Vaccination rates low at LA County child care centers

A toddler receives his first MMR shot, which should protect him against measles. (Lauren M. Whaley/CHCF Center for Health Reporting)

This article originally appeared in the Los Angeles Daily News.

While the ongoing measles outbreak has focused attention on vaccination rates at kindergartens, the even more vulnerable population at preschools and daycares may also be susceptible to vaccine-preventable diseases.

Yet, in Los Angeles County, which has seen 33 confirmed cases of measles, it’s difficult to determine preschool vaccination rates. Nearly 30 percent of county preschools failed last fall to submit state-required vaccination data.

And, under current law, there’s little the state or parents can do about it.

In Los Angeles County, 87.7 percent of its preschoolers and daycare kids over age 2  were up to date on their shots at the beginning of this school year, state data show.

Statewide, 89.4 percent of kids at childcare facilities were fully immunized when they started last fall. That’s below the Centers for Disease Control’s recommended threshold of a 92 to 95 percent vaccination rate required for “herd immunity,” which experts say protects a community from infectious diseases.

And, that figure ­— 89.4 percent — reflects only schools that reported their rates.

Twelve percent of childcare facilities statewide, 1,266 out of 10,537, failed to submit their required reports to the California Department of Public Health (CDPH) last fall. In Los Angeles County, the number of preschools that failed to submit the required report was staggering — 798 facilities out of the county total of 2,799.

The state, however, has no teeth to force child care facilities and preschools to report their vaccination rates. And there is nothing in proposed legislation that would change that.

“CDPH does not have enforcement authority over these state statutes and regulations,” said Dr. Gil Chavez, deputy director and state epidemiologist for CDPH. “CDPH notifies the California Department of Social Services of the facilities who fail to submit reports and notifies the facilities that we have reported them to CDSS.”

The state Department of Social Services is in charge of licensing child care facilities and making sure they have up to date records on each student. But they do not compel facilities to submit fall vaccination rates to the state health department.

“We visit facilities every day,” said CDSS spokesperson Michael Weston. “We’re mandated to inspect a facility every five years, but we’re at the facilities far more often than that.”

Of those that did report fall numbers, 16 Los Angeles County preschools and daycare centers stand out with zero of their children completely up to date on required immunizations.

Those schools range in enrollment from 13 students at Our Lady of Lourdes Early-Fives in Northridge to 122 students at Bethany Preschool in Long Beach and 186 students at Vine Street Early Education Center in Los Angeles.

Administrators at some preschools said there are various reasons why children may not have their full vaccinations. Some parents place their kids on a delayed schedule, while others opt them out of vaccinations altogether.

At Great Beginnings Preschool, a private school in Valley Village, 41 of its 43 admitted children were enrolled for the 2014-15 school year without all their required shots, according to state data. This “conditional” admission requires them to finish their vaccination series as soon as possible. Thirty-eight children had received their first MMR shot, the vaccine that protects against measles.

Owner Lana Costache said the December measles outbreak at Disneyland, which has been linked to low vaccination rates, had little effect on parents’ attitudes toward vaccines.

“There was no increase in concern,” she said. “In fact, no one asked.”

At Bethany School, a preschool in Long Beach, the data show 122 children enrolled in the fall, though administrator Tonia Hill said there are now 130 children. She said every child at the school has to have a vaccination record even if it shows their shots are not up to date. Reasons a kid may not have all the required shots include alternative schedules, medical conditions or personal exemptions, which, by state law, have to be signed by a health care provider.

Countywide, 9.32 percent of Los Angeles County’s 119,268 preschool and daycare kids were under-vaccinated, entering school as “conditional entrants,” with immunizations started but not completed. That does not include an additional 2.22 percent of county preschoolers who were unvaccinated entirely due to personal belief exemptions and the 0.69 percent of kids with permanent medical exemptions.

Statewide, 7.40 percent of preschoolers, or 35,997 kids, started the year as “conditional entrants.”

Students may enter school on a conditional basis if they have received at least one dose of each required vaccination and are not yet due for subsequent doses. The condition is that they get up to date as soon as the shots are due.

Parents whose children are categorized as conditional entrants are notably different from those who do not vaccinate their children due to personal beliefs. Those who have sought personal belief exemptions, however, may not have that option next year if new legislation introduced by Sens. Richard Pan (D-Sacramento) and Ben Allen (D-Redondo Beach) is passed. Their bill would repeal the personal belief exemption that currently allows parents to opt their child out of vaccines.  

For childcare and preschool, children should be up to the date by the time they are 18 months. By this age, a child should have received three doses of the polio vaccine, four doses against pertussis (Whooping cough), one dose of MMR (Measles, Mumps and Rubella), three doses for Hepatitis B, one dose against chickenpox and one dose of hib, which prevents against meningitis and other serious bacterial infections.

Of the 122 children enrolled at Bethany according to the state data, 95 percent have had their first MMR shot. Still, the data show that 92 percent were admitted without complete vaccinations with the promise that they would get up to date.

“There have been a few parents who have elected not to have vaccines,” Hill said, but none of those have changed their minds after the measles outbreak.

Parents can use the state health department’s Shots for School website to look up preschool and child care immunization rates from the fall reports.

But, because there is no additional reporting requirement, parents must contact facilities directly to find out current rates. For those schools that did not submit a report, it is also up to parents to ask individual institutions for their immunization numbers.  

Sen. Tony Mendoza (D-Artesia) recently introduced a bill that will require workers at daycare facilities to be vaccinated against measles, pertussis and influenza. Whether his bill will have enforcement teeth remains to be seen. It says nothing about preschools reporting enrollee vaccination rates.

While daycares and preschools may admit younger children, the state immunization data counts only those who are between the ages of 2 and 4 years, 11 months.

The number of kids at preschools and daycares that reported data to the state totaled 486,634 statewide.

Los Angeles News Group staff writer Susan Abram contributed.

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Lauren M. Whaley

Freelance journalist Lauren M. Whaley is a photographer, radio producer and print reporter specializing in topics related to mental illness, reproductive health care and health disparities. She is also a childbirth photographer.This year, She is working on a series about how low-income parents access care for perinatal mental illnesses. The project is funded in part by the Rosalynn Carter Fellowships for Mental Health Journalism.She was a 2016-17 Knight Science Journalism Fellow at the Massachusetts Institute for Technology.Her work has been recognized by the Association of Health Care Journalists, the Scripps Howard Foundation and the Public Radio Exchange (PRX) STEM story project. She has contributed radio, video, photography and written stories to KQED Public Radio, Southern California Public Radio, the San Jose Mercury News, the New York Times and other media outlets. For six years, she worked as the Center for Health Reporting's multimedia journalist. She is a past president of the national organizationJournalism and Women Symposium (JAWS) and spent her early 20s leading canoe expeditions for young women, including a solo-led 45-trip in the Canadian Arctic. She is based in Los Angeles.

© 2018 Center for Health Reporting

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