Vaccinations by dfavorite

A8 / SUNDAY, DECEMBER 14, 2014 / KALAMAZOO GAZETTE

Michigan’s Growing Risk

Vaccine opt-outs: Is choice becoming threat? Low rates of immunization make outbreak of disease more likely, experts say By Rosemary Parker and Julie Mack

rparker3@mlive.com; jmack1@mlive.com

ichigan is at risk. That’s the warning from public health experts as more and more schoolchildren are not getting basic vaccinations to protect them — and all of us — from preventable disease.

Michigan makes it easy to avoid immunization, and after years of increasing public concerns over side effects and government intervention, the rate of those going without vaccinations is dangerously high. Nearly 45 percent of Michigan residents now live in counties at risk of disease outbreaks, according to an MLive analysis of state data. The risk is not just theoretical. It is very real. A recent outbreak in Traverse City shut down a 1,200-student charter school for a week, infected students at 14 other school buildings in the region, has sickened dozens of people and forced hundreds into quarantine. The culprit was pertussis — also known as whooping cough — a disease once thought to be nearly eradicated. But Grand Traverse County has an undervaccination rate six times the national average. And about 1 in 6 of the kindergarteners (17 percent) at the charter school, Grand Traverse Academy, had parents who signed waivers exempting them from required vaccinations. Last week, the other shoe dropped in Grand Traverse: Two residents were diagnosed with measles, the most contagious disease known to man and one that can have serious complications. Three people from Leelanau County who had contact with them also were diagnosed with the measles. It happened in Traverse City. It could easily happen in other communities. Michigan has one of the highest vaccine-waiver rates for kindergartners in the country, three times the national median, according to the Centers for Disease Control and Prevention. And the number of kindergartners getting waivers is growing. In five years, it has increased 23 percent, the CDC says. The CDC warns outbreaks of vaccinepreventable diseases are most likely to occur where “unvaccinated persons cluster in schools and communities.” Such clusters exist in a third of Michigan public and private schools housing kindergartners — more than 800 school buildings scattered across 68 of the state’s 83 counties, according to the MLive analysis. Many of those clusters are in affluent and welleducated communities, such as Traverse City, Troy, Grosse Pointe and Clarkston. Those opting out of vaccines tend to be healthconscious families who buy organic food, give

Mitch Maher, of Plainwell, waits with his daughter Maia, 4, for her immunizations at Trestlewood Pediatrics in Kalamazoo. (Mark Bugnaski/MLive.com)

WAIVER RATES BY COUNTY

Percentage of kindergartners who obtained vaccine waiver rates in 2013-14, for each of the 83 counties and city of Detroit. The statewide average is 5.9%. 0 - 5.0% Alcona 2.2% Alger 5.6% Allegan 2.1% Alpena 7.2% Antrim 3.3% Arenac 5.0% Baraga 1.6% Barry 4.6% Bay 1.5% Benzie 6.0% Berrien 3.7% Branch 0.9% Calhoun 2.5% Cass 2.6% Charlevoix 4.6% Cheboygan 18.5% Chippewa 6.4% Clare 3.2% Clinton 7.0% Crawford 6.4% Delta 4.8%

5.1 - 10.0%

10.1 - 15.0%

Detroit 2.5% Dickinson 7.1% Eaton 5.8% Emmet 13.7% Genesee 5.7% Gladwin 8.0% Gogebic 3.0% Grand Traverse 12.8% Gratiot 2.3% Hillsdale 4.2% Houghton 15.4% Huron 3.8% Ingham 4.9% Ionia 3.7% Iosco 4.6% Iron 4.0% Isabella 4.7% Jackson 4.2% Kalamazoo 2.4% Kalkaska 8.3%

15.1 - 20+%

Kent 3.7% Keweenaw 0.0% Lake 5.6% Lapeer 12.0% Leelanau 19.5% Lenawee 7.4% Livingston 11.3% Luce 3.8% Mackinac 4.7% Macomb 6.9% Manistee 5.6% Marquette 6.0% Mason 2.8% Mecosta 6.0% Menominee 3.7% Midland 12.1% Missaukee 0.5% Monroe 5.7% Montcalm 4.0%

Montmorency 9.2% Muskegon 2.4% Newaygo 3.7% Oakland 10.1% Oceana 3.8% Ogemaw 7.6% Ontonagon 3.3% Osceola 5.1% Oscoda 12.7% Otsego 3.3% Ottawa 3.5% Presque Isle 6.3% Roscommon 2.7% Saginaw 2.7% St. Clair 9.5% St. Joseph 2.9% Sanilac 5.3% Schoolcraft 3.0%

Shiawassee 7% Tuscola 9.5% Van Buren 2.5%

Washtenaw 7.2% Wayne* 7.1% Wexford 4.2% *Detroit excluded

Source: Michigan Department of Community Health

their children health supplements and are drawn to alternatives to Western medicine. They cite websites skeptical about immunizations and worry the risk of vaccines outweigh the benefits. But, unwittingly and in growing numbers, they are creating a serious health threat, experts say. “Michigan is one of the worst states in the country” in terms of vaccinewaiver rates, and communities with high waiver rates should be “very concerned,” said Dr. Paul Offit, a leading authority on vacciOffit nations in the United States and chief of the infectious diseases division at Children’s Hospital of Philadelphia. “When you have a fairly large number of people who are choosing not to vaccinate, that puts not only their own children at risk, but also everyone else’s,” Offit said. Those particularly at risk include infants, pregnant women, the elderly, cancer patients and others with compromised immune systems. WAIVER RATES

MLive analyzed vaccination and waiver rates for Michigan’s kindergartners for the 2013-14 school year, the latest data available.

Public health officials say the kindergarten vaccination data is one of the best benchmarks for tracking immunization trends. In Michigan, children entering kindergarten must show proof of immunization for measles, pertussis, polio, mumps, rubella, hepatitis B, chickenpox, diphtheria and tetanus — unless a parent signs the waiver. Michigan is one of 20 states that allows parents to obtain a waiver for reasons beyond religious or medical concerns. In 2013-14, Michigan had the fourth-highest rate of kindergarten vaccine waivers in the nation, behind only Oregon, Idaho and Vermont, according to the CDC. Michigan’s waiver rate of 5.9 percent compares to the national median of 1.8 percent. About three-quarters of the waivers in Michigan are because of philosophical objections. The number of waivers in that category has increased 60 percent in the past five years, state data shows. Health experts get especially concerned when a school, community or county has a waiver rate above 7 percent. That’s because whooping cough and measles — the most contagious diseases — need about 93 percent of the population to be resistant to those germs to prevent an outbreak if an infected person comes into the community.

Michigan has 21 counties with a vaccine waiver rate of 7.1 percent or more among kindergartners. Those counties contain 44 percent of the state’s population and include Wayne, Oakland, Washtenaw, Livingston, Lenawee, St. Clair, Lapeer, Midland and Grand Traverse. A number of school communities have doubledigit waiver rates, including Bloomfield Hills, Birmingham, Northville and Rochester. Some of the highest waiver rates are at private schools. At Cranbrook Academy in Bloomfield Hills, one of the state’s most prestigious private schools, 23 percent of kindergartners had a waiver. Based on state statistics, it appears about 150,000 of Michigan’s public and private school students — 6 percent of the K-12

population — do not have all their required immunizations, which includes older children who did not get shots required after kindergarten. As the number of waivers has grown, publichealth experts say it’s no coincidence that whooping cough is making a comeback in Michigan. In 2002, the state had 62 cases of whooping cough. Last year, there were 995 cases, half of which were in children younger than 12. In 114 cases, the patients were hospitalized. An Oakland County infant died of the disease in 2012. A 2008 study found a geographic overlap between clusters of waivers and clusters of pertussis cases in Michigan. Yet the threat of undervaccination is largely invisible. Most people have no idea how many parents do not vaccinate.

Joseph Fleck, of Fulton, 12, receives vaccinations from registered nurses Becky Harrison, left, and Dawn Smith at the Kalamazoo County Health and Community Service immunization clinic. (Junfu Han/MLive.com)

They have no idea that their children, elderly relatives or friends with compromised health go to school or the grocery store in communities where vaccination rates are as low as those in Third World countries. “The first question people ask me regarding the current outbreak of Enterovirus D-68 is ‘Do we have a vaccine?’ Same thing with Ebola,” said Matthew Davis, chief medical executive for the Michigan Department of Community Health. “How do we reconcile that question with our failure to use vaccines on a regular basis with our kids?” he said. “We have the ability to protect ourselves and our most vulnerable, and we are losing more babies to pertussis?” HERD IMMUNITY

If people do not immunize their children, why is that a problem for anybody but those children? It goes to the concept of what experts call “herd immunity.” For outbreaks to occur, germs must not only be introduced to a community, they must also encounter vulnerable people to infect. Those people must encounter other vulnerable people for disease to spread. If enough people are immune, the disease is contained and an outbreak is prevented. Each vaccinated person is not only protected from illness, but is one less receptive host for the disease to exploit. Each immune person helps create a protective bubble around the vulnerable few — such as infants too young to be vaccinated, people with medical conditions that prevent vaccination, those undergoing cancer treatments or whose immune systems have been weakened. “Of 314 million people in the U.S. about 500,000 cannot be vaccinated” for medical reasons, Offit said, “and they depend on those around them to protect them.” Moreover, because no vaccine is 100 percent effective, even those who are vaccinated are still at some risk in an outbreak. “You cannot ignore the people who opt out (of vaccination) because you are going to come into contact with those people and that SEE WAIVERS, A9

KALAMAZOO GAZETTE / SUNDAY, DECEMBER 14, 2014 / A9

Michigan’s Growing Risk

Change will make vaccination waivers tougher to get By Rosemary Parker

it more difficult for parents to opt out of vaccination requirements. In all those states, including Michigan, public-health officials say the reforms are needed because of increasing rates of children not being vaccinated and increasing outbreaks of vaccine-preventable diseases. Michigan is one of 20 states that allow parents to waive school vaccinations for reasons other than medical necessity or religious beliefs. But even among those 20 states, obtaining the waiver in Michigan is easier than elsewhere. For instance, California and Washington require a health professional to also sign a form saying parents have been informed of the risks of not vaccinating. Arkansas and Minnesota require the form to be notarized, and Vermont recently started requiring parents to review online material and to renew the waiver each year. A 2013 study conducted by researchers

Waivers

It matters because of the concept of “herd immunity.” Here’s how it works:

puts you at risk,” Offit said. In explaining the effectiveness of herd immunity, Offit cites a study in the Netherlands after an outbreak there. “Surprisingly,” Offit said, “you were (statistically) better off to be unimmunized in a high vaccine area than vaccinated in a low vaccine area because no vaccine is 100 percent effective, and in low vaccine areas a disease can catch on and spread quickly so your chance of exposure is greater.”

While all states allow kindergarten vaccine waivers for medical reasons, there are 20 states that allow waivers based on “philosophical” objections. Mississippi and West Virginia are the only states that do not allow waivers based on religious beliefs. Numbers designate rankings of the top 10 states with the most kindergartner vaccination waivers for 2013-14. Allow philosophical waivers Washington 9 Oregon Idaho 1 2

Arizona 7

Not immunized but still healthy

Immunized and healthy

Maine Vermont 5 3

R.I. Del. D.C.

Alaska 6

* Missouri philosophical exemption applies only to daycare, preschool and nursery school.

