SPOTLIGHT: Vaccination law fails to touch all 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.

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.”

HELP WITH SCHOOL SHOTS

Georgia law requires that all children be properly vaccinated against measles, mumps, rubella, polio, whooping cough, chickenpox, diphtheria, tetanus and hepatitis B. The state requires audits for compliance when students enter kindergarten and again in sixth grade, when they typically enter middle school.

Children can receive exemptions for medical or religious reasons. And schools can issue waivers of about 30 days to give parents time get shots or documents.

For a medical exemption, a doctor must certify that a child shouldn’t be immunized for a specific reason, such as cancer treatment or an immune disorder. A religious exemption requires a notarized statement that shots violate a family’s beliefs.

Where to call or visit online

For more information about Georgia’s school immunization rules or for help getting vaccines:

Cobb and Douglas Public Health : 770-514-2300; www.cobbanddouglaspublichealth.org.

DeKalb County Board of Health: 404-294-3700; www.dekalbhealth.net.

East Metro Health District, which serves Gwinnett, Rockdale and Newton counties: 770-339-4260.

Fulton County Department of Health and Wellness: 404-730-1211; www.fultoncountyga.gov/county/health.

Why students aren’t in compliance

Here are some reasons kindergartners and sixth-graders weren’t in compliance when their schools were audited in the 2007-08 school year:

Kindergartners

Health District….Total……….No…………..Missing

………………Enrollment ….vaccination ….required

…………………………….proof*……….doses

Cobb-Douglas ……10,843 ……..36…………..395

Fulton …………12,302 ……..264 …………1,328

East Metro** ……16,101 ……..85…………..552

DeKalb …………8,433……….63…………..421

Sixth-graders

Cobb-Douglas ……10,425 ……..65…………..1,487

Fulton …………11,823 ……..353 …………2,650

East Metro** ……15,355 ……..54…………..2,859

DeKalb …………6,943……….133 …………306

* No immunization certificate, waiver or exemption on file.

** The East Metro Health District covers Gwinnett, Rockdale and Newton counties.

Source: Georgia Division of Public Health

School vaccination compliance

Georgia’s standard is that at least 90 percent of students in each school’s kindergarten and sixth grade be in compliance with immunization regulations when they are audited each fall.

Data for the current school year is not yet available. Here are schools* where fewer than 70 percent of students were in compliance on their 2007-2008 school year audits:

Kindergarten

School ……………………..% in…………No. in

…………………………..Compliance**….grade

Atlanta Public Schools….

Venetian Hills ………………29% …………62

Fickett……………………..42% …………74

Perkerson……………………42% …………59

West Manor ………………….46% …………41

Benteen……………………..48% …………69

Scott……………………….49% …………92

Herndon……………………..50% …………36

Dunbar ……………………..58% …………26

Woodson……………………..58% …………57

Burgess- Peterson…………….60% …………45

Parkside ……………………60% …………77

Williams ……………………60% …………60

White……………………….66% …………47

J.W. Dobbs ………………….68% …………80

D.H. Stanton ………………..68% …………63

Gideons……………………..69% …………86

DeKalb County School System

Stoneview……………………51% …………124

Browns Mill………………….66% …………134

Briarlake……………………68% …………77

Fulton County Schools

College Park ………………..29% …………57

Bethune……………………..34% …………96

Randolph ……………………37% …………72

Gullatt……………………..41% …………78

Conley Hills ………………..44% …………94

Liberty Point………………..48% …………108

Oakley ……………………..51% …………96

S.L. Lewis ………………….51% …………96

Hapeville……………………55% …………146

Harriet Tubman ………………55% …………80

Heards Ferry ………………..56% …………132

Renaissance………………….59% …………132

Esther Jackson ………………65% …………149

Barnwell ……………………68% …………131

Gwinnett County Public Schools

Beaver Ridge ………………..48% …………165

McKendree……………………63% …………183

Dyer ……………………….67% …………103

Gwinnett - Private

Harbour Oaks Montessori……….67% …………15

Old Suwanee Christian…………69% …………16

Sixth Grade

School ……………………..% in…………No. in

…………………………..Compliance**….grade

Atlanta Public Schools

Young……………………….31% …………258

Sylvan Hills ………………..36% …………151

BEST Academy ………………..36% …………132

Bunche ……………………..40% …………281

Walden ……………………..48% …………73

Coretta Scott King Academy ……49% …………172

Turner ……………………..54% …………97

Imagine Wesley ………………54% …………24

Inman……………………….60% …………215

Parks……………………….60% …………145

Cobb County School District

Smitha Middle School …………36% …………304

Cooper ……………………..56% …………295

Campbell ……………………65% …………372

Cobb - Private

East Cobb Christian…………..50% …………10

Douglas - Private

King’s Way Christian …………50% …………25

Fulton County Schools

Paul D. West ………………..21% …………327

Sandtown ……………………23% …………302

McNair ……………………..26% …………272

Camp Creek ………………….30% …………253

Ridgeview Charter…………….40% …………213

Sandy Springs………………..49% …………260

Bear Creek ………………….56% …………338

Hopewell ……………………60% …………371

Fulton Science Academy ……….66% …………166

Woodland ……………………67% …………353

Webb Bridge………………….68% …………442

Holcomb Bridge ………………69% …………239

Fulton - Private

Bedford School ………………20% …………20

Landmark Christian …………..56% …………66

St. Jude the Apostle Catholic….69% …………83

Gwinnett County Public Schools….

Hooper Renwick ………………20% …………10

Pinckneyville………………..49% …………464

Summerour……………………56% …………369

Berkmar……………………..59% …………366

GIVE Center East …………….60% …………10

Shiloh Middle………………..61% …………537

Crews Middle ………………..62% …………465

Lanier Middle………………..63% …………922

Richards ……………………66% …………815

Snellville ………………….67% …………752

Gwinnett - Private

Old Suwanee Christian…………45% …………20

* Schools with at least 10 students in the grade audited where a compliance rate was reported.

** In compliance includes fully vaccinated children, children who have obtained legal exemptions from shots based on medical or religious reasons, as well as children who lack vaccinations or required forms but are within a legally allowed waiver period.

Sources: Health department immunization assessment forms and information for schools in Cobb, DeKalb, Douglas, Fulton and Gwinnett counties.

Editor’s note: Today the AJC launches Spotlight, which each Sunday will reveal important information affecting your health, safety or pocketbook. Look for it in the Metro section or on the front page.

If you have a tip about potential wrongdoing, contact us: spotlight@ajc.com; 404-526-5041.

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