Number of students exempt from vaccinations growing

Haleakala Waldorf School has highest rate of unvaccinated students in state

Kaiser Permanente LPN Melody Quedding gives Maui High School sophomore Karl Matillano, 16, a meningitis booster vaccination Friday morning at Kaiser’s Maui Lani Medical Office in Wailuku. “That wasn’t bad,” Matillano said after receiving his shot. -- The Maui News / MATTHEW THAYER photo

HALIIMAILE — More than half of Haleakala Waldorf School’s 245-student population is unvaccinated, the highest amount of students at a single school in the state with exemption from vaccines required by the Hawaii Department of Health, according to recently released state data.

In addition, Haleakala Waldorf, with grade and high school campuses in Kula and Makawao, has the highest percentage of exemptions based on enrollment in the state. Out of the 245 students, 129, or 52.7 percent, are claiming exemptions, all of which are attributed to religious reasons, the report said.

Other Maui County public, private and charter schools with noteable amounts of unvaccinated kids at single locations were Kihei Charter (76-77 students of 624 total) and Kalama Intermediate (70 of 888 total) schools. High exemption percentages based on enrollment were Roots (41.5 percent of 53 total) and Montessori schools (37.1 percent of 181 total).

Local school administrators, parents and state officials are weighing in on the controversial subject of vaccination, where Hawaii’s total exemption numbers are increasing each year. Meanwhile, national reports of measles climbed Wednesday to its highest level in 25 years, according to Centers for Disease Control and Prevention. The latest city among 22 states to be hit is Los Angeles, with more than 700 staff and faculty at two universities placed under quarantine last week. In some states, fines, threats of prosecution, mandatory vaccinations and other measures are being taken to combat the measles outbreak.

Hawaii’s public, private and charter schools are mandated to submit self-reported vaccination information to state DOH by Jan. 1 of each year. The department calculated this school year’s results, broken down by enrollment total and percentage of enrollment claiming either religious or medical exemption. For the 2018-19 school year, two of 51 total Maui County schools — Paia Elementary and Horizons schools — have yet to release reports.

Lincoln Wendorff, 4, picks out a sticker after getting vaccinated Friday morning at the Kaiser Permanente Maui Lani Medical Office in Wailuku. Unvaccinated students at a single school are highest in the state at Maui County’s Haleakala Waldorf School, where more than half of the student body has a religious exemption from state-mandated vaccines, according to a state Department of Health report on the 2018-19 school year. -- The Maui News / MATTHEW THAYER photo

After Haleakala Waldorf, the highest numbers of exempt students per count were at these schools: Honolulu County’s charter Hawaii Technology Academy with 111 exempt of 1,101 total; Kauai County’s public Kilauea Elementary School at 104 exempt out of 312 total; and Hawaii County’s charter Kona Pacific PCS at 83 exempt of 222 total.

Again after Haleakala Waldorf, the highest percentages of student enrollment claiming exemption per county were: Hawaii County’s private Malamalama Waldorf School / Kinderhale with 46.3 percent of 95 students; Kauai County’s charter Alakai O Kauai Charter School with 40 percent exempt of 130; and Honolulu County’s public Sunset Beach Elementary School with 18.9 percent exempt of 403.

State DOH Immunization Branch Chief Ronald Balajadia said the school report should be viewed in a bigger context, where more needs to be done to reduce increasing numbers of exemptions statewide.

“The bigger context is that we should be concerned there are increasing numbers of exemptions,” Balajadia said. He added that due to high rates of travel in and out of Hawaii, our community is especially vulnerable to illnesses that can be prevented with vaccination.

“The fact is, it just takes one person who is susceptible, regardless of which locations have the highest and who has the lowest,” he said Thursday.

Kaiser Permanente LPN Melody Quedding prepares a vaccination shot Friday. An online list of state Department of Health-mandated vaccines for Hawaii schools includes a schedule of age and grade-level requirements for public, private and charter schools. -- The Maui News / MATTHEW THAYER photo

‘A hot topic right now’

Kelly Brewer, Haleakala Waldorf School administrator, speculated about the reasons behind her school’s exemption numbers. It may be the result of parents going slower than the Hawaii vaccine schedule and others possibly deciding a vaccine stance prior to student enrollment.

