Category: Children

Rationale

With research on vaccination in pre-school aged children, a broad research question ‘is compulsory vaccination for pre-school aged children necessary to ensure public health’ was developed based on the initial claim. This was further refined to specifically consider the eradication of infectious disease, in particular measles in Australia.

Measles is vaccinated against in a composite vaccination known as MMR that also protects against mumps and rubella (Australian Institute of Health and Welfare, 2018). This vaccine has been available in Australia a government funded program to all states and territories since 1972 for children aged 12-23 months of age (National Centre for Immunisation Research and Surveillance, 2017). Australia was declared free of measles in 2014, meaning that as of that year there was no ongoing transmission of measles within the population (Australian Institute of Health and Welfare, 2018). However, vaccination is still important because the infection can be brought in from overseas. In recent years, areas of Australia with low vaccination rates have experience outbreaks of the disease, caused by a lack of immunity to the disease (Northern Territory Government, 2019). Given that measles is so contagious, most of the population needs to be immune to stop it spreading (Sadarangani, 2016). This is known as herd immunity and will be discussed further in the Background. Historically, the rate of hospitalisation for measles has been highest among young children up to four years of age (Australian Institute of Health and Welfare, 2018). Children in Australian pre-school are aged between 2-4 years old (Bright Horizons, 2019). Therefore, this essay proposes the following research question.

Background

Measles is a highly contagious viral diseases spread through bodily fluids in which the virus can survive in the air and on surfaces for a number of hours. Symptoms begin with a fever, runny nose, cough, red eyes and sore throat. A rash appears after a few days beginning on the face or neck and spreading to the rest of the body for up to a week. In some cases, there are serious complications including pneumonia and encephalitis (brain inflammation). Young children and adults are the most likely to develop complications. 1 in 15 children with measles develops pneumonia. Encephalitis is much rarer, and only 1 in 1000 children develop it. For every 10 children who develop measles encephalitis, 1 dies and up to 4 have permanent brain damage (Australian Institute of Health and Welfare, 2018).

Herd immunity, mentioned in the Rationale is essential for stopping the spread of diseases within any community. When a large enough number of people are immune to the disease, in this case measles, the infection cannot be transmitted between people. Some people are unable to be vaccinated, including babies which is usually due to a medical condition that results in a weakened immune system or is an allergy to the actual vaccination itself (Sadarangani, 2016). For many diseases like measles children, and in particular those who are young are at the highest risk of contracting an infectious disease and experience the most severe illness (Australian Institute of Health and Welfare, 2018). As mentioned earlier, this is due to their weakened or underdeveloped immune system that is less effective at recovering from a disease than an adult’s immune system. The number of people, especially children required to be vaccinated for herd immunity to work depends on the virility of the disease (how infectious is is). As stated previously, measles is a highly contagious disease and before vaccinations were available each person who contracted it would spread the disease to 10-15 people each, allowing the infection to spread quickly. To achieve herd immunity for measles at least 90-95% of the population needs to be vaccinated (Sadarangani, 2016).

Analysis and Interpretation

As outlined in the Background and Rationale, areas with higher rates of immunisation experience less cases of infectious diseases. Shown below in Figure 1 and Figure 2 are the percentage of children fully vaccinated with the MMR vaccine both Australia-wide and in major capital cities in 2017.

As stated in the Background, measles is a highly infectious disease that requires a vaccination rate of 90-90% in order to successfully prevent the disease. In 2017 Australia had a vaccination percentage of 93.5% (315, 459 children) with the Northern Territory and Western Australia achieving the lowest rates of immunisation at 92.1% and 92.0% respectively (National Centre for Immunisation Research and Surveillance, 2017).

As can be seen in both Figure 1 and Figure 2, the Northern Territory and Darwin have areas with considerably lower rates of vaccination than other areas around Australia. In February 2019, the Northern Territory experienced an outbreak of measles, which at one stage infected 30 people in 40 days (Northern Territory Government, 2019). The outbreak was the largest since 2014 and they experienced a rate of infection 16 times higher than any other state of territory at the time (Woodley, 2019). In order to contain the spread of infection, the most vulnerable individuals were identified and steps were taken to protect them. The most affected were those aged between 20-55 years old, as there had previously only been one measles vaccine offered to them and babies too young to have received any vaccinations. Those who could be vaccinated were advised to take part in a vaccination program to increase the number of people vaccinated against the disease and so achieve her immunity. This proved effective and no new cases of measles have been reported since the 6th of April (Woodley, 2019).

New South Wales brought in legislation in early 2018 that required all children enrolled in child care to be vaccinated. At the time over 93% of children were already vaccinated and in December 2015 only 1.15% of children aged 0-7 were unvaccinated due to conscientious objection in the state (New South Wales Government, 2017). The changes were made in order to prevent disease with the interests of general public health and reduce the risk of transmission of disease within the population. In the 20 months since implementation of the program there have been 43 cases overall of the disease, a number of which were related to international travel.

Historically, children aged 0-4 years of age have experienced significantly higher number of measles cases, hospitalisations and deaths than the rest of the population. This has, however improved drastically since the introduction of the MMR vaccine. In the mid-1990s there were over 900 cases of measles per million in the population but with the introduction of the second MMR dose this decreased rapidly to practically none in 2000 as shown in Figure 3.

Young children are more vulnerable that adults to infectious diseases for a number of reasons. They are constantly growing and breathe, eat and drink more than adults do in proportion to their weight (World Health Organisation, 2019). Their bodies, and immune systems in particular are still developing and disease like measles can lead to irreversible damage later in life. They also behave differently to adults. Pre-school aged children in particular crawl around on the ground, stick objects in their mouths and constantly touch one another. They have poor hygiene and are unaware of the risks of their actions due to their age. All of these factors result in them being more likely to contract infectious diseases, especially those that are more virulent like measles, and suffer from more acute symptoms.

Since the introduction of the MMR vaccine, which children can receive at 12 months of age, with a booster at 18 months the number of deaths decreased significantly. In 1912 there were more than 500 reported cases of measles related deaths but between 1996 – 2016 there were only three (Australian Institute of Health and Welfare, 2018). Due to the immunisation program in effect throughout Australia, the vast majority of cases are found in those too young to be vaccinated and young adults partially vaccinated or unvaccinated in childhood. Most cases diagnosed within the country can be traced back to international travellers (Australian Institute of Health and Welfare, 2018). The information presented shows that the introduction of vaccinations from an early age result in significantly fewer measles cases due to herd immunity. Without high rates of vaccination, international travel and unvaccinated people result in a fast-spreading disease and high numbers of cases.

Evaluation

The data analysed in this report comes from a range of sources. They cover a range of sample sizes from states and territories, to nationally and even internationally. Information has been selected from governmental sources, private medical research organisation, universities and international organisations.

Governmental sources include the Australian Institute of Health and Welfare, the New South Wales Government health department and Northern Territory health department. The data analyse from these bodies is all recent, within the last 3-5 years, covers a wide range of people and is carried out under strict guidelines that demands unbiased sampling and research procedures.

The National Centre for Immunisation Research and Surveillance is one of the largest private research organisation within the country and contributes research to the Australian Technical Advisory Group on Immunisation, including the Australian Immunisation Handbook, a government-issued guide on recommended vaccinations in the interests of public health. It is also certified under and meets the criteria for credibility and content under the Global Advisory Committee on Vaccine Safety. The information analysed from this organisation covers a wide range of sample sizes from major cities, to states and territories and Australia-wide. All research used is relevant and concerns vaccinations within the last 3-5 years.

The World Health Organisation is recognised as the leading authority on health around the world, is governed by qualified health professional and works closely with delegations from each of its 149 member states. The information included from their organisation in this essay is supported by their experience all over the world since 1948.

The information analysed from each of these organisation concerns populations relevant to the research question; pre-school aged children and the wider population of Australia. While the main body of data presented ranges over a period of 3 years, it is all recent and concerns the last 3-5 years. Historical data collected from the AIHW is included to demonstrate the effect of introduction of vaccines over time.

Overall the information presented is highly relevant to the research question presented and gives the resounding conclusion that vaccinations should be made compulsory for all pre-school aged children in the interest of public health and the eradication of measles in Australia. This research could be extended by further research in to the uptake of widespread vaccination has on the prevalence of diseases like measles in pre-school aged children and the wider population in Australia. This research will provide further information as to why vaccination is important.

Conclusion

In conclusion, the evidence provided in the essay shows that vaccination against measles should be made compulsory for pre-school aged children in the interest of public health in Australia. The data available shows that both historically and in recent times, higher rates of vaccination against measles has majorly decreased the number of cases, hospitalisation and deaths from the disease in both pre-school aged children and the wider Australia population. As mention in the Evaluation, further information in to why this is the case could strengthen the evidence in favour of vaccinations.

Bibliography

1. Australian Institute of Health and Welfare, 2018. Measles in Australia. [Online] Available at: https://www.aihw.gov.au/getmedia/c828baef-75d9-4295-9cc9-b3d50d7153a2/aihw-phe-236_Measles.pdf.aspx[Accessed 25 July 2019].
2. Bright Horizons, 2019. Difference Between Preschool and Pre-K. [Online] Available at: https://www.brighthorizons.com/family-resources/preschool-vs-pre-kindergarten-what-is-the-difference[Accessed 30 July 2019].
3. National Centre for Immunisation Research and Surveillance, 2017. Significant events in measles, mumps and rubella vaccination practice in Australia. [Online] Available at: http://ncirs.org.au/sites/default/files/2019-07/Measles-mumps-rubella-history-July%202019.pdf[Accessed 26 July 2019].
4. New South Wales Government, 2017. Question and answers about vaccination requirements for childcare. [Online] Available at: https://www.health.nsw.gov.au/immunisation/Pages/childcare_qa.aspx[Accessed 31 July 2019].
5. New South Wales Government, 2019. Communicable Disease Weekly Report (CDWR). [Online] Available at: https://www.health.nsw.gov.au/Infectious/Reports/Pages/CDWR.aspx[Accessed 30 July 2019].
6. Northern Territory Government, 2019. Measles Update – Vaccination Program Extended. [Online] Available at: https://health.nt.gov.au/news/measles-update-vaccination-program-extended[Accessed 27 July 2019].
7. Northern Territory Government, 2019. No new measles cases but the risk is not over. [Online] Available at: https://health.nt.gov.au/news/no-new-measles-cases-but-the-risk-is-not-over[Accessed 30 July 2019].
8. Sadarangani, M., 2016. Herd Immunity: How does it work?. [Online] Available at: https://www.ovg.ox.ac.uk/news/herd-immunity-how-does-it-work[Accessed 26 July 2019].
9. Woodley, M., 2019. Darwin measles outbreak ‘over’. [Online] Available at: https://www1.racgp.org.au/newsgp/clinical/darwin-measles-outbreak-%E2%80%98over%E2%80%99[Accessed 31 July 2019].
10. World Health Organisation, 2019. Children’s Environmental Health. [Online] Available at: https://www.who.int/ceh/risks/en/[Accessed 10 August 2019].

The standards of vaccination studies and practices have extensively changed throughout the course of the last century, as advancement in medical technology has propelled our research and medicine. Before the 1900s, diseases were much more deadly. For instance, tuberculosis, as anyone exposed, would be diagnosed with a terminal illness and would be expected to die. In the 1900s, this all began to change as medicine was taking its first steps, and vaccines were being created and perfected as time went on. Now in the modern world, it does not take us very long to perfect a vaccine if a new strand of disease comes out.

Whether children should be mandatorily vaccinated has been a subject of interest and controversy for the past couple of years, as some people have grown to believe that if children are vaccinated, there is an increase in the risk of their child presenting neurological problems in the future. This idea stimulated and grew like wildfire as parents gained the misconception of too many vaccines, or the strength of the chemicals would cause damage to the central nervous system. There have been countless articles and research that supports the idea and hypothesis that vaccines do not cause neurological damage.

If anything, not vaccinating one’s child can increase the risk of the child dying from simple diseases that stopped killing humans centuries ago, as these diseases still linger but are harmless due to the number of precautions that vaccines give. Between the 1900s and today, vaccines have significantly changed. Now they are more accessible, prevent deaths, and make a good chance that the virus or disease does not return. The vaccination of children should become mandatory because it keeps children protected from illnesses that derive from vaccine-preventable diseases. Additionally, it has been scientifically proven to be safe, and it protects others by not endangering public health and future generations.

