Schools Not Keeping Track When Kids Are Behind On Their Shots

Schools Not Keeping Track When Kids Are Behind On Their Shots

9:18am Feb 11, 2015
Sara Martín reads bedtime stories with her children. When the kids were younger, she says, staying up to date on their frequent immunizations was tough, because of cost and transportation issues.
Sara Martín reads bedtime stories with her children. When the kids were younger, she says, staying up to date on their frequent immunizations was tough, because of cost and transportation issues.
Lauren M. Whaley / CHCF Center for Health Reporting

When Sara Martín's children were infants, she made sure they got all the recommended immunizations.

"And then somewhere when they became toddlers I started to fall a little behind on the vaccinations," she says. "Not intentionally — just, that's kind of how it happened for me."

Martín is 29 years old and a single mother of two. She says it was a huge chore to travel from her home in East Los Angeles to a community clinic downtown.

"It's not just about paying the fare for the bus — which seems pretty inexpensive, right? Like a dollar and some change," Martin says. It was also a complicated commute. "Maybe two buses there, and two buses back, because it was a long trip."

There was also the challenge, while on food stamps, of feeding the kids throughout that trip.

"I don't want to feel like these are excuses," Martín says. "It was just the reality — these are choices I had to make."

Her kids — 3-year-old Tzintia, and 18-month-old Ricky — eventually got caught up on their shots. There are a lot of children like them who fall behind on their vaccinations simply because the logistics of life get in the way.

California has had at least 103 confirmed cases of measles in the most recent outbreak; the state also experienced a whooping cough epidemic in 2014, with more than 10,000 cases and two infant deaths.

The rise in cases has focused public attention on the state's relatively lenient (and controversial) personal belief exemptions policy, which allows parents to refuse to vaccinate their children.

But experts say under-vaccination may also be a pressing problem.

The state requires kindergartners to have all the recommended immunizations for diphtheria, tetanus and pertussis; measles, mumps and rubella; polio; haemophilus influenza type b; hepatitis B; and chickenpox. For most of these vaccines, full immunization means multiple doses given at specific intervals.

State law allows incoming kindergartners who have received at least one dose of each required vaccine to enroll as what's known as "conditional entrants."

After that, it's up to the school to notify a family when the child's next shot is due. But that follow-up doesn't always happen, says Tonya Ross, a registered nurse and director of nursing services for the Los Angeles Unified School District.

"It's a challenge when, you know, you're busy during the school day, and the days roll by," she says. "And then, three months later you realize you have a student who, you know, you missed notifying them, and the parent forgot."

In a handful of L.A. schools, 60 to 80 percent of incoming kindergartners had not yet completed the full lineup of recommended shots when they enrolled in 2013. The school district says it is unable to report how many of those students ended up fully vaccinated by the end of the school year.

"Once they're in, if there's no nurse there tracking that — it may flag on a system, but there's really no one looking at that," says Ross, citing the lack of school nurses as a barrier for tracking students' immunizations. "So it's very difficult to get those kids the appropriate follow-up."

The state requires schools to report their immunization rates in the fall, but there is no additional reporting requirement (though it randomly audits about 3 percent of kindergartens every third spring). In 2011, the most recent available review, 6 percent of the 286 audited kindergartens were only partially immunized for their initial enrollment; about half of them had received the missing vaccinations by the spring.

The state is not tracking these partially-immunized children, and while state law requires schools to track conditionally-admitted entrants and exclude those who don't get fully vaccinated, schools don't risk any sanctions for failing on either of those fronts.

This issue came as a surprise to L.A. school board member Bennett Kayser. He believes the problem should be easy to solve.

"It shouldn't be difficult to generate a report that says who's needed a booster shot for the longest period of time, and sort the list of students who are still in need of boosters," he says.

The issue also worries Dr. Richard Pan, a pediatrician and state senator (D-Sacramento) who sits on the senate health committee, and who introduced recent legislation that would abolish the personal belief exemption as it pertains to childhood vaccines.

"It certainly is a public health problem, because you have people who are under-vaccinated," says the senator, who plans to introduce more legislation this year to require schools to provide parents with statistics on their students' vaccination status.

