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Where Californians Are Not Immunized
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It looks like a combination of the top and low ends of the socioeconomic distribution, Geographic clusters of underimmunization identified in Northern California:

Underimmunization ranged from 18 percent to 23 percent within clusters, compared with 11 percent outside clusters. Between 2010 and 2012, geographic clusters of underimmunization were found in:

  • the East Bay (Richmond to San Leandro);
  • Sonoma and Napa counties;
  • a small area of east Sacramento;
  • northern San Francisco and southern Marin counties; and
  • a small area of Vallejo.

“Shot limiting,” in which parents limit the number of injections or antigens that children receive during a pediatric visit to two or fewer, was found to cluster in similar areas.

Vaccine refusal ranged from 5.5 percent to 13.5 percent within clusters, compared with 2.6 percent outside clusters. Between 2010 and 2012, geographic clusters of vaccine refusal were found in:

  • the East Bay (El Cerrito to Alameda);
  • Marin and southwest Sonoma counties;
  • northeastern San Francisco;
  • northeastern Sacramento County and Roseville; and
  • a small area south of Sacramento

The paper is not live, but it will be here at some point. In Southern California most of the resistance has been in affluent areas, and in some of these areas the fraction immunized is definitely below the herd immunity threshold. Though this trend looks like it may finally have levelled off in California.

 
• Category: Science • Tags: Anti-Vaccination, Vaccination 
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  1. Some background on the socioeconomics and culture of these areas would be useful for people not native to N. Cal.

  2. marin = upper middle class, very affluent
    sonoma & napa = wine country. socioeconomically diverse. some towns are working class, others are inhabited by very affluent people with second homes, etc.
    south sac = i believe there are some deprived areas here
    east bay = socioeconomically diverse, but aside from some areas around north berkeley probably on average more deprived that san francisco, with areas of deep poverty in oakland and richmond
    roseville, etc. = suburbia

  3. In BC here the clusters have been corresponding both to geography (suburbs east of Vancouver) and religious groups. BC also subsidizes private schools that follow the provincial curriculum at a rate of 50 cents on the dollar compared to public schools, so there are a lot of religious schools. Combine the two and you get measles outbreaks. Fun times. :/

    • Replies: @Pithlord
    Since parents with kids in private school have to pay the same taxes as anyone else, I would say it is more accurate to say BC subsidizes public schools -- which have a labour relations culture similar to Yorkshire coal pits in the 1970s.
  4. East Sacramento: one of the nicest parts of town, 80+% white-plus-Asian, affluent.

    South Sac: depends on what they mean. Around the zoo and the city college is mostly affluent and white+Asian. Or it could mean poor Hispanic.

    North/NE San Fran: In NE San Fran there is a swath of mixed-race poverty from Chinatown to Western Addition. The rest ranges from merely affluent to Zuckerberg.

    The stereotype of the anti-vaxxers is that they are la-di-da liberals with more money than sense. Without seeing the full study (I’d be curious if they have race/wealth/education data on the refuseniks), many of these geographic clusters seem to buttress the stereotype, while others leave (for now) the situation more muddled.

    • Replies: @Dain
    I grew up in South Sacramento. It has a bad reputation for poverty and crime, in line with the southern portion of lots of others cities. (What's with that, anyway?)

    It's astonishing the lack of any development out there too. Things have hardly changed since the days I rode my bike miles to purchase Garbage Pail Kids.
  5. “‘Shot limiting,’ in which parents limit the number of injections or antigens that children receive during a pediatric visit to two or fewer, was found to cluster in similar areas.”

    I don’t really have a problem with this practice. I recall when they gave my son three consecutive immunization injections, and thinking that perhaps it would be better to space them out more. As long as the injections do take place on a reasonable schedule, spacing them out seems like a wise precaution (it may turn out to be totally unnecessary, but I doubt the question’s been thoroughly looked into, and until it is, better safe than sorry). I feel like when you start calling people out, for spacing out their child’s immunizations, that you’re kinda getting into the territory where your primary objection isn’t to anti-vaxer lunacy, but rather to the fact that some of the peasants insist on thinking for themselves.

  6. “Researchers used spatial analysis software and electronic medical records to identify clusters of underimmunization and vaccine refusal among Kaiser Permanente membersin Northern California”

    This study does not match the numbers here in “http://www.cdph.ca.gov/programs/immunize/pages/immunizationlevels.aspx” for any age. Are Kaiser Permamente members in Northern CA more likely to not vaccinate their children?