There is a large variety of different vaccinations that must be given to a child in order for them to be fully protected from the diseases and viruses that once affected humans. As Gerber and Offit would suggest: “Three specific hypotheses have been proposed: (1) the combination measles-mumps-rubella vaccine causes autism by damaging the intestinal lining, which allows the entrance of encephalopathic proteins; (2) thimerosal, an ethylmercury-containing preservative in some vaccines, is toxic to the central nervous system; and (3) the simultaneous administration of multiple vaccines overwhelms or weakens the immune system” (Gerber & Offit). With this being said, over the years, different ideas and conspiracies have been formed against the vaccination of children, all of them as bad as the last and worrying parents of running the risk of their child having autism with the number of different vaccines given to a child.

Furthermore, vaccines and neurological damage have been proven to have no relation. In this very same article a little bit further down, referring to table 1 in the article, contains 14 different studies that support the idea that vaccinations of measles, mumps, rubella do not associate with the formation of autism in the central nervous system and hinder any form of development both physically and mentally. According to Gerber and Offit: “Several issues undermine the interpretation by Wakefield et al. [1] of this case series. First, the self-referred cohort did not include control subjects, which precluded the authors from determining whether the occurrence of autism following receipt of MMR vaccine was causal or coincidental” (Gerber & Offit). This would indicate that the study conducted to support the idea that vaccines cause autism, was done incorrectly and in a manner that if other experimenters tried to replicate the study done the correct way, the outcomes would be very different and more in favor that autism and the vaccination of children do not correlate.

Moreover, the misconception of vaccines causing autism keeps people from vaccinating their children and puts everyone at risk. The increase in autism cases can be attributed to the broadening of the symptom parameters as the attention given to autism, its effects on the human mind, and how it changes the development of a child indefinitely, has been the center of many health organizations across the globe. Gerber and Offit would argue that: “A worldwide increase in the rate of autism diagnoses—likely driven by broadened diagnostic criteria and increased awareness—has fueled concerns that an environmental exposure like vaccines might cause autism. Theories for this putative association have centered on the measles-mumps-rubella (MMR) vaccine, thimerosal, and the large number of vaccines currently administered. However, both epidemiological and biological studies fail to support these claims” (Gerber & Offit). It would almost seem as if scientists are trying to force a causal and correlational relationship between vaccinations in children and the increasing epidemic of autism cases globally as, throughout the decade, evidence keeps compiling debunking the correlation between vaccines in children and autism.

The vaccination of children is beneficial because it keeps children protected from severe illnesses that can be prevented by vaccines. A child without proper vaccinations can lead to a variety of severe health risks and fatalities, all from a simple and obsolete disease that was eradicated centuries ago. As explained by Williamson, “Smallpox exists now almost by sufferance, but owing to neglect, or to the inefficient practice of vaccination, 1,320 deaths by smallpox were registered” (Williamson). Smallpox was a disease that used to kill humans, and ever since the vaccines were created for it, it has not affected us at all except for cases in which parents decide not to vaccinate their kids because they believe it will stunt their neurological growth. The same goes for any disease that used to have excruciating effects on humans, most of these diseases were eradicated centuries ago, although they still linger, they do not cause us any harm if we have the proper vaccinations.

The immunization of children additionally benefits society as a whole by protecting our public health. As seen now in modern society, all it takes is one person to get sick with a new disease to infect the rest of the world and slowly spread across nations like wildfire; the same would go for diseases such as smallpox and measles. Without the proper vaccination, that child could get the disease at any point in time, touching anything or even going to school with other children who already had their vaccinations. As explained by ‘Five Important Reasons’, “it is important that you and your children who are able to get vaccinated are fully immunized. This not only protects your family, but also helps prevent the spread of these diseases to your friends and loved ones” (Five Important Reasons). It could go without saying that not getting proper vaccinations in a child can put the wider public at risk because not all are eligible to receive vaccinations whatever the reason may be, this could be said about any disease, if the proper vaccinations are available, one should always get them so the public can be safer and the spread of the disease can be at a minimum.

Another benefit that comes from the vaccination of children is that it can protect future generations. There have been many diseases in the past that have almost eradicated entire cities or nations, at this very moment there is a global virus that is killing thousands of people every day but once a vaccine is produced it is widely given until the virus does not exist anymore or there are little cases. This can be said about diseases, for example, such as smallpox and measles, which the vaccines were created centuries ago, and they have not affected the public health as severe as they once did. Five Important Reasons goes on to add. “If we continue vaccinating now, and vaccinating completely, parents in the future may be able to trust that some diseases of today will no longer be around to harm their children in the future (Five Important Reasons). Once a vaccine is created, it would imply that the disease or virus will no longer exist to threaten humans ever again, parents and children should not have to worry about diseases that have long since been eradicated and made obsolete.

Because technology has advanced dramatically in the last 100 years throughout history, so has medicine, now that we live in a modern world science has been able to manage ways to fight back diseases. The medical system, how vaccines are produced and created, and vaccines programs have changed tremendously comparing the early 1900s to now.

In the 1900s, vaccines were starting to be introduced into the public to try and decrease infancy deaths, and children were exposed to many different invisible dangers that were only preventable by vaccinations. As explained by Gardner and Turner: “Rather precipitous decline began in this death rate, • which, even with the introduction of penicillin in about 1940, and the Salk polio vaccine in the early 1950s, continued at the same rate until a leveling-off point about 1960” (Gardner 358). With this advancement of medicine, doctors were able to suppress deaths with these vaccinations, and fighting infancy is adolescent death expanding the average lifespan. With these widely accepted vaccinations, deaths were even more preventable, and the likeliness of getting infected also drastically dropped. Gardner and Turner go on to explain: “was the introduction during the 20th century of vaccination campaigns in the United States, which have virtually eliminated previously common diseases, including diphtheria, tetanus, polio, smallpox (considered to be eliminated worldwide), measles, mumps, rubella, and Hemophilus influenzae meningitis” (Gardner & Turner 359). With this being said, now that these diseases were now preventable, the public would begin to not worry about being infected as much as they used to, deaths were now avoidable entirely, and the number of deaths would continue to drop through the decades. With the widespread of vaccines through the ages, this would mean that vaccines were more accessible to the public as the number of cases for infectious diseases kept dropping as the decades passed. Now that they were more accessible to the public, this would undoubtedly strengthen the advancement of vaccines and the push to discover more.

Now in modern times, with the strength of our medicine and research, diseases that killed off much of the population in the 1800s and 1900s would not affect our population at all today due to the many different vaccines that exist in today’s medicine. As Barninghausen et al. would go on to explain: “The prevention of disease and death through vaccination is commonly regarded as one of the greatest public health achievements of the 20th century. Globally, coverage with all major vaccinations has drifted up since 2000. Today more than 100 million children are vaccinated annually against diseases such as diphtheria, tetanus, pertussis, tuberculosis, polio, measles, and hepatitis B” (Barninghausen et al., 12313). At the start of the 2000s, deaths by diseases that flourished in the 1900s have almost all been eradicated due to the advancement of modern medicine. Most infectious diseases are now utterly preventable if the proper vaccinations were given out. In modern times any and all vaccines for these infectious diseases are widely accessible to the public as a vaccinations program was put in place so that any family coming through a hospital or pediatrician would have access to these vaccines. As Nesson would further delve into, according to Oliver Rosenbauer, WHO communications officer for the Global Polio Eradication Initiative, “the more people who are immunized, the less possibility that the virus will spread, because there will be fewer people for it to spread to.” Though vaccinations have proven effective at reducing deaths from entirely preventable diseases, 18.7 million infants throughout the world still do not receive vaccines” (Nesson, 18). With this being said, ever since vaccinations of infectious diseases were introduced, the amount of deaths has drastically decreased, and the further advancement of these vaccinations would go on to make immunization a must in the modern world.

One of the most popular believes among the anti-vaccination community is that putting chemicals in their children’s bodies would cause a complication in the neurological system leaving their children with some disorder. As Comprehensive Primary Care states: “according to the study, some parents feel that there’s a benefit to allowing kids to experience childhood illnesses to boost immunity. Parents may also be concerned about putting chemicals in their children’s bodies and feel that vaccines are not “natural” enough” (Spark & Market). This, in all cases, would be a substantial factor if it was scientifically backed, but fortunately, it is not supported by the scientific community, therefore debunked. These chemicals would not be put into one’s body if not rigorously tested in the scientific community and made sure that no adverse side effects would ensue onto a child that is less than four years old.

A less famous but equally as influential reason would be that of religious reasons such as the parent’s religion rejecting some chemicals or even the vaccination as a whole saying it is unholy to subject to such treatments. There are some states and some specific religions that ban the use of vaccinations on children stating they are unholy or something god did not create for the child deeming it unnecessary and evil. As Comprehensive Primary Care explains: “Many states (including Virginia) offer parents a religious exemption to the vaccination requirement for attending public school. In some cases, a patient’s religious beliefs may lead them to reject some of the ingredients in vaccines or call for avoiding contemporary medical interventions” (Spark & Market). It would seem that having this mindset would make some people believe that its putting children at risk of contracting one of these diseases, but since it is due to religious reasons and religion being a strong force in this country, it would seem there could be little to be done about this. Additionally, some people believe that vaccinating children is not religiously acceptable because they believe that God did not intend for those chemicals to be in our bodies, as stated, “The body is sacred, should not receive certain chemicals or blood or tissues from animals, and should be healed by God or natural means” (Cultural Perspectives on Vaccination). Moreover, even though there are not many people who feel stopped from vaccinating because of religion, there is still a considerable amount of people whose faith is the reason that causes them not to vaccinate.

A multitude of false beliefs exists in the anti-vaccination community revolving around their personal beliefs rather than those backed by science. Some of these reasons being that a child’s immune system is strong enough to ward off against any disease that they are trying to be vaccinated against, some parents saying that home remedies will boost their immune system enough to prevent these diseases from happening. As Mckee and Bohannon state: “Some parents believe that natural immunity is better for their children than is immunity acquired through vaccinations. Others express the belief that if their child contracts a preventable disease, it will be beneficial for the child in the long term, as it will help make the child’s immune system stronger as he grows into adulthood” (Mckee & Bohannon). These beliefs have been the very base of the anti-vaccination community as most of these parents resort to using their vices to treat an ill child or just prevent the disease from happening with these home remedies.

Although many people believe that vaccines cause neurological problems and mainly autism, actually, it has been scientifically proven that there is no connection between vaccines and autism. According to Nelson, in an article by The American Journal of Nursing, “A number of studies have examined the possible link between the MMR vaccine and autism, and none has ever been found” (Nelson, 19). This statement proves that the common belief that the measles-mumps-rubella vaccine, and many others, cause autism in children is an issue that has been researched many different times, and no results have been discovered that show a correlation between vaccines and autism.

All in all, there is much compelling evidence that vaccinations have no adverse effects on children and do not lead to any neurological damage or halts the mental growth of children. It would seem that not vaccinating one’s child could be worse for the child, even leading to the death of a disease or virus that has not affected humanity for decades, putting one’s child at significant risk of contracting one of these ancient diseases or viruses. It would endanger public health for society as a whole if fatalities started to rise again for not vaccinating one’s child

We can undoubtedly say that throughout the last century, the advancement in modern medicine has definitely helped the human species survive many diseases that, if not cured, could eradicate humans in many ways. Vaccinations and immunizations have become a natural standard since, like before the 21st century, they are more accessible to the public, prevent deaths from happening by infectious diseases that are now obsolete, and prevent the initial infection from ever happening due to these immunizations and vaccinations.

Finally, as stated before, most of the reasons why parents hesitate when deciding whether to vaccinate their children or not are mainly that they believe the vaccines will cause neurological damage to the child, for example, cause autism, and vaccines have been proven not to be a cause for autism. Another essential factor is religious believes that people may have, which can prohibit them from vaccinating their children. Furthermore, an additional main reason why parents do not vaccinate their children is because of their personal beliefs and lifestyle choices, like how some parents believe that children are naturally born with proper and adequate immune systems and that a healthy lifestyle will always keep them protected. yup

Recently, the world has seen a reemergence of measles outbreaks. This disease has been on the decline ever since the introduction of the MMR vaccine. However, there is a growing minority of people who refuse to vaccinate despite the benefits of the MMR vaccine. The goal of this literature review is to understand vaccines, why people avoid vaccines, the anti-vaccination movement, and what can be done about it.

What are the dangers of avoiding vaccines?

