Ohio schools challenged by vaccine exemptions, data challenges

Ohio medical professionals are warning measles is likely to return to Ohio because incidents in the U.S. have reached their highest rate in 25 years.

There have been close to 700 confirmed cases and outbreaks in neighboring Michigan, Indiana and Kentucky.

The highly contagious virus is vaccine preventable; the outbreaks are largely attributed to pockets of low vaccination rates and travelers who get measles abroad and bring it to the U.S.

The percent of Ohio children with vaccine exemptions is relatively small, but skepticism over vaccines doesn’t seem to be going away, said Melissa Wervey Arnold, CEO of the Ohio chapter of the American Academy of Pediatrics.

SEARCH: How many kids are vaccinated at your school?

“The concern is we’re seeing a growing problem and now we are seeing these outbreaks,” Arnold said.

On Thursday, more than 200 students and staff at two Los Angeles universities, University of California Los Angeles and California State University, were placed under quarantine because they may have been exposed to measles and either have not been vaccinated or cannot verify that they are immune.

Arnold said Ohio school districts are challenged by a lack of standard vaccination data and can have a hard time getting information from parents. Some schools are vulnerable to viruses because of pockets of unvaccinated children who receive exemptions for religious or philosophical reasons.

It can be difficult for public health officials and for community members to know where there are areas of low-vaccination rates.

The Dayton Daily News each year creates the only public database of school-level vaccination rates in the state. The information comes from data reported to the Ohio Department of Health and obtained by the newspaper.

But even that data comes with challenges. There is no standard way to report vaccination rates, said Arnold, and some schools report low vaccination rates not because parents are opting not to vaccinate but because the school district is struggling to get all the right paperwork from parents.

Related: Ohio may require schools to tell parents how easy it is to skip vaccinations

Every student is supposed to have evidence of all required shots, or have submitted an exemption, by 14 days into the school year or they are not allowed to attend. Ohio law, though, allows wide latitude for exemptions, including religious, medical or “reasons of conscience.”

Kindergarten vaccination rates     
Vaccination rates vary by county.      
CountyTotal Enrolled Total Pupils with All Required ImmunizationsTotal Pupils with a Medical ContraindicationTotal Pupils with a Reason of Conscience or Religious ObjectionTotal Pupils Incomplete with no Exemption on File
Source: Ohio Department of Health     
Due to rounding some percentages may be less or more than 100%.     


State lawmakers are considering House Bill 132, which would require school districts to spell out all the allowable exemptions that parents can invoke to skip vaccinations for their children.

State Rep. Don Manning, R-New Middletown, who sponsored the bill, noted previously that HB132 doesn’t change requirements or exemptions. The intent of the bill is to make sure people are given the correct information, said Manning.

There have been bills that have stalled in previous legislative sessions seeking to standardize vaccine data collection and to require a health care provider signature on school immunization forms, indicating that parents who opt out have had a conversation about the risks and benefits of vaccinations.

Arnold said data on vaccination rates matters for parents; a parent who has a child with a compromised immune system may want to know if they were sending their child to a school with a low vaccination rate.

“You probably don’t want them in a school where they have a really high opt-out rate because of what you are seeing around the country with the measles,” Arnold said.

She also said reliable data is also important if there was an outbreak, that way school officials could quickly know which children were unvaccinated and vulnerable. She said there is a school in central Ohio that was able to quickly contain a mumps outbreak because they had good data to see which children were unvaccinated.

With the current system, it’s hard to know where to work to increase vaccination rates.

“From a public health standpoint, its really hard to even target our efforts,” Arnold said.

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Exemptions and unvaccinated pockets

Both state level and regional data shows overall vaccination rates about 90 percent or higher, but school-level data shows some communities are under-immunized.

For Greene County, 92 percent of kindergartners, 92 percent of seventh graders and 92 percent of twelfth graders have all required immunizations.

Yellow Springs Schools, which at one point had the worst public school kindergarten vaccination rate in the state, has the lowest rate in Greene County with 73 percent of kindergartners complete this school year, only 28.5 percent of seventh graders and 17 percent of 12th graders.

School district officials declined to talk about the vaccination rates.

Springboro Community City Schools had vaccination rates similar to the rest of the state for seventh and 12th grade vaccinations, though kindergartners in the school district had higher than average rate of exemptions. About 8 percent of kindergartners at Clearcreek Elementary School had religious or reason of conscience exemptions, compared to 3.8 percent for Warren County and 2.6 percent statewide, according to Ohio Department of Health.

“I feel that what we are seeing would be coming from parents doing a more step approach or spreading out those vaccines not on the recommended schedules,” said Bronwyn Patterson, district nurse.

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Several Miamisburg schools had relatively high rates of non-medical exemptions compared to Montgomery County. Miamisburg Middle School had 7.2 percent with non-medical exemptions and 13.5 percent of Miamisburg High School students had non-medical exemptions.

Katy Lucas, director of student services at Miamisburg City Schools, said the school district is exploring whether it could offer immunization clinics to help make it more convenient to get required vaccines.

Exemptions aren’t the only challenge. School districts also face challenges getting all the paperwork complete, particularly for recently created meningococcal vaccine requirements for incoming seventh and 12th graders.

In Springboro, to help with high school and junior high vaccination paperwork, Patterson said the school district has found success getting paperwork turned in by offering rewards like early scheduling and an early chance at parking passes for students who complete paperwork, either showing they have vaccinations or exemptions.

Betina Irwin, nurse coordinator for Kettering City School District, said the new requirements for incoming seniors “have proven to be the biggest challenge yet.” This year they partnered with a vaccination program to provide no cost immunizations at school to make it convenient to get requirements complete.

Irwin said it is important for parents to know that when Ohio Department of Health adds new vaccine requirements, it is because of good data on the risk that these diseases present and the importance of herd immunity - the resistance by a group to spread of a disease because a high number of members of the group are immune.

“We are seeing a resurgence of many diseases in other states because of the fact that some of this herd immunity has been compromised because people don’t get their kids vaccinated,” Irwin said.

Associated Press contributed to this story.

How is measles spread?

Measles spreads easily through the air by breathing, coughing, or sneezing. It is so contagious that anyone who is exposed to it and is not immune will probably get the disease.

What are the symptoms of measles?

  • High fever (may spike to more than 104°F)
  • Cough
  • Runny nose
  • Red, watery eyes
  • Rash breaks out 3-5 days after symptoms begin

Source: Ohio Department of Health

Measles incidents in the United States:

2019: 695 (through April 24)

2018: 372

2017: 120

2016: 86

2015: 188

2014: 667

2013: 187

2012: 55

2011: 220

2010: 63

Source: Centers for Disease Control