Measles outbreak: Low vaccination rates at some Bay Area schools raise alarm

This story first appeared in the San Jose Mercury News.

With alarm over the Disneyland measles outbreak growing across California, almost 5,000 kindergartners enrolled in Bay Area schools are without proof they've been fully vaccinated, a major concern as the highly infectious disease continues to spread.

Alameda County is home to schools with some of the highest percentages of kindergartners whose vaccination records are incomplete, according to an analysis of state Department of Public Health records, topping 80 percent at some Oakland Unified schools. On the other side of the bay, about two-thirds of the students at the private Waldorf School in upscale Los Altos Hills didn't have the proper immunizations.

"They're not immunized, they're not protected," said Amy Pine, director of the Immunization Program for the Alameda County Public Health Department.

 

The concerns over the low vaccination rates are growing as the state on Monday announced the measles outbreak climbed by another five cases to 73 in the Golden State, with another 14 cases reported in six states and Mexico. 

Older students also lack vaccinations, but the state kindergarten data offer a snapshot of just how well schools comply. By law, starting in preschool, California children cannot attend day care or public or private school if their parents cannot provide proof they are immunized. Children receive their first measles shot at 12 months old, followed by a booster shot that's given at age 4.

But the reasons why so many kindergartners -- one of 13 in the Bay Area -- don't have up-to-date vaccinations is as diverse as the students themselves: While many lower-income parents struggle to get their kids to the doctor or deliver the paperwork, some higher-income parents are refusing to get their children immunized over concerns the shots lead to autism and other illnesses.

Since the measles outbreak was first reported late last month, growing public attention has focused on the controversial "personal belief exemption" cited by the second group. But less well known is that many students are being allowed to enter school with some, but not all, of their shots. 

These kindergarten students enter on a "conditional" basis -- with the promise by parents to get fully vaccinated soon. Yet it is nearly impossible to tell if this promise is kept at any given school, since no formal process exists to ensure that these students' immunization records are adequately kept and tracked.

Public health experts say schools must maintain at least a 92 percent measles immunization rate to achieve what's known as "herd immunity." If enough people are immunized, it becomes very difficult for the virus to spread. Even the unimmunized are protected.

But if more than 8 percent of parents opt out of getting their children the vaccinations -- or don't complete the full series of vaccinations -- schools are no longer protected. The risk is not just for those who have chosen not to be vaccinated; it's also for those who can't be immunized -- such as infants, a child being treated for cancer or a child with a blood disorder.

Pine has been watching the issue closely, for good reason: This school year, 9.68 percent of Alameda County students entered kindergarten on a conditional basis, well above the state average of 6.86 percent. 

"It is basically an honor system that schools are appropriately following up on those students," said Pine. 

Dr. Gil Chavez, state epidemiologist and deputy director of the California Department of Public Health, acknowledged that.

"There is no reporting required of schools on their follow-up activities with 'conditional' entrants," Chavez said.

California is all too familiar with vaccine-preventable diseases. Last year, the state declared an epidemic of pertussis (whooping cough), with 10,831 cases reported, including two infant deaths.

On Monday, a California lawmaker said he will introduce legislation next month that would not only force schools to alert parents about vaccination rates at their children's schools, but also inform them whether it is above or below what it should be to prevent the threat of disease.

"You can look it up, but you should not have to look it up," said Sen. Richard Pan, D-Sacramento, of California school immunization data that is available on the state public health department website.

"It should be on a piece of paper or an email sent to parents," said Pan, who sponsored legislation that made it tougher starting last year for parents to opt out of vaccinations. To claim an exemption, parents must now meet with a health care practitioner to learn about vaccines and diseases.

At the Los Altos-based Waldorf School of the Peninsula, only 33 percent of the kindergarten class was up to date on vaccines, and half were unvaccinated due to parents' "personal belief exemptions." "We comply with state law," said Sandy Olson, the school's development director. "Vaccination is an issue between a parent and child and their doctor. We don't get involved in that choice."

For most schools, exemptions aren't the major issue. It often comes down to parents not following through with the paperwork, said Lynn Perkins, a nurse with the Emeryville School District. This school year, 28 of 62 students at Anna Yates Elementary School, or 45 percent, enrolled on a "conditional" basis but have since been fully vaccinated. 

"It's not really about immunization -- it's because they haven't submitted the proper documentation," Perkins said. "We hound families to turn it in."

Many California schools, however, don't have full-time nurses on staff any more, so the challenge is left to school administrators. 

"It is something I have to keep doing, on a weekly basis -- letters and phone calls and having one-on-one conversations with families to tell them they're missing a vaccine," said Roma Groves, principal of Martin Luther King Jr. Elementary School in Oakland, which reported a 37 percent vaccination rate -- and 63 percent "conditional" rate.

"Sometimes they can't get a doctor's appointment. Or they're waiting on the doctor to fax it in," she said. "We need a full-time person to do this job of collecting information."

Staff data analyst Daniel Willis contributed to this report.

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