McCarthy (2016) writes that avoiding vaccine makes you more susceptible to catching the disease. While medical advancements will help aid your healing if you catch the disease, it is still nonetheless very dangerous and could be lethal. However, not vaccinating also compromises the health of the community. The World Health Organization defines herd immunity as 95% of the population immunized (cited by Astrup, 2019). If herd immunity is maintained, the majority of the population, who are less likely to catch the bug, won’t get sick and spread it to people who cannot receive the vaccine. If less than 95% of the community is immunized, the disease could spread to people who are physically unable to receive the vaccine.

Why do parents avoid vaccines?

It’s worth noting that most parents do vaccinate their children. The anti-vaccination movement is only a small majority. In the UK, 90% of parents automatically vaccinated when their child was due, while only 2% of parents refused vaccination (Astrup, 2018).

Najera (2018) argued that the effectiveness of vaccines has virtually eliminated fear of catching an illness. Furthermore, Najera (2018) writes that most parents use Google as their source of information. Parents “get led astray by celebrities or by people and organizations that sound official” (Najera, 2018). This misinformation and fear combined with a parent’s need to protect their child have led to the rise of vaccine hesitancy. He notes that he has also faced a similar hesitation for vaccinating his child, despite his knowledge of the benefits tied to vaccines. McCarthy (2016) has argued a similar point on the invisibility of diseases. She writes “[parents] most want to talk to me about are possible side effects of the vaccine. … They rarely worry about the diseases that vaccines prevent” (McCarthy, 2016). The Royal Society for Public Health had similar findings and reports, “fear of side effects was the most common reason for choosing not to vaccinate” (cited in Astrup, 2019).

Handley (2011) reports that there is a rise in the rates of Autism in children. Since the causes of Autism are unknown, a lot of parents of autistic children are lost looking for answers. Heuvel (2013) talks about Jenny McCarthy, a celebrity who has appeared on the United States national television to discuss her views on vaccines. Parents of autistic children may agree with Jenny McCarthy’s unfounded views because they are scared, confused, or desperate.

PublicHealth.org (n.d.) says some parents may avoid vaccines because they think vaccines contain toxins. However, these are not toxins, but substances meant to boost the effectiveness of the vaccine (What goes into a vaccine? n.d.; Colorado Children’s Immunization Clinic, n.d.).

Where did the Anti-Vaccination movement originate?

Heuvel (2013) writes the origin of this movement comes from a paper published in The Lancet by Andrew Wakefield. The paper claimed there was a link between MMR vaccine and autism. Heuvel (2013) makes it very clear that this claim is entirely fabricated and false, and Wakefield’s study has been thoroughly debunked by extensive research. Despite this, the damage had been done and there has been a decrease in immunization rates. To reiterate, there is no connection between the MMR vaccine and autism. (MMR vaccine does not cause autism., 2019; Vaccine myths debunked., n.d.; Colorado Children’s Immunization Clinic, n.d.; Heuvel, 2013)

How has the Anti-Vaccination movement spread?

Heuvel (2013) writes Jenny McCarthy added fuel to the Anti-Vaccination movement. Jenny McCarthy has appeared on the Oprah Show, Larry King Live, and Good Morning America (Heuvel, 2013). Larry King Live had Jenny McCarthy debate a doctor. This implied that her disproven ideas should be given the same equivalence as those of a medical expert. Nyhan argues “‘he said’ ‘she said’ coverage simply puts ‘unsupported claims alongside credible arguments’” (cited in Heuvel, 2013). Graham & Clarke (2013) researched the effects of falsely balanced reporting of autism-vaccine controversy. They found that articles which pose both sides as equally valid reduced reader’s vaccine confidence more than articles that showed no-link between autism and vaccines. The spread of misinformation isn’t based solely on people who believe in Anti-Vaccination, but also includes journalists who don’t put the Anti-Vaccination movement in context. Journalists are then also to blame for the fueling of Anti-Vaccination, and Heuvel (2013) blames these television networks for allowing Jenny McCarthy to spread misinformation about vaccines causing autism.

Generation Rescue, Jenny McCarthy’s organization, also has a website titled “Fourteen Studies” which aims to provide evidence for the autism-vaccine link. However, do not be deceived. The studies on this website have been thoroughly disproven. Gorski (2009) published an article disputing every study. To reiterate, none of these studies were conducted properly and there is no proof of an autism-vaccine link. Autism and Vaccines have no link. There is no correlation or causal relationship.

Social media may also be another cause of the spread of anti-vaccination ideas. Astrup (2019) found that 2 in 5 parents are exposed to anti-vaccination messages on social media. For parents of children under 5 years of age this number grew to 1 in 2 parents. A poll by PHE found that one in ten parents saw information that made them question whether to vaccinate their child. (cited in Astrup, 2019) Shirley Cramer claims social media is the cause of the spread of anti-vaccination (cited in Astrup, 2019) As shown in Graham & Clarke’s (2013) study, false equivalence is enough to reduce reader confidence in vaccines. Xu, Ellis, & Umphrey (2019) also found in a study that Anti-Vaccination articles tend to be more engaging than Pro-Vaccination counterparts. It is easy to be exposed to misinformation on social media, parents may begin to doubt whether to vaccinate their children or not.

What is being done and how can we combat the Anti-Vaccination movement?

As getting more people immunized increases the overall benefit of the community, many countries are treating immunizations as a public health issue. As such, countries are tackling this problem in a range of ways.

Scutti (2018) writes that Australia has the “no jab, no play” policy. Failure to comply removes government benefits and welfare rebates for parents of unvaccinated children, and child-care centers and preschool facilities cannot accept their unvaccinated children. What they have seen in Australia are the immunization levels rise to above 95%, the World Health Organization’s definition for herd immunity. Yet, there are still a small amount refusing to vaccinate their children. This could pose a bigger problem as “unvaccinated people tend to cluster in certain locations. This can decrease vaccination rates in some locations to below the necessary herd immunity percentage” (Scutti, 2018). Leask writes that,

They are children with a right to education and family support payments like any other eligible child…a low-quality child-care market may be growing in support of the families who forfeit benefits to uphold their anti-vaccination beliefs (cited in Scutti, 2018). While the overall community of Australia sees higher immunization rates, it may become increasingly difficult to reach those who firmly believe in Anti-Vaccination.

Scutti (2018) also writes Italy are also using punitive measures to counter the decrease in immunization rates. Italy requires “proof of vaccination when enrolling their children in government-run nurseries or preschools” and “parents of children who have not been vaccinated will be fined” (Scutti, 2018). Astrup (2018) notes that compulsory vaccinations are a highly controversial idea. Germany moves away from compulsory vaccination by requiring proof of vaccination counseling attendance before enrolling children. Schools are not required to report parents who have not been counseled by doctors (Scutti, 2018). The United Kingdom considered compulsory vaccinations, however they have decided to use non-punitive measures. The British Medical Association is calling for instead “’increasing efforts to improve awareness’… ‘sufficient funding to deliver fully resourced vaccination services’” (cited in Astrup, 2018). Larson notes that “Generally, European nations tend to prefer voluntary vaccination to mandates.” Furthermore, as schooling and health care get better, there “are clear trends reflecting more questioning about vaccines,” (cited in Scutti, 2018).

In the United States, up-to-date vaccinations are required for children to attend school. Although some states allow medical, religious, and philosophic exemptions. While this does increase immunization rates, you see similarly from Australia, parents who believe their children have the right to attend school. Lahey writes that parents “can feel like being encouraged to get immunizations gives them a loss of control” (cited by Scutti, 2018).

It’s important to note that there will always be a small minority who refuse to vaccinate, or physically cannot receive the vaccine. However, as noted by Najera (2018), most parents are in the middle. Simply hesitant about vaccines. Astrup (2018) writes that forcing parents who are on the fence to vaccinate their children may push them to become Anti-Vaxxers. The general public still trust their medical provider for advice (Astrup, 2019). Medical providers should answer parent’s questions and concerns and build trustful relationships. Brewer says, “Most parents just want to know that (vaccination) is something a provider recommends.” Brewer and his colleagues created “the announce approach, where physicians start off with just announcing a child is due – a presumptive announcement,” (cited in Scutti, 2018).

The infrastructure for receiving vaccines is also not very effective. Recordkeeping, appointment management, appointment reminders are outdated in most areas, Brewer writes. Improvement in this field would receiving vaccinations more convenient. Brewer also writes that the government directly reaching out to parents using promotional campaigns aren’t effective. However, “if someone in your social circle… puts vaccination forward as a ‘social norm, that does seem to encourage people to be more likely to get vaccination’” (cited in Scutti, 2018).

So, while medical professionals may have a lot of power in convincing parents to vaccinate their children, the general public can also help as well. Do not treat vaccine-hesitant parents with condescension, that will only push them further to one side. Instead respond with understanding, because most parents only want the best for their child. It also goes to note that you should try limit the spread of anti-vaccination messages on social media. Sometimes, sharing an article with commentary may send it into the hands of someone who may begin to agree with the ideas. While good intentioned, sharing may do more harm than good. The Anti-Vaccination is still small and by being mindful and understanding you can help stop the spread of the Anti-Vaccination movement.

References

1. Astrup, J. (2018). Mandatory vaccinations? Community Practitioner, 91(2), 14-16. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=128716019&site=eds-live&scope=site&custid=s3818721
2. Astrup, J. (2019). Catching the anti-vax bug. Community Practitioner, 92(5), 14-17. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=136738689&site=eds-live&scope=site&custid=s3818721
3. Colorado Children’s Immunization Clinic. (n.d.a). Aluminum | immunize for good. Retrieved from http://www.immunizeforgood.com/fact-or-fiction/aluminum
4. Colorado Children’s Immunization Clinic. (n.d.b). Autism | immunize for good. Retrieved from http://www.immunizeforgood.com/fact-or-fiction/autism
5. Dixon, G., & Clarke, C. (2013). The effect of falsely balanced reporting of the autism–vaccine controversy on vaccine safety perceptions and behavioral intentions. Health Education Research, 28(2), 352-359. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=104254763&site=eds-live&scope=site&custid=s3818721
6. Gorski, D. (2009). Welcome back, my friends, to the show that never ends, part II: Generation rescue, the anti-vaccine propaganda machine, and “Fourteen studies”. Retrieved from https://sciencebasedmedicine.org/welcome-back-my-friends-to-the-show-that-never-ends-part-ii-generation-rescue-attacks-14-studies/
7. Handley, J. B. (2009). Autism is preventable and reversible. Larry king live blogs () Retrieved from https://link.gale.com/apps/doc/EJ3010133274/OVIC?u=usfca_gleeson&sid=OVIC&xid=000d7ce6
8. Heuvel, K. v. (2013). Jenny McCarthy’s vaccination fear-mongering and the cult of false equivalence. Nation () Retrieved from https://link.gale.com/apps/doc/EJ3010938209/OVIC?u=usfca_gleeson&sid=OVIC&xid=ff05cafb
9. Jamison, A. M., Quinn, S. C., Qi, S. H., AlKulaib, L., Chen, T., Benton, A., . . . Broniatowski, D. A. (2018). Weaponized health communication: Twitter bots and russian trolls amplify the vaccine debate. American Journal of Public Health, (10), 1378. doi:10.2105/AJPH.2018.304567
10. McCarthy, C. (2016). The inconvenient truth of vaccine refusal. Retrieved from https://www.health.harvard.edu/blog/the-inconvenient-truth-of-vaccine-refusal-201603229426
11. MMR vaccine does not cause autism. (2019). Journal of Paediatrics and Child Health, (8), 996. doi:10.1111/jpc.14509
12. Rene F., N. (2018). In defense of the common anti-vaxxer | history of vaccines. Retrieved from https://www.historyofvaccines.org/content/blog/defense-of-common-antivaxxer
13. Scutti, S. (2018). Encouraging vaccination around the world. Retrieved from https://www.cnn.com/2017/06/06/health/vaccine-uptake-incentives/index.html
14. Vaccine myths debunked. (n.d.). Retrieved from https://www.publichealth.org/public-awareness/understanding-vaccines/vaccine-myths-debunked/
15. What goes into a vaccine? (n.d.). Retrieved from https://www.publichealth.org/public-awareness/understanding-vaccines/goes-vaccine/
16. Xu, Z., Ellis, L., & Umphrey, L. R. (2019). The easier the better? comparing the readability and engagement of online pro- and anti-vaccination articles. Health Education & Behavior, 46(5), 790-797. doi:10.1177/1090198119853614

The health of an individual is important for a variety reasons such as well-being and longer lifespans but will all the aliments in the world there some that are worse than others such as measles. The recent measles resurgence has involved the past decade, but the year of 2019 has shown outbreaks increasing at a significant rate including six that have happened just in 2019 alone (Bortz, 2019b, p.9). The importance of mandatory vaccinations for healthy medically able children is a major step not only in protecting them but also the people who are unable to get vaccinations. Mandatory vaccinations increase the collective health of our communities by preventing outbreaks of diseases that used to be catastrophic.

