Author Topic: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots  (Read 1965 times)

Offline Mr. Bill

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PLOS Medicine, 6/12/18: The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties

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... many families choose to opt out their children from vaccinations required for school entry by obtaining nonmedical exemptions (NMEs) based on religious or philosophical beliefs. In 2016, 18 states permitted NMEs due to philosophical beliefs. A detailed analysis of NMEs within each of the 18 states reveals that several counties, including those with large metropolitan areas, are at high risk for vaccine-preventable pediatric infection epidemics. ...

NME data were collected from all 18 states currently permitting philosophical-belief NMEs (Arkansas [AR], Arizona [AZ], Colorado [CO], Idaho [ID], Louisiana [LA], Maine [ME], Michigan [MI], Minnesota [MN], Missouri [MO], North Dakota [ND], Ohio [OH], Oklahoma [OK], Oregon [OR], Pennsylvania [PA], Texas [TX], Utah [UT], Washington [WA], and Wisconsin [WI]). ... VT, CA, MS, and WV were excluded from our analysis because they no longer have NMEs in their respective states. ... The state NME rate is represented by the number of entering kindergarteners with a documented NME out of the total kindergarten enrollments in the state. ...

From our analysis, 12 of the 18 states permitting religious and philosophical-belief NMEs demonstrated an overall upward trend of enrolling kindergarteners with NMEs since 2009: AR, AZ, ID, ME, MN, MO, ND, OH, OK, OR, TX, and UT. ...

Beyond the statewide data, many county-level NME rates were publicly available from state health departments for the school year 2016 to 2017. ...of the 14 states that were analyzed, ID had an abundance of counties with the highest NME rates: Camas (26.67%), Bonner (19.65%), Valley (18.18%), Custer (17.14%), Idaho (16.06%), Boise (15.63%), Kootenai (14.91%), and Boundary (14.61%). WI’s Bayfield County was ranked 6th in overall NME percent (15.70%), and UT’s Morgan County (14.55%) was ranked 10th. ...

Furthermore, we examined total numbers of kindergarteners with NMEs per county to identify focal areas with large numbers of potentially vulnerable pediatric populations. ... They include Phoenix, AZ (Maricopa County); Salt Lake City, UT and Provo, UT (Salt Lake and Utah Counties, respectively); Seattle, WA and Spokane, WA (King and Spokane Counties, respectively); Portland, OR (Multnomah County); Troy, MI, Warren, MI, and Detroit, MI (Oakland, Macomb, and Wayne Counties, respectively); Houston, TX, Fort Worth, TX, Plano, TX, and Austin, TX (Harris, Tarrant, Collin, and Travis Counties, respectively); Pittsburgh, PA (Allegheny County); and Kansas City, MO (Jackson County). The high numbers of NMEs in these densely populated urban centers suggest that outbreaks of vaccine-preventable diseases could either originate from or spread rapidly throughout these populations of unimmunized, unprotected children. The fact that the largest count of vaccine-exempt pediatric populations originate in large cities with busy international airports may further contribute to this risk. ...

...a child with an NME from the measles, mumps, and rubella (MMR) vaccine is 35 times more likely to contract measles than is a vaccinated child. Moreover, a child without the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine is 3 times more likely to contract pertussis than is a vaccinated child. NMEs weaken herd immunity that protects the population at large, particularly children who are unable to get vaccinated for medical reasons. The target vaccination coverage rate to achieve the ideal herd immunity is 90% to 95%, depending on the infectious agent. ...

Heat map of county-level nonmedical exemption rates

Offline Hurricane

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I don't question the need for, and value of vaccines. The question is, what else is in those shots?

Offline AvenueQ

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I believe the county I used to live in CO (Jefferson) at one point had the highest national vaccine exemption rate...though it could also have been Boulder county, which was only one county over. Jefferson county has a population of ~400,000, with most of the surrounding counties being similar in size.

