An annual assessment of kindergartners’ immunization rates shows that Napa County schools are mostly above the state average of 90.2 percent when it comes to having all required vaccines, but one school falls well below those numbers.
Kindergartners at Stone Bridge School — a Waldorf charter school in Napa — have the lowest rates of vaccination among all enrolled kindergarten students in Napa County. With only 60 percent of its kindergartners up to date on vaccinations, the school’s immunization rate is also far below state average.
Kindergarten students in Napa County — and throughout California — are required to have certain vaccinations before starting school. The required shots are Polio, DTaP (Diphtheria, Tetanus, and Pertussis), MMR (Measles, Mumps, and Rubella), Hepatitis B, and Varicella (Chickenpox).
Parents can opt out of the vaccinations by filing a Personal Belief Exemption form. Among the 40 kindergartners enrolled at Stone Bridge, 40 percent (16 students) have a personal belief exemption, according to data from the California Department of Public Health. This is the highest number of personal belief exemptions for kindergarten students in Napa County.
St. Helena Primary has the second highest exemption rate among the county’s public schools — with 8 percent (six students) out of 80 being exempt from vaccinations.
The purpose of childhood vaccines is to protect against contagious diseases, said Dr. Karen Smith, Napa County’s Deputy Director of Public Health. For these diseases, vaccination not only protects the child who is immunized, but also helps protect children with weakened immune systems — or others who can’t get the vaccines for medical reasons, Smith said.
“When a high percentage of children in a school are protected through vaccination, it is difficult for a disease to spread because there are so few susceptible children left to infect,” Smith said. “This can effectively stop the spread of disease in that school.”
Calls to Stone Bridge School officials for a possible explanation about the low vaccination rates were not returned.
According to a study published in the New England Journal of Medicine, unvaccinated children were more likely to be male, white, belong to households with higher income, have a married mother with a college education, and to live with four or more children.
The study showed that parents who exempted their children from vaccines were more likely to think that their children had low susceptibility to diseases and that the severity of the diseases was low. Those parents were also less likely to trust the efficacy and safety of the vaccines.
Parents of exempt children also tend to gather health care information from the Internet and have providers who offered complementary or alternative health care, according to the study. The most frequent reason for nonvaccination was concern that the vaccine might cause harm.
Personal Belief Exemption
The protection provided by vaccines has substantially reduced cases of pertussis, measles, and other vaccine-preventable diseases — but that protection has also faded people’s memories on the dangers associated with these illnesses, according to the study in the New England Journal of Medicine.
Measles, for example, is a highly contagious disease with a high rate of serious complications, Smith said. About 30 percent of people with measles will develop one or more complications — including pneumonia, which may lead to death in young children and ear infections which may lead to permanent hearing loss. About one child in every 1,000 who get measles will develop encephalitis, an inflammation of the brain which may lead to death or permanent brain injury.
Napa County schools, overall, have high immunization rates and low numbers of parents who opt out by using the personal belief exemption, Smith said.
“Unfortunately, there are a few schools in Napa County where there are higher numbers of unvaccinated children because of these Personal Belief Exemptions,” Smith said. “This is of concern because outbreaks of contagious diseases, including pertussis, are more common in schools with higher numbers of unvaccinated children.”
This is one of the main reasons for California’s new Personal Belief Exemption form, which requires parents to first see a health care provider who will discuss with them the reasons for vaccination and the risks of not vaccinating, Smith said.
“It is very important that parents make an informed decision if they are considering not having their children protected through vaccination,” Smith said.
The form — which became a new requirement on Jan. 1 — must be signed by both a health care professional and a parent or guardian.
The form acknowledges that a health care professional has provided information to the parent or guardian regarding the benefits and risks of immunization, including the health risks to the student and the community as a result of not vaccinating, according to the California Department of Public Health.
High vaccine coverage within a community is “extremely important” for children who cannot be vaccinated — including children with medical problems and those who are too young to be vaccinated, according to the study from the New England Journal of Medicine. These groups are more susceptible to complications from infectious diseases and depend on the protection provided by the vaccination of other children.
“Immunizations save lives and prevent long-term disability,” Smith said. “Childhood immunizations protect the child that has been immunized, that child’s family and the community.”
Immunization rates statewide
For the 2013-14 school year, 90.2 percent of the 533,680 students enrolled in kindergartens statewide had received all required immunizations. Across California, 3.15 percent of students had a personal beliefs exemption, according to data from the California Department of Public Health.
Napa County, as a whole, had a slightly higher immunization rate than the state — with 92.8 percent of its 1,737 kindergarten students receiving all required immunizations.
Napa also had a higher immunization rate than some of its neighboring counties — including Marin (with 80.2 percent) and Sonoma (with 89.5 percent). Solano County’s kindergarten immunization rate was slightly higher than Napa’s with 94.6 percent, according to data from the California Department of Public Health
Over the past five years, the number of California kindergarten students with all required immunizations has decreased slightly — from 91.1 percent in the 2009-10 school year to 90.2 percent this school year. Meanwhile, the percentage of students receiving a personal beliefs exemption has increased annually over the past five years — increasing 1.2 percent since the 2009-10 school year.
By the end of March, the California Department of Public Health had received reports of 49 confirmed measles cases for 2014. This time last year, only four measles cases had been reported in the state.
While no measles cases have been reported in Napa this year, some Napa residents may have been exposed to the disease outside of the county, Smith said.
Pertussis — also known as whooping cough — claimed the life of a Riverside County infant in February. It was California’s first confirmed death from the disease since 2010 — a year that the state experienced a pertussis epidemic, which included the deaths of several infants.
When the epidemic occurred, the National Vaccine Information Center — a nonprofit organization dedicated to preventing “vaccine injuries and deaths” — posted a lengthy article stating that “inaccurate” and “misleading” information about pertussis was being disseminated by the media, as well as medical doctors, “who should know better.”
“Many American doctors are ‘unapologetic’ mandatory vaccination advocates because that is what they are told to be by public health officials and leaders in major medical organizations, such as the American Academy of Pediatrics and the American Medical Association,” the article stated.
“The truth is, vaccines are not safe for everyone and they do not work for everyone. When doctors only tell half the truth about vaccine benefits and risks, people can sense it,” the organization said.
According to the California Department of Public Health, high immunization rates in California are what’s kept preventable childhood diseases at record lows during the past 20 years.
Since 2000, when measles was declared eliminated in the U.S., for example, the number of cases in California for an entire year had ranged from four to 40 cases. In that time, almost all measles cases were linked to travel to parts of the world where measles still circulates.
Among the 49 cases reported this year, 11 patients had traveled outside of the country. Of the patients without international travel, 30 had contact with known measles cases, three had contact with international travelers and five are under investigation to identify potential sources.
“Vaccination is especially important this year,” Smith said. “In addition to continuing to see cases of pertussis and chickenpox in Napa, for the first time in many years, we are seeing increased numbers of measles cases in California, including many in the Bay Area.”