State has poor record for student immunizations, high rate of exemptions

September 20, 2011

By Tom Corrigan

A report released not long before students returned to school said that Washington kindergartners do not meet state or national goals for required immunizations when they enter school.

Completed by the Centers for Disease Control and Prevention, the study is touted by the federal government as the first of its kind. Besides the lack of compliance with vaccinations, the study also notes Washington has the highest immunization exemption rate in the country.

“This is not necessarily news to us,” said Michele Roberts, program manager for immunizations with the state Department of Health. “It’s a dubious honor.”

Opting out is too easy

Jay Fathi is medical director for primary care and community health at Swedish Medical Group. Since 2002, he also has served on a statewide vaccine advisory committee that reports to the health department.

“In my opinion, it has been too easy to opt out of immunizations,” he said.

On the Web

Find a health care provider or immunization clinic in King County at www.kingcounty.gov/health-services/health.aspx. Click on “child immunizations.”

In total, 6.2 percent of Washington kindergartners have parent-signed exemptions for one or more vaccines. Fathi further said the exemption rate has been steadily increasing and he believes a rate of 5 percent or more is alarming. The CDC study showed the number of Washington exemptions more than doubled in the past 10 years.

The data from the 2009-10 school year shows that Washington’s kindergarten coverage for required vaccines — including polio, whooping cough, measles, hepatitis B and chicken pox — ranges from 88 percent to 93 percent. The state and national goals for individual vaccines by the time children enter kindergarten are 95 percent.

“Most of today’s parents weren’t around to see how bad diseases like measles and whooping cough were before vaccines helped bring them under control,” Washington state Secretary of Health Mary Selecky said in a press release. “We’ve done a good job fending off those diseases, but we can’t be complacent. We’re seeing them start to make a comeback and too many of our kids are vulnerable.”

Fathi echoed Selecky’s comment.

“We’re talking about vaccines for preventable diseases … diseases that can lead to death or disability,” he said.

For example, Fathi spoke of children dying every year in King County from whooping cough, also known as pertussis. He clearly believes those deaths are largely preventable.

New law affects exemptions

While it apparently wasn’t passed in reaction to the CDC study, a new Washington law took effect July 22 and changed the way parents can obtain immunization exemptions. The aim clearly is to cut down on the number of so-called convenience exemptions, Roberts said.

Convenience exemptions occur when it is simply easier for the parent to fill out an exemption form than to dig up shot records or actually take a child to a doctor for an immunization. The exemptions originally were for parents who have legitimate philosophical or medical reasons for not having a child immunized, Roberts added.

The new rules say that if a parent wants to exempt a child from school or child care immunization requirements, they must first receive immunization information from a qualified health care provider. The provider must go over the risks and benefits of immunizations and sign a statement confirming the parents were provided that information.

The form must then be turned into the appropriate school district or care provider. Old exemptions already accepted by schools or other care providers are not affected by the new rules and still will be in force.

There is only one exception to the new exemption rules and it is for parents who can demonstrate membership in a church that voices religious objections to immunizations. In that instance, no consultation with a care provider is needed.

In any case, if a child is not in compliance with immunization rules, parents will be given a 30-day notice. If immunizations are not brought up to date and no exemption is filed in accordance with state rules, children can be sent home.

The state estimates about one-third of all exemptions filed in the past were of the convenience variety, Roberts said. Officials know this, she added, because they find, in the case of many exemptions, there is a record somewhere of the child having had an immunization at some time or another.

Students with exemptions can end up missing considerable school time. If a classmate comes down with, for example, measles, students who have not been vaccinated — including those with exemptions — must be sent home for at least two weeks to prevent the spread of disease.

“Sometimes, that’s a pretty good motivator,” Roberts said, adding that in such situations, shot records often suddenly appear.

‘Vaccines are safe’

Locally, as of May 2011, 651 students, or 3.8 percent of the student population, had exemptions filed in their names, according to information provided by the Issaquah School District.

Of the local exemptions, 77 were medical, 554 were personal and 18 were listed as religious.

In Fathi’s mind, education is key to reducing exemptions and prompting parents to get children immunized. There are too many myths about the possible dangers of immunizations, he added.

“The risk of not getting vaccinated is far greater than the risk of getting vaccinated,” Fathi said, adding he is “profoundly” sure of that statement, both as a doctor having treated thousands of children and as a parent.

“The overwhelming, vast majority of medical research shows vaccines are safe,” Fathi said.

In the end, Fathi said he supports the new exemption rules, but offered they may not go far enough in promoting immunizations.

Residents can obtain free vaccines for all children younger than 19, according to the state health department. Health care providers can charge for an office visit or bill an administrative fee; this may be waived for low-income households.

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