MICHAEL FISHER / PORTLAND PRESS HERALD GRAPHIC SOURCE: Maine Centers for Disease Control

Maine’s vaccination coverage for students entering kindergarten worsened in 2017-18, making outbreaks of preventable diseases like measles, chicken pox and pertussis more likely.

Five percent of kindergartners — about 600 students of the 12,500 in that grade — attended school this year without getting required vaccines because their parents opted out on philosophic or religious grounds. An additional 0.3 percent of students were exempted from vaccines for medical reasons, such as having leukemia, according to data released this week by the Maine Center for Disease Control & Prevention.

The 5 percent opt-out rate will likely be among the worst in the nation – with unvaccinated children attending school posing a persistent public health threat in Maine since at least 2013. Maine law allows parents to easily forgo vaccines for their children, by signing a form objecting for religious or philosophic reasons. Efforts to make it more difficult to opt out of school vaccines failed in the Legislature in 2015.

Maine’s 4.8 percent voluntary opt-out rate in 2016-17 was seventh-worst in the nation for vaccine coverage, and more than double the national average of 1.8 percent. Maine releases its annual data in the spring, while the state-by-state comparison data reported by the federal Centers for Disease Control and Prevention comes out in the fall, when the comparisons will be available for 2017-18.

Myths about vaccines – that they cause autism and aren’t safe – persist despite the overwhelming evidence that vaccines are safe and the retraction of a 1998 article in a British scholarly journal claiming a link between autism and vaccines. The Maine CDC this week also released school-by-school data, revealing that dozens of schools operate with worrisome opt-out rates. Thirty-one elementary schools across the state have opt-out rates of 15 percent or higher, making those schools more likely to experience a significant infectious disease outbreak.

Blue Hill Consolidated School has 26.9 percent of its kindergartners and 36.4 percent of first-graders attending school without required vaccines, the highest rate of unvaccinated students in the state among public schools with at least 15 kindergarten students. Mark Hurvitt, superintendent of School Union 93, which includes Blue Hill, told the Portland Press Herald that the high opt-out rate at Blue Hill didn’t register with him as a major concern.

“We keep track of it, but it hasn’t risen to a level that anybody here thinks of this as a big problem,” Hurvitt said.

Other schools with high rates of kindergarteners who haven’t been immunized include Lincolnville Central School at 22.7 percent, West Bath at 19 percent and Conners Emerson School in Bar Harbor at 17.1 percent. Private schools with at least 10 kindergarten students reporting high opt-out rates included Ashwood Waldorf School in Rockport at 60 percent and Seacoast Waldorf School in Eliot at 40 percent.

Vulnerable to a large outbreak

For Christina Paul, 39, of Windham, vaccines are a lifeor death matter for her 6- year-old daughter, who was born with a rare birth defect that required a liver transplant at age 2. Paul said every day, her daughter Zoé has to take medications that help her body accept the transplant but weaken her immune system. For now, Zoé is home-schooled because the Pauls are worried about her being around unvaccinated students, and children that age tend to not have the best hygiene, she said.

“For us, it’s not just a big deal, it’s the biggest deal,” Paul said. “If she contracted any one of these communicable diseases, it could be lethal to her.”

Dr. Laura Blaisdell, a Yarmouth pediatrician and staunch proponent of childhood immunization, said schools with many unvaccinated students are a ticking disease bomb.

“There has been a certain amount of luck that a spark didn’t start in one of these schools where there’s lots of unvaccinated students,” Blaisdell said. She said Maine is vulnerable to a large outbreak, similar to recent outbreaks of pertussis and measles in California in 2010 and 2014, and a measles outbreak in Minnesota in 2017. Thousands of children contracted pertussis in California, resulting in more than a dozen infant deaths.

Maine has the third-highest pertussis rate in the nation, at 18.3 cases per 100,000 residents in 2016, the most recent year for which nationwide comparisons are available, according to the federal CDC.