The outbreaks have not always been the way they are now such as in the year 2000, the usage of vaccinations had made the disease considered eliminated in the United States (Bortz, 2019b, p.1). Due to below recommended vaccine coverage rates outside of the U.S., Europe has also experienced a spread of measles throughout the continent with over 14,000 cases from 2016 to June of 2017 (Astrup, 2018, p.14). Before the invention of the measles vaccination the outbreaks were not so different in scale according to Russell (2019) who states, “…epidemics in large population centers occurred every 2 to 3 years, and 95% of children were immune by age 15 years” (p.1835). The number of outbreaks today that were caused by a proposed “eliminated” disease is frustrating as there is a tool available to people that can help prevent the disasters from happening in the first place.

The origin of the first measles vaccine came from a boy named David Edmonston in 1954. The original vaccine while causing measle-like symptoms to the recipients for a short period of time was a crucial step towards developing the modern measle vaccine used today (Russell, 2019, p.1836). Another example of a vaccine with similar life saving capabilities is the smallpox vaccine as with the removal of smallpox with aggressive vaccination programs, lives were saved and overall health of populations increased(Astrup, 2018, p,14). All good things must come to end as Stulpin (2019) remarks “Measles cases have surged worldwide amid a growth in anti-vaccine sentiment and gaps in vaccination coverage” (p.20). Ensuring the education and stance changing for the members of anti-vaccine groups is crucial to changing the disease spreading throughout the civilized world.

With all the lives saved by vaccination programs, the purpose seems to be simple, to increase the overall health of a population and ultimately save lives. The amount of lives saved by vaccination programs is upwards of two to three million every year according to the World Health Organization (Mallory, 2018, p.64). However, the lives saved could easily be overshadowed by the concerning fragility of overall vaccine coverage according to research by JAMA pediatrics in Bortz (2019b) which states, “Even slight reductions in measles, mumps and rubella (MMR) vaccine coverage caused by vaccine hesitancy could result in a threefold increase in measles case…” (p.1,8). Another point made by JAMA pediatrics was the lower the MMR vaccine use, as the lower use and coverage is a greater risk to measles for children ages 2 to 11 (Bortz, 2019a, p.12). All the information points toward the conclusion that vaccine use is highly important, but the people in charge of children receiving the vaccines are not always looking for incite on vaccine use towards are accurate or credible places such as social media.

While social media itself is not a source for all things evil, there does exist a potential for the widely used platform to be a place for spreading information that anyone can produce with little to no effort or credibility required. The concern to the use of social media to learn about vaccines is best described in Larson (2018) which states, “The deluge of conflicting information, misinformation and manipulated information on social media should be recognized as a global public-health threat” (p.309). If the information on social media is such an issue then possibly just giving hard facts on social media would solve the problem, however, when Ethan Lindenberger, a child of an anti-vaccination household spoke to the Senate about how his parents don’t rely on statistical information is because they believe heavily in anecdotal evidence because the information comes from real people they may know in the community (Bortz, 2019a, p.12). So while social media use and overreliance on anecdotal evidence are a major problem, a point was made by Saad Omer, experienced member of vaccine research in the U.S. at the same Senate meeting calling out that physicians allow an opportunity for people regardless of their positions of vaccines to learn and are commonly seen as the most trusted source for medical information (Bortz, 2019a, p.12). The knowledge and experience physicians have is important to providing an informative experience but, high ranking members of the medical scientific community have also caused many issues for vaccine acceptance.

One issue has stood among others as a prime example of why parents have such strong hesitancy toward vaccines. The link between Autism spectrum disorder to MMR vaccination use has plagued the vaccination movement for years. When looking at what causes the most fear when people get involved in understanding science, Larson (2018) states, “Among the most damaging is bad science: people with medical credentials stoking overblown or unfounded fears” (p.309). One of those people who at one point had medical credentials was Andrew Wakefield, a scientist who published a study that linked autism to use of the MMR vaccine. The study was supported by prominent figures in the U.S. government such as Robert F. Kennedy Jr. who was a possible candidate assigned by Donald trump to chair a commission on vaccine safety (Bortz, 2019b, p.10). From 2004 to 2014, the Somalian American population around the city of Minneapolis, Minnesota had a decrease of 50% of MMR vaccinations. The decrease was due to concerns of higher than expected autism levels in their community, but according to as study by the University of Minnesota in Dyer (2017) which stated, “… Somali children were statistically similar to those in white children although lower than in Hispanic and other black children” (p.1). After the decrease in MMR vaccines had been going on for some time the rates of autism did not change. Even after the measles outbreaks in the Somalian American community, Andrew Wakefield, a speaker at several anti-vaccine meetings in the community stated to the Washington Post in Dyer (2019), “I don’t feel responsible at all” (p.1).

Parents are the people with the most responsibility in whether their child get vaccinated, but with the use of vaccine exemptions, a parent can evade a major hurdle for their child’s ability to participate in the public-school system. States allowing exemptions including several in the Northwest, Southwest, and sections of the Midwest for philosophical and personal reasons are becoming hot spots for high exemption rates. States can have two and a half times the amount of exemptions than states with only religious and medical exemptions only (Bortz, 2019b, p.1,8). Anti-vaccine groups such as the Canary Party abused the use of exemptions when they proposed to members of the Somalian American community to obtain philosophical objects to evade requirements of public services in the state of Minnesota (Dyer, 2017, p.1). The importance of the use of exemptions should be used for medical reasons such as the CDC states in Bortz (2019b), “…people who have had a life-threatening allergic reaction to a component of the vaccine; people living with HIV/AIDS or another disease that affects the immune system; people who are treated with drugs that affect the immune system; and people who have any kind of cancer, who are being treated for cancer with radiation or drugs or who have a blood disorder” (p.8). Medical exemptions have a purpose for protecting those from complications, but since they cannot get vaccinated, the people who are able to get vaccinated can protect them by means of herd immunity.

Herd immunity is crucial in protection of the people who are not able to get vaccinated due to medical reasons. The concept of herd immunity is best described in Mallory (2018) which states, “…immunization of large portions of the population to protect the unvaccinated, immunocompromised, and immunologically naive by reducing the number of susceptible hosts to a level less than the threshold needed for transmission” (p.64). However, to ensure herd immunity to be minimally effective, a population’s vaccination status must be at least 95% (Astrup, 2018, p.14). With the importance of high levels of vaccination coverage to maintain herd immunity, Offit in Bortz (2019b) compares the recent resurgence of measles to “the canary in the coal mine” (p.8). The canary is used to ensure the safety of miners by seeing if a canary will return after being released into a mine shaft. For measles the connection is that as herd immunity declines, unvaccinated people entering areas of outbreaks may become infected due to lower vaccine coverage levels.

The places where the outbreaks are located are generally groups of people of similar stance on vaccinations and exemptions. The places where outbreaks are occurring according to the CDC in Bortz (2019b) who states, “…have consistently tracked with communities of lower immunization rates” (p.8). A reason why the areas are susceptible is mentioned in a study done by Hotez in Bortz (2019b) which states, “In areas with high rates of nonmedical vaccine exemptions, the researchers observed low rates of MMR vaccine coverage, leaving unvaccinated residents susceptible to disease if an outbreak were to occur” (p.8). The CDC also mentioned in the same article that the origin of where measles come from are travelers from outside countries who are linked to transmission of measles (Bortz, 2019b, p.9). The connections to communities of outbreaks and communities of unvaccinated people is certainly a cause for concern as being apart of a group is important to many people.

A study showing if there is a link between autism and MMR vaccine was done in a study on the comparison of Autism Spectrum Disorders with MMR vaccine use of children with siblings who do or do not have Autism Spectrum Disorder by Jain, Marshall, Buikema, Bancroft, Kelly, and Newschaffer (2015) Data was used from Children from the US with commercial insurance or Medicare from the period of 2001 to the end of 2007. Information from status of the child and their older siblings with or without 2 claims of Autism Spectrum Disorder was also used. Their finding showed there was no substantial difference between individuals with children who have MMR vaccine with older siblings with Autism Spectrum Disorder and those without MMR vaccine with older siblings with ASD (p.1535). A limitation for the study was only children with commercial insurance or Medicare were considered with no information on children without insurance is examined.

A study done to see the effect of current vaccination requirements compared to those of strict compulsory polices on measles susceptibility in high-wealth countries using simulations from 2018-2050 by Trentini, Poletti, Melegaro, and Merler (2019) Data from birth rates and mortality rates by country and transmission rates of measles for a population were used (p.2-3). Their findings showed vaccination policies in the U.S., U.K., Ireland, and Australia do not meet the required coverage to meet the 95% herd immunity standard (p.5). They also found compulsory vaccination polies would allow for countries to increase overall coverage to the herd immunity threshold and therefore lead to measle elimination. The major limitation for the study was the scope of when, where, and how large a measles epidemic can occur is challenging as well.

A study on the effect of the political party preference of an individual can increase their use of Personal Belief Exemptions for avoiding mandatory vaccine requirements in public schools from 2000 to 2015 was done by Estep (2018, p.4298). Information from Personal Belief Exemptions [PBE] for kindergarten in California public schools which included 6348 schools. Also, data from California Republican and Democratic registrations and statistics from voting data and their approximate location was used (p.4299). According to the findings, the more a community aligned with the Republican party, the amount of Personal Belief Exemptions increased over the period from 2000 to 2015. Along with the information it was found after the introduction of AB 2109 requiring parents to request a Personal Belief Exemption after visiting a health care professional, all groups regardless of political alinement lowered their use of exemptions (p.4300). The limitations of the study included the issue with the use of political party preference does not specifically allow for understand which belief play a role in vaccine hesitancy. Another limitation was the use of only California public elementary school measurements instead of all school levels including private schools (p. 4302-4303).

The recent resurgence of the measles disease is certainly difficult to combat due to how widespread the disease is and where outbreaks may occur, however, understanding the concepts of the research done to help support the use of vaccines is crucial to informing people about what they can do to help prevent outbreaks. Healthy people who can get vaccinated should be required to do as the choice to not get vaccinated is one that not only is dangerous to themselves, but to those who are not medically able to be vaccinated. Some people will feel the requirements are hurting their right to personal freedom, but spreading measles by transmission of their unvaccinated bodies, they take away the rights of those who may not survive a measles outbreak.

References

1. Astrup, J. (2018). Mandatory vaccinations? The journal of the health visitors’ association. Community Practitioner, 91(2), 14-16. Retrieved from https://login.glacier. sou.edu/login?url=https://search.proquest.com/docview/2023683759?accountid=26242
2. Bortz, K. (2019a). Senate committee warned about harms of vaccine hesitancy. Infectious Diseases in Children, 32(4), 12. Retrieved from https://login.glacier.sou.edu/login ?url=https://search.proquest.com/docview/2215508581?accountid=26242
3. Bortz, K. (2019b). Nonmedical vaccine exemptions ‘violate’ a ‘fundamental right’ of children. Infectious Diseases in Children, 32(4), 1-10. Retrieved from https://login. glacier.sou.edu/login?url=https://search.proquest.com/docview/2215508736?accountid=26242
4. Dyer, O. (2017). Measles outbreak in Somali American community follows anti-vaccine talks. BMJ : British Medical Journal (Online), 357 doi: http://dx.doi.org/10. 1136/bmj.j2378
5. Estep, K. A. (2018). Neighborhood political composition and personal belief exemptions from immunization requirements in California kindergartens, 2000–2015. Vaccine, 36(29), 4298-4303. doi:http://dx.doi.org/10.1016/j.vaccine.2018.05.108
6. Jain, A., Marshall, J., Buikema, A., Bancroft, T., Kelly, J. P., & Newschaffer, C. J. (2015). Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. Jama, 313(15), 1534. doi: 10.1001/jama.2015.3077
7. Larson, H. (2018). The biggest pandemic risk? Viral misinformation. Nature, 562(7727), 309. doi:http://dx.doi.org/10.1038/d41586-018-07034-4
8. Mallory, M. L., Lindesmith, L. C., & Baric, R. S. (2018). Vaccination-induced herd immunity: Successes and challenges. Journal of Allergy and Clinical Immunology, 142(1), 64-66. doi:http://dx.doi.org/10.1016/j.jaci.2018.05.007
9. Russell, Stephen J,M.D., PhD., Babovic-Vuksanovic, D., Bexon, A., M.D., Cattaneo, R., PhD., Dingli, David,M.D., PhD., Dispenzieri, A., M.D., . . . Peng, K., PhD. (2019). Oncolytic measles virotherapy and opposition to measles vaccination. Mayo Clinic Proceedings, 94(9), 1834-1839. doi:http://dx.doi.org/10.1016/j.mayocp.2019.05.006
10. Stulpin, C., & Hotez, Peter J, M.D., PhD. (2019). Mandatory school vaccination could keep measles at bay, study suggests. Infectious Diseases in Children, 32(7), 20. Retrieved from https://login.glacier.sou.edu/login?url=https://search.proquest.com/docview/2258090705?accountid=26242
11. Trentini, F., Poletti, P., Melegaro, A., & Merler, S. (2019). The introduction of ‘No jab, no school’ policy and the refinement of measles immunisation strategies in high-income countries. BMC Medicine, 17 doi:http://dx.doi.org/10.1186/s12916-019-1318-5

INTRODUCTION

Nutrition is the study of food in relation to health. Adults require the same type of nutrients such as proteins, carbohydrates, vitamins, minerals and fats but children however, need different amounts of specific nutrients at different ages for the child’s growth. Due to this, the need for dietary guidelines are set for all age groups and sometimes gender .The child category can be divided into 3 ; an infant stage , childhood stage and adolescent stage.

