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CDC Sometimes Struggles to See Who's Not Vaccinated

Almost all U.S. kids get at least one vaccine by the time they start school, federal officials reported Thursday. But while a lot of media coverage ha

Almost all U.S. kids get at least one vaccine by the time they start school, federal officials reported Thursday. But while a lot of media coverage has focused on parents who deliberately skip certain vaccines for their kids, the actual picture of who misses vaccines, and why, is less clear.

That’s because only 21 states are reporting vaccine data in the type of detail that’s needed to see just where the holes are, the Centers for Disease Control and Prevention says.

And while statewide data may make it appear that nearly all kids are fully vaccinated, county-by-county details can alert health officials to holes. For instance, California has generally high vaccination rates but several communities where parents selectively immunize their kids. One report found that nearly 18 percent of children in Marin County, north of San Francisco, did not get all the recommended vaccines between 2010 and 2012.

“Pockets of children who miss vaccinations exist in our communities and they leave these communities vulnerable to outbreaks."

“Pockets of children who miss vaccinations exist in our communities and they leave these communities vulnerable to outbreaks of vaccine-preventable diseases,” said Dr. Anne Schuchat, director of CDC’s vaccine center.

“We always worry about children and others with leukemia and other similar medical problems who can’t actually receive the vaccine themselves,” she added.

The Disneyland measles outbreak ended up infecting 147 people in the U.S. and the CDC said it was driven by pockets of unimmunized people.

The CDC released two back-to-school reports that show 99 percent of Americans kids have at least some vaccines. Nationwide, fewer than 2 percent are exempted from vaccination for medical, religious or philosophical reasons.

“As in previous years, fewer than 1 percent of children received no vaccinations,” the CDC team writes in one report.

A careful look at the data shows it’s not just a case of fearful parents refusing vaccines because they worry they might cause autism (they don’t) or because they resent government requirements. Some parents may not be able to get their kids to clinics to get the full series of vaccines, and others may just sign a page saying they are invoking the exemption because it’s too much trouble to get the immunization form from the pediatrician, a CDC team of experts said.

The two different types of surveys for the 2014-2015 school year show that strict state laws make a difference. In Mississippi, where only medical excuses are allowed for not vaccinating a child enrolled in public school, fewer than 0.1 percent of children had an exemption. Idaho had the highest rate, at 6.5 percent.

Idaho allows exemptions for personal reasons but specifically tells parents they cannot claim them casually. “The law does not allow parents/guardians to claim an exemption because the shot record is lost or incomplete, or because it is too much trouble to contact the physician or clinic and obtain a copy,” the state says on its website.

But the CDC researchers found parents in some states may be doing just that.

“Parents or guardians might have obtained an exemption rather than submit docu­mentation of a child’s vaccination history. This could account for up to 25 percent of nonmedical exemptions,” they wrote.

And they found big differences in full coverage depending on the type of vaccine.

Under the current schedule, kids should get about 25 different vaccinations by age 6, protecting against 14 different diseases, including polio, rotavirus, measles, influenza, a family of bacteria that cause pneumonia and other ills.

"Fewer than 1 percent of children received no vaccinations."

Coverage ranged from 93 percent of kids who got all three doses of polio vaccine to just 91 percent for chickenpox. But it differed by state – only 87 percent of children in Colorado were up to date on the measles, mumps and rubella (MMR) vaccine while 99 percent of Mississippi kids were.

Rates for rotavirus, hepatitis and other vaccines fell even lower. Black and Hispanic kids were more likely to miss out than white kids.

“Children living below the poverty level had rotavirus coverage that was 14.1 percentage points lower than that of children at or above the poverty level,” the CDC researchers wrote.

It shouldn’t be due to cost – health insurance is required to cover vaccines with no co-pay, and the Vaccines for Children program provides free vaccines at clinics. It might be logistics, the CDC said.

“Therefore, the window for administering rotavirus vaccine is narrow and could be missed because of transportation challenges, difficulty obtaining time off from work, or other logistical issues, situations that might occur more frequently in poorer families,” the team wrote.

Children can miss out when pediatricians agree to space out shots, as well.

School requirements are an important tool. “School vaccination regulations provide an opportunity for children who are behind on vaccination in infancy to be vaccinated by school entry,” the CDC team said.