I'm a little relieved that Nevada doesn't have this exemption.

Online FreeLancer

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California no longer allows NME, but there's enough sleazy/shady/crackpot docs willing to trade medical exemptions for cold hard cash to keep the state's overall exemption rate high. 

Offline David in MN

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Bad data. I hate to be a broken clock on this stuff but the data assumes that a state that doesn't have the exemption has full immunization. Poppycock. Then they have the guile to use a sliding scale where the highest bracket is 5-30%. Seems a little arbitrary to me and not at all how something should be reported. One would suppose we top out at a 30% county but they fail to report which county it is.

Also, the data only presents "non-medical vaccine exemptions". We are left wanting for total non-vaccinated numbers (which I presume are much higher). We would need data on medical exemptions, unvaccinated immigrants, older people who didn't get the full modern course, etc. For all we know from this data NMEs aren't even the leading cause those not vaccinated.

Feels like scientifically inaccurate fear mongering.

Offline mountainmoma

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Another very real problem with reporting about vaccination exemptions is that they report all or nothing, and you file an exemption all or nothing. I have done this, if, for example, you decide not to vaccinate the new HPV vaccine, but did vaccinate for MMR, DTP and polio, you would have to file an exemption, and the school would just report the child as "exempt" . Many exempt filers actually have a least some vaccines.

The vaccines required in a given school district may be very different than in another state, it is even possible that parent A complying with requirements in their district and parent B who has not complied have actually chosent to give the exact same vaccines, but that school district B has a few on teh required list that are optional in district A , an both families have decided to avoid that one ! The point is, you dont know much from the map.


Then, the news likes to "report" in the most controversial way possible, and does not even mention the limitations to the data
« Last Edit: June 14, 2018, 08:41:27 PM by mountainmoma »

Offline mountainmoma

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This is a very politically charged topic, having alot to do with parental rights to choose medical treatment for their children.

And, you can see the divisiveness potential from the comments here. " My opinion is right, and any other ways of looking at this topic is crazy, " that is the message I see on this topic.

Offline David in MN

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And the data captures those who took the exemption in order to get the shots at 2 years of age rather than 6 months.

Digging through the actual data (I'm a nerd) it's a little worrisome that it got a title about "the state of antivaccine..." because I'm dubious of studies with a conclusion built into the title.

They did do the courtesy of publishing some actual data (rare in medicine these days) and they actually did try to correlate NMEs to kindergarten cases of measles, mumps, and rubella (presuming there would be a link) and reported Spearman correlation of rho=.03. I presume they used Spearman because R squared would have been 0 and even rho=.03 is about as non-linear a response as one could get. They reported it as meaningful, though, which I suppose is a method of reporting unsubstantiated conclusions to an uninformed audience.

The sad (unreported to those who don't speak statistics) truth is that this study offers no actual conclusion and instead of leading with the correlation of NMEs to disease which didn't pan out they fell back on a poorly designed scaremongering "heat map" that offers almost no valuable information and whose methodology could be picked apart by a well informed 5th grader.

Someday math will win out. But not soon.

Offline surfivor

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And the data captures those who took the exemption in order to get the shots at 2 years of age rather than 6 months.

 Gee, someone questioned medical advice and thought they would use their own judgement after doing some research, can't do that can we

Offline Mr. Bill

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...the data assumes that a state that doesn't have the exemption has full immunization. ...

That, I do not see.  They merely limited their study to states with the exemption -- hence all the white areas on the map.

I don't much care about their statistical stuff -- it's the locations with lots of unvaccinated kids that interest me.  I'm looking at this as a prepping issue.  If you (or your family members) are susceptible to infection by these diseases (because you can't be safely vaccinated, or because you chose not to get vaccinated, or because you have an immune system problem), it's worth considering whether you really want to live in places like Camas County ID or Maricopa County AZ if you can avoid it.

