Amid the current Disneyland-vector measles outbreak and the new spotlight it's putting on vaccine gaps, many a parent is wondering: What's the vaccination rate at my own child's school? What are the chances that my kid will come into contact with an unvaccinated kid? And does our school make the cut-off for "herd immunity," that desirable state when so many people are vaccinated that even if a bug gets in, it's unlikely to spread?
USA Today has published a beautifully granular look-up tool of vaccination rates broken down by school, with data for 13 states, including Massachusetts. Its interface lets you look up a specific school by typing in its name.
But we in Massachusetts are particularly data-rich, in that the state Department of Public Health has just recently posted a spreadsheet of all our schools, grouped together by town; that means we can not only check a particular school's rate but also compare it with its neighbors'.
The full state list of schools and their kindergarten vaccination rates is here, in an easy format that looks like the spreadsheet shown above.
So what are we to make of these numbers, particularly if our own school's rate looks low?
I spoke with Pejman Talebian, chief of the immunization service at the state's Department of Public Health. My biggest takeaway: If your school's numbers look low, don't freak out. It could be an artifact of under-reporting, particularly if the numbers of vaccine exemptions are low. But there are, he said, pockets of concern, particularly on Cape Cod and in western Massachusetts, where the numbers of exemptions tend to be high and vaccination rates lower than desired.
Our conversation, lightly edited:
What would you hope that parents and school communities do with this data?
We hope that it starts conversations around immunization. And we hope that in areas of the state where there are lower rates, and higher rates of exemptions, it prompts more conversations between health care providers in those communities, local health officials in those communities, and the community as a whole — that they talk about the benefits of immunization, prompting folks to potentially reconsider their stance around immunization. Hopefully, it will lead to more individuals seeking to be fully vaccinated.
"These pockets are not in lower-income city areas, they generally tend to be in middle and upper middle class communities."Pejman Talebian, state Department of Public Health
Is there anything that communities should be sure not to do?
I wouldn't take one data point around one specific school and assume there’s definitely a concern or definitely a problem. This is all self-reported information and some of it may not be a true reflection of what is the actual immunization coverage in the school. So if you do see a school with what appears to be very low immunization rates, that doesn’t mean that that school is definitely ripe for an outbreak tomorrow and that’s a major concern. It should just prompt questions and conversations with school health staff and with the community, ensuring the population is being properly vaccinated.
How long have we had this data? When did it go public?
We’ve been surveying schools on an annual basis going back decades; it's a core component of our program, to be sure schools are in compliance with state regulations and for our own statewide surveillance purposes, to be sure the population is adequately immunized. So we’ve always been collecting this data, but in the past we have taken a stricter stance on release of the data down to the school level, due to privacy concerns.
But because of everything that's been going on over the last year or two, with concerns around higher rates of immunization exemptions, and certain pockets of the state having potentially lower immunization rates than others, and outbreaks of vaccine-preventable diseases starting to crop up that were close to eliminated several years ago, we felt this would be an important tool to help us address some of these issues. We looked at our data release policies and decided to take a more open stance. Just within the last couple of months, we posted this data online.
As of right now, we've just posted our kindergarten data, because we felt that was the most important, ensuring all children are fully immunized by the time they enter elementary school. But we're in the process of fine-tuning and cleaning up our data with the anticipation of releasing our data on 7th grade, colleges and child-care centers over the next several months. This is all data from last year, but probably every spring we'll be releasing the data from the prior fall.
When I scanned the spreadsheet, I got the impression that the schools with lower rates tended to be either in lower-income areas or private schools, which I think of as probably higher income, though I know that's too broad a brush. We know this is a problem of pockets — how do you see the shape of this data?
Right, we've always been concerned about the pockets around the state where we’re seeing high rates of immunization exemptions and lower rates of immunization. In general, those pockets have been located in some of the communities in Western Massachusetts and also some of the communities on the Cape and the islands. That’s where we see most of the pockets.