Source: Adapted from "School Vaccination Requirements: Legal and Social Perspectives,” James G. Hodge Jr., NCSL State Legislative Report, August 2002; LexisNexis 2008.

this protocol, requiring parents to sit through a session about vaccines before they can obtain a waiver — basically the same as what Michigan’s new rules will require. At a hearing last month in Lansing about the new rules, none of the 25 peo-

(MLive.com)

ple there voiced opposition. The change was also supported by documents from doctors, nurses, professional organizations and health officials. “We are so happy the state will have a uniform approach, and I am hopeful it will make a change in

waiver rates,” said Dawn Smith, Immunization Action Plan nurse for Kalamazoo County. “It has kept our rates low (in Kalamazoo County),” Smith said. In other counties with higher waiver rates, similar changes at the local level have had “really significant results,” she said. “It will take those convenience waivers out of the equation, and for those who are on the fence, it may sway them a little bit,” she said. It also informs parents about the Vaccines for Children, a federally funded program that provides vaccines at no cost to families that might otherwise avoid or delay vaccination because of inability to pay. Some parents remain steadfastly opposed to vaccination in spite of the information nurses provide, Smith acknowledged. “We may not sway those folks,” Smith said, “but at least we can give them science-based information.”

WHAT RE ADERS SAY

HARD TO FIND A MIDDLE GROUND

Not immunized, sick and contagious

Here is a selection from comments on the vaccination stories on MLive.com. ward5: I am not in favor of forcing parents to vaccinate their children, or do a lot of other medical recommendations. This is a slippery slope of giving government absolute control of our childrens’ health. No way would I go for this government control.

... disease spreads through the population. When some of the population is immunized ... ... disease spreads through some of the population. When most of the population is immunized ... ... spread of the disease is constrained. (MLive.com)

immune system strong through proper nutrition and hygiene,” Waltman said. “You don’t keep it strong by injecting your body full of disease. It’s just so basic.” “If you want to vaccinate, go right ahead,” she added. But “it’s our right to make the decision not to do it.” Offit argues, though, that it is no one’s right to catch and transmit a potentially fatal infection. “I think in a better society we wouldn’t let it happen,” he said.

Michigan 4

Colorado 10

When no one is immunized ...

cines may contribute to long-term neurological problems, such as autism. Among those questioning the conventional wisdom on vaccines is Marcel Lenz, a Traverse City resident who is father of children ages 4 and 2. Lenz, who has a doctorate in horticulture, said he had a “falling out with Western medicine” and is persuaded by the arguments of alternativehealth advocates who say vaccines are potentially harmful. “I haven’t seen the studies that convince me that vaccines are safe and effective,” Lenz said, adding he believes that diseases such as polio already were on the wane before the vaccines were introduced. Based on his reading, he said, “the probability of getting one of these diseases is low, and even if you do get something, it’s probably not going to be that severe.” By contrast, he said, “every vaccine has components in it that are toxic that you don’t want in the bloodstream.” “There are pros and cons to everything,” Lenz said, “and I just don’t trust vaccines.” Parents signing vaccination waivers say it’s their right to opt out. “I don’t believe you can drug your way to good health,” said Sue Waltman of St. Clair Shores, who founded Michigan Opposing Mandatory Vaccines in 1994. “The most important thing is to keep your

Allow only medical waivers

Wisconsin 8

WHY DOES MY CHOICE MATTER TO OTHERS?

THE SAFETY DEBATE

There is wide scientific consensus that vaccines are safe and effective, and that the fear vaccines led to a rise in autism has been thoroughly discredited. The American Academy of Pediatrics says immunizations “are the best way to prevent disease.” The Centers for Disease Control says vaccines are “held to the highest standard of safety.” In 2011, the Institute of Medicine reviewed medical and scientific evidence, looking at eight vaccines given to children. It found “these vaccines are generally very safe and that serious adverse events are quite rare.” “The simple message is that vaccines save lives, millions of lives throughout history,” said Dr. Jevon McFadden, medical epidemiologist at the Michigan Department of Community Health. “They are the most important achievement in public health.” In 1920 alone, nearly 2,000 Michigan residents died of diphtheria, measles or whooping cough — the equivalent to nearly 6,000 people as a proportion of today’s population. Many people still recall the terror of polio epidemics and the excitement in 1955 when, at the University of Michigan, the Salk vaccine was declared safe and effective against polio. Still, skepticism about vaccines dates back to the 19th century, when the Anti-Vaccination Society of America railed against smallpox immunizations. Then, opposition to vaccinations was rooted in fears of catching the disease from the shot, which occurred in rare instances. Today, opponents are more concerned the vac-

at New York University and published in Health Affairs found a correlation between vaccine waiver rates and the ease of obtaining a waiver in that state. States with an easier process had waiver rates twice as high as states with a more complex process. That suggests, the study said, that “parents’ decisions about whether or not to have their children immunized continue to be unduly influenced by matters of convenience.” For example, some parents will opt for a waiver simply because it’s easier than getting the child his or her shots. Michigan allows counties to use their own process for obtaining a waiver, which means the level of difficulty can vary. Some counties make the form readily available or allow parents to submit their own form. Other counties require parents to pick up the form in person from the health department. Ten counties, including Kalamazoo, already follow

WHO CAN OPT OUT?

The Michigan Department of Community Health is working to force parents to think twice before opting out of vaccinations for their children. Under new rules that will take effect Jan. 1, Michigan parents still will have the right to refuse the required shots for their children. But they will have to: • Be informed by a health worker about vaccines and the diseases they are intended to prevent. • Sign a form saying the parents understand they may be putting their children and others at risk by refusing the shots. On Thursday morning, the Joint Committee on Administrative Rules approved the new requirements. In making the changes, Michigan is following the example of other states, such as California, Vermont and Colorado, which recently have made

rparker3@mlive.com

children’s best interest,’ not for the public good.” He says health officials need to address parents’ issues, including the number of vaccines required for babies and toddlers. The current vaccination schedule requires children get 22 shots in the first 15 months of life. Largent also said “myway-or-the-highway” doctors who blithely dismiss parents’ concerns also are part of the problem. While some parents are anti-vaccine, “the bigger MAKING THE ARGUMENT chunk are vaccine-anxIn this debate, it is clear ious,” Largent said. many public health offi“We don’t want the cials and parents are talkvaccine-anxious to find ing past refuge in anti-vaxxers. We each other, want to help parents feel says Mark the authorities are speakA. Largent, ing to them, not at them,” associate Largent said. dean of Largent said skepticism Lyman about science and mainBriggs stream medicine also is an College at issue. Like debates over Largent Michigan climate change, stem cell State University and research and evolution, he author of the 2012 book said, “no scientific finding “Vaccine: The Debate in and no agreement among Modern America.” physicians can bring it to a “I share public health close because the debate is officials’ belief in the value cultural and political, and of vaccines to help protect only partially about science both individuals’ and the and medicine.” public health,” he said. But Health officials say vac“things that (public health cines have become a victim officials) find a compelof their own success. ling argument are not the “Today’s parents have things (parents) find a not seen tetanus or polio,” compelling argument.” Davis said. “There is a “Why aren’t parents reason for that, and that compelled by communal reason has a name — vacgood? Because I don’t cines. When we learn not (care) about public good, to respect a threat, that I care about my child,” he threat comes back to said. “We need to say: ‘You challenge us. That’s the need to vaccinate your challenge we face in child because it is in your Michigan.”

CIngersoll: Anyone that wants to argue about not vaccinating their children should talk to someone over the age of 75. Nearly all of them (my mother included) have a story about “The summer Billy/ Sally never came out to play again.” Later when she was older she learned from her own mother that her friend had died from whooping cough but no one wanted to tell the other children. SkepticalShowers: So if vaccines are useless, whatever happened to that tiny little issue of smallpox we as a species used to face? Just a conspiracy of history books, hmmm? Murica4eva: I am hoping that immunizations in adults and older kids increase with the increased use of electronic health records. It is ridiculous that I have to track down all the immunizations that I have ever had to see if I am up to date. We have computers now.

smallestoceans: When we had our daughter my wife and I were against vaccinations. Not because of any good reason, but because a friend of a friend of a friend told us that they were bad. After talking with the doctor for 2 minutes we were on board. I’m not sure why these people are allowed to put everyone else in danger just because they believe in conspiracy theories. titotaler: I’d be interested in hearing whether the antivaccination crowd also rejects prescription medications, all of which carry the risk of complications and side effects, and none of which are guaranteed to be effective 100% of the time. drunkenmonkey: “Some of the highest waiver rates are at private schools. At Cranbrook Academy in Bloomfield Hills, one of the state’s most prestigious private schools, 23 percent of kindergartners had a vaccination waiver.” Hmmm ... highly prestigious private school. Hmmm ... most likely highly educated parents. Hmmm ... highest waiver rates. So, highly intelligent parents sending their children to prestigious private schools are opting out of the vaccine schedule. Hmmm ... Basic Bob: @drunkenmonkey Their brains and money will not be an advantage when the disease strikes.

COMING UP

“I’m a staunch believer in keeping healthy and building the immune system from the inside out.” GRETCHEN PERRY, SHOWN WITH CHILDREN PARKER AND PAIGE. SHE STOPPED THEIR VACCINATIONS 10 YEARS AGO.

Tuesday: Where vaccinations lag, diseases move in. Also, parents who don’t vaccinate say they are making an educated decision. Thursday: Family scarred by measles wants no more victims in Michigan.

TUESDAY, DECEMBER 16, 2014

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TODAY’S MUST READS

TRAVERSE CITY

Outbreaks illustrate danger

NILES

Stabbing suspect must undergo psych eval

jmack1@mlive.com

Over the past seven weeks, the Traverse City area has become an unnerving, real-life example of the consequences of undervaccination. Cases of whooping cough and measles have impacted hundreds of families, overwhelmed local doctors and public health officials, and put parents who don’t vaccinate their children on the defensive. “Nobody likes to be the person who says, ‘I told you so,’” but what’s unfolding now is exactly the scenario feared by those worried about the region’s low immunization numbers, said Dr. Bradley Goodwin, a Traverse City family physician who is president of the Grand Traverse County Medical Society. Grand Traverse County has one of Michigan’s highest rates of schoolchildren opting out of vaccines — 13 percent of incoming kindergartners, twice the state average and six times the national rate for kindergartners in 2013-14. In some schools, the rate is even higher. That includes Grand Traverse Academy, the 1,200-student charter school associated with the initial outbreak of whooping cough, also known as pertussis, an illness nicknamed “the 100-day cough.” A teacher at Grand Traverse Academy was diagnosed with whooping cough on Oct. 16. Once introduced into the school community, the disease took off. To date, a 151 confirmed and probable cases of whooping cough have been linked to the school. One reason the illness swept through the academy: A significant number of its students are unvaccinated. In 2013-14, 17 percent of Grand Traverse

KALAMAZOO

Menorah goes up at Bronson Park A small group of Jews from the Kalamazoo area were joined by a handful of interested citizens Sunday while they set up a Hanukkah menorah in Bronson Park. This is the second year the menorah will be displayed at the corner of Rose and South streets alongside the park’s other holiday decorations, a development local resident Becky Doorlag said she hopes continues for years to come. Details, A8

WASHINGTON

Longtime Rep. Dingell fractures hip in fall

DAILY QUOTE

We should stop all “traditional practices for now so that we will live to continue to practice them later.”

