Despite outbreaks of whooping cough and measles, some parents continue to choose not to have their children vaccinated – some for religious reasons, others fear a link between vaccines and autism or other developmental problems. Although many medical researchers say there is no evidence of a connection.

Roberta Platt, from Lockbourne, was leaving the Whetstone Library in Clintonville with her two children ages 10 and 12 who are home schooled. It was not until her husband became ill and the children had to attend public school that she says they got their first shots.

Platt said her family has seen Tourettes as well as another form of autism, so she wanted to wait until her two youngest children were older to get them vaccinated. Even then Platt remains skeptical about vaccination safety.

“I believe there’s a cover up on what’s happening with vaccinations. However, it’s a two-edged sword. You can’t deny the fact that polio has been largely eradicated because of vaccinations. So I’m grateful,” she said.

Lilia Ramirez from Columbus holds her nine month old daughter outside the library. Her 11-year-old son is nearby. Ramirez was not aware of the newly required whooping cough booster, but she said once her son reaches seventh grade he’ll be getting it. And in Ramirez’s words “it’s risky” for parents not to have their children vaccinated.

“It’s valid for them to do what’s right for their family. But I think they have to also consider the implications it has for the children that their children are around and associated with,” Ramirez said.

Starting this year Ohio requires the booster vaccine called Tdap for all seventh graders. It’s similar to the vaccine they received as infants and pre-schoolers. It offers protection against tetanus, diphtheria and pertussis.

The new law comes in to play as the number of whooping cough cases have increased around the country and in Franklin County.

As many as six babies are dead after contracting pertussis in California. While Ohio has not had any deaths from the disease since 2008, the number of cases is going up. According to the Ohio Department of Health, Franklin County has seen 154 whooping cough cases so far this year. That’s an 88 percent increase over the same time last year.

Pertussis is not the only preventable disease that has made headlines in recent months. Last year, several states saw measles outbreaks. These outbreaks have led medical experts to push inoculation. And some to say children are under vaccinated.

Amy Bashforth is ODH’s immunization program chief. She worries about under vaccination.

“About 30 percent of teens in Ohio have received their Tdap booster. Unfortunately Ohio’s rate is below the national average,” Bashforth said.

To be most effective medical experts say 90 percent of children need to be vaccinated against communicable diseases. Dwight Powell is in the infectious diseases unit at Columbus Children’s Hospital.

“When you immunize say 90 percent of a population of kids at a certain age, that ten percent of non-immunized kids is probably not going to see much of that disease because of the herd immunity effect,” he said.

But the herd immunity effect, Powell said, does not apply to whooping cough and measles – two of the most highly contagious preventable diseases. Powell said by the time children reach their pre-teen years, the whooping cough vaccine they received as babies is all but ineffective. In other words, it’s not life-long protection.

“Pertussis is a relatively short term immunity that begins to wan in pre-adolescence and definitely through adolescence. It’s adolescence and adults who tend to get infected and carry the illness back to their younger sibling,” Powell said.

And that’s why Powell said the booster is needed to stop the spread of the disease.

“Outbreaks like pertussis particularly are going to require more unique effort,” he said. Public health clinics and doctors’ offices likely will be busy in the coming days as schools prepare to open.

Kylie Scott remembers the first clinic she visited with her two-year-old son Teagan “It was the 28th of October at the Ohio Historical Society and we waited about 4 hours,” Scott says. Scott brought Teagan for a second dose of the vaccine, the procedure that’s recommended for children under ten years of age. “He has had the first dose and just needs the second dose. At his age group it’s high risk if he does get the flu so we want to try to prevent that if at all possible,” Scott says. Since the Centers for Disease Control and Prevention began funneling H1N1 vaccine to Ohio, more than 2.5 million doses have been distributed statewide. Until now, the vaccine has been restricted to people in high risk groups. But the Ohio Department of Health says the vaccine will soon be available to anyone who wants it.

“In looking at the supply, in consulting with public health officials in other states we made the decision that this was a good time to open up the vaccine to anybody who’s interested in getting it,” says Kristopher Weiss.

Weiss is the state health department spokesman.

