CASPER, Wyo. — Danielle Sample, of Casper, used to argue with her mother, a nurse, about her choice to discontinue vaccines for her children.
She's taken heat from medical providers. It's hard to find a physician in Casper who will treat unvaccinated children.
Sample's oldest son was vaccinated until he was about 18 months old, when she concluded she didn't want her children getting immunizations after reading some items on the topic.
Her second child wasn't vaccinated at all. And the child she is pregnant with probably will not be vaccinated, either.
"I don't think there is enough research on them to prove that they work," she said.
From vaccinations for the flu to meningitis to smallpox to human papillomavirus, immunizations are believed by most people to save lives and extend lifespans.
But a number of people in the past decade have declined to immunize their children, convinced they are not helpful or are even harmful. Yet the medical community blames recent outbreaks on the so-called anti-vaccination movement, also called the anti-vax movement.
"The re-emergence of vaccine-preventable diseases that have largely been eliminated is a legitimate health concern," said Kim Deti, spokeswoman for the Wyoming Department of Health.
In Wyoming, there has been a marked increase in whooping cough, also known as pertussis, in recent years, Deti said. The Centers for Disease Control and Prevention says that is driving up measles cases in the U.S.
"There is likely more than one reason for that, but many of the reported cases in our state have been in unvaccinated children," Deti told the Casper Star-Tribune.
In Wyoming, 67.2 percent of children between 19 months and 35 months were current on their vaccines, according to the 2012 National Immunization Survey.
That's slightly below the national rate of 68.4 percent.
But by the time Wyoming children begin school, they're mostly caught up on their vaccines, said Deti.
In the 2012-13 school year, kindergarteners were 97.01 percent to 98.11 percent compliant on school immunization requirements, depending on each vaccine. Seventh-graders were 96.51 percent to 98.56 percent compliant, according to the Health Department.
In both grades, fewer than 1 percent were noncompliant in each vaccine category. The remaining students received an exemption from having to be vaccinated.
State figures for kindergarteners were slightly higher than national figures.
Nationally, 94.5 percent of kindergarteners had the measles, mumps and rubella vaccine, 95.1 percent had the tetanus, diphtheria and pertussis vaccine, and 93.8 percent had two doses of the varicella vaccine for chickenpox, according to the 2012 National Immunization Survey.
Casper mother Hayley Sigler said it may be in the Wyoming spirit to question vaccination of children.
"I'm a traditional Wyomingite," she said. "I question a lot of things."
Sigler chose to stop vaccinating her first child when she was 1 and never vaccinated her second.
Other Wyoming parents who don't get their children immunized are fiercely independent, too. Since the medical community heavily promotes vaccinations, some Wyomingites may equate that to stifling parental rights.
"For some people, it's like, 'You're not going to tell me what to do. And that's the end of it,'" she said.
Sigler halted family vaccinations when she looked at their ingredients, she said. She couldn't figure out their long-term effects. She doesn't like the fact that they contain mercury or aluminum salts.
While researching the issue, she encountered some people in the anti-vax community whom she considers hokey, in particular actress Jenny McCarthy, who believes vaccinations cause autism.
"I've read Jenny McCarthy, and I'm like, 'Please stop talking.'"
Society, Sigler believes, assumes Sigler's children are diseased because they aren't vaccinated. But she said she monitors their diets and believes her family lives a healthy lifestyle.
It is hard to find a doctor who will treat children who are not vaccinated in Casper, she said.
Mark Dowell, a Casper physician who is a board-certified infectious disease physician and a Natrona County health officer, isn't surprised.
"A parent would bring a highly contagious child into their office," Dowell said. "It's one thing if the child has been appropriately vaccinated and comes in with something that's highly contagious. That's part of medical care. But with moms intentionally not vaccinating their children, it certainly endangers other kids" in the doctor's office.
Most of the children who are exempted from vaccinations are exempted for religious reasons, said Deti, the Health Department spokeswoman.
Health Department rules allow exemptions for religious or medical reasons. An example of a medical exemption would be a compromised immune system or a previous reaction to a vaccine, which Deti described as rare.
Medical exemptions require a doctor's note. Religious exemptions only require a parent or guardian to sign a notarized Wyoming Department of Health form stating that immunization conflicts with the person's religious beliefs and practices.
Only 11 percent of exempted kindergarteners and 19 percent of seventh-graders had medical exemptions. The remaining exemptions were religious.
In 2013, the Health Department had 366 exemptions, Deti said: 19 were medical and 347 were religious. In 2012, the department had 458 exemptions: 24 were medical and 434 were religious.
When there is an outbreak of a vaccine-preventable disease, state and county health officers can prevent children who have immunization exemptions from attending school, Health Department rules state.
Sample and Sigler, the Casper mothers who have stopped immunizations, are not entirely anti-vax. If their families were to travel abroad, the mothers said, they would consider vaccinations.
Sample said that if one of her children got measles, she would also consider getting the other vaccinated.
Sample believes she saw signs of autism in her son. He acted out emotionally. He had gastrointestinal problems that the physician couldn't treat.
While modifying his diet, she believed that autism could be connected. After changing her diet and stopping vaccinations, she believes the autism effects went away.
Medical professionals do not know what causes autism, but rigorous scientific studies show there is no relationship between vaccines and autism, said Deti, the Health Department spokeswoman, and Dowell, the Natrona County health officer.
"It's understandable that families affected by autism seek explanations for its cause," Deti said. "Unfortunately, science has not yet given us an exact answer."
Autism is often diagnosed at the same time children get their routine immunizations, Deti said.
"Huge numbers of children are vaccinated every year," Deti said. "It's not surprising that if some of these children develop autism during these ages, there may be a few times it will be noticed within a day or two after vaccinations."
People who believe there's a link between vaccines and autism used a 1998 study by British physician Andrew Wakefield as proof. But that study was later debunked when it was discovered that Wakefield had misrepresented the medical histories of the 12 patients in the study.
Wakefield lost his medical license. A 2011 study in a British medical journal found there had been damage to public health as a result of his work.
Some parents are concerned about the amount of mercury in vaccines, which they believe may be harmful to their kids. Dowell said mercury does not cause problems in vaccines.
"There are no studies now that show that it does," he said. "But most vaccines are mercury-free, and those that have any mercury in them have less than you'd get from eating fish."
It is estimated that 50 million children died before vaccination existed, said Dowell.
Modern vaccination research reached a heyday in the 1930s and 1940s, when researchers began to isolate viruses for infections and develop vaccinations, Dowell said.
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If immunizations didn't exist today, people would have shorter lifespans because infections they got when younger would result in long-term complications. The child mortality rate would be higher, and more children would have long-term injuries from infections, Dowell said.
"Vaccines are very safe and are a huge public health success story," said Deti. "Vaccines are thoroughly tested before they are licensed and are monitored after we begin to use them."
Some diseases, such as polio, have been almost eradicated thanks to vaccinations, Dowell said.
He added: "The people who are anti-vaccine have not looked at history, have not looked at the lives it saved."