What do Wilton’s Student Immunization Rates Mean in the Conversation about Measles Vaccines?

With the largest U.S. measles outbreak since before its eradication in 2000, towns nationwide and in CT are asking if there’s cause for concern in their communities. Connecticut is considered ‘low risk’ for potential outbreak, but a newly released report by the CT Department of Public Health (DPH) on school immunizations and exemptions rates (from 2017-2018 survey data) indicates that more than 100 schools in CT fall well below federal guidelines of 95% student vaccination rates for measles, mumps, and rubella (MMR).

Six of Wilton’s schools are included in the state’s report. Of the six, two fall below that guideline number.

School	Type	Religious Exemptions	Medical Exemptions	Total Exemptions	Total % Vaccinated
Cider Mill	Public	.1%	0.0%	.1%	99.9%
Middlebrook	Public	1.8%	.5%	2.3%	97.7%
Miller Driscoll	Public	2.0%	0.0%	2.0%	98%
Our Lady of Fatima	Nonpublic	7.6%	0.0%	7.6%	92.4%
Montessori School	Nonpublic	11.3%	.7%	12.0%	88%
Wilton High School	Public	1.4%	0.0%	1.4%	98.6%

Growing Interest and State Response

The DPH released its report after interest from state legislators as well as an inquiry from the online news website, CTNewsJunkie.com. With the legislative session in full swing, CT legislators held hearings and began discussing the merits of revising public school entrance requirements by repealing CT’s religious exemption for vaccinations.

Lawmakers had considered rushing legislation to the floor as early as this legislative session, but at a press conference in Hartford last Thursday, May 16, it was articulated that they would look to the DPH for legislative recommendations about what is necessary to boost immunization rates among school-aged children before moving forward with any vote. “The data showed us the problem, but it didn’t necessarily show us the way,” Rep. Liz Linehan (D-Cheshire) said at the press conference.

The debate to end religious exemptions in schools is fueled by two things–how virulent measles is and the growing numbers of unvaccinated children. Measles is highly contagious:  the airborne disease can live in the air and on surfaces outside of the body’s respiratory tract for up to two hours after being released through a simple cough or sneeze. The Centers for Disease Control (CDC) reports a 90% chance of infection for susceptible persons who come into contact with an individual who has the virus.

The CDC has confirmed 839 individual cases of measles in 23 states this year, most recently in Brooklyn–which is where one of the three reported CT cases was contracted. Connecticut is considered at “low risk” for a widespread measles outbreak because of what’s called “herd immunity”:  high vaccination rates of 95% or above in the overall population create insulated barriers of increased protection for vulnerable community members–infants, the elderly, the unvaccinated, and those with compromised immune systems.

Students can request exemptions in Connecticut for two reasons:  medical and religious. The exemptions are granted by the state via a form (found online) that must be filled out and signed by the parent/guardian and a CT-liscensed official as deemed appropriate by the state.

Statewide, the rate of students requesting religious exemptions is increasing, which DPH commissioner Renee Coleman-Mitchell attributes to a growing number of kindergarteners who are not fully immunized, calling it a “troubling trend.”

Year	New Enterers	Religious Exemptions	Medical Exemptions	Total Exemptions
2015-2016	84,793	1088 (1.3%)	190 (.2%)	1.5%
2016-2017	82,339	1100 (1.3%)	217  (.3%)	1.6%
2018-2019	83,508	1255 (1.5%)	258 (.3%)	1.8%

Some of the schools with the highest rates of non-vaccination are located in Newtown, Fairfield, Putnam, New Hartford, Easton, and Stamford, including these schools that fall below the federal immunization guideline of a 95% vaccination rate:

School	Type	Town	Religious Exemptions	Medical Exemptions	Total Exemptions	Total % Vaccinated
Housatonic Valley School	Nonpublic	Newtown	37.7%	0.0%	37.7%	62.3%
Giant Steps	Nonpublic	Fairfield	34.2%	0.0%	34.2%	65.8%
Crossway Christian Academy	Nonpublic	Putnam	25.9%	0.0%	25.9%	74.4%
Ann Antolini School	Public	New Hartford	21.2%	.8%	21.9%	78.1%
The Speech Academy	Nonpublic	Easton	13.2%	3.8%	17.0%	83%
Apples Preschool	Public	Stamford	15.7%	1.2%	16.9%	83.1%

Digging Down into the Wilton Numbers

At first glance, the exemption rates might seem alarming for the two Wilton schools that fall below the CDC’s recommended guidelines. But what do the percentages mean in terms of actual numbers of students? Below is a breakdown:

School	Total Enrollment	% Total Exemptions	Actual Number of Students Exempted
Cider Mill	859	0.10%	0.859
Middlebrook	981	2.3%	22.56
Miller Driscoll	729	2.0%	14.58
Montessori School	148	12.0%	17.76
Our Lady of Fatima	134	7.6%	10.18
Wilton High School	1,338	1.4%	18.73

Barry Bogle, health director for the Town of Wilton, described the numbers in the report as a specific “dataset within the Connecticut School System that does not provide any definitive association between the exposure risk for students who have one or more immunization exemptions and contracting measles.” In other words, vulnerable students who otherwise might be protected by the herd within the school setting, may become exposed as they head out to camp, sports, activities, or home, where interactions with carriers are also a possibility.

The Wilton schools cited in the report remain compliant with state reporting on immunization records, as is evidenced by the numbers. The Montessori School directed GOOD Morning Wilton to a previous statement that the school’s head of school, Lisa Potter, gave to other media:  “The health and well-being of our students is the highest priority for us. Exemptions for medical or religious reasons are granted by the state of Connecticut, not by schools. Our school is 100% compliant with state law.”

Like schools across the country, Our Lady of Fatima School has seen an increase in requests for immunization exemptions. Sue Schneider, school nurse at OLF, pointed out that the state report can be confusing because it does not break down the numbers reported by individual schools. She said that all students might not be vaccinated on the same timeline and thus might not be included in the data submitted in October. She also stated that while the school’s total exemption rate is 7.6%, “the immunization rate for MMR is 96%, which is within the 95% guideline for herd immmunity.”

Wilton schools remain compliant in state reporting, exemption requests have increased, and measles outbreaks have been on the rise in the US and around that world. As can be seen above, the results of the state report provide important data for reviewing some of the concerns associated with immunization exemptions, vaccination rates, and contagious disease, but it appears to leave more questions than answers for town and school officials, and the community. It is written on the DPH report’s first page, that “data is limited in a number of ways.   Some of those ways include; self-reporting discrepancies by districts; lack of shared data on schools with fewer than 30 students; timing of state reporting vs. actual student innoculation; unknown numbers of exemptions received for individual children; and serologic proof of immunity.

What is clear is that school and town health officials need to have the same discussions going on, as the state and national levels and numbers share parallel trends. Preparedness and proactive measures for systemic response strategies and communication are helpful to assist in providing district-wide support to all community members. This is especially true when the discussion is about a disease that can be acquired through a high-five, a shared drink, or the tossing of a baseball.

Maria Coleman, director of human resources for Wilton Public Schools, said that in the event of a possible case of measles the district would “work through the school nurse and district medical advisor” to collaborate with the student and family, medical professionals, and local/state DPH for guidance on confirmation of diagnosis and implementation of appropriate health and safety protocols. She added that the district’s priority “is the protection of students who are fragile [those with medical waivers].”

Bogle echoed this response and reiterated that immediate town/state reporting would occur and that both DPH offices would be “jointly responsible for the investigation and control of reportable diseases, including measles.”