“What we’re hearing from our local health departments is that the clinics are not as full as they were,” Weiss says. “That’s part of the reason we want to try and open it up. We do understand that there are some people who just won’t seek out the vaccine.” According to the Columbus Health Department, there are a half-million people in the high risk category living in Franklin County. But as of the end of November only 140,000 had been vaccinated against Swine Flu. The number of people in Franklin County who’ve become ill with H1N1 is unknown says Columbus Public Health Commissioner Doctor Teresa Long. She does have figures on the number of people who’ve been admitted to hospitals with flu-like illnesses. “And that number is almost exactly 450 persons have been hospitalized,” Long says. “As far as the absolute diagnosis of H1N1 of influenza-like illnesses, it’s a smaller number; about 260 persons. And while we do know there have been deaths of adults, the only reportable condition has to do with pediatric deaths. And of those there have been 2.”

Swine flu first came to the world’s attention this spring with news of the outbreak and deaths in Mexico. In the weeks that followed, the CDC ordered mass production of H1N1 vaccine swine flu acquired the title pandemic; there were daily briefings from health officials; businesses began preparing for widespread employee illnesses. But has the disease been as serious as was predicted early on? Columbus Health Commissioner Teresa Long says officials acted on the information that they had. “You only get one chance in a pandemic to get it right so you have to come on strong and then back off and moderate as what makes sense with what you experience,” Long says. Predicting the course of the disease is made more complicated, say health officials, because influenza comes in waves. Last week the state health department downgraded swine flu activity in Ohio from “widespread” to “regional.” But officials say another widespread outbreak could be just around the corner. “History can also tell us that in the various subsequent waves often the severity of illness has increased so another reason to think about getting that vaccine now,” says Long. “But the important news is that so far the severity of illness is serious, but it hasn’t had that very, very high level of mortality that we were concerned about, whether the history of the pandemic of 1917/1918 or what we first thought was going on in Mexico.” Vaccinations at public health clinics will continue to be free of charge; the federal government is paying for the production of H1N1 vaccine and is not passing along the cost to the states. Providers such as drug stores and doctors offices are allowed to charge a small fee for administering the vaccine. The state health department has spent $1.5 million fighting the disease – the majority of that in personnel expenses. Meanwhile, health officials continue to urge all Ohioans to get vaccinated. The state health department’s Kristopher Weiss “This is not a time to be complacent, this is a time to seek out vaccine if you can find it and get it. The flu season in Ohio typically runs through mid-March; we’re here in mid-December. So I think that prevention steps remain very important,” Weiss says.

Hospital officials in central Ohio strongly recommend that employees get both seasonal and swine flu shots, but only one says failure to get the vaccine will have dollars and cents consequences. At Children’s Hospital doctors, nurses and other patient care workers who refuse the H1N1 vaccine will not be eligible for bonuses, raises or cost of living increases. Director for Epidemiology Dr. Dennis Cunningham says their policy is based on concern for their young patients.

“We don’t want to spread it to our patients. We have some very vulnerable children here. Children who have been immunocompromised either because of medications or who were born with an immune problem.”

Cunningham says he also wants to make sure Children’s can maintain safe staffing levels.

Gingy Harshey-Meade is CEO of the 8600 member Ohio Nurses Association.

“We support everyone getting a flu vaccine. We do not support everyone being mandated for a flu vaccine. In this country, everyone should be able to decide for themselves what they want to do.”

While the Mt. Carmel hospitals are still working on an H1N1 policy for employees, the Ohio State Medical Center and Ohio Health say employees who decline the H1N1 vaccine will be asked to explain why. They will receive additional education about swine flu, and they are required to wear a mask in clinical settings where they come in contact with patients.

Susan Bunevich is a breast health specialist at Grant Medical Center. Even though she doesn’t like shots, Bunevich took the seasonal flu vaccine, and she will also take the swine flu vaccine.

“It’s not really that I’m thinking about me, I’m thinking about patient contact. My patients have cancer. Their immune system is low. I have an obligation to them.”

Ohio State Medical Center operating room nurse Amanda Miller thinks concern over swine flu is blown out of proportion. She says seasonal flu kills people also. She will not take either flu shot.

The state is supposed to get 61,500 doses of swine flu vaccine soon. This round of doses will be in nasal mist form. The mist form is only available to healthy individuals because it contains the live virus like the season flu mist does.

