Majority at some LAUSD kindergartens are under-vaccinated
This story originally appeared in the Los Angeles Daily News.
While a measles outbreak and a statewide pertussis epidemic have focused public attention on parents who refuse to vaccinate their children, experts say under-vaccination is also a pressing problem.
Over 90 percent of kindergarteners at some Los Angeles Unified School District (LAUSD) schools are walking the halls without all of their state-required vaccinations. At some Oakland schools, the numbers top 80 percent.
These “conditional entrants” must have received at least one dose of each of the required vaccines to enter school, with the promise to get fully up to date in due time.
But neither the state nor school districts has a formal tracking system to ensure that these children become fully vaccinated.
“There is no reporting required of schools on their follow-up activities with ‘conditional’ entrants,” said Dr. Gil Chavez, state epidemiologist and deputy director of the California Department of Public Health.
LAUSD, for example, was unable to determine how many of the 13 percent of kindergarten students who entered on a conditional basis last school year ended up fully vaccinated by the end of 2013-2014.
This year, 20 percent of all LAUSD kindergarteners entered conditionally. That’s over three times the state rate of 6.86 percent.
Schools report their kindergarten vaccination rates to the state each fall. The schools are supposed to follow up with students who are behind and exclude them from school if they fail to get the required vaccines.
“We strongly encourage schools to be tracking those students and making sure that the ones who are admitted conditionally move out of that category and into the fully vaccinated category,” said Dr. James Watt, Chief of the Division of Communicable Disease Control at the California Department of Public Health.
But that doesn’t necessarily happen.
“Once they’re in, if there’s no nurse there tracking that, it may flag on a system but there’s really no one looking at that,” said Tonya Ross, LAUSD Director of District Nursing Services, citing a shortage of school nurses as a barrier for tracking student immunizations. “So it’s very difficult to get those kids the follow-up, the appropriate follow-up.”
District officials said they did not keep any children out of school for incomplete vaccinations last year.
State data for LAUSD schools show 97 percent of Dolores Street Elementary’s 133 kindergarteners entered school this year on a conditional basis, closely followed by 94 percent entering conditionally at George De La Torre Jr. Elementary School. Dr. James Edward Jones Primary Center, Lenicia B. Weemes Elementary and Raymond Avenue Elementary each had 92 percent of their kindergarteners entering conditionally.
“It’s a challenge when you’re busy during the school day, and the days roll by, and then three months later you realize you have a student who you missed notifying them and the parent forgot,” Ross said. “And that happens all the time.”
A child could be under-vaccinated for a number of reasons, including lack of training resources for school staff charged with tracking students; families moving in and out of care; or parents who are unable to get a child to the doctor in time.
One single mother experienced this firsthand when she had to cart her two young kids on two buses from East Los Angeles to a downtown clinic.
“Somewhere when they became toddlers I started to fall a little behind on the vaccinations,” said Sara Martín, 29. “Not intentionally, just that’s kind of how it happened for me.”
Her children, 18 months and three-years-old, are now up to date. She said she found it difficult to keep up with obligations such as getting them shots and taking them to the dentist.
“These simple things were actually a pretty big struggle to get through,” she said.
Under-vaccinated children are found in districts throughout the state. Los Angeles County schools had a “conditional entrant” rate of 12.28 percent, almost double the state’s rate.
In Northern California, Alameda County also stands out: 9.68 percent of its students entered kindergarten on a conditional basis this school year.
“We have a conditional entrant problem here,” said Amy Pine, director of the Immunization Program for the Alameda County Public Health Department. She has made it her mission to address this issue.
“They’re not immunized. They’re not protected,” she said. Together with Dr. Kristen Lum, a pediatric resident at UCSF Benioff Children’s Hospital Oakland, Pine visited Alameda County schools this fall with chronically high rates of “conditional” entrants. Pine and Lum have made recommendations that they hope will improve tracking of “conditional entrants,” and ultimately, immunization rates statewide.
“Maybe it’s just not as sexy as Personal Belief Exemptions,” Pine said. “But I think it’s powerful information. Under-vaccinated is still making you vulnerable for disease, for getting the disease and for transmitting the disease.”
When discussing vaccine-preventable diseases, experts often talk about “herd immunity.” A certain threshold of immunized people – over 90 percent of the population – will keep those who are unvaccinated largely safe from disease. Those who are too young or too frail to receive vaccines must rely on the inoculated to keep them safe.
The state requires kindergarteners to be up to date on immunizations against nine vaccine-preventable diseases: Diphtheria, Tetanus and Pertussis; Measles, Mumps, Rubella; Polio; Hepatitis B and Chickenpox. Most require multiple doses given at specific intervals.
“Everyone in the vaccine world is concerned when any child is not fully vaccinated because then you have a keyhole for disease into the community,” said Dr. Elizabeth Rosenblum, a clinical professor at UC San Diego and recipient of the 2014 Centers for Disease Control’s CDC Childhood Immunization Champion Award in California.
Added together, the percentage of “conditional entrants” and vaccine exemptions due to medical or personal beliefs approaches 10 percent of kindergarteners un- or under-vaccinated statewide.
This worries Dr. Richard Pan, a pediatrician and state senator (D-Sacramento) who sits on the senate health committee. Pan sponsored last year’s legislation requiring doctors to sign off on parents’ decisions not to vaccinate their children.
“It certainly is a public health problem, because you have people who are under-vaccinated,” he said. “There’s a much higher percentage of these children who may not have the protection against a contagious disease, a vaccine-preventable illness.”
Some experts think the recent disease outbreaks may inspire more people to vaccinate their children. Or to catch them up on missing shots.
“There’s nothing like an outbreak to remind people about the importance of getting vaccinated,” said Alameda County’s Amy Pine. “Unfortunately it has to come to an outbreak or a vaccine shortage to get people lined up.”
Center Data reporter Ronald Campbell and Southern California Public Radio’s Rebecca Plevin contributed to this report.