Childhood vaccines for diseases like measles, polio dropped at area schools amid pandemic

The number of kids entering kindergarten reported as fully vaccinated against diseases like measles and polio dropped across Ohio and plummeted at some area elementary schools amid the pandemic, a Dayton Daily News investigation found.

In the nine-county Dayton region, the number of elementary schools where more than a quarter of students didn’t have vaccines required to attend school jumped from six in the school year that started in 2019 to 18 in the year starting in 2020. This doesn’t include charter or private schools.

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Statewide, kindergarten vaccination rates fell at more than two-thirds of elementary schools in 2020, after the rates had increased at more than half of schools the year before.

This is according to data obtained from the Ohio Department of Health and analyzed by the Dayton Daily News. Vaccination numbers are reported by every school district in the state in October of each year. Data for the school year that started in 2021 is not yet available.

The data is only for vaccines students are legally required to get, which does not include the COVID-19 vaccine. Because of privacy laws, it excludes schools with 10 or fewer students in kindergaten.

The data shows that until 2020, nearly every kindergarten in the nine-county Dayton region had a vaccination rate of well over 60% during the prior three years. In the 2020-21 school year, five schools in Dayton, Fairborn, Yellow Springs, Middletown and Springfield fell below that threshold.

“Sixty (percent) is worrisome. When you tell me that, I’m worried that the kids who are not vaccinated at those schools will be at greater risk,” said Dr. Sara Guerrero-Duby, a pediatrician at Dayton Children’s Hospital.

“That’s really a sign for us to sit up and look and see what we can do in those five hot spots,” she said.

Guerrero-Duby said that populations generally need about 80% vaccination rates to reach herd immunity, where enough people are immune to the disease to make it unlikely to spread. In this region, 29 schools fell below 80% in the 2020-21 school year.

Sara Paton, a professor of epidemiology and public health at Wright State University, said the 80% threshold is needed for diseases like polio, but others like measles require vaccination rates closer to 95% for herd immunity. This is to protect not only the people with the vaccine but those who can’t get the vaccine because of underlying health issues.

“In general, I would want at least 80% covered, minimum, but for some diseases I want more,” she said.

Of 152 schools in the area, 57 had at least 95% of students current on the measles vaccine.

For diseases like tetanus, there is no herd immunity so it’s important to get kids vaccinated for their individual protection, she said.

Contributing factors

At some schools, parents filing religious or conscientious exemptions was a factor. Snyder Park Elementary School in Springfield, for example, has the lowest regional vaccination rate (50%) and the highest percent of parents who filed exemptions (40%).

Snyder Park is among a handful of schools that saw a spike in exemptions. Newton Elementary School in Miami County saw the number of exemptions jump from 5% in 2019 to 26% in 2020. Two Kettering schools — Greenmont and Orchard Park — saw their rates rise to 10% and 12%, respectively, putting them in the top five for exemptions.

But overall, the number of parents filing vaccine exemptions for moral or religious reasons decreased from 2.5% in 2019 to 2.3% in 2020 statewide. Versailles Elementary School, the last school in the top five, saw exemptions drop from 19% to 13%.

This means the main reason for the overall decline is either parents just not getting their kids vaccinated, or schools failing to collect required paperwork.

School officials say it’s a little bit of both.

“This data was collected during the height of the COVID-19 pandemic, when many physician’s offices were only conducting telehealth visits. During this time period, thousands of students across the United States who were entering school missed appointments in which they would normally receive routine vaccinations,” said Jenna Leinasars, spokeswoman for Springfield City Schools.

Middletown City Schools head nurse Sara Neu said Central Academy Nongraded Elementary School — which reported a 51.7% kindergarten vaccination rate — didn’t have a school nurse when the numbers were reported.

Neu said the district started the year virtually, and nursing staff was “drastically cut,” leaving them with only enough nurses to assist special needs students on Tuesdays. When kids returned to classrooms, it took time to bring back nurses to all 10 buildings.

“I do not believe the issue was a low percentage of Central Academy students compliant with immunizations at that time, but a lack of nursing staff to hunt down the immunization records and enter them into the system,” Neu said.