The Ohio Department of Health will divvy out those doses to the state’s 88 counties. And that will be based on population and requests from private health care providers and public health departments.

Franklin County Health Department spokeswoman Mitzy Klein said she’s unsure how much the county will get in this round of doses. But she said whatever the county does get will be used to vaccinate EMS workers.

“Unless we can identify there’s health care workers who their needs aren’t met then we will offer that. But at this point that’s not part of our plan,” Klein said.

The swine flu shot is not available yet, but Klein sayid it could be as early as later this month. When that happens the county health department will hold various vaccine clinics. Klein said she cannot say at this point when and where those will be, but she insists there is a plan in place.

“It’s so hard for us. Because like I was just in a meeting this morning and we talked about two dates and two locations to start out that first week. But we don’t know if we’re going to have enough vaccine to do it,” she said.

Klein said the health department may not know how many swine flu shots it will receive until the week before a clinic is set to be held.

“We don’t want to give the public misinformation, and at this point we simply can’t guarantee we can do it based on all of these factors,” Klein said.

If this set of cases is confirmed, that will bring the total number of bacterial meningitis cases to four this year for Ohio University. OU Dean of Students Ryan Lombardi says he is concerned about this most recent set of the disease, “it’s certainly a concern of mine that if these two are confirmed that they would be the third and fourth cases, if they were to be so of bacterial meningitis this year.”

Both OU students live on the East Green on campus. They are being treated a hospitals in Columbus.

Kim Fox, WOSU News.

The flu – fever, chills, muscle aches, lethargy, cough, headache – yuck. And that’s only if the infection is mild to moderate. Other people can develop complications like pneumonia. In rare cases influenza can be fatal. This is why Federal health officials recommend many of us get a flu shot. It’s supposed to be quick and painless – well there might be a slight pinch…possibly from the $20 to $30 it takes from one’s pocketbook.

The Flu shot has become a big business for retailers. You cannot miss the signs saying “GET YOUR FLU SHOT HERE” at the grocery store or drug store.

Retailers seized a flu shot opportunity after the Visiting Nurses Association had a lot of success administering the flu shot in grocery stores in the early 1990s.

Ann Paulins directs the School of Human and Consumer Sciences at Ohio University. She said there are a number of reasons why retail chains offer the flu shot – the bottom line is one of them. And in a recession when prices are increasing and consumers are watching every dime retailers are even more conscious of it.

“Certainly all companies, retailers, need to be aware of their bottom line. So it is a particularly wise strategy to think about what do consumers need? What will consumers be willing to pay for? And can we offer that and can we promote it in a way that we’re selling the product as opposed to our customers going to a competitor for that product,” she said.

For grocery stores, which operate on thin profit margins for food, flu vaccines are an excellent source of revenue and profit.

Kroger Grocery stores and CVS pharmacies each plan to administer one million doses this year – nationwide.

Neither Kroger nor CVS would disclose how much they pay for their flu shots. But the average wholesale price of a single dose of flu vaccine is about 12 dollars. Kroger sells the shots for $24.99. CVS charges $30 bucks. So if we do the math…with a million does sold…each chain’s profits could be between $13 and $18 million. And profits are likely higher if the retailers get volume discount rates from the vaccine manufacturers.

Widespread use of the flu shot has surged in the last two decades. The number of flu vaccines produced since 1988 has increased 530 percent. The nation’s population only increased 25 percent in that same time period.

Curtis Allen speaks for The Centers for Disease Control and Prevention in Atlanta. Allen said one reason for the increase is manufacturers realize there’s a market for flu vaccines. He said another reason is there are more people that need to be vaccinated.

“We’re learning more about the potential complications of influenza and the science is growing, and as the science grows we recognize that there are more people who should be vaccinated than have been vaccinated in the past,” Allen said.

Doctor Jacob Teitelbaum is an internal medicine physician and graduate of the Ohio State University Medical School. Teitelbaum, who recommends the flu shot, said there’s a perfectly good reason for the large increase in flu shot production.

“How did the Pink Floyd song go? Money, money, money. I mean, fear sells. And if there’s a buck to be made, especially in medicine, it’s going to be made,” Teitelbaum said. While more of us are getting the flu shot, the percentage of the population that dies from the flu has actually increased. While still very rare, flu deaths are up 44 percent since the late 80′s.