SIERRA LEONE PRESIDENT ERNEST BAI KOROMA, AFTER PUBLIC CHRISTMAS AND NEW YEAR’S CELEBRATIONS WERE CANCELED. DETAILS, A11

PERTUSSIS ON THE RISE IN MICHIGAN

By Julie Mack

The suspect in the Amtrak train stabbings in Niles earlier this month has been ordered to undergo a psychiatric evaluation. Michael Darnell Williams, 44, is facing four counts of assault with intent to murder after stabbing four people on an Amtrak train Dec. 5. Several family members have expressed concerns about the mental health of Williams, a Saginaw native who was employed as a truck driver. Details, A5

Retiring Rep. John Dingell has a fractured hip, and it will take time for the 88-year-old Michigan Democrat — Congress’ longest-serving member — to recover. An update Dingell was posted on Facebook by his wife, Debbie Dingell, who was elected to the seat last month. Details, A12

KVCC GRADS URGED TO RAISE BAR

Michigan's vaccine-waiver rate for kindergartners is among the nation's worst and growing. Public health experts say it's no coincidence that pertussis, or whooping cough, is making a comeback in the state: Cases of pertussis Grand Traverse Academy experienced a whooping cough outbreak in November. Last year, 17 percent of its kindergartners had vaccine waivers, more than twice the state average. (MLive.com) INSIDE Parents say refusal to have children vaccinated is well-thought, factdriven decision, A7 ONLINE Look up waiver rates for schools, counties, bit.ly/vaccinedata

1,132*

1,500

1,000

500

103

0 Academy kindergartners had parents who signed a waiver exempting their children from the required childhood immunizations. “When you have (pertussis) spread so fast through a school community with high waiver rates, that’s not coincidental,” Goodwin said. Also fueling the outbreak: When the teacher was first diagnosed, students classified as “close contacts” were told to take antibiotics as a preventive measure, but not all followed the directive, said Wendy Trute, health director for the Grand Traverse County Health Department. Some parents didn’t want to give antibiotics to children who

1995 ’97 ’99 ’01 ’03 ’05 ’07 ’09 ’11 ’13 ’96 ’98 2000 ’02 ’04 ’06 ’08 ’10 ’12 2014* *As of Nov.29 (MLive.com)

Source: Michigan Department of Community Health

don’t seem sick. But whooping cough is contagious before symptoms appear. “Two families didn’t get or take antibiotics, and they account for eight or nine of the confirmed cases,” Trute said. “People not following through (with medical directives) is one of the issues.” The school had so many cases of whooping cough that school officials canceled the elementary fall carnival as well as four days of classes. While the school was shuttered, the 1,200 students were told to stay at home in

quarantine to prevent spreading the disease further. That was the second week of November. Since then, whooping cough cases have been reported at 14 other school buildings across the region and new cases are still coming in, Trute said. This month, as Trute and her staff were still dealing with whooping cough, two county residents turned up with measles — considered the most contagious disease known to man and one more prone to serious SEE VACCINES, A2

KALAMAZOO

Commission approves bonds for retiree health care By Emily Monacelli

emonacel@mlive.com

The Kalamazoo City Commission approved issuing $90 million in bonds Monday to help pay the city’s $188 million unfunded retiree health care liability. Commissioners approved issuing the bonds in a 5 to 0 vote. Commissioner Bob Cinabro abstained, citing his position as a city retiree. Commissioner Stephanie Moore was absent.

Commissioner Don Cooney, who was part of a 21-member Legacy Costs Task Force that recommended the city issue bonds to pay the unfunded liability, called it “the most reasonable way to move forward. “It’s a serious, serious step, because we’re borrowing a lot of money here,” Cooney said. “But the one thing that has been clear to me from the beginning is we have to live up to the promises that we made to the peo-

ple who worked here, and this will ensure that.” Under the administration’s plan, the city will pay $6.8 million a year from its general fund toward retiree health care costs over the 30-year life of the bonds. That figure includes $4.2 million in annual payments on the bond debt and $2.6 million in contributions toward future health care liabilities, according to Kalamazoo City Manager Jim Ritsema. Right now, the city pays

INDEX Advice.......... C10 Classified......A15

1,564

2,000

“The one thing that has been clear to me from the beginning is we have to live up to the promises that we made to the people who worked here, and this will ensure that.” COMMISSIONER DON COONEY

$6.6 million in retiree health care premiums from the general fund, which does not include funding toward future liabilities. Ritsema said

the bonding plan includes a commitment to pay $3.5 million toward those future liabilities. SEE BONDS, A9

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complications than pertussis. Three more cases were confirmed last week in neighboring Leelanau County, involving people who had contact with the first two patients. Measles “is so contagious that if someone with measles went into a waiting room where nobody was vaccinated, 90 percent of the people in that room would get measles,” Trute said. The quarantine period for an unvaccinated “close contact” of a measles patient is 21 days, compared to five days for whooping cough. One good aspect of measles: Two doses of the measles vaccine last a lifetime and are highly effective in immunizing an individual against the disease. By comparison, while pertussis is less contagious

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tagious illness around the holidays. “People can be overly cautious, like not wanting their kid to go to school, but I’ve also seen a lot of legitimate concern,” Goodwin said. Among those impacted has been Amy Ettawageshik, a Grand Traverse Academy parents with six children under age 12, including an infant. Infants are particularly susceptible to pertussis, and 50 percent of babies who catch the disease need to be hospitalized. To be on the safe side, Ettawageshik brought her 2-month-old son to the health department for a pertussis vaccine, even though he was a little young for the first round of shots. The outbreak also meant she had to track down antibiotics for the older children, even though they were fully vaccinated, and keep them away from others for several days. “I tend not to get too frightened,” Ettawageshik said. But, “I have a lot of kids, and I don’t want them infecting anybody else.”

HUNDREDS AFFECTED

NEW NORMAL?

It’s been a brutal six weeks for the Grand Traverse County Health Department. Trute said her staff has stepped up to the challenges of responding to the outbreaks, but they’re working long hours and giving up their holidays and weekends to keep pace. That includes dealing with 1,500 phone calls received on a pertussis hotline established a month ago. The health department and local physicians aren’t the only ones scrambling. Beyond the confirmed cases of diseases, hundreds of families have been affected — from quarantine orders, to tracking down the prophylactic antibiotics, to getting booster shots, to keeping kids home from school and staying clear of church, stores and other public places for fear of contracting a nasty and highly con-

The whooping cough outbreak has become a hot-button issue in Traverse City, pitting parents who vaccinate their children against those who don’t, said Beth Milligan, a reporter for The Ticker, a Traverse City news website. “People on the provaccination side are very angry at the anti-vaxxers for exposing their children to disease,” Milligan said. Meawhile, “the antivaxxers are latching onto the fact” that some fully vaccinated people are getting whooping cough, which they say proves their point that vaccinations are ineffective, Milligan added. “A lot of people who don’t vaccinate don’t see the need,” said Milligan, who wrote an in-depth story in September about the county’s low vaccination rate. “Many are families who are into holistic medicine” feel there are better ways to

Amy Ettawageshik holds her 2-month-old son, Ty, as he receives a round of immunizations, including one for pertussis. Ettawageshik has five older children, some of whom attend Grand Traverse Academy, which was experiencing an outbreak of whooping cough, and Ettawageshik wanted to protect her newborn against the disease. (Julie Mack/MLive.com)

build the immune system and ward off disease. The problem with that thinking, Goodwin said, is that unvaccinated people are much more likely to spread disease compared to those who are immunized, even if the unvaccinated people don’t appear sick. “I’m a big believer in better living through better living,” Goodwin said. “But while your immune system is fighting off an illness, you can still be contagious and infect others, and those others may not be as healthy as you.” If anything, Trute said, the fact the pertussis vaccine is not 100 percent effective is all the more reason to maintain high immunization rates, to prevent the disease from getting a foothold in the community. Her fear, she said, is that what’s happening this year will become a semi-regular event in Grand Traverse County. “This is going to be our new normal if we don’t get our vaccination rates under control,” Trute said.

Complete obituaries begin on Page A9. For more information, go to MLive.com

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The question going forward is whether the uproar and disruption associated with the pertussis and measles cases will create community change in Traverse City. “It’s certainly helped raise awareness on how quickly disease can spread,” Goodwin said. “I think there was a sense of complacency about how serious these

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parents who choose not to vaccinate their children. But she is also thinking of hosting an immunization clinic at the school next year. Meanwhile, The Children’s House, a Montessori school in Traverse City, which also had a student with whooping cough, has been educating parents on the value of vaccinations. “I don’t think you’re ever going to change the minds of some people,” Trute said. “We’re trying to affect people on the fence.” Milligan agreed some opposed to vaccinations are “digging in their heels,” but recent events are changing attitudes. “When you’re faced with a highly contagious outbreak, it creates a lot of fear, and that fear can be a useful catalyst,” Milligan said. “Sometimes, you need something scary to happen to realize the consequences of not vaccinating.”

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OBITUARIES LIST TUESDAY, DEC. 16, 2014

diseases can be. For an adult, a 100-day cough is an inconvenience, but for an infant, it can be fatal. “It’s also helping people to reconsider and re-evaluate their stance against vaccines,” Goodwin added. “Most people are seeing now that there is a value to getting vaccines, and realizing their previous premise about going without being vaccinated was overzealous.” Trute agreed there has been a “fair amount of conversation” in recent weeks about trying to reduce the number of schoolchildren with vaccination waivers. “A lot of people are becoming vocal now because it’s effecting them,” she said. “I do think it’s possible that once we get through this craziness, there will be a call to positive action.” Some educators are thinking the same way. Susan Wagner-Dameron, director of Grand Traverse Academy, said it is important to remain respectful of

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SCHOOLCRAFT TOWNSHIP KALAMAZOO COUNTY, MICHIGAN NOTICE OF ADOPTION OF ZONING ORDINANCE TEXT AMENDMENT TO: THE RESIDENTS AND PROPERTY OWNERS OF THE TOWNSHIP OF SCHOOLCRAFT, KALAMAZOO COUNTY, MICHIGAN, AND ANY OTHER INTERESTED PERSONS: PLEASE TAKE NOTICE that at a meeting held on December 9, 2014 the Schoolcraft Township Board adopted the following Ordinance No. 266: TOWNSHIP OF SCHOOLCRAFT COUNTY OF KALAMAZOO, STATE OF MICHIGAN SCHOOLCRAFT TOWNSHIP ORDINANCE NO. 266

DELIVERY Kalamazoo Gazette Published seven days a week by Mlive Media Group 300 S. Kalamazoo Mall, Kalamazoo, MI 49007 Phone 269-388-7789 or 800-466-2472 Postage paid at Kalamazoo, MI Publication identification: (USPS 289-500) Postmaster Send address changes to Advance Central Services, 3102 Walker Ridge Dr., Walker, MI 49544 Subscription Rates Tues-Thur-Sun $4.99 per week Thur-Sun $4.49 per week Sun $3.99 per week By Mail: Tues-Thur-Sun $5.00 per week, Sunday Only $4.50 per week Subscription includes access to the print or digital edition during the time covered by the current subscription payment period. No credits or refunds for temporary stops of print delivery. Thanksgiving Edition charged at the then current Sunday retail rate. Deliveries by independent carriers.

