The number of Hawaii students requesting exemptions from mandated immunizations is growing, according to state health officials.
To attend school, students are required to receive DTaP (diphtheria/tetanus/pertussis), polio, MMR (measles, mumps and rubella), hepatitis B, Hib and Varicella (chickenpox) immunizations, and must meet minimum age and interval requirements between vaccine doses.
Children, however, can be exempt from immunization requirements for medical or religious reasons if the appropriate documentation is given to the school. The DOH recently released the rates of immunization exemptions at Hawaii schools for the 2018-19 academic year, which schools are required to report to the state each year.
Throughout Hawaii, the number of requests for religious exemptions “have been slowly increasing upwards,” said Department of Health Immunization Branch Chief Ronald Balajadia.
Having more unvaccinated individuals in a community brings with it the potential of acquiring vaccine-preventable diseases, he said.
In 2016 there was a hepatitis A outbreak in Hawaii, Balajadia said. And last October marked the conclusion of a statewide outbreak of mumps that began in March 2017. In total, 1,009 people with mumps were identified during the outbreak.
Earlier this year, the DOH confirmed two cases of measles in unvaccinated children visiting the Big Island from Washington state, where a state of emergency was declared in response to a measles outbreak there.
“These diseases are still present not only in our community, but elsewhere,” Balajadia said. “With the ease of transportation, (you) can fly pretty much anywhere in a couple of hours and possibly have exposure, not only from our people going to these places, but individuals who may be sick coming to visit our island and having contact with our local people here in Hawaii.”
According to the Centers for Disease Control and Prevention, from Jan. 1-March 21, 314 individual cases of measles were confirmed in 15 states: Arizona, California, Colorado, Connecticut, Georgia, Kentucky, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas and Washington.
There were 372 reported cases in 2018, 120 in 2017, 86 in 2016, 188 in 2015, 667 in 2014, 187 in 2013, 55 in 2012, 220 in 2011 and 63 in 2010.
Six outbreaks of the disease, which are defined as three or more cases, have been reported this year, including in Rockland County, N.Y., where children unvaccinated against the measles were last week barred from public places.
Lawsuits have even been filed in response to vaccine requirements.
In Kentucky, a senior at a Catholic high school experiencing a chickenpox outbreak sued the Northern Kentucky Health Department after he was barred from playing basketball and attending school because he did not have a vaccine against the illness.
Vaccination exemption rates vary throughout East Hawaii schools, according to the recently released numbers.
At Chiefess Kapiolani Elementary, for instance, just 0.3 percent of the school’s 363 students claim religious exemption, while Haaheo Elementary, with a student body of 196, has a religious exemption rate of 9.2 percent.
At Connections New Century Public Charter School, 14 percent of its 349 students requested a religious exemption and 0.3 percent have a medical exemption. Laupahoehoe Community Public Charter School, which has 339 students, has a religious exemption rate of 13.3 percent, and Malamalama Waldorf School/Kinderhale, a private school with a student enrollment of 95, has 46.3 percent religious exemption rate.
“The Hawaii State Department of Education supports the state Department of Health’s goal to protect Hawaii’s population from vaccine-preventable diseases,” said DOE Assistant Superintendent Heidi Armstrong. “This is especially true for susceptible groups like our children, and immunization is a proven means of stopping outbreaks before they happen. Parents are strongly encouraged to get their children immunized before they attend school to help protect them and their fellow students from unnecessary health risks.”
Attempts to reach a number of public and charter school principals were unsuccessful.
Choosing not to vaccinate
Some parents, however, opt to forego immunizations for their children.
Shannon Matson of Hilo is the mother to a 5-year-old in preschool and an 11-month-old.
Neither child has received vaccines or shots of any kind yet, but Matson said she and her partner are considering a delayed vaccination schedule.
“Based on our experiences within the health care industry as parents we’ve decided vaccination according to the current CDC recommended schedule is not right for us,” she said in an email. “At this time, we believe in informed consent and that the possible risks to our children associated with vaccination do not outweigh the potential benefits. Until vaccines have been scientifically proven (with the same scrutiny and testing requirements other drugs approved by the [Food and Drug Administration] undergo) to be safe and effective, especially when administered all together, we will be following an alternative vaccination schedule as agreed upon with our health care professionals that we trust and who know our family history.”
Matson said there have been a number of incidents, involving her and her children, that affected the family’s decision, including, among others, allergic reactions to medications and misdiagnoses of various illnesses and rashes.
The CDC, however, says vaccines are “tested extensively by scientists to ensure they are effective and safe” before they are approved by the FDA, but no vaccine is 100 percent safe or effective because each person’s body reacts differently.
