hool-required vaccines, and strongly urges parents to consider also getting the flu shot each year as well as immunizations for hepatitis A and HPV (human papillomavirus).
"Since we have started this, we have only dismissed somewhere between 1% and 1.5% from our practice," Hornik said. "This is not like a massive number. This is a small number of patients who those were probably the people that I could give you 50 pages of facts, and it’s not going to change their minds. And unfortunately, those are the people who are part of the circumstance that’s going on right now."
The sick are vulnerable, too
Dr. Eric McGrath, an attending physician in the division of infectious diseases at Children’s Hospital of Michigan and an associate professor of pediatrics in the Wayne State University School of Medicine, said he thinks about the people who can’t get vaccinated because they are immune-compromised, such as those with autoimmune disorders, some patients with cancer or who are undergoing chemotherapy, those using high-dose oral systemic corticosteroids, patients with HIV and those who have received organ transplants.
"That’s what we’re the most worried about," he said. "Those patients are sitting out there in the community, and there’s nothing they can do in a sense, other than just sit in their homes, trying to avoid exposure, and that’s a sad life."
Because the incubation period for measles is so long — a person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days, according to the CDC — and people can be infectious while still asymptomatic, it makes it especially hard to avoid exposure.
"I had a question today from our cardiac transplant team about what to tell families about what they can do and what they can’t do. … It becomes this thing where — are they going to be doomed to sit in their homes until this abates? It’s difficult, though, because if you see the list of places where infected people have been at, it’s pretty broad now. It’s getting harder and harder to avoid places like Kroger, Meijer and all those general kind of places where people go for everyday shopping."
Tightening vaccine exemptions
Hornik said it's time for state lawmakers to take action to toughen up on vaccine exemptions for school-age children.
"We’re going to keep seeing increased numbers (of measles cases) until we take a stronger stand on these vaccinations," he said.
Michigan's public health code requires children enrolled in public or private schools, licensed day care centers and preschools to be vaccinated. Kindergartners must have immunizations for diphtheria, tetanus and pertussis, measles, mumps, rubella, polio, chicken pox, and hepatitis B before they start school. Children entering seventh grade must also be vaccinated for meningococcal disease.
But if parents object to those required vaccinations for religious, philosophical or medical reasons, they can request a waiver to get an exemption. Michigan is among 17 states that allow vaccine exemptions for religious, philosophical and medical reasons.
Parents who want to opt out of vaccinating their kids must get a waiver from the county health department to enroll their children in school (unless they get a medical waiver). Only three states — California, West Virginia and Mississippi — limit vaccine exemptions to medical reasons alone.
Overall, 3.66% of Michigan schoolchildren in 2017 had vaccine waivers that allowed them to skip one or all of the state-required vaccines or allowed them to deviate from the mandated immunization schedule, according to the MDHHS.
But in some parts of Michigan, as many as 1 in 10 school-age children have gotten waivers to exempt them from getting at least one school-mandated vaccine. In Oakland County, where the current measles outbreak is concentrated, the vaccination waiver rate was 4.8% in 2017, the latest year for which data was available.
“I do think long-term, we have to try to bring reason back to the discussion about vaccines because I think 