York County students have high immunization rates despite exemptions

Stefaura Prince, 18, grimices as she and her brother Steven, 17 from Haiti, receive back-to-school vaccinations from community health nurses Debbie Stoops, left, and Eva Walker at the City of York Bureau of Health, Monday, August 15, 2016. The Bureau of Health will hold another free back-to-school vaccine clinic Wednesday, August 31, 9:30 a.m.to 6:30 p.m. Vaccines are free for York City residents, uninsured or underinsured and children on Medicaid. Zoster (shingles) vaccines are FREE to City residents 50 years of age or older and are uninsured or underinsured.  John A. Pavoncello photo

Despite being in one of the states with the most liberal policies on exemptions to mandatory school vaccinations, York County is in good shape, according to health officials.

In the past three years, the county's immunization percentages have been in the mid- to high 90s, according to self-reported data from schools compiled by the state Department of Health.

The average rate to achieve herd immunity — which protects those in the community who are not vaccinated — is 90 percent, with different safe thresholds depending on the disease, according to Pennsylvania Medical Associates.

The rate for measles, for example, is between 90 percent and 95 percent, according to the U.S. Department of Health & Human Services. 

York County's MMR (measles mumps rubella) vaccination rate was 95.76 percent for 2014-15, rising to 97.4 percent the next year, and falling back slightly to 97.2 percent the following year, the state Department of Health reported.

In 2014 and 2015, there were measles outbreaks in a number of states nationwide, which originated in unvaccinated Amish communities in Ohio and an amusement park in California, according to the Centers for Disease Control and Prevention.

York County kindergartners and seventh-graders had a 92 percent immunization rate for receiving two doses or more of the vaccine in the 2013-14 school year — and only 82.5 percent for private school students, The York Dispatch reported in 2015.

So far, Pennsylvania seems to be on track for a good year in 2018. The state has had only  two cases of measles and averages four per year, said state Health Department press secretary Nate Wardle.

Though this year, and the two previous, have been in the normal range for outbreaks nationally, the CDC reports, Almira Contractor, a pediatrician and medical director for the York/Adams Immunization Coalition, said that doesn't mean the disease is not a concern. 

At any moment, she said, there could be a small area with an outbreak, so kids being exposed is still a possibility, especially when those who are unvaccinated travel to countries with less availability for immunizations.

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And those types of outbreaks are usually in areas where immunization rates have dropped, she said.

One of a handful: Pennsylvania is one of eighteen states in the U.S. that has provisions for medical, religious and philosophical exemptions — meaning families could choose to forgo the immunizations based on any reason, if they feel strongly. 

Missouri, however, only allows philosophical exemptions for child care facilities, not public schools, according to a recent study.

The study, published in health journal PLOS Medicine, looked at entering kindergartners with documented nonmedical exemptions from those states, using data from the CDC and state health departments.

Twelve of those 18 demonstrated an overall upward trend since 2009, accelerating the most between 2009 and 2014, but Pennsylvania was not one of them.

Some states have plateaued over the past three years, according to study analysis, while others, including Arkansas, North Dakota and Ohio, have rates that continue to rise today.

According to data from the Pennsylvania Department of Health website, kindergarten and seventh-grade students attending public and private schools show a fairly steady rate of exemptions in the state and the county from the 2014-15 school year through the 2016-17 school year.

Data for 2017-18 is expected within the next month or month and a half, Wardle said.

That time frame also marks a change in the provisional period students have to get the required vaccines before exclusion from school. Previously, they had eight months, and now they have only five days.

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A breakdown of data is no longer available for public vs. private schools, Wardle said, as the department's focus is to make sure all students, regardless of where they attend, are immunized.

The state reported 1,261 medical, 2,732 religious and 3,814 philosophical exemptions in the 2014-15 school year, with slight increases or decreases in the next two years, though never more than 1.5 percent of the reported enrollment.

In the county, the total number of exemptions rose from 73 medical, 68 religious and 89 philosophical in 2014-15 to 80, 75 and 99, respectively, the following year but dipped  again to 64, 77 and 83 in 2016-17.

Fewer reports: However, it's important to keep in mind that the data pool is not the same each year.

In both York County and the state, the number of schools reporting immunization data dropped each year. 

In York County, 125 schools reported in 2014-15, 116 in 2015-16 and 108 in 2016-17. Statewide, numbers also decreased — from 4,449 to 3,908 and 3,659, respectively.

In general, these numbers  correlate with decreasing enrollment numbers reported in both data sets. 

Pennsylvania is one of the only states that relies on self-reporting from school districts, which allows for a larger data pool, Wardle said, but schools are not mandated to report.

State to state: Though the number of exemptions could be a concern if it gets too high, recent data show  that, out of the 18 states, Pennsylvania has a higher immunization rate than most.

“Pennsylvania was an above-average state,” on making sure children are vaccinated, said Wardle.

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The CDC recently released data from the 2017 National Immunization Survey for ages 13 to 17, and the state scored higher than 12 of the 18 states that allowed exemptions  — with a rate of 90.6 for students receiving the DTaP (tetanus, diptheria, pertussis) vaccine, which is  above the national average of 88.7.

The state came in much higher than the national rate on the MenACWY (meningococcol) vaccine (93.4 vs. 85.1) and was higher than all but one of the 18.

Results from the survey showed wide range of state vaccination rates, but the highest tended to be in the states without all three exemptions, and some of the lowest were in those that had all three.

As a pediatrician, Contractor said it's important for parents to remember that just because they're not seeing some diseases anymore, doesn't mean their child is not at risk.

And getting a vaccine does not mean there is anything wrong with how parents are keeping their children healthy — it's just a preventative measure, she said.