As Texas battles against its largest measles outbreak in decades, immunization data obtained by Houston Landing shows that more than 1,000 kindergarten and seventh grade students in the Houston ISD either had vaccination exemptions or lacked proof they were fully immunized against the highly contagious virus.
The data, which is from mid-December, indicates that 91 schools across HISD – the largest school district in Texas – may be at increased risk of a measles outbreak because of pockets of children who are not fully vaccinated.
At these schools, fewer than 95 percent of the kindergarten or seventh graders were up-to-date on their measles shots – the percentage the Centers for Disease Control and Prevention says is needed to create “herd immunity,” which prevents the onward spread of the disease.
Some HISD elementary schools had particularly low levels of measles protection, with fewer than 80 percent of kindergarteners listed as fully vaccinated for their age, the Landing found.
The measles virus, which is particularly dangerous for babies and young children, causes a high fever, rash and sometimes serious complications such as pneumonia, brain swelling and loss of hearing or speech. The current outbreak has so far killed two children in West Texas and a third person in nearby New Mexico.
Texas statewide school immunization requirements mandate that children who lack proof of vaccination against measles and several other communicable diseases be excluded from class until they are either up-to-date on their shots, or they provide a form exempting them from vaccination for medical, religious or other reasons of personal conscience.
But HISD told the Landing that the district’s schools aren’t enforcing these rules.
The district’s records indicate that the vast majority of students who weren’t up-to-date on their measles shots had no exemption, no evidence of being fully vaccinated, and they also weren’t in the process of getting immunized or transferring records.
“At this time, we are not excluding students from learning based on vaccine status,” the district said in an emailed statement, which noted its schools “are focused on ensuring all students have access to high-quality instruction every day.”
District officials did not grant interviews. In their emailed statements, they emphasized that district-wide – when students at all schools in all grades are combined – current data shows that students are “96.6% compliant” for the MMR (measles-mumps-rubella) vaccine. That includes students who are fully immunized with this vaccine – as well as those who aren’t, but who have a vaccine exemption on file.
The district acknowledged that some of its individual schools have lower measles vaccination rates – including below the 95 percent level health experts say is needed to prevent outbreaks.
The data analyzed by the Landing was gathered by the district in December as part of annual state reporting requirements. It represents a snapshot in time of the measles immunization status of students in two key grades – kindergarten and seventh grade – that nationally are used as benchmarks for assessing vaccine coverage.
HISD said that throughout the school year it has tried to address low measles immunization rates at individual schools by sending information to parents and providing “targeted immunization efforts” in partnership with healthcare providers.
Yet between December and mid March, the district had only managed to reduce by 133 students the number of kindergarten and seventh graders who were at risk of measles infections.
At that time, there were still 1,011 students in these two grades who were either not up-to-date on their measles shots or were exempt from vaccination against the disease, according to information HISD provided in response to the Landing’s questions.
Many of these students are clustered at specific schools, making those locations more vulnerable to outbreaks if one of the students becomes infected.
Blindspots for public health and for parents
There is currently no easy way for most parents in Houston and across Texas to find out whether the specific public school their child attends has low vaccination coverage and is vulnerable to an outbreak.
Even public health officials don’t have routine access to school-level vaccination data.
The result is that amid the current measles outbreak, the Texas Department of State Health Services (DSHS) told the Landing it doesn’t know which individual schools in Houston or across the state are at greatest risk because of clusters of unvaccinated children.
DSHS only requires public school districts to report their students’ vaccination rates at the district level, which the department posts on its website.
Accredited private schools that are part of a multi-school organization also report aggregated data to DSHS. But when a private school operates on its own, its data is available individually.
“You may want to check with local health departments to see if they evaluate [school-level data] since they would be the entities responding to outbreaks or other public health concerns in those areas,” DSHS said in an emailed response to the Landing’s questions.
The Houston Health Department declined to answer the Landing’s questions about how easy or difficult it is for its staff to know whether there are pockets of unvaccinated children at individual public and private schools across Houston, and whether the department routinely collects and reviews school-level data.
Local immunization advocates say the state needs to start collecting and making public school-level data on vaccination coverage.
“We don’t have campus level immunization data to see where the pockets of need are so we can respond through outreach or education,” said Rekha Lakshmanan, chief strategy officer for The Immunization Partnership, a Houston-based advocacy group.
“When you look at what is publicly available, all we have is our county level data and [school] district data, which is ok, but it doesn’t give us a clear picture as to where those pockets are,” she said.
House Bill 2755, filed earlier this year in the Texas Legislature, would require DSHS to collect and post on its website vaccination coverage information for individual school campuses. Schools and school districts also would be required to share this information on request with a student’s parent or guardian.
