Vineyard elementary schools have some of the lowest vaccination rates in the state, according to school nurses and a list of vaccination rates released this year by the state Department of Public Health.

In response to the measles outbreak that began in California in December and has spread to several other states, the DPH released a list of last year’s vaccination exemption rates for most schools in the state, with the West Tisbury School and Tisbury School near the top of the list. The goal was at least partly to encourage more parents to vaccinate their kids.

Schools report their exemption numbers from incoming kindergarten classes to state public health officials at the outset of the school year.

The West Tisbury School had an exemption rate of 26.4 per cent, about 75 under vaccinated and non-vaccinated students, surpassed only by the Waldorf School in Lexington at 31.4 per cent. The Tisbury School had a rate of 13.9 per cent, or about 44 students. Edgartown had the lowest exemption rate on the Island, at 2.6 per cent. The state average was 1.5 per cent.

The Chilmark School and the Martha’s Vineyard Public Charter School, which have fewer students, were not included in the list, but their exemption rates are also high. Janice Brown, the nurse for both schools, reported rates of around 35 per cent for the Chilmark School, which has 56 students; and 20 per cent for the charter school, which has 180 students.

“I think it’s a cause for concern,” said Vineyard schools superintendent Dr. James H. Weiss. “You would like to see 90 or 100 per cent of our students be inoculated and clearly that is not the case. We have a lot of exemptions.” Of the approximately 1,300 students in Island elementary schools, 168 were under vaccinated, although some may have been lacking only one or two shots.

To comply with state law, parents who do not want to immunize their children must submit a medical or religious exemption prior to the start of the school year. Students who are under immunized may be kept out of school in the case of an outbreak, as some were when a West Tisbury student had chicken pox three years ago.

Medical exemptions require the approval of a doctor and must be renewed every year, but religious exemptions require only a one-time written statement by a parent or guardian.

The vast majority of exemptions nationwide and on the Island are religious. Only a handful of students at each Island school last year had medical exemptions.

“Religious exemptions become kind of the catch all,” said West Tisbury school nurse Kristine Cammorata. “If there is not a medical reason for children to receive vaccinations, that’s what parents opt for and we don’t ask a lot of questions.”

School nurses have drafted a letter to parents reminding them to vaccinate their kids if they have not done so, and they plan to finalize the letter next week. The nurses also provide materials from the DPH and the federal Center for Disease Control to parents looking for more information, and encourage them to visit their physicians. They said those materials are the same at each school.

“The nurses do a lot of education around this,” Mr. Weiss said.

Island boards of health also provide information about vaccinations, but their response to the outbreak has been minimal. Board of health members in West Tisbury, Oak Bluffs, Edgartown and Aquinnah, reached this week, said they are not taking any extra precautions in light of the measles outbreak.

Statewide, Franklin County had the most exemptions, at 5.5 per cent, followed by Cape Cod counties at 4.9 per cent. But the state overall vaccination rate is above 90 per cent, among the highest in the country.

Tejman Talebian, director of the immunization program at DPH, said there have not been any significant outbreaks of disease related to areas of high exemption in the state, but noted that if there were an outbreak, the Vineyard would be at risk. “I definitely would be concerned in those communities,” he said. He hoped the list of exemption rates would encourage parents to more fully immunize their kids.

Mr. Talebian noted a national correlation between the high rates and wealthier communities, although the DPH has not studied that connection in the state. People who object to vaccinating their kids tend to favor natural, organic foods and alternative medicines, he said. “So that might be the reason why there is a correlation between socioeconomic status and higher rates of exemption.

“We are not seeing a lot of disease out there right now but certainly those communities with high rates of exemption and low immunization coverage rates would be more prone or more likely to see the beginnings of an outbreak than other areas of the state, that’s for sure,” he said.

Longtime Island pediatrician Michael Goldfein said the last time he encountered measles was in the 1970s, before he came to the Island. He has never encountered a case here, but he believed the high exemption rates could compromise the Island’s ability to fend off an outbreak through widespread vaccinations — a phenomenon known as herd immunity. Dr. Goldfein said it was “socially irresponsible” for parents not to vaccinate their children. “They are taking advantage of the fact that the rest of the population is choosing to immunize their children,” he said, adding that the unvaccinated children “would be at great risk” in the case of an outbreak. As a result of the MMR vaccine (for measles, mumps and rubella) the federal government in 2000 declared that measles had been eliminated in the U.S. But cases have increased since then, peaking last year at 644 cases in 27 states. Some blame an anti-immunization movement that they say is fueled by the internet and a discredited study linking the MMR vaccine to autism. “I don’t think it’s a matter of education,” said Dr. Goldfein, who also noted the study, which was published in 1998 but later retracted. “These people refuse to be confused by the facts, so to speak. They have their very strong opinions and they are not swayed by anything you say.”

Nevertheless, he said about a half dozen parents have changed their minds in response to the measles outbreak and have brought their children in to get the MMR vaccine. “These are people that would never have previously vaccinated their children,” Dr. Goldfein said. But he didn’t know if that would lead to a wider shift in public opinion, or to an openness to other vaccines.

Concerns surrounding vaccines also include potential side effects like skin reactions and fever, Ms. Cammorata said. “For a parent, that’s scary, so for many it puts them off,” she said. Island school nurses routinely meet with the parents of incoming kindergarteners. Some parents already oppose vaccinating their kids, but some are unsure, or may want to stagger the doses.

“There are a lot of people who have their mind made up and I don’t think they are going to be swayed, no matter what information they are given,” Ms. Cammorata said. “Those open to discussion are usually more willing to have their kids immunized according to state guidelines.”

She agreed that the low vaccination rates were cause for concern. “I think about the kids who for medical reasons can’t be immunized,” she said. “Or you have siblings — a kid who is immunized but a sibling too young to receive the vaccine. You worry about those. It is scary.”

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