Offline David in MN

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I don't much care about their statistical stuff -- it's the locations with lots of unvaccinated kids that interest me.  I'm looking at this as a prepping issue.  If you (or your family members) are susceptible to infection by these diseases (because you can't be safely vaccinated, or because you chose not to get vaccinated, or because you have an immune system problem), it's worth considering whether you really want to live in places like Camas County ID or Maricopa County AZ if you can avoid it.

Again, using the studies own data, the correlation of NMEs to measles, mumps, and rubella is not statistically significant. In other words, NMEs don't drive infections (at least in the parameters of the study). This study suggests that in keeping your kids safe from some diseases NMEs are not a good indicator.

Beyond this, there are multitudes of other possible avenues for disease other than NMEs. I would think living in proximity to a port or busy airport would carry increased risk.

Bottom line, even if you were trying to use this data to make a decision the study itself refutes its value and there are very likely more significant variables.

That, I do not see.  They merely limited their study to states with the exemption -- hence all the white areas on the map.

Yes, they chose to color the states with no data white, But the scale of "danger" goes from pale pink to reddish. This gives the casual viewer the belief that the white states are (on the scale) below .1%. They should have been colored gray and indicated that there is no data in the key. These are sort of red flags to anyone with a statistical background that the results are being massaged to influence the viewer.

Offline surfivor

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Yea, I don’t know why I get the impression that all the cutting-edge research on vaccine effectiveness is mostly hundreds of years old. We are just told that vaccines work and it matters not what kind of vaccine it is whether smallpox, polio, or whatever they may invent. They just throw them all into the same boat along with flu vaccines. Any thinking person should see a problem there. I also hear claims that vaccines are not really tested for safety

Offline Mr. Bill

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #12 on: November 19, 2018, 11:38:02 AM »
Chickenpox outbreak in Asheville NC:

11/17/18: School with major chickenpox outbreak has high vaccination exemption rate

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...As of Friday, 36 students at Asheville Waldorf School had contracted the varicella virus, known to most as chickenpox. The school has one of the highest vaccination religious exemption rates in the state. ...

...the outbreak at Asheville Waldorf should cause concern, said Dr. Jennifer Mullendore of Buncombe County Department of Health and Human Services.

According to the Centers for Disease Control and Prevention, chickenpox is particularly dangerous to infants, pregnant women those with compromised immune systems, such as people who are HIV positive or coming out of cancer treatment.

"People don't think it's a serious disease, and for the majority of people it's not. But it's not that way for everybody," Mullendore said. Two to three out of every 1,000 children infected with chickenpox required care in a hospital, she said. ...

Those recommendations have by and large have gone unheeded by the parents of Asheville Waldorf's 152 students — 110 of whom have not received the chickenpox vaccine, which was made available in the United States in 1995. ...


American Journal of Public Health, 9/12/18: Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate

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...Russian trolls and sophisticated Twitter bots post content about vaccination at significantly higher rates than does the average user. Content from these sources gives equal attention to pro- and antivaccination arguments. This is consistent with a strategy of promoting discord across a range of controversial topics—a known tactic employed by Russian troll accounts. ...

Unlike troll accounts, content polluters (i.e., disseminators of malware, unsolicited commercial content, and other disruptive material that typically violates Twitter’s terms of service) post antivaccine messages 75% more often than does the average nonbot Twitter user. This suggests that vaccine opponents may disseminate messages using bot networks that are primarily designed for marketing. By contrast, spambots, which can be easily recognized as nonhuman, are less likely to promote an antivaccine agenda than are nonbots. ...

Several accounts could not be positively identified as either bots or humans because of intermediate or unavailable Botometer scores. These accounts, together constituting 93% of our random sample from the vaccine stream, tweeted content that was both more polarized and more opposed to vaccination than is that of the average nonbot account. Although the provenance of their tweets is unclear, we speculate that these accounts may possess a higher proportion of trolls or cyborgs—accounts nominally controlled by human users that are, on occasion, taken over by bots or otherwise exhibit bot-like or malicious behavior. ...

