By BETSY BETHEL
Associate Life Editor
What do you do when you know your highly allergic child could have a reaction if given a government-required vaccine, but the government tells you you're wrong?
This photo was taken by a Wheeling mother of her 12-year-old son’s arms following an MMR vaccine skin-prick test at West Virginia University Hospitals in November. The arm on the left has two pricks — the second is a tiny red dot at the bottom of the frame. Those two pricks were done with substances designed to show what a severe reaction would look like, top, and a negligible reaction, bottom. The arm pictured on the right is the one pricked with the vaccine, showing a severe reaction.
If you're like one Wheeling mom, you fight for your child's safety.
The woman's 12-year-old son was kept out of school for six weeks last fall before his medical exemption to the measles, mumps and rubella vaccine finally was granted by the Ohio County Health Department. The News-Register is not identifying the boy or his mother because he is a minor.
The boy has a severe milk allergy, a rarity at his age. In 2006, he was exempted from receiving the MMR vaccine by his personal physician, Dr. Albert Jellen, due to an egg allergy. But when his file was reviewed by a school nurse upon entering a new school in the fall, she called health department officials because the exemption was from a doctor and not the health department.
Medical exemptions in West Virginia are provided only by the county health officer, not a child's treating physician. Only one other state, Massachusetts, has a similar statute, according to Claudia Raymer of Moundsville, a member of We the Parents, a West Virginia group advocating for vaccine reform.
Once the health department learned of the 12-year-old's unorthodox exemption, Ohio County Health Department health officer Dr. William Mercer informed Jellen and the family that patients with egg allergies can receive the vaccine, according to the Centers for Disease Control and Prevention's Epidemiology and Prevention of Vaccine-Preventable Diseases handbook, otherwise known as the "pink book."
The boy's mother has been vigilant about the boy's safety his whole life. He's so severely allergic to milk, for example, that he had a near-anaphylactic reaction from inhaling airborne particles of milk-containing dog kibble. Anaphalaxis is a life-threatening allergic reaction that requires immediate administration of epinephrine. It can be fatal.
Upon realizing the egg allergy was not a threat and then reviewing the vaccine's ingredient list provided by the health department, she discovered it contains a small amount of bovine serum, which comes from a cow. She voiced her objection to the vaccine based on the bovine serum.
The mom said she wasn't needlessly arguing. Her other children are fully vaccinated and the son with the milk allergy is otherwise fully vaccinated.
Although he'd never heard of the MMR being a problem for children with milk allergies, Mercer said he investigated it with due diligence. He called several authorities, including a local allergist, the state Bureau of Public Health, a CDC immunologist in Atlanta, the drug manufacturer (Merck) and vaccine champion Dr. Paul Offit from University of Chicago, but could find no basis for the bovine serum/milk allergy connection.
"Everybody is worried about their kids. My duty as a health officer is to determine is that worry founded scientifically," Mercer said. He found no basis for granting the exemption. "I have to very careful because if you give one exemption that is 'iffy,' then everyone wants it," he said.
Mercer said he is concerned that if more and more people receive medical exemptions, public health will be compromised. He wouldn't want to see, for instance, an outbreak of measles, a highly contagious respiratory disease that kills one out of 1,000 children it infects, according to the CDC.
"Widespread use of measles vaccine has led to a greater than 99 percent reduction in measles cases in the United States compared with the pre-vaccine era, and in 2009, only 71 cases of measles were reported in the United States," the CDC states.
Raymer countered that in the 48 states that have medical exemptions granted by doctors, about 1 percent to 3 percent of the population is exempted from one or more state-required vaccines and no major outbreaks have occurred because of these exemptions.
After Mercer denied the 12-year-old's exemption, the Wheeling mother still was not convinced that her son could safely receive the MMR vaccine. (Meanwhile the family filed an injunction with Ohio County Circuit Court so her son could return to school during this process. The injunction was denied.)
Mercer suggested the boy have the vaccine administered at the office of the boy's treating allergist, Dr. Krishna Urval in Wheeling, in a controlled environment, with epinephrine at the ready if he had an anaphylactic reaction. She did not want to have the vaccine given at all, however, and decided instead to take the boy to a pediatric allergist at West Virginia University Hospitals, where a skin-prick test of the MMR vaccine was performed on her son. In this test, a small amount of the vaccine is injected just under the surface of the skin.
Mom's fears were confirmed. He reacted positively.
"The skin prick test to the MMR was strong," the allergist, Dr. Yesim Yilmaz-Demirdag, said in an email statement Friday. In a Nov. 29 letter to the health department, she said that while the boy wasn't tested for which component of the vaccine caused the reaction, he should not receive the vaccine. She also suggested he be retested in two years.
Mercer was surprised at the result but granted the boy a temporary medical exemption based on Yilmaz-Demirdag's recommendation, and the boy was permitted to return to school.
His absence and the whole ordeal has taken a toll, the mother said. He was outgoing and now he's shy and reserved. He cries easily. People he had met at the beginning of the school year had forgotten who he was by the time he returned.
"It's awful. This is the hardest thing I've ever done. I was up until 3 or 4 at night researching everything. ... It's been stressful for my husband and me," she said.
She said the lengths to which she had to go, and the school days her son missed, could have been avoided.
Now she is concerned that he will have to be retested in two years.
"If a child is allergic to a component of a vaccine or allergic to the vaccine itself, you have a permanent exemption," she said, citing the CDC's "pink book," which is a comprehensive source for health care practitioners on vaccine-preventable diseases. This is the protocol laid out in the state code.
Mercer said, however, that most food allergies are outgrown, so retesting is commonplace.
"About 75-80 percent of children who are allergic to cow's milk will outgrow their milk allergy by 16 years of age," said Yilmaz-Demirdag. Most outgrow it by the age of 3. But she added, "there's chance that he may be allergic to milk for the rest of his life."
If he tests positive again, Mercer said he will grant another exemption based on the physician's recommendation.
The boy's mother said every reaction her son experiences is a hardship on him. The fact he reacted so strongly to the test at WVU should warrant a permanent exemption, she said.
West Virginia Delegate Erikka Storch, R-Ohio County, has echoed the mother's concern.
"To have him have to be poked and prodded year after year is ridiculous. To keep subjecting him to this seems like cruel and unusual punishment," Storch said.
The mother has appealed the decision to the West Virginia Department of Health and Human Resources Bureau of Public Health commissioner, Dr. Marian Swinker.
She has an appointment to meet with deputy state health officer Dr. Teresa Frazier, who has been assigned to the case, in Charleston on Tuesday. She also plans to meet with Northern Panhandle elected officials and the chair of the Senate health committee, Dr. Ron Stollings.
"I just want them to follow their own laws. I'm not asking for special treatment," she said.