Thousands of Hawaii students not immunized against measles

After Hawaii confirmed its first measles case in years, the state Education and Health departments are ramping up vaccination efforts, focusing on thousands of students who remain noncompliant with school immunization requirements.

“The health and safety of our students and staff are essential to maintaining supportive learning environments. Hawaii law requires that all students meet immunization requirements to attend school, including protection against communicable diseases like measles. These requirements are in place to keep our school communities safe and healthy,” a DOE spokesperson told the Honolulu Star-Advertiser in an email.

“Our schools work closely with families to ensure students are in compliance, while also supporting those who may need additional time to meet the requirements. In the event of a public health concern, we are prepared to act in coordination with the state Department of Health to protect our students and staff and minimize disruption to learning.”

In the 2023-2024 school year, among 185,579 public and private school students, 4.07% had religious exemptions, 0.16% had medical exemptions, 2.76% had no immunization records and 14.33% were missing required vaccines — meaning 21.33% had incomplete immunization records. Another 9.68% were missing physical exams.

In a recent letter to parents, DOH warned that students without proof of MMR vaccination may be excluded from in-person learning if an outbreak occurs. The DOH and DOE sent the letter earlier this month, encouraging families to vaccinate their children.

The letter stated that certain Hawaii schools have low vaccination rates and are at increased risk of measles and other disease outbreaks.

According to DOH, some Hawaii schools have alarmingly high rates of vaccine noncompliance, according to new data from the state Department of Health.

Malamalama Waldorf School on Hawaii Island reported the highest percentage of religious exemptions statewide at 62.89%, followed by Haleakala Waldorf School on Maui at 58.46% and Kohala Adventist School at 52.94%.

Several public charter and private schools, including Kona Pacific charter school — 35.48% — and Alakai o Kauai charter school — 36.23% — also had high exemption rates.

Meanwhile, schools with the most students not up to date on required immunizations included St. Catherine School on Kauai, which reported 100% of students as noncompliant, Life Legacy Academy in Honolulu at 97.73% and Waianae Intermediate School at 69.48%. Other high-risk campuses included Konawaena Middle School at 65.32%, HI Academy of Arts & Science charter school at 64.18% and Kapaa Middle School at 63.42%. The data highlights significant pockets of vulnerability that could accelerate the spread of communicable diseases like measles if an outbreak occurs.

On Monday night, DOH’s State Laboratories Division confirmed a measles case in an unvaccinated child under 5 years old on Oahu and began investigating potential exposures.

The child had recently returned from international travel with family and developed a fever, runny nose and cough before seeking care after a rash appeared. The child is recovering at home, and a symptomatic household member is being evaluated for possible infection.

Gov. Josh Green signed emergency rules Tuesday allowing students with religious exemptions to receive the MMR vaccine while maintaining their exemption status for other vaccines. The rules, in effect for 120 days, aim to boost measles protection without forcing families to give up broader exemption rights.

The urgency follows new data revealing persistent immunization gaps. Preliminary 2024-2025 numbers show 28,300 students are still noncompliant. The statewide MMR vaccination rate is 89.8%, below the 95% needed for herd immunity.

Some schools — especially on Maui, Kauai and Big Island — report rates as low as 42%. Nearly 10% of schools statewide have more than half of students not up to date on required immunizations, according to state Rep. Trisha La Chica (D, Waipio-Mililani).

DOE is working closely with DOH to enforce compliance with immunization laws and emergency guidelines. Under Hawaii law, students must meet immunization, physical exam and tuberculosis clearance requirements unless they have medical or religious exemptions. While provisional entry is allowed with proof of a future appointment, this can be suspended during a public health emergency.

Officials warned that students without required vaccines may be excluded from school during an outbreak. Both agencies say rising vaccine hesitancy — driven by misinformation and pandemic-related health care disruptions — poses a serious threat to public health and learning continuity.

“Hospitals and clinics across Hawai‘i are on high alert,” Dr. Nadine Tenn Salle, clinical chair of pediatrics at The Queen’s Health Systems, said. “We’re ready to identify and isolate cases, but our best defense is prevention. That means vaccination — not just for your child, but to protect newborns, the immuno-compromised, and others who cannot be vaccinated. This is a community effort, and the medical community is here to help every step of the way.”

DOH is urging families to check immunization records and schedule any missing vaccines, which are available at pediatricians’ offices, clinics and pharmacies.

“There’s no need to panic — but there is a need to act,” Green said. “Measles isn’t just a rash and a fever — it’s one of the most contagious viruses known. We’ve already seen what happens when vaccination rates drop: more cases, more outbreaks, more lives at risk. The best thing you can do to protect your family, your community and our keiki is to get vaccinated. It’s simple, it’s safe and it saves lives.”