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(ZONING ORDINANCE TEXT AMENDMENT) An Ordinance to amend Section 16.3 of the Schoolcraft Township Zoning Ordinance (Ordinance No. 137, as amended) pertaining to the uses designated as special land uses in the LI Local Industrial District.

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SECTION 1 AMENDMENT OF SECTION 16.3 PERTAINING TO SPECIAL LAND USES IN LI LOCAL INDUSTRIAL DISTRICT

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Section 16.3 of the Schoolcraft Township Zoning Ordinance (Ordinance No. 137, as amended), pertaining to the uses designated as special land uses in the LI Local Industrial District, is hereby amended to add a subsection 3 designating another land use as a special land use in that District, reading as follows:

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The full text of the original of Ordinance No. 266 may be inspected and a copy of same may be purchased by contacting the Schoolcraft Township Clerk, Virginia Mongreig, at the address and telephone number below during regular business hours of regular working days, and at such other times as may be arranged. Virginia Mongreig, Clerk Schoolcraft Township Offices 50 East “VW” Avenue Vicksburg, MI 49097 (269) 649-1276

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than measles, its vaccine also is less effective — it requires a booster shot every 10 years and some people immunized against pertussis can develop the illness, albeit in a milder form. Trute said about a third of the pertussis cases in the Traverse City area involve people who are vaccinated. Children around age 10 or 11 have been particularly vulnerable because the immunizations they received in infancy are wearing off and they haven’t yet had a booster shot. It didn’t help that the outbreak at Grand Traverse Academy started in the upper elementary grades, Trute said. Still, it’s clear that unvaccinated children were those most at risk. A state epidemiologist ran the numbers for the Traverse City pertussis outbreak and calculated that children who aren’t vaccinated have been five times more likely to come down with pertussis than those who have been immunized, Trute said.

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Vaccines

KALAMAZOO GAZETTE / TUESDAY, DECEMBER 16, 2014 / A7

Michigan’s Growing Risk

Skipping vaccine matter of health, parents argue

that promotes dietary supplements, and Dr. Robert Sears, a pediatrician who has written a number of well-known parenting books and has expressed By Julie Mack skepticism about the numjmack1@mlive.com ber of vaccines that chilA registered nurse dren receive. who once worked in the Perry said the Internet pharmaceutical industry, has allowed parents to Gretchen Perry didn’t connect with each other question the potential risk and look beyond the mainof vaccinations until she stream medical establishbecame a mother. ment for advice. Her son was born 11 “We all talk about this, years ago, and was a sickly and we’re all on social infant and toddler, she media reading the inforsaid. He had a series of mation from the good gastrointestinal issues, nonprofits that educate us didn’t sleep through the on the dangers of vaccinanight until he was in kintion,” Perry said, adding dergarten, and showed lan- her belief that the mainguage delays and socializa- stream medical establishtion problems consistent ment “ignores the very real with autism, said Perry, adverse events” associated who lives in Rochester. with vaccinations. Her daughter, who is While vaccines are now 10, had similar probtouted as safe and effective, lems, although not as experts acknowledge they severe, she said. are not 100 percent safe Perry said she thinks her nor 100 percent effective. children were born with Some people who are vaccompromised immune cinated still get the disease, systems and suspects vac- albeit in a milder form, and cinations were aggravating a few experience a serious their health problems. harmful reaction from an She swore off vaccines immunization. a decade ago, and says The latter is why the her children’s health has federal government improved considerably, has a Vaccine Injury thanks to their diet and Compensation Program. health supplements that Since 2010, the program have “detoxified” their has received an average systems. of 1,244 claims a year and “I’m a staunch believer paid out on an average of in keeping healthy and 284. The average award building the immune syswas $715,000. tem from the inside out,” However, to put that Perry said. into context, more than Perry’s skepticism of 100 million Americans vaccines is not unique in get immunizations each her community. One of year, including childhood every eight kindergartvaccines, adult boosters ners in Rochester Public and annual flu shots. And Schools last year had a still, there are thousands parental waiver last year who die every year from exempting them from vaccine-preventable dismandatory vaccinations. eases, including influenza, “Most people around pneumonia, meningitis me don’t vaccinate, or they and hepatitis. selectively vaccinate,” “Vaccines save lives,” Perry said. said Dr. Jevon McFadden, medical epidemiologist at HEALTH OBJECTIONS Michigan Department of Statewide, about 6 perCommunity Health. cent of Michigan school“We know vaccines are children have vaccination safe, they are the highly waivers, which equates scrutinized and there to about 150,000 children is a significant surveilwho are unvaccinated or lance effort ongoing that undervaccinated. is unlike surveillance for Many are in affluent any other medication,” he communities such as said. ” Rochester and have wellHeather Stevens, the educated, health-conscious mother of a preschooler in parents who buy organic Oakland County, doesn’t food and avoid antibiotics buy those assurances. in favor of a homeopathic She has a master’s approach to illnesses. degree in environmenThey fear injecting so tal engineering and has many viruses into their helped conduct human children could do more health risk assessment for harm than good, and see environmental pollutants. immunizations as being She says vaccine safety driven by “Big Pharma,” studies are typically conwhich they see as more ducted by pharmaceutical concerned about profits companies who have an than public health. interest in downplaying Their views are reinsafety issues, and says forced by anti-vaccination there hasn’t been adequate websites and alternative research into the “cumulamedicine gurus such as Dr. tive and sometimes synerJoseph Mercola, a Chicago- gistic effect of chemicals area osteopathic physician on the human body,” espewho has a popular website cially over the long term.

Well-educated people say they’re responding to dangers of vaccinations

COMING UP

“I often think: ‘What would Tammy be like? Would she have a family, would she have children?’” BECKY HOOKER, SPEAKING OF HER SISTER, TAMMY BOWMAN, RIGHT, WHO DIED OF THE MEASLES IN 1990.

Thursday: Family scarred by measles wants no more victims in Michigan.

“I’m a staunch believer in keeping healthy and building the immune system from the inside out.” GRETCHEN PERRY, OF ROCHESTER, SHOWN WITH HER CHILDREN, PARKER AND PAIGE

“I’m not saying you should never vaccinate, but you should weigh the risks.” SUE ALLASIO, OF DETROIT, WITH HER DAUGHTER GRACE

risk,” Heikkinen said. “But diseases was going down “Ultimately, I’m responsible for my own ultimately, I’m responsible even before they had vacfor my own children and cines,” Waltman said. I’m not willing to risk Her skepticism led children, and I’m not willing to risk health complications.” Waltman to found health complications.” Sue Allasio, of Detroit, Michigan Opposing has three children in their Mandatory Vaccines in HOLLIE HEIKKINEN, OF HOWELL, PICTURED WITH HER CHILDREN, 20s who did not receive the early 1990s, when the HANNAH, 13; AUSTEN, 19; JORAH, 7, AND NOAH, 16 childhood vaccinations. Legislature was considerShe said she first heard ing a bill to limit the ability “The media tends to ste- like “playing Russian concerns about vaccines of parents to get a waiver. reotype us as this random, roulette ” and thinks it’s through other moms in the Today, her group has a scared/fearful, mob-crew better to ward off disease La Leche League, which mailing list of about a thoubunch of crunchy hippies,” with an “extremely healthy promotes breastfeeding. sand parents, and is a leadStevens said. “At least lifestyle.” Allasio was further coning voice in Michigan for speaking for myself, and She acknowledged that vinced after hearing about those skeptical of vaccines. my parent friends that some parents are critical of a potential link between She says much of the choose to selectively vacci- her decision. vaccines and autism and research into vaccines is nate or not vaccinate at all, “There’s a couple of reading a book by Dr. by pharmaceutical comwe are all very well-edupeople who don’t want Robert Mendelsohn, a panies. “It’s not the right cated prior to becoming their children playing with pediatrician and critic of kind of research that help a parent and have spent a mine, but if your child is Western medicine in the people make good decisignificant amount of time vaccinated, why should you 1970s and ’80s. sions,” she said. researching vaccines for worry?” Heikkinen said. “I’m not saying you She said she’s not conthe most important people Experts say the cause should never vaccinate, vinced that vaccines aren’t in our life.” for worry has to do with but you should weigh the linked to autism and other Stevens said she rec“herd immunity” — keeprisks,” Allasio said. “I don’t neurologic disorders. ognizes the downsides of ing the vaccination rate think kids need to be vacWe need to be honest. going unvaccinated. high enough to prevent cinated against whooping Vaccines may be doing “It’s something I conoutbreaks that could infect cough and measles,” saymore harm than good,” tinually look at and reinfants too young to be ing, in her view, the diseas- Waltman said. “Common evaluate every single day,” vaccinated, those with es aren’t that serious. sense has you asking: Why Stevens said. compromised immune sysSue Waltman, of St. Clair inject viruses into my child tems, such as the elderly Shores, agreed, saying with hopes of preventing a ‘RUSSIAN ROULETTE’ and people on chemothershe grew up in the 1960s disease down the line?” Marcel Lenz, a Traverse apy, and the percentage of when almost every child Getting “vaccinated is a City resident with two the population where the had measles, mumps and very important decision,” young children, shares vaccination isn’t effective. chicken pox. she said. “I believe everysimilar concerns. “I’ve heard people say“Most of us survived. one has the right not to do “I thought vaccines were ing I’m putting the herd at The death rate from those it.” magical, but then I started looking into it,” said Lenz, who has a doctorate in horticulture and a big interest Many vaccine-preventable diseases can be serious, or even deadly. in homeopathic medicine. Here’s a look at measles cases around 1960, prior to the vaccination era He said he was particularly influenced by books in the United States: written by Sears and Neal Z. Miller’s 2008 book, “Vaccines: Are They Really Safe and Effective.” deaths per year hospitalizations suffered encephalitis Lenz said he was struck by Miller’s contention that (swelling of the brain) while vaccine-preventable diseases were once prevaIn the vaccine era, cases have remained low until recently: lent and deadly, the threat of such illnesses has ebbed considerably in the era of 700 modern medicine. reported cases “The probability of get600 ting one of these diseases from January 1 500 is low, and even if you do to October 31 400 get something, it’s probably not going to be that 300 severe,” Lenz said. 200 Hollie Heikkinen, of Howell, said she carefully 100 weighed the risks in decid0 ing not to vaccinate her

WHY SHOULD I VACCINATE MY KIDS?

400-500 48,000

4,000

603

four children, ages 7 to 19. She said injecting viruses into her children seems

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2014*

* Provisional data reported to CDC’s National Center for Immunization and Respiratory Diseases Source: Centers for Disease Control and Prevention

(MLive.com)

THURSDAY, DECEMBER 18, 2014

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LOCAL / A3

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MICHIGAN’S GROWING RISK: PART 3

TODAY’S MUST READS

WAYLAND

Woman still carries pain of sister’s death from measles in 1990

‘It happens so quick’

PORTAGE

School facilities panel has long wish list A committee charged with planning the facility needs of the Portage Public Schools has come up with a list of recommendations to create what a consultant calls “a state-of-theart school system.” Among other things, the proposal calls for building two middle schools, four elementary schools, two stadiums and two pools. More community discussion is coming up. Details, A5

By Rosemary Parker rparker3@mlive.com

en Bowman took two of his daughters to a measles immunization clinic held in February 1990, hoping they could both get protection against an outbreak of the disease that was traveling through Wayland Union High School.

