By Jennifer Wohlleb
With Kentucky’s relatively high rates of immunizations among school-age children, it hasn’t been hit with quite the number of vaccine-preventable illnesses that other states have seen, but some illnesses are creeping in.
“We’re not doing as well as we have done in the past,” said Dr. Kraig Humbaugh, director of the state’s division of Epidemiology and Health Planning.
Kentucky is currently in a statewide outbreak of pertussis, also called whooping cough, with at least 230 cases diagnosed so far this year and more than 300 confirmed last year.
“And those are just reported cases, and most of those are in children,” Humbaugh said. “And young children are the ones most likely to have the severe consequences, including unfortunately, death.
“Measles, we haven’t seen a case of it this year, but almost all of our surrounding states have and there is currently a measles outbreak … with cases that have been imported from other countries.”
He said that is why it’s so important to keep high numbers of the state’s population immunized against these preventable illnesses.
“We live a global economy and every day, people can come here from other countries,” where illnesses like measles and polio are still an issue, Humbaugh said. “…Vaccines and immunizations are really, really important, but some people get really complacent because we don’t see them (these diseases) as much anymore, but they’re still a threat.”
During the 2013-14 school year, 81.7 percent of Kentucky sixth-graders received theTdap booster shot, which protect against tetanus, diphtheria and pertussis. That is below the national average of 84.6 percent. The state’s rate of childhood series immunizations has fallen since hitting a high point of 80.6 percent in 2011,which was an increase of 17 percent from 2007. In 2013, the most recent year for which data is available, that rate was 72.7 percent, according to the National Immunization Survey.
Schools have been ground zero for much of the pertussis outbreak in recent years. Scott County had an outbreak last year and district officials are hoping the lessons they learned will prevent or lessen future problems.
“In our discussions with the regional epidemiologist, one of the things we found, the age where whooping cough was hitting, it was those who needed the booster or were right before that age they were to get the booster,” said Steve Hill, Scott County’s school health coordinator. “So it was either an aggressive level of pertussis that was causing this to hit before the booster … or a sibling had a strong exposure to it. So we don’t believe it was kids not getting immunized, but getting sick right before their boosters.”
He said the district had a learning curve, but with help from their local health department and the epidemiologist, they were able to get the right message out.
“If there’s anything that came of it that we learned it was, how do you roll out the information,” Hill said. “Because one of the things you don’t want to do as a district is be alarming to the community, but you also want to be real, too, letting them know what to look out for.”
Learning about exposure and who to notify was a big part of the process.
“They talk about close proximity, and it’s not really that contagious unless you’re in close proximity within a certain range of that child,” Hill said. “Do you want to communicate with everyone on the bus, do you want to communicate with those in after-school care, the kids who sat with the child at lunch? Those are plans that districts have to start thinking about as this problem may occur again this year.”
He said when pertussis first popped up in the district, school officials notified only those directly impacted.
“But we found it was so widespread in our district that after the first couple of weeks we just started promoting the information throughout the district and sent out notifications to tell families how they can protect themselves,” he said.
Hart County Schools experienced a similar outbreak last year, also seemingly among students approaching the Tdap booster shot age.
“All of these students, their immunizations were up-to-date,” said district School Health Coordinator Steven Caven. “Our guidance counselors and nurses work very closely each year to monitor and make sure our students are up-to-date, and we contact parents to let them know that they’re approaching the next set of boosters when they’re getting ready to exit fifth grade.”
Sharon Ray with the Barren River District Health Department said Hart County Schools was able to provide the department with good information when the outbreak started.
“Mr. Caven had a very strong knowledge of his students and their activities, and he was very involved in providing us with information, which made it much easier for us to make the appropriate public health recommendations,” she said. “He was actively engaged in conversation with us, at times on a daily basis, which was very helpful for the local health department to provide recommendations.”
Local health departments can help districts communicate with parents, as well as provide them with crucial information about the course of an illness.
“Once (a student) is considered to be infectious, it would be recommended that they stay out of school until they have received five days of the appropriate antibiotic treatment, or 21 days from the onset of cough,” Ray said. “So you can see, if we don’t find out about it until you’re three weeks into a cough illness, you’ve already been there your whole infectious period, so we can’t shorten your infection time; where if we know early, we may not keep that student from getting sick, but we may shorten their infectious time to others.”
Caven said developing a communication plan was one of the most important lessons Hart County Schools officials learned.
“That was probably the biggest thing that came out of it; we looked at all the avenues of communication during that process and would be prepared to use those same avenues if faced with this again, or something else of this nature,” he said. “If there happens to be a need, we’re notifying all homes, so those parents who have opted out for religious or medical exemptions, they are being notified that there are cases in our buildings. We’re not telling them to keep them home, but if a parent chooses to keep them home, then we’re working with the family. A child (with an exemption) will not be penalized for missing school.”
Exemptions and being informed
In addition to medical exemptions for students with conditions that do allow them to receive vaccinations, Kentucky allows parents to exempt their children for religious reasons, but Humbaugh said that accounts for less than 2 percent of all exemptions.
“We also have small numbers of medical exemptions as well, and when we compare that to other states it’s actually pretty low,” he said. “Some states have philosophical exemptions; that is not an option for parents in Kentucky … I think people understand the importance of (vaccinations) in general.”
Humbaugh, who called vaccines one of the greatest medical success stories of the 20th century, said fear and misinformation about vaccinations may be contributing to lower rates of immunizations in areas of the country.
“I think one thing people fear are side effects of vaccinations,” said Humbaugh, who is also a pediatrician. “I think the literature shows that certainly, and the 20th century will bear that out, the benefit of being vaccinated for childhood diseases is greater than the small risks associated with vaccinations. To me, vaccinations are like any other type of medication that you give, everything has risks; taking Tylenol has risks. But the risks are very low. These are in general safe, proven effective vaccines, all FDA approved.
“The most common side effects are soreness or redness at the injection site, and even that is in the minority of children who are vaccinated. These are vaccines that are tested and proven and safe for children.”
Humbaugh said he tries to direct people to credible sources of information, such as from the Centers for Disease Control and Prevention. He said health care providers also are an invaluable resource for school and public health officials.
“Studies have shown that if health-care providers recommend it, people pay attention to them,” he said.
He encouraged schools to work with local health officials to help keep vaccination rates high.
“The more educated our population is, the healthier our population is,” he said. “But in order for children to learn, they have to be healthy. And this helps to keep kids healthy and prevent outbreaks.”
Required Immunizations in Kentucky
For kindergarten entry, all children at least 5 years of age must have:
- Five doses of DTaP or DTP (diphtheria, tetanus, pertussis) or combinations of the two vaccines.
- Four doses of IPV or OPV (polio) or combinations of the two vaccines.
- Three doses of hepatitis B.
- Two doses of MMR (measles, mumps, rubella).
- Two doses of varicella (chickenpox), unless a health-care provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a health-care provider or a diagnosis of herpes zoster disease or verification of history of herpes zoster disease by a health-care provider.
For sixth grade entry, age 11 or 12 years or older, a child shall have received:
- One dose of Tdap (diphtheria, tetanus, pertussis) if it has been at least 2 years since the administration of the last dose of tetanus-containing vaccine.
- Two doses of varicella, unless a health-care provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a health-care provider or a diagnosis or herpes zoster disease or verification of a history of herpes zoster disease by a health-care provider.
- One dose of MCV or MPSV (meningococcal vaccine).