December 6, 2011

Schools worry as more parents opt out of school shots

Wichita school officials say a rising number of parents are opting out of school shots for their children, echoing a nationwide trend that has health officials worried about possible new outbreaks of diseases.

Wichita school officials say a rising number of parents are opting out of school shots for their children, echoing a nationwide trend that has health officials worried about possible new outbreaks of diseases.

Kansas schools allow exemptions from vaccine requirements only for medical or religious reasons.

But Kathy Hubka, coordinator of health services for the Wichita district, said school nurses have found instances where parents sign a religious exemption for philosophical or political reasons.

“Some truly believe there’s something wrong with the shots,” Hubka said.

“Others, it’s more of, ‘It’s my kid, I’m going to do what I want.’ Or, ‘I had chicken pox when I was little and it’s no big deal,’ that kind of thing.”

Officials with the Kansas Department of Health and Environment, which only last year began recording the total number of vaccine exemptions, said about 1 percent of Kansas kindergartners opted out of required shots for the 2010-11 school year. Nearly three-fourths of those were religious exemptions.

A recent analysis by the Associated Press named Kansas as one of 10 states where exemption rates increased 1.5 percentage points or more over the past five years. That estimate by the Centers for Disease Control and Prevention was based on sample data the state previously reported to the federal government.

The AP analysis found more than half of states have seen at least a slight rise in the rate of exemptions over the past five years.

State epidemiologist Charlie Hunt said new reporting procedures in Kansas will improve how health officials count and report the number of exemptions.

“We’ve recognized that we probably were not getting complete information, and we just don’t think the information was reliable enough to assess a trend,” Hunt said. “It’s a factor in terms of immunization coverage, and it’s important for us to understand all those factors.”

Parents’ reasons for skipping vaccines vary. Some doubt that shots are essential. Others fear that vaccines carry their own risks. And some find it easier to check a box opting out than to get the shots and required paperwork.

Still others are ambivalent, believing in older vaccines but questioning newer shots against, say, chickenpox.

The number of shots also is giving some parents pause. By the time most children are 6, they will have been stuck with a needle about two dozen times – with many of those shots given in infancy. The cumulative effect of all those shots has not been studied enough, some parents say.

“Many of the vaccines are unnecessary, and public health officials don’t honestly know” the effects of giving so many vaccines to such small children, said Jennifer Margulis, a mother of four and parenting book author in Ashland, Ore., a small liberal community that has unusually high vaccination exemption rates.

Vaccination rates in Kansas schools remain high overall – between 85 and 90 percent after the first month of school, Hunt said.

Hubka, the Wichita coordinator, said school nurses’ primary concern isn’t families that file exemptions, but the hundreds, often thousands, each year that just don’t get their children to a clinic for the required shots.

“It’s that parent who says, ‘We’ll go to the doctor next week,’ and next week never comes,” she said.

Last month, the Wichita district pulled hundreds of students out of class and informed parents they wouldn’t be allowed to return to school until their immunizations were up to date.

At West High School alone, about 400 students – about one-fourth of the student body – were not up to date on shots on Nov. 1. In late November, Hubka said, that number was down to 59.

Kansas schools allow an unvaccinated child to attend school under two conditions:

•  The child has an annual written statement from his or her doctor saying that the child’s life or health would be endangered by undergoing the inoculation.
•  Or, the parent or guardian has signed a written statement that the child is an adherent of a religious denomination whose teachings are opposed to inoculations.

A Wichita district policy says the school “reserves the right to require verification by the clergy of the religious tenet which precludes immunizations.”

School nurses are “questioning more, checking with the minister or requiring verification,” Hubka said. “Because they truly believe the vaccines are required for a reason, and the bottom line is to save lives.”

This school year in Wichita, 48 children have filed medical exemptions and 71 have submitted religious exemptions, Hubka said.

As part of the exemption, families agree that their child could be excluded from school for 21 days or more if another child in the class is diagnosed with a vaccine-preventable disease.

Parents who let their kids skip vaccines put others at risk, health officials say. Because no vaccine is completely effective, if an outbreak begins in an unvaccinated group of children, a vaccinated child may still be at some risk of getting sick.

Studies have found that measles has suddenly re-emerged in some communities with higher exemption rates. Vaccinated kids are sometimes among the cases, as are children too young to be vaccinated.

Pertussis, or whooping cough, is another risk. Last year California had more than 2,100 whooping cough cases, and 10 infants died.

“It’s important to have a high enough (vaccine) coverage level that if a disease is introduced into a community, enough people are vaccinated that it suppresses transmission,” said Hunt, the epidemiologist.

Hubka said school nurses in Wichita try to talk with families about their concerns and explain the reasons behind the vaccine requirements.

“Just like there’s a speed limit on the highway and everyone has to follow it, whether they agree with it or not, it’s the same with shots,” she said.

“We definitely work with families, because we want the kids in school,” Hubka said. “We want those kids safe, and we want other kids safe as well.”

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