Nearly 1,200 kindergartners across Oklahoma opted out of one or more required vaccinations during the 2017-18 school year with exemption rates at some schools exceeding 20%, according to a state Health Department survey.
One pediatrician said the share of kindergartners who are unvaccinated at some Oklahoma schools points to a need for continued work by health officials to achieve national immunization goals.
“Exemption rates this high in certain schools and communities is alarming,” said Dr. Christopher Smith, chairman of Pediatrics at the OU-TU School of Community Medicine and OU Physicians-Tulsa.
Data obtained by the Tulsa World from the state Department of Health shows about 90% of kindergartners to be up-to-date on their vaccines. However, vaccination rates are much lower at some individual schools.
State law prohibits any school from admitting a student unless they have received or are “in the process of receiving” immunization against diphtheria, pertussis, tetanus, haemophilus influenzae type B (HIB), measles, rubella, polio, chicken pox and hepatitis A.
The law does not apply to students who are likely to be immune due to previously having the disease or those exempt from immunization.
Parents can exempt their children from required immunizations for medical, religious or personal reasons.
“These children are at greater risk to get one of the 16 diseases prevented by vaccines and these schools and communities are at a much higher risk for being the place where the next outbreak could happen,” Smith said in a written response to Tulsa World questions.
Public and private school rates
The data, obtained through an Oklahoma Open Records Act request, lists vaccination rates for 778 schools across the state. The Health Department withheld data for an additional 37 schools in cases where the kindergarten class was less than 10 to avoid identification of individual students.
The rates were compiled from an Oklahoma Department of Health survey conducted during the 2017-18 school year of both private and public schools.
Current school year numbers won’t be available until later this year.
Statewide, about 91% of public school kindergartners and 84% of private school kindergartners were fully vaccinated, according to the survey.
The Centers for Disease Control reports U.S. measles cases this year had reached a 25-year high. The CDC reported that 839 cases in 23 states had been confirmed through May 10.
Oklahoma officials on Wednesday confirmed the first case of measles in the state in 12 months. Three cases were reported in 2018 in Oklahoma.
Smith said Oklahoma “still has some work to do” to reach the nationwide goal of a 95% full immunization rate. He cautioned that the actual immunization rate may be lower since nearly half of private schools did not respond to the survey and virtual and homeschooled students are not covered by the survey.
Charter school rates
The survey results also left charter schools — some with double-digit exemption rates — out of the aggregated totals reported to the CDC.
Virtual charter schools, where students complete all of their work from home, are some of the fastest growing schools in the state.
Epic Charter Schools reported to the state Health Department that one in three of 562 kindergarten students were not up-to-date on their vaccines at its Blended Learning Centers, where children attend class at a physical location in addition to taking online classes from home. One in five, or 116 kindergarten Epic Charter Blended Learning Center students, had filed an exemption from vaccinations, records show.
Epic schools spokeswoman Shelly Hickman said the 2017-18 data was accurately reported in the state Health Department report, but in an email she called the figures “artificially low.”
Hickman said the data “isn’t an accurate rate of how many of our kindergartners were actually immunized.”
Hickman supplied data that indicated this school year 90.7% of kindergartners had “shot records” and 9.3% had supplied exemptions.
The figures represent both students who attend Epic Blended Learning Centers, and the virtual charter school Epic One-on-One.
Of the 451 elementary students grades pre-kindergarten through sixth grade attending the Blended Learning Centers this year, 431 had supplied shot records, while 20 had completed exemptions, Hickman said.
Hickman did not respond to a request for current data for only kindergarten students.
Survey response rates
Officials with the Oklahoma State Health Department, meanwhile, say they are pleased with the current school participation rate in the vaccination survey. They are also hopeful a new online poll design will drive up participation rates.
About 89% of public schools and 52% of private schools responded to the 2017-18 survey.
The responses represent about 91% of students enrolled in public kindergarten programs and 59% of private school programs, according to the state Health Department.
“We are confident in our public school response since we did achieve very close to 90% of schools responding and over 90% of enrolled public school kindergartners responding,” said Ozair Naqvi said, epidemiologist in the Acute Disease Service division of the state Health Department.
“For private school data, we did achieve last year the highest response we’ve ever had for private school kindergartners,” Naqvi said.
The Oklahoma vaccination survey found that about 93.4% of public school kindergartners and 87.6% of private school kindergartners were up-to-date for the vaccine that contains the measles vaccine.
Meanwhile, exemption rates among Oklahoma kindergartners increased from 1.9% in 2016-17 to 2.2% in 2017-18. In 2014, the exemption rate in Oklahoma was 1.5% of kindergartners.
Smith said nationwide, the goal is to achieve a 95% or greater vaccination rate for all immunizations.
The likelihood that an outbreak could occur in Oklahoma is greater since it ranks towards the bottom of states in immunization rates, Smith said.
The Health Department survey found that 92.6% of kindergartners were current on the measles vaccine.
Mike Mannell, epidemiologist at the state Health Department’s Acute Disease Service division, said the immunity threshold to achieve herd immunity for measles was about 94% of the population.
The 2017-18 survey found 92.6% of kindergartners to be up-to-date on the vaccine that protects against measles.
Vaccination rates in TPS
A Tulsa World analysis of the Oklahoma Health Department survey data found 87.9% of Tulsa Public School kindergartners to be up-to-date on all vaccines.
Or put another way, about 360 of the approximately 3,000 TPS kindergartners were not up-to-date on their vaccines.
Of the total, about 63 TPS kindergartners claimed an exemption from one or more vaccines.
TPS’s Eisenhower International Elementary School a French and Spanish language immersion school, had the second highest number of kindergartners in a state school who claimed an exemption: 16.
Dr. Ebony Johnson, executive director of Student and Family Support Services, Tulsa Public Schools, said the district conducts a “big push” prior to the beginning of each school year to ensure students have received all of their vaccinations or have completed an exemption form.
The effort includes offering free vaccinations during student registration, Johnson said.
“Everyone works collectively and collaboratively with families to get those vaccinations completed,” Johnson said.
However, Johnson said students are permitted to attend school regardless of whether vaccinations have been obtained or an exemption has been filed.
“We do allow students to (attend) because we don’t want to not allow students to come to school and then to be behind,” Johnson said.
So is it possible for a TPS student to attend class for an entire school year without providing the proper vaccination paperwork?
“I’ll just say that we definitely make a very strong effort to get both vaccinations completed and shot records updated as well as for families who choose not to get exemption forms filled out,” Johnson said. “We are very committed to supporting our families to actually get either the vaccinations done or the exemption filled out without penalization of students not being able to receive their education.”
Regarding the nearly 14% exemption rate for Eisenhower Elementary kindergarten students, Johnson said: “The 13.9% is a reflection of families who are choosing to not vaccinate for whatever those particular family values and beliefs are. Those are things that we typically just respect, the fact that families have chosen that decision, but on the other hand we strongly encourage all of our families to have their students vaccinated.”
As for the 300 TPS students the survey showed to not have up-to-date vaccination records or an exemption form on file, Johnson suggested that the information may have been updated later in the school year.