My phone wasn’t working well today so I stood in line at the “genius” bar this afternoon to resolve the problem. To be clear, that was 2 1/2 hours ago and I’m home with the promise from a very nice genius that it would be activated by the time I reached my home. It didn’t happen and I’m phoneless (a new thing for me) so it’s quiet around here. In lieu of being able to communicate by phone, I’ll share something I learned while waiting for help. It turns out to have shaped my thoughts for the afternoon.
While at the store, I ran into a researcher who works at the interface of vaccine hesitancy and immunization rates. We got to talking about his work, my writing and work in clinic, and what will ultimately help families. I mentioned what I really want is for families to get good information from their pediatricians (online and off) so when they immunize their children, they rest easy knowing that their children are protected. He asked a question, well two questions, that I didn’t have the answer to in my own life. I wonder, do you?
- What is the rate of immunization coverage at my son’s preschool? (I have no idea, they have never told me or published the data as far as I know, so I’m unsure how well protected he is). The school collects immunization records and requires immunizations, but I don’t know their exemption policy. If the rate to protect my son from being at risk for acquiring a vaccine-preventable illness is around 90%, I should know if his school meets the mark. I’m writing an e-mail in a moment to find out.
- If the school isn’t 90% immunized, is he in a safe preschool? If not, what should I do about it?
We got to talking about how we’d get these numbers. And then what we’d do with the results (if below 90%). Public school vaccination rates by county are publicly available in Washington but are not necessarily shared readily. From a quick search, I couldn’t find it broken down by individual school. So maybe it’s up to us, the community, to find out about the numbers. When you go to the PTA meeting and/or when you evaluate a school for your child, we’re taught to think about teaching efficacy, safety, teaching philosophy, and student success. We often think to ask about math test scores, violence and bullying, teacher-to-child ratios, principal vision, and graduation rates. From a safety perspective, shouldn’t we also be asking about immunization rates, too? Shouldn’t this be a requisite part of the checklist?
Do you know what percent of children in your child’s preschool or school are fully immunized? What about the soccer team? Do you care? Recently I heard about a parent organizing a “vaccinated” playgroup on Twitter (see below). Going too far? Since we rely on community immunity for our children’s safety, what number is acceptable for you?
This may be an uneducated question but… if you child is fully immunized what makes a school that has less than a 90% immunization rate a risk for your child?
Wendy Sue Swanson, MD says
Colleen, you ask a great and important question.
My son is fully immunized, however, we know vaccines are not 100% effective in all people. It’s possible that even though he’s had the chicken pox vaccine, if he were exposed to a child with active chicken pox, he could have a mild case or even a robust case, depending on his immune response to the vaccine. When we reach 90% of the community immunized, it’s far less likely an infection can spread around the room or the group…thus decreasing risk for all in the room, those immunized, those with only partial immunity or those unable to get the vaccine.
A child could be up to date on all their immunizations but not necessarily immune to all infections. Most vaccines have a 90-99% success rate when given at correct age and at correct interval. But none have 100% efficacy in protecting all recipients. It’s the reason we do boosters too, as immunity can wane as time goes on.
Dr. Alanna says
I never thought to ask my kids’ preschool either-intersting idea!
Along those same lines…during a recent prenatal appointment, my partner was asked about our office vaccine policy. He proceeded to give his argument for why vaccines are so critical in protecting our children from preventable illness. The expecting mom then said, “Well, I am glad to hear your thinking is in line with mine. I wouldn’t want my baby to be in a waiting room with unvaccinated children.” It was such a refreshing perspective and one of the smarter prenatal interview questions I had ever heard.
Natasha Burgert, MD says
Great post. As a pediatrician with 2 young children, I had a very detailed discussion about vaccine policies with the center’s owner prior to attending my current daycare. Not only was I concerned with the potential exposure to vaccine preventable disease in my own children, but i was also concerned about the potential transmission of an illness – to either of my kids – to me – to the kids I was caring for in my office. I am so glad the owner of the center we loved agreed with the importance of vaccines for all the children in her care. All of my kids’ classmates are vaccinated – yeah!!!
