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School vaccination data can hide problems

Emily Balser
| Thursday, Aug. 31, 2017, 9:36 p.m.
Registered nurse Eileen Schaffer applies bandaids after giving Jayceon Peebles, 4, two vaccines at the Primary Care Center of Children's Hospital in Pittsburgh on Tuesday, Aug. 29, 2017.
EMILY BALSER | Tribune-Review
Registered nurse Eileen Schaffer applies bandaids after giving Jayceon Peebles, 4, two vaccines at the Primary Care Center of Children's Hospital in Pittsburgh on Tuesday, Aug. 29, 2017.
Breonna Whitaker holds her son, Jayceon Peebles, 4, while he receives his vaccinations at the Primary Care Center of Children's Hospital in Pittsburgh on Tuesday, Aug. 29, 2017.
EMILY BALSER | Tribune-Review
Breonna Whitaker holds her son, Jayceon Peebles, 4, while he receives his vaccinations at the Primary Care Center of Children's Hospital in Pittsburgh on Tuesday, Aug. 29, 2017.

Some medical experts say the changes to the state's school vaccination timeline likely won't make a big difference in how many students are vaccinated because exemptions are still allowed.

The new requirements were put in place by the state Department of Health.

They changed the grace period for being vaccinated from eight months to five days from the first day of school in an effort to get students vaccinated sooner and have more accurate vaccination reporting to the national Centers for Disease Control and Prevention.

Under the new time limit, only parents in the Fox Chapel Area, Highlands, Leechburg Area and Plum school districts still have time to report their children's immunization status. The five-day time limit already has expired or expires today in all other Alle-Kiski Valley districts.

A Tribune-Review analysis of schools and vaccines found:

• Exemptions are the biggest reason students aren't vaccinated.

• It's difficult for parents to find out how many children are vaccinated in a school.

• County and state vaccination data can hide areas across the state with low vaccination rates.

Even with the timeline changes, there aren't any changes to exemptions that are permitted for parents who choose not to vaccinate their children for religious or philosophical reasons, or for children who have a medical condition that prevents them from being vaccinated.

That, experts say, is where the issues lie.

“The people who vaccinate are going to do what we ask them to do — they want their child to be protected,” said Dr. Andrew Nowalk, who works with the pediatric infection diseases department of Children's Hospital of Pittsburgh. “The exemptions are the problem.”

Nowalk said not being vaccinated for a medical reason is out of families' hands. Medical exemptions must be from a doctor.

But he said Pennsylvania is one of the easiest states to get religious and philosophical exemptions.

Nowalk said, for philosophical or religious exemptions, all it takes is a letter from parents to the schools.

“The personal exemptions are the ones that are concerning,” Nowalk said. “Those are the ones that, I think, put our community in danger.”

That's because exemptions affect the “herd immunity” that has been responsible for keeping those who are most vulnerable protected from these deadly diseases.

Dr. Wilbert van Panhuis, an infectious disease epidemiologist at the University of Pittsburgh's Graduate School of Public Health, said herd immunity is the idea that immunizing most of the population will help protect those who are most at risk, including children who can't be vaccinated because of medical reasons such as chemotherapy.

“They have no choice, so they can be protected by the herd,” van Panhuis said, “but if the herd doesn't protect itself, then they stand no chance, either.”

Vaccines and schools became synonymous because diseases spread so quickly among children in school because of the close quarters.

Vaccinating from an early age reduces the possibility of an outbreak of diseases like polio, meningitis and measles.

“It's really school-based vaccination programs that have led to the elimination of diseases in the United States,” Nowalk said.

Making vaccines a requirement to attend school also gives families an incentive to do it — they don't want their kids to not get an education.

Data not readily available

Neither the state Department of Health nor the state Department of Education keep individual school district or school data on how many students are vaccinated, despite every school being required to submit those numbers to the state each December.

Immunization data is available by county and statewide numbers only.

“Individual school data is attained by asking the school for that data,” said Wes Culp, spokesman for the state Department of Health.

So, parents who want to find out about the school they may be sending their children to would have to request it from the district because that information is not public.

Philosophical exemptions are relatively new for Pennsylvania, but were utilized by nearly 4,000 students for the 2015-16 school year, the most recent data available. Nearly 3,000 students utilized religious exemptions that same year.

Culp said philosophical exemptions were added during the 2013-14 school year in an effort to better report exemptions to the CDC.

In Allegheny and Westmoreland counties, 385 students out of nearly 31,000 were exempt for philosophical reasons and about 365 were exempt for religious reasons during the 2015-16 school year.

Although those are relatively low percentages overall, there could be a single area with a high concentration of unvaccinated children.

“I really think that it needs to be better data,” Nowalk said. “It would be very nice if the state did something to help with that.”

Van Panhuis said looking at only state data can be a problem.

“All the states (vaccinate rates) look pretty good, but we still have epidemics,” van Panhuis said. “There is a fundamental problem in looking at states: the state numbers cover up anything that goes on inside the state.”

Van Panhuis is spearheading a project at Pitt to get states to be more transparent about their vaccination data called Project Tycho.

“There is really no inherent HIPPA (Health Insurance Portability and Accountability Act) or whatever other kind of problem with making this available,” he said. “The only reason not to do this is because they think they may cause a problem with the school.”

Emily Balser is a Tribune-Review staff writer. Reach her at 724-226-4680, emilybalser@tribweb.com or via Twitter @emilybalser.

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