Credit: Jane Meredith Adams/EdSource Today

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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  1. Another Jane 2 months ago2 months ago

    "SB 277 was an unneeded solution to a non-existent problem." I agree. SB277 came in response to (or at least capitalized on), a non-fatal and ultimately uneventful disease outbreak that began at a major tourist attraction frequented by international travelers and spread to a population with a diverse age range of 6 weeks to 70 years. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm So how did California legislators respond? They went after statewide school-children, a move that makes as much … Read More

    “SB 277 was an unneeded solution to a non-existent problem.”

    I agree. SB277 came in response to (or at least capitalized on), a non-fatal and ultimately uneventful disease outbreak that began at a major tourist attraction frequented by international travelers and spread to a population with a diverse age range of 6 weeks to 70 years. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm
    So how did California legislators respond? They went after statewide school-children, a move that makes as much sense as discovering ants in your own home and calling the exterminator to go after termites in your neighbor’s.
    And they didn’t stop at measles. They went for the pharmaceutical Gold, requiring absolute compliance to a vaccine schedule that includes vaccines totally unrelated to measles and often for diseases not even casually communicable in a classroom setting. If that doesn’t reek of fanaticism, I don’t know what does.
    Now, any given California school could have 100% vaccine compliance, and Disneyland (or Sea World, or Legoland) remains just as vulnerable to measles. (It would take a heroic act of statistical manipulation to prove that a smattering of California school-children visiting the park will offset that vulnerability).
    Finally, I homeschool my children and could write an entire tome on the benefits of homeschooling. It also, however, requires extraordinary dedication and is not a decision to be taken lightly. The choice to homeschool must necessarily be made freely and not out of a real and valid need to escape state-sanctioned medical coercion. That California lawmakers overlooked this fact demonstrates a prevailing attitude that in the end, rigid vaccine compliance is more important than children.

  2. Emery 2 months ago2 months ago

    In California reports, students can have the status of "complete," "exempt," or "conditional entrance." The personal belief exemption rate was only 2.5% or so prior to SB 277. The mistake that all journalist make is not taking a theoretical 100%, subtracting the exemption rate %, and then understanding that any rate below that is unrelated to the exemption rate, but instead due to "conditional entrants," who are students who are still in process, … Read More

    In California reports, students can have the status of “complete,” “exempt,” or “conditional entrance.” The personal belief exemption rate was only 2.5% or so prior to SB 277. The mistake that all journalist make is not taking a theoretical 100%, subtracting the exemption rate %, and then understanding that any rate below that is unrelated to the exemption rate, but instead due to “conditional entrants,” who are students who are still in process, or have incomplete documentation. The “ideal 95%” mentioned in this article was achievable without SB 277 by simply decreasing the number of “conditional entrants,” which is where the bulk of the increase has occurred here. Another mistake is citing these “low vaccination rate” areas without understanding they are very low population centers, where only a handful of conditional or exempt students can dramatically impact the percentage measurements.
    If you stratify California counties by exemption rates, you immediately see the relationship to the population: High population counties have low exemption rates, low population counties higher rates due to the over representation of a single individual. For example Sierra County has only 28 kindergarteners – if a single student is exempt they give the county an almost 4% rate. Most of the 10 counties listed above have enrollments below 1000. In order, Calaveras 433, Humboldt 1393, Lasses 335, Mariposa 10, Nevada 801, Plumas 133, Santa Cruz 3551, Sutter 1802, Trinity 109, Tolumne 474.
    SB 277 was an unneeded solution to a non-existent problem.

    Replies

    • Jane Meredith Adams 2 months ago2 months ago

      Interesting point, Emery. I see how the statistics on vaccination status are magnified in low population counties. In my reporting, I spoke with public health directors who noted that measles is an extremely contagious disease and that even low numbers of unvaccinated people could put themselves -- and others who can't be vaccinated because of age, infirmity or a compromised immune system -- at risk. Also, I do remember that during the SB 277 debate, … Read More

      Interesting point, Emery. I see how the statistics on vaccination status are magnified in low population counties. In my reporting, I spoke with public health directors who noted that measles is an extremely contagious disease and that even low numbers of unvaccinated people could put themselves — and others who can’t be vaccinated because of age, infirmity or a compromised immune system — at risk. Also, I do remember that during the SB 277 debate, several people argued that collecting immunization paperwork from students who were “conditionally” admitted could or would lead to a 95 percent vaccination rate.

