Record: Matthew G. Johnson, Kristy K. Bradley, Susan Mendus, Laurence Burnsed, Rachel Clinton, and Tejpratap Tiwari, “Vaccine-Preventable Disease Among Homeschooled Children: Two Cases of Tetanus in Oklahoma” in Pediatrics 132 , no. 6 (December 2013): e1686-e1689. Available Here.
Summary: Johnson and colleagues begin by noting that rates of vaccination among homeschoolers are unknown because in many states they are not subject to the same school-entry vaccination requirements as are other schoolchildren. The authors then explain that tetanus has become extremely rare in the United States thanks to vaccinations. In the entire United States there were only 37 reported cases of tetanus in 2012. In Oklahoma there were only two. Both were homeschoolers, one of whom had never received a vaccination and the other of whom had not received the 10 year booster shot.
The first patient, a 17 year-old white male, after puncturing his foot on a rusty boat anchor, contracted tetanus and was admitted to the hospital in June of 2012. Ten days later, after several rounds of very powerful drugs, he was discharged in stable condition.
The second patient, an 8 year-old white male, after puncturing his foot on a rusty nail, contracted tetanus and was admitted to the hospital in October of 2012. This patient had a more severe case, which included respiratory failure requiring intubation and mechanical ventilation. He was in the intensive care unit for 18 days and was finally discharged from the hospital nearly two months after he had first been admitted.
After describing both cases the authors return to the issue of homeschoolers and vaccinations, noting that some states (notably North Carolina) require of homeschoolers the same vaccinations they require of students attending public and private schools. But most do not. While the authors would like to see changes in law, they recognize that “strong resistance exists nationwide for any attempt to regulate homeschooling.” (p. e1688) They recommend that in lieu of legal changes efforts should be made to work with primary care physicians, with church groups and homeschooling associations, and with extra-curricular organizations homeschoolers tend to frequent to spread the word about the importance of vaccination. They also recommend periodic vaccination clinics for homeschooling families.
Appraisal: Unfortunate situations like the two anecdotes described in this brief article occur quite frequently in the homeschooling community given the pervasive distrust many homeschoolers feel toward medical professionals and especially toward vaccinations. This article’s recommended policies are well-intentioned, but they do not take into consideration this incredulity toward medical authority. The anecdotes themselves, however, are to me the more effective motivator. It’s not lack of access in most cases that is leading large numbers of homeschooling parents to forgo vaccination for their children. It is conviction that vaccines have harmful side effects. But what parent wants her child hospitalized for two months because of a poor parental judgment call? My policy proposal would be to increase public awareness of the horrible, needless suffering brought upon some children by such decisions. This article, appearing as it does in an obscure medical journal, is not likely to raise public consciousness. What is needed is a large-scale social marketing campaign analogous to campaigns to alert citizens to the dangers of smoking or the virtues of breastfeeding.
Milton Gaither, Messiah College