“The school makes no statement on vaccines; there’s nothing that the parents are encouraged to do or not encouraged to do,” she said last week. “When our parents are making choices similar to other schools in our area, and perhaps in Maui in general, by the time they’ve come to us, they’ve made the heart of their immunization choices.”

Asked whether immunization choices would impact the health or safety others in the community, Brewer said the decision is up to each parent.

“The whole thing is a little bit of a hot topic right now, as far as what others are choosing to do and how it affects others in the community, we have no stance on this,” she said. “It is up to parents in consultation with their own physicians.”

All of the students claiming exemption at Haleakala do so for religious reasons, the state report said.

Cheryl Zarro, director of financial services at Kihei Charter School in South Maui, said that their numbers might be attributed to enrollment approaches, where siblings of an existing student are given priority over others. Typically if one student is claiming exemption, the others will be as well.

Kihei Charter complies with DOH vaccination reporting requirements, Zarro said, adding that she, herself, is supportive of vaccines and has vaccinated her children.

“There was a lot of misinformation in regards to people feeling like it (vaccination) causes problems,” she said. “I do think we have an element of that going on for some families who don’t remember how bad it can be, being sick, because they’ve had vaccination. Some children today don’t even know what polio looks like. . . . I believe we need to do all we can to keep our students healthy.”

Eric L. Dustman, head of Montessori School of Maui, said his Makawao school for 18-month-old to 8th-grade students complies with state rules and it works to inform families.

“As you would expect, great efforts are extended to ensure the safety, health and well-being of all students on our campus and elsewhere,” he said. “We ensure that all our policies and procedures are aligned with the Department of Health rules, and we work to educate our families to ensure their compliance.”

Melita Charan, head of Roots School, a preschool to 8th-grade institution in Haiku, said the school does not have an official stance on vaccination and did not reply to requests for feedback on the state DOH report.

Kalama Intermediate and Paia Elementary schools, along with Horizons Academy of Maui, did not respond to requests for comment on the report. Two schools, Lahainaluna and King Kekaulike high schools, shared vaccination exemption numbers Friday that were not yet tallied on the state website. Their exemption totals did not rank them in the top three for Maui County.

The state Department of Education deferred questions to the state DOH, saying it takes the health department’s lead when it comes to vaccination efforts, but said that rates were “relatively low” for its public schools.

“Religious and medical exemptions at DOE schools in Maui County are generally low at less than 10 percent with the only exception being Kula Elementary at 12.9 percent,” state DOE spokesman Derek Inoshita said last week.

Doctor calls report ‘pretty shocking’

Hawaii state law requires that all students meet immunization, physical exam and tuberculosis clearance requirements before they attend any public or private school. Immunizations required for school attendance include diphtheria/tetanus/pertussis; polio; MMR (mumps, measles, rubella); hepatitis B; hib (haemophilus influenzae type b for preschool attendance); and varicella (chickenpox). A number of vaccine doses are required by age and grade, as listed in a state DOH schedule online.

Parents and guardians may obtain exemptions from a physician for medical reasons, for example, if the immunization is medically contraindicated due to a stated cause. They may also get a religious exemption by filling out paperwork, which states that “the person’s religious beliefs prohibit the practice of immunization.” It cannot be based on objections to specific immunizing agents, the law said. The vast majority of exemptions in Hawaii cite religious reasons.

Kenneth B. Kepler, a Kihei-Wailea Medical Center doctor who has experience in internal medicine and pediatric work, said the reason for rising exemptions may be attributed to social influences more than religious beliefs.

“There is no major world religion that says vaccines are harmful,” he said last week.

“I think it has to do with the fact that we attribute our friends’ opinions to be very important and valid,” he added. “We see that in all aspects of life. . . . The other truth is that if you are exposed to someone who doesn’t vaccinate, you are more likely to not vaccinate yourself. That’s particularly true in social media.”

