Students tardy on vaccines alarm officials

Many Houston-area children are being exposed to unvaccinated schoolmates at rates greater than previously thought, whether because of exemptions for non-medical reasons or simple tardiness in getting the required shots, according to a new analysis of the latest state data.

The analysis shows that vaccine exemptions at schools throughout Harris County have increased 175 percent since 2010, and that HISD’s 2018-2019 kindergarten delinquency rate for the measles, mumps and rubella shot was about five times the state rate.

“Vaccine exemptions plus tardiness can create deadly pockets of vulnerability,” said Rekha Lakshmanan, director of advocacy and policy for the Immunization Partnership, a Houston-based pro-vaccine group. “It’s a dangerous, frightening picture in some places.”

Those places include some

Houston-area schools, mostly private, where the non-medical exemption rate ranges from 4 percent to 25 percent of the student population, and HISD schools where the delinquency rates range from 16 percent to more than 40 percent.

The new numbers, some obtained through a Houston Chronicle open records request, provide the first look at the Houston area’s pockets of vulnerability since the state issued a report showing there were 64,176 exemptions for “reasons of conscience” at Texas schools in 20182019. That total is up 2,000 percent from 2003-2004, the first school year after the Legislature changed state law to allow such opt-outs.

It also coincides with a recordbreaking national outbreak of measles. There have been 1,109 confirmed cases so far in 2019, the most in the United States since 1992 and since measles was declared eliminated in 2000. Twenty-eight states have reported cases, including Texas, which has had 15. Five of those were in the Houston area.

The outbreak has been attributed to the increasingly vocal efforts of the anti-vaccination movement, whose claim that vaccines cause harm has steadily picked up adherents in recent years. Concerned about the threat, Baylor College of Medicine issued a rare position paper two weeks ago, calling vaccines “among the most important lifesaving technologies ever developed by humankind” and decrying the “misinformation” that has fueled the growth of anti-vaxxers.

In particular, public health experts worry the movement’s growing numbers represent a threat to “herd immunity,” the overall protection that exists when a large majority of a population becomes immune to a disease. Such immunity breaks down when unvaccinated people cluster in certain environments, such as schools, churches or jails.

Late vaccinations

The most striking new information in the data was not exemptions, but HISD’s delinquency rate. Two months into the 20182019 school year, when independent school districts report their data to the state, 4.15 percent of HISD’s kindergartners had not requested an exemption but still hadn’t fulfilled their MMR requirement. The state rate was 0.81 percent.

“This is a wake-up call that we urgently need a new concentrated effort on ensuring children receive their MMR vaccine,” said Peter Hotez, a Houston vaccine scientist with Baylor College of Medicine and Texas Children’s Hospital. “Otherwise, Texas is at risk for a large measles epidemic.”

Children enrolled in school despite not having met vaccine requirements are not in compliance with Texas law. Under the law, schoolchildren are supposed to show proof they’re received six vaccines by kindergarten — those for chickenpox, diphtheria/pertussis/tetanus, MMR, polio, hepatitis A and hepatitis B — all requiring more than one dose. By seventh grade, they also need to be vaccinated against meningitis.

Concern about the issue caused Stephen Williams, director of the Houston health department, and Dr. David Persse, the public health authority for the city, to recently write to the roughly 50 HISD schools whose delinquency rates exceed 5 percent to urge them to do better.

“There are some immediate next steps that we encourage you to take, which include having your school nurse inform all delinquent parents of their student’s status and require their compliance with state of Texas school requirements,” Persse and Williams wrote in the May 8 letter.

“We would also like to take this opportunity to empower you to make the tough decision of not allowing students into your school who are not compliant with immunization requirements.”

The letter noted that a copy had been sent to HISD Interim Superintendent Grenita Lathan.

Highest delinquencies

HISD elementary schools with the highest MMR delinquency rates among kindergartners were Burbank (41 percent), Cunningham (30 percent), Crockett (28 percent), Atherton (27 percent), Dogan (24 percent) and Foerster (16 percent).

Gwendolyn Johnson, HISD’s director of health and medical services, said the district’s policy is to be compliant with state law but that some schools are “not as restrictive as possible.”

“We continue to battle that, to remind administrators and anyone registering students about being compliant with state law,” said Johnson. “There are gaps in understanding we’re trying to improve. We’re constantly working it because we’re bound by state law and we want children to be safe.”

Johnson said that schools that allow students to enroll without being up to date on their vaccinations work with parents, who typically assure them they’re going to get it done but then often have difficulty navigating work schedules and access to health care. She said HISD’s 2018-2019 delinquency rate dropped to 1 percent by the end of the school year.

But Dr. Susan Wootton, a pediatrician at McGovern Medical School at UTHealth, said a letter from the health department and an HISD pledge to keep battling aren’t enough. After all, the rate has grown from 3 percent three years ago.

“The question is, who’s holding these schools accountable?” asks Wootton, who led recent research on the delinquency issue at HISD. “No student should be enrolled until they have the necessary vaccines.”

Wootton said the Texas Education Agency should enforce vaccine compliance. She also said HISD needs to start working with parents earlier in the summer to give them more time to meet their child’s vaccine requirements.

The Houston Health Department’s health centers offer vaccines to those without health insurance on a sliding-scale basis — either free, $5 or $15, depending on family income. The fee is for all shots needed at the time of a visit.

‘Public health tsunami’

HISD’s delinquency rates for the meningitis vaccine were even worse. Sixteen percent of the district’s 7th graders were delinquent in 2018-2019, compared with the state average of 1.7 percent.

Wootton, Hotez and Lakshmanan all said the new numbers suggest non-medical exemptions, so talked about in recent years, are really just the tip of the iceberg.

They mentioned not just delinquencies at public and private schools, but the lack of information about home-schooled children and for vaccines recommended but not required, such as for the flu. Homeschooling estimates vary widely and range from 150,000 to 300,000 children across Texas.

In truth, HISD’s non-medical exemption rate isn’t that high. Though the rate of students with non-medical exemptions to at least one vaccine ranges from 2 percent to 5 percent at a few schools, the district’s overall 0.57 percent rate ranks in the bottom fourth of Houston area ISDs.

The area’s highest exemption rates belong to Huffman, Tarkington, Friendswood, Tomball and Montgomery ISDs, all above 2 percent. Huffman’s is the highest (2.86 percent) and Tarkington’s is the fastest growing (up 346 percent in the last four years, from 0.59 percent to 2.63 percent).

Among urban counties, the greatest exemption spike has come from Bexar, which includes San Antonio, whose rate has increased 238 percent since 2010. Dallas and Harris counties are next at 184 percent and 173 percent, respectively. Travis County’s jump was only 114 percent, but that’s because its rate was significantly higher at the start. Travis County includes Austin, and its 2.42 percent exemption rate is easily the highest of urban counties. By contrast, Harris County’s exemption rate is 0.90 percent.

“Responding to anti-vaccine activists is sucking all the oxygen, energy and time on this issue when this new data shows they’re just one symptom of the problem,” said Lakshmanan of the Immunization Partnership. “These additional health factors suggest we are moving toward a public health tsunami.”

“This is a wake-up call that we urgently need a new concentrated effort on ensuring children receive their MMR vaccine. Otherwise, Texas is at risk for a large measles epidemic.” Peter Hotez, a Houston vaccine scientist with Baylor College of Medicine and Texas Children’s Hospital