There’s a difference between the state-required vaccinations record and the full vaccination record. If your kid is in daycare (< age 2) you will care about rotovirus and hib, not required for schools. My daughter attended an in-home daycare with 2 other kids and our provider would call us when she was due for another dose so that she could update her record accordingly. Having complete records and having 100% compliance was how she helped protect her livelihood. I get my kids flu shots at my daughter's well child appt in Oct, and but our daycare provider really preferred she get it as soon as it was released.
I know all the details of the state-required vaccines for preschooler for my daughter's school. We attend a parent-run coop so teachers and members who have administration duties keep the forms. 1 was missing their MMR and 1 was missing their hep B series, otherwise complete. Most (my kid being the only exception) got them on the AAP schedule. I have had new parents ask.
I don't think I would ask or concern myself too much about the % compliance though. I take my kids everywhere. Everywhere. Including zoo, kids museum, mall. My younger one is extremely susceptible to GI bugs because he has a allergy syndrome that just wreaks havoc on his intestines and had him hospitalized, in the ER, etc. He had gastroenteritis 6 times in 8 weeks in the fall and 4 times in 6 weeks in the spring. I isolated him more when he was a sick baby and hadn't started any vaccines yet. He's bigger, heartier, is as protected as he can be. I just can't live in a bubble. He's never missed a flu shot yet got the flu this year. He was really sick for a week and had this junky cough. He'd cough so hard trying to bring up phlegm it would make him gag and puke. I like to think the vaccine helped him bounce back from the virus. My husband had the same bug and got pneumonia and needed an inhaler for 1 month after.
I wouldn't attend a vaccine playgroup unless I had a child with a compromised immune system. Our playgroup is pretty conscientious and follows dept of health guidelines strictly. It's worked very well. Same goes for school and daycare. Between both kids, they've gotten all of 3 colds from school, daycare, or playgroup. All our worst illnesses came from restaurants, zoo, park, mall, kids museum.
I’m not following Dr, Alanna’s post ~
“I wouldn’t want my baby to be in a waiting room with vaccinated children.”
What am I missing?
Wendy Sue Swanson, MD says
Kaiya, I suspect it’s a typo; you’re not missing anything. I suspect she meant “I wouldn’t want my baby to be in a waiting room with unvaccinated children.” I’m awaiting confirmation for her prior to changing it.
Wendy Sue Swanson, MD says
It’s been updated (and confirmed) to represent Dr Alanna’s thoughts. Thanks for the pick up, Kaiya.
I do not know what the rate of vaccination is at my daughter`s preschool, but I do care what it is. I hope it is 100% or close to it. I was not asked for her vaccination status when I signed her in, as far as I recall, so they probably do not know what the rate is anyhow.
It is particularly pertinent now, as my four month old boy visits the school everyday when I pick my daughter up.
I can’t say I have a specific number in mind (the expert recs of 90% sounds good to me), but I did go and look at the county/school district data. Was disappointed (yet not surprised) to see the precipitous drop in vax rates in my county and increased exemptions over the last decade. Most recent data being 2009-2010, I’m hoping it will improve for 2010-2011, but still…would be interesting to investigate the relationship between the vax misinformation, and the Lancet (or was it BMJ?) retraction this past year. Was there any positive effect?
And for the anecdotal record, my kids are fully vax’d and have been very healthy children. The oldest was in childcare/preschool (now in K), but our youngest has stayed home (3yrs old). We don’t *screen* friends based on vax status, although it does seem like a wise idea (although knowing one of my BFFs who we see a few times a year has an unvaxed child, this would not be an easy conversation).
On another note, the start of your post makes me wonder — how many parents are on their cell so much these days, that they have reduced interaction with their children? I constantly see moms walking with kids/stroller or at the park with their kids, but rather than interacting with their kids, they are on their phone talking or texting. It’s pretty sad.
Kathy, I finally looked at the data, too. The school district I live in is one of 2 “yellow” (4-4.9% exemptions). A lot less green in my county than I expected! In any case, about the data: the Lancet study was specifically about the MMR vaccine, no? MMR vax rates are holding right around 95% in my county. It’s the DTap and Varicella vax that are falling. Varicella is just at 88% for kindergarteners. The data gets worse for 6th grade and advancing ages. To wit, I heard of a pertussis outbreak a few towns away (different district) in both the elementary and high schools.