Kepler, the son of a local pediatrician and public health nurse, said there is “profound medical evidence” supporting vaccination, and is often frustrated with misstated medical information even in “good-meaning articles.” He traced some vaccination-linked-to-autism fears to a British medical journal that has since retracted the findings.

Another Maui doctor, Joel Friedman of Maui Health Network, who specializes in cranial-sacro therapy and homeopathy, said that his job is to “counsel parents regarding pro and con of vaccines” and let them decide what they feel is best for their child. “This is called informed consent and is a cornerstone of modern medicine,” he said.

“The conversation about childhood vaccinations has gotten very loud and very angry between the pro- and anti-vax proponents,” Friedman added, declining to elaborate on the topic.

Friedman instead suggested reading articles from nationally known vaccine skeptic Robert F. Kennedy Jr.’s foundation.

Kepler, meanwhile, encourages everyone to follow all Advisory Committee on Immunization Practices guidelines on vaccinations, saying it’s especially important for those in health care.

“If you’re taking care of someone else, you have an ethical duty to keep them well. You wash your hands; if you’re sick you stay home; if you can prevent the flu, you get vaccinated.”

He also encouraged people to do research at CDC and ACIP, and added that the DOH report is insightful for parents.

“I think it can be valuable to people, sure,” he said. “If I knew there were 50 percent of children unimmunized, there is no way my kids would go that school. It’s pretty shocking.”

Measles at highest level in 25 years

All the while, measles in the U.S. has been climbing to its highest level in 25 years, with 695 cases reported by the CDC in 22 states this year as of Wednesday afternoon. The number reflects the highest annual total recorded since the disease was declared eliminated in the U.S. in 2000.

Measles in most people causes fever, runny nose, cough and a rash all over the body. However, a very small fraction of those infected can suffer complications such as pneumonia and a dangerous swelling of the brain.

The CDC recommends the vaccine for everyone over a year old, except for people who had the disease as children. Those who have had measles are immune.

The vaccine, which became available in the 1960s, is considered safe and highly effective, and because of it, measles was declared all but eliminated in the U.S. in 2000. But it has made comebacks since then, including 667 cases in 2014.

Los Angeles in the most recent area hit by an influx of cases. More than 700 students and staff at University of California, Los Angeles and California State University, Los Angeles were placed under quarantine because they may have been exposed to measles and either have not been vaccinated or cannot verify they are immune, officials said last week.

National totals were 626 Monday and nearly 700 by Wednesday, making this the nation’s worst year for measles since 1994. There were 963 cases in 1994.

Roughly 75 percent of this year’s illnesses in the U.S. have been in New York state, mainly in two ultra-Orthodox Jewish communities in Brooklyn and suburban Rockland County. Most of those cases have been in unvaccinated people, according to the CDC.

There have been three measles-related deaths reported in the U.S. since 2000, the last one in 2015. The worst year for measles in modern U.S. history was 1958, with more than 763,000 reported cases and 552 deaths.

Going ‘down the rabbit hole’

Parents remain divided on the childhood vaccination topic, so much so that out of more than a dozen requests for comment, only one agreed to be on the record for vaccination stance. One father declined, citing worry over what other parent friends would think.

Kuau resident Valerie Petredis, a single mom of one student in Haleakala Waldorf and one in Montessori, described her vaccination position as moderate.

When her children were born, she said, she was looking for a pediatrician with a slower, more flexible vaccine schedule because she wanted her kids to have some but not all of the required shots. Eventually, Petredis said she was more open to vaccines and a balance of modern medicine.

“The people who choose not to vaccinate believe in nature’s way, and that their bodies are going to fight certain things, which is interesting,” she said. “Because we are in an age where we are not dealing with mass deaths due to crazy diseases.”

“There are so many conspiracy ideas,” Petredis added. “You can really go down the rabbit hole, thinking some puppeteer is positioning us for different reasons. For me, I try not to get too crazy because there’s a balance between modern medicine and the reality of diseases that are out there.”

* Kehaulani Cerizo can be reached at kcerizo@mauinews.com. The Associated Press contributed to this report.