‘At the edge of the safe zone’: Hampshire County has some of the highest vaccine exemption rates in the state

  • Rates of kindergarten students with an exemption by county, 2017. Massachusetts Department of Public Health

Staff Writer
Published: 4/8/2019 7:13:27 PM

NORTHAMPTON — Massachusetts just saw its first case of measles for this year. On Monday, the state Department of Public Health confirmed a case of the highly contagious disease in the greater Boston area. Across the country, measles cases have surged — there have been more U.S. cases of measles in the first three months of 2019 than in the entire previous year.

A single dose of the measles, mumps and rubella (MMR) vaccine is 93 percent effective against measles, according to the Centers for Disease Control and Prevention. But there are some pockets in the state with higher-than-average vaccine exemption rates, like in western Massachusetts — including schools in the Pioneer Valley. Across the county, 3.7 percent of kindergartners were exempt from at least one vaccine, compared to the state average of 1.3 percent, according to the state Department of Public Health’s most recent data.

The Hampshire County schools with the highest exemption rates in the 2017-2018 academic year data include The Hartsbrook School (25 percent) in Hadley, Jackson Street School (13 percent) in Northampton, RK Finn Ryan Road School (10.3 percent) in Florence, and Fort River (6.1 percent) and Crocker Farm (5.4 percent) in Amherst.

Because some area schools, like Hadley Elementary and Hatfield Elementary, reported data for fewer than 30 students, the Department of Public Health will not release it.

“It’s disappointing. I think we would like to see that near 100 percent,” Dr. Jonathan Schwab, medical director of Northampton Area Pediatrics, said of western Massachusetts’ vaccination rates.

The high exemption rates at some of the schools are concerning, said Pejman Talebian, director of the Massachusetts Department of Public Health Immunization Program. “I think whenever there’s a school or a community that has exemption rates that are significantly higher than normal, it does make that particular school or setting more prone to an outbreak,” he said.

Religious, medical exemptions

Valley schools are well aware of the issue. “We take vaccination rates very seriously,” said Robbin Suprenant, Amherst-Pelham Regional Schools school nurse leader. “It’s something the nurses spend countless hours on, collecting information from families and local health care providers.”

As a whole, Massachusetts has high rates of vaccination compared to the rest of the country. For children between 19 and 35 months, 98.3 percent had their MMR vaccine in 2017, according to Centers for Disease Control and Prevention data. In some states like Missouri and Colorado, the rates were less than 90 percent.

But there are certain areas with higher exemption rates, such as Cape Cod, Martha’s Vineyard and western Massachusetts.

Those areas have been consistently higher for the past five to 10 years, Talebian said. “This is not an anomaly — it’s a trend we’ve been noticing,” he said.

Generally, in the U.S. there are three types of exemptions: medical, religious and philosophical. All states allow medical exemptions for those who have a condition — such as an allergy to the vaccine or a weakened immune system from a disease like HIV/AIDS or from undergoing chemotherapy — preventing them from getting some vaccines. Most states, according to the CDC, allow either religious or philosophical exemptions. The Christian Scientist Church, for example, says many members rely on prayer for healing and use vaccine exemptions “conscientiously and responsibly” but allow members to make their own decisions.

The Massachusetts Department of Public Health data combines religious and medical exemptions; philosophical exemptions are not allowed in Massachusetts.

While there are some medical reasons, most exemptions in the state are religious, according to the state Department of Public Health. To get a religious exemption, parents must submit a letter saying that a vaccine goes against their religious beliefs, but there is no verification of that information, Talebian said: “The law is fairly open in that regard.”

Because the data is self-reported by schools, it’s likely that the true vaccination rate is slightly higher due to clerical issues on the part of the school or parents, Talebian added. Data is also collected in the fall, and vaccination rates may rise later in the year as records are updated.

Still, public health experts are watchful. “I think those numbers are concerning,” Nicholas Reich, a University of Massachusetts Amherst associate professor in the School of Public Health and Health Sciences said of the highest exemptions rates in Hampshire County which top 10 percent.

