Many stu­dents not vac­ci­nated, de­spite new law

Med­i­cal ex­emp­tions tripled as state’s tough leg­is­la­tion took ef­fect.

Los Angeles Times - - FRONT PAGE - By Soumya Kar­la­mangla and San­dra Poin­dex­ter

Even with a new law that has boosted kinder­garten vac­ci­na­tion rates to record highs, hun­dreds of schools across Cal­i­for­nia still have so many chil­dren lack­ing full im­mu­niza­tion that they pose an in­creased risk of dis­ease out­breaks, ac­cord­ing to a Times anal­y­sis of state data.

At nearly 750 schools, 90% or fewer kinder­gart­ners had been fully vac­ci­nated last year, the anal­y­sis found. Ex­perts say the rate should be at least 95% to pre­vent the spread of highly con­ta­gious dis­eases such as measles.

Cal­i­for­nia’s tougher in­oc­u­la­tion law, known as SB 277, was ap­proved in 2015 af­ter a measles out­break that orig­i­nated at Dis­ney­land.

The law bars par­ents from cit­ing re­li­gious or per­sonal be­liefs to ex­cuse their chil­dren from im­mu­niza­tions, but some who al­ready had such ex­emp­tions were al­lowed to keep them.

The rest of the un­vac­ci­nated chil­dren need a form signed by their doc­tor say­ing they had a med­i­cal rea­son not to get their shots.

In the school year that be­gan last fall, the law’s first year, the num­ber of kinder­gart­ners in Cal­i­for­nia with med­i­cal ex­emp­tions tripled, the anal­y­sis found.

Doc­tors say that at most, 3% of peo­ple could have a

med­i­cal rea­son for not tol­er­at­ing vac­cines, such as a gelatin al­lergy or be­cause they’re un­der­go­ing chemo­ther­apy.

But the Times anal­y­sis found that at 58 schools, 10% or more kinder­gart­ners had med­i­cal ex­emp­tions last fall. The rate topped 20% at seven schools.

“That’s just to­tally wrong,” said Dr. James Cherry, a UCLA re­search pro­fes­sor and se­nior ed­i­tor of the “Text­book of Pe­di­atric In­fec­tious Dis­eases.” “This idea of 20% hav­ing med­i­cal ex­emp­tions is non­sense, and cer­tain doc­tors buy into that, but it’s wrong.”

Ex­perts say some par­ents who are he­si­tant about vac­cines may be ask­ing doc­tors to vouch that their chil­dren have med­i­cal rea­sons to avoid them or get them later than when they’re re­quired by law.

Pub­lic health ad­vo­cates cheered the law’s suc­cess when the frac­tion of Cal­i­for­nia kinder­gart­ners who were fully vac­ci­nated jumped to 96% last year.

But as a new school year be­gins this fall, the high num­bers of un­vac­ci­nated kids at hun­dreds of schools last year have raised ques­tions about whether even one of the strictest laws in the na­tion can per­suade par­ents who are skep­ti­cal or fear­ful of vac­cines to im­mu­nize their chil­dren.

At Se­bastopol In­de­pen­dent Char­ter in Sonoma County, 11 of 45 kinder­gart­ners had a med­i­cal ex­emp­tion from vac­ci­na­tion last school year. An ad­di­tional 17 had per­sonal be­lief ex­emp­tions that rolled over from the pre­vi­ous year. All to­gether, only about a third of the class was fully vac­ci­nated — among the low­est rates in the state.

“To be hon­est, I’ve been a lit­tle un­easy about the amount of th­ese med­i­cal ex­emp­tions. It just kind of sticks out,” said ex­ec­u­tive di­rec­tor Chris Topham, who added that char­ter schools are al­ready un­der ex­tra scru­tiny. “It’s not some­thing I’m proud of or ex­cited about.”

He thinks the low rates are due in part to the pol­i­tics of Sonoma County, which has a “very high pop­u­la­tion of lib­eral thinkers and maybe a lit­tle bit of counter cul­ture.”

He said he in­vited a county health of­fi­cial to speak to par­ents about vac­ci­na­tions and was re­cently au­dited by the health de­part­ment, but there’s not much he can do if par­ents come in with signed med­i­cal ex­emp­tion forms.

“I would be con­cerned if there was an out­break,” he said. “Safety for a school leader is al­ways No. 1, even be­fore ed­u­ca­tion, frankly.”

Statewide, pri­vate and char­ter schools ac­count for the ma­jor­ity of schools where 90% or fewer kinder­gart­ners had re­ceived all their shots, the Times anal­y­sis found.

The anal­y­sis in­cluded 6,500 schools with 20 or more kinder­gart­ners — the state did not pro­vide data on schools with fewer than 20 kinder­gart­ners.

A third of the schools with low vac­ci­na­tion rates were in Los An­ge­les County, fol­lowed by San Diego and Or­ange, the anal­y­sis found.

Many school ad­min­is­tra­tors said they did not want to com­ment on de­ci­sions made by par­ents. Oth­ers could not be reached for com­ment or were out of the of­fice for sum­mer va­ca­tion.

Be­fore kinder­garten, chil­dren must be vac­ci­nated for sev­eral dis­eases, in­clud­ing po­lio, chick­en­pox, measles and whoop­ing cough.

