For more than two decades, Washington parents have had the option of sending their children off to kindergarten vaccine-free.
Data for the 2013-14 school year show 4.6 percent of the state’s kindergartners received exemptions from the vaccines required for school entry. In Pierce County, 3.9 percent of students in all grades fell under some vaccination exemption.
The number of exemptions is important, health authorities say, because “herd immunity” against a disease occurs when a significant portion of the overall population is protected, either by a vaccine or by previously contracting the disease.
Exemptions to vaccinations have been available for medical and religious reasons, and for what the state deems “philosophical or personal objections.”
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That last category — claimed most often by parents who believe vaccines are dangerous — is by far the most frequently claimed exemption, according to the state Department of Health.
The personal belief exemption could disappear if an Everett lawmaker’s bill succeeds. Democrat Rep. June Robinson introduced the bill to drop the exemption this week.
Gov. Jay Inslee said Friday he supports the measure. So does the Washington State Medical Association.
“We all have an interest in keeping children healthy,” Inslee said in a statement. “If everyone gets immunized, our children would be at lower risk of getting these avoidable and serious infections.
“Immunizations save lives and are among the most effective ways to protect everyone from serious, preventable illnesses — especially young kids.”
New alarms about the unvaccinated, in school or out, stem from a December outbreak of measles traced to visitors to Disneyland. Health officials in Washington urged residents and health care providers to be alert for potential measles cases among people who traveled to Disneyland in late December and early January — and with good reason.
In early January, the state Health Department put out an alert about an unimmunized woman in her 20s who picked up a case of measles while at Disneyland in December.
She flew to Sea-Tac Airport and visited King and Snohomish counties while contagious. She didn’t know she had measles until she returned home to California and was diagnosed in early January.
Those who choose not to vaccinate their children argue that vaccines can damage kids. The most persistent argument over the years has been that childhood vaccines cause autism.
That possibility has been heavily researched, and public health authorities say unequivocally that vaccines do not cause autism.
Others believe vaccines might create different health dangers. Still others say government mandates to vaccinate children violate individual liberties.
But public health officials don’t mince words.
“This is not a story that has two sides,” said Paul Throne, of the state Department of Health’s immunization office. “The science is overwhelmingly on the side of vaccinating. People in our state are allowed to opt out if they choose. But there is overwhelming evidence that vaccines save lives.
“It is frustrating that we have not been able to change hearts and minds. Vaccines are so helpful. And they are safe.”
One reason health officials keep tight tabs on measles is its potential to spread rapidly.
“It’s the most contagious disease we know of,” said Nigel Turner, director of the Communicable Disease Division for the Tacoma-Pierce County Health Department.
Measles viruses are airborne. An infected person can enter and leave a room, and measles germs could still be in the air two hours later, just waiting for another unvaccinated person to breathe them in.
You can catch measles from a contagious person even before they have the tell-tale red measles rash, health officials note.
To the unvaccinated, measles is more contagious than the common cold or flu, Throne said.
Almost every unvaccinated person who comes in contact with the virus will get the disease, Turner said. One person infected with measles can infect several more, who in turn go on to infect even more, spreading the disease exponentially.
The measles vaccine was introduced in the 1960s. Originally just one dose of the vaccine was required, but this was later extended to two.
Before the vaccine was available, plenty of children came down with the disease, and most people who grew up before the vaccine era probably had the disease, officials say.
“In the old days, there was nothing you could do about it,” Throne said. “People made the best of it. But it was always dangerous.”
“People have forgotten how serious this is,” said Turner, noting that during the current outbreak, about a quarter of those infected have been hospitalized.
For every thousand measles cases, two or three people will die. Complications from the disease can include diarrhea, which can be especially serious in babies and young children, blindness, deafness, brain inflammation and pneumonia. Measles can trigger premature labor and delivery in pregnant women.
The possible effects from measles are what inspire health authorities to preach the gospel of vaccination. The vaccine is highly effective against measles, they say, and requiring it, as well as other shots, for school entry has been an effective public health strategy.
