Required shots
Every kindergartner in Ohio is required to have the following shots before entering school: Four or five doses of DTaP, DTP or DT in any combination; three or more doses of the OPV or IPV polio vaccine; two doses each of measles, mumps and rubella vaccine, usually given in combination as the MMR shot; three doses of the Hepatitis B vaccine; and two doses of the Varicella vaccine which prevents chicken pox.
To enter seventh grade another set of MMR, Hep B and Tdap shots are required.
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In-depth investigation
Our reporters spent months pressing state officials for public health data they didn’t want to release. We then analyzed records for thousands of schools to bring you this exclusive report.
Enough parents are refusing to have their children vaccinated in some area school districts that health officials worry it puts those communities at risk.
The I-Team found that nearly 30 percent of Yellow Springs kindergartners came to school without their required shots because their parents opposed the vaccines.
That was more than any other school district in the state.
New students in grades 1 through 3 at Fairborn Primary School had a similarly high rate — about 20 percent.
While the vast majority of Ohio schoolchildren have all of their required shots, the investigation found enclaves across the state where diseases like measles and mumps have a greater chance of spreading.
“Obviously you have a dangerous situation there,” said Dr. David Morens, senior advisor to the director of the National Institute of Allergy and Infectious Diseases.
“The forest is dry. What are the chances someone’s going to drop a lit match in the forest? Because I guarantee if someone drops that lit match, you’re going to have an epidemic.”
The investigation also revealed that many schools allow students to attend school without required vaccines — sometimes more than half the class — despite state law requiring students show proof of immunization. And the state does not share these numbers with local health officials.
The situation is critical because in order for vaccines to be most effective, a large percentage of the population must have them, creating what public health experts call “herd immunity.” Immunity against measles, one of the most contagious vaccine-preventable diseases, requires about 94 percent of the population to have their shots.
At 190 schools across Ohio, more than 5 percent of this year’s kindergarten class has an exemption against getting the measles vaccine, mostly citing moral or philosophical grounds. This includes 24 schools in southwest Ohio.
A larger number of parents aren’t opposed to vaccines but hadn’t gotten their kids all their shots by the time kindergarten started. At 122 schools statewide, 30 percent or more of kindergartners started the school year without all their documented shots. At some schools in Cincinnati and Cleveland as many as 89 percent of students could not show proof of vaccination as of the Oct. 15 state reporting deadline.
School officials say they’ve worked with parents to bring most of them up-to-date.
Opting out
Malayla Smith looked away and squeezed her eyes shut as a nurse pricked her with a series of shots Wednesday at the Montgomery County health district office. The brave little 5-year-old didn’t shed a tear.
Smith needed the shots to stay in school at the Trotwood Early Learning Center. Her mother, Nina Davis, has older children and said she believed “conspiracy theories” about vaccines when she was younger.
“I was kind of against it early on, then I started seeing things on TV like (diseases) that weren’t around for years are coming back, like the measles,” she said. “The older I got the more I thought about it and said, ‘You know what, they do it for a reason.’ I got them when I was young and I’m fine.”
Ohio is one of 17 states where parents can choose not to vaccinate their kids, and area parents have been increasingly opting out in recent years. In Montgomery and Greene counties, 1.6 percent and 3 percent, respectively, have refused vaccines on ideological grounds. This is up from 1.5 percent and 2.2 percent in the 2012-2013 school year.
The statewide percentage also is low: 2,424 kindergartners have such an exemption this year, or 1.8 percent of the total.
But at some schools the numbers are much higher. And those with the highest numbers tend to be grouped ideologically.
At Mills Lawn Elementary School in Yellow Springs, 16 out of 41 kindergartners were not fully vaccinated at the beginning of the school year, 12 because their parents objected on religious or philosophical grounds. Another 10 new kids in grades 1-12 have personal exemptions, or 11 percent of the incoming students.
That 29 percent exemption rate for kindergartners is the highest of any district in the state. If each incoming class continues the trend, 30 to 40 percent of the school district will be unprotected against infectious diseases.