Finally, trolls—exhibiting malicious behaviors yet operated by humans—are also likely to fall within this middle range. This suggests that proportionally more antivaccine tweets may be generated by accounts using a somewhat sophisticated semiautomated approach to avoid detection. This creates the false impression of grassroots debate regarding vaccine efficacy—a technique known as “astroturfing”...

Offline cmxterra

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #13 on: November 19, 2018, 02:31:55 PM »


This..

Ignorance of the science of vaccines is not an argument against them. 

Chickenpox outbreak in Asheville NC:

11/17/18: School with major chickenpox outbreak has high vaccination exemption rate


American Journal of Public Health, 9/12/18: Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate

Offline Mr. Bill

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #14 on: November 19, 2018, 03:12:49 PM »
When I was a kid in the 1960s, nobody had chickenpox vaccinations, but the virus was always floating around at low levels, and I assume the constant exposure (i.e. natural vaccination) gave us a little bit of immunity.  It would spread around our school now and then, and I caught it eventually.  But we never had a situation like this one in Asheville, where one-third of the unvaccinated students (so far) have come down with the disease at the same time.

Offline mountainmoma

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #15 on: November 24, 2018, 12:31:31 AM »
The reason the kids came down with it all at the same time is that once one got it, the parents purposely make sure the others are exposed as they want them to get it.  This is because this was at  waldorf school, which has a specific spiritual reason and viewpoint of normal childhood illnesses role in normal childhood developement.  And, since it is getting harder to come in contact with chicken pox in the general population, once one kid got it the phone tree went to work to let the other parents know of the opportunity.  This would not be done for serious childhood illnesses, but chicken pox is seen as the most mild one, so it is the one to expose the kids to to get a childhood illness experience without the risks of a mor serious illness.  Anyway, this has absolutely nothing to do with russian trolls or any other printed information or alt news or opinions, it is a settled part of the spiritual viewpoint of anthroposophy and specifically anthroposophical medicine, and this spiritual belief system has been around for like 100 years, so well before the internet.

I hesitated to post on this as I am realy not in the mood for ridicule.  But, I will say this, if you look this up completely disregard wikipedia as that has got to be the most  inaccurate garbage I have ever read on the subject of anthrophosophy. 

In any case, you should expect alot more of this at waldorf schools, as I said, as having chicken pox parties is now the only way to ensure exposure before they get to aldulthood.  I know how hard it was to find an opportunity to expose my youngest to chicken pox, so I get it.  It is real easy to have them all get it at once when you invite them over to the sick kids house and have the kids purposely double dip in the snack dip, share lollypops, etc... While you may not understand it be assured that people are going to continue to practice their deeply held values and beliefs.  If you want to do statistics, what should be done is to do a follow up as the years go by, a controlled study or something, and compare future health outcomes of the vaccnated vs. purposely exposed kids and see, that way we wont have to speculate on which approach results in an overall long term more robust and healthier person.


« Last Edit: November 24, 2018, 12:38:13 AM by mountainmoma »

Offline David in MN

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #16 on: November 24, 2018, 08:39:01 AM »
The reason the kids came down with it all at the same time is that once one got it, the parents purposely make sure the others are exposed as they want them to get it.  This is because this was at  waldorf school, which has a specific spiritual reason and viewpoint of normal childhood illnesses role in normal childhood developement.  And, since it is getting harder to come in contact with chicken pox in the general population, once one kid got it the phone tree went to work to let the other parents know of the opportunity.  This would not be done for serious childhood illnesses, but chicken pox is seen as the most mild one, so it is the one to expose the kids to to get a childhood illness experience without the risks of a mor serious illness.  Anyway, this has absolutely nothing to do with russian trolls or any other printed information or alt news or opinions, it is a settled part of the spiritual viewpoint of anthroposophy and specifically anthroposophical medicine, and this spiritual belief system has been around for like 100 years, so well before the internet.

