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No, eliminating religious exemptions to school vaccine mandates will not endanger immunosuppressed children

Liz Rovegno claims that eliminating the religious exemption to school vaccine mandates in New Jersey will kill her son Keanu. It won’t.

In response to low vaccine uptake, more and more states have been considering passing laws that would eliminate all exemptions to school vaccine mandates other than medical exemptions. It started in California in the wake of the Disneyland measles outbreak five years ago. Led by Senator Richard Pan, the California legislature passed SB 277, which eliminated all personal belief and religious exemptions to school vaccine mandates and allowed only medical exemptions. It worked. Last year, that law was strengthened with SB 276 and SB 714. Last year, as a result of several measles outbreaks, other states have been considering eliminating nonmedical exemptions, be they religious or personal belief exemptions. For example, New York banned religious exemptions last year, and out-of-state antivaxxers have descended upon Trenton because the New Jersey state legislature is also considering eliminating religious exemptions. To oppose this bill (and others like it) mothers like Liz Rovegno are claiming that children like her son Keanu would die if they were “forced” to be vaccinated. It’s a message that could sound convincing to legislators.

Unfortunately, a New Jersey newspaper, Asbury Park Press, published a letter by Ms. Rovegno that uses exactly this argument, even going so far as to publish it under the headline Removal of NJ’s religious exemption for vaccines could kill our son:

Our son Keanu has congenital heart disease, had life-saving open heart surgery and will need further heart surgeries. Keanu’s organ placement is abnormal, causing an issue with his intestines called malrotation for which he may also need surgery.

Keanu is severally immunocompromised in that he has no thymus and polysplenia. The thymus is where T cells go to mature, hence he is deficient in mature T cells. Polysplenia, or multiple spleens, results in no spleen function. The spleen is where B cells go to mature, hence he is deficient in mature B cells. Without mature T and B cells he cannot fight infections. Keanu is so severely immunocompromised that doctors have ordered prophylactic antibiotics every day for the rest of his life.

The inserts of some vaccines, including the MMR, state they are contraindicated in those with “cellular immune deficiencies.” Clearly Keanu falls into this category but his very rare condition does not meet the state Department of Health criteria to qualify for a medical exemption.

It sounds as though Keanu likely has DiGeorge syndrome, which does include congenital heart disease, missing thymus, and T-cell immune abnormalities, although it could be another syndrome. Whatever the specific congenital syndrome Keanu has, he’s obviously immunocompromised. That’s exactly contraindication number one to vaccination with live attenuated virus vaccines like the MMR or rotavirus vaccines. If there’s one contraindication to vaccination that’s medically valid and universally agreed upon, it’s that severely immunocompromised children should not receive live virus vaccines.

Indeed, if you look at the New Jersey guidelines for obtaining medical exemptions, they explicitly invoke accepted reasons, including immunodeficiency:

In order to obtain a medical exemption, N.J.A.C. 8:57-4.3 requires a written statement to be submitted to the school, preschool, or child care center by a physician licensed to practice medicine or osteopathy, or an advanced practice nurse who is licensed in any jurisdiction in the United States indicating that the immunization is medically contraindicated for the child for a specific period of time, and the reason(s) for the medical contraindication, based upon valid reasons as enumerated by the Advisory Committee on Immunization Practices (ACIP) of the United States Public Health Service or the American Academy of Pediatrics (AAP) guidelines.

These guidelines are accessible on the CDC and AAP website at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html or https://redbook.solutions.aap.org/redbook.aspx.

Among the reasons:

A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons (1). However, certain conditions are commonly misperceived as contraindications (i.e., are not valid reasons to defer vaccination).

