School vaccination rates rise as controversy persists – The San Diego Union-Tribune
Immunization rates for kindergartners are up in San Diego County and statewide despite fears that parents leery of vaccination would find ways to skirt a law that bans personal-belief exemptions.
Data released last week by the California Department of Public Health shows that San Diego County’s kindergarten immunization rate hit 94.7 percent this school year. That’s one percentage point higher than the figure from the previous academic year.
And although this year’s rate in the San Diego region is nearly a point lower than the statewide level of 95.6 percent, it’s still the highest one for the county since the current vaccination schedule was adopted in 2001.
The increased rates across most of California occurred even though there is evidence that some parents who would otherwise decline to vaccinate their children based on personal beliefs managed to find a doctor willing to write them a medical exemption. Under current state law, medical exemptions from a licensed physician are still valid.
The massive change in school vaccination behavior started with a measles outbreak at Disneyland in 2015. Dismayed by how the outbreak grew, legislators banned personal-belief exemptions by passing Senate Bill 277. The new law inspired a number of now-dismissed lawsuits, including one filed by a group in San Diego, which claimed that it violated students’ constitutional rights to a public education.
Concern over vaccination rates has been building in San Diego County for years and ever since it became clear that some schools, most often private and in relatively-affluent areas, had vaccination rates that were far below county averages. Public health officials have fretted that, when vaccination rates drop too low, preventable diseases such as measles and mumps spread through pockets of students at individual schools even if the region’s overall vaccination rate exceeds 90 percent.
Dr. Wilma Wooten, the county’s public health officer, applauded the latest state numbers.
“I think that this is good news. It shows the bill is working. Now we just need to maintain the progress we have made,” Wooten said.
State results show that personal-belief exemptions dropped from 3.6 percent of county kindergartners during the 2015-2016 school year to 1.4 percent this year. The new law barring the exemptions allows any kindergartner who was enrolled in prekindergarten last year, and who had a personal-belief exemption on file by the last day of 2015, to keep that exemption until they enter seventh grade. That is also the case for anyone who had an exemption in kindergarten or a higher grade last year. Seventh grade exemption numbers, and results for individual schools, have not been released by the state but should be out later this year.
The county’s kindergarten personal-belief exemption rate is more than twice as high as the state rate of 0.6 percent, according to statistics from the California Department of Public Health. In addition, San Diego County saw the ratio of medical exemptions granted by doctors jump from 0.2 percent last year to 0.9 percent this year. The number of medical exemptions also jumped statewide, reaching 0.5 percent.
Locally, 329 kindergartners were not immunized by the time local districts filed their immunization reports with the state in October 2016. Those kids were home-schooled, were on an independent-study program with no classroom work or had special needs programs that require them to be granted access to public schools even if they’re not immunized.
Another 247 kindergartners were deemed “overdue” for immunization, meaning that they started the school year with a started, but not completed, vaccine schedule and did not get the required shots to complete the process within specified deadlines. It was unclear Friday whether or not these kids ended up getting sent home or if they were allowed to stay in school despite the new state law.
Jeanne Salvadori, a school nursing program specialist with the San Diego County Office of Education who serves as a resource to school nurses at public schools across the county, said she did not know what the final resolution was for those deemed overdue.
“They may have gotten bounced from school or they may not have. We don’t know about those 247 students, what their situations are,” Salvadori said.
She referred the question to the county’s immunization services branch. Jennifer Sterling, the agency’s school and child care coordinator, declined to comment, referring all questions to the county’s media relations department. County communications officer Jose Alvarez said Friday afternoon that “school nurses follow up with those families,” but he did not indicate whether children who were granted conditional public school enrollment were asked to leave when they failed to follow through with needed shots by specified deadlines.
Overall, it appears that many did see the law’s mandate as a good enough reason to get fully immunized.
Dr. Eyla Boies, a pediatrician with the UC San Diego Medical Group who chairs the immunization committee of the American Academy of Pediatrics’ San Diego chapter, said that she and many of her colleagues noticed a difference in the fall of 2016 as the new school year approached.
“They have been saying ‘yes, I do want to do this so my child can go to school,’” Boies said.
But she also noted that some have taken another route, going online to find a doctor willing to write a letter testifying that their child has a medical problem that makes vaccinating them too risky.
“I know of one family who went to an outside pediatrician, paid to get the letter for school enrollment, and then came back for their primary care to the original doctor,” Boies said.
Technically, there is nothing necessarily illegal about this practice. While the U.S. Centers for Disease Control and Prevention generally considers only severe allergic reaction to a previous vaccine dose, and in some cases a compromised immune system, as valid reasons to skip vaccination, state law takes a less-strict approach. Any licensed doctor can grant a medical exception based on his or her medical judgment on a case-by-case basis. When SB 277 passed, some doctors began listing prices for vaccine exams online for interested families.
In the end, Boies said, convincing families to follow the vaccination schedule and not look for a doctor willing to write out an exemption letter comes down to pediatricians seeing patients day in and day out. It is the job of doctors, she said, to work with their patients and explain all of the aspects of the vaccines that parents are being asked to have administered to their children.