The number of students opting out of mandatory vaccinations is on the rise at McKinney ISD and other schools across the state. During the 2018-19 school year, 2.51% of MISD students had conscientious vaccination exemptions on file, according to the Texas Department of State Health Services. This compares to the previous year’s exemption rate of 2.09%. The state average exemption rate is 1.2%. A conscientious exemption is when there is a religious, philosophical or moral objection to a vaccine. In this case, a parent or guardian has the choice to exclude their children from otherwise required immunizations. While the number of unvaccinated students is low compared to the number of those vaccinated, the risk for an outbreak of vaccine-preventable diseases is much higher when more than 5% of students are unvaccinated, according to the state health department. “If it’s one [unvaccinated] person and everybody else is immunized, it’s not going to be [a problem], but when you see immunization rates falling under 95%, you start to get concerned,” said Chris Van Deusen, director of media relations for DSHS. As of April 5, DSHS has confirmed 15 measles cases in Texas—the highest number in six years. Two of these cases were identified in Collin County in March. “Getting immunized is really the best way … [and] it’s the most straightforward way to protect yourself, protect your family and really anybody else around you,” Van Deusen said. Requirements and exemptions In accordance with Texas law, public and private schools require students to receive six mandatory vaccines before they can enroll in kindergarten. These vaccinations are meant to prevent chickenpox, diphtheria, tetanus, acellular pertussis, polio, measles, mumps, rubella, and hepatitis A and B. A seventh vaccine is also required for students to enroll in seventh grade. This vaccine protects against meningitis. But there are options for parents who want to opt out of the requirements for their kids. A medical exemption, which requires a letter from a doctor, is granted when a child is unable to receive a certain vaccine due to a health condition. Conscientious exemptions require a notarized letter from a child’s guardian and remain valid for two years. During the 2018-19 school year, 612 MISD students were exempt from getting the required measles, mumps and rubella vaccine. Records show 581 students were exempt for conscience reasons and 31 students for medical reasons. “It is concerning as we potentially have students that do not have immunity to vaccine preventable diseases and areas where herd immunity may not be present,” Julie Blankenship, MISD director of health services, said in an email. Herd immunity occurs when the greater proportion of people in a community are immunized, said Zachary Simoni, senior lecturer of sociology at the University of Texas at Dallas. This reduces the chances of a disease spreading, especially to those who cannot or choose not to be immunized. In an effort to increase students’ access to immunizations, MISD partners with BlueCross BlueShield of Texas to provide vaccinations to underinsured students. “We also have a cover letter for those parents choosing conscientious exemptions, explaining potential exposure to vaccine preventable diseases and possible exclusion from school if the health department deems necessary,” Blankenship said. And while the majority of parents choose to vaccinate their children, those who do not offer a variety of reasons. McKinney resident Jen Hodges said the decision to not vaccinate her son was one of the hardest choices she has ever made. While her son is not of school age, Hodges said after researching the potential side effects and harmful ingredients, she decided to opt him out of all required vaccinations. “Vaccines are not one size fits all,” Hodges said. “People [can] have reactions to medications and vaccines. Where there is a risk, there should always be a choice.” Risk of outbreaks Following the recommended vaccination schedule is important to prevent an outbreak of diseases, said Dr. Jawaid Asghar, chief epidemiologist with Collin County Health Care Services. An outbreak occurs when there are more cases of the same disease than expected, Asghar said. And while this year’s number of measles cases is higher than expected, DSHS does not classify it as an outbreak. According to DSHS, the measles cases in Texas so far this year have been unrelated, as of this paper’s print deadline of May 29. The state health department classifies an outbreak if there are three or more related cases. The measles vaccine is 97% effective, Van Deusen said. The most common way people contract measles is through travel to countries where the virus is more prevalent, Van Deusen said. Once a person is infected, he or she is contagious up to four days before symptoms become visible, which makes it difficult to contain the virus before an outbreak occurs. Private schools Every year public schools and accredited private schools are required to report their vaccination rates to DSHS. In McKinney, private schools have had higher conscientious exemption rates than public schools, according to state data. McKinney private schools include McKinney Christian Academy and Cornerstone Christian Academy. In the 2018-19 school year, McKinney Christian Academy reported 5.98% of students had exemptions. Cornerstone Christian Academy reported 17.09% of student had exemptions—the highest exemption rate among all Collin County schools, according to state data. Sandy Hanson, principal of Cornerstone Christian Academy, said the numbers surprised her because the school encourages all families to immunize their children. “We serve a community of parents that are committed to homeschooling, and those parents tend to [have] some skepticism [toward vaccines], I believe,” Hanson said. “I know there are a variety of reasons that contribute to it, but we encourage our families to [vaccinate], and we want them to get their kids vaccinated.” One school that is veering from the trend is charter school Imagine International Academy of North Texas, which is the only school in McKinney with an exemption rate that has been decreasing in recent years. The school reported an exemption rate of 5.28% in the 2016-17 school year and 3.8% in the 2017-18 school year. The rate dropped again this school year to 3.63%. Olivia Lueckemeyer and Cassidy Ritter contributed to this article. View our other Health Care Directory coverage.