Severely immunocompromised persons generally should not receive live vaccines (3). Because of the theoretical risk to the fetus, women known to be pregnant generally should not receive live, attenuated virus vaccines (4)

In the table later on the page, we see this contraindication further specified:

  • Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Family history of altered immunocompetence

It sounds very much as though Keanu qualifies for a medical exemption to live virus vaccines. On the other hand, I think I know what’s going on here. If Keanu actually has DiGeorge syndrome, here are the recommendations, published in 2014:

Children with partial DiGeorge syndrome (pDGS) should undergo immune system assessment with evaluation of lymphocyte subsets and mitogen responsiveness in order to determine whether they should be given live viral vaccines. Those with ≥500 CD3 T cells/mm3, ≥200 CD8 T cells/mm3, and normal mitogen response should receive MMR vaccine and VAR (weak, low).*

My guess? Either Keanu’s parents didn’t want to have his immune system tested to see if he could safely take the MMR vaccine and other live virus vaccines, or he didn’t meet the criteria above for a medical exemptions (i.e., his immunodeficiency is not severe). On the other hand, the evidence for the above recommendation was listed as lower quality. In other words, there’s room for disagreement, and I bet that most doctors would be OK with a medical exemption for a child like Keanu. (I’m not a pediatrician, though, and am welcome to correction.) Moreover, immunodeficiency is in general not a contraindication to vaccination with vaccines not containing live virus; so none of the considerations above applies to inactivated vaccines, which contain no live virus but rather just protein from killed virus or bacteria chosen to provoke a protective immune response.

I have the sneaking suspicion here that this is not about the MMR or Keanu’s ability to safely handle live attenuated virus vaccines. Here’s what it’s about:

We exercise the religious exemption because vaccinations go against the very core of our religious beliefs. However, if the religious exemption is removed in the name of herd immunity our son’s only option to stay in public schools will be to be vaccinated, which could kill him.

Again, it’s not about live attenuated virus vaccines. It’s about all vaccines. Religion was simply a convenient reason for Liz Rovegno to do what she wanted to do anyway based on her antivaccine views: Not vaccinate Keanu at all. Invoking a religious exemption was simply the easiest way for her to refuse to vaccinate Keanu without the state of anew Jersey objecting. Getting a medical exemption would have required a letter from Keanu’s doctor and possibly tests to assess his immune system..

And, make no mistake, Liz Rovegno is hard core antivaccine. All it takes to see that is a brief perusal of her Facebook page. For instance, just the other day, she was promoting the sequel to the antivaccine propaganda film VAXXED:

Just yesterday, she posted this:

And there are memes like this aplenty:

There’s a lot more where this came from on her page. I quickly became nauseated as I scrolled further down..

There is, of course, a dark irony here. Children with congenital immunodeficiencies are exactly one of the kinds of children who most rely on herd immunity to avoid becoming ill. Yet, Liz Rovegno is doing her damnedest to spread fear, uncertainty, doubt, and loathing of vaccines by promoting antivaccine misinformation. If her disinformation were to be believed by more parents, it could result in a decline in vaccination rates, which would threaten herd immunity, which would directly threaten her son Keanu. In a rational world, she’d be urging everyone to vaccinate their children, as the vast majority of parents of children with compromised immune systems do, if only out of pure self-interest and concern for the son whom she loves. Instead she’s doing the exact opposite.

Finally, shame on whatever editor at Asbury Park Press decided that it would be a good idea to let someone like Liz Rovegno print a letter promoting antivaccine misinformation. Her letter basically promotes the antivaccine propaganda message that deceptively claims that the elimination of nonmedical personal belief and religious exemptions means the elimination of all exemptions to school vaccine mandates. It doesn’t. Antivaxxers have a long list of “contraindications” to vaccination that (they think) should merit medical exemptions, most of which are not based in science. Conflating children like Keanu, who likely has a legitimate contraindication to vaccination because of his congenital immunodeficiency, with all the children with bogus “contraindications” to vaccination and trying to convince legislators that children like Keanu will be put at risk of death if they have to be vaccinated is propaganda, not science.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

54 replies on “No, eliminating religious exemptions to school vaccine mandates will not endanger immunosuppressed children”

I wonder if laws could ever be put on the books such that the parents of those with valid medical exemptions could sue the parents of children that dont get vaccinated because of their personal beliefs. Then every time an immunocompromised child ends up in the hospital because of these people, they get fined a hefty sum.

There is, of course, a dark irony here. Children with congenital immunodeficiencies are exactly one of the kinds of children who most rely on herd immunity to avoid becoming ill. Yet, Liz Rovegno is doing her damnedest to spread fear, uncertainty, doubt, and loathing of vaccines by promoting antivaccine misinformation.

Indeed. Hopefully the irony won’t be lost on some.

