Texas Department of State Health Services, which receives the information from schools of students who have declined vaccination  says, “Maintaining adequate immunization rates in schools is critical to preventing disease outbreaks and ensuring the health of Texas children.” 

Jason Terk, a Cook Children’s pediatrician and former president of the Texas Pediatrics Society, states that “immunizations are the safest, easiest ways to protect your kids from unnecessary and sometimes, fatal, childhood diseases.”

And yet, last year the number of conscientious exemptions in the state of Texas rose to 52,756 last year, compared to 44,716 the previous school year.

These numbers occur as more and more cases of diseases once thought to be wiped out have returned. Last year, mump outbreaks occurred in Johnson County, Texas. Almost 30 people, mainly children, were identified and health officials traced the virus to an outbreak in Arkansas, where several students from Keene, Texas visited.

In 2017, more than 300 mumps cases have been identified in the state. In April of this year, the Texas Department of State Health Services investigated multiple outbreaks of mumps, calling the recent resurgence the highest incidence of the virus in 22 years.

"At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high," said Justin Smith. M.D., a Cook Children's pediatrician. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.”

Dr. Smith said private schools, for example, have a high likelihood of having people go overseas for mission trips or other opportunities. Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.

“I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation," Dr. Smith said. "Let’s pray we don’t get there.”

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated friends return from overseas travel. If they are sick, stay away.

House Bill 2249 would require the Texas Department of State Health Services to provide reports every other year on vaccine-preventable outbreaks and the number of students at public schools who have vaccine exemptions.

“Parents want the choice about where to enroll their children to lessen the chance of their child contracting a vaccine-preventable disease from an unvaccinated child,” J.D. Sheffield, R-Gatesville and the bill’s author, said.

Lisa Pomeroy, a general pediatrician in Lubbock, spoke to the committee about this issue. Her daughter is in remission from leukemia, but remains immunocompromised because of the chemotherapy she must continue to receive.

“I don’t want to put my daughter in a dangerous environment,” said Pomeroy. “I want to keep her safe, and this information will let me decide what school is best for her.”

Jason Terk, M.D., a Cook Children's pediatrician in Keller and on the Committee on Federal Government Affairs for the American Academy of Pediatrics, says current school district information is not specific enough.

"The parent of a child with special needs, such as one with cancer or any disease which makes him or her more vulnerable to infections, needs to know if the school that child may attend is safe," Dr. Terk said.

"Currently the percentage of exemptions per district is available, but that information is not that helpful when you consider that many school districts cover large areas and may have a large number of individual schools," he added.

For example, the Keller ISD has 23 elementary schools, 6 intermediate schools and 4 high schools spread over a very large area.

"Knowing the district level exemption rate is not very helpful when the exemption rates may vary widely across all of the many schools," Dr. Terk said. "Risk is specific to the environment that your child learns in and that is what parents need to know about."

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. In the 2015-2016 school year, the Texas Department of State Health Services reports 44,716 children from kindergarten to twelfth grade claimed exemption.

Of the state’s 10 largest school districts, three have vaccine exemption rates higher than the statewide rate of 0.84 percent:

• Austin ISD (Travis) – 1,582 students exempted (2.02 percent exempted)
• Katy ISD (Harris) – 866 students exempted (1.22 percent exempted)
• North East ISD (Bayer) – 657 (0.97 percent exempted)

Dallas ISD is eighth on the list with 497 students and 0.34 percent exempted, followed by Tarrant County as ninth with 197 students and 0.24 percent exempted.

Opponents of the bill say they fear families that opt not to have their children vaccinated will face harassment. Sheffield counters by saying no identifying information would be included in the information.

Keeping vaccination rates relatively high (somewhere around 90-95 percent) helps protect all children (vaccinated or not) from diseases, Justin Smith, M.D., a pediatrician at Cook Children’s, said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together. What if an outbreak occurs in these schools?”

That’s the concern of Justin Smith, M.D., a pediatrician at Cook Children’s. The Houston Chronicle reported “the number of children whose parents decline vaccinations for non-medical reasons rose nearly 9 percent last school year.”

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. According to the Chronicle, that number has since multiplied to 45,000 last year.

“If you look at the statistics, you see a lot of geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children,” Dr. Smith said. “I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.”

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

Dr. Smith points to an NBC5 report last year on vaccination rates in local school districts that he found not only enlightening, but a bit frightening to him. The news focused on the growing number of vaccine exemptions in three public school districts (Frisco, Plano and Lewisville).

