All required immunizations (% complete)
Any exemptions (%)
MMR vaccine complete (%)
2015-16 school year
Source: Washington Department of Health
Almost 10 percent of students ‘at risk’ as mumps spreads
By Marcy Stamper
Immunization rates in the Methow Valley School District are among the lowest in the state, raising concerns among local health officials during this winter’s mumps outbreak, the state’s most serious in 50 years.
Almost 10 percent of the district’s 600 students are considered “at-risk” because they do not meet the required immunization schedule for measles, mumps and rubella (MMR), said Laura Brumfield, the nurse for the Methow Valley School District.
Concern about mumps itself is decreasing now that the number of new cases has slowed — it is no longer doubling every week — but the situation underscores the vulnerability of the local population.
“I get worried about that here, because the community is not completely immunized,” said Brumfield.
If 10 percent of the population is not adequately immunized against MMR, it’s not enough to provide protection for the community and to prevent the spread of disease — what’s sometimes called “herd immunity,” said Brumfield.
School district policy requires students to have all required immunizations when they register for school. Otherwise, they must submit an exemption form signed by a health care provider. They can also provide a religious exemption, which does not require a doctor’s signature.
About half of the families in her practice follow the recommended vaccination schedule, said Leesa Linck, a pediatrician with the Confluence Health Methow Valley Clinic in Winthrop. Most of those who deviate from the standard schedule do so because they are concerned that if their children receive too many vaccines at once it could weaken their immune systems, said Linck.
“It’s a personal fear,” said Linck. “Children’s immune systems readily deal with lots of vaccines at once.” Outbreaks seem to motivate people to come in for vaccines if children haven’t already received them, she said.
Brumfield typically looks only at the non-compliance rate — students who have not been vaccinated nor submitted an exemption form — and follows up with those families. She checks the at-risk rate only when there is a disease that could require unimmunized students to stay home from school if there were a local disease outbreak, such as with mumps this winter. Decisions to keep students home are made by the health officer with Okanogan County Public Health.
Low local rates
The Methow Valley School District was 28th from the bottom — out of 296 school districts in the state — for the number of kindergarteners who had completed all required immunizations in the 2015-16 school year. Ranking 28th-lowest is somewhat misleading, because it puts the Methow ahead of 10 very small school districts with fewer than 10 kindergarteners each.
For sixth-graders, the Methow had the 17th-lowest rate of completed immunizations in the state (including three districts with fewer than 10 sixth graders). Immunization data was compiled by the Washington Department of Health from information provided by school districts.
Immunization rates in the Methow Valley were notably lower than in other school districts in Okanogan County (see table, above).
Because of the serious mumps outbreak statewide, Brumfield sent letters to all families whose children hadn’t had two doses of MMR, notifying them that the children could be kept out of school for up to 26 days by order of the health officer.
The school district doesn’t typically track immunization rates for staff but, in light of the mumps outbreak, Brumfield contacted staff about their immunization status and notified them of the possibility of being kept home from work. School staff were diligent about obtaining old records or seeing a health care provider to get a vaccine, she said.
“I felt, if mumps comes here, we have done what we can,” she said. “We’re not 100-percent immunized, but at least everyone knows.”
Monitoring immunization status is complicated for a number of reasons — students may receive a second dose of a vaccine and not notify the school, or families may vaccinate on a schedule that’s different from the standard recommendations, said Brumfield. Sometimes parents assume their kids are immunized because their doctor didn’t mention it, she said.
There could also be confusion because vaccine requirements tend to be adjusted annually. “Medicine does have a sense of art to it. You start with one vaccine and then, down the line, find out you need two,” said Brumfield.
Depending on the vaccine, there may be precise intervals between doses or specific age requirements, all of which influence efficacy. As a result, a child may be entered in school records for not being up to date on required immunizations because a shot was given a few weeks early, said Brumfield. Parents are trying to do their best in a complicated situation, she said.
The state has a registry called the Immunization Information System (formerly called Child Profile) that tracks immunization records for people of all ages. Health care providers consult and update the registry, and parents can also check immunization status through the registry.
When someone wants an exemption, the health care provider must explain the risks and benefits of immunization to the family, said Linck. All the exemptions she has signed have been for philosophical reasons, never for a medical reason.
Once a student has a signed exemption on file, Brumfield has no reason to follow up and the school district may not be aware that a student has subsequently had the vaccine.
Comparing the at-risk and out-of-compliance reports for MMR showed that most of the children who were at risk of mumps had submitted exemption forms, said Brumfield.
When parents are reluctant to do all the recommended vaccines, Linck suggests immunization for the most serious, potentially life-threatening diseases. For infants, that means diphtheria, tetanus and pertussis (whooping cough); haemophilus influenzae type B; and pneumococcal disease (these two are bacterial infections that can lead to meningitis). For older children, Linck suggests adding MMR.
Mumps is a virus that spreads through coughing, sneezing or other contact with saliva. As of March 8, there were 586 cases in Washington — 259 in Spokane County, 219 in King County, and one in Okanogan County.
Most people who get mumps will have a mild illness that lasts a week to 10 days. Brumfield said she had been more worried about a measles outbreak a few years ago, because measles is so highly contagious — it can linger in the air for up to two hours after an infected person leaves a room and then infect someone who simply enters the room. “Measles does concern me, because people can die from it,” she said.
Two doses of the MMR vaccine are about 88-percent effective at preventing infection. For every 100 vaccinated people exposed to mumps, only 12 are at risk of getting sick.
Vaccines are available for free for children through the age of 18. For more information, visit www.withinreachwa.org, or call Okanogan County Public Health at (509) 422-7140 or the Family Health Hotline at 1-800-322-2588.