The Atlanta Journal-Constitution | February 08, 2009

Five months into the school year and fearing bad publicity, Atlanta Public Schools kicked 105 students out of class on Jan. 30 for failing to get vaccinations they should have had on Day One, documents show. The district says all its schools are now 100 percent in compliance with state law on vaccinations.

Meanwhile, the Fulton County School System said last week that all its kindergartners and sixth-graders, except 212 students at three schools, are properly vaccinated.

Those two Atlanta-area districts were the worst at ensuring their students complied with Georgia’s school vaccination law when they were audited during the 2007-08 school year, Spotlight reported last fall.

Since then, school and health officials said they’ve gone to extraordinary lengths, including home visits and organized trips to clinics, to make sure this year’s kindergartners and sixth-graders have all required shots. (Those two grades are the ones health departments audit.)

State, Fulton, DeKalb and Cobb county health officials also said they have emphasized the importance of vaccinations in the 2008-09 school year. Gwinnett County health department officials declined to be interviewed.

“I think the positive part of this is that all the principals, as well as the public school superintendents, now understand the importance of compliance,” said Juliet Cooper, nursing director at the Fulton County Department of Health and Wellness.

Enforcement of school vaccination laws is an important fail-safe in preventing disease outbreaks, said Dr. Lance Rodewald, an immunization expert at the Atlanta-based Centers for Disease Control and Prevention. When children don’t get all required doses of a vaccine, their risk of being unprotected can increase significantly, he said.

Despite progress in metro Atlanta, Cooper said, there is still work to do making sure children don’t linger for months without required shots — in violation of state law. “Most principals are very hesitant to dismiss a child from school,” she said.

The Fulton health department offered to give vaccinations at schools, Cooper said, but so far districts have sent children to county clinics. “We’ve been doing a tremendous amount of immunizations in the past two weeks,” Cooper said. Her department gave districts a Jan. 31 deadline for updated compliance reports.

As of Jan. 13, Atlanta Public Schools had 477 kindergartners and sixth-graders listed as “noncompliant,” according to district records obtained under the Georgia Open Records Act.

At Price Middle School, just 35 percent of sixth-graders were in compliance as of Jan. 13; at Brown Middle School it was 62 percent; at Turner Middle School, 70 percent. State law requires that all children be properly vaccinated against several diseases unless they have medical or religious waivers. It’s a misdemeanor crime, punishable by up to 12 months in jail and a $100 fine, to let children attend classes in violation of the law. But nobody is ever prosecuted.

A Georgia Division of Public Health work group began meeting last month to assign roles and responsibilities for enforcing the law.

An Atlanta district official, in internal e-mails last month, expressed concern about more bad publicity if undervaccinated children were allowed to stay in class.

The “perception in the state is that Fulton County and Atlanta have the worst immunization rates and are nonresponsive to blatant notification of violations or media scrutiny and the media is ready to write a follow-up story documenting this fact,” Jayketa Singleton, Atlanta Public Schools health services director, wrote in a Jan. 9 e-mail to key district officials.

Singleton, in the e-mail, warned that “all noncompliant students need to be excluded from school immediately next week to get the stats to 100% or the district will look really bad alone as Fulton County schools are insuring that their stats will be 100% in all schools.”

Atlanta district officials declined interview requests. In written statements they said they have withdrawn 212 students from classes in the 2008-09 school year due to immunization noncompliance; 144 were kicked out during the week of Jan. 26. District staff are following up with those students to make sure they get shots and are re-enrolled. Most are back in class in a day or two.

As of Jan. 30, when it withdrew 105 students in one day, the Atlanta district reports all of its schools’ kindergartners and sixth-graders are 100 percent in compliance.

However, it remained unclear last week whether students at “100 percent” schools statewide were really properly vaccinated.

For the 2008-09 school year, the Georgia Division of Public Health changed its vaccination audit forms in a way that can falsely inflate compliance rates. Using the state’s new math, children who are missing required doses of vaccines are counted on the form as being in full compliance with the law.

Children who lack doses are not fully protected against disease, which is why the booster shots are required. In the past, such children were counted on audit forms as noncompliant. As a result, schools this year can tout themselves as being 100 percent in compliance, when in fact they may have many children who aren’t properly immunized and are in violation of state law.

State health department officials declined to be interviewed. In written statements, they said the new calculation is intended to avoid “penalizing” schools when doctors certify children are properly vaccinated when they aren’t. “The definition of ‘compliance’ must be re-examined. The work group is tackling this issue,” the department said.

State officials noted that “severe budget cuts” and a nursing shortage have made public health efforts at the local level more difficult.

The Fulton County School System made an internal decision to consider children who are missing doses as being out of compliance and subject to withdrawal, said Lynne Meadows, the district’s student health services coordinator.

Last week Bear Creek Middle School had 84 students with missing doses, and Stonewall Tell Elementary had one. Renaissance Middle School had 85 students missing doses, 34 who lacked any vaccination documentation, and eight who had expired documents. Parents have until Thursday to get them their shots or file waivers, or they’ll be withdrawn from school, district officials said.

WHAT’S BEING DONE

• Statewide: Officials at the Georgia Division of Public Health said they will be taking a closer look this spring at four schools in Atlanta Public Schools and Fulton County School System, including two that were highlighted in the AJC in October for having vaccination compliance rates below 80 percent in the 2007-08 school year.

“The low rates spotlighted in previous articles sparked serious concern among immunization program leadership,” the department said in a written statement. Before the newspaper’s investigation, the state looked only at aggregate data for counties or districts — not individual schools.

Vaccination audit information for each school was not yet available from the state last week.

• Cobb-Douglas: The health department covering these two counties is now making sure several levels of school administrators are informed about vaccination compliance results. When kindergartens and sixth graders were audited last fall, 1,482 students in Cobb and 285 in Douglas — about 8 percent — were missing required doses, mostly of the chickenpox vaccine, the department said. Health officials said they haven’t conducted further audits to determine how many are still missing doses. For help with shots, call 770-514-2300.

• DeKalb: The DeKalb County Board of Health is now using a standard script to make sure all schools and daycare providers are aware that 100 percent compliance is required. Officials are developing training to educate about the importance following the school vaccination law. For help with shots, call 404-294-3700.

• Fulton: The Fulton County School System is putting new procedures in place to ensure children have all their vaccination paperwork before they are allowed to register. The Fulton health department has asked private schools that last fall weren’t 100 percent in compliance reassess students’ vaccination status by Feb. 14. For help with shots, call: 404-730-1211.

• Gwinnett: Officials at the East Metro Health District, which covers Gwinnett, Rockdale and Newton counties, declined to be interviewed. For help with shots, call 770-339-4260.

THE LAW ON INOCULATIONS

Georgia law requires that children be properly vaccinated against several diseases before they are allowed to enroll in public or private schools, or day care.

Required shots may include measles, mumps, rubella, polio, whooping cough, chickenpox, diphtheria, tetanus and hepatitis B. Children can receive exemptions for medical or religious reasons. And schools can issue waivers of about 30 days to give parents time to get shots or documents.

Local school and health officials say problems with compliance are not because of parental concerns about vaccine safety. Finding time, money or transportation for medical appointments is the main issue, they said.

To find out how your school did on its 2008-09 vaccination audit, ask the principal or county health department to see its official audit form.

Read the AJC’s earlier investigations of school and day care vaccination compliance.