This story appeared first in the Sunday edition of the Wisconsin State Journal.
Kai Hirata's parents feed him healthy foods. When cold and flu season hits, they increase his vitamin C.
But they haven't given the 7-year-old any vaccines. Diseases such as measles, which sprang up around the country last year, including in Milwaukee and Minneapolis, don't worry them.
"I feel safer with him getting the measles than getting a vaccine he could have a reaction from," said Kai's mother, Bridget Hirata, of Fitchburg.
Hirata and her husband, Taka, are among a growing number of Wisconsin parents whose children have personal conviction waivers exempting them from school vaccination requirements.
Twenty years ago, less than 1 percent of students opted out of shots. Last year, nearly 4 percent did, including nearly 3 percent in Madison.
The trend impacts everyone, health officials say, because no vaccine is completely effective, infants are too young for many shots and medical conditions prevent some people from being immunized.
"As more people get waivers, our herd immunity goes down to the point where the entire community is at risk," said Dr. James Conway, a UW Health pediatric infectious diseases specialist who is on the board of the Dane County Immunization Coalition.
The Hiratas, like many parents who don't inoculate their children, worry about the risks of vaccines, which some say include links to autism, sudden infant death syndrome and other conditions. The Hiratas also question the need for the shots, saying people can fight diseases naturally.
"Our body should be able to take care of itself," said Bridget Hirata, whose 2-year-old daughter, Hana, also hasn't been immunized.
Conway said most alleged risks, such as a reported link between the measles, mumps and rubella vaccine and autism, have been refuted. Vaccines are so effective that parents no longer see the diseases they prevent, so some have become unconcerned, he said.
Measles flare-ups, including two cases in Milwaukee in September and 23 cases in Minneapolis in March and April — many among unvaccinated children — should serve as a warning, Conway said.
Measles is highly contagious and can cause pneumonia, encephalitis, deafness and death. Outbreaks of mumps and pertussis, or whooping cough, also have put unprotected children at risk in Wisconsin, Conway said.
Not vaccinating against the diseases "is like putting your kids out in traffic," he said. "They might not get hit by a car, but if they do that's a world of hurt."
'It is a concern'
Wisconsin requires 15 doses of five vaccines to enter kindergarten, and additional immunizations are recommended. The goal is to keep children healthy and prevent them from spreading diseases to others, health officials say.
The state has granted personal conviction waivers since 1980 and is among 20 states that do so today.
Parents check a box on their child's immunization form and sign it. A small number of children also get medical or religious waivers.
The state's vaccine requirements and data on waivers apply to public and private schools but not to children who are home-schooled.
Health officials can keep unvaccinated students out of school during outbreaks, as happened in April when many children at Chippewa Valley Montessori School in Eau Claire contracted chicken pox.
Some children with waivers get some shots. Of the 788 students with waivers this year in the Madison School District, 656 got at least one immunization, said Freddi Adelson, health services coordinator.
But since additional children are behind on their shots, many go unprotected from some diseases, Adelson said.
"You don't want any non-immunized kids," she said. "It is a concern."
Statewide, 91 percent of students meet the vaccine requirements, a figure that tends to drop when new shots are added to the list, said Dan Hopfensperger, the state's immunization program director.
"We are concerned about the trends," Hopfensperger said. "We are certainly keeping an eye on the situation."
Despite the increase in waivers, Wisconsin's immunization rates remain above the national average, he said.
Among children 19 to 35 months old, for example, 83 percent have received the recommended vaccines, compared to 73 percent nationwide, according to the Centers for Disease Control and Prevention.
Influenced by vaccine critics
The Hiratas said they were leaning against vaccinating their children when they attended a seminar that convinced them not to.
Dr. Mark Geier, a Maryland-based critic of vaccines, led the seminar. He and other well-known critics, such as Neil Z. Miller of the Thinktwice Global Vaccine Institute in Santa Fe, N.M., say vaccines do more harm than good.
The medical establishment discounts such claims, saying rigorous studies have found no links to serious side effects. The British medical journal The Lancet last year retracted a 1998 article by Dr. Andrew Wakefield that said the MMR vaccine can cause autism.
Kai Hirata attends Madison Central Montessori School, and Hana will start preschool there this month.
The family regularly sees a chiropractor and uses herbs, essential oils and other natural remedies to stay healthy, the Hiratas said.
Their chiropractor, Heather Olson of Madison, said she educates parents about the risks of vaccines and points out the apparent rise in allergies and autoimmune disorders.
"Why are kids today sicker?" Olson said. "Something isn't right."
The Hiratas' family physician, Dr. Adam Rindfleisch, shares information about vaccines with them and calls when outbreaks arise, asking if they might reconsider vaccination.
"I try to be as respectful as I can be in helping them make an informed choice," said Rindfleisch, of UW Health's integrative medicine clinic.
He said his two children have received the recommended vaccines.
'Confused with all of the information out there'
Bridget Hirata's sister, Anne Servick of the DeForest area, hasn't vaccinated her 7-year-old son and 15-month-old daughter. Her son, who attends Heritage Elementary School in Waunakee, has a personal conviction waiver.
Kristina Amelong, of Madison, whose 10-year-old daughter has a personal conviction waiver at Madison Waldorf School, said she thinks some ingredients in vaccines are harmful.
"I don't want to do something that's wrong just because a lot of people are doing it," said Amelong, who runs Optimal Health Network, an alternative medicine store.
Some parents, such as Michelle Yoo, who lives north of Sun Prairie, select which vaccines their children receive.
Yoo's 21-month-old son got two doses of the Hib vaccine against bacterial infections that can cause meningitis and pneumonia. He will get a tetanus shot next year because the family lives in the country, she said. But that's it.
"The more research I did, the more I added to my list of vaccines that were bad," Yoo said.
Conway said many parents who oppose vaccination mean well.
"They're trying to do the right thing for their kids, but they're getting confused with all of the information out there," he said.
"Vaccines aren't perfect," he said, "but they're a whole lot better than allowing kids to be susceptible."
Bridget Hirata said her proof that she's doing the right thing is her healthy children. Kai has never needed antibiotics, she said, and Hana had them once, by mistake, for a virus.