The senator says he supports increasing funding for school nurses, so they have the ability to ensure that all kids get vaccinated.

Following up on immunization "is something that's been falling by the wayside," says Pan. "We need to focus on that again."

This story is the result of an NPR collaboration with Southern California Public Radio and Lauren M. Whaley of the California Healthcare Foundation's Center for Health Reporting.

Copyright 2015 Southern California Public Radio. To see more, visit http://www.kpcc.org/.

Transcript

ROBERT SIEGEL, HOST:

The measles outbreak linked to Disneyland has grown to 114 cases in seven states. It has started a new conversation in this country about the decisions parents make when it comes to vaccinations. In states where it is easy to get a nonmedical vaccination exemption, disease rates go up, and we're going to explore that further in a few minutes.

RACHEL MARTIN, HOST:

First, the challenge school districts face in keeping track of children who are partially vaccinated. They're enrolled on the condition that they will eventually get all their shots. In Los Angeles, the school district can't even say if these under-vaccinated students ever become fully vaccinated. Rebecca Plevin of member station KPCC begins our coverage.

REBECCA PLEVIN, BYLINE: When Sara Martin's children were infants, she got them all of their vaccinations.

SARA MARTIN: And then somewhere when they became toddlers, I started to fall a little behind on the vaccinations - not intentionally, just that's kind of how it happened for me.

PLEVIN: Martin is 29 and a single mother of two. She says it was a huge chore to travel from her home in East LA to a community clinic downtown.

S. MARTIN: It not just about paying the fare for the bus, which seems pretty inexpensive, right? Like, a dollar and some change - maybe two buses there and two buses back because it was a long trip.

PLEVIN: There was also the challenge of feeding them throughout that trip while on food stamps.

S. MARTIN: I don't want to feel like these are excuses. It was just the reality. These are choices I had to make.

PLEVIN: Martin's kids, three-year-old Tzintia and 18-month-old Rick, eventually got caught up on their shots. There are a lot of kids like them who fall behind on their vaccinations simply because the logistics of life get in the way. California law says these kids must have all of their shots in order to start kindergarten. But there's flexibility. Schools enroll kids without all their shots as conditional entrants on the understanding that they will get the shots they need, says Tonya Ross of the Los Angeles School District.

TONYA ROSS: Then that information will be tracked by the school nurse, and then they'll - the parent will receive a letter saying your child is due for this immunization.

PLEVIN: By law, a family will then have 10 days to show proof of vaccination or the child will be kept out of class. But Ross admits schools don't always alert families on time.

ROSS: It's a challenge when, you know, you're busy during the school day and the days roll by and then three months later you realize you have a student who - you know, you missed notifying them and the parent forgot.

PLEVIN: And, she says, no kids were barred from class last year for falling behind on their shots. KPCC and the California Healthcare Foundation's Center for Health Reporting found in state records that in some Los Angeles kindergartens 60, 70 - even 80 percent of kids were enrolled conditionally during the 2013-2014 school year. In a written statement, and LA Schools spokeswoman said the district does not know how many children actually end up getting all their vaccinations. And, she says, no school district in the state has that information. Tonya Ross of the LA Schools says it's a resource problem.

ROSS: Immunizations - you know, if you're looking at a continuum, it's probably not high on the radar of a school that does not have a full-time school nurse or even a three-quarter-time nurse.

PLEVIN: The state is not tracking either. And under the law, schools don't risk any sanctions for not tracking conditional entrance or for failing to keep those who didn't get fully vaccinated out of school. For policymakers, the measles outbreak that started at Disneyland is a prime example of why schools and the state should do a better job of keeping track of students' immunizations. Bennett Kayser is a member of the LA school board. He says the problem should be easy to fix.

BENNETT KAYSER: It shouldn't be difficult to generate a report that says, who has needed a booster shot for the longest period of time - and sort the list of students who are still in need of boosters.

PLEVIN: The measles outbreak has brought the issue of unvaccinated kids to the attention of California lawmakers who recently proposed a bill to boost immunization rates. But nothing is in the works yet to ensure under-vaccinated kids get all of their shots. For NPR News, I'm Rebecca Plevin. Transcript provided by NPR, Copyright NPR.

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