For the first time in a decade, Minnesota schoolchildren are required to receive additional vaccines this fall.

Seventh-graders now must get the meningococcal vaccination and an additional pertussis (whooping cough) booster. And younger children in day care and early-childhood programs must get hepatitis A and B shots.

For most parents, complying is not a problem. Vaccination rates in Minnesota top 90 percent for almost all immunizations required by law, according to the state Department of Health. Less than 2 percent of the state's more than 70,000 kindergartners enter school unvaccinated under Minnesota's conscientious-objection exemption, the agency says.

But two Minnesota moms worry that the small minority of parents who oppose routine childhood vaccinations often dominate public discussion about them. Karen Ernst and Ashley Shelby have joined forces to give a stronger public voice to the silent majority of parents who support vaccination. Their nonprofit website, Voices for Vaccines (, is based in the Twin Cities, but it's attracting an international audience.

"You hear it so much, it gets a stickiness to it," Ernst said of anti-vaccine rhetoric. "The reality of it is [that] most of us have chosen to protect our children from disease. These requirements are good."

This year's additions to the list of required vaccines — the first since the chickenpox vaccine became mandatory a decade ago — offer an opportunity to remind parents that vaccinating is the norm, said Ernst, a former teacher who lives in St. Paul.

Lynn Bahta, immunization clinical consultant for the state's immunization program, said the requirements went into effect after 18 months of consultation with experts and collection of public opinion. But the vaccines are not new. Many pediatricians have been giving them to children for years. Rather, state law is catching up with recommendations from the U.S. Centers for Disease Control.

All told, schoolchildren are now required to receive about 13 vaccines during the K-12 years, Bahta said.

"An overwhelming majority of parents support vaccinating our children," she said. "We do have parents who are hesitant. … Parents are still trying to raise above that fear and do what's right for their children, which is to vaccinate."

Inaction has results

Patsy Stinchfield, a pediatric nurse practitioner and director of infection prevention and control at Children's Hospitals and Clinics, said pro-vaccine parents, including the Voices for Vaccines organizers, are critical in an era when vaccine opponents are becoming louder and more visible via websites, blogs and social media.

"It has to be a constant drumbeat of information about the safety of vaccines and how well they work and why we do them and why vaccination is important," Stinchfield said.

Just last week, Children's Hospitals and Clinics saw four cases of whooping cough — ominously known as the 100-day cough, Stinchfield said.

Medical experts also point to a 2011 measles outbreak in the Twin Cities. A child whose parents delayed vaccination traveled overseas, contracted measles, came home and spread it to vulnerable children at a drop-in day care. Those children were under 1 year old — too young to be vaccinated for measles. In total, 21 people contracted the illness.

During the 1989-91 measles outbreak in the Twin Cities, three children died and more than 600 were infected, Bahta said. She said she keeps a note taped to her computer screen to remind her daily of the importance of her work: "430 children die of measles every day in the world."

Choosing facts over fear

Ernst, a mother of three, said a close call six years ago sparked her advocacy. A day after she had taken her newborn with her to one of her older children's classroom, she learned that a child in the class whose parents objected to vaccines had come down with chickenpox.

"This was a conscientious mother. A kind mother, a good mother who didn't think her child needed the chickenpox vaccine," Ernst said. "Nothing tragic happened, but it felt like a near-miss to me."

The confusing results parents get when googling vaccines also prompted her to act.

"Parents feel they should look at all the information and come to their own conclusions," Ernst said. "[But] the amount of information you are supposed to sort through is overwhelming, and very bad information can look legitimate."

Ernst and Shelby took over the Voices for Vaccine website in 2013 with the idea that it should be a grass roots, parent-run effort. They use the same social-media storytelling methods as antivaccine parents. But the difference is that they have science on their side, including the vast majority of the medical community, the U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics and the Minnesota Department of Health.

"It has to be about parents speaking out, but it has to have science in the background," Ernst said.

One of their most read posts is from a British mother who writes about growing up in an idyllic farm setting unvaccinated. Her parents restricted sugar and food additives and fed her organic homegrown vegetables and raw milk, she said. She contracted measles, mumps, rubella, a type of viral meningitis, whooping cough and chickenpox.

"If you leave your children unvaccinated, they will get sick," Ernst said.

Dr. Anne Edwards, chair of pediatrics at Park Nicollet, said occasionally parents come in and decline vaccines.

"My first question is, 'Tell me more. Help me understand,' " Edwards said. "Every parent, their goal is to keep their children healthy. I am able to answer a lot of questions. Many times we do come to an agreement to vaccinate."

Stinchfield said misinformation about the link between vaccines and autism has been the most difficult to dispel. The study that linked them has been discredited, but fear lingers.

"It was hard to break the fear," she said. "We can confidently say there is no relationship between vaccines and autism."

Stinchfield compares vaccine laws to car-seat and traffic laws.

"Our newborns need to ride in a car seat," she said. "We have laws in place to make sure they are safe. We don't see people opt out of that.

"I feel the same way about vaccines," she said. "These laws are in place to protect."