Fort Worth

How Tarrant County came to be known as an anti-vaccine ‘hotspot’

More Texas families are opting out of vaccines with non-medical exemptions filed at schools — a trend that helped Tarrant County earn the description of “hotspot” in a recent national study and is causing worries about potential disease outbreaks.

“It is expanding at really scary rates,” said Allison Winnike, president and CEO of The Immunization Partnership (TIP), a Texas nonprofit that works to eradicate vaccine-preventable diseases.

Last school year, 56,738 or 1.07 percent of Texas students in kindergarten through grade 12 filed an exemption, according to an annual report by Texas Health and Human Resources. That is up from the previous school year when 52,756 (0.97 percent) students filed the exemptions.

Recently, Fort Worth, Plano, Houston and Austin were singled out as “hotspots” because of large numbers of non-medical exemptions, in a study in PLOS Medicine.

Exemption trends in Tarrant County show a “big” increase that should worry families, Winnike said.

“The public at large should be concerned that they are not going to be protected,” Winnike said, explaining that measles had been declared eradicated in the United States but has re-emerged.

Vaccine proponents are often at odds with an anti-vaccine movement that maintains parents should be allowed to choose whether they want to immunize their children. The issue plays out on social media with passionate comments and posts.

The Keller-based group Texans For Vaccine Choice said the issue is about parental rights. Their mission statement reads: “We promote the preservation of personal liberties and informed consent by opposing measures to limit vaccine choice rights or discriminate against those who exercise such rights.”

Jackie Schlegel, executive director for Texans For Vaccine Choice, said there is no “wild, anti-vaccine movement.” Instead, there are parents who want to have the right to decide whether or not to vaccinate with the consultation of their healthcare providers.

“We are all trying to do the best we can for our children,” Schlegel said.

A growing concern

Texas students have to show vaccination records to attend child care centers and public or private schools. But Texas is among 18 states that allow families to opt out of vaccines through personal exemptions.

An exemption is filed for “Reasons of Conscience” when parents decide they do not want their child to receive vaccines for any reason.

Families fill out an “Affidavit Request for Exemption from Immunizations for Reasons of Conscience” obtained by the state. The form is submitted to a school or child care facility within 90 days of being notarized. They are typically turned into a school nurse, according to the Fort Worth school district.

Refusing immunizations for religious reasons also falls under the conscientious exemption process..

But exemptions for medical reasons fall under different state rules that require a statement signed by a doctor.

Fort Worth school officials said sometimes students enroll with an incomplete immunization record but are on schedule so they are allowed to enroll in school provisionally for 30 days until the next vaccine is due.

Tarrant County was ranked eighth among metropolitan areas with the largest numbers of kindergarten students with non-medical exemptions according to the study “The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in the states and counties.”

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Fort Worth, Texas was described as a “hotspot” because of increasing numbers of families that file non-medical exemptions for vaccines. Courtesy PLOS Medicine

Local immunization advocates aren’t surprised to see Texas and Tarrant County described as a “hotspot.”

“It was not new. It’s been coming. We have been watching it for years,” said Terri Andrews, president of the Immunization Collaboration of Tarrant County. “It’s growing exponentially.”

Health experts want communities vaccinated at a 95 percent level to protect entire communities from disease — a practice known as herd immunity.

Andrews said she worries some Texas campuses are getting too close to falling under 95 percent.

Immunization advocates point to recent headlines about measles cases, including cases investigated in January in Ellis County. This week, a confirmed case of measles at Plano West Senior High School drew more headlines. Collin County health officials announced the case, adding that anyone at the school between Aug. 14 through Aug. 16 could have been exposed.

Dr. Jason Terk, a pediatrician who practices in Keller, said people are protected from vaccine-preventable diseases by herd immunity. But when more and more children opt out of vaccines, communities become vulnerable to outbreaks.

“The one we are so concerned about is measles because it is so contagious,” Terk said, explaining that it is one of the most infectious diseases.

Terk said once exposed to the measles virus, a person who is unvaccinated has a 90 percent chance of getting sick. He said the measles virus is airborne. Once the virus is in a space, it remains contagious for 30 minutes. The Centers for Disease Control and Prevention describes measles as a serious respiratory disease that causes rash and fever. It spreads when an infected person breathes, coughs or sneezes.

“It is ridiculously contagious,” Terk said.

The CDC reports that measles can be dangerous for babies and young children. Between 2001-2013, 28 percent of children younger than five who got the measles were treated in a hospital. In some cases, it can lead to pneumonia, brain damage, deafness and death.

Terk said parents should not worry about the safety of vaccines.

“Vaccines are safe, they are important, they are critical to the health of their child,” he said.

Looking at local data

Texas’ annual report shows the highest rates of exemptions were at private schools last year. For example, in Tarrant County, Messiah Classical Academy reported the area’s highest rate with 18.07 percent.

Some private schools in Tarrant County didn’t have any exemptions recorded because they don’t accept non-medical ones. That policy is reflected at schools operated by the Catholic Diocese of Fort Worth and Fort Worth Country Day.

“We allow medical exemptions and that is it,” said Eric Lombardi, head of school at Fort Worth Country Day, adding there are no plans to change.

In Tarrant County, the public school system with the highest percentage of non-medical exemptions last year was Northwest schools with 2.84 percent. It was followed by Keller schools at 2.45 percent.

A local analysis, conducted by students at TCU, offers a grassroots look at which Fort Worth schools have the highest percentage of non-medical exemptions. The Fort Worth school district’s rate last year was 0.47 percent, but several campuses were higher than the state’s rate.

For example, the TCU data indicates that North Hi Mount Elementary had the district’s highest percentage of exemptions at 3.4 percent (14 of 412 students were not vaccinated).

The campuses with the next five highest percentage of students listing a non-medical exemption are Burton Hill at 2.77 percent, Benbrook Elementary at 1.72 percent, Tanglewood at 1.67 percent, Lowery Road Elementary at 1.62 percent and Daggett Montessori at 1.6 percent.

The TCU sampling didn’t include all campuses. It reflected 232 exemptions filed at 122 campuses. Last school year, the district’s total enrollment was 86,869 students and there were 143 campuses.

Chip Stewart, a journalism professor at TCU, assigned students in his media law and ethics course to make requests under the Texas Public Information Act as part of a class project in the spring semester. Each student requested information about vaccine exemptions and total student numbers from three elementary schools in the Fort Worth Independent School District. While many schools responded individually, ultimately FWISD officials provided data on nearly every school in the district.

“The Texas Public Information Act is a crucial tool for government transparency,” Stewart told the Star-Telegram. “It allows citizens to hold our institutions accountable, and it’s important for every journalist to know how to make requests under the act. That’s why I have my students do this every semester. I was pleased with how responsive Fort Worth ISD schools and the district itself were in the spring, and I hope we were able to let people know a bit more about an important public health issue.”

Measles symptoms

High fever

Rash of tiny red dots that start at the head and spread througout the body

Diarrhea

Ear Infection

Source: Centers for Disease Control and Prevention

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