In addition, there are state vaccination requirements for children in day care or preschool. Because not every child attends such places, health authorities have targeted kindergarten entry as a point to ensure widespread vaccination.
“Kindergarten is our benchmark,” Throne said.
By age 5 or 6, when kids enter kindergarten, most of the childhood vaccines have been administered.
DISEASE ON THE REBOUND
After decades of routine immunization, measles was declared eliminated in the United States by 2000. But the disease still is common elsewhere in the world, and imported cases continued to crop up here and there.
On Friday, Clallam County officials released information about a confirmed measles case there.
Pierce County saw its first case of measles since 2006 in June 2014. It was traced to someone in South King County who had visited Micronesia, in the Western Pacific.
“This is something you never want to get complacent about,” Turner said. “With international travel, people are going to arrive, and we are going to get cases.”
One goal of health officials is to ensure isolated cases don’t turn into widespread outbreaks.
By August 2014, there had been 592 cases of measles reported for the year in 21 states, including Washington. The surge was attributed largely to U.S. citizens who traveled abroad, caught the disease, brought it home and spread it to others who had no immunity.
State officials keep their eye on kindergarten vaccination rates, which are reported to the Health Department by school districts and private schools throughout the state. They serve as a kind of bellwether for the overall population, since there is no thorough way to track immunization rates among adults.
The state tracks how many Washington students receive vaccination exemptions, from measles or from one of the other required immunizations.
In Thurston County during the 2013-14 school year, 6.3 percent of students in all grades fell under some vaccination exemption, according to the state Health Department. In King County, the rate was 4.8 percent.
Exemption rates were among the highest in counties outside the urban area, including Jefferson County on the Olympic Peninsula at 14.4 percent and rural Ferry County in Eastern Washington, where 22.3 percent had exemptions.
State health officials rely on schools and school districts to report immunization statistics, and errors or misinterpretations can occur, they say. Schools, in turn, rely on parents to turn in immunization forms, most of which must be signed by a health care provider.
People who can demonstrate membership in a religious group that does not believe in medical treatment are exempted from this requirement. State law requires schools to accept children whose parents have vaccination exemptions on file with the school.
“We expect people to tell the truth,” Throne said. “We look at the data and call out the obvious problems. But we don’t have the capacity to look at kids’ records ourselves.”
Even without exemptions, some students don't get their required shots.
All told, 83.3 percent of kindergartners had paperwork on file last year showing they had received all required vaccines, a rate that worsened slightly from the previous year. National immunization data from 2013 shows 71 percent of Washington children between ages 19 to 35 months had received all of their shots on time.
The share of Washington students with exemptions has leveled off lately but is far below the 7.6 percent seen five years earlier.
State officials aren’t sure why, but the rate began falling around the time officials made it slightly less convenient to fill out exemption paperwork, in the 2008-09 school year.
Lawmakers then added further conditions in 2011 when they required a medical provider's signed declaration that the provider had informed a child's parents about the risks and benefits of vaccines.
“I think we're making some progress against the hysteria that was in place and sort of rampant,” said Sen. Karen Keiser, a Des Moines Democrat who pushed for the 2011 law.
Keiser’s 2011 measure was a bipartisan one, and so is Robinson’s current bill, which would eliminate the exemption based on personal or philosophical objections.
Rep. Joe Schmick, R-Colfax, voted against the 2011 bill and said he had concerns about the current proposal.
“I’m not against vaccination,” he said. “I just think it should be the parents’ choice.”
House Majority Leader Pat Sullivan, D-Covington, said concerns over the bill ultimately will come up as the bill progresses, but he said he believes the measure has strong support.
“We’re seeing cases of measles and preventable diseases that I think need to be addressed,” he said. “We’re hearing from our school directors that this is a problem they want us to solve.”
Sen. Randi Becker, a Republican from Eatonville who is chairwoman of the Senate Health Care Committee, said she’d be open to hearing the bill if it passed the House and came to the Senate.