Over 1/3 of Ky. students in violation of rule requiring hepatitis A shots; other immunizations fall short; report has county figures

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More than a third of Kentucky school students are in violation of the year-old state law requiring them to be vaccinated for the liver disease hepatitis A, according to the annual report by the state Department for Public Health on student immunizations.

"While hepatitis A rates were the lowest of all required vaccines, they reflect a broader trend: Kentucky students still aren’t getting the required number of shots," reports Alex Acquisto of the Lexington Herald-Leader. "Kindergartners, who have the highest compliance rates to meet, failed to meet state standards in all categories."

Only 65 percent of students in kindergarten, seventh grade and the 11th and 12th grades had received at least two doses of the hepatitis A vaccine. Only kindergartners, at 84.3%, came close to "meeting the state’s target compliance rate of 85%," Acquisto notes. "Rates were lowest among high school seniors, at 46 percent, followed by high school juniors at nearly 50%, and seventh graders at 76%."

Among high-school students, Hickman County was the only one that met the 85% hep-A standard; it also was the only one where juniors met the target compliance rates for all immunizations. Nearby Ballard County was the only one to meet all of the target compliance rates for seniors.

In Johnson County, only 9 percent got two hepatitis A shots, and the county was out of compliance with every immunization requirement for high schoolers, according to the county-by-county report.

In adjoining Magoffin County, where 21% of high school seniors and 14% of juniors got two hep-A shots, School Supt. Scott Helton told Acquisto there isn't a sense of urgency. “When it’s change, it’s always hard at first,” Helton said. “Most people seem to think it won’t happen to them.”

The state required hepatitis A vaccination for the current school year after an outbreak of the disease, which began in late 2017 and has infected 4,943 Kentuckians and killed 61. "One health official says initially low rates of compliance are normal, even in the face of a public-health crisis," Acquisto reports, quoting Dr. Sean McTigue, a University of Kentucky infectious disease pediatrician.

“Anytime there’s a vaccine that’s added to school requirements there’s some hesitancy among parents, even though this is not by any stretch of the imagination a new vaccine,” McTigue said, adding that it will take “at least two years,” to get close to 85%, because immunization requires two shots six months apart and the school year lasts nine to 10 months. "Most children and teens get vaccines from their pediatricians, who they might only otherwise see once a year," Acquisto notes.

Stigma is also an obstacle, because other strains of hepatitis "are spread primarily by sharing needles for injection of drugs," Acquisto reports. Unlike blood-borne hepatitis C, hepatitis A "is spread primarily through contact with an infected person, or through consumption of fecal material, usually by way of unclean food or water."

Reporting and exemptions

In addition to the lack of vaccinations, there is a lack of reporting, Acquisto notes: "State law requires immunization records to be filed within two weeks of when a student begins attending school, but the report shows 796 high school seniors didn’t provide vaccination records to their schools at all, along with 1,087 11th-graders, 674 seventh-graders, and 1,696 kindergartners — 8%, total.

"Some counties reported significant numbers of students who had no vaccination certificate on file. In Robertson County, 23 percent of high school seniors had no immunization record on file. The same went for 25 percent of Wolfe County kindergartners, 10 percent of Magoffin County seventh-graders, and 15 percent of Clark County juniors."

The report does not include the estimated 19,250 students who are home-schooled, because the state law requiring immunization does not apply to them.

In 2017 the state made it easier to claim a religious exemption from the immunization law. "Roughly 4%, or 2,040 students, claimed a religious exemption, while 2.3%, or 1,175, claimed a medical exemption," Acquisto reports. "Carlisle County had the most high-school seniors, 6%, who claimed a religious exemption, followed by 3.4% of Jessamine County eleventh graders, 5.5 percent of Clinton County seventh graders, and 5% of Crittenden County kindergartners.

Public-health experts worry that the exemptions and the anti-vaccination movement threaten "herd immunity," which occurs when enough people have been immunized against a disease to protect others who are not immunized. (Some can't get vaccinations because their immune systems are too weak to allow them to get shots, or because they are too young.)

The report quoted research that has found high immunization rates are “particularly difficult” to maintain “as populations become more sophisticated and more likely to question recommendations. Unless direct communication about the social benefits of vaccinations are relayed to parents, there will continue to be increases in ‘free-ride’ or reliance on herd immunity to avoid vaccination within school settings. Therefore, more education needs to be provided to parents about the public health impacts vaccinations have within schools, especially for the protection of vulnerable students who are immunocompromised.”