“Yellow Springs is a conscientious and deeply thoughtful community,” Yellow Springs superintendent Mario Basora said. “The law permits parents to choose the number and timeline of vaccinations they want their children to have. While we strongly encourage parents to vaccinate their children, we also appreciate the nuances around this important decision.
“Our plan moving forward will be to engage in further and more formal dialogue with our parents and community about vaccines.”
Greene County health officials said they are aware of pockets in the community where vaccination rates are lower and are working with schools to educate the public.
“What we see is about a 93 to 94 percent vaccination rate that is needed to prevent sustained outbreaks for most vaccine preventable diseases,” said Dr. Don Brannen, an epidemiologist with the health department.
Moral, personal reasons
“People do what they believe, so I’m not surprised,” said Susan Miller, whose granddaughter is a student at Yellow Springs High School, about the high exemption rate. “A little disappointed. I’d like to see more vaccinations because I think it’s important.”
Lindsay Burke’s son is 3 and got his shots on a delayed schedule because she wanted to do more research. But news of a mumps outbreak in Columbus last year motivated her to get him immunized.
“I think that there’s a really good reason that vaccines exist, and I definitely appreciate not having polio or measles be a problem,” she said. “But I also understand why people want to do research on it.”
Tony Siemer chose not to vaccinate one of his children because he was distrustful of vaccines.
“At the time, I’d heard there were bad reactions,” he said, and he feels exemptions have not become prevalent enough to be of great concern.
The four other schools in this area where more than 10 percent of the students have exemptions are private religious schools. Two are Catholic.
Some Catholics oppose vaccines because some of them use cell lines derived from aborted fetuses more than 50 years ago, according to this month’s issue of the Catholic Telegraph, a publication of the Archdiocese of Cincinnati.
It also says Catholics do not need to refuse these vaccines in situations where no alternative exists.
Not all students with conscience exemptions opted out of all the required shots. Of this year’s kindergartners who had exemptions, 98 percent did not get the Varicella shot, 90 percent were exempt from MMR, 85 percent opted out of the polio vaccine and 83 percent the DTaP.
The least common exemption is for the Hepatitis B vaccine, with 73 percent of those with conscience objections skipping those doses.
‘Herd immunity’
Serious allergic reactions to the millions of vaccines administered are possible, but are very rare. The federal government has a fund set up to compensate families for adverse reactions. Last year it paid $114.5 million to settle claims brought by 258 families.
“A serious complication from these common vaccines are extraordinarily rare — almost non-existent,” said Morens.
Chances are more likely of coming in contact with a preventable disease. Ohio last year saw the nation’s largest measles outbreak in at least a decade, as well as a mumps outbreak in Columbus. Montgomery County records show there was an isolated case of diphtheria here last year, and 73 children became sick with pertussis and seven with chicken pox.
“The effects you could have if you get the disease are worse (than the vaccine),” said Julie Goode, immunization program coordinator for the Montgomery County health department. She said parents often raise concerns about autism and she directs them to scientific studies that have debunked any connection between modern vaccines and autism.
Health officials say that when large numbers of people start foregoing vaccines, it puts the entire community at risk. This is because some people can’t get vaccinated, such as very young children and people with immune disorders. They rely on an immunized public to create a buffer between them and sick people.
“(The outbreak) runs into a brick wall,” Morens said. “The susceptible people just don’t bump into each other often enough to keep the virus going.”
The percentage of the public that needs to be vaccinated or immune for this safety net to work varies based on the setting and disease. In general, health officials put it above 90 percent.
Even vaccinated people are at some risk when herd immunity drops because vaccines don’t work on some people. Someone could have the shot, but still be susceptible to a disease and not know it. The measles vaccine, for example, is 93 percent effective after one shot and 97 percent effective after two.
“We want 100 percent of people to be vaccinated,” said Thomas Herchline, medical director for the Montgomery County Combined Health District. “When you get below 90 percent you become more susceptible as a community, significantly more susceptible to outbreaks.
“As that number goes down it has a very dramatic impact on the potential for an outbreak.”
State law
Among those relying on herd immunity are the 345 Ohio kindergartners who have exemptions for medical reasons: Their little bodies have health issues that make the vaccine unsafe for them.