I hesitated to post on this as I am realy not in the mood for ridicule.  But, I will say this, if you look this up completely disregard wikipedia as that has got to be the most  inaccurate garbage I have ever read on the subject of anthrophosophy. 

In any case, you should expect alot more of this at waldorf schools, as I said, as having chicken pox parties is now the only way to ensure exposure before they get to aldulthood.  I know how hard it was to find an opportunity to expose my youngest to chicken pox, so I get it.  It is real easy to have them all get it at once when you invite them over to the sick kids house and have the kids purposely double dip in the snack dip, share lollypops, etc... While you may not understand it be assured that people are going to continue to practice their deeply held values and beliefs.  If you want to do statistics, what should be done is to do a follow up as the years go by, a controlled study or something, and compare future health outcomes of the vaccnated vs. purposely exposed kids and see, that way we wont have to speculate on which approach results in an overall long term more robust and healthier person.

Far from ridicule you knocked it out of the park. We considered a Waldorf school a while back and they definitely attract a certain fringe. I can't imagine one in Asheville (which also attracts a fringe). It's a very niche set of people.

I sound like a broken record with my "bad data" claims but these are the patterns you look for when you analyze a statistical claim.

Offline Mr. Bill

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #17 on: November 24, 2018, 09:32:54 AM »
The reason the kids came down with it all at the same time is that once one got it, the parents purposely make sure the others are exposed as they want them to get it.  This is because this was at  waldorf school, which has a specific spiritual reason and viewpoint of normal childhood illnesses role in normal childhood developement. ...

If someone intentionally gets their child infected with a serious disease for medical reasons, I would be able to criticize it, but if they're doing the same thing for religious reasons, I can't.

Offline surfivor

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #18 on: November 24, 2018, 09:45:45 AM »

How serious is chicken pox in reality? I am not sure if I heard that it is more serious for an adult to get it.

The argument seems to be that even if hardly anyone dies from it, if just one person might die then everyone else should be forced to be vaccinated. This is a good system for those selling medicines

Offline Alan Georges

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #19 on: November 24, 2018, 09:54:41 AM »
How serious is chicken pox in reality? I am not sure if I heard that it is more serious for an adult to get it.
I had it in my early 20's, and it was horrible.  Not life-threatening, but horrible for about four days, and I looked like something from a zombie flick for about a month afterward.  I mean as in "people jump out of my way on a sidewalk" looking horrible.  Still have a few scars from it, decades later.

Whichever course you choose, get your kids either vaccinated or infected at an appropriately young age.  It's a miserable disease when you're older.  I could see it being a killer under austere conditions.

Offline mountainmoma

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #20 on: November 24, 2018, 04:29:34 PM »
I had it in my early 20's, and it was horrible.  Not life-threatening, but horrible for about four days, and I looked like something from a zombie flick for about a month afterward.  I mean as in "people jump out of my way on a sidewalk" looking horrible.  Still have a few scars from it, decades later.

Whichever course you choose, get your kids either vaccinated or infected at an appropriately young age.  It's a miserable disease when you're older.  I could see it being a killer under austere conditions.

It is common for many to vaccinate later, in early adulthood or teenagerhood for certain diseases that they did not get as children for example not vaccinating for MMR, but doing it later because there was never an opportunity to get it when young.  Measles and mumps are not good to get as adults, and not good for pregnant women to get measles/ rubella.  So vaccinations on this for late teens who did not get the illness is very common, my youngest got MMR vaccine at 18 or 19 years old.  The common, if not universal one to give them when little is tetnus or the combo tetnus diptheria ( Td), and polio at some point. 


Offline mountainmoma

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #21 on: November 24, 2018, 05:19:52 PM »
Far from ridicule you knocked it out of the park. We considered a Waldorf school a while back and they definitely attract a certain fringe. I can't imagine one in Asheville (which also attracts a fringe). It's a very niche set of people.