Matson said she does have concerns about recent outbreaks because of the amount of visitors to the island and wished the DOH would consider requirements for foreign and domestic travelers to be vaccinated before traveling to Hawaii to protect vulnerable populations, or at the least an education campaign to highlight prevention techniques such as frequent hand-washing or self-quarantine when one has a fever or potentially contagious disease.
“That is truly where the risk to our young children, pregnant women, elderly and immune-compromised individuals comes from, not those families who seek exemptions for their children based on their religious, personal or medical concerns,” she said. “As parents, we all want what is best for our children, which is why parents deserve to have all the facts and be allowed to make decisions for their families based on their children’s health needs.”
Dr. Miki Cain, a pediatrician with Hawaii Island Family Health Center, located at Hilo Medical Center, said when talking about vaccine safety there are “probably very few things in medicine in general that are proven to be more beneficial,” and vaccines are the “top of the list on ways to optimize your child’s health.”
At the clinic, where he has been practicing for four years, about 5 percent of families choose not to vaccinate and “probably a little higher” percentage of people delay vaccinations.
Certain patients cannot be vaccinated, and “the best protection they can get is everyone around (them) being vaccinated,” Cain said.
Cain said one of the biggest challenges is getting the right information to parents, “so giving educational materials to them so they can make wise decisions in regards to their children.”
Parents should be able to make their own decisions about their own children to a degree, he said, so it’s “just giving them the right tools to make those decisions.”
Cain said most pediatricians like to keep an open dialogue and most are willing to talk if there are concerns.
Email Stephanie Salmons at ssalmons@hawaiitribune-herald.com.
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Exemption rates in Big Island schools (enrollment in parentheses):
CHIEFESS KAPIOLANI SCHOOL, 0.3 percent religious exemption;
CHRISTIAN LIBERTY ACADEMY (46), 2.2percent religious exemption;
CHRISTIAN LIBERTY SCHOOL (136) 0 percent religious exemption;
CONNECTIONS: NEW CENTURY PUBLIC CHARTER SCHOOL (349) 14 percent religious exemption;
E.B. DE SILVA ELEMENTARY SCHOOL (455) 4 percent religious exemption;
HAAHEO ELEMENTARY SCHOOL (196) 9.2 percent religious exemption;
HAILI CHRISTIAN SCHOOL (117) 4.3 percent religious exemption, 4.3 percent medical exemption;
HAWAII ACADEMY OF ARTS & SCIENCE PUBLIC CHARTER SCHOOL (672) 2.4 percent religious exemption;
HAWAII MONTESSORI SCHOOL – KAMUELA CAMPUS, not reported;
HAWAII MONTESSORI SCHOOL – KONA CAMPUS (7) 0 percent religious exemption;
HAWAII PREPARATORY ACADEMY (620) 9 percent religious exemption;
HILO HIGH SCHOOL (1170) 2.6 percent religious exemption;
HILO INTERMEDIATE SCHOOL (563) 2.3 percent religious exemption;
HILO UNION ELEMENTARY SCHOOL (425) 0.9percent religious exemption;
HOLUALOA ELEMENTARY SCHOOL (536) 10.8 percent religious exemption, 0.4 percent medical exemption;
HONAUNAU ELEMENTARY (133) 5.3 percent religious exemption;
HONOKAA ELEMENTARY SCHOOL (404) 3.5 percent religious exemption;
HONOKAA INTERMEDIATE AND HIGH SCHOOL (615) 2.1 percent religious exemption, 0.2 percent medical exemption;
HOOKENA ELEMENTARY AND INTERMEDIATE (110) 4.5 percent religious exemption;
INNOVATIONS PUBLIC CHARTER SCHOOL (237) 16.9 percent religious exemption;
KA UMEKE KA EO PUBLIC CHARTER SCHOOL (215) 5.6 percent religious exemption;
