This version corrects information provided by Vivian Lyons.
As the number of measles cases rises around the country, public health experts say that Vashon’s low vaccination rate puts the island at risk of an outbreak of the disease, which is highly infectious.
Measles cases around the country have topped 120 so far this year, and four cases have been reported in Washington, including one last week in Port Angeles. Experts agree that the reason for the resurgence of measles, which had been declared eradicated in the United States in 2000, is the high number of people who have chosen not to vaccinate their children against the disease.
Vashon has long had a reputation for its low immunization rate, and in recent weeks has been mentioned in several Seattle news stories, in a short online video by the Tacoma News Tribune and an article in The New York Times.
At Seattle-King County Public Health, Interim Health Officer Dr. Jeff Duchin recently said his agency has long had concerns about Vashon’s low vaccination rates.
“It’s a tinderbox,” he said. “If there is no fire in the community, the risk of Vashon igniting is relatively low. But as fires smolder locally and nationally, the risk of Vashon igniting increases.”
The possibility of Vashon igniting is a concern at the Vashon Island School District, which has one of the lowest rates of vaccination in the state. The vaccination rate at Vashon’s public schools is well below the level needed to ensure herd immunity, or the level of immunity needed to prevent the spread of illness within a community.
“Of course we are deeply concerned about it,” Superintendent Michael Soltman said last week. “We have created a substantial vulnerability here.”
District nurse Sarah Day, who keeps close track of students’ vaccines and reports Vashon’s numbers to the state, said she is also worried about a possible outbreak, citing concerns about the people who could be hurt, the amount of work that containing it would require and the financial toll it could take on families and the wider community.
The overall measles vaccination rate at Vashon’s public schools is slightly less than 89 percent, though Day noted the district is seeing improvements in the rates of both measles and whooping cough vaccines. In 2009, only 83 percent of students at Chautauqua Elementary School had received the MMR vaccine, which protects against measles, mumps and rubella. In 2013, that number had risen to just 84 percent. This year it is 87 percent, with McMurray Middle School reporting 89 percent and the high school 90 percent.
“We are vulnerable but still improving,” Day said. “We need upwards of 94 percent to prevent an outbreak.”
Of additional concern is that vaccine rates vary from grade to grade, and in the kindergarten class, Day said, only 82 percent of students have been fully vaccinated against measles, though this number is up from roughly 78 percent last year. That 22 percent MMR-exemption rate among Vashon kindergartners contrasts with about a 4 percent exemption rate at other King County public schools during the same time period.
Should an outbreak happen on Vashon, public health officials would step in and set policy at the schools, which would include keeping unvaccinated students out of the classroom. In the event of an outbreak, Duchin said that he hopes more families would make the choice to vaccinate their children, but he cautioned that the vaccine does not work immediately and that two weeks are needed for immunity to develop.
It is difficult to know the exact immunity of an adult population, he added, as immunity can wane as people age, and individuals who received shots between 1963 and 1967 may have received lesser quality vaccines. Some health officials say middle-aged and older people may wish to have their immunity checked with a blood test or be vaccinated again. However, Duchin said, while older people may contract the disease, the susceptibility of kids is a larger concern, as they are the ones who would likely spark an outbreak.
“The major risk is school-age children because of the way they interact,” he said. “The key issue here is congregating together.”
Because of that risk, Day has reached out to 2008 Vashon High School graduate Vivian Lyons, who is earning a master’s of public health degree in epidemiology and maternal and child health at the University of Washington. Lyons, who is the daughter of district curriculum director Roxanne Lyons, is now helping Day predict the potential for an outbreak at Vashon schools, but has not finished the calculations.
Via email, Lyons spoke to her perceptions of the vaccine picture on Vashon and also noted her concerns.
“I think there is a lot of fear surrounding the measles vaccination, and I think it comes from parents wanting to do what is best for their kids. However, measles is very infectious. One person with measles can infect up to 18 other non-immunized people. About one in every 1,000 people with measles dies, and as many as one out of every 20 people with measles will develop pneumonia,” she wrote, citing CDC statistics.
Additionally, she noted that the quarantine approach may not work for measles, as measles is most infectious in the three to four days before any symptoms show and spreads very easily through the air or on surfaces.
Attention to the current measles outbreak has drawn considerable discussion at the local, state and national levels. In Washington, Rep. June Robinson (D-Everett) has introduced a bill that would allow parents of public school children to opt out of vaccinations only for religious and medical reasons, and not for personal beliefs. Gov. Jay Inslee has expressed his support of the bill, as has Rep. Eileen Cody (D-West Seattle), who represents Vashon and is the chair of the House Health Care and Wellness Committee.
Typically, personal belief exemptions make up the majority of those filed, and that is true on Vashon as well. In the 2011-12 school year, for example, there were 262 exemptions, one for medical reasons, four for religious reasons and 257 for personal reasons.
Reached Monday, Cody said the bill will likely be heard early next week and voted on by Friday, Feb. 20. The final bill may not omit all exemptions for personal beliefs, she said, but may make it harder to claim such an exemption.
“We will see where the support is,” she said, noting the polarization on the topic.
“It’s an emotional question on both sides,” she added.
Indeed, the issue has drawn acrimony from both sides of the vaccine debate, though school district staff, public health officials and others stress that hostility will not help the situation and may make it worse.
Islander Celina Yarkin, a farmer and mother of three who would like to see Vashon’s vaccination rate increase, said the acrimony she has seen and heard about has been a worry of hers since she created a display about the importance of vaccines in 2010.
“This issue has become really contentious. It always has been, but it is blowing up at the local level,” she said. “That really worries me. I hate to see it go there on either side.”
She added that she believes the anger directed at those who have not vaccinated their children may keep parents who are questioning the safety of vaccines from asking questions and getting information.
“I feel like it is going to drive people into wedged positions and not come out,” she said.
Day noted that a small number of parents have recently reported they have vaccinated their children and no longer need exemptions.
At the Franciscan Medical Center, the island’s largest clinic, vaccine rates have been normal in recent months, though Scott Thompson, a Franciscan spokesman, said doctors at the clinic are having conversations concerning vaccinations with patients, particularly older patients.
Later this month, Yarkin, who has created vaccine displays for Chautauqua for the last five years, and Day will put what Yarkin called “very non-inflammatory” vaccine information out in all three schools.
“The school is taking a stand,” she said. “We are pro-vaccine.”
For his part, Duchin attributes to luck whether an outbreak will occur on Vashon or in any community with low immunization rates, as officials cannot predict the behavior of an infected person or where he or she might go.
Day would rather not leave the possibility of a Vashon measles outbreak to luck, but to science instead, especially considering the tragedies the island has seen in recent years.
“I am thinking about our island and all we have been through,” she said. “We do not need this. This is entirely preventable. … I want to be keeping my eyes on the things that we do not even have a shot to prevent.”