With the number of measles infections growing each week in Texas and and across the country, many Houston parents are concerned for their children’s safety.
At Felix Cook Elementary School, where the Landing found that only 82 percent of kindergarteners were up-to-date on their measles shots, Claudia Ponce said she’s doing what she can to protect her son. She’s made sure the fourth grader is fully vaccinated, she said.
“There could be more kids with the virus but if I protect him it possibly wouldn’t hit him as hard,” Ponce said in Spanish. “I think it’s an obligation that we have to keep kids vaccinated. At this age, they’re more prone to death.”
Pockets of unvaccinated people fuel measles outbreaks
The risk of measles outbreaks has been on the rise for several years in the United States and around the world because of declining vaccination rates against the disease.
“I think what we’re seeing happen in West Texas is a great example of what can happen in communities where the number of people who are vaccinated against measles starts to drop below 95 percent,” Dr. David Persse, the City of Houston’s chief medical officer, told Houston Landing.
Since late January, what was initially a handful of measles cases that emerged among unvaccinated members of a Mennonite community in Gaines County has grown into a deadly outbreak that so far has infected more than 561 people in Texas; 58 required hospitalization.
Two Texas children have died, the first in February, and state health officials recently announced that a second child died from measles pulmonary failure on April 3 at a Lubbock hospital. Both of these school-aged children were unvaccinated and had no known underlying health issues.
It’s unclear whether a measles infection identified April 3 in a northwest Harris County child is connected to the West Texas outbreak; county health officials said they are still investigating. Three other measles cases in the city of Houston this year have involved people whose infections were related to international travel.
In nearly all of the West Texas outbreak’s cases, those who became infected either were not vaccinated against measles, or did not know their vaccination status, health officials say. Two doses of measles vaccine is 97 percent effective at preventing the disease.
The outbreak’s epicenter continues to be in West Texas and an adjoining part of New Mexico, where at least 63 additional people have been infected and one adult has died. However as people travel and they encounter other unvaccinated people, infections have started spreading farther away, including to a few other parts of Texas, as well as to Oklahoma, Kansas and Mexico.
“It’s the same situation for the schools that have got a low vaccination rate against measles,” said Persse, talking about schools generally. “Should measles get into that community, that school population, those children who are not vaccinated against measles would be at risk of contracting it because it spreads so very easily.”
Infected people can spread the virus for four days before the distinctive measles rash appears on the face and begins to spread down the body. The virus can linger in a room’s air for two hours after an infected person has left, according to the CDC.
Data reveal names of schools at risk for measles
To examine the risk of measles spreading at individual schools within the state’s largest school district, the Landing used the Texas Public Information Act to obtain vaccination data that HISD routinely gathers from its individual school campuses to compile its annual report. The data do not include any student names or personally identifying information.
The Landing’s analysis of this measles vaccination data for more than 23,000 Houston ISD students in the two grades shows how the state’s reliance on district-wide data can obscure local public health risks from parents, the public, policymakers and public health officials.
When data from all HISD schools is combined, it shows 95 percent of kindergarteners and seventh graders were up-to-date on their measles shots – the level of coverage needed to protect against an outbreak. Yet, in examining rates at individual schools, the Landing found:
- Fewer than 80 percent of kindergarten students were classified as up-to-date on their measles shots at five elementary schools: Briargrove (75%), Piney Point (76.4%), Shadowbriar (77.6%), Braeburn (78.7%) and Askew (79.8%).
- At another eight schools, fewer than 85 percent of kindergarteners were listed as up-to-date: Kate Smith Elementary (80.4%), T.H. Rogers School (80.6%), Felix Cook Elementary (82%), Longfellow Elementary (83.6%), Ray Daily Elementary (83.6%), Hobby Elementary (84.3%), Bruce Elementary (84.6%), and Clemente Martinez Elementary (84.9%).
- At 91 schools – most of them elementary schools – measles vaccination coverage was less than 95 percent among kindergarteners or seventh graders.
- For seventh graders, the schools with the lowest percentage classified as up-to-date on measles shots included: Clifton Middle School (86%); Fondren Middle School (87.6%), Sugar Grove Academy (90.1%); Long Academy (90.4%); and Revere Middle School (90.9%).
- Despite so many schools with low levels of measles vaccine coverage, students in many of the district’s other schools were well protected against infection. There were 145 schools where at least 95 percent of kindergarteners or seventh graders were up to date for measles. At 39 of these schools, all of the students in these two grades were fully vaccinated for their age.
The Landing is publishing details of each school’s measles vaccination coverage in a chart that is available at this link.
