Vaccination rates for California 7th-graders reached their highest recorded levels, the California Department of Public Health reported, in another sign that a stricter vaccination law is having an effect in its first year. The increase in 7th-grade immunizations follows previously released record-high levels of kindergarten vaccination rates.
The new results end a year of speculation and angst in school districts about what parents opposed to vaccinations might do in the face of the law, which on July 1, 2016 ended the “personal belief exemption” that allowed thousands of parents not to vaccinate their children in public and private schools. In 2013-14, nearly 17,000 California kindergartners were granted personal belief exemptions from school-required vaccinations — about 3.2 percent of total kindergarten enrollment. Communities of children who were not fully vaccinated emerged, among them the Yuba River Charter School in Nevada City, where 81 percent of kindergartners in 2013-14 were not up-to-date in immunizations. In emotionally charged testimony at state legislative hearings on the matter, some parents from around the state vowed to homeschool their children or move rather than have them immunized to attend school. Speculation swirled that parents would persuade doctors to give their children coveted medical exemptions to vaccinations.
In the end, vaccination rates increased. The percentage of 7th-grade students who met school-entry immunization requirements rose to 98.4 percent in the 2016-17 school year — an increase of 1.8 percentage points over the last three years, the California Department of Public Health said. Seventh-graders must receive booster immunizations against three diseases — tetanus, diphtheria and pertussis (whooping cough). And if they had not been vaccinated in the past because of personal belief exemptions, they must also have received vaccinations against polio, measles, mumps, rubella and chicken pox to enroll in 7th grade.
“Our school nurses and public health departments have done a tremendous job,” said Catherine Flores-Martin, director of the California Immunization Coalition.
Rates of medical exemptions did rise, moving from 0.1 percent in 2015-16 to 0.4 percent in 2016-17 for 7th-graders. And Kristie Sepulveda-Burchit, executive director of Educate Advocate, a Southern California organization opposed to the law, said she knows “about 100” families that left California because of the school vaccination requirement, including one family that is “RV’ing across the country, homeschooling.” She said other families have left the public school system for homeschooling. The California Department of Education said it doesn’t have data on the number of homeschooled students and the number of parents leaving the state to avoid vaccinating their children is not tracked.
Ken Cutler, public health officer for Nevada County, where about 20 percent of kindergartners held personal belief exemptions to vaccinations from 2011-2014, the highest or second highest rate in the state, said it was impossible to know what choices vaccination opponents are making. “It’s probably a mix, where some people have decided to get vaccinated, while others have pursued ways to not be vaccinated,” he said.
Under the 2015 law, Senate Bill 277, students are not required to be vaccinated if they are homeschooled or enrolled in independent study without classroom instruction. In addition, the California Department of Public Health has said that students who qualify for special education services will continue to receive those services regardless of their vaccination status.
Even in outlier areas like Nevada County, where parents who refused to fully immunize their children have congregated, vaccination rates increased, Cutler noted. In 2011-12, 72 percent of kindergartners and 89 percent of 7th-graders in the county were fully immunized. In 2016-17, those immunization rates rose to 80 percent of kindergartners and 90.5 percent of 7th-graders in the county — a gain, but still among the lowest rates in the state.
“We had a nice increase, but clearly people have found alternatives to getting vaccinated,” Cutler said.
The statewide increase in vaccination rates follows a widely publicized 2014-15 outbreak of measles, which struck visitors to Disneyland in Orange County and infected 136 Californians. The spread of measles has been attributed largely to unvaccinated individuals. Outbreaks of whooping cough also have drawn attention. In 2014, whooping cough was declared an epidemic in California and the cause of death of three infants who were too young to be vaccinated.
State law requires students who are entering kindergarten be immunized against 10 serious and potentially fatal diseases: diphtheria, Hib disease (bacterial meningitis), measles, mumps, pertussis, polio, rubella, tetanus, hepatitis B and chicken pox.
Community immunity, also known as herd immunity, is the goal. Achieving community immunity requires vaccination rates that vary by disease, but the California Department of Public Health is pushing for vaccination rates of 95 percent or higher. The higher the vaccination rate, the greater the protection from disease for infants too young to be vaccinated, individuals whose immune systems are compromised and the elderly. Of concern, the department said, was that 10 out of 58 California counties reported 7th-grade booster vaccination rates below 95 percent, making children more vulnerable to disease. Those counties are: Calaveras, Humboldt, Lassen, Mariposa, Nevada, Plumas, Santa Cruz, Sutter, Trinity and Tuolumne.
In its report, the California Department of Public Health credited the rising rates to public health outreach, parent awareness of vaccine-preventable diseases, the new state law and the health department’s 2016 and 2017 audits of school vaccination data. The audits have put school districts on notice that investigators will be checking to make sure that students who are enrolled have valid vaccination records.
In the 7th-grade data collection, 108 public schools did not report student vaccination status data to the state. The schools, which are subject to audit in 2017, are located in 15 counties, the report said: Alameda, Imperial, Kern, Los Angeles, Madera, Mariposa, Mendocino, Monterey, Riverside, Sacramento, San Benito, San Bernardino, Siskiyou, Solano and Stanislaus. A list of the schools that did not report can be found here.
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