Blaisdell said that when more people are vaccinated, it provides the “herd immunity” that helps keep those who aren’t vaccinated – such as the immune-compromised or infants too young to be vaccinated – safe from communicable diseases.

“The immunity that vaccinated children provide to other children in school cannot be understated. When a school has 3 percent of kids unvaccinated, the 97 percent that are vaccinated are keeping outbreaks at bay,” Blaisdell said. “But there is a threshold for each disease at which community immunity can no longer afford protection. The rates of vaccinations in an increasing number of (Maine) schools are well below the threshold to prevent outbreaks.”

Blaisdell said that if more than 5 percent of children at any one school opt out of vaccines, the “herd immunity” is threatened.

Paul said her family must rely on “herd immunity” to keep her daughter healthy.

Informed vaccination devisions

Maureen Sturtevant, of Portland, has a son, Sam, 4, who needed a liver transplant as a baby and is immune compromised. The Sturtevants inquired about preschool vaccination rates before deciding where to enroll Sam this year.

They also are keeping a close eye on vaccination rates at their neighborhood elementary school, Longfellow Elementary, which has optout rates at about the state average, for when Sam is old enough to go to kindergarten.

“We don’t want him to live in a bubble, but it’s absolutely a concern,” Sturtevant said. “We hope that people are making informed, evidence-based decisions.”

In recent years, Maine has experienced several pertussis and chicken pox outbreaks at schools, including six pertussis cases at Sanford schools this spring.

Yarmouth schools reported a pertussis outbreak in spring 2017, and in that same school year, pertussis cases also were reported at SAD 51 in Cumberland, at Waynflete in Portland and in South Portland. In the 2014-15 school year, chickenpox outbreaks were reported at Seacoast Waldorf School, Lisbon Community School and others.

In response to high pertussis rates and the waning effectiveness of the pertussis vaccine by the time students reach middle school, Maine started requiring a seventh-grade booster shot for the pertussis vaccine for 2017-18.

Andrew Dolloff, Yarmouth superintendent, said there’s only so much that school or health officials can do because state law allows parents to sign a form and opt out of vaccines.

“Although our goal is 100 percent vaccination, the reality is that we settle for 100 percent compliance with the law, which does allow for opting out so long as the appropriate paperwork is completed,” Dolloff said. “We have had to exclude a small number of students from school when a contagious disease has been detected, which has the immediate impact of increasing vaccination rates.”

Dolloff said some parents of unvaccinated children, faced with a 21-day exclusion from school when there’s an infectious disease outbreak, choose to immunize their children so they can return to school.

Support for new legislative push

Dr. Linda Sanborn of Gorham, a former Democratic state representative who is running for a state Senate seat this year, was the sponsor of the 2015 bill that would have made it more difficult for parents to opt out. The law, if it had passed, would have required the signature of a health professional before parents could opt out.

Republican Gov. Paul LePage vetoed the bill, and the House fell five votes short of a veto override. Some Republicans, including LePage, viewed the bill as an intrusion on parental rights. And some liberal Democrats doubt the safety of vaccines, although only one House Democrat voted against the measure in 2015.

Sanborn said she believes the Legislature should try again in 2019, although the prospects of the bill depend on who wins the governor’s race and the makeup of the Legislature.

“This is so important,” said Sanborn, a retired primary care doctor. “We really need to bring back another bill and try again.”

Blaisdell said that although public education is important, changing the law is what is needed. After the measles outbreak in California, lawmakers there eliminated all non-medical exemptions. The opt-out rate then plummeted from 2.9 percent in 2013-14, before the law was approved, to 0.6 percent in 2016-17, according to the federal CDC.

“Other states are leading the way on this. Will we learn from the wisdom of other states?” Blaisdell asked. “With tobacco, the needle didn’t move until we put laws in place that put parameters on what was acceptable behavior.”

Joe Lawlor can be contacted at (207) 791-6376 or jlawlor@pressherald.com Twitter: joelawlorph