Draft immunization policy puts Island school nurses on same page

— File photo by Ralph Stewart

With the success of immunization programs nationwide, some people mistakenly think that childhood diseases are a thing of the past. Not so.

This year a child at West Tisbury School came down with chickenpox. Another Island child, not in school yet, was recently diagnosed with pertussis, also known as whooping cough.

What these children and a small percentage of others on the Island share in common is that they haven’t been immunized.

Although a state law requires proof of immunization for children to be admitted to school, some parents and guardians seek exemptions or do not comply. Others do not follow the recommended schedule of doses, which leaves their children under-immunized. In both cases, their children are at risk for outbreaks of vaccine-preventable disease, as is the community at large, according to health care providers.

With that in mind, school nurses recently developed a draft immunization policy for Martha’s Vineyard Public Schools (MVPS) that is currently undergoing review by school committees Island-wide. If approved, the immunization policy would spell out state law for compliance, grounds for exemptions, and guidelines for exclusion of unvaccinated children from schools, in the event of an outbreak of a vaccine-preventable disease. The policy and exclusion guidelines will be given to parents and guardians of all students with immunization exemptions who enter Island schools.

“Every school nurse follows the same Massachusetts Department of Public Health guidelines,” Martha’s Vineyard Regional High School (MVRHS) nurse Linda Leonard said in a phone conversation with The Times last week. “We’re just putting it in writing now and formalizing it so we can help parents understand.”

Exemptions and exclusion

The draft policy notes that Island schools adhere to Massachusetts General Laws Chapter 76, Section 15, which states, “No child shall be admitted to school except upon presentation of a physician’s certificate that the child has been successfully immunized.” The policy also explains that Massachusetts does allow exceptions for students with a medical or religious exemption. Also, homeless children cannot be denied entry to school if they do not have their immunization records, in accordance with Federal law.

Schools state-wide are required to have a policy that details those exemptions. As the MVPS draft policy explains, a medical exemption is allowed if a physician submits documentation, renewed annually, that an immunization is “medically contraindicated.” For example, a child who is severely allergic to eggs should not get flu vaccine, which contains egg protein. Or, a child who is moderately or seriously ill should usually wait for recovery before getting any vaccine.

A religious exemption is allowed if a parent or guardian submits a school-accepted religious exemption form. They are not required to provide an explanation of their religious beliefs. Massachusetts does not allow philosophical exemptions, even ones signed by a physician, for those who object to immunizations because of personal, moral or other beliefs.

“For me, the exemptions are important to spell out, because when a child comes up to the high school, the religious exemptions parents sign for elementary schools are no longer valid,” Ms. Leonard said. “Also, if their children change elementary schools, they have to submit a form to the new school.”

The draft immunization policy also informs parents that when one or more cases of a vaccine-preventable disease occurs in a school, all students deemed to be susceptible to infection, including those with medical or religious exemptions, are subject to exclusion from school. The Island schools follow the state’s department of public health exclusion guidelines for vaccine-preventable diseases in a school setting.

A regional effortMs. Leonard and the other school nurses collaborated on the draft immunization policy during weekly meetings they hold throughout the school year. The group includes Nicole Barlett, Edgartown School, Kristine Cammorata, West Tisbury School, Jeanne Dowling, Tisbury School, Mary Vivian, Oak Bluffs School, and Janice Monteith Brown, who serves as the school nurse for both Chilmark School and the Martha’s Vineyard Public Charter School.

Last week The Times spoke with several of them by telephone about immunization issues and the draft policy. The case of chickenpox at West Tisbury School, which required asking parents and guardians of unvaccinated children to keep them home, prompted the citation of exclusion regulations in the school-wide policy, Ms. Cammorata said.

“Some parents did know that their child could be excluded, but other families did not know that,” she said. “For most people that won’t be a deal-breaker, because they feel strongly about their choice. But we felt the responsible thing to do was to make sure they are informed.”

At West Tisbury School, about 76 percent of kindergarten students and 80 percent of students school-wide are immunized, Ms. Cammorata said. The other 20 percent includes both unimmunized and under-immunized students. About 7.9 percent of West Tisbury students have religious exemptions, compared to about 1 percent nationwide, she noted.

The measles, mumps and rubella vaccine, which received some bad publicity a few years ago due to an erroneous report, and the varicella (chickenpox) vaccine are the two that a lot of people balk at getting for their children, Ms. Cammorata said.

“Some parents have the attitude that everybody has had the chickenpox, so their child does not need to be vaccinated,” she explained. “But what they forget is that if their child does get chickenpox, that can put others in the community in danger.”

At Edgartown School, Ms. Barlett said she has a few religious exemptions and one or two medical exemptions. Ms. Leonard and Ms. Vivian said their school populations are highly immunized.

“I think it’s great parents are being thoughtful about immunizations and are talking to their doctors about them, who are helpful in turn about giving them the facts,” Ms. Vivian said. “There was so much fear about the possible link between autism and vaccines, which has since been proven unfounded.”

Ms. Barlett suggested that parents share their concerns with school nurses as well. “Every child is an individual, and we want to hear your situation and work it out. It’s all about communication.”

For the good of the herd

As the head and long-time practitioner at Vineyard Pediatrics and the chief of pediatrics primary care at Martha’s Vineyard Hospital, Dr. Michael Goldfein is a fierce advocate for immunizations.

“It’s always unfortunate when a child comes down with an illness that could have been prevented with a vaccine,” he told The Times in a phone conversation last week.

“There is a fair number on this Island who for various reasons choose not to immunize their kids,” Dr. Goldfein added. “It’s a big concern, because they’re not only putting their own children at risk, but they’re also putting other members of the community at risk for a lot of illnesses.”

Those may include babies that haven’t received all their vaccinations yet, elderly people whose vaccinations may no longer be effective, or people whose immune systems are weak.

As Dr. Goldfein explained, unvaccinated children may compromise what health care professionals call “herd immunity.”

“With a lot of illnesses, if you can protect a certain percentage of the population, then it’s not likely that that illness will be in the population,” he said. “So these people that are not immunizing their children are really taking advantage of the other people in the community that are immunizing their children, and of the fact that it’s not too likely that their kids will catch these illnesses.”

If they do contract an illness, they present a potential risk to the rest of the community.

“If they contract an illness, whichever one it may be, it means that they are contagious to other children,” Dr. Goldfein said. “And some vaccines are more protective than others. For example pertussis is not 100 percent protective. If you get a true outbreak in a community, you can catch pertussis even though you’ve been vaccinated. It’s great as long as you’ve got this herd immunity and there’s no pertussis in your community.”

Although there are some who think that measles and chickenpox are harmless childhood illnesses, Dr. Goldfein said, “A small percentage of people have permanent neurological damage as the result of measles. And chickenpox can sometimes be fatal, not so much the actual illness, but the complications of the illness.”

In regard to parents who request flexibility in their children’s vaccine schedule, Dr. Goldfein said it is not ideal but better than no immunizations at all. “But what people need to realize is what that does is it really delays the time in which the children are finally, truly protected.”

The draft immunization policy must undergo three readings by Island school committees, as well as the All-Island School Committee, which will vote on its final approval. School committee meetings are open to the public and comments are invited during the review process.