I believe she did it to herself with the help of anti-vaccine death cult propaganda.
I say this in light of her past history of getting religious exemptions instead of medical exemptions which indicates she knows exactly what she is doing.
As Orac points out – The likelihood is that she knows her child qualifies for a medical exemption but it won’t be an all inclusive medical exemption and she is firmly anti-vaccine so any vaccine is unacceptable. There is no convincing needed for her.
From her FB postings it is clear she is the anti-vax propaganda agent distributing the lies and distortions to other, vulnerable young parents (and dimwitted politicians and news persons).
IMO – She is not a victim… she is a victimizer.
Have fun.

I don’t think she is misled at all. I think she knows an immunocompromised child would get a medical exemption for live attenuated vaccines. But that is not enough for her. She wants an exemption for her children for all vaccines. She seems to be deliberately doing a lot of conflating to try and use her child’s case to argue against the law.

Do to previous experience someone who has heart surgery is not back in school the next day or even week, plus if a child is on antibiotics they are usually sick enough to not be in school. Just like a child who has pertussis, diphtheria, measles, etc is too sick to be in school.

So why is it better to let kids be vulnerable to those diseases than to prevent them with a vaccine? Do you prefer kids suffer from high fevers, seizures, pneumonia, etc? Plus spread those diseases to others in a school setting. Only a heartless child hater would want that.

Need to edit this sentence: “Plus spread those diseases to others in a school setting. Especially kids like Keanu and others.”

Heart surgery and daily antibiotics are not mandated for work or school attendance

“Chronic Lyme disease,” on the other hand….

Heart surgery and daily antibiotics are not mandated for work or school attendance Dr. Hickie….that is the difference.

School mandates have nothing to do with what Dr. Hickie pointed out. It’s about risk and going along with established medical advice, except for where this ignorant mummy thinks she knows better.

Obviously it is the SheDz(tm).

I see this shedding myth spread all over measles-resistant rants by antivaxxers. What I don’t see is evidence that shedding has contributed to even a single case of measles transmission.

They also say that the measles people contracted is the variant used in vaccines and that most people who get measles are vaccinated.

It’s hard to believe the rate of lying they display:
I read articles, tweets, listen to broadcasts and watch films made by woo-meisters/ anti-vaxxers.
The prevarication rate may nearly eclipse that of Mr Trump: quite an accomplishment.

What really bothers me is how they create densely packed arguments/ Gish Gallops padded with myths and imagined data. These packets of misinformation are reiterated frequently and remembered easily by the faithful and repeated . SBM is more complex, less emotionally charged and more difficult to retain, making its substitution less likely. In other words, they use scientifically valid findings from cognitive psychology/ learning to “teach” totally unscientific BS
There oughta be a law.

I wonder if she blames her sons condition on vaccines, as its clear everything these people don’t like about their children is a vaccine injury.

I suspect she was AV long before she had kids and would still object as strongly had her son been the picture of health, she’d no doubt be saying exactly the same thing, but based on MTHFR or some such trope.

Obviously, she wants to scare up support to stop the bill eliminating the religious exemption; although, it has failed twice ( in December and in January) it will be introduced again. As Orac notes, there has been a concerted effort by out-of-state activists like RFK jr, Mary Holland and Del Bigtree and social media operators.
I recently read a strong opinion piece ( Star Ledger, nj.com) describing anti-vax misinformation.

She claims that:

We exercise the religious exemption because vaccinations go against the very core of our religious beliefs.

What religion is she?

Hey, Orac, why don’t you quit blogging and spend that time reading package inserts, especially since you wasted all that time in medical school reading tainted textbooks and listening to biased instructors? Obviously, Timmy’s Mom is better at “researching peer-reviewed articles” than you!

What religion is she?

This is a lousy bit of triteness, IMNSHO. I’ve already pointed out (repeatedly) the decisions available from the NYSED Office of Counsel, which provide both wins and losses in such cases. Yes, it takes some effort.

Looking at her FB page, she also takes her 3 or 4 year old child to a chiropractor. She’s just your standard antivax nutter who is exploiting her son’s condition. Gross.

“It worked” We sold more vaccines and there is no data anywhere to show that kids are healthier because of it. Just like we planned. Nice work.