The Mason Early Childhood Center Elementary School has four of these kids, the most in this area. It also has the highest number of children with ideological exemptions — 16 among its 544 kindergarten students.
Mason Schools spokeswoman Tracy Carson said the school knows who the unvaccinated children are and works with parents to decide whether to keep any of the kids out of school if there’s an outbreak of some kind.
But Mason is one of 60 area schools where all of the non-exempt kindergartners have all of their vaccines.
“We can’t get you registered until you have those vaccinations or you have the exemption,” she said. “We just follow Ohio law.”
Most schools will allow unvaccinated children to start school, then will use letters and phone calls to urge them to get the vaccines.
At 11 area schools, more than a quarter of this year’s incoming kindergarten class was lacking some shots. At the Spring Valley Academy in Centerville, it was more than half. Four of these schools were Dayton public schools.
Most of those kids have already gotten vaccinated or are in the process, Dayton schools head nurse Virginia Noe said, noting that districtwide only 2.5 percent of the students are incomplete, which is far better than the state average.
“We just sometimes have parents who are not compliant,” she said. “We are never going to tell a student, ‘I’m sorry you can’t come back to school,’ because that would be wrong.”
The only exception, she said, would be if there were an outbreak and the county recommended keeping home non-vaccinated kids. That would likely be done with measles, she said, though not with whooping cough or chicken pox.
‘Who are these people?’
Of the Dayton school district’s more than 14,000 students, 41 have religious exemptions, 25 have medical exemptions and another 59 have parent exemptions without a stated reason.
This was consistent with other urban schools that tended to have lower exemption rates than suburban or country schools.
The Fairborn Primary School, for example, had 140 new kids sign up for school this year in grades 1-3. One in five of them had an non-medical exemption for vaccines.
“With a highly transient community, you’re going to get that,” said Fairborn schools spokeswoman Pam Gayhart, saying the city has an unusually high number of people move in and out every year. “I think that’s part of the reason we’re seeing that large number.”
Among the new students at Wayne High School this year is 16-year-old Amandeeb Chahan, who moved here from India. His aunt Satnam Sidhu drove him to the county health department downtown last week to get hepatitis B shots that weren’t required in India.
Sidhu said a decade ago when her son was about 10, he contracted hepatitis. “(At first) they thought maybe he had cancer,” she said. “I cried very much.”
She couldn’t understand why someone would willfully decide not to vaccinate their children against infectious diseases. “Who are these people?” she said.
Public records
Every school in the state is required to report vaccine data on kindergartners, seventh-graders and new students to the Ohio Department of Health every October. But the data is not shared with the public or even local health officials, the I-Team found.
The I-Team pressed for this data under Ohio’s public records law and received it nearly two months later.
Officials from the Dayton-Montgomery County Combined Health District said even they haven’t been able to get these records, instead receiving only a years-old countywide summary telling them 90 percent of the kids in the county are vaccinated.
And the state has no enforcement capability even if schools report a high number of students who are not in compliance with the law.
“If you’re not going to do anything with the data, then why collect it?” said Clark County health commissioner Charlie Patterson. “Why have the schools go through all of the time and trouble to do it?”
If the information were available to local health departments, they could better target their programming even if they can’t change the minds of parents who object to vaccinations, Patterson said.
Department of Health officials said they plan to start sharing the data with local health departments this year.
‘I wanted to die’
Statewide, the schools with the highest rates of unvaccinated children tend to be in the Amish community, especially in Holmes County.
The county, located between Columbus and Cleveland, received a wake-up call last year when measles tore through the Amish community after it was picked up by a missionary in the Philippines. The ensuing epidemic was historic, infecting 382 people.
Holmes County health director D.J. McFadden said the Amish turned out in droves for the vaccines once they saw the viciousness of the disease that nearly killed a young girl, had three pregnant mothers in fear of losing their babies and afflicted hundreds with severe pain.
“Many people said, ‘First I thought I would die. Then I wanted to die, then I got better,’ ” he said.
“When they saw measles, measles was such a very serious disease they did this mental math and said measles are much worse than the vaccine could be, and measles is here,” he said. “These diseases are only a plane ride away.”
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