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Local parents and guardians are sending more than 230 students to Rapid City schools who are exempted from vaccinations because of religious reasons, records show.

At a time when the Centers for Disease Control and Prevention is observing the second largest number of measles diagnoses since the disease's elimination in 2000, State Epidemiologist Joshua Clayton said local immunization rates deserve careful attention.

“When we’re talking about different diseases that could find a foothold because of some of those low vaccination rates that needs to be an area of concern for school administrators and for parents," Clayton said Thursday.

State law requires that children receive multiple rounds of vaccines for diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and chicken pox by the time they enter kindergarten. At least one dose of Tdap — the booster for diphtheria, tetanus and pertussis — is generally required for students entering the sixth grade, in addition to a round of meningococcal vaccine.

South Dakota, like 47 other states, will waive immunization requirements for students whose families oppose them on religious and philosophical grounds. Exceptions are also made for medical reasons, such as when an individual has an allergy to a vaccine or has a weakened immune system.

But while a doctor's signature is required to be granted a medical exemption, religious ones can be obtained with only a legal guardian's written approval. Waiver forms do not require an individual to disclose their religious affiliation.

In Rapid City schools, 256 students have been granted vaccine waivers, 238 of which are religious. State data puts Rapid City Area Schools enrollment at 13,832. Records provided by the district did not indicate the buildings in which exempt students attend school.

According to school records, 121 students in kindergarten through the sixth grade have vaccine waivers, 117 of which are religious. In the middle grades, sixth through eighth, 71 of the 81 waivers reported are religious.

At the high school level, 52 students have been granted waivers, 48 of them religious. Two children enrolled in school pre-kindergarten programs have religious waivers as well.

In the event of an outbreak, any and all of those students could be ordered to stay home from school, although Special Services Director Gregory Gaden said that such a decision would have to be made in consultation with school legal counsel and the board of education.

Statewide, schools are still meeting federal targets for vaccination rates, according to the most recent South Dakota public health bulletin. But that same report shows the number of children entering kindergarten with religious exemptions is growing, albeit slightly. 

In 2017, according to the Health Department, 2.2 percent of kindergartners statewide had vaccine exemptions, up from 1.8 percent in 2013. Of the 262 recorded that year, 239 were religious.

Vaccination exemption rates for state sixth-graders rose from 1.9 percent in 2016 to 2 percent in 2017.

“It is a concerning event when any child does not get the vaccines that they need to maintain their optimal health," Clayton said. "We know that vaccines themselves have a small risk and that cannot be understated, but the overall benefit from vaccines far outweighs any of the small risk that you have following vaccination."

State health department officials did not speculate as to why more parents are choosing not to vaccinate. Meanwhile, Family and Community Health Director Colleen Winter said dubious sources are disseminating inaccurate information on the safety of immunization practices on the internet.

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“I think any opportunity that we have to talk to families about the importance of vaccine and the safety of vaccine helps us to minimize exemption," Winter said. "A lot of people today have not seen firsthand the consequences of some of these vaccine-preventable diseases."

Seizures, deafness and other serious complications can accompany measles infections, Winter said.

Clayton said under-vaccination may factor into the number of pertussis, or whooping cough, cases that have been diagnosed in South Dakota. He said diagnoses of the illness spike every three to five years, partly because vaccines for pertussis are not as effective as those for other diseases.

Clayton said 40 cases of the disease have been diagnosed so far this year. Preliminary case counts for last year number 163, while the previous five-year high of 109 was recorded in 2015.

Elsewhere, flare-ups of vaccine-preventable diseases have led to strict response measures.

The New York City health department confirmed 329 cases of measles so far this year in Brooklyn, one of six sites in the United States where outbreaks of the disease are occurring. Residents and children who reside and work there have been ordered to vaccinate for the disease under penalty of fines.

Locally, some children lack vaccinations because of parental neglect.

Gaden estimates there are 20 children who returned to the district this year without required vaccinations because their legal guardians either could not be located or were incarcerated.

"We're not going to punish those kids," Gaden said.

Federal law requires that homeless students remain in attendance regardless of their immunization status and directs schools to refer their parents to agencies that can help get them up to date.

Without an exemption, parents of students entering the district have two weeks prior to the last Friday of September to either provide shot records or proof that an immunization treatment plan is in place. Gaden said the district tries to work through any issues with families on a case-by-case basis.

Military children enrolling in the school, according to school policy, are given 30 days to provide such documentation.

Regional Health Family Physician Cathy Hennies said a patient's primary caregiver is one of the best sources of information on the safety of vaccines. Doctors treating patients who are hesitant about immunization, she said, also often direct them toward reliable resources provided by the CDC and by medical associations.

It can be frustrating, she admits, building trust with individuals who do not immediately realize that refusing vaccinations puts other children who are too young to receive them at risk. Unvaccinated individuals also risk transmitting diseases to those with weakened immune systems, such as patients undergoing chemotherapy.

"It really is important for everyone to do their part,” Hennies said.

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