When Jefferson County realized its vaccination rates for school-age children were dropping, school and health officials picked up the phone.

They attempted to reach each of the 78 students whose vaccination records were incomplete or who had no records at all. They wanted to ensure that students wouldn’t be turned away on Wednesday. School Exclusion Day. The third Wednesday in February is the day in Oregon when all students in public and private schools, preschool and day care centers must have proof of vaccinations or provide a completed medical or non-medical exemption form.

Until students show they have vaccinations that are up to date or a completed exemption form, they cannot attend school, according to state law. The law is designed to protect the spread of highly contagious diseases, like measles, that can be controlled by vaccinations.

Of the three counties in Central Oregon, Jefferson had the highest participation for school-required vaccinations with 94.9% in the 2022-2023 school year for kindergarten through 12th grade. Jefferson also had the lowest percentage of children filing exemptions in the region, with 6% of the students exempted.

In Deschutes County, 11.1% of kindergarten to 12th grade students filed for a non-medical vaccination exemption in 2022-2023 school year, according to the Oregon Health Authority, Just 89% of school-age children had all of their required vaccinations. Crook County had a 5.4% non-medical exemption rate, with 93% fully vaccinated. Statewide, the non-medical exemption rate for school-age children was 6.6%.

Central Oregon is in the middle of the state’s 36 counties in terms of vaccination rates, according to state health data. Morrow County had 97.1% of its students vaccinated in the 2022-2023 school year and had 1.6% of its students requesting a non-medical exemption, according to Oregon Health Authority data. That’s the highest vaccination rate in the state. The lowest was Josephine County, with 85% of kids vaccinated.

The goal is to get up to 95% of the students vaccinated, as it creates herd immunity, a concept where the vaccinated protect the unvaccinated for vaccine-preventable diseases in Central Oregon. Many people can’t get vaccinations due to medical reasons and rely on herd immunity to protect them from illness.

“Vaccinations are the most effective public health measures against communicable diseases,” said Dr. Rita Bacho, Deschutes County Health Services communicable disease and immunizations program manager. “We’re not just protecting the most vulnerable, but ourselves and our families with vaccinations.”

Vaccination exemptions rise in 28 Oregon counties

The reasons families cite for seeking a non-medical exemption for at least one, or even all of these required immunizations are varied, Bacho said.

Some parents don’t have the time. Some choose not to immunize their children for religious or moral reasons. Some don’t have access to accurate information, Bacho said.

Oregon is one of 17 states that allows parents to file for an exemption from the vaccination requirement for a non-medical reason. In Oregon, parents have a say whether they want their children vaccinated, said Stacy de Assis Matthews, Oregon Health Authority public health coordinator.

The non-medical exemption rate in the state in the 2022-2023 school year was 8.1%, compared to 6.9% the year before. In 28 of the 36 counties, non-medical exemptions grew, de Assis Matthews said.

In 2023, county health departments statewide mailed 26,688 letters alerting parents that they needed to submit records showing up-to-date immunizations. On the Exclusion Day, 4,048 children statewide were sent home.

To file for an exemption, parents watch a video and fill out a form or have a medical professional sign the form. That form must be turned into the school before the Exclusion Day, de Assis Matthews said.

“We don’t collect data on the reason a parent claims a non-medical exemption,” de Assis Matthews said. “Anecdotally, it’s a number of reasons: access, staffing at clinics, and hesitancy.

“We know that parents want to do what is best for their children.”

On Wednesday, if a child doesn’t have the paperwork to prove a non-medical, medical exemption or a vaccination record, parents can walk into any county or school-based health clinic and get their child vaccinated or get the exemption completed and the child can go right back to class.

“It was designed to make it easier for people to request an exemption for non-medical reasons,” Bacho said. “We try to offer community outreach.”

Health officials, working with medical practitioners, try to eliminate barriers for families by offering vaccine clinics, extending hours of clinics and offering free vaccines at school-based clinics that don’t require an appointment, Bacho said.

It’s a partnership

When parents come to see Dr. Rebecca Hicks, a Mosaic Community Health physician, she talks to them about vaccinations. It’s not a top down lecture, but she lays out the pros and cons for parents.

“I make recommendations,” Hicks said. “Their opinion matters. I’m always open to talking about their worries and concerns. I strongly recommend that my patients receive childhood vaccinations. We should prevent these diseases.”

