There have been a record number of measles cases across the country this year, and health experts fear there could be an outbreak in Colorado.
“It’s coming,” said Bernadette Albanese, a medical epidemiologist at the Tri-County Health Department, which serves Adams, Arapahoe and Douglas counties. “We’re not immune by any means from that happening here. We have enough pockets of unimmunized people here.”
Herd immunity — protection from disease outbreaks when a large majority of a population is vaccinated — usually requires immunization rates of 90% to 95%. Last school year, only 87% of Colorado kindergarteners were fully immunized against measles — one of the lowest rates in the country. At some schools, fewer than half of students are vaccinated against the disease.
Measles is extremely contagious and can spread easily to unvaccinated people, including babies who are too young to get shots and people who can’t get shots for medical reasons. Common symptoms of the virus include fever, cough, runny nose, and later a rash. It can lead to ear infections, pneumonia, encephalitis, and in rare cases, death.
“You’re contagious four days before your rash has started,” Albanese said. That means people with measles can start infecting others well before they know they have the illness.
“These outbreaks are a monster to control,” she said.
Experts say high vaccination rates are the best way to keep diseases like measles at bay. Colorado law requires students be vaccinated against a number of diseases, including measles, to attend school or child care, but there are some exceptions.
Read on for answers to your questions about immunization rules and to learn what steps schools and health officials may take in case of an outbreak.
Can child care centers or schools decline to enroll children who are not vaccinated?
Private child care providers can refuse to enroll un-immunized or under-immunized children as long as providers have a written policy detailing their rules, said officials from the Colorado Department of Human Services, which oversees child care licensing. This is true even if the child’s parents have claimed a religious or personal belief exemption.
For schools, including preschool programs run by school districts, state rules say that students can be “denied attendance” if they’re missing some or all of their vaccines, unless they have an exemption or are in the process of getting caught up on shots. If students have an exemption, public schools have to let them come to class, unless there is a disease outbreak. (More on that later.) State health department officials said they haven’t heard of a public school refusing to enroll a child because he is not fully immunized.
What kinds of vaccine exemptions can parents claim in Colorado?
There are three types of vaccine exemptions recognized by the state: Personal belief, religious, and medical exemptions. The first two allow parents to opt a child out of shots if they are opposed to vaccines for personal or religious reasons. Medical exemptions, which require a signature from a health care provider, are permitted for students who can’t be vaccinated for health reasons. About 90% of exemptions in Colorado are personal belief exemptions.
Can a child be barred from attending school where they are enrolled until they are fully vaccinated?
Yes. As mentioned above, students can be barred from school if they are not up to date on their shots, “in process,” or covered by an exemption. If there is an outbreak of a vaccine-preventable disease, health officials can bar an unvaccinated child from school even if the child has a valid exemption on file. The number of days a child can be kept out of school depends on the type and severity of the outbreak.
If a child isn’t vaccinated and hasn’t claimed an exemption when school starts, is there a grace period that allows parents more time to comply with vaccination rules?
Yes, parents have 14 days to get their children caught up on shots, submit an “in process” plan for their child to become vaccinated, or file an exemption. The 14-day window starts when the school notifies parents that their child doesn’t have the required vaccinations or a valid exemption. Technically, this two-week period could start after the first day of school, but in practice it often starts weeks or months later.
If I want to claim a personal belief or religious exemption from vaccinations for my child, am I required to do so on an official state form or website?
No. While there is an online state form available here, and downloadable forms in 11 languages here, parents are not required to use them. If they choose not to, they can submit a statement of exemption to their child’s school or child care provider. The statement must include the child’s name, age or date of birth, date the exemption was filed, the vaccinations being declined, and which type of non-medical exemption they are claiming — personal belief or religious.
There were measles outbreaks around the country last year. How worried should I be about an outbreak in Colorado?
State health officials say Colorado is vulnerable to a widespread measles outbreak because of low state vaccination rates, the availability of international air travel to other at-risk countries, and clusters of undervaccination in Colorado schools and communities.
Several states, including Washington and New York, experienced measles outbreaks this year. Nationwide there have been 1,164 reported cases in 30 states in 2019, the highest number since 1992. Colorado has had four measles cases in the last five years — one in 2019, two in 2016 and one in 2015.
Health experts say the MMR vaccine, which protects against measles, mumps, and rubella, is safe and effective. Kids need two doses of the vaccine — the first at 12 to 15 months old and the second at 4 to 6 years old. Two doses is about 97% effective in preventing measles infection, according to state health department officials. (Use the searchable chart at the bottom of this story to find out MMR vaccination and exemption rates for Colorado schools.)
If a student at my child’s school contracts a contagious disease preventable by vaccine, does the school have to notify parents?
State health department officials say in most cases, schools should notify parents. Schools typically work with the state or local health departments to determine whether to send letters, emails, or post the information on the school’s website.
Schools won’t provide the name of the sick student or identifying information. However, they will notify parents of students who may have been in close contact with the child so parents know what symptoms to watch for and can get medicine if needed.
Schools don’t always notify parents when a student contracts a contagious vaccine-preventable disease. For example, if a child is diagnosed with whooping cough but is on school break during the contagious period, a letter to parents isn’t usually necessary, state health officials said.
Also, if there are multiple cases of a disease in a short period, school officials may notify parents about the initial case but not subsequent cases. Finally, some diseases, such as shingles, HPV, and pneumococcal disease, are contagious but don’t easily spread to others and wouldn’t pose a risk to the general school population, state health officials said.
My child can’t be vaccinated for medical reasons. Should I pull her out of school if there’s a vaccine-preventable disease outbreak?
It depends on several factors: which disease is causing the outbreak, how widespread the outbreak is, and the seriousness of your child’s medical condition. Talk to your child’s doctor or your local health department for guidance.
If my child contracts a contagious vaccine-preventable disease, who do I have to notify?
You should tell your school nurse that your child was diagnosed with a contagious, vaccine-preventable disease so the school can work with public health officials to notify other parents, if needed. Sometimes public health officials will contact you to ask questions about other people who may have been in close contact with your child.
What is the Colorado Immunization Information System and who has access to it?
It’s a computerized system that collects vaccination and exemption data for Coloradans
of all ages from a variety of sources. It helps health care providers, schools and child care
centers keep track of the shots their patients or students have received.
State rules allow information in the database to be shared with the following sources under certain circumstances:
- The individual or parent/guardian;
- The individual’s health care provider;
- A school, child care center, or university where the individual is enrolled;
- A managed care organization or health insurer where the individual is enrolled;
- State health department contractors working on CIIS; and
- The Colorado Department of Health Care Policy and Financing, for individuals enrolled in Medicaid.
How can I find out immunization rates at my child’s school?
Go the state health department’s searchable database to find school and child care immunization and exemption rates for required vaccines for 2018-19, or the previous two years. Rates for a small number of schools — mostly in rural areas — are not in the database because the schools or their districts failed to submit them to the state health department. Parents or the public can still request immunization and exemption rates directly from schools. State law requires schools to provide it.
The searchable chart below shows 2018-19 MMR vaccination and “personal belief” exemption rates for Colorado schools. The chart doesn’t show the percentage of students with religious or medical exemptions, the percentage of students “in process,” or the percentage who have turned in no vaccination or exemption paperwork at all. The data comes from the Colorado Department Of Public Health and Environment.