I appreciate your concerns as expressed in the recent Editorial “Education Not Force the Key for Vaccinations.” There is much truth underlying your statements, but there are several significant factual errors and omissions.

The overwhelming majority of the children, infants, and adults becoming ill with measles in the Disneyland-associated outbreak in California are not immunized. Some are not immunized because they are too young for the vaccine. It is usually not given until 12-15 months but during an outbreak, it may be given as early as six months of age, but will still need another two doses after 12 months old.

There are a few breakthrough cases in immunized persons — the vaccine is not 100 percent effective at preventing infection, but one dose is about 93 percent effective, and the recommended two doses are 98 percent-99 percent effective at preventing infection. The vast majority of people with measles in this outbreak, however are people who have not availed themselves of the vaccine.

Measles and chickenpox are illness that are spread by airborne transmission, and measles is one of the most contagious viruses known. Measles virus can persist in the air and on surfaces for up to two hours. If you are measles susceptible and enter a room with someone contagious with measles, there is a 90 percent chance that you will become ill with measles. People can be contagious for a long time — for four days before they become symptomatic until four days after symptoms appear.

Measles is not an innocuous disease — 1-3 out of every thousand people getting the disease will die from it. Many more will be severely ill and several will suffer permanent damage following their illness.

The pertussis (whooping cough) vaccine is very different — it is probably the least effective of the vaccines currently in use. In the mid-1990’s an updated version of this vaccine was introduced (“acellular pertussis”) that has fewer side effects than the older (“whole cell”) vaccine. The newer vaccine has fewer side effects and were delighted to use it, but it gives immunity for a significantly shorter time. It is still very important to protect the youngest children from pertussis through immunization and a healthy family — about 60 percent of infant pertussis is transmitted from a family member and about half of them are the mother. There is ongoing research as to how best to immunize for better protection. For adults the pertussis is usually a nagging, nasty cough lasting about three months. For an infant, pertussis is a life-threatening disease.

Your editorial brought up concerns about the Hepatitis B vaccine. For several years after it was introduced, it was only being given to “high-risk” individuals. The rates of Hepatitis B infections continued to climb, in part because it was too difficult to know who was at high risk. It was only after the introduction of “universal” immunization for Hepatitis B that the rates of infection began to fall. It is especially important to prevent infections in newborns as they have a far higher risk of chronic infections with subsequent liver cancer.

In 1986 Congress passed legislation establishing the National Vaccine Injury Compensation Program (VICP). The VICP was established to ensure an adequate supply of vaccines, stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines. The VICP is a nofault alternative to the traditional tort system for resolving vaccine injury claims. It is funded by an excise tax on each dose of vaccines and provides compensation for specified injuries that have been associated with vaccines. Prior to passage, we were at risk for not having an adequate supply of vaccines because of the uncertainties associated with litigation over vaccine safety.

There are several bills under consideration in our current legislative session addressing the threat to our children’s health from increasing numbers of children not receiving the set of vaccines required for school entry. As has been pointed out, there are increasing numbers of inadequately immunized children entering kindergarten in Maine — the rate of parents declining recommended vaccines for non-medical reasons has nearly doubled and is the fifth highest in the nation. One in 20 Maine children entering kindergarten are not fully vaccinated. There are two approaches in the bills that I am familiar with. One bill eliminates the “philosophical exemption” for required immunizations.

Two others require that parents have a signed statement from a health care provider that they have been counselled about the recommended vaccines. This would assure that when parents decline vaccines that they are educated and aware of the risks of not being immunized against the diseases for which immunizations are required for school entry .

The bottom line is that vaccines are among the greatest public health successes of this last 100 years. We should all be checking on our vaccine status, and especially in light of the current measles outbreak, anyone born after 1956 should make sure they are up to date on their measles immunizations.

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Dr. Larry Losey is a pediatrician with Brunswick Primary Care and a member of the Maine Vaccine Board; he lives in Harpswell. Dr. Dora Mills is vice president for clinical affairs and the University of New England and former director of Maine CDC; she lives in Brunswick.