INFANCY

Babies at this age can be breast fed for the first six months without any solid food incorporation because the breast milk contains all the optimal nutrient mix for the infant. Breast milk has antibodies, antimicrobial factors, enzymes, and anti-inflammatory factors along with fatty acids (which promote optimal brain development). Two benefits of breastfeeding are for both the infant and mother;

1. Breast feeding helps the baby develop and grow without complications and fight off diseases such as gastrointestinal and respiratory infections.
2. It helps stimulates the release of beneficial hormones such as oxytocin and prolactin, which helps the mother lose weight and bond with her baby.

Breast milk or infant formula is the only nourishment needed by most healthy babies until they are 4-6 months old. Cow’s milk or other dairy products should not be given until at least one year of age. Breastfeeding is recommended to begin within the first hour of a baby life and continue as often and as much as the baby wants. During the first few weeks of life babies may nurse roughly every two to three hours, and the duration of a feeding is usually ten to fifteen minutes on each breast.

An infant that receives exclusively breast milk for the first six months rarely needs additional vitamins or minerals. However, vitamins D and B12 may be needed if the breastfeeding mother does not have a proper intake of these vitamins. The infant may now be introduced to solid food at 6 months and should be preferably consume solid food with iron since the iron the infant stored from the womb will have been depleted at 6 months.

Using formula

This form of nutrition may be used instead of breast milk due to life style choices or the fact that other women cannot breast feed due to pathological reasons .An infant who may have an allergy or may be premature may get a formula specific for their state not forgetting the lactose intolerant babies who may turn to soy based formulas or lactose free formulas.

The formulas can be consumed in the following quantities;

Newborns consume half an ounce for the first 2 days after birth but will gradually increase to 1 or 3 ounces until 2 weeks after birth. They will begin to drink 2 to 3 ounces.

• Babies at 2 months of age will begin to drink 4 to 5 ounces every 3 to 4 hours
• A 4 month old baby should drink 4-6 ounces every 4 hours.
• A 6 month old should drink 6-8 ounces every 4–5 hours.

CHILHOOD PERIOD [2-11 YEARS]

This includes children who have started school and require to eat healthy in order to nourish the brain since their brains are rapidly developing and without the right nutrients they might struggle to develop the skill of concentration.

A toddler whose age is between 2 to 3 years there servings is as follows;

1. Grains and cereals is 3-4 ounces
2. Fruits 1to one and a half cups
3. Vegetables is 1-2 cups
4. Meat and beans 2-4 ounces
5. Dairy is 2 cups

When choosing proteins, consider lean meat, sea food, poultry, eggs, beans, soya products and unsalted nuts and seeds for maintenance and building of body tissues. When it comes to fruits variety of fresh, canned, frozen or dried fruits are preferred rather than fruit juice.

Serve a variety of fresh, canned, frozen or dried vegetables. Aim to provide a variety of vegetables, including dark green, red and orange, beans and peas, starchy and others, each week. The grains should be whole-wheat bread, oatmeal, popcorn, quinoa, or brown or wild rice and limit refined grains such as white bread, pasta and rice. Dairy should be fat-free or have low-fat for example milk, yogurt, cheese or fortified soy beverages.

ADOLECENT [12-18 YEARS]

In this stage a surge of appetite is noted in both genders and eating healthy is important as body changes hence need healthy food to meet their growth needs. The best way an adolescent can maintain a healthy weight is to eat a diet rich in whole grains, fruits, vegetables, no-fat or low-fat milk products, beans, eggs, fish, nuts, and lean meats.

This includes a meal with the following quantities;

• Fruits and vegetables every day where the serving should be 2 cups of fruit and 2 ½ cups of vegetables every day.
• Proteins should be 5½ ounces of protein-rich foods every day from good sources such as lean meat, poultry, or fish.
• Iron-rich foods example lean beef, iron-fortified cereals and breads, dried beans and peas, or spinach are good sources of iron. For boys , they double their lean body mass between the ages of 10 and 17, needing iron to support their growth on the other hand girls need iron for growth too, and to replace blood they lose through menstruation.

Adolescents should limit their fat intake to 25 to 35 percent of their total calories every day and they should choose unsaturated fats over saturated fats. Healthier, unsaturated fats include olive, canola, safflower, sunflower, corn, and soybean oils; fatty, cold water fish like salmon, trout, tuna, and whitefish; and nuts and seeds.

When it comes to dairy, three 1-cup servings of low-fat or fat-free calcium-rich foods every day are advised. Good sources include yogurt or milk which is a good source of calcium. Apart from dairy, drinking a lot of water should be observed since children at this age engage in a lot of physical activities hence need to hydrate enough.

CONCULUSION

Nutrition is important at every age .Children need proper nutrients to stay and grow up healthy and strong. Nutrition for children can also help establish a foundation for healthy eating habits and nutritional knowledge that a child can apply throughout life.

REFFERENCES

1. https://www.mana.md/the-importance-of-child-nutrition/
2. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team; Humphrey, J. H.; Jones, A. D.; Manges, A.; Mangwadu, G.; Maluccio, J. A.; Mbuya, M. N.; Moulton, L. H.; Ntozini, R.; Prendergast, A. J.; Stoltzfus, R. J.; Tielsch, J. M. (2015-11-24).

The contemporary issues of care and protection of children and surrogacy in the Australian legal system have led to the establishment of both legal and non-legal mechanisms in response to this matter. Many families and its members go through depraving situations sometimes together and sometimes on their own as individuals. These issues are what the law aims to demonstrate its effectiveness in as a source of aid as well as protecting individuals’ rights however there are many factors, legislation and unexpected mishaps that occur and prove the law to be quite inefficient in tackling such issues. There are legal instruments used to aid and/or combat care and protection of children and surrogacy in the Australian legal system which includes the courts, legislation and legal organizations, however there are people who have their own opinions, and many of those feel the need to voice their own as they may believe its importance is too much to keep quiet about. As a result, many non-legal mechanisms have also been established to aid and/or combat the care and protection of children and surrogacy including namely; Surrogacy Australia, the media, NGO’s and lobby groups.

Currently, commercial surrogacy is illegal in NSW under the Assisted Reproductive Technology Act 2007 (NSW). The costs of Assisted Reproductive Technology are quite high at $55,000 – $75,000 on average according to Surrogacy Australia, and the law does not provide much support, therefore, proving a lack of resource efficiency in this area of the law. However, if people decide to go through with the process regardless of these high costs and if you are a woman below 40 years of age you have a 16-27% chance of having a successful live birth according to the Victoria State Government, meaning multiple attempts would be necessary to achieve the goal of a child. These statistics prove this legal mechanism to be an ineffective way of achieving freedom from being surrogate as the likelihood of success is slim as well as time-consuming and expensive.

There are also inconsistencies between jurisdictions in Australia’s states. For example, the Northern Territory does not have any laws regarding surrogacy making it completely legal whereas in New South Wales as previously mentioned, commercial surrogacy is illegal. This conflicting legislation, as a result, increases the ineffectiveness of law regarding surrogacy because it creates inequalities between state legislation.

According to the ‘Status of Children Act 1996’ (NSW) which created the ‘presumption of paternity’, when a woman becomes pregnant by using donor sperm from someone other than her husband, the man is presumed not the father of the child born. This ideology was widely accepted by sperm donors however they defend themselves against any responsibilities an actual guardian as a father would have over the sperm donation recipient’s child. In the, B v J (1996) case, the father refused to pay any sort of maintenance arguing that the child was not his and that maintenance was the sperm donor’s responsibility rather than his too, however the court rejected this argument under ‘presumption of paternity’ clause created by the ‘Status of Children Act 1996’ (NSW), which proves the effectiveness of courts in maintaining consistency with legislation ultimately achieving equality and justice for all.

Although the court has demonstrated its effectiveness inconsistency with legislation there was also a case which proved its ineffectiveness where, Re Evelyn (1998), a birth surrogate mother removed her baby from prospective parents after 7 months. The court was exposed to its incapability in this kind of matter in the way it couldn’t do anything due to a lack of enforcement mechanisms and lack of binding legislation. The law’s ineffectiveness does not end in that kind of case but also has been ineffective in clarifying the rights and responsibilities of commissioning parents and birth parents and the rights of the child. This shows that there is much of a need for law reform as these cases have proven to show that there are many loose ends in finding justice for those abiding by the law.

Surrogacy Australia is an NGO which aims to progress the rights, social and legal status of Australians using surrogacy overseas and within Australia support surrogacy as an effective means for infertile adults to have children and raise a family. It also supports the idea that surrogacy does not necessarily have any long-lasting effects on the surrogate mother and child. Surrogacy Australia has been able to align with politicians to educate people on such information and lobby for laws which protect surrogates. This has proven the effectiveness of this non-legal response to surrogacy in supporting its future by being able to give people the privilege to raise a child.

There are many non-legal lobby groups like ‘stop surrogacy now’ that have chosen to oppose surrogacy as it gives a means of same-sex couples raising children as they argue that parents of the same sex face difficulties ranging from problems accompanying small child of the opposite sex to a public toilet to social stigma. These lobby groups also believe that surrogacy is “indistinguishable from the buying and selling of children” and will have a notable impact on the child/children in their future. This is understood to be one of the key values of the Convention on the Rights of the Child (CROC) where all actions concerning children should be firstly in the best interests of the child then others involved may follow as secondary and tertiary considerations. This shows the effectiveness of ‘stop surrogacy now’ as a non-legal lobby group due to the support and backing of human rights in their cause.

Similar groups tend to focus on using the media to oppose surrogacy and birth technologies to raise the issues of inequity and injustice and strongly express concerns of dehumanization. Although, these methods of opposition against surrogacy are undermined due to lack of other organization support demonstrating that “strength in numbers” is key for success in this area of practice. In saying this, it is fact that these non-legal lobby groups can be effective through the backing of international law but are ineffective in comparison to other legal responses in opposing surrogacy as they lack the ability to enforce their values due to them not being legally binding. However, when united with supporting media mechanisms , these non-legal lobby groups prove their effectiveness in promoting surrogacy as shown in media intervention regarding surrogacy in an article on ‘Online Opinion’ which states there is no absolute barrier to conception, which can be proved and that there has also been an uprise in concerns about long term health risks for children of IVF as a foundation of reason for strict laws pertaining to surrogacy.

Certain professionals are required to report to Family and Community Services if they suspect child abuse, and a caseworker will make an assessment to determine the extent of risk. A child assigned to a caseworker is supposed to be receiving medical attention, however, in 2007, more than 150 children who have previously been reported to Community Service died at the hands of their abusive parent or carer and also approximately 150 children that have been reported to DOCS (FACS) as being at the risk of harm have died at the hands of abusive parent or carer most aged less than 4 years. This is due to low financial resources being assigned to the Department of Community Services (DOCS) not allowing them to protect and support victims of child abuse effectively proving resource inefficiency and altogether inefficiency as a non-legal mechanism.

