By David Eggert, Associated Press

EAST LANSING (AP) – Public health officials and doctors who worry that not enough Michigan children are immunized against diseases must combat a trend not helpful to their cause: More parents are simply refusing to get their kids vaccinated.

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Michigan has the country’s fourth-highest rate of parents getting religious or philosophical waivers to vaccine requirements, according to the Centers for Disease Control and Prevention.

About 7,300, or 5.5 percent, of the state’s roughly 125,000 kindergartners had medical, religious or philosophical waivers on file last school year. That’s up from about 6,900 the year before and 5,700 in 2010-11.

Three in four of the exemptions were for philosophical reasons. Parents may be skeptical that vaccines are essential, fear they carry their own risk or believe in older vaccines but question newer shots. Others may take pause at the sheer number of shots and wonder if the cumulative effect has been studied enough. By the time most children are 6, they will have been stuck with a needle about two dozen times.

One reason Michigan has a high number of exemptions is it allows philosophical waivers while roughly 30 states do not.

“We have maybe a little more liberal view of what qualifies as a waiver than other states. And so I think more and more people have taken advantage of that,” said Bob Swanson, director of the state’s Division of Immunizations. “That’s where we need to really voice the importance of making sure kids are vaccinated and that only legitimate waivers are being utilized.”

Some parents may have no philosophical opposition but find it easier to file a waiver after forgetting to schedule a vaccination before the school year starts, said Jevon McFadden, an epidemiologist with the CDC who is based at the Michigan Department of Community Health. He took part in a news conference Thursday to help raise awareness about immunizations and newly released statistics causing concern among the state’s medical community.

“An event like this is very, very important because it’s to remind parents that school season is coming up and now is the time to start thinking about getting your kids up to date on vaccines,” McFadden said.

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Less than 72 percent of young children and 63 percent of Michigan adolescents are fully immunized, according to the Michigan State Medical Society.

To attend a public or private school, kids must be vaccinated against a number of diseases and medical conditions depending on their age: diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, hepatitis B, chickenpox and meningitis.

Particularly alarming to doctors is the prevalence of whooping cough and measles. Before vaccines became widely available in the 1940s, about 200,000 U.S. children became sick with whooping cough each year, leading to 9,000 deaths. While between 10,000 and 25,000 cases a year are reported now, with 10 to 20 deaths, they have risen in the last 30 years.

The trend is largely attributable to better testing, reporting, waning immunity and other factors, according to the CDC. But in Michigan, which had nearly 850 whooping cough cases last year – including the death of a 3-month-old – officials say immunization can make such deaths entirely preventable.

“It’s scary. … We had a decline but not enough of a decline to satisfy the medical community that we’re doing the right thing,” said Kenneth Elmassian, a Lansing anesthesiologist and president of the Michigan State Medical Society.

The group plans to organize more awareness events across the state this month.

There is no talk of asking Michigan lawmakers to restrict or eliminate waivers from immunization requirements, though one lawmaker has introduced legislation to prevent the state or schools from adding the flu vaccine to the list of required immunizations. In the case of an outbreak, the state health department or local health agency has the power to exclude unvaccinated children from school.

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