She said 86% of kindergarten students at that school have all required immunizations this year, which is comparable to prior years, and they are still gathering immunization records from parents and helping families access vaccinations.

Causes, consequences

Statewide, schools with the lowest vaccination rates tended to be in large urban districts like Cincinnati with higher poverty rates, in areas with a large Amish population like Holmes County or charter schools.

The newspaper’s analysis found that there is generally a correlation between the percentage of unvaccinated kids and the percentage of a school’s students considered economically disadvantaged in Ohio Department of Education data.

That correlation became even more pronounced in 2020.

Paton said in lower-income areas more people don’t have health insurance, transportation, or time to get to a medical appointment.

Ohio law allows students to remain in school for “no more than 14 days since enrollment,” unless the student provides evidence that they have received the required immunizations or that they are in the process of being immunized. Parents can file for exemptions for medical, religious or moral reasons.

Kindergarteners must be vaccinated against diphtheria, tetanus and pertussis, polio, measles, mumps, rubella, hepatitis B, and chickenpox. Most of these involve multiple doses. There are additional booster and vaccination requirements for grades 7 and 12.

Guerrero-Duby said in the last century these diseases routinely killed and crippled children, and because of vaccines many young doctors have never even seen them. But that could change.

“We know these diseases are around. We know the consequences of if our vaccine rates drop down. They will come roaring right back,” she said.

Shawna Moore got her seventh-grade daughter, Brooklyn Brundidge, caught up on shots at a vaccine clinic in Hamilton last week provided by the Butler County General Health District. Moore said they were late getting these shots because of some troubles with getting appointments and some insurance-related issues.

She believes the delay for most parents getting their children’s pediatric vaccinations was caused by COVID-19 precautions and schedule challenges, plus that the pandemic “put everything on the back burner.”

Credit: Michael D. Pitman

Credit: Michael D. Pitman

Dayton, Fairborn, Yellow Springs

Dayton Public Schools saw the average vaccination rate among its 15 kindergartens in the data drop to 76% in 2020 after a gradual decline in previous years. Some schools saw an increase, such as Fairview Elementary which went from 50% to 77%.

Charity Adams Earley Girls Academy, however, went from having 44 of 49 kindergarteners (89%) fully vaccinated to 31 of 53, or 58%.

DPS officials say the overall decrease was caused primarily by kids not getting usual doctor visits.

“At the time, some families shared that they were fearful of going to a doctor’s office or immunization clinic because they may be exposed to COVID-19,” said Associate Superintendent Sheila Burton. “Throughout the pandemic, DPS nurses made phone calls, mailed resources to families, and encouraged families to stay up-to-date on immunizations.”

She said DPS nurses contact parents through the school year to inform them that their child is not up to date on vaccines. Nurses provide information on resources for families without primary care providers, help for scheduling appointments and district transportation to the school-based health center with parents’ consent.

A 2015 Dayton Daily News investigation found Mills Lawn Elementary School in Yellow Springs had the highest percentage of kindergarteners with vaccine exemptions in the state, at nearly 30%. Exemptions rates since then have fallen consistently to nearly 5% last year. But the percent of unvaccinated kindergarteners also fell to nearly 55%.

Yellow Springs Schools Superintendent Terri Holden did not respond to questions about what contributed to the vaccination rates.

“Based on guidance from the Ohio Department of Health, Yellow Spring Schools encourages parents and guardians to vaccinate their children to safeguard the school community,” Holden said.

The last school in the bottom five was Fairborn Primary School, which went from having 341 of 389 kindergartners (88%) with all their shots in 2019 to 130 of 232 in 2020, or about 56%.

Fairborn officials did not return messages seeking comment.

Vaccine opposition

While schools and health departments work to increase vaccination rates, growing opposition to vaccine mandates could decrease numbers further.

“More and more parents are directly correlating their beliefs about COVID-19 vaccines with routine childhood vaccinations, such as polio or rubella. It is evident that Springfield is following this wider trend,” said Leinasars of the spike in exemptions at Snyder Park.