It’s simple. Simple enough for an anti-vaxxer anyway. When you ignore or discard all the data that shows kids are healthier there is none left that shows kids are healthier. Make sense now?

Oh, really? So kids are less healthy now because they do not all get measles? Is actually getting diphtheria healthier than getting the DTaP series? Oh, do tell us with citations how that worked historically.

Perhaps you can answer this very simple question. It is the US Census data of rate of measles incidence in the United States of America during the 20th century. If you look at the table you will see the rate of measles incidence dropped 90% between 1960 and 1970. Now tell how that happened by providing verifiable citations to explain your answer.

Please do not change the subject, stick to the data that is provided. Do not mention mortality or deaths, because the data is only on incidence. Do not mention any other disease because it is just about measles. Do not mention any other decade unless the incidence went down at least that much and never went up again. Do not mention any other country, because this is just data gathered in the USA, remember neither England nor Wales are American states:

From http://www.census.gov/prod/99pubs/99statab/sec31.pdf
Year…. Rate per 100000 of measles
1912 . . . 310.0
1920 . . . 480.5
1925 . . . 194.3
1930 . . . 340.8
1935 . . . 584.6
1940 . . . 220.7
1945 . . . 110.2
1950 . . . 210.1
1955 . . . 337.9
1960 . . . 245.4
1965 . . . 135.1
1970 . . . . 23.2
1975 . . . . 11.3
1980 . . . . . 5.9
1985 . . . . . 1.2
1990 . . . . .11.2
1991 . . . . . .3.8
1992 . . . . . .0.9
1993 . . . . . .0.1
1994 . . . . . .0.4
1995 . . . . . .0.1
1996 . . . . . .0.2
1997 . . . . . . 0.1

And when you are done with that, you can do the same for diphtheria for 1920 to 1930:
Year Rate per 100000 of Diphtheria in the USA
1912. . . 139
1920. . . 139
1925. . . 82.1
1930. . . 54.1
1935. . . 30.8
1940. . . 11.8
1945. . . 14.1
1950. . . 3.8
1955. . . 1.2
1960. . . 0.5
1965. . . 0.1
1970 0.2
1975 0.1
1980 (Z)
1985 (Z)
1990 –
1991 –
1992 –
1993 (NA)
1994 –
1995 (NA)
1996 (Z)
1997 (Z)

And finally pertussis for the decade 1950 to 1960:
Year Rate per 100000 of Pertussis
1912 (NA)
1920 (NA)
1925 131.2
1930 135.6
1935 141.9
1940 139.6
1945 101
1950 80.1
1955 38.2
1960 8.3
1965 3.5
1970 2.1
1975 0.8
1980 0.8
1985 1.5
1990 1.8
1991 1.1
1992 1.6
1993 2.6
1994 1.8
1995 2
1996 2.9
1997 2.5

You might want to listen to this as you do your research: http://thispodcastwillkillyou.com/2020/02/18/episode-44-pertussis-whoop-here-it-is/

Prove that you are not a cold heartless child hater who loves to see kids suffer from high fevers, seizures, pneumonia, etc. I say this as a mother who had to take care of a six month old baby who got chicken pox the year before the varicella vaccine was available. I am not fond of people who like kids to suffer like that baby (who now is more susceptible to shingles as a twenty-something grad student, because getting chicken pox before first birthday makes it more probably for shingles in twenties, especially when under stress with things like grad school).

Yeah, you’re missing some important data there hot shot. That’s alot of years there you posted. Looks very impressive. Everything except whats valuable. Probably on purpose knowing your type of ilk and who you hang with. Maybe you don’t know when SB277 took effect? No you do….. you’re just another k3yboard [email protected] from people figuring out some truth. One of the many that lurk here.

@ norcalskinny
You said “Everything except whats valuable.”

What could possibly be more valuable than a human life? Than a child not getting polio, or the measles, or diphtheria or pertussis?

@ JustaTech

“What could possibly be more valuable than a human life?”

Let me guess… Giving meaning to one’s death? If people believe there are more important things than their own life, it may eventually be true…

It’s fairly straightforward to put somebody in a situation where he believes, or even knows, that there are more important things than his own life or the life of someone else; and where it would be hard to disagree with that person. But what that person would believe to be more valuable than his own life or the life of someone else would likely be a taboo in our societies.