He pointed to the measles; experts say that around 95 percent of a population should be vaccinated to avoid a risk of an outbreak. “On the face of it, 3.7 percent is sort of in the safe zone — but at the edge of the safe zone of vaccination coverage,” he said.

Exemption rates in the Northampton school district tend to run high, said Karen Jarvis-Vance, Northampton Public Schools director of health, safety and equity programs. At 13 percent, Jackson Street has the second-highest exemption rate reported in the county, after Hartsbrook. Leeds Elementary and Bridge Street Elementary School both have lower rates at around 2 percent.

“It’s not so much around access anymore because most children do have a primary care provider and have access to immunizations,” Jarvis-Vance said of the rates. “It’s more around the religious exemptions.”

Religious exemptions also outnumber medical ones in Amherst-Pelham schools, said Suprenant.

“We obviously respect that and follow the regulations to do what we need to do in order to keep the rest of the population as healthy as possible,” she said. But, “People definitely have the right to their own religious beliefs.”

And data, she points out, doesn’t tell the whole story.

In Crocker Farm Elementary and Fort River Elementary — two schools with rates higher than the county average — kindergarten enrollment is relatively small, containing between 35 and 65 students in a school. That means just a few exemptions can push the rate up, said Suprenant: “It kind of skews the numbers.”

The state recently updated its recommendation and suggested that schools ask families to update their religious exemption statement each year, Jarvis-Vance and Suprenant said.

It’s more work, Jarvis-Vance said, but “it is an opportunity to have that conversation each year.”

Other exceptions

While most students come to Amherst-Pelham schools with a vaccination record, not all do. Homeless students, for example, don’t always have a record on hand when they enroll; nurses may help to track their information down, Suprenant said.

Jarvis-Vance added that there has been an influx of students from other countries, as well as from Puerto Rico. “When they come here, either we don’t have records or they may not be on the same schedule that’s mandated by the state of Massachusetts.” In that case, students are put on a catch-up schedule.

That still doesn’t fully capture why Hampshire County has a higher-than-average exemption rate.

“I don’t have an explanation as to why our community is higher than others in the state,” said Schwab, medical director at Northampton Pediatrics, which continues to provide care to patients who haven’t gotten the recommended vaccines.

With some patients, he said, “I see that they have anxiety about the side effects of the vaccine,” even though he tells them that the vaccines are safe and have undergone clinical trials. He said he rarely hears patients say they are opting out for religious reasons; instead, they usually cite concerns about side effects or express a feeling that the vaccine is not necessary.

“People have a skepticism of government and pharmaceutical companies that makes them question the authorities that are saying that they should get these vaccines,” he said.

While he agrees with the CDC and American Academy of Pediatrics recommendations, Schwab added that he reviews the research that went into them: “We study this thing … We make our own determination on the safety of these vaccines.”

Gloria DiFulvio, a senior lecturer at the UMass Amherst School of Public Health and Health Sciences, offered a similar perspective. “What we know about vaccinations is that they are very safe and they are one of the biggest (if not the biggest — clean water is also at the top of the list) public health prevention successes,” she wrote in an email.

People often don’t realize how serious some vaccine-preventable illnesses are, she added: “We forget these diseases weren’t just like, ‘I feel terrible my child is sick.’ They were killing people. We forget that because we’ve done a good job with prevention.”

Dr. David Norton, a pediatrician at Holyoke Pediatric Associates, agrees. “Most people nowadays have never seen anyone with polio — they don’t know how bad polio can be,” he said.

In an effort to increase vaccination rates, Norton is part of the Vaccine Confidence Project with the Massachusetts chapter of the American Academy of Pediatrics and the state Department of Public Health. The initiative targets areas including the Valley to better understand concerns about vaccines and plans to do greater outreach.

“The more of us that are vaccinated, the more protection we offer to our most vulnerable citizens,” said Jarvis-Vance. “I think that’s important.”

Reporting from the Associated Press was used in this article.

Greta Jochem can be reached at gjochem@gazettenet.com

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