  7. @CupOfCanada
    In BC here the clusters have been corresponding both to geography (suburbs east of Vancouver) and religious groups. BC also subsidizes private schools that follow the provincial curriculum at a rate of 50 cents on the dollar compared to public schools, so there are a lot of religious schools. Combine the two and you get measles outbreaks. Fun times. :/

    Since parents with kids in private school have to pay the same taxes as anyone else, I would say it is more accurate to say BC subsidizes public schools — which have a labour relations culture similar to Yorkshire coal pits in the 1970s.

    • Replies: @CupOfCanada
    Fair enough lol. It's a good policy in my opinion. Just happens to help spread measles though.
  8. @Noah172
    East Sacramento: one of the nicest parts of town, 80+% white-plus-Asian, affluent.

    South Sac: depends on what they mean. Around the zoo and the city college is mostly affluent and white+Asian. Or it could mean poor Hispanic.

    North/NE San Fran: In NE San Fran there is a swath of mixed-race poverty from Chinatown to Western Addition. The rest ranges from merely affluent to Zuckerberg.

    The stereotype of the anti-vaxxers is that they are la-di-da liberals with more money than sense. Without seeing the full study (I'd be curious if they have race/wealth/education data on the refuseniks), many of these geographic clusters seem to buttress the stereotype, while others leave (for now) the situation more muddled.

    I grew up in South Sacramento. It has a bad reputation for poverty and crime, in line with the southern portion of lots of others cities. (What’s with that, anyway?)

    It’s astonishing the lack of any development out there too. Things have hardly changed since the days I rode my bike miles to purchase Garbage Pail Kids.

    • Replies: @Walter Sobchak

    the southern portion of lots of others cities. (What’s with that, anyway?)
     
    Upstream and high ground are the most valuable pieces of urban land. Excrement flows downhill and downstream. The land farther down stream is more subject flooding and contamination.
  9. @Pithlord
    Since parents with kids in private school have to pay the same taxes as anyone else, I would say it is more accurate to say BC subsidizes public schools -- which have a labour relations culture similar to Yorkshire coal pits in the 1970s.

    Fair enough lol. It’s a good policy in my opinion. Just happens to help spread measles though.

  10. The LA Times has a page with a listing of the number of exemptions in the 2014 kindergarten class for all schools in California with more than 10 kindergarteners.

    It’s ironic that one of the public schools with the worst rate in Berkeley is the “Rosa Parks Environmental Science Magnet”.

  11. I’ve had a lifetime of Scientists waffling back and forth on what’s good for me, I’ve been robbed blind and lied to by my government and don’t even get me started on big Pharma. I don’t get the flue shot and if a Doctor suggests a treatment I go home and carefully research it before I take it. Too many people telling too many lies.

  12. Anonymous • Disclaimer says:

    I researched the CDC recommended vaccine schedule 25 years ago when our oldest was born. At that time the US was the only Western developed country that started vaccines at 2 months (6 months for 1st shot was the norm everywhere else.) A couple years later they started giving the Hep B vax to newborns, which is insane. The only risk a newborn has of getting Hep B is from his/her Hep B infected mother’s birth canal or from an accidental contaminated-needle stick while in the hospital. At that time, the Hep A vax wasn’t even on the schedule at all, even though Hep A risk is far higher for the general public (food prepared by foodservice worker with unwashed hands, for instance.)
    I dug around to find the reasons for the early schedule and discovered that the CDC wanted the whole country on an early schedule in order to catch the underclass families who might not take their kids to the doctor after the first couple of months or at all (e.g. the first few hours after birth might be the only chance you get to immunize that drug addicted mom’s newborn, after all).
    I didn’t feel the need to comply with policies developed for the underclass. I started my kids first vaccines (DtaP) at 6 months old, continued with the schedule, delayed Hep B until they were adolescents (when they might start having unprotected sex or share needles!!), but requested Hep A before they went to kindergarten (it still wasn’t on the recommended schedule). Had to manipulate the doctor to get Pertussis booster shots for the whole family after California’s mini-epidemic in 2005 (better to weather the 2008, 2010, and 2014 epidemics.)

  13. @Dain
    I grew up in South Sacramento. It has a bad reputation for poverty and crime, in line with the southern portion of lots of others cities. (What's with that, anyway?)

    It's astonishing the lack of any development out there too. Things have hardly changed since the days I rode my bike miles to purchase Garbage Pail Kids.

    the southern portion of lots of others cities. (What’s with that, anyway?)

    Upstream and high ground are the most valuable pieces of urban land. Excrement flows downhill and downstream. The land farther down stream is more subject flooding and contamination.

  14. Don’t know if you read Crooked Timber (my only-mildly-informed guess is no), so I thought I’d send this link to you:

    http://crookedtimber.org/2015/01/30/vaccination-exemptions-in-california-kindergartens/#more-34865

    I’ll similarly give the blogger there this link.

  15. The refusal clusters relate closely to Waldorf school locations.

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