So you know, that’s a question that’s better not asked since people usually do not like the answers… Don’t get me started quoting Peter Singer.

@F68.10
You’re right, I wasn’t prepared for a serious philosophical discussion about the different ways that life can have value (not that I disagree). I was mostly making a counter-point to norcalskinny’s implication that vaccines are about money rather than reducing suffering and death, which I still hold is more valuable than any money.

So, norcalskinny, you cannot answer my questions. It has nothing to do with the legislation in one state. Perhaps you should just go back to nursing your paleo margarita.

@ JustaTech

Yeah. Well as far as I see the level of norcalskinny’s claims, we’re in QAnon territory. While I’m not happy about many things in medical politics, believing it’s all about the money is ridiculous. Just to make a very scurrilous analogy: it’s just as ridiculous as believing that selling weapons is all about the money. Hey! Here’s news: it’s not!

Though I can admit I mis-remembered. But still the troll made a statement and refused to support that statement. Plus their username is a name of an alcoholic drink, which is hilarious.

Though it does not excuse them of wanting kids to suffer from some rather nasty diseases for unknown reasons. Plus that they do not understand that California is not the only state in the United States of America. I have been to France, and even I know that there are several regions with their own flavor.

Seems the Norcalskinny is a consummate antivaxxer. Managed to make a statement that doesnt actually say anything, while ignoring the important stuff. So meaningless that I’d actually consider the wear and tear on finger joints while typing as a reason not to bother.

@Norcalskinny,

1… what important data are missing?

2… You still didn’t answer the question. What caused 3 different diseases to decline a lot in incidence ar 3 different times?

3…. what is valuable that was left out of Chris’s post?

P.s. Try studying up on writing for clarity.

So if it’s only about profits for Big Pharma, why do they vaccinate at government expense in China and Cuba?
Why did they do it in the former Soviet Bloc? Big Pharmski?
Why is poliomyelitis found only in places where antivaxxers use machine guns and rocket launchers to prevent vaccination?
If you’re going to give me the “improved nutrition and sanitation” trope, don’t bother. We both know it’s total bullshit.

Has anyone been keeping up with developments in mRNA vaccines?
What is opinion on whether such vaccines would be OK for the immunocompromised? Since there is zero chance of contracting the disease because no actual viral bits are are present it would seem that they might be acceptable. If the person is unable to produce antibodies they would presumably be left with some “home made” viral antigens drifting about for a while.Of course those who get all aeriated about foreign DNA are likely to go apoplectic about mRNA vaccines. We’d probably start to hear claims about “protein shedding.”

Apparently the first SARS-CoV-2 vaccine is an mRNA type and ready for phase 1 testing in humans. My understanding, which is very limited is that mRNA vaccines still fall in the realm of being a very interesting concept but something that has yet to deliver in any significant way.

While it would not be dangerous for them to get the vaccine, if the child is unable to mount an immune response, would such a vaccine be effective in preventing the disease?

Weirdly enough, I do not feel concerned by the situation of Timmy. I’d reply that, no, my mom went to med school, and I’d trust any flat earther instead of her.

But maybe I’m not the target of that media campaign…

“Yeah, you’re missing some important data there hot shot. That’s alot of years there you posted. Looks very impressive. Everything except whats valuable. Probably on purpose knowing your type of ilk and who you hang with. Maybe you don’t know when SB277 took effect? No you do….. you’re just another k3yboard [email protected] from people figuring out some truth. One of the many that lurk here.”

That’s some nice tap-dancing. Did you expect it to distract us from the fact that you didn’t answer the question. +1 for the use of leetspeak. When you Mom brings the Hotpockets down to your basement apartment (I hope she knocks), you can show her how kewl you are.

Up here in Maine, the legislature last year narrowly passed a law abolishing religious and philosophical vaccine waivers. This was promptly challenged by a “people’s veto” petition, which appeared on the ballot this Tuesday. The result: 3 to 1 vote to uphold the law! Nonetheless, antivaxxers are claiming that this crushing defeat “does not represent the true feelings of Mainers”.

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