Dr. Pia Pan­naraj, pe­di­atric in­fec­tious dis­eases spe­cial­ist at Chil­dren’s Hos­pi­tal Los An­ge­les, said that as many peo­ple as pos­si­ble in a com­mu­nity need to be vac­ci­nated against a dis­ease so if it’s in­tro­duced it can’t spread, pro­tect­ing even those who can’t get in­oc­u­lated for med­i­cal rea­sons.

Schools in par­tic­u­lar can be hot­beds for viruses, she said.

“The kids are al­ways close to­gether, they don’t wash their hands as of­ten as they should, they touch ev­ery­thing,” she said. “It’s very easy for in­fec­tions to spread.”

But Chris­tine Ku­glen, who runs In­no­va­tions Academy, a char­ter school in San Diego, said she felt as though the law had put her in an un­com­fort­able po­si­tion of polic­ing par­ents.

“If this was all started by Dis­ney­land hav­ing an out­break of measles ... then why isn’t Dis­ney­land al­lowed to check vac­ci­na­tion rates at the door? That’s where peo­ple got it, not here,” she said. “I wish the leg­is­la­tors who passed this would’ve had to sit with th­ese par­ents and tell them, ‘I’m sorry, your child can’t go to school.’ ”

Ku­glen said she’s talked to par­ents who de­cided not to at­tend the school af­ter she ex­plained the law’s re­quire­ments. She said she’s un­sure what hap­pened to them.

“If it’s true what it says in the Cal­i­for­nia Con­sti­tu­tion that ev­ery­one’s en­ti­tled to a pub­lic ed­u­ca­tion, then right now we are break­ing our own Con­sti­tu­tion,” she said.

Seven of 46 kinder­gart­ners at In­no­va­tions Academy had med­i­cal ex­emp­tions last year. State data show there were no stu­dents with med­i­cal ex­emp­tions in the pre­vi­ous year.

Sen. Richard Pan (DSacra­mento), a pe­di­a­tri­cian who co-wrote the new law, said he is happy that kinder­garten vac­ci­na­tion rates had im­proved over­all and hoped they would con­tinue to.

“Let’s just hope a child in one of those schools doesn’t travel abroad and bring back one of those dis­eases,” Pan said.

Pan said he thinks the in­crease in med­i­cal ex­emp­tions is par­tially due to par­ents of chil­dren who needed one pre­vi­ously but had been us­ing per­sonal be­lief ex­emp­tions in­stead be­cause they didn’t re­quire a doc­tor’s sig­na­ture.

How­ever, Pan said he was wor­ried physi­cians were im­prop­erly writ­ing med­i­cal ex­emp­tions for some chil­dren. Af­ter the law was en­acted, web­sites popped up coach­ing par­ents how to re­quest med­i­cal ex­emp­tions, in­clud­ing lists of doc­tors who would be likely to write the notes.

“It would be very un­for­tu­nate if there were physi­cians who’ve shirked their pro­fes­sion­al­ism, and ba­si­cally are try­ing to mon­e­tize their pro­fes­sional li­cense by putting chil­dren at risk and be­tray­ing pub­lic health,” he said.

Though the num­ber of med­i­cal ex­emp­tions in­creased last year, a very small num­ber of stu­dents had them. Across the state, .5% of kinder­gart­ners — 2,850 stu­dents — had one on file in the school year that be­gan last fall.

Re­becca Estepp, part of an ad­vo­cacy group that op­posed SB 277, said the law might’ve in­creased vac­ci­na­tion rates, but did so by strip­ping par­ents of their rights.

“They co­erced peo­ple into do­ing some­thing, so I don’t think that’s a win for any­body. The rate of peo­ple not vac­ci­nated be­fore SB 277 was so minute, so minute — this was just an over­re­ac­tion,” she said.

Op­po­nents of the law filed a law­suit last sum­mer claim­ing the law vi­o­lated Cal­i­for­nia chil­dren’s right to an ed­u­ca­tion un­der the state’s Con­sti­tu­tion, but later with­drew their case. They also failed to gather enough sig­na­tures last year to put a ref­er­en­dum on the Novem­ber bal­lot to over­turn the law.

Cather­ine Mar­tin with the ad­vo­cacy group Cal­i­for­nia Im­mu­niza­tion Coali­tion said she thinks that op­po­si­tion to vac­cines could fade over time.

She pointed out that the other two states that bar per­sonal be­lief ex­emp­tions, West Vir­ginia and Mis­sis­sippi, have some of the high­est vac­ci­na­tion rates in the coun­try.

“This is the long haul. We are chang­ing our cul­ture in Cal­i­for­nia,” she said.

‘Safety for a school leader is al­ways No. 1, even be­fore ed­u­ca­tion, frankly.’ — Christo­pher Topham, ex­ec­u­tive di­rec­tor of Se­bastopol In­de­pen­dent Char­ter, in Sonoma County

Ge­naro Molina Los An­ge­les Times

DES­MOND SEWELL, 12, re­ceives a vac­ci­na­tion from med­i­cal as­sis­tant Jes­sica Reyes at Lou Colen Chil­dren’s Health and Well­ness Cen­ter in Mar Vista on Aug. 4.

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