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.”

In the report, what’s happening in our area includes:

• Thirty schools in the DFW area have vaccination rates below 96 percent.
• Five schools in the DFW area have vaccination rates below 90 percent.
• The highest unvaccinated rate in our area is around 13 percent. The highest in the state is near 50 percent.

Why does it matter?

“If you read the names of the schools, you’ll see a trend,” Dr. Smith said. “They are private schools. They are schools that have a high likelihood of having people go overseas for mission trips or other opportunities. Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.”

Do you think this is far-fetched?

Dr. Smith points to the Tarrant County measles outbreak from 2013 that basically had all the characteristics that he’s describing. A large group of unvaccinated people, grouped together based on their faith that contracted measles from a visitor who brought measles into the United States after traveling overseas.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated contacts return from overseas travel. If they are sick, stay away.

About the source

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

Last year, the Cook Children's Trauma team saw 22 children, either biking or walking, who were hit by cars from August through the month of October. Eight children were hit by cars in September and 10 in October. 

But with school already started, so are the dangers of kids and cars.

Already, a teen was hit in front of a high school in Crowley. The injuries seem to be minor, but it places an emphasis on how vulnerable children are near or even in front of schools.

More children are hit by cars during September than any other month of the year, according to Safe Kids Worldwide.

“Children do not have the cognitive skills to be crossing streets safely alone until at least age 10,” said Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s. “They haven’t yet developed the depth perception or the ability to maturely judge the speed of an object.”

Kids age 10 and younger should not walk or ride bicycles, scooters or skateboards alone to school because they:

• Are easily distracted by friends and toys.
• Can’t determine the direction of sounds. Some children may be listening for sounds and may not realize that some newer model electric/hybrid may not make much of a sound at all.
• Can’t judge the speed or distance of a moving vehicle.
• Don’t understand how long it takes a vehicle to stop.
• Have too narrow a field of vision.

Even when kids reach age 10, it’s still best for parents to accompany them to school whenever possible.

Teaching Your Child Pedestrian Safety

“When I visit children who have suffered pedestrian injuries, the most common thing they tell me is that they thought the driver saw them,” explained Evans. “It’s important to teach your children that just because they see a driver, it doesn’t mean the driver sees them. They need to make eye contact with the driver and wait for the driver to stop and signal to them before attempting to cross the street.”

While teaching your children to ride their bikes or walk to school, don’t forget to tell them to cross only at crosswalks; look left, right and then left again; and to watch for cars that are turning or backing up. The best way to teach your child pedestrian and bike safety is to be a good role model yourself. It’s also a good idea to encourage your children to wear bright clothing and reflectors when they’re walking before dawn or after dusk.

"It’s important for parents to remember they are the most important models of proper pedestrian behavior for children," said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. "Parents should also make sure they follow the rules when they are driving in school zones, including going the speed limit at all times through the zone and not texting or talking on the phone."

Safe Kids recommend teaching your kids these safe behaviors:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing. Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

Practice safe behaviors:

• Don’t allow a child under age 10 to cross streets alone as he may not be able to fully appreciate the speed of cars on the road.
• Require children to carry a flashlight at night, dawn and dusk. Add retro-reflective materials to children’s clothing so that a child can be seen by motorists, even in the dark.
• Don’t let kids play in driveways, unfenced yards, streets or parking lots. Drivers may not see or anticipate children playing.

Interactive Infographic: How to not get hit by a car - Safe Kids Worldwide

With an average of 44 kids getting hit while walking every day in the U.S., it’s time for action. HOW TO NOT GET HIT BY A CAR is a fun new interactive infographic that guides walkers through seven common ways kids get hit by cars, and seven ways to avoid it. Parents and kids alike give it great reviews; not only do they think it’s fun to experience the action, they can usually relate to it. Try it out and see if you make any of the common mistakes when you cross the street.

Try the interactive infographic from Safe Kids

For more information

Whether it is the correct use of a child passenger seat, drowning prevention education in the schools, or providing a better awareness of poison hazards to new moms, we are working to create safe homes and communities for children.

• Bicycle safety
• Car safety
• Safe Kids Tarrant County
• CARE Team
• Drowning prevention
• Human trafficking
• Oral health prevention
• Poison prevention
• Sexting
• TV and furniture tip-overs