At the school level, there are some individual schools outside of those geographic regions where we’re also seeing bigger pockets as well, of higher rates of exemptions and lower immunization rates. And generally, these pockets are not in lower-income city areas, they generally tend to be in middle and upper middle class communities. Some of what appear to be lower immunization rate pockets you're seeing in some of the lower-income communities, from our interpretation tends to be more data collection issues than actual lower rates.
It’s cool that this data is public — we're clearly ahead of many other states on this — but what are your biggest caveats for parents and school staffs as they look at their own school's numbers?
Some of the caveats related to the data are listed with the data but i’ll highlight a few:
• There are small schools with grade sizes of 30 kids or less where we can’t release those data points.
• Some schools did not respond to the survey so there’s no data on those schools as well.
• The most important caveat is that these data are all self-reported by the school. Generally, the school nurse collects the data on all the incoming children in the school; we survey the school on an annual basis and they provide that data to us. So the school nurses are relying on immunization records that parents are providing to them, and then they compile that information and report it to us.
It’s important to keep that fact in mind because the actual immunization coverage rates you see in these tables may not necessarily be a true reflection of the immunization coverage in that population. Oftentimes there's poor record keeping, or records don’t get from the doctor’s office to the school nurse in a timely fashion or in a complete fashion. So oftentimes schools don't have as accurate and complete an immunization record as they would like.
So as you go through the table, you might see some odd things, where schools might appear to have a low immunization rate but you also don’t see what you would expect, which is high exemption rates. In reality, we know most children are vaccinated; it's just a record-keeping issue.
• Also, the data is fluid. We record it in the early fall and school nurses often are continually following up with parents to get records throughout the year, so immunization records may go up through the year.
So overall, the data are probably skewed to be low, the rates are probably better than what we see.
Correct. There's generally going to be under-reporting rather than over-reporting.
What's the overall rate for Massachusetts of kindergarten immunizations?
The overall rate is actually high. Being fully immunized with all the recommended vaccines is at over 90 percent, and historically has been at over 90 percent for the last 10 to 15 years. The general goal is to have 100 percent of children fully vaccinated, and the national threshold is to ensure at least 90 percent of school-aged children are vaccinated, so we are generally above that threshold routinely on a statewide basis.
In terms of "herd immunity," I'm a little confused about whether it's 90 or 95 percent for your community is considered to have it...
There are different national studies around this concept of herd immunity. Our goal is to have 100 percent of the population vaccinated, but this concept of herd immunity is something that depends on which disease you're talking about. There are different levels for most vaccine-preventable diseases: 90 percent is what is generally adequate to achieve a good level of herd immunity but with measles, because of how infectious it is, you generally need a herd immunity level closer to 95 percent.
Is the Department of Public Health planning any initiatives aimed at raising the lower-scoring schools?
Every year we do look at some of the low-scoring schools and we do focus in, oftentimes on a particular vaccine of concern. So given what's' going on recently, we're right now focusing in on schools that have lower rates of MMR vaccine coverage, and are reaching out to those schools directly to see if they can improve their data collection, if it’s a data collection issue, or address the actual immunization rates. And oftentimes, as I said previously, it tends to be more of a data collection issue than actual coverage rate. So we are reaching out to those schools directly.
And I understand the state is creating a new immunization registry?
Yes, that's a separate process. We’re in the process of rolling out a statewide immunization registry where we'll be collecting statewide immunization rates directly from health care providers, primarily from electronic health records where they’ll be sending data directly to our system. Ultimately, in the long run, this will provide an even more accurate picture of the actual immunization coverage in the state because it will be based on the actual medical record rather than information that’s sent to the schools. That’s in process now, and it will be probably a couple more years before our system is fully populated and we can rely on that to look at pockets around the state.
Readers, as you look at the table of immunization rates, what strikes you? And any lingering questions?