Vaccination law not enforced for many kids

Thousands of metro Atlanta children were allowed to enroll and remain in school last year without proof of required vaccinations, in violation of state law.

Even though the vaccination law is a cornerstone in the protection of public health, some school principals ignore it and some health department officials do little to enforce it.

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Most local schools meet the state standard: having at least 90 percent of students in compliance by the time their kindergarten and sixth-grade classes are audited each fall.

But at least 99 schools’ kindergartners and 81 schools’ sixth-graders failed to meet that standard during the 2007-2008 school year, according to the AJC’s review of 625 public and private school audits conducted last fall in Cobb, DeKalb, Douglas, Fulton and Gwinnett counties. Results of this year’s audit are due to the state Nov. 30.

The problem was most severe in Fulton County, where the county health department has failed to monitor individual school compliance for years and allowed the Atlanta and Fulton County systems to police themselves.

While the Centers for Disease Control and Prevention estimates that most children are properly vaccinated, federal officials have repeatedly expressed concern that pockets of unvaccinated children across the country are increasing the risk of disease outbreaks. Because no vaccine is 100 percent effective, outbreaks potentially threaten even vaccinated children.

Officials at the Georgia Division of Public Health said they were stunned by the number of schools identified by the AJC that allowed 30 percent to 80 percent of their kindergartners or sixth-graders to attend classes nearly two months into the 2007-08 school year without proof of all vaccinations, temporary waivers or forms legally exempting them from shots.

“It just makes me physically ill to see this,” said Michelle Conner, the division’s senior director of essential preventive clinical services, on viewing the AJC’s list.

Conner said state officials rarely examine individual schools’ performances, conducting spot-audits of fewer than 30 schools statewide each year. Instead, they review aggregate data that span counties or health districts and rely on local officials to monitor individual schools.

In 2009, the state will begin examining school-level data using a new Internet-based reporting system in the works since March.

School officials said there are many reasons students fail to follow the immunization law: they may have missing or incomplete paperwork; doctors may certify children have all their shots when they don’t; some children are missing vaccines or booster doses to ensure immunity; others lack health insurance, transportation or parents who can miss work for doctors’ appointments.

In most cases, school officials said, students eventually get their shots or file required forms.

Following federal recommendations, in 2007 Georgia began requiring a second dose of chickenpox vaccine to increase its effectiveness. Despite nearly six months’ warning to schools and parents, that requirement likely contributed to poor compliance at some schools, officials said.

The extent of the health risk posed by schools with low vaccination compliance is unclear, state and federal health officials said, because nobody tracks how much of the problem involves documents and how much of it is unvaccinated or under-vaccinated children.

“Fortunately, we haven’t had outbreaks in our schools in the past, but we don’t want people to get complacent and think that’s not going to happen or there isn’t the potential for it to happen,” said Ben Sloat, immunization coordinator at the state health department.

Enforcement of vaccination laws is essential to prevent outbreaks, said Dr. Lance Rodewald, CDC director of immunization services.

Parents’ concerns about vaccine safety and fear that vaccines may be a cause of autism — though unsupported by studies cited by the CDC and the American Academy of Pediatrics — have prompted a small but growing number to question school vaccination requirements and in some cases obtain exemptions.

But exemptions are rarely used by Georgia parents, the AJC’s review of school audits shows.

At College Park Elementary, only 29 percent of its 57 kindergartners were in compliance last fall, records show. Although the law says such children should be barred from the classroom, they aren’t, said principal Gretchen Thornton.

“I can’t do that. Our business is to educate children,” she said. “The bottom line is, it isn’t the child’s fault if they don’t have the document.”

Georgia law says parents who fail to comply and school officials who allow noncompliant children to remain in school are guilty of a misdemeanor and subject to fines and jail time. But neither school officials nor parents are ever prosecuted.

Some school nurses said they have been left powerless when principals and health departments refuse to enforce the law.

“There are no repercussions,” said Jayketa Singleton, who heads health services at Atlanta Public Schools. Even after school nurses make repeated calls and send warning letters to parents, she said, some principals refuse to keep unvaccinated children out of school.

They’re more concerned about meeting attendance targets, said Singleton.

“You’re going to have to exclude the kid from school to get some of these parents to act,” Singleton said. Principals who tell parents their child can’t come back without vaccinations achieve 95 percent to 100 percent compliance, she said, and children rarely miss more than a day of class.

The Georgia Division of Public Health says it can’t take action against principals who ignore the law: The departmental rule enabling state enforcement of the vaccination law was repealed in 1979. But local health departments can enforce the law, state officials said.

The Fulton County health department was unaware it had so many problem schools, said Georgia Goseer, department immunization coordinator. She said she’s allowed the Atlanta and Fulton school districts to submit composite numbers for years.

“I’m going to be concerned in the future about the individual school reports,” Goseer said, “This is absolutely shocking information.”