not spread if an infected person comes into the community. This protects those few who are unable to be vaccinated because of health reasons and babies too young to be vaccinated.

shutterstock_225395599“Herd immunity provides protection for those who can’t be immunized, such as newborns — and they are very vulnerable to pertussis — or those with comprised immune systems, such as people who have had a bone marrow transplant,” said Lisa Klein, M.D., a pediatrician with Child Health Associates in Troy and Farmington Hills.

“If enough people do not get immunized, the barrier is lowered and diseases can spread more easily. Even one case of measles can spread quickly if others in the vicinity are not vaccinated.”

Measles is one of the most contagious diseases. Early symptoms include sore throat, a hacking cough, runny nose, light sensitivity and fever, followed in a few days by a red rash. In rare cases, the disease is fatal.

An MMR shot — for measles, mumps and rubella — is given to infants at about 12 months and again at age 5 or 6.

Jewish View
Jewish objections to childhood vaccinations seem to come mainly from some ultra-Orthodox groups.

For example, measles cases in New York have been concentrated in the Borough Park and Williamsburg areas, both of which have large Orthodox populations. Fifty-eight people there were diagnosed with measles in the spring of 2013, one of the largest outbreaks since 2000.

A story in the Jewish Daily Forward says a CDC report on the incident showed nearly 80 percent of the people who fell ill were members of “three extended families whose members declined use of measles vaccine.” Nine of those who got sick in Williamsburg had also refused vaccination.

Yet, a New York City Department of Health and Mental Hygiene representative said 96 percent of yeshivah students in Brooklyn are vaccinated, according to the Forward story, and ultra-Orthodox insiders in Brooklyn say vaccinations are near-universal in the community.

Rabbi Jason Miller

Opposition to vaccines does not appear to be based on Jewish law. Although some vaccines can be made with gelatin or pork products, Jewish law bans consumption of non-kosher products, not injection, Rabbi Menachem Genack of the Orthodox Union’s kosher division said in the Forward story.

Most Jewish authorities feel vaccination is justified by the principle of pikuach nefesh, which holds that anything done to save a life supersedes all other Jewish laws.

Pikuach nefesh was the concept driving Hillel, where most of the students identify as Conservative, and Akiva, which is Modern Orthodox, in their policy revisions.

“As a religious school, we can determine whether refusal of the vaccine has any religious merit, and we decided it does not,” Hillel’s Freedman said. “We are concerned with the safety not only of our students, but also of the community.”

Jason Miller of West Bloomfield, a Conservative rabbi who has three children at Hillel, said he was very happy with Hillel’s decision. Just one unvaccinated child at the school would put all the children at risk.

“A core ethic of Judaism is pikuach nefesh,” he said. “With modern medicine, we understand that it is essential for good health that babies and young children receive vaccinations on the required schedule. Not receiving these vaccinations puts that individual’s life at risk as well as countless others. I argue that refusing vaccinations is antithetical to living in accordance with Jewish law.”

By Barbara Lewis, Contributing Writer

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