KALAMAZOO COUNTY

Newest judge ready to get to work Tiffany Ankley’s new job isn’t exactly what she had first hoped for, but she’s still excited to start Ankley ran for judge thinking she’d work in family court if she won Instead, she found she was competing for a spot in district court. After winning the election, she says she’s eager for whatever lies ahead. Details, A4

His older daughter, Becky, was given a shot. But Tammy, his youngest child, was a fifthgrader at Steeby Elementary. The clinic was for older students, he was told, and no records were on hand for younger students. Bring her back, Ben Bowman was told. By the time Tammy Bowman the clinic for elementary students came around, Tammy already was sick with the fever and rash characteristic of measles. A week later, she was dead. By so many measures, Tammy Bowman, 11, was just an ordinary girl. She loved people, loved her pets, and she was in high demand as a babysitter in the apartment complex where she lived with her parents and two older sisters. But in death, she holds a sad

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Let hometown pride show in your gifts Stuck for a gift idea? Take shopping local to the next level with a gift that literally says Kalamazoo. Clothing, food, art objects and beer growlers are among the items available that give your holiday presents a sense of place. Details, A14.

K WINGS BRING KIDS CHEER

Facebook. This was their avenue for discussion, to be able to call in and voice their opinion.” BUDDY HANNAH, WHO IS RETIRING FROM HIS RADIO SHOW, “THE TOUCH.” DETAILS, A6.

THE OUTBREAK

Becky was two years older than Tammy and 11 months younger than their sister Khristy. The oldest sister, Wendy, lived in her own home in the Allegan County community of Wayland at the time, Hooker said.

MLIVE • Look up waiver rates for schools, counties, bit.ly/vaccinedata •Read other stories in this series and follow related news, including outbreaks and policy debates in Lansing, bit.ly/MLivevaccines

was battling such an outbreak. A high school sports team had traveled to a competition in northern Michigan and brought back measles, Becky said. The disease quickly spread among other teens, and the Allegan County Health Department pulled the records of older students and set up a clinic to administer vaccinations to any In those days, Michigan had who had no record of being the lowest childhood vaccination immunized. rate in the country, leaving the “First, they started off with the state vulnerable to outbreaks of high schoolers, then they pulled vaccine-preventable diseases. in the middle schoolers,” Becky In the days before Tammy’s death, the Wayland community SEE MEASLES, A2

New commissioners sworn in, others bid farewell amitche5@mlive.com

A lot of my listeners “aren’t on Twitter or

distinction: Tammy Bowman is the last child in Michigan to have died of measles. “I would love it if that record would stand forever,” said her sister, Becky Bowman Hooker, 38, who now lives in Otsego. “She was my very best friend.”

KALAMAZOO COUNTY

By Alex Mitchell

DAILY QUOTE

Becky Hooker holds a favorite photo of her sister, Tammy Bowman, at Washington Street Elementary in Otsego, where she works. Tammy Bowman was the last person to die of measles in Michigan. Tammy was 11 years old at the time of her death in 1990. Michigan then had the lowest childhood vaccination rate in the country, leaving it vulnerable to outbreaks of vaccine-preventable diseases. (Mark Bugnaski/MLive.com)

Six new commissioners were sworn in as members of the Kalamazoo County Board Tuesday night. The board’s new members are: Stephanie Moore, D-Kalamazoo; Kevin Wordelman, D-Kalamazoo; John Gisler, R-Brady Township; Dale Shugars, R-Oshtemo Township; Larry Provancher, D-Portage; and Scott McGraw, R-Portage. Commissioners John Taylor, D-Kalamazoo; Michael Seals, D-Kalamazoo; Julie Rogers, D-Kalamazoo Township; Jeff

Heppler, R-Richland and Roger Tuinier, R-Comstock, also were sworn in after being re-elected. The meeting also served as a time of goodbyes for county board chairman David Maturen, R-Brady Township; vice chair David Buskirk, D-Kalamazoo; and commissioners John Zull, R-Portage; Carolyn Alford, D-Kalamazoo; Brandt Iden, R-Portage; and Phil Stinchcomb, R-Portage; each of whom is leaving the board. Maturen and Iden will move on to the state House next SEE COUNTY, A2

Friends and relatives capture the scene after the Kalamazoo County Board of Commissioners is sworn in Tuesday. (Christian Randolph/MLive.com)

INDEX Advice.......... A20 Classified........B8

FEEDBACK Comics ........... C8 Local............... A3

Lottery ............ A2 Nation...........A17

Obituaries.....A15 Opinion.........A19

Religion ........A16 Stocks...........A18

TV ................... C7 Weather........A21

Send your comments to comments@mlive.com.

KA DAILY

A2 / THURSDAY, DECEMBER 18, 2014 / KALAMAZOO GAZETTE

Local&More

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CONTINUED FROM A1

month. Buskirk and Stinchcomb were defeated in their bids to become state representatives. Zull, 74, and Alford, 64, did not to seek reelection. Each of the departing members received a personalized send-off and rose from a group that featured Kalamazoo County Prosecutor Jeff Getting, Kalamazoo County Treasurer Mary Balkema, Kalamazoo County Sheriff Richard Fuller, Kalamazoo County Clerk Tim Snow

and Kalamazoo County Drain Commissioner Pat Crowley. Maturen, who has sat on the county board since being elected in 2002 and has served as chairman since 2012, bid farewell to his colleagues by recalling that, as a boy scout, his troop leader always told him to leave a camp site in better condition than he found it. “I would like to think that I’ve left Kalamazoo County in better condition than when I found it in 2003,” Maturen said. Buskirk also reflected on his tenure as a county commissioner, which saw him serve as board chair-

man in 2000 and from 2006 to 2010 and as vice chairman in 2005 and from 2010 to 2014. “It’s been an interesting 20 years, but when I first got on this board, I learned early on you don’t represent just a district on the county board ... you represent this county and all the people in it,” said Buskirk, who was first elected to the board in 1994. The new commissioners won’t officially assume their seats until the board’s next meeting Jan. 6. They then will select a new chair and vice chair.

that killed her, Becky said. “Her health just continued to go downhill, and she was just sad. She never recovBECKY HOOKER, ON THE DEATH OF HER SISTER, TAMMY ered.” Becky Hooker is mara week after Tammy was dinners and offering moral ried with children of her taken to the hospital, when support and kind gestures, own now. She works she was called down to the Hooker said. with children every day office. A few more kids in as a media room special“They told me to gather Wayland got sick, and the ist at Washington Street my stuff, that my sister was measles outbreak ended Elementary School. She on her way to pick me up. with a tally at the time of has maintained her friendI knew in the back of my Tammy’s death of 22 chilships from childhood, and head something must not dren in Allegan and Kent keeps photos of Tammy be right, though what was counties sickened, part of a and of her mother in her not right, I wasn’t sure,” national outbreak of more dining room hutch. she recalled. “I was only in than 55,000 measles cases “I often think: ‘What eighth grade and I couldn’t reported between 1989 and would Tammy be like? put the pieces together.” 1991. Would she have a family, A family friend drove Dr. Walter A. Orenstein would she have children?’ the girls to Detroit. At the from Emory University There’s not a day that goes hospital, she said. “They School of Medicine in by that I don’t think of her,” brought us in and they said: Atlanta wrote in a 2006 Hooker said. ‘You need to say goodbye.’” article for the Pediatric She said her sister’s Weeping, she recalled: Infectious Diseases death has made her a dif“It was a really, really hard Journal that the outbreak ferent mother. thing to do because she “was particularly severe, “I am very protective. didn’t look like herself. accounting for more than Maybe too protective,” she She was kind of different 11,000 hospitalizations and said. in color, and it was just a 123 deaths.” Her children are fully very traumatic time for my To this day, Tammy immunized, and she doesn’t Bowman is the last known understand the reluctance whole family.” person to die of measles of parents who do not get Afterward, she said, “I played a lot of mind games in Michigan, said Jennifer shots for their children. with myself.” Smith, spokeswoman for “Measles can kill you,” “I told myself this wasn’t the Michigan Department she said. “It’s very imporreally happening, that of Community Health. tant to immunize your chilthis must be a bad dream Life went on in Wayland, dren, to keep up on your immunizations because and that tomorrow we but life for the Bowman family never returned to these childhood diseases are going to wake up and are back. everything is going to be normal without Tammy, OK,” she said. “The reality Hooker said. “Our parents really did is that it wasn’t.” “No parent should ever love us and care for us. We were loved, fed and have to lose a child,” she THE AFTERMATH said. “I just know my parclothed. This could happen to anybody,” she added. It was standing room ents, my mom, never did recover from it. It was like “You have a healthy little only at the Moline Baptist girl, and next thing you Church the day of Tammy’s the lights were shut off on funeral, the first funeral her.” know — it happens so quick, so fast. One minute Becky had ever attended. Diane “Dee” Bowman The community of died 10 years later. She was we have our little baby sister, the next we are at her Wayland rallied to help the 52. funeral.” stricken family, bringing “I think it was sadness”

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Complete obituaries are on Page A15. For more information, go to MLive.com.

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“There’s not a day that goes by that I don’t think of her.”

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times worse. She was just peppered with it,” Hooker said. “On Monday, my mom came home from work and we were all realizing how sick Tammy was. Her breathing was not good, she was lethargic, and it was really taking a toll on her,” Becky said. “It was just so quick.” That evening, a downstairs neighbor took Tammy and her mother to a doctor, who immediately sent Tammy to Butterworth Hospital in Grand Rapids, Hooker said. Tammy developed pneumonia, and was taken to Detroit Children’s Hospital, where she was placed on a heart-lung machine for several days, records show. “That was the only children’s hospital around at the time,” Hooker said. Sister Wendy came to look after Becky and Khristy while their parents stayed with Tammy. Every day their parents called from the Ronald McDonald House where they were staying to be near Tammy, Becky said. Although they tried to keep the news positive, Tammy required surgeries for lung problems, and her kidneys began to fail. “Her body was just rejecting everything they were giving it,” Hooker said. Still, she had no clue her sister might die, she said. “None. I honestly don’t believe my parents knew it either,” she said. Becky was at school Tuesday morning, Feb. 27,

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said. “They wanted anyone who showed on their record that they did not have that MMR (measles, mumps and rubella shot), just to make sure.” That included the Bowman girls, even though their mother said all four of the girls had their shots — Tammy’s before she attended the Head Start preschool program. The family’s vaccination records were lost in a basement flood, the girls’ father, Ben Bowman, said in an earlier interview, so the parents had signed a waiver form for Becky and Tammy to meet school enrollment requirements when they transferred to Wayland from another district. Though she remembered getting booster shots at Kelloggsville High School in Wyoming,

Hooker said, “there was no record of me having (a measles immunization). So my dad brought me to the clinic. I do recall him trying to get Tammy a shot, too. But they weren’t giving them to elementary kids yet.” “She was actually at the clinic with me,” Hooker said, “and they denied her a shot” because they had no copy of her records from the elementary school, where a clinic for younger students originally was scheduled for Feb. 16. That clinic was postponed because of heavy snow and school cancellations, and by the time it was rescheduled, for Feb. 20, Tammy already was too sick to attend, Hooker said. The girls likely already had been exposed to the disease by the time the first clinic was held, she said. Becky fell ill a few days after receiving her vaccination shot with the rash, headache, sensitivity to light and high fever that are characteristic of measles. Tammy, home from school because of the snow day, brought Becky water and made her mashed potatoes, her favorite comfort food, Becky recalled. When Tammy got measles a few days later, Becky was already on the mend. She took her turn playing caregiver, this time making mashed potatoes for Tammy and bringing her drinks. But Tammy was much sicker than Becky had been and developed an extensive rash. “Tammy, she got it 10

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SCHOLARSHIP IMPROVES COLLEGE SUCCESS TODAY’S MUST READS SOUTHWEST MICHIGAN

Easy to find fun on the Fourth Communities all across the region are preparing for Independence Day celebrations next weekend. So whether you like fireworks, marching bands, classic car shows or chicken barbecues, somebody has got a party for you. Details, A13

ALLEGAN COUNTY

Fish out of water make a real mess When a downpour caused flooding in Gun Plain Township last week, it caused more than the usual disruption. Hundreds of fish that were in a pond that overflowed into yards followed the flood waters. But when the water receded, the catfish were left high and dry, much to the consternation of neighbors. Details, A16

NOTE TO READERS

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The customer service call center will close early Friday, July 3, in recognition of Independence Day. You can reach the customer service center 7 a.m.-noon Friday, July 3, at 1-800-466-2472. Normal business hours resume Sunday, July 5.

