As a new school year begins, parents, nurses and local health officials are engaged in the annual scramble to get students immunized.
When the flurry of doctors visits and paperwork is done, every student is supposed to have documentation of being fully vaccinated in accordance with Ohio law unless they have a medical, religious or philosophical exemption.
But most Ohio schools are missing that mark — some by a mile and without much recourse — according to an analysis of vaccination data that every school in the state reported to the Ohio Department of Health last year.
At 157 schools statewide, 30 percent or more of kindergartners started the 2015-16 school year without all their documented shots, including 14 schools in southwest Ohio. That’s up from 122 schools the year before.
A new Ohio law requires all incoming seventh-graders have one dose of the meningococcal vaccine, and all incoming seniors must have a second dose.
Some, like Russia Elementary (47 percent incomplete) and Botkins Elementary (31 percent incomplete) in Shelby County, have such low immunization rates due to a large number of families opting out of vaccinations.
Many more, including several Cleveland schools where more than 90 percent of incoming kindergartners were missing all or some shots, are simply failing to hold parents to the 14-day deadline after which students are supposed to be excluded from school.
In response to declining rates statewide, and the release of this school-level data for the first time last year, health advocates have worked with Democrats in the Ohio House to draft legislation aimed at improving immunization rates and making information about local schools more readily available to the public.
Many opt out
Russia had the highest rate of exemption of any public school in the state last year with nearly half its kindergarten class opting out of immunizations.
School leaders didn’t return messages seeking comment, but the Sidney-Shelby County Board of Health handles the school nursing for the county districts and said officials are aware of the high number of families opting out.
Some of the objections are religious, according to nursing director Margie Eilerman, due to a large Catholic population in Russia. But many include families who are against government intervention or are concerned about vaccine safety.
“They read so much on the internet,” Eilerman said. “We can talk until we’re blue in the face (about the importance of vaccines).”
Fairfield Central had the lowest vaccination rate of any Butler County school for kindergartners last year. Spokeswoman Gina Gentry-Fletcher said the school has a lot of transient students and a large English-as-a-second-language population that may contribute to the difficulty in getting every student up to date.
Two Mad River Local Schools elementary buildings topped the list of the worst rates in Montgomery County.
Although the district reported that Saville and Virginia Stevenson schools had only about 70 percent of their kindergartners fully immunized by the Oct. 15 deadline, school leaders said they work with parents all year long to get caught up.
“A lot of that paperwork is coming in after the fact,” said Special Education Supervisor Jack Stephens, who oversees the school nurses.
The district said it could not provide numbers on how many students finished the school year fully immunized because nurses were off this week.
Miami View Elementary in the Southeastern School District has the lowest rate in Clark County last year. Superintendent David Shea said they also try to work with parents through phone calls to get every student in compliance, but they do have a few families who have chosen to sign exemption forms because of concerns over vaccine safety.
“It’s not my place to tell a parent they have to do it,” Shea said.
Does it matter?
Low vaccine rates even in one school building have the potential for disaster, according to health officials.
“Something like measles is so highly contagious,” said Melissa Wervey Arnold, CEO of the American Academy of Pediatrics Ohio Chapter.
If someone with the disease entered a room of 100 people without immunity, 89 of them would become sick, she said.
Health officials say when large numbers of people start foregoing vaccines, it puts an entire community at risk because some individuals can’t get vaccinated. Very young children and people with immune disorders rely on an immunized public to create a buffer between them and sick people, which doctors call “herd immunity.”
Ohio has seen an increase in pertussis, or whooping cough, in recent years, according to Thomas Herchline, medical director for Public Health Dayton and Montgomery County.
“Adults might get a cough,” he said, but in infants it can be fatal.
The percentage of the public that needs to be immune for the safety net to work varies based on the disease, but in general, health officials put it above 90 percent.
Of the more than 2,200 kindergartens in Ohio, 60 percent of schools met that standard by the October reporting deadline last year. That was down from 62 percent at the start of the 2014-15 school year.
Hundreds of schools reported vaccination rates of 75 percent or less. The worst rate for entering kindergartners in the state last year was 6.25 percent at Denison Elementary in Cleveland.
Allowing immunization rates to remain that low may not have an immediate impact, but can lead to headaches or worse if an outbreak hits, health experts said.
Nearly 400 people in Amish communities in Holmes County were infected in 2014 with measles introduced by a missionary returning from the Philippines. The disease nearly killed a young girl and had three pregnant mothers in fear of losing their babies. In response, the community was quick to get vaccinated.
But many parents see the vaccine debate as a fundamental freedom issue. They don’t want the government interfering with medical decisions for their children.
Fight for choice
Laura Adams, a single mom in New Lebanon, said she was warned by a friend about the potential dangers of vaccines when she had her son Landyn. But she trusted her doctor’s advice that immunization was best.
She noticed more intense reactions in her after every set of vaccines, including swelling at the injection site and pain. When he was 15 months old he had what she believes was a seizure shortly after receiving a flu shot booster and the measles, mumps rubella vaccine.
“All of a sudden I saw him completely slump over in the back seat of the car,” she said.
In the next few weeks her son, who had been talking and developing normally, lost his speech. He wouldn’t respond to his name or make eye contact. He has been diagnosed on the autism spectrum and Adams believes the shots are to blame.
“I have videos and pictures of him before the shots and after and it’s a completely different child,” she said.
Concerns have continued to grow due to claims of a CDC coverup of a study allegedly linking the MMR vaccine to increased risk of autism in African-American boys. But the study’s author has admitted it contained misleading information and additional peer-reviewed studies have contradicted the findings.
In the midst of the debate, concerned parents like Adams are committed to preserving their right to choose whether to vaccinate. She and the group Ohio Advocates for Medical Freedom believe the state is trying to take away that right.
“I wouldn’t want someone to tell me what to do with my child,” Adams said. “I am very vocal about it … but I would never tell you what to do with your child.”
Lawmakers step in
In 2005, Ohio was third in the nation for vaccination rates, according to the National Immunization Survey. By 2013, the state’s immunization rate was 63.4 percent for children 19 to 35 months, putting Ohio second to last out of 50 states.
It was this decline, along with headline-grabbing outbreaks, that caught the eye of state lawmakers.
State Rep. Dan Ramos (D-Lorain) introduced House Bill 564 in May. It proposed a number of changes to Ohio’s immunization laws, including eliminating a parent’s ability to decline immunization for “reasons of conscience.” Medical and religious exemptions would remain.
The bill also would require the department of health to develop a common form to be used when documenting a student’s immunization history. It would require every school to report to the state by Oct. 15 a summary of the immunization records of all students enrolled, rather than only “initial entry” students as under current law. And it would require the state to publish immunization summaries by school and district on its website.
Ramos said he hopes the bill will prompt more discussion on the topic and the final version of the law, if passed, would give schools more tools to deal with vaccinations and enforce the law.
He said he’s willing to compromise on the personal choice piece of the bill, although he believes communities have a responsibility to protect those who can’t get vaccinated.
“If enough people exempt their children and enough others just don’t do it for one reason or another, that can cause such great harm,” he said.
The state previously said it was going to make school-level data more readily available to county health departments, but many local officials have said they aren’t sure how to get those numbers.
“We had tried for years to get that information,” said Wervey Arnold with the American Academy of Pediatrics.
The group eventually used data to guide legislators in drafting the bill.
Parents should be able to search the data and health advocates need it to target intervention, she said.
“If you have a child that is immune compromised … you’d want to do (research),” she said.