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Alison Young: Unvaccinated kids in schools

Georgia law requires children to be immunized against certain diseases before they can enroll in school. But many metro Atlanta schools and health officials don’t enforce the law, allowing thousands of children to enroll and remain in school without proof of required vaccinations. Public health officials consider school vaccination laws a cornerstone in wiping out measles, mumps and other diseases – and keeping those diseases from reemerging in the United States. But in the past year, the CDC has expressed repeated concern about isolated outbreaks across the country of measles. The disease is being imported from parts of Europe with low vaccination coverage, then spreading among pockets of children whose parents have chosen not to vaccinate them. How did you get started? (tip, editor assignment, etc.) While Georgia hasn’t had any of these mini outbreaks of measles, I was trying to determine whether we had pockets of unvaccinated children that put our state at risk. Vaccination coverage data collected by CDC and the state health department was only available for the entire state – which masks pockets of unvaccinated kids. Knowing that Georgia had a school vaccination law, I set out to find how the data was collected on compliance with the law, and whether parents had sought legal exemptions from vaccinating their children for religious or medical reasons. My initial question was: Are more parents seeking exemptions from vaccination due to concerns about vaccine safety or fears of a possible link between the shots and autism? As the reporting would later show, parents seeking legal exemptions accounted for very few of the children who failed to be in compliance with the school vaccination law. What were the key sources? (people, documents, etc.)

  • Individual school vaccination audit forms. Each fall, county health departments audit vaccination compliance among kindergarteners and sixth graders in all of Georgia’s public and private schools. Unfortunately the state health department only receives a county summary from each local health department and does not have any school-level data. So I had to use the state Open Records Act to get individual school audit forms for each school from each of the county health departments in metro Atlanta. In Fulton County, it turned out they weren’t examining individual school audits and simply got aggregate numbers from each of the two largest school districts. So I had to request their individual forms from those two districts. In some cases county health officials had put individual school data into a spreadsheet (or a grid in a Word document). In others, they hadn’t. I entered all the fields of information into an Excel spreadsheet.
  • The state’s vaccination law and related regulations.
  • School nurses and school health officials.
  • County health department officials.
  • Vaccination experts at the Centers for Disease Control and Prevention and agency press releases/news conference transcripts on recent measles outbreaks.
  • Medical literature about the impact of school vaccination laws, including: “The immunization system in the United States – the role of school immunization laws,” Orenstein, Hinman, in the journal Vaccine 17 (1999) S19-S26; “Enforcement of Age-Appropriate Immunization Laws,” Freed, Am J Prev Med 1998; 14(2); “Impact of Addition of Philosophical Eemptions on Childhood Immunization Rates,” Thompson, Am J Prev Med 2007; 32(3).

What was the biggest roadblock you had to overcome? The time it took to gather the individual vaccination compliance forms/data for each school and input the data into a spreadsheet. I started requesting the documents during the summer and did the data entry in spare moments while working on other stories. One county health department attempted to charge the AJC nearly $1,000 for pulling and copying the individual school forms – a clearly unreasonable cost. To save time arguing over their calculations, we agreed I could come over and review the records at no cost. So I brought my laptop and spent a day and a half in their offices doing data entry. Do you have any advice for journalists working on a similar story? ? Ask for a blank copy of the form used to collect information from individual schools. Then ask each person along the way – school district, county health department, state health department – what they do with that information. Be careful about asking for “data.” Some health officials, I later found out, said they didn’t keep the information in data or spreadsheet form. But it later turned out they had tallied it and put it in a grid in a word processing program. Fact-check with school districts and health departments the final lists you plan to publish. By doing this we discovered that we were furnished wrong forms for two schools. To head off complaints about your reporting, make sure individual private schools and school districts aren’t surprised by the numbers you’re going to report. In calling schools prior to publication it became obvious that many were unaware of the specifics of the state law and thought it was OK for them to not score well on their audit so long as they eventually came into compliance (though no later audit is performed in most cases).

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