Allen said the CDC predicts about 36,000 people will die from flu or complications this year. But he said some scientists think that number is a conservative one.

There are a number of reasons, Allen said, why the number of flu deaths is increasing. He said the U.S. has more people over the age of 65 than ever before, and seniors are more prone to get the flu and develop life-threatening complications. And he adds not every one who needs to get a flu shot is doing so.

“Even under the best of circumstances we’re vaccinating well less than 50 percent of the people who should be vaccinated,” Allen said.

Dr. Tietelbaum agrees that an aging population accounts for the increased number of deaths from flu, but only partially. He adds for the first time in U.S. history people are obese and malnourished. And he said if a person is vitamin deficient the flu shot will not work.

“I think the increased death rate has to do with the American public in general having poor nutrition and poor immune function. I think those statistics are ignored because no one wants to question vaccinations,” he said.

And picking the right flu vaccine is not always easy. Last year millions of Americans opened up their wallets for a flu vaccine that did not match the viruses that were going around. Every year, health officials make an educated guess on which flu strains they think will circulate that season. Allen said the 2007 vaccines were mismatched.

But he said the flu shots were not totally in vain. He says despite the wrong combination, the vaccine was about 50 to 60 percent effective. And Allen said the flu is likely to be less severe if it’s contacted after receiving a flu shot.

The U.S. Center for Disease Control and Prevention began shipment of flu shots earlier than expected. Five manufacturers will supply a record number of 143 million doses to the U.S. Last winter, many were sick due to a mismatch of strains found in vaccine.

Spokesman, Kristopher Weiss, of the Ohio Department of Health, says that new strains in vaccine are not surprising.

“Vaccine does not guarantee that somebody will not get sick, but they prevent about 70 to 90 percent of infections, and those who do get sick who have been vaccinated will likely have a much less severe illness,” says Weiss.

“He basically told ‘It could be a lot of things. It could be hormonal, it cold be all kinds of stuff.’ He said ‘In one out a million, it gets more serious.’ Well, it kept on bleeding, and I had to do a biopsy,” Witter said. “I went back about 10 days later, and he said ‘Honey, you’re one in a million. You have cancer.”

Witter’s cervical cancer was caused by the sexually-transmitted Human Papilloma Virus, or HPV. OSU Medical Center gynocologist David Cohn says HPV is the most common STD in the United States, but cancer cases such as Witter’s are rare because HPV sits dormant in most people.

“Despite the fact that HPV is very common in the general population, and almost anyone who has been sexually active has been exposed to the virus, this virus usually goes away, and in almost all women never causes any problems, and very rarely causes cervical cancer,” Cohn says.

HPV accounts for about 70 percent of cervical cancer cases. Cervical cancer kills about 3,500 women in the U.S. each year, and about 290,000 worldwide. While both men and women can carry HPV, the virus is rarely harmful to men.

Food and Drug advisers yesterday unanimously endorsed a vaccine that blocks infection of the two strains of HPV responsible for most cases of cervical cancer. Officials with the drug company Merck say the vaccine could slash the number of cervical cancer cases by two-thirds if given to patients before they become sexually active. But some Conservative groups have been hesitant to fully endorse the vaccine. Focus on the Family spokeswoman Linda Klepacki says vaccines for sexually transmitted diseases should not be necessary.

“Focus on the Family affirms that above any availbable health intervention, abstinence until marriage and faithfulness after marriage are the best and primary practices for preventing HPV and all other sexually transmitted infections.”

Dr. Hal Wallis of the conservative thinktank Physicians Consortium is quoted in Reason magazine as saying STD vaccines send the message that a person can take a shot and be as sexually promiscuous as they want without consequences. Dr. Cohn disagrees with that statement, and says an HPV vaccine should not replace common sense.

“I think that we still have to recognize that sexual education is critically important, and discussions with our children and with our peers about the appropriate techniques to minimize the risk of infection is critical,” Cohn says. “But just vaccinating a child does not mean we give them free license to be promiscuous.”

Officials with Physicians Consortium did not respond to interivew requests for this story. The vaccine proposal now awaits full FDA approval, which could come within weeks.