    • Terry 2 months ago2 months ago

      When you look into the historical data and really crunch the numbers, California’s children were already vaccinated at a rate of 97.46% before SB 277 passed. http://ow.ly/DLoF30egJ3F

  3. Annie 2 months ago2 months ago

    Curious…what is the vaccination rate for adults in these communities? Do they have all 66-72 shots required to be up to date like these children? Or do they still have just the 4-13 that were required up to 1983?
    Are we concerned that they are out spreading “epidemics”? No we aren’t.

  4. Nathaniel Lane 2 months ago2 months ago

    Community immunity? They are forcing this on the children only. The teachers, principals and administrative staff, the janitors and employees, including all volunteers MUST also be up to date on all the same shots. And so must the rest of the community if they want their herd immunity. Not a good direction for civil liberties.

  5. Paul 2 months ago2 months ago

    This is encouraging news. It's as much a sign of the impact of the new vaccination policy as it is a sign of the success of the Affordable Care Act: Medicaid/Medi-cal expansion, which, numerically-speaking, probably helps the largest number of children, plus the employer and individual mandates, which benefit smaller numbers, and, regardless of the category under which a child is covered, the law's requirement that preventive care be included. Twenty years ago, California insurers … Read More

    This is encouraging news. It’s as much a sign of the impact of the new vaccination policy as it is a sign of the success of the Affordable Care Act: Medicaid/Medi-cal expansion, which, numerically-speaking, probably helps the largest number of children, plus the employer and individual mandates, which benefit smaller numbers, and, regardless of the category under which a child is covered, the law’s requirement that preventive care be included. Twenty years ago, California insurers achieved vaccination rates low enough to attract media attention.

    One question for you, Ms. Adams: What sort of audit process is in place for the vaccination records that parents submit? I’m assuming that schools still rely entirely on paper records. With the scanners, image editing software, and laser printers available for use at any office store, such records would be easy to fake. Sampling a certain percentage would make sense, although the operation would be expensive and terribly complex, because releases of medical records would have to be sought.

    I worry that vaccination records are treated much like applications for subsidized school lunch: presumed to be true, without verification. With school lunches, money is the only thing that’s at stake, and lax certification might actually improve equity. With vaccinations, the health of other people’s children is at stake, and it would make sense to confirm some percentage of paper submissions.

    Replies

    • Jane Meredith Adams 2 months ago2 months ago

      Hi, Paul. I believe vaccination records are taken at face-value, as you suggested. Paper records are most often provided to schools, as far as I know. Perhaps electronic records will become more prevalent, but that might prove a technical challenge for some schools. In the audit guide http://eaap.ca.gov/wp-content/uploads/2016/04/2016-17-Audit-Guide.pdf , auditors are instructed to review records to ensure that enrolled kindergartners and 7th graders are up-to-date in vaccinations. If schools don't prove that, they are at … Read More

      Hi, Paul. I believe vaccination records are taken at face-value, as you suggested. Paper records are most often provided to schools, as far as I know. Perhaps electronic records will become more prevalent, but that might prove a technical challenge for some schools. In the audit guide http://eaap.ca.gov/wp-content/uploads/2016/04/2016-17-Audit-Guide.pdf , auditors are instructed to review records to ensure that enrolled kindergartners and 7th graders are up-to-date in vaccinations. If schools don’t prove that, they are at risk of losing their funds based on attendance, the state has warned. But to your point — I believe the documents are those that could be fudged by someone with a knack for that sort of thing. Interesting point you make.

  6. Robert Schecter 2 months ago2 months ago

    Forcing unwanted medical treatments on innocent children is a good thing?