I sound like a broken record with my "bad data" claims but these are the patterns you look for when you analyze a statistical claim.

I am part of this fringe, which is why I know exactly why one would expect this to happen. 

Anthroposophical medicine is more of a thing in Europe, but we also have it here.  So, I had an anthroposophical doctor for my families GP for many years. She was a fully licensed MD, worked part time in a major local hospitals emergency room as an emergency room physician and then had her own private practice the other half the week.  So anthroposophical medicine is practiced by licensed MD's, not random herbalists...... they know when you or your childs illness is serious and can give good information on treatment options and vaccines  -  anyway, do not think all doctors think every child should have every vaccine, especially on the CDC's scheduale.  European countries will even have anthroposophical doctors within the nation health service, the netherlands for sure pays for it publicly. It is also a big thing in germany, sweden, switzerland, the Uk and austria, but I did not take the time to look up which or all have it paid for by the government.

So, it is not a religion it is  a philosophical outlook that is different than our current mainstream medical approach.  Osteopaths are also different than our mainstream medical approach, but an OD is regarded to be an alternate to an MD, very different way to look at the reasons and treatment of disease form an OD or an MD, so an anthroposophical MD is also a different philosophy of reasons and treatments than a mainstream MD.  Criticize all you want , but it would be better to acknowledge that this is an established alternate philosophy and practice of medicine, it is not " quack". If you want to criticize it as quack, then first you would need to get the studies done to show worse outcomes for these medical practices, of which there are none.  You of course do not need to bring yourself or your family to an OD or an anthroposophical MD, you can stay with mainstream Md's. 

I think it is a hard time we are in where people are getting more controlling of others and wanting everyone to all think the same way. This is happening in all spheres, you cannot give your own true beliefs - political, medical, educational, firearms, the list goes on and on.  Without much thought or evidence a state like california has done away with any and all vaccine exemptions, including religious. So, more people are homeschooling.  This would be par for the course out here as the same argument used for guns was applied to vaccines, ie., we dont care about peoples rights if it saves just one life.....

Anyway, while there is a spiritual component to anthroposophy, and this underlies anthroposophical medicine, still it is not a religion but has a different view of the role of illness in the overall health of the person, it looks at the entire life, not the convenience of this moment, there is value seen for the role of normal childhood illnesses and also to allowing fevers during an illness.  Since there is a whole systems approach to this style of medicine, it is likely very different from someone just saying " I dont want vaccines"  in that the anthroposophical treatment of the illness and the sick ( and the well) child is also very different than the mainstream, so it is not just putting off the vaccines the whole health approach is different.  If one was to forgo vaccines without having the full approach to health, likely their outcomes would be much worse.

Offline LvsChant

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Re: County-by-county analysis of vaccine nonmedical exemptions reveals hotspots
« Reply #22 on: November 27, 2018, 10:18:58 AM »
If someone intentionally gets their child infected with a serious disease for medical reasons, I would be able to criticize it, but if they're doing the same thing for religious reasons, I can't.

I'm not sure what the motivations are, but I recall a situation similar when my boys were very young. In my homeschooling group, I recall one mother stating that she had chicken pox at her house and offered to allow other moms to bring their kids over to be exposed to it. It seems to me that the idea was that it would be a way to get the whole family through the disease at one time, rather than dragging it out over time (don't know if that is even a correct assumption). It was considered by them to be a very low-risk typical childhood disease that wasn't to be feared. I had vaccinated my boys, hoping that they wouldn't get it. I know that those who have chicken pox as children sometimes experience scarring and then have a high chance of getting shingles later in life... it would be nice to avoid that for them.

There were some in the group who had a moral objection to the way that the vaccines are prepared (I believe it was related to the use of embryonic tissue, but cannot remember the details). While I respected their right to that opinion (and agreed with them on some levels), I wasn't willing to take the chance that one of my children would die of a preventable childhood disease when a vaccine was available and highly effective.