The Children’s Commissioner, considering such detrimental statistics, has now established ‘monitor state programs’ to resolve the issue of child abuse and strengthen existing child protection proposing a national framework for child protection. As a result under the newly formed ‘Child Protection (Working with Children) Act 2012’ , a child is placed in the protection of people who work with children and background police checks are done to assess whether the person is unable to care and protect the child while being employed through a ‘Working with Children Check’ for further support. This shows the laws attempt in resolving these conflicts by protecting children rights against unjust crimes but also displayed a lack of responsiveness as it took around 5-6 years to make this legislation work and as a result showing its level of effectiveness and ineffectiveness in response to this crucial societal issue.

Around 2 years later an article was published by ABC News April 2014 titled, ‘Vulnerable children getting lost in NSW child protection system’ which reported that an ombudsman declared that 21% of children at risk of severe harm had face-to-face contact with a caseworker in 2011 compared to 29% in 2014. Regardless of this improvement, still more than 2/3 of children in DOCS were not given a chance for face-to-face interviewing and assessment proving a lack of balance in rights for all children who need such a service as well as poor accessibility which forces the rest to remain lost in a seemingly hopeless system. Further failure of the system is shown in the article by SMH 2013 titled ‘Case workers unable to cope with workers’ which outlines the failure to protect vulnerable children against, in this case, Donna Deaves who pleaded guilty to the manslaughter of 2-year-old Tanilba Warrick-Deaves. All this clearly shows that even after multiple changes and law reform the ineffectiveness of DOCS as a legal mechanism in achieving just outcomes for the care and protection of children is still present and dominating any sense of effectiveness that has been previously proven to work.

Just like in any case of an important contemporary issue, there are always non-legal mechanisms standing up for what they believe should be done in the matter. In the case of caring and protecting children, organizations such as the Salvation Army provide extensive support and educational services to children in need such as childcare centers, counseling services, and emergency housing. Due to the salvation army being a nongovernmental organization they lack the capability to enforce and spread their aid to where it’s needed due to it not being legally binding as well as lacking financial support necessary to make it work. Instead, they utilize the media to raise issues of inequity and injustice proving its effectiveness as a not so large non-legal mechanism through using the media as the media commonly popularises any cases regarding the care and protection of children because of how important it is universally accepted to be as a contemporary issue.

Another non-legal mechanism that fights for the care and protection of children is the ‘Kids Helpline’ which is a counseling service for young people between 5-25 years freely offered through phone calls, emails and over the internet contact. They focus on helping people with relationship problems, drug and alcohol abuse, depression, etc. The fact that it is a free and willing open source for assistance makes it a very accessible form of aid in caring for and protecting children from making wrong decisions. The helpline has shown its effectiveness in having responded, helped and ultimately bettered over 8 million callers making it a reliable way of help for those in need. Furthermore, this proves its effectiveness as a non-legal mechanism and as a result achieving just outcomes for children or youth who reach out to them for support.

The media proves its effectiveness as a non-legal mechanism against the mistreatment of children through articles which can reach out to a large audience. This is shown in an article called ‘Big Rise in child abuse reports’ by Yahoo News were in September 2012; there was an increase of 50% in reports of child abuse and neglect to the Department of Child Protection. The Minister of the organization Robyn McSweeney stated that this may be due to lack of “moral force” in nongovernment organizations which then again outlines the ineffectiveness of enforcement of the media as a non-legal mechanism.

To conclude, both legal and non-legal instruments used to combat and aid care and protection of children and surrogacy in the Australian legal system including the courts, media, legal organisations and non-governmental organisations have proven to be both effective and ineffective methods in fighting injustices and/or supporting the wishes of people in need within these two major contemporary issues.

The controversy of whether parents should have the right to abstain from vaccinating their children, has become a prominent debate in the media. As it stands, parents legally have the choice to not vaccinate their children. The controversial arguments surrounding this topic have been heightened particularly by the recent reappearance of illnesses which have not been diagnosed for years, as a result of the slight decline of vaccination rates. The ethical issue in this case, is that an unvaccinated child could potentially contract an illness which in turn could spread to other children, thus creating a continuous cycle of illness which could have easily been avoided with a vaccination. Those who oppose making child vaccinations compulsory, argue that it is a human right to have authority over the way in which they choose to raise their child, and that vaccinations present a potential risk of autism. The moral beliefs of various religious and cultural groups present differing views on the controversy, for example the Catholic Church recognizes the value of vaccine while Christian Scientists do not support medical intervention.

The ethical theory of utilitarianism can be applied to the view that vaccinations should be mandatory. Utilitarianism centers on the belief that an action should be performed to result in the benefit of the majority. Many pro-vaccinators adopt the ideals of utilitarianism in their arguments. They believe that vaccinations are designed to prevent illness for the majority and in turn, preserve the health and well-being of the society in general. Those in favour of mandatory vaccinations adopt the viewpoint that the wishes of a small minority (anti vaccinators), are far outweighed by the benefit which would be delivered to the vast majority. This utilitarian standpoint is shared by several religious groups including Catholicism, Buddhism and the Jewish religion and Islamic religion. While each of these religions’ standpoints on vaccination is slightly ambiguous due to the recent dating of vaccination use, the morals of each religion seem to support vaccinations. Catholics, Buddhists, Jews and Islamics generally support the use of vaccinations for the same principle: that vaccinations posses the ability to preserve life. In saying this, neither of these religions explicitly believes that vaccinations should be compulsory.

In contrast, those who oppose making vaccinations compulsory for children argue that it is the right of the parent to choose how they wish to raise and protect their child. The ethical ideology of ethical subjectivism supports this point of view. Ethical subjectivism is the view that moral truths exist, but they are determined by the individual. Thus, if an individual possesses a certain view point, this opinion is considered morally subjective and cannot be considered ‘incorrect.’ Relativism could also apply to the viewpoint that vaccinations should not e compulsory for children. Relativism is define by the belief that knowledge, truth, and morality exist in relation to culture, society, or historical context, and are not absolute. Christian Scientists for example, do not condone medical intervention. Given vaccinations are considered a medical intervention, they do not support making vaccines for children mandatory. However, the religious groups which do not support vaccines are in the vast minority.

The ethical issue of whether parents should be allowed to withhold from vaccinating their child, has become a controversial topic in the media due to the varying ethical, religious and cultural perspectives which present differing views on this ethical dilemma. Medical professionals argue that outbreaks of illness and the increasing number of religious vaccine exemptions make unvaccinated children have a higher risk of acquiring vaccine preventable infections. In take this standpoint, they are ultimately adopting the view point of a utilitarianist. In contrast, those religious and cultural groups that argue against medical intervention, are contending from a standpoint of moral subjectivism. This also applies to those parents who believe it is a human right to decide the healthcare of their child. Thus the ethical dilemma of vaccinations has become an issue of whether Australia should give way to certain religious and cultural groups and reluctant parents, or to the vast majority, even if the latter causes dissatisfaction for others. It could be argued, that ignoring peoples’ religious beliefs is unethical in itself.

Thus, the ethical issue of wether vaccinations for children should be made mandatory revolves around the will of the parent, religious and cultural groups, as well as the Australian medical industry. To make vaccinations compulsory for children would remove the right of the parent to decide the healthcare treatment of their child and would ignore the beliefs of certain religious groups. To allow the parent to decide whether their child should be vaccinated is potentially putting other children at risk of illness. There are contentious arguments for both view points, which makes the controversy of vaccinations an ethical issue.

Abstract

Educating children with students who have a special impairment, could be beneficial to their health and in environmental conditions. Parents spend an average of $326 per month, or just under $4,000 per year, on out-of-pocket medical expenses on their special needs child according to New Mexico Statistics for Special Education. Making an environment more comfortable could increase their grades and social interaction in high school or college (2017 Annual Disability Statistics Compendium). 17% of high school students receive accommodations and support at the postsecondary level. A disability does not label any student on their ability to do an activity or job. Whether it is in the classroom, sports, a job, and others, having a shoulder to lean on because it is very important that the impaired children feel supported. A special education teacher, Clinton, at an elementary school in Iowa, teaches alternatives to students who always have to be moving, such as tapping their finger on the table. Fidget spinners are supposed to help those students with ADHD. About 6.4 million children between the ages of 4 and 17 are diagnosed with ADHD. The types of interventions could possibly help the Pueblo of Acoma.

Introduction

The idea of Special Education programs started in the United States around the year 1776. Special education started off as almost little to nothing. Over the years, laws and mandates were made to help special impaired children or adults receiving special education. In the 1970s, state and local institutions provided 91% funding for special education, the other 9% of the funding came from the federal government. Individuals with Disabilities Act (IDEA) established in 1975 to offer a free and public education to those special impaired children who need special education. IDEA offers parents to have a say so in the children’s education. An Individualized Education Plan (IEP) serves under IDEA. An IEP is a plan that provides services to meet the unique needs of a child and it is offered grades kindergarten through 12th grade. IDEA and IEP only serve 13 impairment such as ADHD, deafness, and Autism. A 504 is different from an IEP. The Rehabilitation Act, Section 504, is a plan on how the child will have access to learning at school and there are no age limits as to have a 504. A 504 also helps those students who have suffered from head trauma or medical condition, such as epilepsy. 504 also make accommodations for students such as extended time on tests, excused lateness or absences, and adjusted class schedules. Special education is a sensitive topic to talk about especially to a community. I am interested in researching and learning about the topic of Special Education because I do not know what it is like in the classrooms on the Pueblo, for those younger children with impairments. “It is important to address people’s needs so that they can be successful in or out of the classroom” (Raelene Woody. Interviewee. Sept. 13, 2018). How and what the educators are doing to educate them in the best way possible. What benefits are not only the children receiving but the families as well. My brother is 1 year and 9 months old and we found out he was diagnosed with Down Syndrome when he was just 4 months old in the womb. As I started to get more aware of his conditions it made me think what can I do to help him and be an advocate for him and his education. It is very important for me to know what kind of help he is going to be getting to help him learn and speak. Getting an education is very much important for him to become successful, not only just him but the children in Acoma who have an impairment as well. As for the Pueblo, I want to know if they are at least helping them with physical therapy, speech pathology, and other medical needs. What do the school offer to those special impairment children? Do they serve all children with special impairments?

On October 3rd, 2018, my brother had open heart surgery to fix a hole in his heart that we thought would go away on its own. Going to go see him in the hospital, I was expecting to see him as like crying, but he was energetic and laughing. He is a very happy baby and loves attention. He gets sick often and his mom takes him up to the Acoma-Canoncito-Laguna (ACL) Hospital to get checked. His mom, in the beginning, was uneducated about his condition and unsure where he was going to go to school. Building a better community with knowledge to the parents and other students as well with a sibling or cousin that may have a disability. I want to bring the education out to the people. I want my community to interact with children with special needs and see what it is like talking to them or even just seeing how their behavior changes. A simple change to start informing the community is to have a short biography in the monthly paper that comes out in Acoma. Education for children with impairments is not often looked at and ignored even sometimes. In Acoma, the programs have little to no information to what the schools offer, such as what the pueblos are doing specifically. No child deserves to be left behind in the educational system, because they should have those equal rights to their own education. I would really like the children to feel good about being enrolled tribal members in Acoma. The entire Acoma community needs to welcome all special needs individuals with open arms.

Theories and Methodologies: Learn and Accept

Special education today in society can be very scary for some children. Special education today is very important, why? Is because there are students going to school that have learning disabilities and have a special education class to help improve their weaknesses in learning. Special education helps with students who need as much help as they can get, for example, school projects, quizzes, finals exams, and more” (Kaylene Valencia. Interviewee. Jan. 8, 2019.) Special education today is becoming more aware of such as what schools can do to provide the best of education the child is receiving. In the past, the children were being kept apart from the non-special education students. The Individuals with Disabilities Education Act was introduced in 1975, along with the Individualized Education Plan. Special education since the early 1970s has increased by 90% over the years (ASCD Services).

