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Why blood tests are no longer a requirement for a RI marriage license

Question raised in a tweet by Ted Nesi to the R.I. Department of Health offered a chance to dig deeper into how public health policies evolve

By Richard Asinof
Posted 1/16/17
A question and answer on Twitter about the reasons why blood tests are no longer required for marriage licenses in Rhode Island provided the grist to dig a little deeper about what the tests had been looking for and why they were eliminated as a requirement.
What is the status of the initiative to make testing for HIV a standard practice of primary care in Rhode Island? What are the participation rates? Similarly, what are the participation rates for Baby Boomers to get tested for Hep C? What kinds of genetic testing will become commonplace in the future as more and more personalized vaccines and biologics are developed to treat cancer and other diseases.
As much as there are new ways to trace a family’s lineage through DNA testing, some of the stories about a family’s history often get lost in translation from generation to generation, as part of a hidden past that may not get talked about.
My own experience with Tay-Sachs disease is a case in point. The disease causes a progressive deterioration of nerve cells in infants and usually results in death by age four. It is a recessive genetic trait that may skip a generation.
It turns out I am a carrier for Tay-Sachs, but did not discover this until testing was done four months after my wife was pregnant. [Why the testing was not done initially is a much longer story.] It is a genetic disease that is very common among Ashkenazi Jews from Eastern Europe descent as well as in French Canadians in Quebec. Thankfully, my wife was not a carrier.
It turned out that the incidence of Tay-Sachs had been well known in my father’s family, but it was information that had never been shared with me, perhaps because of the tragic deaths that had occurred in a previous generation – until I brought it up.
It is, in some ways, similar to miscarriages, which occur frequently but are rarely shared as part of family history.

PROVIDENCE – As most people in the media world know, Ted Nesi is engaged to Kim Kalunian and they are planning to get married this year.

So, it was a brief but fascinating Twitter exchange when Nesi asked the R.I. Department of Health on Jan. 4: “When did Rhode Island stop making you get a blood test to get a marriage license? (Not that I’m complaining, @RIHEALTH).”

The R.I. Department of Health responded on Jan. 9: “@TedNesi sorry for the late reply…We stopped requiring blood tests around 1996.”

The question and answer on Twitter, as tweets often do, did not seem to explain the context and nuance about why there were once the regulations in Rhode Island around marriage licenses that included blood tests, and the reasons behind why those regulations had lapsed in the mid-1990s.

Translated, what were public health folks looking for, and why were they looking for it? And, why did they then stop looking for it?

Some answers
ConvergenceRI reached out to the R.I. Department of Health, asking a series of questions to clarify the policies. Here are the answers, provided by Joseph Wendelken, the agency’s public information office.

First, after conducting some research with folks at the agency, Wendelken corrected the information in the tweet responding to Nesi. The requirement for blood tests for marriage license was actually eliminated in 1994.

ConvergenceRI: What was the reasoning behind ending the requirement for blood tests for marriage licenses?
The reasoning was that testing should be risk-based [as evaluated by a physician], and getting married is not a risk factor for the illnesses that were being tested for. Also, the rare cases that were detected did not justify the investment.

ConvergenceRI: What had the blood tests been looking for? I heard from a retired pediatrician that they tested for syphilis and rubella? Is that correct? Were there any other things that were being looked for?
Yes, syphilis and rubella, and gonorrhea as well.

ConvergenceRI: Was the reason these diseases were being looked for was the possibility to be passed along to potential future children?
Much of the testing at marriage that was done throughout the country dates back to New Deal-era anti-venereal disease campaigns.

ConvergenceRI: Do you think that there is any likelihood that the requirement might be reinstated in the future?
It is not likely that testing will be reinstated in Rhode Island. Only a few states still require testing. There has been national movement away from this kind of requirement.

ConvergenceRI: On a related story, what is your response to the apparent plans of President-elect Donald Trump to convene a panel looking at the safety and validity of vaccines, looking at the potential connection to autism, with Robert Kennedy, Jr., heading such a panel?
I am reluctant to respond too directly to what, at this point, is still a matter of speculation. But I will note that the Centers for Disease Control and Prevention already has a 15-member advisory body [known as the Advisory Committee on Immunization Practices] with expertise in vaccinology, immunology, public health, infectious diseases, and other health areas.

This group develops recommendations on vaccine use based on scientific evidence and research. This evidence and research has not indicated that any connection exists between autism and vaccines.

ConvergenceRI: As a follow-up question, could you, in a concise manner, talk about the impact of vaccines here in Rhode Island as a key component of public health?
Vaccines continue to be one of the most cost-effective public health tools we have to keep individuals healthy and communities strong. Many vaccine-preventable diseases, such as smallpox, polio, and hepatitis, were common just a few generations ago. They have been completely, or almost completely, eradicated because of vaccines.

Incidence rates of vaccine-preventable diseases that are still in circulation, such as pertussis [whooping cough] and chicken pox, are much lower than they otherwise would be due to consistently high vaccination rates.

Last year, Rhode Island ranked among the highest in the country in childhood and adult vaccination rates, and was first in the country in adolescent immunization coverage rates. All of this has implications for health care costs, and our economy, in Rhode Island.


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