New Arizona Law Sparks Battle on Vaccine Exemptions in Foster Care
May 28, 2013

This guest post has been written by Jessica Orwig, of Scientific Technologies Corporation, as a follow-up to a previous post entitled “Immunization Legislation May Impact Foster Care in Arizona” by Debbie McCune Davis, Executive Director of The Arizona Partnership for Immunization and an Arizona State Representative from District 30.

On May 2nd, Arizona Governor Janice Brewer signed into law Senate Bill 1108 that allows the Arizona Department of Economic Security (DES) to grant families, who choose not to fully vaccinate their biological or adopted children for medical, philosophical or religious reasons, a license to accommodate foster children. In her signing letter, Brewer stated that she hopes a result of this law will be more home opportunities for foster care kids.

The law, however, does not change the foster parents’ legal obligation to ensure that the foster child receives all of the necessary vaccines on time.

Democratic State Representative Debbie McCune Davis says she worries that the families who do not vaccinate their biological or adopted children, and then take in foster children now permissible under Senate Bill 1108, are therefore not experienced and might not know how to keep a child current on their vaccinations.

“We should help foster parents learn how to work with their pediatrician to keep foster kids up to date,” Davis says.

This task can be difficult because of the number of vaccines and the time frames in which children should receive them, says Andie Denious, MS, RN, a special projects liaison contractor for the Arizona Immunization Program Office and former Medical Services Manager for the Comprehensive Medical and Dental Program (CMDP), which provides health care to foster kids. Denious also expresses concern about the law, noting that it could put some foster children at higher risk for contracting a vaccine-preventable disease.

Health care professionals do not recommend vaccines for children with certain allergies or other, more severe, medical conditions. Therefore, foster children who have such medical conditions may lack one or more vaccines leaving them more vulnerable to diseases when placed in families whose members are not fully immunized.

“The possibility now exists for a foster family’s biological child to contract and transmit a vaccine-preventable disease to a foster child, and this is not a good thing,” Denious says.

Discussions with the foster care community indicate that if a foster child were to contract such a disease in one of these homes, it raises liability concerns for both the foster placing agency and the foster family. Not to mention the danger imposed if that foster child then infected children from other households.

Foster children with medical complications are just one of the groups whose health is at risk, says Dr. Matthew Barcellona, a practicing pediatrician who serves on the board of directors for the Arizona Chapter of the American Academy of Pediatrics (AzAAP).

“Infants are especially at high risk,” Barcellona says. “Infants are much more likely to die if they contract a preventable disease and may be too young to receive the vaccines needed for protection.”

Take pertussis (whooping cough) for example. Infants are eligible for their first pertussis vaccine at 2 months of age. The reason that pertussis is not thriving in most infants younger than 2 months is because a large percentage of the population is already immunized, leaving the virus few available hosts. This is called herd immunity, and it is hindered by under-immunization.

Case in point, in early 2011 Tweed Hall, a town in Australia, was in the midst of a pertussis epidemic. A family who had scheduled their newborn’s pertussis vaccine lost him to the disease because he contracted it at 4-weeks old.  Infants remain at risk until immunity is established, often until 8 to 10 months of age when vaccinated on schedule.

The CDC and American Academy of Pediatrics recommend that by 2 years of age a child should have received the established number of vaccine doses for DTap, Hep A, Hep B, Hib, IPV, MMR, PCV, Rotavirus, and Varicella (Chickenpox). According to CMDP, 85.1 percent of Arizona foster children 2 years of age had received the necessary 4 doses of DTap and PCV vaccines by March of last year. About 95 percent of those foster children had also received the necessary dosage for Hep B, Hib, IPV, MMR, and Varicella.

To address the protection younger children lack against transmittable diseases, Brewer directed the DES to develop a policy that restricts foster agencies from placing young children and infants with families who have not immunized their children. However, no such policy exists yet.

“This policy is an important thing to do, but it’s the bare minimum and it’s not enough,” Barcellona says. Finding ways to protect these foster kids is just one piece of a larger, more serious issue, he says.

Since 2009, the CDC has documented the percentage of enrolled kindergarteners with reported vaccine exemptions in each state. In the last 3 years, this percentage has continued to increase for the majority of states, with Arizona being one of them. Three percent of children in Arizona were exempted during the 2009-10 school year and that rose to 3.7 percent during the 2011-12 school year.

Higher exemption rates for kindergarteners come at a time when the country has suffered outbreaks of measles, mumps and pertussis in parts of Washington State, California and Oregon brought on, in part, by under-immunized children. At 5.9 percent, Oregon had the highest percentage of exemptions for the 2011-12 school year, and in 2012 the state experienced a pertussis epidemic. That year, Oregon faced 910 cases of pertussis, which hospitalized 24 infants 3 months old or younger.

In her signing letter Brewer states, “With careful implementation, this legislation has the potential to provide more children with a safe and loving home.”

< p>To keep children safe, Davis suggests that families who take in foster children should request reminders for upcoming vaccinations, talk with their doctor to ensure that all shots for every family member are reported to the state’s immunization information database, and schedule their child’s next vaccine appointment before leaving the pediatric office.

The state of Arizona requires annual medical checkups, which includes any necessary vaccinations, for foster children. Children older than 2 years need vaccines about every 4 years, whereas children younger than 2 years require routine vaccinations every two months. These checkups will also help keep foster children up-to-date, Davis says.

Furthermore, resources such as the Arizona State Immunization Information System developed by Scientific Technologies (STC) will help the community know what vaccines are required and when they are due. Michael Popovich, CEO of STC, indicated that in the near future families will have access to information within such systems, which collect immunization records submitted by state providers and merge them into a single historical vaccination record for every child. This will enable parents and guardians to ensure that their foster children are fully immunized.

“By providing such records, we will empower families,” Popovich says.

Although she opposed the bill, Davis says it presents a golden opportunity. The fear of certain side-effects from vaccines, most of which are scientifically unfounded such as the theory that vaccines are linked to autism, are part of the misinformation that is discouraging parents from vaccinating their children.

“If we can inform families about the importance of vaccines, maybe they will vaccinate their biological children in addition to foster children,” Davis says.

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