Vaccination status not necessarily ideological

This article originally appeared in the Orange County Register.

The mother of an Orange County child who exposed 20 infants to measles last year never intended for her baby to go unvaccinated.

“That baby was not in a family that was against vaccinations. The mom … had four children, and was juggling so much, it had simply slipped her mind,” said Dr. Jan Johnson, a partner at Sea View Pediatrics, with offices in Laguna Niguel and Aliso Viejo.

In the past year, as a measles outbreak has stricken 141 people in 17 states and a whooping cough epidemic has killed two infants and sickened more than 10,000 people, public attention has focused on parents who refuse to immunize their children, often obtaining personal belief or religious waivers to permanently skirt vaccination laws. 

Just under 10 percent of elementary school students in California enroll in school without having all of their vaccines. But it may have more to do with caution and time constraints than ideology.

Some parents are wary of vaccines, even if they understand the necessity. They get an initial round of vaccines, but then delay some of the 15 state-required follow-up shots designed to fully protect against nine diseases, health officials say. Other parents don't follow through because they lack access to health care; still others are so busy they either forget or don't have time to get required booster shots.

Those children, who may have as few as one dose of each required vaccination, are allowed to enroll in school. But this partial, or conditional, vaccination is supposed to be temporary.

Schools are required by state law to follow up with families and eventually exclude students from classes if they fail to get all of their vaccines by the time they are due.

Unless there's an outbreak of a disease, however, those students who don't follow through are rarely, if ever, kicked out. The problem is, officials often don't know who has followed through.

“The law says schools need to review (immunization) records every 30 days. It does happen, but I'm sure it's not as often as legally it should,” said Pamela Kahn, a registered nurse overseeing health and wellness for the Orange County Department of Education.

“When our health care staff is out there caring for chronically ill, our acutely ill children, our special education students, this follow-through often does not rise to the priority level that it probably should,” she said. “It's probably not realistic (given) how schools are staffed right now.”

About 7 percent of Orange County kindergartners were enrolled conditionally this year. In Riverside County, the figure was 2.98 percent.

Some individual schools had much higher rates – including a number of private schools in affluent neighborhoods. Saint Joachim, a private school in Costa Mesa, began the year with 75 percent of its 28 kindergartners in the conditional category, more than any other school in the county.

At Serrano Elementary in Villa Park, part of the Orange Unified School District, 38 percent of 63 kindergartners were enrolled conditionally, the second highest percentage of all public schools. The district's lead nurse, Helen Burzumato, said that percentage is much lower now than when the school year started, but she did not provide an exact figure.

“Most parents comply. We don't really have an issue with that,” Burzumato said. “They understand their students are conditionally accepted into school.”

Schools aren't required to report follow-up figures to the state, so the state has an incomplete picture of how many students have followed up to be fully vaccinated.

“We take it on good faith that it's happening,” said Dr. David Nunez, family health medical director for Orange County Health Care Agency.

“Most school nurses have been alarmed by this outbreak and have taken some proactive action,” Nunez added.

But the school does get a partial snapshot of conditional vaccine follow-ups. Every three years, the state audits 3 percent of kindergartners randomly. Then it is up to the county to follow up with those schools.

The most recent audit, completed in the 2010-11 school year, showed that the number of conditional entrants statewide dropped by about half between autumn and spring.

How successful school districts are at following up and enforcing the immunization laws depends on staffing, said Kahn, of the county department of education.

Nurse-to-student ratios are as broad as one nurse per 15,000 students, she said, and those nurses “don't usually have the time to do the clerical paperwork.”

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