The system designed to track the number of Pennsylvania schoolchildren immunized against contagious diseases like measles and pertussis is flawed, state health officials admit.
The revelation, as well as current immunization policies, puts public health officials at a disadvantage when trying to identify potential weaknesses in disease immunity and, more importantly, leave children with illnesses or who are unable to be vaccinated at a greater risk of becoming sick, an infectious disease physician and parents say.
"The school laws are the linchpin,” said Dr. Sarah Long, who leads the Infectious Disease section at St. Christopher’s Hospital for Children in Philadelphia.
"I think that this points out that we're in a very uncomfortable position that we don't know what our immunization rates are in Pennsylvania, from this," she said.
Commonwealth law requires children be vaccinated against eight diseases including measles, mumps and chickenpox before attending kindergarten. Adolescents entering 7th grade must get shots for meningococcal, tetanus, diphtheria and pertussis. Children should get a minimum of 33 doses of vaccines by the time they leave middle school, according to government recommended immunization schedules.
Each year, schools across the state collect immunization records from children in those two grade levels. Parents are asked to fill out a form listing what immunizations a child has received and when. Once returned to the school, the data is entered into a state database which calculates immunization rates within schools and districts. The records are due by October 15 of every year.
NBC10 requested data from the Pennsylvania Department of Health and was provided figures from the 2013-2014 year for 495 school districts statewide. Districts with less than 20 students in a grade level were excluded for privacy concerns.
At our request, Dr. Long, a former chair of the American Board of Pediatrics and editor of the organization's "Red Book" infectious disease report who has worked for the Centers for Disease Control and Prevention and as a physician for decades, reviewed the information. She questioned its validity after finding vaccination rates to be abnormally low or high for certain districts.
"Some of it is just not believable," Long said. "For instance, when somebody here said that 100 percent of their students received TD, which is tetanus and diphtheria, that would be outrageous."
Eight school districts of varying sizes statewide, including Salisbury Township School District in Lehigh County, said 100 percent of their children had been given such a shot, according to the data.
It would be more likely that less than 1 percent of students would have been given the TD vaccine because it is typically given as a booster shot after a child has already received TDAP vaccine, Long said.
Other more glaring examples were discovered, as well.
None of the 120 7th grade students at Kutztown Middle School in Berks County were immunized against a number of diseases like polio, hepatitis B and varicella, according to the data. Thirteen kids did get the TDAP vaccine, though.
"That's not the case. Our nurses have very thorough and complete records. I'm sorry that the state records are wrong," Kutztown Area School District Superintendent Katherine Metrick told NBC10.
Kutztown school nurses do enter immunization records into the state database and are "very practiced," Metrick said.
At Jenkintown Middle/High School in Montgomery County, all 116 students in 7th grade were exempt from getting vaccines based on either medical or religious grounds, the data showed. However, all but two students had gotten all the mandated immunizations.
The Department of Health later revised the number saying it was a mistake. A spokesman eventually said the agency became aware with problems in the reporting earlier this year while trying to determine measles immunization rates after a case cropped up.
“Basically, it’s child abuse"
Pennsylvania has the second lowest immunization rate against measles nationwide at 85 percent, according to data collected by the CDC. Doctors strive for a rate of 95 percent or higher to keep the easily spread infection — that can lead to blindness, hearing loss and death in severe cases — at bay.
"Measles is so contagious. So for every case, 12 to 18 cases will occur from that case if they're not immunized," Long said.
Statistics like that worry Bucks County father Michael Kraft. The 38-year-old and his wife Jackie delayed giving their son Joseph the MMR vaccine over Autism fears — a common, but scientifically disproven argument used by parents skeptical of immunizations.
"We thought, at the time, why am I giving my son a shot when there hasn't been any measles in years," he recalled. Joseph was given shot around 18-months, instead of the recommended age of 12-months, he said.
Fast-forward two years, Kraft said, doctors diagnosed Joseph with a high-functioning form of Autism. "Looking back, it was a waste of time," he said.
With measles on the rise nationally as of late — some 159 people diagnosed in the first four months of the year and 668 cases in 2014, the CDC found — Kraft won’t delay when it comes time to have his 1-month-old son, Justin, vaccinated.
"We do not want to wait for any vaccine that could potentially prevent him from getting sick," he said. Justin can't begin getting the vaccine until he's around 12-months-old for it to be most effective. Until then, he will be unguarded from the disease.
"Infants between 6- and-12-months are vulnerable in the United States right now. All infants. That is a lot of susceptible little babies," Long said, who adds that a child doesn't need to be in school to catch the disease.
Infants aren't the only children at risk. No vaccine is 100 percent effective so doctors strive to achieve herd immunity -- when most of a particular population is protected against a disease -- to limit outbreaks among vulenerable people whose bodies did not respond to the immunization. The more people protected, the less chance it will be spread.
That high community immunity also helps older kids who are unable to be vaccinated or forced to get a less effective shot because of a chronic medical condition or battle with a disease like cancer.
Lauren Kuerschner is one of those children. The 13-year-old Collegeville middle schooler suffers from severe asthma and has an immune deficiency. She has been vaccinated, but was given a less-effective type that introduced a dead virus to her system. Most people are given a live virus to build a better immunity.
"If she gets whooping cough, it could kill her," the girl's mother, Julie Kuerschner explained.
