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When Emily Adams started scouting preschools for her 2-year-old, her checklist went beyond a school’s location, reputation and instruction.
Something else weighed on the mind of the Jefferson County mother of two: vaccination statistics.
A state law passed last year gives parents unprecedented access to school-by-school breakdowns on immunizations at a time when a national measles scare has reignited vaccinations concerns.
But, as Adams learned, the data often can provide an incomplete picture.
The school she was looking at, like others in Colorado, has a large number of students classified as noncompliant — meaning their parents have not submitted either vaccination records or forms exempting their children from vaccinations.
“This is where my struggle is,” said Adams, who did not want to identify the school. “(A woman there) could tell me how many kids were vaccinated, but what she didn’t have was the difference between who were opting out and children who just hadn’t turned in the paperwork.”
A Denver Post review of immunization records at metro-area school districts showed large pockets of parents who receive vaccination exemptions concentrated in the Boulder Valley district, schools with more liberal teaching methods, and public school programs for home-schoolers.
“There is a hope”
Among 14 metro-area school districts that provided data, the highest rates of students lacking immunization records or an exemption were Littleton, Sheridan and Denver.
“It doesn’t surprise me to hear that,” said state Sen. Irene Aguilar, D-Denver, who co-sponsored the legislation requiring schools to make vaccination records available to the public.
“There was a concern that it may be that parents are not even being noncompliant but that they don’t know how to get the records,” Aguilar said. “There is a hope that more kids are getting vaccinated than we can document.”
The Centers for Disease Control and Prevention recently cited Colorado as having the lowest rates of fully vaccinated children entering kindergarten — 81 percent to 82 percent.
Officials from the Colorado School of Public Health say a population must have high enough vaccination rates — as high as 95 percent for measles — to protect vulnerable kids.
To be compliant in Colorado, parents or guardians must provide records showing vaccinations for nine diseases, including measles, mumps, whooping cough and chicken pox.
Under state law, children without vaccines or exemptions can be barred from school.
After a second or third notice reminding parents to submit records, officials will set a date when children may be asked to stay home. School officials say it’s a last resort, used rarely — if ever.
In the Mapleton district, officials say if they reach that point, they select a date when a local clinic is offering walk-in appointments for shots.
Liberal, wealthy, highly educated Boulder County has long been known as a center for the anti-vaccination movement.
School-level data bear that out, with Boulder Valley School District schools accounting for seven of the 10 schools with the highest exemption rates among metro-area schools surveyed.
“We work with families, yet in our state, it is a parent’s right to choose,” said Boulder Valley Superintendent Bruce Messinger.
Messinger said the district works closely with the county health department, communicates with parents and focuses on fulfilling record-keeping requirements. He said of the district’s high rate of unvaccinated students: “It’s a public health worry, so it’s our worry.”
He noted the district, like others, is underfunded and short-handed. Boulder Valley has nurse supervisors covering multiple schools, he said.
Other districts have found resources to put nurses in all or most schools. The Cherry Creek School District employs 70 school nurses — about 15 percent of all school-based nurses in Colorado — and has a nurse in every building, district officials say.
A 2004 study in the journal Pediatrics found the presence of a school nurse reduces exemptions sought for vaccines. Other research correlates nurses on campuses to higher immunization rates.
The opt-out rate in the Cherry Creek School District is 4 percent — higher than more urban districts but below that of Douglas County School District and Jefferson County Public Schools.
The Adams 12 Five Star School District in Thornton, in contrast, has high compliance rates and few parents seeking exemptions. The district’s noncompliance rate is 1.4 percent — the lowest in the metro area — and just 3 percent of district students get exemptions.
About 38 percent of the district’s students qualify for free or reduced lunch, a measure often used to gauge poverty.
Julie McRae, health services coordinator for Adams 12, said the district three years ago started efforts to better distribute health workers in schools.
Adams 12 has a full-time health aide at each school who may not be certified as a nurse but is trained and supervised by one of the district’s 15 registered nurses that each cover three or four schools. McRae cited the nurses as contributing to the high vaccination rates.
“They often are the ones that know the families; they know the children,” McRae said. “They do whatever it takes to work with families.”
Denver Public Schools has 15 clinics funded through a grant program that helps provide school-based health centers in low-income areas.
No difference
The Denver Post reviewed immunization rates at those schools and found almost no difference compared with the district overall.
John Simmons, executive director of student services for DPS, said that makes sense because the district focuses on making sure services are available to students districtwide.
Simmons said officials believe efforts to increase vaccination opportunities for students are keeping all opt-out rates and noncompliance rates lower than they could be in a large urban district.
“You can only imagine what it would look like if we didn’t,” Simmons said. “It would be disastrous.”
Esperanza Ybarra, chief of the state Department of Public Health and Environment branch that includes the grant program, said the department launched a new data system last month that will be used to gauge the program’s impact, including on immunization rates.
At one such clinic, in a modular building behind Crawford Elementary School in Aurora, pediatric nurse practitioner Julie Zavala believes factors other than access to health care are at work.
The clinic, staffed by Rocky Mountain Youth Clinics, is one of two in Aurora Public Schools drawing students districtwide.
Visits costs as little as $2 each and no more than $7.
Zavala said families who use the clinic typically have traditional belief systems that place a high level of trust in health care advice.
“Most of the parents that we see here are both working full time, so it is very difficult for them to stay at home with a sick child,” she said. “If they can get a vaccine to prevent illness, they will take it.”
One afternoon this week, Carlos Cholico and Luz Barajas brought in their children, ages 8 and 5, for a flu shot. Both kids, students at Kenton Elementary, are up to date with vaccinations.
Cholico, a self-employed handyman, said he is unfamiliar with the measles outbreak in California or the opt-out movement in Boulder County. While he said vaccination is a personal choice for parents, he worries about putting his children at risk.
“As soon as they get sick, their mom gets sick, I get sick,” Cholico said. “It’s a lot of stress. That is what we are trying to avoid, all the time.”
MOBILE: Click to see school immunization charts
Staff writer Electa Draper and Keli Rabon of 7News contributed to this report.