Ohioans may also vote next year on whether to do away with childhood vaccine mandates altogether. The Ohio Ballot Board in June allowed a group to start gathering petitions to add a “Medical Right to Refuse” clause to the state constitution.

This would add the following language to the Ohio Constitution: “No law, rule, regulation, person, employer, entity or healthcare provider shall require, mandate, or coerce any person to receive or use a medical procedure, treatment, injection, vaccine, prophylactic, pharmaceutical, or medical device nor shall the aforementioned discriminate against the individual who exercises this right.”

To get on the ballot, the measure needs signatures equal to at least 10% of the votes cast in this year’s gubernatorial election. Organizers are aiming for the May 2023 ballot.

Diana Smith, a certified medical assistant from Bradford, told the Associated Press she helped initiate the petition not out of opposition to vaccinations, but to ensure Ohioans are “free to do their own research and do what they want with their bodies without fear of losing their livelihood.”

“This isn’t just about COVID-19,” Smith added. “I’m not an anti-vaxxer, I’m anti-mandate, I’m anti-discrimination.”

Charter schools

The newspaper’s analysis focused mostly on traditional, public schools. ODH data shows some local charter schools have the region’s lowest reported vaccination rates, though that has been the case for years.

Of the 10 area schools with the lowest reported vaccination rates, four were charter schools.

Woodbury Community School and the Montgomery Preparatory Academy, both in Dayton, have more than 50 students each and both reported a vaccination rate of about 38%. This is tied for lowest in the region.

This was a decrease for Woodbury, but an increase for Montgomery Preparatory Academy.

“I would not be able to comment on the factors that contribute to why some families choose not to immunize their children as those are very personal decisions,” said Woodbury Principal Melissa McManaway. “As educators, however, we realize the importance of having healthy students so we encourage families to have their children caught up on all well-child visits along with vaccinations before starting the new school year.”

She said they share information with parents about free clinics offered by the health department, and many parents did catch up on vaccines after the October reporting period.

Officials from Montgomery Preparatory Academy did not return messages seeking comment.

Jennifer Schorr, president of the Ohio Association of Charter School Authorizers, said most charter schools tend serve lower socio-economic populations where healthcare access is an issue. And in 2020 they saw the same obstacles as traditional schools.

“Our reasons are no different in that regard,” she said.

What’s being done

Ohio Department of Health officials say the decrease in vaccination rates during the pandemic occurred nationwide and “Ohio was no exception.” They are conducting outreach programs to the public, vaccine providers and school nurses, as well as providing free vaccines to providers under a federally funded program.

Springfield City Schools officials say they go to great efforts to meet ODH requirements, including sending at least three letters home to parents over the summer, calling them at least twice, and offering vaccines at a school-based clinic.

Public health and hospital officials say they know many parents missed routine visits during the pandemic, and they are working to assure them it’s safe to get in now and vital for them to get their children vaccinated in order to protect them and the community.

“We continue to actively work with schools and the community as a whole to help get children caught up on the essential vaccinations needed for the start of school,” said Butler County General Health District Health Promotion Director Erin Smiley.

She said their childhood vaccine clinic re-opened this year and they have had events focused on kids who may have fallen behind on vaccinations. This fall they will launch a promotional campaign to encourage people to stay up-to-date no all vaccines including COVID, flu and monkeypox, in addition to those required for school.

Public Health – Dayton & Montgomery County took the unusual step this year of offering walk-in vaccination clinics where parents could get their children vaccinated without an appointment.

“We knew going in that there were people behind on their vaccinations because of this disruption of service available during COVID,” said health department spokesman Dan Suffaletto. “This was an effort to make up for that and remove as many barriers as possible for people getting vaccinated.”

As of early September, the clinics provided 157 back-to-school vaccinations with three more drop-in sessions scheduled.

“Because of vaccines we were able to stop the spread of a lot of childhood diseases and the only way that is going to continue is if more people continue to get vaccinated,” Suffaletto said.

Staff Writer Michael D. Pitman contributed to this report

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