Getting Religion about Vaccines

Herd Immunity?

As the current measles epidemic continues unabated, many are looking for explanations. One obvious target are the religious and personal belief exemptions that have allowed for increasing pediatric undervaccination. Yet the fact that many states and other entities allow religious exemptions might suggest that most religions object to vaccines. Miriam Krule writing in Slate explodes the myth of religious exemptions and describes how despite few true exemptions, it is very easy to claim one.

Her conclusions:

"The only two religions that have any possible negative stance (though it’s not even clear that they do) on vaccination are Christian Scientists and the Dutch Reformed Church."

"In order to apply for a religious exemption, you don’t even need to be religious. If you live in Connecticut, for example, all you have to do is fill out this incredibly simple form... In Florida, all that is needed is the child’s name, date of birth, and social security number—no proof of religion, or even name of a religion, is needed."

Irrespective of the lack of formal religious exemptions, when we speak with parents as physicians or public health officials, we need to be aware that three existing vaccines (hepatitis A, rubella, chicken pox) were developed from cell lines derived from aborted fetuses. For this reason, some Catholic and other parents might refuse to vaccinate their children. However, this issue has been well studied by the National Catholic Bioethics Center and the Pontifical Academy for Life who "have determined that it is morally licit, and even morally responsible, for Catholics to use even those vaccines developed from aborted fetus cells."

Dr. Paul Cieslak in the Catholic EWTN news states "While the new measles cases are cause for concern, the outbreak isn’t nearly as bad as it could be, and that is thanks to vaccinations. The fact that it doesn’t spread to everybody is a testimony to the fact that most of them [who were exposed] are immune, and most of them got that way through vaccinations. And when we have seen transmission of multiple cases, it has been largely among unvaccinated people. As a Catholic, I would argue that it [vaccination] is a socially conscious thing to do. It’s not only good for you, it’s good for your fellow man."

Religion vs infection control: issue #7

The June 15 issue of Clinical Infectious Disease has a letter which attempts to link the Islamic practice of ritual ablution with the development of primary amoebic meningoencephalitis (PAM). In this ritual there is repeated irrigation of the mouth, ears, nostrils, arms and feet; some also irrigate the sinuses. The authors note 20 deaths from Naegleria fowleri infection at a small Pakistani hospital in 2010. All were males who performed the ritual regularly and had no history of swimming. The link between ritual ablution and PAM seem plausible, particularly when the sinuses are irrigated. Last year, there were two fatal cases of PAM in Louisiana which were preceded by the use  of Neti pots for sinus irrigation.

Photo: Laurie Skrivan, St. Louis Post-Dispatch, National Press Photographers Association

Religion vs infection control: issue #6

Here's a new and very sad case to add to our series on the intersection of religion and infection control. A few days ago, The New York Daily News reported that an infant died in a Brooklyn hospital due to disseminated herpes simplex virus type I infection. The virus was transmitted to the baby via a practice, metzitzah b'peh, performed by some mohels following circumcision whereby the mohel uses his mouth to suck blood from the wound. In a related piece, a rabbi and mohel in the Broward-Palm Beach New Times blog, provides details on how the procedure can be performed safely while still fulfilling Talmudic requirements. Several other cases of neonatal herpes infection (see full text paper from Pediatrics here) and at least one death have been previously reported. Additional information from the New York City Health Department can be viewed here.

Graphic:  The ceremony of Brit-Milah by Herman Gold.

Religion & infection control: issue #5

I've written several posts about religion and infection control over the last few years. Now there's a new issue. My friend, Gonazlo Bearman, has covered it in a great post, so I'll simply refer you there.   

New twist in the infection control vs. religion battle

We have blogged several times about the issues in the UK regarding religion and infection control. In a recent posting, I noted that the NHS softened its stance on bare below the elbow by allowing Muslim women to wear disposable sleeves. And they have given an exemption to Sikhs who wear karas (a bracelet) if they can be pushed up the arm when providing patient care. However, the crucifix remains banned, and this is causing a bit of a stir in the press. The nurse at the center of the controversy is pictured here holding the crucifix. Officials have previously stated that the crucifix is an infectious risk; now they argue that it could scratch a patient. It seems to me that disposable sleeves are a reasonable accommodation, and with a little imagination you would think the NHS could come up with a solution for the healthcare workers who wear a crucifix. Nonetheless, I find it hard to understand how the crucifix in question is either an infectious risk or a safety risk.

Photo: The Daily Mail

Religion vs. infection control: an update

We've blogged before about Muslim women who are healthcare workers in the UK facing disciplinary action for refusing to follow "bare below the elbows" on religious grounds. Now the National Health Service has made a concession: these women can now wear disposable sleeves with elastic cuffs when they have contact with patients.

Religion vs. infection control: issue #4

We have previously blogged about Muslim women who refuse to follow "bare below the elbows" due to the prohibition of having their arms uncovered, the Catholic phlebotomist in England who was sanctioned for wearing a crucifix under her clothing, and the concern in the Church of England regarding transmission of influenza via the communion chalice. Now another issue has arisen. Some Muslim healthcare workers in the UK are refusing to use alcohol-based hand hygiene products when caring for patients with H1N1 influenza on the basis of the Koran forbidding Muslims to come into contact with alcohol. Others are claiming the Koran allows the use of alcohol for medicinal purposes. It seems to me that this issue could be quickly resolved by allowing healthcare workers to wash their hands with another product that does not contain alcohol. CDC currently recommends the use of either an alcohol-based product or soap and water for hand hygiene when caring for patients infected with H1N1 influenza.

Religion vs. infection control, part 2

Last month I blogged about a phlebotomist in the UK who was facing disciplinary action because she wore a crucifix while working. Today, British newspapers are reporting that she has resigned her position because she refused to comply with an order to remove it. She reports that she wore it under her clothes. If this is true, the claim that the crucifix represents an infection control risk is baseless, and such heavy handed treatment only serves to undermines infection control efforts.

When infection control and religion collide

The BBC News reports today that a healthcare worker in the UK is facing disciplinary action because she wears a cross around her neck on a chain, which is reported to impose an infection control risk. This is not the first time that infection control and religion have crossed paths in the UK. Last year a female Muslim healthcare worker was fired becaused her faith does not allow women to show their arms in public and her long sleeves violated the hospital's bare below the elbow policy. While the UK's serious attitude about infection control is noteworthy, the actions beg the question as to whether some reasonable accomodations could be made for observant workers (e.g., plastic isolation gowns for patient contact, ensuring that necklace chains are short to prevent jewelry from coming into contact with patients). If the UK's National Health Service continues its strident approach, then infection control will have become a religion unto itself.