Since the pandemic, the conversation about vaccinations has been tough, Hicks said. Parents wade through massive amounts of information, some of it accurate, some of it inaccurate, she said. They have questions.

“It’s hard for parents to sort it out,” said Hicks. “They deserve to have the right to question me and get accurate information. Sometimes it’s not vaccine hesitancy, but rather pure questioning.”

Outbreaks of measles still occur because not enough people are immunized against the disease. In Deschutes County, about 91% of the kindergartners in the 2022-2023 school year were vaccinated for measles, compared to about 92% statewide, according to state health data.

“Infants are susceptible to measles because they cannot get a vaccination until they’re 12 months of age, so herd immunity protects them,” Hicks said. “Where we see pockets of transmission, particularly measles can really spread in communities that do not have high enough herd immunity.”

School nurses vital in vaccination process

School nurses from districts in Jefferson, Crook and Deschutes County said the vaccination process is going well this year. Nurses assess if a family is in compliance, enter records and notify and follow up with families to make sure they know to get their child’s vaccines up to date or file an exemption, said Wendy Perrin, a nurse at Crook County Schools. School nurses also refer families to health departments and pharmacies to get vaccines.

Christina Kelley, Jefferson County School District’s nurse, praised the community nurses for helping to get children vaccinated, and said that’s why she believes the county has such high compliance.

“(The Jefferson County registered nurse) has been available, like, 24/7 for me,” she said. “She’s worked so hard at being available to give these free vaccines to everyone. She’s so easy to work with and so helpful to the families.”

Though a handful of families have filed an exemption, the number is low overall, said Kelley.

In Crook County, Perrin said this year she’s seen more non-medical exemptions filed by parents, though she didn’t have a final number yet. Parents are not required to explain their reasoning.

“The vast majority of families understand we’re trying to keep our schools healthy and safe and keep students in school,” wrote Scott Maben, Bend-La Pine Schools’ communications director, in an email. “Parents are doing their best to provide immunization records or exemption paperwork before the deadline.”

The more outreach, the lower the exclusion

For the past two weeks, Helen Bicart, the Jefferson County registered nurse, and a host of other medical professionals have worked the phones tracking down parents to remind them that their children may be excluded on Wednesday if they don’t get vaccinated.

“We were met with mixed reactions,” Bicart said. “Some thanked us and said they’d already taken care of it. Many of the phone numbers on file were no longer in service and the letters we mailed out were returned.

“People move or change their number and don’t update the school records.”

Experience has taught Bicart that the more outreach, the lower the exclusion rate and higher the vaccination rate.

So this fall, when the next school year begins, Kelley and county health officials are going to hold vaccination clinics where the parents and children can hang out. That will be a barbecue at the beginning of the school year for incoming sixth graders entering middle school. All 11-year-olds need a booster shot for diphtheria, tetanus and pertussis, she said.

Free immunizations

Free immunizations

Deschutes County holds weekly immunization clinics free to the community from 11 a.m. to 3 p.m. Wednesdays at 2577 NE Courtney Drive in Bend. Call 541-322-7499 to make an appointment.

Source: Deschutes County Health Services

They once tried a “pizza and poke” event during the school exclusion day and only had nine children vaccinated. So now they’ll try holding a vaccination clinic at the start of school at the middle school barbecue.

Last school year the county had 114 students who were going to be excluded, and this year 78 students are on the list, she said.

“This year we had an overall (vaccination) rate higher than the state,” Bicart said. “That’s good. We’re happy about it. We’ve done a lot better job than last year. Our rates are already better in terms of exclusions this year than last.”

Vaccinations at school-based health centers

Vaccinations at school-based health centers

School-based health centers offer vaccinations for anyone and do not require an appointment. Mosaic Community Health operates seven school-based health centers. Health insurance is not required.

All sites offer immunizations to anyone up to age 18. The student does not have to be a student at the school or a patient of Mosaic. Those 15 and older do not need a legal guardian present.

Mosaic has several programs that support reduced to no-cost services, depending on qualifications.

Bend: Mountain View SBHC, 2755 NE 27th St. and Bend High SBHC, 230 NE 6th St., Room S-19

Madras: Madras High SBHC, 390 SE 10th St.

Prineville: Crook Kids SBHC, 757 E 1st St.

Redmond: Redmond High SBHC, 675 SW Rimrock Way or Lynch SBHC, 1314 SW Kalama Ave., Room B

Sisters: Sisters SBHC, 535 N Reed St.

Source: Mosaic Community Health