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KALAMAZOO

Celebrating equality

By Ryan Shek

rshek@mlive.com

obert Guise and Nathan Moore married a year ago in Chicago, but wanted to renew their wedding vows in light of Friday’s historic Supreme Court ruling.

Reverend Nathan Dannison unites Catrina and Marashette Burks in marriage for the first time in Bronson park. Community members celebrate the legalization of same sex marriage Friday night in Bronson Park. The United Sates Supreme Court ruled, Friday, July 26, that no state can ban same sex marriage.

“I’ve been waiting 30 years for this, from when I first came out,” Guise said, surrounded by hundreds of same-sex marriage supporters at Bronson Park. “I never thought a day like this would be possible.” On Friday, hundreds of Kalamazoo-area residents gathered at Bronson Park to celebrate the U.S. Supreme Court ruling that legalized same-sex marriage. The 5-4 decision ruled that the equal protection clause of the 14th Amendment means gays and lesbians have the right to marry and struck down a Michigan law passed in 2004 that limited marriage

(Daytona Niles/ MLive.com)

Gov. Snyder reacts to ruling, C1

SEE EQUALITY, A2

Equality wins, but work to do, H1

MORE INSIDE Timing is important: Why you shouldn’t delay those baby shots. H1

MICHIGAN

VACCINATION RATES AT DAY CARES

Day care dangers

baby with whooping cough struggles for life while attached to a heart-lung bypass machine. A child on a ventilator suffers intractable seizures because of meningitis. Drs. Ryan and Andrea Hadley, both physicians for University of Michigan Health System, know first-hand the devastation caused by vaccinepreventable diseases. They

Opinions changed before law, H4

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Find vaccination rates for your day-care and your county. bit.ly/SchoolVaccinations

also know contagious diseases such as measles and whooping cough are making a comeback. So when it comes to seeking day care for their 1-yearold daughter, they’re looking beyond cost and location. A top priority for them is finding a center where all or nearly all of the children are fully vaccinated.

COMING TUESDAY Being around unvaccinated children could prove fatal for 6-year-old with leukemia.

Dr. Kelli Dodson-Hunt, a Kalamazoo pediatrician. says she made sure to check vaccination rates when picking a day care center for her son, Jack, pictured here.

SEE VACCINATION RATES, A10

(Mark Bugnaski/MLive.com)

CHRISTIANA HARRISON, A FRIEND OF THE WOMAN SHOT WEDNESDAY IN A PORTAGE DRIVEWAY. DETAILS, A2

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Vaccination rates CONTINUED FROM A1

That’s no simple task in Michigan, where three-quarters of children in licensed day care attend a center with vaccination rates below federal guidelines, an MLive.com analysis shows. Many of those centers are in the state’s wealthiest, most densely populated counties, including Oakland, Washtenaw and Livingston, although virtually every county has day cares with low vaccination rates. Day cares house the very population most at risk of catching vaccine-preventable diseases. Infants and toddlers too young to receive many immunizations often play alongside older children with no sense of personal hygiene. When very young children do get sick from vaccine-preventable diseases, they are more likely to develop complications. “I have seen babies too young to be vaccinated near death in the ICU or who died from vaccine-preventable diseases that were passed to them from unvaccinated kids. It’s terrible,” Andrea Hadley said. But while state law requires day cares to provide parents with detailed daily records of what their baby eats and drinks, of every diaper change and nap, there is a lax approach to the threat posed by vaccine-preventable diseases. MLive.com’s investigation found: • There are no consequences for day cares that enroll unvaccinated or undervaccinated children. In theory, the law requires children in day care to be vaccinated unless their parents sign a waiver. In reality, day care providers are not penalized for enrolling unimmunized children. Their only responsibility is to document each child’s immunization status, good or bad. • A focus on record-keeping compliance over actual vaccination rates. The state sends out congratulatory letters to day cares with at least a 90 percent compliance rate, even if a center’s actual vaccination rate is low. “They know what they have to do” to meet state regulations, which is to collect records on each child, said Wendy Trute, public health director of Grand Traverse County. “They haven’t been focused on the bigger picture’’ of the threat posed by a disease outbreak. Moreover, “no consequences exist for preschools or centers that do not reach a certain level of compliance,” said Karen Manni, Washtenaw County’s school immunization liaison. • State law does not require day care workers to be immunized. “That’s completely crazy,” Hadley said. “It’s almost inexcusable.” • Publicly funded day cares can’t exclude unvaccinated children, though private day cares can exclude unvaccinated children and staff. And parents may not even know whether their day care is receiving public money. • The vaccination status of individual children and staff is confidential. A center is allowed to tell what percentage of staff and children are vaccinated, but cannot identify the individuals or provide additional information such as ages, which can make it hard for parents to assess the level of risk for their child. Of the 159,000 children in a licensed day care with at least five children, the MLive.com analysis of state data shows 119,000 are in centers where less than 95 percent of the children are fully vaccinated, the benchmark recommended by the federal Centers for Disease Control and Prevention. The average day care vaccination rate of 87 percent is lower than the rate in Michigan’s K-12 schools, which rank among the worst in the country. MLive.com published in December an investigation of K-12 school vaccination rates in Michigan. Read it at bit.ly/ SchoolVaccinations. Even children who are up-todate on immunizations are at risk when they have playmates or caretakers who are unvaccinated, because no vaccine is 100 percent effective. Experts say the real safety net comes from “herd immunity,” an environment where everybody who is medically able is vaccinated and

DAYCARE VACCINATION RATES The percentage of children in Michigan day cares with five or more children who are fully vaccinated. Alcona Alger Allegan Alpena Antrim Arenac Baraga Barry Bay Benzie Berrien Branch Calhoun Cass Charlevoix Cheboygan Chippewa Clare Clinton Crawford Delta Dickinson Eaton Emmet Genesee Gladwin Gogebic Grand Traverse

Gratiot Hillsdale Houghton Huron Ingham Ionia Iosco Iron Isabella Jackson Kalamazoo Kalkaska Kent Keweenaw Lake Lapeer Leelanau Lenawee Livingston Luce Mackinac Macomb Manistee Marquette Mason Mecosta Menominee

70-79% 80-84% 85-89% 90-94% 95-98%

Midland Missaukee Monroe Montcalm Montmorency Muskegon Newaygo Oakland Oceana Ogemaw Ontonagon Osceola Oscoda Otsego

Source: Michigan Department of Health and Human Services

Ottawa Presque Isle Roscommon Saginaw St. Clair St. Joseph Sanilac Schoolcraft Shiawassee Tuscola Van Buren Washtenaw Wayne Wexford (MLive.com)

Day care vaccination rates are a top priority for Drs. Andrea and Ryan Hadley as they seek child care for their daughter, Claire. The Hadleys work for the University of Michigan Health Systems. At the end of June, they are moving to Grand Rapids to take new jobs there. (Melanie Maxwell/MLive.com)

contagious disease can’t gain a foothold. In 2013, about 400 Michigan children age 5 or under had a vaccine-preventable disease, including whooping cough, chicken pox, measles, mumps, meningitis and Haemophilus influenza, also known as Hib, state data shows. Yet, “I honestly think vaccinations are off most people’s radar” as a public health concern, Trute said. Grand Traverse County experienced outbreaks last winter of measles and pertussis, better known as whooping cough. Before those outbreaks, Trute said, “people thought everybody got vaccinations and there were only small pockets that didn’t.” Traverse City learned the error of that thinking the hard way. More than 20 schools and day cares got caught up in the pertussis outbreak. Trute’s office tallied 91 confirmed cases of pertussis and at least 142 probable cases, and that doesn’t include cases not reported to health officials. The youngest victim was 4 months old. Some were hospitalized. Around the same time, a nationwide outbreak of measles sickened a dozen babies at a KinderCare in a suburb of Chicago. Health officials in Oakland and Grand Traverse counties, where there also were cases of measles, say it was pure luck they dodged that bullet. In Traverse City, measles were confined to a single family with young children because the children fell ill during the Thanksgiving holiday and were not in school exposing classmates, Trute said. In Oakland County, a mother with a child in day care called health officials immediately when she realized she could have measles, said Shane Bies, administrator of public health services for the Oakland County Health Department. The department ramped up an emergency response within hours, contacting more than 130 people who had potentially been exposed, and vaccinating adults and children over the weekend. Luckily, the day care the wom-

an’s child attended already had a high vaccination rate, and there were no additional cases. “That’s how herd immunity works” — a well-vaccinated community can stop an outbreak in its tracks, Bies said. “Had it popped up in a different center in this community, the outcome might have been far different.” It shows why parents should make it a priority to check vaccination rates when looking for day care, said Dr. Kelli Dodson Hunt, a Kalamazoo pediatrician and mother of a young son. “When you have a newborn, you don’t want anyone around — siblings, grandparents, cousins, friends — who haven’t been vaccinated. You’re taking a huge risk otherwise,” she said. That also includes children and staff at day care. “I have a lot of families where it doesn’t cross their mind” to ask about day care vaccination rates, she said. “But it’s very important. .... Kids are very vulnerable.” NEAR THE BOTTOM

The Michigan Department of Health and Human Services annually tracks vaccination records of children in public and private schools and licensed day care centers. The data for licensed day care centers with at least five children is public. In October 2014, state records show, there were 3,629 licensed day cares with at least five children. Of those, 2,560 were below the federal recommended benchmark of having 95 percent of their children fully vaccinated. Only eight of Michigan’s 83 counties have average day care vaccination rates above 95 percent. As is true with K-12 vaccination rates, undervaccination among day cares is due in part to parents who shun vaccinations or who devise their own prolonged schedules for their children’s shots. Counties with the worst average day care vaccination rates include Clare (70 percent), Leelanau (79 percent), Livingston (82 percent), and Oakland, Washtenaw and Grand Traverse (all 83 percent). It is difficult to say where Michigan ranks nationally because the CDC does not track

Immunization vials and paperwork for vaccinations are shown at the Kalamazoo County Health Department in Kalamazoo. Michigan children are supposed to be fully vaccinated to attend licensed day care, but few centers meet federal vaccination rate guidelines. (Christian Randolph/MLive.com)

Why delayed vaccination schedules are risky idea By Rosemary Parker rparker3@mlive.com

