AT RISK IN SMALL SCHOOLS
Low vaccination rates at small Arizona schools leave students more vulnerable to measles
Sending your kindergartner to a school in Arizona with 20 or fewer students in the class likely puts your child at a higher risk for catching measles than going to a larger school, according to an analysis of public records obtained by The Arizona Republic. ¶ About three out of every five kindergarten classes with 20 or fewer students had such low vaccination rates last year that measles could easily spread among the children — and even to the community. For whooping cough, or pertussis, which is less contagious but known to kill infants, it was about two out of five kindergartens with 20 or fewer kids. ¶ Compare that with schools with larger kindergarten classes: about three in eight were not protected from measles outbreaks and less than two in 12 weren’t protected from whooping cough. ¶ But parents can’t find out from the state how big that risk is at their small school. The school doesn’t have to tell them, either. ¶ And local health officials in the two most populated counties wouldn’t know.
The Arizona Department of Health Services releases vaccination rates for schools with more than 20 students, but not for the smaller ones, citing protection of student privacy. The Republic obtained the records by seeking vaccination rates and enrollment data without school names.
Maricopa County Department of Health Director Bob England said his staff hasn’t looked at small-school vaccination rates because no one asked for them. The Pima County Health Department hasn’t inspected small-school data, either. The county relies on the state to select schools to audit but also works with schools that request help, said Julia Flannery, Pima County Health Department information manager.
The Republic’s analysis found most of the small schools reported that less than 95 percent of their kindergartners received measles vaccines for the past four school years. That places them below the herd immunity rate, which is achieved when enough people in a population are vaccinated so the disease cannot spread effectively.
Dozens of the schools reported that less than three-quarters of their students came to school vaccinated against the measles.
England said he was surprised to learn from The Republic that so many schools are not protected from an outbreak.
“I’m sure going to ask for (small-school data) from now on so we can keep track of it,” England said, adding, “We’ve always tolerated the fact that this isn’t available to parents in really small-school settings ... so maybe that’s part of the problem.”
Some parents who do not vaccinate fear the ingredients will make their children sick or balk at the number of vaccines the government recommends, which has tripled over the past few decades.
Moderate to severe complications from vaccines are rare. One in 3,000 people who get the measles, mumps and rubella vaccine (MMR) have a seizure caused by fever and one in 14,000 who get the Diphtheria, Tetanus and Pertussis (DTAP) vaccine have a seizure. Serious allergic reactions occur in less than one out of 1 million doses for both. The National Vaccine Injury Compensation Program has, however, paid out more than $2.9 billion in compensation to people claiming harm from vaccines since 1989.
Arizona law requires parents to vaccinate their children or sign exemption forms before entering kindergarten. The Republic has found that hundreds of schools have allowed some students to enroll without either.
Parents need to pay attention to the whether other parents immunize their children, said Rep. Debbie McCune Davis, D-Phoenix, also the director of the Arizona Partnership for Immunization, a statewide organization that promotes vaccines.
“Some may assume that their kids are protected by parents who immunize only to find out when an outbreak of a disease occurs that they then have to take responsibility for their own children’s education during the time of an outbreak,” she said.
A small school may decide to release its rates to a parent that asks. Leaders of Ahwatukee Foothills Montessori, Arcadia Montessori School and the Maricopa Village Christian School, for example, all told The Republic they would tell a parent who wanted to know. They also said they’ve maintained high vaccination rates.
An outbreak could shut down a school if a large enough portion of the students are not immunized, but England said that hasn’t happened in Maricopa County. Children exempted from vaccines must stay home during outbreaks.
The blanket approach
Health officials have offered several explanations for the pattern of low vaccination rates in small schools: About 94 percent of kindergartners in schools with more than 20 kindergartners enrolled last year were vaccinated for the measles, while just 84 percent were at smaller schools.
Many of these schools have few employees, which could make it difficult to keep track of student health records. Also, most of them are private and charter schools, which health officials and educators have said tend to attract parents that are skeptical of vaccines.
A smaller portion of charter and private schools reach herd immunity than public schools, according to previous Republic investigations.
The state takes a “blanket approach” in its education efforts to promote immunization, said Jessica Rigler, bureau chief of epidemiology and disease control at the Department of Health Services.
The DHS sends letters to schools regarding their vaccination and compliance rates each year. For more targeted education campaigns, the state looks to local health officials to work with schools that are struggling to obtain high vaccination rates, she said. England said that doesn’t happen. “We only go out to actually educate school personnel not many times a year . ... It’s not based on any threshold. It’s not based on any data. It is based purely on when (the schools) ask for help,” he said.
England said he doesn’t have the staff to do what he considers ideal: meet with decision makers at schools with low vaccination rates to make sure they understand what risk they’re placing on their students.
The DHS also selects schools for local officials to audit, but Pima County Health Department’s Flannery said the schools are largely picked at random.
A social contract
Arizona has had two measles scares the past two years. One started in early 2015 at Disneyland and spread across the Southwest. Seven Arizona residents got infected, exposing about 1,000 people to the disease.
The other started this summer at the Eloy Detention Center in Pinal County. Twenty-two people got sick, and health officials cautioned that residents in Gilbert, Mesa and Pinal County may have been exposed.
Measles spreads through the air when an infected person coughs or sneezes. England said measles did not spread rampantly this summer because so many Arizonans had assumed the social responsibility of getting vaccinated.
It is often considered a social contract to protect those most vulnerable in a community from contracting preventable diseases.
Measles causes a slate of short-term symptoms such as a rash or diarrhea, but can lead to pneumonia, lifelong brain damage and deafness. Measles kills one or two out of every 1,000 children who contract it in the U.S. Pertussis, one out of 100. While a healthy person may recover without long-term effects, that person could spread the disease to another with a weakened immune system — a kid with cancer, for example — and trigger more severe complications.
Infants who are too young for vaccinations can have severe reactions if a sibling brings disease home. Pertussis, known as the “100-day cough,” lands half of babies who catch it in the hospital. An Australian mother’s video went viral this month when she posted footage of her 5week-old baby with whooping cough as she struggled to breathe. She posted, she said, to show just how scary the disease is for babies who are too young to be vaccinated. Babies rely on herd immunity to keep them safe, she wrote.
In addition, immunizations are not always effective. Vaccinated people, if surrounded by enough infected people, will have that efficacy tested, England said.
Because the small schools with low vaccination rates have so few students, it is likely that an outbreak would stay fairly contained. But that’s just “playing the odds,” England said.
“Whether your neighbor is immunized or not matters to you because you are protected partly by the immunizations of the people around you. The fact that we never get exposed anymore is what really protects us,” he said. “Even people without kids in school should have a stake in this.”