Vaccination rates are up in 49 out of 58 counties in California, according to data released Tuesday by state health officials.

The California Department of Public Health annually reports vaccination data for kindergartners at virtually all public and private schools statewide. For the 2015-2016 school year, 92.9 percent of kindergartners were up-to-date on their vaccines, an increase of 2.5 percentage points from last year.

In California, 2015 was the year of heated debate around vaccines. It started last January with the first reports of a measles outbreak tied to Disneyland. Then, in early February, lawmakers introduced a bill to eliminate the “personal belief exemption” (PBE) which allows parents to refuse vaccines on behalf of their children.

The law takes effect in July, but this school year the PBE rate declined slightly — it’s now 2.38 percent, down from 2.54 percent last year. It’s the second straight year of declines.

While no one can say for sure exactly what’s driving the increasing vaccination rates, it seems reasonable that all the focus on vaccinations — and those who choose not to vaccinate —  last year had an impact.

But James Watt, chief of the division of communicable diseases with the state’s department of public health, says another big factor is “conditional admissions.” These are children who arrive at school with some vaccines, but are not up to date.

This school year, 4.4 percent — about 24,000 — of the state’s 550,000 kindergartners were admitted conditionally.

The problem, Watt explained to me in an interview, is that the rules around conditional entry are actually quite strict. It’s not simply that a child has some vaccines and will get the rest at a later date. In other words, “conditional entry” is not for children whose parents haven’t gotten them to the doctor’s office or clinic for a shot.

“If those children could get a dose ‘today,’ they’re not supposed to be admitted to school,” Watt says.

To say it in reverse — conditional entry is for children who cannot be vaccinated “today.”

Why couldn’t you be vaccinated “today”? Here’s one example: Children are supposed to receive two doses of the measles, mumps, rubella (MMR) vaccine. But the second dose can only be given starting one month after the first dose. If school starts less than one month after the child has had the first MMR dose, then the child is eligible for “conditional entry” to school, until the month has passed and the second dose can be given.

Department of public health estimates show that more than 90 percent of those 24,000 children with conditional entry do not meet the requirements of the policy and should not have been admitted to school.

Watt says the criteria have been misunderstood and “can be confusing,” so the state’s health department has been working with local health departments to inform them about correct use of conditional entry. In addition, schools financial and compliance audits for the current school year “will scrutinize reimbursements for attendance at schools with higher rates of conditional entrance.”

The department said it turned to approaches used successfully by the Alameda County Public Health Department. The state says Alameda had the biggest decrease — 7.2 percent — of any California county in its conditional entry rate. Statewide, the rate declined 2.5 percent.

Watt acknowledged “there is a tension” between health requirements and school attendance, but even if children need vaccinations, there’s “no need to be out of school for more than a day,” Watt said. “There should not be prolonged absences from school because of the immunization requirement.”

Despite the increases in the rate of kindergartners now fully vaccinated “a number of schools and communities remain at risk of contagion,” the state says. For the current school year, 20 of California’s 58 counties have rates of fully-vaccinated kindergartners below 90 percent.

Here are the counties with the lowest rates of fully vaccinated kindergartners this year:

  • Trinity 77.0 percent
  • Nevada 77.1 percent
  • Tuolumne 77.7 percent
  • Mariposa 81.5 percent
  • Humboldt 82.0 percent
  • Siskiyou 83.8 percent

Many of those counties also have high rates of personal belief exemptions. But individual schools even within counties with high fully vaccinated rates may have high personal belief exemption rates.

You can look up the personal belief exemption rate at your own school below.


You can also see the school search tool on its own page.

Why Vaccination Rates Are Up Across California 22 January,2016Lisa Aliferis

  • pHarma

    The Non-medical exemption rate was only 2.54% last year, and dropped to 2.38% this year. This is the maximum downward pressure on vaccination rate that non-medical exemption can cause- 100% – 2.38% is 97.62%. Any vaccination rates below that rate are unrelated to non-medical exemption use.

    The reason that the vaccination rates are below 97.62% is due to CDPH measurement policies, not vaccine resistance. CA requires sixteen injections for Kindergarten entry- 5 DTaP, 4 Polio, 2 MMR, 3 Hep B, and 2 Chicken Pox. Four of the final doses in the series are CDC scheduled during a 2 year administration window ages 4 to 6. CA enrolls Kindergartners at age 5, with some private schools younger. Younger Kindergartners who are in a medical practice that uses the latter half of the administration window for any of these final four injections will be within medical guidelines, but not yet “complete” per CDPH definition until they age into the final injections as they turn 6 years old during Kindergarten and First Grade. Kindergarten is a poor checkpoint because it straddles the final injection administration window. Further suppressing rates is the deadline which occurs early in the year and is actually a snapshot of the first few weeks of school and the clerical and bookkeeping efficiency of any given school, district, or county. Until 2012 CDPH used to do a “Selective Review”, in the spring of each school year to revisit vaccination rates and would commonly pick up another 2% or more per antigen and a drop in non-medical exemptions. For detailed information about California exemption rates and vaccination coverage please google “CA SB277 Corrections “. For a paper describing policy changes that would provide more accurate assessments google “California Immunization Information Accuracy Analysis and Recommendations for Improvement to Eliminate Dangerous Pockets”.
    The reason that the counties with low fully vaccinated Kindergartners are all low population is due to using percentage measurement for an all-inclusive criteria where one child is over represented. These counties have only 114 to 1600 Kindergartners. Any child who has less than 16 of 16 injections on the measurement day cannot be called “fully vaccinated”, and the small populations skew percentage data. Trinity has only 114 Kindergartners, Mariposa 168, Tolumne 462, Siskiyou 510, Nevada 854, and Humboldt 1600. LA county has 130,000 Kindergartners.

Author

Lisa Aliferis

Lisa Aliferis is the founding editor of KQED's State of Health blog. Since 2011, she's been writing and editing stories for the site. Before taking up blogging, she toiled for many years (more than we can count) producing health stories for television, including Dateline NBC and San Francisco's CBS affiliate, KPIX-TV. She also wrote up a handy guide to the Affordable Care Act, especially for Californians. Her work has been honored for many awards. Most recently she was a finalist for "Best Topical Reporting" from the Online News Association. You can follow her on Twitter: @laliferis

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