By Amy Wang
February 7, 2015

Although Oregon has the nation’s highest rate of childhood vaccination exemptions, a solid majority of the state’s children attend schools and child care facilities with immunization rates high enough to protect everyone, according to an Oregonian/OregonLive analysis.

Nearly 80 percent of the public and private schools and child care facilities in the state have vaccination exemption rates of 6 percent or less, low enough to produce so-called herd immunity — when enough people are vaccinated to keep a virus from spreading past a few isolated cases — for the most contagious diseases.

While the state’s overall rate of nonmedical exemptions has been rising steadily for the past 15 years, from 1 percent in 2000 to 7 percent in 2014, it’s not a statewide rate, said Dr. Paul Cieslak, medical director for Oregon’s immunization program.

“It’s not a case of everybody’s claiming more exemptions,” Cieslak said. “It’s rather that there are focused areas that are just going through the roof with exemptions.”

That’s borne out by an analysis and mapping of data from the Oregon Health Authority. The Oregonian/OregonLive has published statewide vaccination opt-out rates in a searchable database of 1,700 Oregon public and private schools and licensed child-care facilities.

The 10 schools at the top of the opt-out list, with exemption rates of 60 percent or higher, are all private, charter or alternative schools. Last school year, they had a combined enrollment of 1,604, less than the enrollment at some individual Portland-area high schools.

Looking at the data another way, last school year 3,331 Oregon kids had exemptions for one or more of the vaccinations required for children who are 18 months or older and enrolled in school or child care. That number might sound big: It’s the equivalent of eight to 10 elementary schools. But it’s also about a half of 1 percent of the 669,030 children enrolled in Oregon’s schools and child care facilities that year.

Cieslak attributed the exemption clusters to parents who “don’t necessarily believe in typical medicine.”

“They tend to discount a lot of what public health officials would tell them,” he said.
Exclusion day

Oregon parents have until Feb. 18 to get their children immunized or face exclusion from school and child care facilities. State law also allows parents to receive a non-medical exemption, either by talking to a health care provider about the benefits of vaccines or by watching an online educational module.

In response, Cieslak said, public health officials have worked to put out as much information as possible about vaccines’ effectiveness.

“Parents have the right to not have their children vaccinated if they want to,” he said. But, he said, after hundreds of millions of doses of vaccinations, the record is solid. “Our data clearly indicate, at any age you’re better off with the doses than without them,” he said.

That argument clearly doesn’t hold much water with the parents at St. Thomas Becket Academy, a K-12 Catholic school in Veneta, near Eugene, that is listed as having the highest exemption rate in Oregon: 72 percent, based on its enrollment of 103 last year. The school’s website describes it as “a most valuable alternative to the anti-family attitudes found in public school.”

At 69 percent, Woodland Charter School, a three-year-old K-8 school in southern Oregon, has the highest exemption rate among Oregon public schools.

Woodland’s principal, Lois Horan, said the rate didn’t surprise her given “the population of parents” at the school. “They all have their individual reasons,” she said. “I don’t query them about it. As long as it’s covered under the law.”

Asked how she’d respond if measles or another preventable contagious disease appeared at Woodland, she said the school dealt successfully with a case of whooping cough last year by addressing it immediately.

“We asked everyone to self-quarantine if they were coughing or having any symptoms,” she said. “It turned out that five students had it. … They were the only five students that got it.”

Horan added that the school asks its families to “take special care” around the elderly, babies too young for certain vaccines, and others who are more vulnerable than average.

“We’re a school that follows the law,” Horan said. “It just so happens that our population is that group that decides to not vaccinate, but we’re very, very careful.”

Stacy de Assis Matthews, school law coordinator in the Oregon Health Authority’s Public Health Division, said it’s important to know which schools and child care facilities have high exemption rates in case a highly contagious disease is diagnosed.

She noted that Oregon’s 7 percent exemption rate has put the state “right at the cusp” of where it must be for protection against outbreaks.

Take measles: The threshold for herd immunity for that disease is a vaccination rate of approximately 92 to 94 percent, Matthews said. Among Oregon kindergartners, 93.2 percent have received the recommended two-dose vaccination against measles.

“It would be concerning if our immunization drops further than that,” Matthews said.

She provided these other statistics about vaccination exemptions:

In the Portland metro area, Multnomah County had the highest rate of exemptions, at 9.6 percent. Clackamas County had an exemption rate of 8.1 percent; Washington County, 4.8 percent.
Among Oregon children who have vaccination exemptions, about half have exemptions for all vaccines required by Oregon law.
Among Oregon kindergartners, the highest number of exemptions was for the measles vaccine.
Among Oregon children in kindergarten and child care, the lowest number of exemptions was for the DTap vaccine, which inoculates against diphtheria, tetanus and pertussis, also known as whooping cough.

“We are unable to track data as to the reasons why people are claiming exemptions for some vaccines and not others,” Matthews said.

The 2012 whooping cough epidemic could have influenced parents’ decisions about whether to get their children the DTap vaccine, she said.

As of June 2014, Oregon was one of four states permitting exemptions from school and child care immunization requirements for medical or “personal belief” reasons, according to the federal Centers for Disease Control and Prevention. “Personal belief” reasons can include religious beliefs.

Twenty-seven states and the District of Columbia were allowing exemptions for medical or religious reasons. Seventeen states were allowing such exemptions for medical, personal belief or religious exemptions. Two states, Mississippi and West Virginia, allow only medical exemptions.

But this week, lawmakers in Oregon, Washington and California moved to introduce bills that would abolish nonmedical exemptions for vaccinations.

Lynne Terry of The Oregonian/OregonLive staff contributed reporting for this story.

— Amy Wang