Alicia Lebens
Stillwater Gazette
Ryan Howard
News Editor
The Minnesota Department of Health calls the vaccination against childhood diseases one of the greatest medical achievements of the 20th century. According to the Annual Immunization Status Report, 97.24 percent of Minnesota kindergartens entered the 2013-2014 school year with all the required measles, mumps and rubella (grouped together in the classification of “MMR”) vaccines – an exemption rate of 2.76 percent.
In Washington County, 3.7 percent of kindergartners, or about 115 students, opted out of the MMR vaccine for “conscientious objection” reasons, and that has health officials concerned. In addition, .42 percent of kindergardeners were medically exempt from the vaccine.
In the Forest Lake area, on the other hand, very few kindergartners are opting out of MMR vaccinations, according to recent trends.
“Vaccination is a critical part of community health,” Washington County Public Health Director Lowell Johnson said. “The best way to protect yourself and your community is by getting vaccinated.”
According to the immunization status report, the overall percentage of Forest Lake-area kindergarteners who were opted out of MMR vaccinations in the 2013-2014 school year was 2.67 percent – lower than both the overall state and county percentages. The percentages include all of the Forest Lake Area District’s public elementary schools as well as St. Peter Elementary School, but Lakes International Language Academy (4.2 percent) was counted separately by the report. The local school with the highest rate of unvaccinated kindergarteners was Linwood Elementary, where 5.66 percent of the school’s 53 kindergarteners were opted out. At St. Peter and the FLAS Central Montessori Elementary, all kindergartners were vaccinated. The next lowest opt-out rate was the area’s largest kindergarten class at Forest View Elementary, where 2.14 percent of the 140 kindergarteners were opted out.
“Please keep in mind that these percentages are influenced by the size of the denominator, so if we’re looking at numbers for a smaller school … it may not take much to significantly change the percentages,” Johnson said. “One or two students within a small class can influence the percentages greatly when doing these comparisons. Nonetheless, we would certainly like to see fewer unvaccinated students.”
The FLAS licensed school nurses agreed that the percentages can be misleading when it comes to the number of unvaccinated kids.
“These percentages don’t really direct what we’re doing because there’s so many pieces to the puzzle,” LSN Kimberly Blum said.
In the Forest Lake schools, there are multiple examples of small sample sizes skewing percentages. For example, the 5.66 percent of Linwood Elementary students puts the number of opted-out students at three kindergartners – the same number as Forest View Elementary, a school with a larger kindergarten class and thus a smaller percentage of opt outs. Lakes International Language Academy, which had the second-highest percentages in the area during the 2013-2014 school year, was estimated to have highest number of opt-outs at around five students. LILA Director Shannon Peterson said the school makes sure to follow all Department of Health regulations regarding vaccination procedure, a topic that some parents ask staff about.
“Parents are concerned about vaccinations, depending on what parents they are,” she said, adding that more attention has been given to the topic in the wake of recent news reports. “It certainly has come up more this last year than it has in the past.”
The Minnesota Department of Health wants incoming kindergartners, by the time they are starting school, to get a variety of vaccinations, including MMR, polio, varicella (chicken pox) and others. To continue attending school, the students must show that they’ve gotten the vaccines, or their parents must fill out paperwork to register their children as either conscientious objectors or medically unable to be vaccinated.
“We’d prefer them to be vaccinated (rather than conscientious objectors),” Forest Lake LSN Darla John said. “It’s just safer for everybody.”
Because the schools must report their numbers of vaccinated kindergartners by Dec. 1 every year, the fall is spent documenting the students who are in compliance and calling the parents of those not in compliance to remind them to schedule vaccination appointments or register as objectors. The nurses also answer any questions parents might have about vaccines or the vaccination process, but Director of Special Education Kelly Lessman stressed that, ultimately, the decision is between the parents and their physicians. That said, the nurses are happy that they have a low rate of opt-outs.
John noted that sometimes the opt-out numbers can be misleading. For example, if a child finishes his or her regimen of MMR vaccines several days before his or her first birthday, the child is considered out of compliance for the vaccine even though the child is protected. In those cases, John said, some parents sign a conscientious objection form because they think, “I’m not going to get another MMR just to fall into their numbers.”
The nurses said they don’t have any kind of threshold for unvaccinated children that they want to meet before getting concerned; rather, they noted, it’s all about understanding individual student needs. A few years ago, one student had symptoms that were thought to indicate mumps, though it turned out not to be the case. When a potentially infectious disease is manifested in a child, the Minnesota Department of Health is alerted, and the school checks out the immunization records of all of the potentially exposed children. Based on the situation, the MDH instructs the schools on what the next steps should be.
“They … guide our practice,” Lessman said.
Peterson said LILA does everything “the exact same way” as the school district schools when it comes to vaccinations. She noted that the school nurse is available to answer questions from parents about vaccinations but noted the nurse’s need to be impartial.
“She can’t tell them which way to go,” Peterson said.
Though they were generally pleased with the vaccinations at the various schools, Blum and John encouraged parents of seventh-graders to get their children vaccinated for meningitis – a new requirement that started in 2014. Though new vaccination requirements are sometimes met with skepticism by parents (the chicken pox vaccine is still catching on for elementary-level kids), John stressed that meningitis is a fast-acting illness that students would be better off avoiding. Meningitis involves the inflammation of the membranes surrounding the brain and spinal cord.
“It’s … a very important vaccine, especially when (the students) start getting into their college dorms,” she said.
What is measles?
According to the Minnesota Department of Health, measles is a highly contagious respiratory disease caused by a virus. The infection starts with symptoms similar to a cold. After two to three days, tiny white spots develop inside the mouth, followed by a rash with flat red spots. About three out of 10 people who get measles will develop one or more complications, including pneumonia, ear infections or diarrhea. For every 1,000 children who get measles, one or two will die from it.
The 2011 Disease Control Newsletter annual summary of measles disease stated that 26 cases of measles were reported in Minnesota — the highest number of cases in Minnesota since 1991. Twenty-one of the 26 cases were associated with an outbreak in Hennepin County occurring in February through April. None of the outbreak cases was known to have been age-appropriately vaccinated. There is one case of measles recorded so far in Minnesota in 2015.
“Vaccination is a critical part of community health,” Johnson said. “The best way to protect yourself and your community is by getting vaccinated. For persons that are concerned about vaccine safety, they should be reminded that all vaccines are held to extremely high safety standards in order to receive FDA approval because they are given to healthy children. Vaccines are made to prevent suffering and death.”