The Centers for Disease Control for Prevention has confirmed a reported 880 measles cases in the U.S. between Jan. 1-May 17. Measles is a highly contagious respiratory illness that spreads through coughing and sneezing.
The Department of State Health Services issued a health alert in February after seven measles cases were reported across the state. At press time, the DSHS had confirmed 15 measles cases statewide—five in Harris and Montgomery counties. Texas reported nine cases of measles in 2018 and one in 2017, according to DSHS.
The increase in reported measles cases has caused some health care officials to point to the growing number of vaccination exemptions of conscience as a contributing factor, which are rising in Humble and New Caney ISDs as well as local private schools.
“I’m seeing more parents refuse vaccines for reasons other than religious- or health-related reasons, such as an allergy, and ... that’s consistent with the increase in vaccination exemptions due to ‘reasons of conscience,’” said Dr. Richard Lyn-Cook, medical director at Harris Health Pediatric Clinics.
In 2003, state lawmakers made it legal for parents to seek exemptions for their children for reasons of conscience. Prior to 2003, only religious or medical reasons were considered, according to CDC information.
DSHS data showed the conscientious exemption rate topped 1.72% at HISD and 1.18% at NCISD for the 2018-19 school year, increases for both districts from 0.79% and 0.6%, respectively, in 2012-13. Meanwhile, at least three local private schools recorded campus exemptions of at least 1.85% in 2018-19.
Lyn-Cook said parents who choose not to vaccinate for measles cause concerns among the health care community because the CDC recommends 95% of the population be vaccinated for measles to prevent rapid spreading.
“We still don’t vaccinate kids less than a year old, so that entire population of kids is now vulnerable to not only folks who choose not to vaccinate but to people who come from other countries who may not have been vaccinated for other reasons such as access or ... personal choice,” he said.
Rising rates
Children enrolled in public and accredited private schools are required by state law to receive certain vaccinations unless the parent submits a notarized affidavit for these exemptions, according to the DSHS.
While the DSHS does not yet recognize a significant statewide concern, DSHS Media Relations Director Chris Van Deusen said there is a concern for smaller parts of the state, such as individual school districts, counties or neighborhoods where the vaccine exemption rate is higher.
Dr. Catherine Troisi, associate professor of epidemiology at the UTHealth School of Public Health in Houston, said unvaccinated children are vulnerable to get the disease they are not vaccinated against.
“There’s an economic theory called tragedy of the commons that says if mostly everyone vaccinates and a few people don’t, the risk of getting the disease is smaller,” Troisi said.
State data shows the percentage of students with conscientious vaccine exemptions at Humble and New Caney ISDs for the 2018-19 year ranks above the state average of 1.2%. HISD ranks third highest for public school districts in Harris County, while NCISD ranks fourth highest in Montgomery County, according to DSHS data.
However, MMR immunizations, or the measles, mumps and rubella vaccine, at local school districts have increased overall. In 2017-18, 93.26% of HISD kindergarten students were vaccinated for MMR, whereas 97.19% were vaccinated in the 2018-19 school year.
In NCISD, 97.74% of kindergarten students were vaccinated for MMR in the 2017-18 year compared to 97.97% in the 2018-19 year. Scott Powers, the executive director of public relations at NCISD, said via email parents have the right to choose whether to vaccinate their children.
“There are various reasons parents choose to exempt their children,” he said. “Under the law, parents have the right to choose, and more are doing so.”
Susan Luethold, coordinator of health services for HISD, said via email that while students are required to be immunized, parents can choose to opt out by submitting exemption affidavits.
“The rate is something we monitor but do not control. The rate reflects parent choices; parents make choices that they believe are best for their children,” Luethold said.
At local private schools, vaccine exemption rates vary across schools. The Covenant Preparatory Academy has a conscientious exemption rate of 1.85%, but its rates have actually decreased since 2012-13, when it reported 4.46% conscientious exemption rates. School officials said they were not sure why the their rates dropped as vaccinate rules remained the same.
Meanwhile, Humble Christian School is almost four times the state average at 4.24% in the 2018-19 year. Officials with Humble Christian School did not respond for comment by press time.
However, the Lake Houston-area private school with the highest conscientious exemption rate is Pines Montessori School in Kingwood, which has a 16.67% exemption rate for the 2018-19 year, according to DSHS data.
“Conscientious exemptions are a personal, family decision,” said Patty Sobelman, head of school at Pines Montessori School. “We have noticed, however, that going into next school year, we will have about half the number of exemptions on file. We cannot speak to why that is, but we see this trend.”
Legislative efforts
Local advocacy groups on both sides of the issue advocated for vaccination exemption changes in the 2019 legislative session, which ended May 27 barring a special session being called after press time.
The Immunization Partnership, a Katy-based nonprofit that educates about the importance of vaccination, has advocated for two state companion bills—Senate Bill 329 and House Bill 3551. Rekha Lakshmanan, director of advocacy and policy for The Immunization Partnership, said the bills—which were pending in committees as of press time—would require school districts to provide the DSHS with conscientious exemptions by campus and by district total and make the information available on the agency’s website.
On the other hand, HB 1490 would make the filing process for a vaccine exemption easier by requiring the DSHS to make exemption forms available for download on the agency’s website and in all public schools, and stop the DSHS from maintaining a record of said exemptions, according to the bill.
The bill, which was also pending in committee as of press time, has received support from political action committee Texans for Vaccine Choice, said Jackie Schlegel, the group’s founder and executive director. She said TFVC’s mission is to protect and advance informed consent, medical privacy and vaccine choice for Texans.
“It’s very, very dangerous when we start allowing the government to mandate any medical procedures ... and vaccines should be no exception,” she said.
However, Troisi said exemptions for reasons of conscience increase the risk of vaccine-preventable diseases making a comeback in the U.S.
“Today’s mothers haven’t seen these infectious diseases. They don’t understand these diseases can be very dangerous and fatal,” Troisi said.
Additional reporting by Hannah Zedaker
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