Dr. Susan Wootton, a professor of pediatric infectious diseases at UTHealth Houston McGovern Medical School, said the data obtained by Houston Landing shows how the data Texas makes public at the school-district, county and state level can give a false sense of security.
“Our policy folks need to be diving in like you have. Where are we within these districts? Those are the areas where we need to mobilize our responses. These are the hot spots,” she said.
At Briargrove Elementary School on Houston’s west side, where just 75 percent of kindergarten students were up-to-date on their measles shots, several parents expressed mixed levels of surprise and concern when told about the Landing’s findings as they picked up their children.
“I had no idea,” said Yanna Drake, who said her daughter, a first grader at Briargrove, is vaccinated. “Ideally I’d like for everybody to be vaccinated. That’s what’s necessary for everybody, the public safety.”
Eric Vargas, who has children in pre-kindergarten and first grade – both of whom are vaccinated – said he’s been following the spread of measles across Texas and considers it “alarming.” Vargas said he’s concerned “not just for my kids, but for everybody else’s kids.”
Dr. Tammy Camp, a Lubbock pediatrician and fellow of the American Academy of Pediatrics, said the low vaccination rates the Landing found at some Houston schools will concern parents.
“For a parent whose child is fully vaccinated, I would encourage them to continue their normal activities and continue to participate in school. You are protected,” she said. “If your child is in a setting where there are many unvaccinated children and your child is also unvaccinated, it only takes a single exposure for that group of people to be at high risk of the disease spreading.”
Vaccination is the most important thing parents can do to protect their children, Camp said.
Few HISD parents obtain exemptions from measles vaccine
It’s unclear why the measles vaccination rates are so low at some HISD schools.
While there has been significant attention focused on the role that anti-vaccination beliefs and vaccination exemptions have played in declining immunization rates in Texas and nationally, relatively few HISD students have obtained these exemptions.
Of the 1,144 students not up-to-date on their measles shots as of mid December, 262 had exemptions from the vaccines for “reasons of conscience” and 28 had exemptions for medical reasons.
The rest of the 854 Houston ISD students who were not listed as fully vaccinated for their age against measles were categorized by the district as being “delinquent” on their shots.
This is a term that state health officials define as students who aren’t up-to-date on vaccines, don’t have an exemption on file and also aren’t in the process of either completing their shots or getting their records transferred to the school.
Delinquent students are required under the Texas Administrative Code to be excluded from attendance until they can show they are up to date on their immunizations, but HISD spokespeople told the Landing in emails that the district isn’t following this rule.
HISD spokespeople provided little explanation in their emails for why so many of the district’s schools have low measles vaccination rates.
“Some HISD campuses with a less than 95% vaccination rate for MMR do historically have challenges with immunization compliance,” the district said in an emailed response to the Landing’s questions. “Some of the campuses that experience the largest challenge with vaccination compliance are campuses that have a high mobility rate.” The district didn’t elaborate.
Christine Hurley, a member of the parent-teacher organization at Askew Elementary School where she has children in the first and third grades, said she suspects a lack of easy access to vaccinations is one of the big reasons for her school’s low vaccination rate.
At Askew, less than 80 percent of kindergarteners were fully vaccinated against measles, the data show.
“When these parents are struggling with how they’re going to keep a roof over their head, how they’re going to keep their kids fed, vaccination unfortunately just doesn’t seem like that high of a priority,” said Hurley, whose own children are vaccinated.
Most of Askew’s students are identified as economically disadvantaged, Hurley said, and a significant number of students are newly arrived immigrants. Many of the school’s families don’t have cars.
“A lot of families at Askew can only make it to places they can walk to,” she said, noting that Askew no longer has an on-site “wraparound specialist,” a school employee whose job it was to help connect parents with needed services.
District officials, however, said there is no connection between vaccination rates and the district’s strategic shift away from onsite wraparound specialists and its new approaches for providing medical and other support services. They said that schools with low measles vaccination rates “are provided with ongoing communications and resources for families.”
Some of the district’s low-vaccination schools have hosted one or more on-site vaccination clinics this school year. Braeburn Elementary offered on-site shots in December, March and another event is scheduled for May. Piney Point Elementary held two events in August and a third in December. Shadowbriar Elementary had a clinic last November.
Askew Elementary, however, has not had an on-site vaccination clinic this school year. District officials said a clinic has been scheduled for eight months from now, on Dec. 18.
Kate King, president of the National Association of School Nurses, said access is an important tool in reducing the number of children who are vulnerable to infectious diseases.
“It is really making that effort to link children and parents with resources, making every effort to make it easy for them to get immunizations,” King said.
Houston Landing Data Visualization Reporter Adriana Rezal and Education reporters Asher Lehrer-Small, and Angelica Perez contributed to this report.
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