KAHAKAI ELEMENTARY SCHOOL (750) 5.9 percent religious exemption, 0.1 percent medical exemption;
KALANIANAOLE ELEM. & INTER. SCHOOL (307) 2.3 percent religious exemption;
KAMEHAMEHA SCHOOLS – HAWAII CAMPUS 9-12 (575) 1.4 percent religious exemption;
KAMEHAMEHA SCHOOLS – HAWAII CAMPUS K-8 (580) 1.7 percent religious exemption;
KANU O KA AINA SCHOOL: PUBLIC CHARTER SCHOOL (598) 1.7 percent religious exemption;
KAU HIGH & PAHALA ELEM. SCHOOL (489) 0.8 percent religious exemption;
KAUMANA ELEMENTARY SCHOOL (243) 2.5 percent religious exemption;
KE ANA LA AHANA: PUBLIC CHARTER SCHOOL (39) 0 percent religious exemption;
KE KULA O EHUNIKAIMALINO SCHOOL (209) 10 percent religious exemption;
KE KULA O NAWAHIOKALANI OPU U IKI: LAB PUBLIC CHARTER SCHOOL (362) 6.4 percent religious exemption;
KEAAU ELEMENTARY SCHOOL 878 (1.6) percent religious exemption;
KEAAU HIGH (1,014) 2.5 percent religious exemption, 0.1 percent medical exemption;
KEAAU MIDDLE SCHOOL (717) 3.6 percent religious exemption;
KEALAKEHE ELEMENTARY SCHOOL (78) 0.2 percent religious exemption;
KEALAKEHE HIGH SCHOOL (1,329) 4.3 percent religious exemption
KEALAKEHE INTERMEDIATE SCHOOL not reported
KEAUKAHA ELEMENTARY SCHOOL (406) 0.3 percent religious exemption
KEONEPOKO ELEMENTARY SCHOOL (571) 2.6percent 0.0percent
KOHALA ADVENTIST SCHOOL (11) 0 percent religious exemption;
KOHALA ELEMENTARY SCHOOL (330) 3 percent religious exemption;
KOHALA HIGH (255) 3.1 percent religious exemption;
KOHALA MIDDLE SCHOOL (182) 2.2 percent religious exemption
KONA ADVENTIST CHRISTIAN SCHOOL (15) 0 percent religious exemption;
KONA PACIFIC PUBLIC CHARTER SCHOOL (222) 37.4 percent religious exemption;
KONAWAENA ELEMENTARY SCHOOL (554) 5.4 percent religious exemption;
KONAWAENA HIGH SCHOOL (815) 3.2 percent religious exemption;
KONAWAENA MIDDLE SCHOOL (672) 4.9 percent religious exemption;
KUA O KA LA: PUBLIC CHARTER SCHOOL (217) 14.7 percent religious exemption;
LAUPAHOEHOE COMMUNITY PUBLIC CHARTER SCHOOL (339) 13.3 percent religious exemption;
MAKUA LANI CHRISTIAN ACADEMY LOWER CAMPUS (110) 13.6percent religious exemption, 0.9 percent medical exemption;
MAKUA LANI CHRISTIAN ACADEMY UPPER CAMPUS (170) 7.6percent religious exemption;
MALAMALAMA WALDORF SCHOOL/KINDERHALE (95) 46.3 percent religious exemption;
MAUNA LOA SCHOOL not reported
MT. VIEW ELEMENTARY SCHOOL (439) 5 percent religious exemption;
NAALEHU ELEMENTARY SCHOOL (393) 2 percent religious exemption;
PAAUILO ELEM. & INTER. SCHOOL (191) 8.9 percent religious exemption;
PAHOA ELEMENTARY SCHOOL (388) 8.5 percent religious exemption;
PAHOA HIGH & INTER. SCHOOL (545) 2.9 percent religious exemption; 0.2 percent medical exemption
PARKER SCHOOL (319) 10.7 percent religious exemption;
ST. JOSEPH ELEMENTARY SCHOOL – HILO (151) 2.6 percent religious exemption, 0.7 percent medical exemption;
ST. JOSEPH JR & SR HIGH SCHOOL – HILO (81) 3.7 percent religious exemption;
VOLCANO SCHOOL OF ARTS AND SCIENCES PUBLIC CHARTER SCHOOL (197) 5.1 percent religious exemption;
WAIAKEA ELEMENTARY SCHOOL (868) 1.8 percent religious exemption;
WAIAKEA HIGH SCHOOL (1,207) 1.7 percent religious exemption, 0.1 percent medical exemption;
WAIAKEA INTERMEDIATE SCHOOL (886) 1.1 percent religious exemption;
WAIAKEAWAENA ELEMENTARY SCHOOL (709) 1.6 percent religious exemption;
WAIKOLOA SCHOOL (844) 2.8 percent religious exemption;
WAIMEA COUNTRY SCHOOL (35) 17.1 percent religious exemption;
WAIMEA ELEMENTARY SCHOOL (505) 3 percent religious exemption;
WAIMEA MIDDLE SCHOOL PUBLIC CONVERSION CHARTER SCHOOL (256) 1.2 percent religious exemption;
WATERS OF LIFE-“WAI OLA” NEW CENTURY PUBLIC CHARTER SCHOOL (149) 10.7 percent religious exemption;
WEST HAWAII EXPLORATION ACADEMY PUBLIC CHARTER SCHOOL (259) 16.6 percent religious exemption.