Interactive Action Plan One: Wonder

On December 18th, I showed a movie in the high school dorm rotunda to any high school student that wishes to come. The movie I showed was Wonder. The movie is about a little boy named, Auggie who was born with facial deformities. He attends a public school for the very first time and he does face a lot of challenges. Showing the movie I received four people, two freshmen, and two sophomores. After the movie, I provided the students with a questionnaire about the movie to see if they were paying attention. The individual who got all the questions right received a $15 dollar gift card to Target. Showing this movie will bring awareness to those who have a disability and how they are just like us. Providing an optimistic perspective as well to show how important it is to show that acceptance from family, friends, and even the staff. I also provided snacks. Prior to this Interactive Action Plan, I did plan to speak at the Special Education Parent Meeting here at Santa Fe Indian School in October. That didn’t go quite as planned because I had an urgent family emergency. Canceling that put a huge gap in what I was going to do for an action plan. Coming up with the movie was something easy to get together. Spending about $65 dollars on snacks for about 25 people all went to waste and I did not know what to do with the leftovers. I am glad some students even showed up at all.

Interactive Action Plan Two: Scholarship

On March 6th, I had a meeting with Ms. Rosetta to discuss future scholarship funding that will take place either here at SFIS or in my home community. Ideas my SHP instructor, Ms.Huber and I, have come up with is hosting a possible Special Olympics with a donation of 5% or 10% of the funding, Senior account could possibly donate some money or it could come from my community in Acoma. Ms. Rosetta liked my idea, but I will present the information about the scholarship to the Board of Trustees here at SFIS. Scheduling this meeting is a little hard due to the number of events that are happening toward the end of the year. Apart from that, I will plan to meet with the Department of Education in Acoma to promote my idea. The name of the scholarship that I am thinking of is “Gifted”. Children in special education are gifted with something unique and challenging. Providing funding to attend higher education gives them that attention and care. Acoma Pueblo would like everyone to attend college and provide back to the people. If I have trouble with promoting this idea to both, I will try and have the governor of Acoma join in me in watching to see what is happening in the special ed classrooms at Haak’u Community Academy.

My inspiration for creating this scholarship is a 38-year-old woman named Marla Gonzales. Marla has Down Syndrome since she was born. Marla is a Global Messenger which is someone who advocates for others with a challenge. One of her favorite speeches to give was, “Spread the Word to End the ‘R’ Word”. Getting bullied in middle school occurred a lot to Marla. Marla got to high school people where more aware of her condition. College was just around the corner and Marla wanted to take some college classes. Funding for college can be expensive and finding out that she paid for college out of pocket, was a question I had and wanted to do something about.

Special Education Data: Santa Fe Indian School Community

In my Special Education Data, I conducted a school survey here at SFIS and I received 102 responses from grades 9-12. The first question that I asked was ‘Do you have a disability?’ I was honestly surprised by how much responses that I received and the number of kids that are in a special education class. With 13 students having an impairment is shocking, to think that, I thought there would only be 3 or 4. The next question that I asked was ‘Do you know what a disability is?’ based on a definition. I chose this quote because it showed a great example that an impairment can be more than just physical. It can be mental and intellectual. It can also develop when you are born or develop later down the road.

Global Data/Connection: India and the United States of America

In India, there are children that are not in school. 90% of the students that are not in school wired to 90% of the students that are not in school are due to the parents. Children with impairments in India are kept inside all day because the parents are ashamed of them. India has a total of 30,000 children who are or have never been enrolled in a school before (Special Needs in India). Some parents even kill impaired children because they’re so “ugly” and they can’t look at them.

In California, a 13-year-old male had autism. The boy was acting up in class and the teacher restrained them and ended up killing him. This is not the first time that this has happened to this school today in California. The school has been saved more than three times and has gotten away with the charges (Student with Special Needs Dead After Being Restrained at School). In my Senior Honors Project, I showed a graph on the restraint right levels on children with impairments based on ethnicity. American Indian/Alaskan Native stands at 1%, but I and educators of indigenous students would love to have it at 0%.

Conclusion and Sustainable Change

In Acoma, sustainable change to the accepting special inspired children could be even greater and better. A part of my sustainable change that I would like to do is having a Special Olympics within the Pueblo of Acoma. Having a Special Olympics will combine different kinds of families and it’ll create a more welcoming environment in those who have an impairment. Having this annually will also bring more people to talk, and maybe even possibly have donations along the side. Secondly, I would like to have the children who have a special impairment, have a little biography in the Acoma Department of Education newspaper that goes out every month. Having a section with for children with special impairments could also bring the public to know these children personally. Getting to know the child a little better you could even say hi to them when you’re at the feast, at the grocery store, or even just around the community common areas. Another thing and I, that could be possibly done is hosting an honorary night to the parents and to the students at the special impairment along with the tribal leadership. Hosting this honorary night well let the students know that the tribal leadership is 100% behind the children as to receiving higher education and being enrolled members of Acoma. Lastly, I would like to include the student artwork that they do in the classrooms on some flyers that can go out during either trash day or even through the mail. The artwork is very powerful and having these children’s work out into the community, will show how strong they are in the classroom and outside of the school.

Here at the Santa Fe Indian School, the sustainable change that I would like to make is also hosting a Special Olympics here for the very first time. Schools and families from all over Santa Fe could be welcomed and are allowed to make a donation if they want to. Santa Fe Indian School is already a welcoming campus and I want and love for it to stay this way. It is very important for the children to know that they are welcomed here and are accepted by the students, staff, and educators. When progress reports or report cards go out to parents included some artwork along with those papers would be extraordinary as well. Last but not least I would still like to continue the scholarship here at Santa Fe Indian School. Having the scholarship will not only allow the students to continue on to post-secondary education but it will also let the students know that Santa Fe supports them in that decision to attend. I myself will still donate money to the scholarship every year in the future to come. Any student that is willing to continue the topic of special impairment children I am 100% behind them if they decide to proceed with this scholarship and make it even better.

Learning from my action plans and my research it is very important that children do feel accepted by not only their parents but my friends other family members educators staff and people on the outside world. Not only Acoma but everyone would like to see these children succeed in the future and see what The children could do. Accepting the students will make them feel more comfortable in the classroom and outside as well.

Background:

Children are the group age malaria which affects lymphocyte levels and decreases in hemoglobin as measured by the erythrocyte index.

Objective:

To find out the effectiveness of multivitamins on the biochemical nutritional status of malaria sufferers in Sanggeng Health Center, Manokwari Regency.

Research Methods:

The experiment with two group case-control. The population was 61 children with malaria and a sample of 15 children in the case group (giving vitamin B complex and vitamin C) and a control group that was not treated. Data were obtained using a questionnaire for respondents’ identities and laboratory tests using the hematology analyzer Sysmex 300 to determine lymphocytes, MCV levels, MCH, and MCHC.

Results:

Respondents with malaria in children aged 6-9 years as many as 15 people (50%) and at the age of 10-12 years as many as 15 people (50%). Male sex as many as 16 people (53.3%) and women as many as 14 people (46.7%). There were no differences in lymphocyte levels before and after administration of vitamin B complex and Vitamin C in children with malaria sufferers in Sanggeng Community Health Center, Manokwari Regency (p-value = 0.318) with differences in average lymphocyte levels of -0.6133. There were differences in MCV levels before and after administration of vitamin B complex and Vitamin C in children with malaria sufferers in Sanggeng Health Center, Manokwari Regency (p-value = 0.044) with an average value in the jerseys and controls group of -2.27000. There were differences in MCH levels before and after administration of vitamin B complex and vitamin C in children with malaria sufferers in Sanggeng Health Center, Manokwari Regency (p-value = 0,000) with an average value in the case group of -2.12000. There are differences in MCH levels before and after administration of vitamin B complex and vitamin C in children with malaria sufferers in Sanggeng Community Health Center, Manokwari Regency (p-value = 0.001) with an average value in the case and control groups of -1.06333Malaria is a global health problem which is still a concern for governments and world health agencies with a high prevalence rate in 106 tropical and subtropical countries. The estimated incidence of malaria in 2017 ranges from 227 – 670 million cases, with the number of deaths from malaria reaching 4.3 million cases per year and affecting the quality of health for infants, toddlers, and pregnant women (WHO, 2017). Malaria cases in Indonesia until 2016 there were 374 malaria-endemic districts/cities including Papua, NTT, Maluku, and North Maluku. Nationally, malaria incidence in 2014 was 256,592 cases with annual parasitic incidence (API) of 1.94, in 2015 as many as 417,819 cases with API amounting to 1.69, and in 2016 as many as 343,527 with APIs of 1.38. This shows that nationally from 2014 to 2016, API fell 0.56% (Indonesian Ministry of Health, 2016). The incidence of malaria in West Papua Province in 2014 was 141,670 with API 64, 2015 as many as 168,530 (API = 58), 2016 as many as 241,450 (API = 77). The malaria incidence in Manokwari Regency in 2014 Annual Malaria Incidence (AMI) was 18.6 per 1000 and API 84.6, 2015 AMI was 27.9 per 1000 and API = 12.7 and in 2016 AMI was 26 per 1000 and API = 10.3. This shows an increase in the incidence of malaria in West Papua Province and the Manokwari Regency.

Tropical malaria is a parasitic infectious disease caused by Plasmodium falciparum which attacks young erythrocytes and is only characterized by the discovery of asexual forms in red blood caused by Plasmodium falciparum protozoa which are transmitted to humans through mosquito saliva (Sucipto, 2015).

Plasmodium infection causes an increase in lymphocytes due to the presence of lymphocyte cells played by helper 1 T cells that are specific to Plasmodium antigens which overproduce and changes in hematological status include the erythrocyte index (changes in hemoglobin level), thrombocytopenia and leukopenia to leukocytosis which causes lymphocyte changes due to the process hemolysis by malaria parasites (Van, 2013).

The research conducted by Mau (2017) in positive patients with Plasmodium falciparum found 84% increased lymphocyte cells from reference values. The average number of P. falciparum 39.7200 lymphocytes with statistical test results showed that there was a significant difference between the number of lymphocytes in P.falciparum. Whereas Muslim research (2015) found changes in hemoglobin levels in tropical malaria patients between 7-14 g / dL with an average of 8.96 g / dL due to a decrease in hemoglobin levels affecting the erythrocyte index value. Research conducted by Sofiyetti (2016) reveals that administration of zinc supplementation with zinc and vitamin B12 can increase hemoglobin levels and erythrocyte index in malaria vivax. Research conducted by Fitri (2013), that the administration of vitamin C can reduce high lymphocyte levels to normal on the third and seventh day and Mizoc’s (2011) study of giving vitamin B contributed to lymphocyte proliferation, lymphoid tissue formation, and in the antibody response.

The Malari incident in Manokwari district from the Manokwari District Health Office report data amounted to 4,127 with API values of 22.17 (Manokwari District Health Office, 2018). The incidence of malaria in Sanggeng Manokwari Community Health Center in 2018 had malaria cases with 1,717 cases, tropical malaria with 115 cases, and malaria mix in 3 cases. In January 2019, there were 61 cases of malignant malaria, 11 cases of tropical malaria, and 1 case of malaria mix.

Sanggeng Health Center was used as a place for sampling and research because there were many malaria sufferers with hemoglobin results below the normal range. In addition, there are many cases of tropical malaria in the Sanggeng Health Center using an examination of the number of lymphocytes and erythrocyte indices using automatic tools using the Hematology Analyzer (Sysmex XP 300). Sanggeng Health Center is a health center located in the center of Manokwari and covers a wide area. The treatment process for Malaria sufferers in the puskesmas is a dilemma because there are two methods of treatment that are equally believed to produce good results. The first treatment to provide multivitamins in malaria patients and the second treatment does not provide multivitamins in malaria sufferers. Looking for the truth of the two methods of treatment for malaria sufferers, a research is needed to do a research entitled ‘Effectiveness of Multivitamins Giving Against the Biochemical Nutritional Status of Malaria Patients in Children in Sanggeng Health Center, Manokwari Regency’. Malaria is one of the public health problems because it affects high rates of morbidity and mortality. High-risk groups who are prone to malaria infection are toddlers, children, pregnant women, and nursing mothers. Other high-risk groups are residents who visit malaria endemic areas such as refugees, transmigrants, and tourists (Harijanto, 2012).