The 53-year-old mother of three says she feels helpless, at times, worrying about Lauren getting sick from another child, and has kept her home from school as a precaution.
"We are very, probably overprotective of her, and I keep her home from school a lot. In fact, I debated home schooling Lauren by myself, but she really loves going to school and interacting with the other kids," she said.
"It's not fair for her," she added.
Kuerschner is frustrated that parents choose not to vaccinate their children based on "debunked" myths about links to Autism and other disorders.
"In my opinion, any child goes to the public school system should be required to be immunized,” she said.
Kraft agrees, though has a more pointed point-of-view.
“Basically, it’s child abuse if you’re not going to get your child immunized," he said.
Children can be exempt from getting vaccinations for three reasons in Pennsylvania — medical concerns, religious concerns and philosophical differences. The latter is currently under siege by state lawmakers.
Pennsylvania is one of 20 states that allow parents to opt their child out of the required immunizations based on personal objection to the practice. A parental signature on an immunization document provided to a school is all that’s needed to bypass the state requirement. It’s at the school’s discretion whether to accept it.
It’s an option that is vital to ensuring parents have control over their child’s health says Diane Soucy.
The 44-year-old Hatboro, Montgomery County mother says she chose to put two of her three sons on a delayed vaccination schedule — something she says she could not have done without the philosophical exemption.
"I think it's important to say that I'm not against vaccines,” she said. "I decided to put my children on a delayed schedule. Maybe waiting six months before they get the first dose, just to give them a chance to grow and adjust."
Soucy, whose youngest son, 12-year-old Matthew, has Autism, began delaying the vaccinations while doing research about his developmental diagnosis. She voiced concerns about ingredients used in the vaccines and worries about a lack of training by doctors. Soucy chose not to give her sons the flu shot and said her 13-year-old boy Marcus would not be getting vaccinated for human papilloma virus or HPV at this time.
"I'm not going to be bullied by my government. I'm not going to be bullied by my pediatrician,” she said. "It's the same way that I cannot allow my child to have McDonald's everyday followed by cheesecake and pie, I will choose what is introduced into their body and when."
But vaccine advocates like Dr. Long and lawmakers in both the Pennsylvania House and Senate feel the exemption is simply a loophole that could put children and the public in danger.
A gaggle of local state representatives led by Chester County Rep. Becky Corbin (R-155) have sponsored House Bill 883 that would remove the philosophical exemption. It would also require parents seeking a religious exemption seek out advice and a signature from a physician and be provided with risk factors for not being immunized before it could be granted. The bill was referred to the House Subcommittee on Health this week.
State Sen. Daylin Leach (D-17) plans to introduce similar legislation in the state senate. He told NBC10 in February that the exemption is “unusual."
Asked whether Gov. Tom Wolf’s Administration would support the removal of the philosophical exemption, a health department spokeswoman would only say they would like to have all school children properly immunized.
Fixing the System
Having incorrect or incomplete data means the loss of time and money when it comes to responding to an outbreak says Dr. Long, the infectious disease expert.
"It's horribly handicapping for them,” she said of health workers. “They have to devote so many resources and you have to follow every child, every person they came in contact with. Then you have to verify that they’re not infected."
On the money front, Long cited a paper in the journal Vaccine that found the investigation of 16 measles outbreaks in 2011 that resulted in 107 confirmed cases cost health agencies between $2.1 and $5.6 million.
"It would be a huge help — A: if children in schools were immunized and if the records were accurate and that you made it harder for people to be exempt so that you have your ducks in the row. And then you will have your catastrophes and you’ll address them,” Long said.
The Pennsylvania Department of Health says it is working to address current lapses in the immunization surveillance database. Amy Worden, Communications Director for the agency, said the Wolf Administration inherited the problem from its predecessor and that it is striving to fix the system.
The Health Department along with the Department of Education plans to offer training for school staff members who are collecting and entering the data into the state database. Worden said it’s up to schools to decide who is qualified to handle the complex data. In some schools it could be a nurse, in others, like Philadelphia where nurses do not serve a school everyday, a principal or secretary could be in charge of the task.
Both agencies will also stress the importance of ensuring the information is accurate, officials said.
A new validation policy has now gone into effect, officials say. Nurses on staff at the health department will review the data to look for problems. “When an outlier is identified, the Pa. Department of Health contacts the district to validate,” Worden said. She adds that the department is always looking to improve its practices.
Health officials plan to push for legislation that would remove an eight-month grace period that allows new students time to get up-to-date with their vaccinations. This delay keeps health officials from having the latest data at their disposal, they say.
While these may improve internal reporting, it is still difficult for a parent to ascertain the risk their child faces of being exposed to unvaccinated children at school. Julie Kuerschner says her daughters’ school would not tell her the vaccination status of other children citing privacy concerns.
But statistics could, and should, be published by schools each year just like crime, standardized testing performance and graduation rates, Long says.
"They should be required to publish or make public not only their exemption rates, but their immunization rates. And they should make them for parents who want to know whether to send to that school and then for donors and alums that what to be part of the safe school alliance,” she said.
The health department says there are no laws or regulations barring the release of such data, which can already be provided through an open records request. It shouldn't be that hard, however, Long says.
Passionate against the current surge in delayed and anti-vaccine movements, the doctor looks to another hot button health topic surrounding classrooms across the country — the peanut allergy — and wonders why some parents embrace one and not the other.
"Why not have this be as important as peanuts?"