What’s the big deal if a child gets behind on vaccinations, or if a parent delays the beginning of baby shots, and then spaces them out a little further than recommended? “We vaccinate children at a young age because we want to make sure that they are as protected as they can be by the time they are likely to be exposed to these bacteria or viruses,” said Dr. Paul Offit, a leading authority on vaccinations in the United States and chief of the infectious diseases division at Children’s Hospital of Philadelphia. In addition, the ability of each vaccine to help the body produce immunity can vary depending on the age when the vaccine is given. So the timing of shots is carefully calculated, not an arbitrary guess. The science-based schedule from the Centers for Disease Control and Prevention is finetuned to time shots for maximum effectiveness and to allow the child’s immunity to build before the most likely time of exposure. For example, pneumococcal vaccine is given at 2, 4 and 6 months of age because pneumococcus commonly affects children between 6 and 24 months of age, Offit said. Children begin shots for some vaccine-preventable diseases as newborns and continue to receive new shots for other diseases, as well as subsequent boosters, throughout infancy. By the age of 18 months, a child on the CDC schedule should be fully protected against, at minimum, all childhood diseases as required for preschool enrollment. For maximum protection, and to be considered valid, doses must be administered at the appropriate age and have appropriate spacing between them. Shots given late are better than no shots at all. But delaying shots puts all kids at risk

day care vaccination rates as it does in the case of kindergartners. In 2013-14, Michigan had the fourth-highest rate of kindergarten vaccine opt-outs in the nation, behind only Oregon, Idaho and Vermont, according to the CDC. Mississippi allows only medical waivers to vaccination for children entering kindergarten or in day care. Its vaccination rate for children entering kindergarten is near 100 percent, according to CDC records. Mississippi requires that any child attending a licensed day care center be up to date on vaccinations, said Liz Sharlot, director of communications for the Missisippi State Department of Health. The vaccination rates for day cares hover at around 95 percent, she said. In addition, facilities are randomly selected quarterly and every third child in a selected site is sampled to assure children are, indeed, up to date on their shots, she said. Centers that fall short are subject to penalties if they do not improve their prac-

of being exposed to diseases before they are fully protected and increases the chance that dangerous diseases will get a foothold in the classroom or day care center and quickly spread, health officials say. Michigan follows the CDC’s schedule for vaccination against the 11 serious childhood illnesses as required for day care enrollment: Diphtheria, tetanus, pertussis (whooping cough), Pneumococcal Conjugate (once a leading cause of bacterial meningitis), H. influenzae type b (once a leading cause of mental retardation), polio, measles, mumps, rubella, hepatitis B and varicella (chickenpox). The CDC vaccine schedule for this line-up of shots is based on recommendations from the Advisory Committee on Immunization Practices — a group of medical and public health experts — and is approved by the American Academy of Pediatrics and the American Academy of Family Physicians. Researchers continue to adjust the schedule based on their annual reviews of data on new and existing vaccines. They look at how well a vaccine works for children of different ages, and the recommendations may change as new information becomes available. For instance, timing and formulation of the pertussis vaccine currently are under scrutiny. A popular vaccine developed in 1991 to result in fewer possible side effects appears to have less long-term effectiveness than earlier vaccines had. As a result, in 2011 the group recommended that pregnant women should receive a booster shot in the third trimester to confer immunity to their newborns, who are at greatest risk of death if they catch pertussis. And a study published in April concludes that more work needs to be done to find a pertussis vaccine that is both safe and long lasting.

tices, she said. While waivers can be a big issue in K-12 schools, an even bigger problem for day cares is posed by parents who have started vaccinating but have fallen behind. Some couldn’t get to the doctor, or a shot couldn’t be given on schedule because the child was sick or the doctor’s office was out of the vaccine. In yet other cases, the parents worry about giving too many shots in rapid succession and plan to try a different schedule that increases the time between vaccinations, public health experts say. Statewide, only 87 percent of children in licensed day cares have received all the recommended vaccinations for their age, the most recent data shows. Of the remainder: • Six percent are classified as provisional, which means the child has received at least one round of the recommended vaccinations and is waiting for, but is not yet overdue on, another shot. These are the children who may have fallen behind because SEE VACCINATION RATES, A11

KALAMAZOO GAZETTE / SUNDAY, JUNE 28, 2015 / A11

Vaccination rates

WHO SHOULD PARENTS ASK?

While the vaccination rates for day cares with five children or more is public information, deciphering the data can be confusing — even for day care operators. Day cares and preschools report their immunization records once a year, in October. While the status of fully vaccinated children 18 months or older likely will not change over the course of the year, that is not the case for infants who are just beginning their shots, or those whose parents delayed their vaccinations or followed a schedule not recommended by the CDC. Their provisional status may fluctuate during the year as they get caught up with more shots — or fail to keep up. When MLive.com contacted a sampling of day cares with the lowest vaccination rates in the state, day care officials questioned the accuracy or currency of the data — which the centers themselves report. Day cares may view their “provisional” children as “up-to-date” because they are not overdue on their next series, even though they are behind where they should be. For instance, state records show that Gretchen’s House day care facility on Stadium

of parents think they should be informed of the number of children in a day care who are undervaccinated, and 41 percent support a policy to exclude under-vaccinated kids from day care until they become current. Sarah J. Clark, a U-M researcher involved in the survey, said the takeaway message is parents shouldn’t be shy about asking questions. “It’s perfectly legitimate for Dr. Kelli Dodson-Hunt drops off her son, Jack, at day care. parents to ask questions Dodson-Hunt, a Kalamazoo pediatrician, says she made of their day care provider sure to check vaccination rates when picking a day-care about the number of chilcenter for her son. (Mark Bugnaski/MLive.com) dren who aren’t fully vaccinated,” she said, “and Boulevard in Ann Arbor “In fact, we nominated then to make choices about has a compliance rate of them for a community hero which day care their child will attend.” 95 percent, which means award.” the state has paperwork on — Julie Mack and Beth Olosky runs a day 41 of 43 children. It’s a task care out of her home in the Rosemary Parker are they take seriously, said Traverse City area. When reporters for MLive.com. Lowest Price Guarantee New Home/Remodeling Discounts Heidi McFadden, director whooping cough surfaced Reach them at jmack1@ 250 Mall Drive, Portage (S. Westnedge at Southland Mall) of Gretchen’s House. in her oldest son’s high mlive.com and rparker3@ Mon-Wed-Fri 9-8 Tues-Thurs 9-6 “Each center has a sysschool last winter, she mlive.com. tem for regular review was concerned about the of the immunization and possibility he might bring ALL THE BEST GEAR FOR YOUR NEXT health records throughout it home and infect his the year, and as children younger siblings, as well transition to new proas the children she cares grams, such as moving for. Vaccination rates were from an infant room to not something she thought toddler, or to preschool much about “until the outwithin our centers,” break hit home.” McFadden said via email. Now she says her par“The penalty for not havents are asking about the ing appropriate documen- immunization status of the tation (no medical waiver other children, and she is or approved philosophical thinking she would decline waiver) would be that a to care for a child whose child cannot be enrolled. parents refuse to vaccinate. We comply with the state “It was absolutely an requirements on such eye-opener,” she said about matters.” the outbreak in Traverse But only 21 of those City. “It was a scary time children — 49 percent — for a while.” are fully vaccinated, state A recent national surrecords show. Another 20 vey conducted by the are provisional and two University of Michigan were incomplete. suggests that parents At Karnak Creative want increased transparInfant Center in Wayne ency and more stringent County, where state requirements when it Come in today and check out our great selection of records show only 11 percomes to day care vaccinaOsprey Backpacks and all the other backpacking gear cent of the children were tion policies. The survey you’ll want for your adventure. fully vaccinated in October questioned 614 parents 311 W. Kilgore Rd. Portage Mi. 49002 2014, the records show with children under age 6. 269 381 7700 • LeesAdventureSports.com there are no waivers on The poll found two-thirds file. But only three of the 28 children enrolled were listed as fully vaccinated. Another 24 were provisional and one was incomplete. The center’s website says it accepts infants from birth to 18 months. Sharon and Cyril say there is nothing like Jennifer Skeens, director the close-knit community at Wyndham. of the center, declined to comment except to insist Sharon loves to connect with their neighbors and that every student is “100 explore the calendar of events while Cyril enjoys the warmth percent completely up to date, all are current on of their apartment, sipping his morning coffee and combing their shots,” a fact she said she had confirmed with the pages of the New York Times. And as Heritage Community local health officials. Lifecare Members, they feel secure knowing that the services However, Nickert and Bies said a provisional and accommodations are available to them in the future at designation is not the same Heritage Community. as being fully vaccinated. They said parents can contact local health departments with questions they have about a particular day care’s vaccination rates.

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Recent outbreaks of measles and pertussis have served as a wake-up call for some parents and day care centers. KinderCares across the country now require all staff working in infant rooms to be vaccinated against measles. The day care chain also is “also limiting access to our infant classrooms to immunized teachers and center management staff and to those dropping off or picking up a child,” a spokeswoman said. KinderCare has 22 centers in Michigan. After the whooping cough outbreak this past winter in Grand Traverse County, The Children’s House — a private Montessori school in Traverse City — implemented a rule that new students must be fully immunized as a requirement for admission. Only medical waivers will be allowed. Trute said her office is encouraging other day cares in Grand Traverse County to follow that example. “They set what we consider as a kind of a gold standard,” she said.

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of scheduling issues, a parent’s inability to get to an appointment or a variety of reasons. • Four percent of children in day care are overdue for their required shots. Those children are classified incomplete. • Three percent have waivers indicating their parents do not intend to vaccinate the children. If they adhere to the recommended schedule — seven vaccines totaling 16 shots that immunize the child against 11 diseases — children should be able to complete all of the preschool vaccines by age 18 months. “It is more difficult to keep kids current because of the number of vaccines being administered at the young ages,” said Bob Swanson, director of immunization for the Michigan Department of Health and Human Services. But it’s important. Research shows children who fall behind early on the immunization schedule are more likely to either not complete the vaccines or complete them late, Swanson said. Public health officials note children with “provisional” status are not as fully protected as they could be — and that increases a day care center’s vulnerability to vaccine-preventable diseases. “The vaccine-preventable disease doesn’t know ‘provisional,’” said Jane Nickert, director of Nursing for the Washtenaw County Health Department. “The disease does not know your good intentions.” As is the case statewide, Washtenaw County health officials face challenges of delayed vaccination schedules and parents or guardians who are opposed to vaccination, relying on incorrect information, said Karen Manni, a public health nurse who is the county’s school immunization liaison. In addition, until requirements were made more stringent in January 2015, some parents sought waivers out of convenience, she said. “If we’re making it easier to sign a waiver than to get the vaccines, that’s a problem,” Trute said.

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TODAY’S MUST READS

Flooding might move Fourth of July baseball game, fireworks to Battle Creek

A bit water-logged

KALAMAZOO

Surcharge for 911 dispatch begins Wednesday

By Rosemary Parker

Kalamazoo County residents and business owners will see a new tax on their monthly phone bills starting Wednesday when a countywide phone surcharge to support 911 dispatch services takes effect. The tax, approved by the county commissioners last fall to support an effort to consolidated 911 dispatch services countywide, will cost residents 42 cents each month on every device they own that can access emergency 911 services. Details, A3

rparker3@mlive.com

umping has begun on the flooded Homer Stryker baseball field, said John Bollinger, assistant general manager for the Kalamazoo Growlers. Whether the field will be dry enough to host the ballgames and fireworks planned for the July 4 weekend will depend a lot on this week’s weather. The show will go on, even if that means moving it to Battle Creek, the club’s management said.