Malaria can cause blood deficiency because many destroyed blood cells are damaged or eaten by plasmodium. Malaria also causes splenomegaly, which is an enlarged spleen which is a symptom of a typical malaria clinic. Anemia occurs mainly due to the rupture of infected red blood cells, plasmodium falciparum infects all stages of red blood cells until a decrease in hemoglobin levels below normal can occur in acute and chronic infections. Anemia is a state of decreased hemoglobin levels, hematocrit, and rupture of red blood cells below the normal value added for individuals (MOH, 2007). Experiments carried out on 30 respondents in children who were divided into case groups and controls by giving a multivitamin, namely the administration of vitamin B complex and vitamin C are described as follows:

4.1. Provision of multivitamins (vitamin B complex and vitamin C) in the age of malaria sufferers in children

The results showed that of 30 respondents at the age of 6-9 years as many as 15 people (50%) and at the age of 10-12 years as many as 15 people (50%). In children who are given vitamin B complex and vitamin C occurs changes in lymphocyte, MCC, MCH, and MCHC levels in normal levels. Research is in line with previous research conducted by

Jannah that giving vitamin B complex syrup and vitamin C to anemic elementary school child in Sayung Subdistrict, Demak Regency, given once a week for three months can increase Hemoglobin levels by 2.2 g / dL (Jannah, 2009). Research by Subandi (1998) revealed that phagocytosis is very evident when parasitemia falls, this is because the presence of circulating antigens is also caused by the presence of vitamin B 12 and vitamin C which act as prooxins that can attract all circulating macrophage cells into peritoneal fluid and activate it.

Vitamin B complex is needed in the formation of blood cells red and is important in the final maturation of red blood cells for DNA synthesis (Deoxysio Nucleic Acid) because each vitamin in a different way is needed for the formation of thymidine triphosphate, which is one of the essential building blocks of DNA deficient in vitamin B12 or folic acid can cause DNA abnormalities and reduction and consequently are failure of core maturation and cell division (Guyton, and Hall, 2008). Vitamin B complex and vitamin C are known as anti-oxidant vitamins in the body, whose role is to help reduce free radicals simultaneously with endogenous antioxidants SOD (Super Oxide Dismutase), GPX (Glutathione Peroxidase), and catalase. In addition to functioning as an antioxidant, vitamin C has another important role, namely maintaining Se stability in the stomach (Suwondo, 2009).

4.2. Provision of multivitamins (vitamin B complex and vitamin C) in the sex of malaria sufferers in children

Respondents who were male were 16 people (53.3%) and women were 14 people (46.7%). This research is in line with Fitri’s research (2013) that administration of vitamin B complex and Vitamin C is given to children with malaria regardless of sex.

Length of time given to children for 14 days, both route and frequency of giving vitamin B complex and vitamin C to children. The presence of parasites that persist in the human body can cause immunosuppressive reactions and can cause pathological tissue trauma. So that the main problem that occurs in the pathology of malaria is increased production of free radicals and decreased immune response (immunosuppression) in the final stages of the disease course. Immunosuppression that occurs in malaria turns out to be about cellular and humoral immune responses. The effects of immunosuppression occur on macrophage activity, antigen presentation, and secretion of immunoregulatory mediators (Fitri, 2013).

4.3. Effectiveness of giving multivitamins (vitamin B complex and vitamin C) to lymphocyte levels of malaria sufferers in children

Lymphocytes are cells that play a role in the immune response because they have the ability to recognize antigens through special surface receptors and divide themselves into a number of cells with identical specificity, with long life span of lymphocytes which makes the cell ideal for adaptive responses (Suparman, 2014). The results were obtained in children suffering from malaria with lymphocyte levels before the administration of vitamin B complex and Vitamin C in the case group as many as 11 people (73.3%) in the normal category and after administration of vitamin B complex and Vitamin C, there was an increase of 13 people ( 86.7%) in the normal category. In the control group before giving vitamin B complex and Vitamin C as many as 9 people (60%) in the normal category and after 2 weeks there was a decrease to as many as 8 people (53.3%) in the normal category.

Before giving vitamin B complex and vitamin C to lymphocyte levels, the average value in the case group was 25.7% and after giving vitamin B complex and vitamin C to lymphocyte levels, the average value in the case group was 27.6%, while in the control group it was 24.8% and after 2 weeks it decreased with an average of 24.1%.

The mean value is -0.6133 with a standard deviation value of 3.30420. The paired t-test results obtained a significance value at the significance level of 95% p-value = 0.318>  0.05 which means that there were no differences in lymphocyte levels before and after administration of vitamin B complex and Vitamin C in children with malaria in Sanggeng District Health Center Manokwari. This research is in line with that conducted by Fitri (2013), that administration of vitamin C can reduce high lymphocyte levels to normal on the third and seventh day. While in this study the researchers examined lymphocyte levels on day 14. This can cause changes in lymphocyte levels that are not significant. In addition, with the presence of the malaria drug which decreases the level of parasitemia, lymphocyte levels experience a significant insignificant decrease in normality.

Vitamin B consists of several forms, and those that are beneficial in the immune system are vitamin B12, vitamin B6, folic acid, and niacin. Vitamin B6 contributes to lymphocyte proliferation, lymphoid tissue formation, and in antibody responses. Vitamin B12 plays a role in the augmentation of phagocyte performance and T cell proliferation. Folic acid with vitamin B12 can affect NK cells (Mizoc, 2011). Giving vitamin C here can also be intended as an immunostimulator because vitamin C is a nutrient that is able to regulate the immune system because of its anti-viral and antioxidant abilities, has an important role in phagocytic function, and has the effect of stimulating lymphocyte cells. Giving vitamin C also caused a significant increase in phagocytic activity of peritoneal macrophages in mice. This is probably due to the immunostimulatory effect found in vitamin C, this has also been proven by (Fuente et al. 1997) who found that vitamin C can increase the proliferation and activity of immunocompetent cells, especially macrophages and T lymphocytes,

4.4. Effectiveness of giving multivitamins (vitamin B complex and vitamin C) to MCV levels

Low MCV values indicate a small size of red blood cells (called microcytes), normal MCV

values indicate the normal size of red blood cells and high MCV values indicate large red blood cell size (or macrocytes). This value can determine the type of anemia (lack of red blood cells) based on the size of the red blood cell. Normal values of 80-97 fl / red blood cell MCV in adults. The range of normal values can be different in each laboratory and the age of the patient (Kurniawan, 2016). The results showed that MCV levels before administration of vitamin B complex and Vitamin C in the case group were 5 people (33.3%) in the normocytic category and after administration of vitamin B complex and Vitamin C there was an increase of 11 people (73.3%) in the normocytic category. In the control group before giving vitamin B complex and Vitamin C as many as 4 people (26.7%) in the normocytic category and after 2 weeks there was no increase of 4 people (26.7%) in the normocytic category. The mean value of MCV levels in the case group before administration of vitamin B complex and Vitamin C was 77.4 fl and after administration of vitamin B complex and Vitamin C was 82.1 fl. In the MCV level control group, a value of 75.8 fl and after 2 weeks was 75.7 fl.

MCV levels before and after administration of vitamin B complex and vitamin C at an average value of -2.27000 with a standard deviation value of 5.90716. The paired t-test results obtained a significance value at the significance level of 95% p-value = 0.044 The results of the research on the combination of vitamin B complex and vitamin C were able to reduce eritorist degrees and provide healing in mice infected with Plasmodium berghei. However, it turns out that the combination of vitamin B complex and vitamin C can reduce the degree of parasitemia faster. This is likely because in vitamin C there is an immunostimulator effect so that it can increase the proliferation and activity of peritoneal macrophages which in turn will cause the parasite elimination process to occur faster. In addition to the second possibility, the group treated with anti-malarial drugs has the effect of releasing free radicals so that the healing process from malaria infection is slower than the group treated with a combination of Chloroquine and vitamin C so that chlorokuin eliminates vitamin C. antioxidants will help prevent tissue damage from free radicals (Fitri, 2013).

4.5. Effectiveness of multivitamins (vitamin B complex and vitamin C) on MCH levels (mean corpuscular hemoglobin)

Patients who have low MCH have a tendency to have iron deficiency type anemia. Anemia that occurs in these patients usually occurs due to lack of iron nutrition or bleeding that occurs, such as in colon cancer and bleeding in other digestive tracts. High MCH can indicate a large size of red blood cells that can occur due to liver damage, vitamin B12 deficiency, and also lack of folic acid (Kurniawan, 2016). The results showed that the levels of MCH before administration of vitamin B complex and Vitamin C in the case group were 5 people (33.3%) in the normochromic category and after administration of vitamin B complex and Vitamin C there was an increase of 10 people (66.7%) in the normochromic category. In the control group before giving vitamin B complex and Vitamin C as many as 4 people (26.7%) in the normokromikk category and after 2 weeks there was an increase to as many as 7 people (46.7%) in the normochromic category. The mean value of the respondents’ MCH levels before giving vitamin B complex and vitamin C was 25 pg and after the treatment was 28 pg or there was an increase in MCV levels in the normal direction. Whereas in the control group before treatment, 32.8 pg and after 2 weeks without treatment increased to 32.9 pg or 0.1 pg. this increase is lower than the provision of vitamin B complex and vitamin C.

The level of MCH before and after administration of vitamin B complex and vitamin C in the case and control groups with an average value of -2.12000 with a standard deviation value of 2.59634. The paired t-test results obtained a significance value at the significance level of 95% p-value = 0,000 This study is in line with Sofiyetti’s research (2016) revealing that there are differences in MCH levels before zinc and vitamin b6 supplementation with hemoglobin, hematocrit and erythrocyte levels of anemia in vivax malaria patients.

Parenting a child is not an easy task to do. Especially when it comes to a child’s diet, parents must be concerned about the eating habits of their child. Kids usually don’t know what’s good or bad for them to eat; they just eat anything presented to them. In this case, I believe it is the parent’s responsibility to take care of what their child is eating. Parents should try to develop good and healthy eating habits in their children. There are many tips and tricks which can be used by parents to train their children for eating healthy and staying away from unhealthy food. All these good eating habits must be taught to children at an early stage because once they have grown up, there is no way to go back and their bad eating habits will remain for their entire life. We need to remember that no one is born hating vegetables and loving unhealthy extra cheesy pizzas; our choices become unhealthy because we are mostly exposed to unhealthy eating options. Some options and ways discussed below help parents build healthy eating habits in their children.

Firstly, and most importantly, parents should be role models for their children. Children usually follow their elders in many parts of life. They might follow their elders in eating habits too. If parents want to build healthy eating habits in their children and do not have nice eating habits themselves, then it is not possible for the children to have healthy eating habits. In this way, it will be impossible for children to adopt healthy eating behaviors. Therefore, to train their children to eat healthily, parents must show them first. Kids will follow their parents’ eating habits, and if they are healthy, then they will automatically develop healthy eating manners.

One more way is to prefer meals at home instead of outdoors. To train children to eat healthily, it is mandatory that they eat healthily at home. Parents would have to separate some time from their busy schedule and cook at home if they want to build healthy eating manners in their children. Once children get used to home-cooked meals, there is no way to go back, and they will always love healthy meals cooked at home. Meals cooked at home can never be compared with any kind of food or taste from outside of the house. That’s why, this should be the prime focus of parents to keep their children’s meals home-cooked. In this manner, children will develop affection for home-cooked food and will request parents to cook for them at home.

Also, it is important to create an eating routine for children. Routine-less doing of anything causes harm. When it comes to food and eating habits, routine-less eating can cause severe harm to children especially. Even eating of a healthy meal without a particular routine can cause damage to children. They might get overweighed because of overeating. To stop routine-less and overeating habits of children, parents must give them a proper eating routine to follow and be strict with them to make it applicable. When children will follow the meal routine given by their parents, changes in them will surely be observed. They will start getting healthier and more active than before.

For the sake of children’s health and to build healthy eating manners in them, parents should visit a nutritionist with them and make them aware that what bad can happen if they keep eating unhealthy food. A nutritionist should make them a healthy and yummy diet to follow, and it would be the parents’ duty to implement it. Once the children get to know the consequences of bad eating habits, they will automatically leave those bad habits and would follow healthy eating habits. Of course, they would require constant motivation and a little pinch of love from their parents to keep them following the healthy diet chart given by the nutritionist.

And the last but not less important option is to make meal time some fun. Usually, meal times are not so attractive and friendly for children. Parents have an opportunity there, they can make meal time some fun for children and in this way, children can be taught about good and bad eating habits. There are a lot of options to make a meal table a happy place for children on which they would love to spend time and learn good and healthy eating habits. Parents can arrange some games on the dining table at the time of the meal to keep their children’s interest right on the point. They can either go for a small picnic at a nearby park to have a fun lunch as well as learning for children about good eating habits. Or they can invite friends of their children and have an educative get together with their children about healthy eating.

Despite the fact that developing healthy eating habits in children is not an easy task for parents, it is possible. First of all, they should set an example for their children to follow a healthy diet, support their children’s eating routine, instill a love for home-cooked food, develop children’s awareness of right and wrong food, and of course, not forget to add a little fun to this important process.