According to new research from the University of Pennsylvania School of Nursing, parents are causing a new problem for their children by worrying about the safety of vaccinations: the comeback of their grandparents' childhood diseases.

Controversy over children's immunizations has caused an increasing number of parents refusing to get their kids vaccinated, even though there has been a great success of immunizations, said Penn Nursing researcher Alison M. Buttenheim, Ph.D., MBA, in the American Journal of Public Health. Parents are obtaining legally binding person belief exemptions against vaccinations.

Dr. Buttenheim explained that the people who cannot get immunizations because of allergies or compromised immune systems depend on "herd immunity," which means they are protected from diseases because the rest of the population is immunized or immune.

If many people are unvaccinated intentionally because of personal belief exemptions, herd immunity is compromised, putting people in danger of diseases.

Data that more than 7,000 public and private schools report each year for about 500,000 kindergartners to the California Department of Public Health was analyzed by Dr. Buttenheim and colleagues.

Results showed that the amount of children from 2008 to 2010 with one or more personal belief exemptions increased 25% in the state, and the exempt kids tended to aggregate within individual schools. An increasing amount of both vaccinated and exempt kindergartners were going to schools that had potentially risky personal belief exemption rates.

Dr. Buttenheim explained:

"Vaccines are one of the great public health achievements of the last couple of centuries. They protect us from diseases that used to routinely kill hundreds of thousands of children in the United States and still kill hundreds of thousands globally. It's not just important for a child to be vaccinated, it's important at a population level to have high rates of coverage."

A measles outbreak spread in California back in 2008 which was traced to a child whose parents had chosen not to get him vaccinated. After bringing the disease back from Europe, he infected other kids at his doctor's office as well as his classmates. His parent's had signed a personal belief exemption affidavit because they didn't believe in some or all of the immunizations, leaving the child unvaccinated entering school.

Twenty states allow such exemptions, California being one of them. Vaccine-preventable childhood diseases that once caused many diseases and deaths in the Unites States remain rare occurrences because of the nationally widespread vaccination coverage among kids.

Four million people were once infected with measles while killing 4,000 of them each year, mostly young kids. Endemic measles was eliminated in the U.S. as of 2000. An estimated 42,000 deaths and 20 million cases of disease will be prevented by the current routine childhood immunization schedule. It will also save $14 billion in direct medical costs per U.S. birth cohort.

In order to increase adherence rates, the author plans to test several interventions at the school level, such as new incentive structures for schools. The school nurse can play a key role in encouraging parents to get children immunized, she believes.

The Dr. concluded:

"We know everyone is heavily influenced by social norms and pressure,and school nurses can set the expectation that children get fully vaccinated. I think the school nurse can really act as a gatekeeper here, and reset the norm in favor of immunization."

Written by Sarah Glynn