The spike in measles cases on the mainland is raising concern that the highly infectious and sometimes fatal disease could break out here as well.
Statewide, 97% of Hawaii’s schoolchildren are up to date on their immunizations, but there are clusters of unvaccinated students, mostly at small private schools and charter schools on the neighbor islands.
At Haleakala Waldorf School on Maui, half of the 285 students have filed religious exemptions to vaccination — the highest rate in the state.
An interactive map posted online by the state Department of Health vividly illustrates the hot spots for students who have religious exemptions to vaccination. Statewide, 29 schools have exemption rates of 10% or more, out of the pool of 393 public and private schools.
“The schools end up being kind of a proxy for us to look at which communities are potentially at the highest risk for a vaccine-preventable outbreak,” said Dr. Sarah Park, state epidemiologist. “It is a growing concern.”
“Especially as you look at data over the years, we’ve gone from nearly 0% (religious exemptions) at one time, then gradually increasing, to now it’s 3% statewide. … It seems to be growing in some communities more so than others.”
Haleakala Waldorf, with 53% of students exempted, is followed by Malama Waldorf School in Hawaiian Paradise Park with 46% and Roots School in Haiku at 42%. Two charter schools come next: Alakai o Kauai Charter in Kalaheo at 40% and Kona Pacific Charter School in Kealakekua at 37%.
The vast majority of traditional public schools in Hawaii have religious exemption rates below 1%, as do large private schools such as Punahou, ‘Iolani and Kamehameha Schools. Across Oahu, home to more than two-thirds of the state’s population, the exemption rate is also less than 1%.
Just four schools on Oahu have rates of 10% and up: Sunset Beach Elementary School (19%), Myron B. Thompson Academy (18%), Hawaiian Mission Academy’s Windward campus (14%) and Hawaii Technology Academy (10%).
Measles, an acute viral respiratory illness with a distinctive rash, was declared eliminated in the United States in 2000 due to widespread vaccination. But it is still active in other countries, and unvaccinated travelers, both American and foreign, can bring it back.
Officials on Friday quarantined or sent home 900 college students and staff in Los Angeles who had been exposed to the virus. New York state is dealing with two outbreaks. Nationwide, cases have reached 700 already this year, a new record since the year 2000. Health officials fear that pockets of vaccine skeptics may be fueling the current outbreak.
In January, Hawaii officials quarantined a family from Washington state after hearing from Washington health authorities that the family had been exposed to the virus. Two unvaccinated children in the family came down with measles during their stay on the Big Island while confined to their remote vacation home. They were not contagious on the way here or on their way back.
Measles can have serious consequences, including pneumonia, brain swelling and death, according to the Centers for Disease Control and Prevention.
The disease starts with fever, and symptoms include cough and runny nose, before a rash of red spots spreads across the body. People are contagious four days before and four days after the onset of the measles rash.
Measles is spread through the air when a person coughs or sneezes, and the airborne droplets can linger for two hours after the person leaves the room.
State law requires that before attending school, students meet immunization requirements for diseases including measles, mumps, rubella, diphtheria, whooping cough, polio, hepatitis B and chickenpox. But exemptions are allowed for medical or “bona fide” religious reasons.
Medical exemptions are few and far between, with the vast majority of Hawaii schools reporting none. But the religious exemption is easy to obtain. Parents can simply sign a note refusing vaccination based on their “personal belief.”
“The frustrating thing for the Department of Health and others in schools is that we are not allowed by law to ask for specific details,” Park said. “We can’t request they list what their religion is. We can’t get the names or addresses of the kids.”
That makes it challenging to reach out and encourage immunization and to work to prevent outbreaks.
The American Academy of Pediatrics announced last month at its Annual Leadership Forum that its top priority for the year is to work with state legislatures to reduce or eliminate nonmedical vaccine exemptions.
Babies under a year old, who are too young to be vaccinated, and those with compromised immune systems are especially vulnerable to measles. Also at risk of complications are young children and adults over age 20.
“I’m a new mom,” Park said. “There’s the professional side of my life and the personal side. On the personal side, I have to say, as much as don’t want to see my son grow up too fast, I can’t wait for him to be old enough to be eligible to get the MMR vaccine.”
After a measles outbreak that started in Disneyland in 2014, California stopped allowing religious exemptions to vaccinations at its schools, joining a few other states that take that stance. Hawaii’s religious exemption is written into statute, and any change would require action by the Legislature.
Although Waldorf campuses on Maui and Hawaii island have high rates of religious exemptions, just 1% of students at Honolulu Waldorf School in East Honolulu filed exemptions, underscoring the geographic divide between Oahu and the other islands when it comes to immunizations.
Kelley Lacks, school director at Malamalama Waldorf School in Hawaiian Paradise Park, said it’s hard to speculate why so many students opt out there. She said the school follows state law in seeking immunization records before enrolling students and ensures proper paperwork is completed.
“We don’t want to tell people what they should and should not do,” Lacks said. “As a parent, that’s up to them in consultation with their physician.”
Some students whose families filed religious exemptions have let their children have some vaccinations but not the full complement, she said.
That’s true at Kanuikapono Charter School in Anahola, as well, according to school health aide Kai Wojak. She has been trying to encourage vaccination, and state data shows a slight decline in exemptions at her school from 36% in 2013-14 to 32% this school year. The school plans to take a firmer approach in the future, she said.
“There’s a lot of misinformation and fear-mongering on those social media websites,” Wojak said. “It’s a new generation where they don’t believe in science.”
Health officials urge parents to consult with their pediatricians rather than relying on online information that may be misguided.
“There is no reason for any healthy child not to be vaccinated,” Park said.
Two doses of the measles vaccine are about 97% effective at preventing the disease, according to the Centers for Disease Control. By contrast, 9 out of 10 unvaccinated people exposed to the disease will contract it.
The Health Department is reaching out to partners in education, including the leaders of Catholic schools, the Charter School Commission, the Hawaii Association for Independent Schools and Department of Education, in hopes of encouraging more parents to immunize their keiki.
“I don’t think we’re going to change the minds of people who are dead-set, passionately, emotionally, against vaccines,” Park said. “It’s an uphill battle with them. But I think there are a lot of people who are on the fence.”
Hawaii’s high vaccination rates overall show that parents support immunization to protect their children, she said.
“I think the vast silent majority needs to understand that they cannot be silent anymore. We cannot afford to be silent,” she added. “We at the Health Department are speaking with legislators, with others, to try to get them to understand the importance of vaccination. But we need the help of the community to also speak up.”
Check your school’s vaccination rates:
>> To see how vaccination rates vary at schools across the state and to check your own school, visit the Department of Health’s interactive map online at 808ne.ws/2unvax.
>> More information on immunization and a list of schools and their exemption rates are also online at 808ne.ws/exemptionlist.
Source: State Department of Health
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