I think the DTaP rates are low because of two possible reasons:
1) thimerosal scare. some versions of the DTaP vaccine contained thimerosal before 2006. Kids who are in kindergarten today may have missed doses.
2) Easy to miss a DTaP dose… If the 4th dose is given after age 4, then you only get 4 instead of the usual 5 doses. I’m wondering if missing a dose qualifies as an exemption, even if there’s no makeup for the missed dose.
I think varicellla vax rates are lower because the vaccine isn’t taken as seriously. Me included! I put off giving my older one that particular shot because I hoped she’d get the actual disease and have lifelong immunity, minus boosters. I didn’t think the chicken pox were such a big deal. I got in in the winter and loved being home sick. I finally relented at age 4 because she hadn’t gotten it yet and time was running out for getting two doses before kindergarten. And then I was only persuaded to get the shot because my pediatrician just said “yes, chicken pox is no big deal for your kid. but she’ll miss 3 weeks of school, which will be inconvenient. If she gets other kids sick, imagine the wrath of the PTA.” Elementary schools are large and chicken pox or the flu can wreck havoc for weeks. I guess the social pressure about loss of productivity was more persuasive than the science.
I think vax rates decline over time because there is still a lot of ignorance about boosters. Many people think immunity lasts forever. Boosters aren’t pushed as part of physicals. (No one ever asked or offered me one until I traveled to a 3rd world country.)
I’d love to see a law that affects adults – health care workers, state employees. If more grownups get regular boosters, won’t that help these pertussis outbreaks? If a growup is vaccinated it probably improves the chances that their children are. At a hospital near me, the OB group appears to have started a pertussis campaign. I’ve heard from several moms who are urging (or requiring, depending on how high the hormones are coursing) close family and friends to get all their boosters before they meet the baby.
Linda Pourmassina, MD says
I am an internist and don’t have as much contact with young children or with the issues of what I consider basic vaccinations. I respect the pediatricians who work hard every day to educate each parent about the importance of immunizations.
When I first saw the comment about “vaccinated play groups,” I was really surprised and wondered how that would play out. Would it cause a sense of ostracism? How would children be granted “entry”? With proof of immunization? Would anyone ever consider having an unvaccinated playgroup? But, it actually might be a good idea for concerned parents to consider creating “vaccinated play groups,” particularly if they have very young children who are in the middle of their series of vaccines and are more vulnerable.
As for schools, a school that is not “adequately” immunized is a school that is poised for a vaccine-preventable oubreak… which affects the local community…the state, and, potentially, the world as people travel. I would want to know the data, especially since schools are already gathering it.
I would also hope that schools participate in “primary prevention” by pointing out missing immunizations to the students that need them and recommending that these students see their doctors. (Not sure if they are doing this). Luckily, we have done fairly well in terms of vaccine-preventable outbreaks in this country. BUT we have had 118 cases this year, and that is a 15-year high, according to a recent NPR report (https://n.pr/k6Dobu).
I am digressing, but I have two requests regarding immunizations:
1. Summer is coming soon, so make sure vaccinations are up to date, especially prior to international travel. Most of the cases in the US have been imported from India and from France (which had 10,000 cases this year by the end of April!).
2. Please keep a copy of your child’s immunization records in a file. I am an internist, and I will eventually see your children and want a record of them. (They are SO HARD to track down!) When they go away to college, keep a copy with you and send a copy with them. (Have a hardcopy in case your computer crashes).
Dr. Pourmassina, when my oldest son was a baby and toddler I actually made it a point to ask about the vaccine status of the children in any new group. He had neonatal seizures as a newborn and was denied the DTP vaccine due to the scares from the mid-1980s. Unfortunately King County was having a pertussis outbreak at that time (1989-1991).
I only got one “no” in those years, and it was at a breastfeeding support group. So I never went back. The attitude the proud mother who claimed her doctor did not believe that her kids needed the vaccines put me off. So it was no great loss to avoid her and her friends.
Also, many years ago there was a measles outbreak in a private school not far from where we live. It was about the time when the second MMR vaccine recommendation was lowered from eleven/twelve years old to four. So I took that opportunity to get my first and fourth grade children their second MMR vaccine (their older brother already had his).