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Two interview for administrator’s job

Saturday, the Kalamazoo River flooded out of its banks, leaving the field and its dugouts under water. The Growlers rescheduled the team’s weekend and Monday night games, tentatively trying double-headers this coming weekend. Sean Fletcher, director of parks and recreation for the city of Kalamazoo, said that is an optimistic plan. “We’ll do whatever we can do,” Fletcher said of getting the field ready for the Fourth of July. Barring more rain or continued river flooding, the city’s strategy for restoring the ball field will be to remove the water as quickly as possible, then begin SEE FLOODING, A2

Saturday the Kalamazoo River flooded out of its banks, sopping Homer Stryker Field and drowning its dugouts. The flood prompted the Kalamazoo Growlers to reschedule their weekend games against the Lakeshore Chinooks. Officials said it is expected to take several days for the minor league baseball stadium to dry out. (Ryan Shek/MLive.com)

Two men vying for the job of Kalamazoo County administrator stated their cases to the Kalamazoo County Board of Commissioners on Monday. Dave Benda and Jeffrey Davis met with the board during hourlong interviews. Details, A5

Sesame Street Bert and Ernie top the wedding cake of a same-sex couple whose reception took place during the weekend in Kalamazoo. (Submitted by Amy Taylor)

KALAMAZOO

Gay couples might find venues packed Now that the legal barriers are erased, same-sex couples planning a wedding might face the same logistics problems other couples are this summer — booked bakers, booked venues and the possibility of price gouging in the face of the sudden influx of exuberant couples. Welcome to summer in the wedding business, where details are often hammered out months, years, in advance of the big day. Details, A6

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“this.”There is a big split on DEVIN SCHINDLER, A PROFESSOR FOR WMU’S COOLEY LAW SCHOOL, ABOUT WHETHER JUDGES ARE REQUIRED TO MARRY GAY COUPLES. DETAILS, A6

KALAMAZOO

VACCINATION RATES AT DAY CARES

For child with cancer, vaccinations can mean life or death Ç GO ONLINE

By Rosemary Parker rparker3@mlive.com

Almost every one of Jeffrey Posthumus’ preschool classmates is vaccinated — as recommended — against diseases such as polio, measles, mumps and whooping cough. That’s a stroke of luck in Michigan where only one-quarter of licensed day-care centers and preschools come close to meeting federal guidelines for vaccination of their children. Vaccination rates are of vital importance to the Posthumus family. Six-year-old Jeffrey’s immune system has been wiped out by powerful medications he

Find vaccination rates for your day-care and your county at bit.ly/SchoolVaccinations •Watch the Posthumus family talk about their son’s journey at bit.ly/Jeffreyjourney

was given to kill cancer cells. He now is counting on the health of others around him at the Gagie School in Kalamazoo to give him time to recover from cancer. “Honestly, Jeffrey could die from chickenpox,” his mother,

(Mark Bugnaski/ MLive.com)

SEE VACCINATION, A4

INDEX Advice............ A9 Classified........B7

Jeffrey Posthumus, center, is surrounded by children at the Gagie preschool in Kalamazoo, which has a high student vaccination rate. Jeffrey has leukemia, and his immune system has been weakened by treatments.

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Vaccination rates at day cares Vaccination

ing — results from a second round of blood tests showed with near certainty the cause of Jeffrey’s Jenny Posthumus, said recent fever and lethargy: about this period of his leukemia. recovery. A bed had been reserved The family’s story under- for Jeffrey, who was 3 at scores one reason why the time, at Bronson public health officials put Methodist Hospital in so much emphasis on the Kalamazoo, the doctor importance of high vacsaid. Further tests were cination rates in schools scheduled, and it would and day-care facilities. be best to bring him there Children, in general, are immediately, she was told. vulnerable to catching Posthumus made a and spreading vaccinequick call to her husband, preventable diseases, and Jim, a pharmacist workyoung children with coming a 12-hour shift at a promised immune systems nearby Walgreens store. are especially at risk. The store closed the To keep diseases such as pharmacy, Grandma took whooping cough, chickenon baby-sitting detail for pox and measles at bay, the Jeffrey’s 6-month-old sisfederal Centers for Disease ter, Kennedy, and within an Control and Prevention hour, Jeffrey was admitted recommends schools and to Bronson. day cares ensure at least “We were totally blind95 percent of their chilsided,” said Posthumus, dren are fully vaccinated. who works as a nurse in Yet only one of every four the labor and delivery unit Michigan day cares and at Bronson. Within two preschools meets that stan- days, Jeffrey had more dard. blood and bone marAt The Gagie School’s row drawn for analysis preschool program Jeffrey and surgery to insert a attends, all of the school’s port for delivery of drugs staff are up to date on their directly into his veins. vaccinations, the school’s Chemotherapy began almost immediately. preschool director said. According to data collected Additional tests showed Jeffrey’s leukemia was a in October by the state Department of Health rare and particularly tenaand Human Services, The cious type, T-cell, that usuGagie School reported ally hits older children. The drugs used to fight it were 98 of their 104 preschoolso strong local doctors coners were fully vaccinated. Five students’ shots sulted with a specialist in Boston to fine-tune a regiwere incomplete — they have fallen behind on the men for Jeffrey. Jeffrey’s body temperarecommended schedule — and one student was ture was monitored closely, and any fever meant a classified provisional, not trip back to the hospital for currently overdue for any vaccine doses, but not fully a week of antibiotics. vaccinated. Chemotherapy sessions None of the Gagie prerequired hospitalization, too. schoolers had vaccination waivers on file from Jeffrey lost his hair during chemotherapy and parents purposely opting out of vaccination for their picked up a fungal infection that nearly landed him child. in the pediatric intensive “I am blessed with a very responsible clientele,” care unit. “That was very scary,” said Laura Gagie-Kelpin, preschool director at The Posthumus said. But her life as a cancer Gagie School. Jenny Posthumus, a mom was just beginning. nurse, has little patience With an immune system for those parents who have weakened by chemotherapy, every outing was a a chance to protect their threat to Jeffrey’s health. children’s health by vaccination but refuse to do so. “We couldn’t go out “It makes me angry that in public,” she said. “We moms choose not to vaccouldn’t go to McDonald’s. cinate, because I think they We couldn’t go to the groare really doing a dissercery store.” The isolation was stagvice to their children,” she said. “Not having them vac- gering. Playing outdoors was cinated is a huge deal. allowed because germs “You don’t want me to have peanut butter couldn’t live long outside, so the park seemed like because your child might have an allergy? Yet you Jenny will not vaccinate your and Jim child” to help protect Posthumus other children, Posthumus with their added. children, London, 1, LIFE OF A CANCER MOM Jeffrey, 6, On Feb. 22, 2012, Jenny and Posthumus was in the Kennedy, 3. parking lot of a Target (Mark store in Kalamazoo when Bugnaski/ her cellphone rang and her MLive.com) heart dropped. The caller was her son’s pediatrician with the news she dreaded receiv-

Left, Jeffrey Posthumus attends the Gagie preschool in Kalamazoo where 98 of the 104 preschoolers were fully vaccinated, according to 2014 data. Jeffrey has leukemia and his immune system has been weakened by treatments. Below, Jeffrey arrives at preschool.

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(Mark Bugnaski/ MLive.com)

a promising activity. But Jeffrey’s bald head was conspicuous, and other parents ushered their children away from him, Posthumus said. It was not out of unkindness, she said she believes, but because they feared their children might make him sick. Posthumus ended up buying a double jogging stroller and strapping Kennedy and Jeffrey in for runs through her Portage neighborhood, aiming for every sprinkler they could find. The neighbors probably thought she was crazy, she said, but “he loves water.” As chemotherapy continued, the family adjusted, with help from extended family and friends. Although Jeffrey’s chemotherapy treatments won’t end until July, in January 2013 he returned to the Gagie preschool, the program he was enrolled in at the time of his diagnosis. Gagie-Kelpin remembers Jeffrey’s return. She and staff first met with the Posthumus family and a medical social worker to talk about ways to keep the boy’s day as near normal as possible while protecting him from infection. A letter was sent home to parents of his classmates explaining Jeffrey’s medical condition, Gagie-Kelpin said. KEEPING GERMS AT BAY

The hygiene practices in Jeffrey’s classroom are good lessons for all preschoolers to learn, GagieKelpin said, and many are applied in other classrooms as well.

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full as possible. It was a conversation with one of Jeffrey’s chemotherapy nurses that led to the decision to allow him to continue in preschool. NO BACK TO NORMAL “She said: ‘Jen, he is Even with Jeffrey back in a normal kid who hapschool, cancer continues to pens to have leukemia,’” leave its mark. From blog Posthumus recalled. entries Jenny Posthumus The fear that other uses to document her fam- people might not vacily’s journey, one thing is cinate their children on clear: She never forgets schedule, putting her son that, even after more than at risk, is something she three exhausting years hadn’t thought about until of treatment, it might not the measles outbreak in work. California last winter, she The cancer might come said. back. Posthumus spoke with There currently is no Gagie-Kelpin and was match for Jeffrey’s bone relieved to learn of the premarrow, so there is no school’s high vaccination backup plan if that haprate. pens. Every parent should These days, Jeffrey is have that peace of mind, looking forward to his that other parents have “End of Chemo Party” in done their part to protect July, when he will need all children, said Dr. Paul “no more chemo or steOffit, a leading authority on roids,” his 3-year-old sister vaccinations in the U.S. and explains. chief of the infectious disBut as that day eases division at Children’s approaches, Posthumus, Hospital of Philadelphia. with the help of her good Offit said he believes friend Colleen Roemer, the rights of vulnerable writes in a blog entry: “All babies and children like too often children relapse. Jeffrey should trump those ... We could still lose him.” of adults who are anxious He is such a typical little about vaccines, and that boy, so much of the time, parents should all be she writes. required to vaccinate their “So typical. ...” she writes, children unless they have a “until he asks a question. compelling medical reason ... ‘Mom, am I going to go to not to. heaven?’ How does a can“Why should it be (anycer mom respond? ‘Buddy, one’s) right to catch and I hope not soon.’” transmit a potentially fatal It is not easy to strike the infection,” Offit said, “to balance between protectexpose those with whom ing Jeffrey as he recovers they come into contact to and keeping his life as unnecessary harm?”

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come to my preschool to get sick more often because we are not as diligent as we could be,” Gagie-Kelpin said.

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For example, kids put toys in their mouths. So toys go into a bucket by the sink to be cleaned before they are returned to the shelf. Teachers reinforce lessons on how to use facial tissue, not wipe noses on a sleeve or the back of a hand, and remind children to cough into their shoulders. Kids are helped with vigorous hand-washing with soap before snacks and after using the bathroom. During flu season, kids get a squirt of antibacterial hand sanitizer as well. The school day begins with a personal greeting for each student, upon arrival, that allows for a quick screen of health issues such as pink-eye that might have gone unnoticed by parents. Gagie-Kelpin said those measures are not required by her license, as many other “best practices” are, but it’s something she thinks is an important part of her program. “I don’t want kids who

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