In this Jan. 30, 2019 file photo signs posted at The Vancouver Clinic in Vancouver, Wash., warn patients and visitors of a measles outbreak. A measles outbreak near Portland, Ore., has revived a bitter debate over so-called personal belief exemptions to childhood vaccinations. Four percent of Washington secondary school students have non-medical vaccine exemptions. (AP Photo/Gillian Flaccus,File)

Hundreds of Michigan schools and child-care programs are vulnerable to outbreaks of contagious disease such as measles, whooping cough and chicken pox based on the percentage of children with vaccination waivers, according to public health data.

Almost 400 public and private K-12 schools and 295 day care programs had 10 percent or more of their students submit a vaccine waiver form in lieu of immunization records in 2017, state records show.

And more than 1,000 K-12 schools and 800 day cares have vaccine waiver rates of more than 5 percent.

The state collects immunization data from about 3,900 schools and 3,700 child-care programs.

Public health officials say schools should have vaccination rates of 95 percent to protect against measles, the most contagious disease. A current measles outbreak in the Pacific Northwest has been fueled by people who shun immunizations.

While Michigan has improved its school vaccination rates in the past few years, there are still too many schools with worrisome numbers, said Bob Swanson, director of the state's immunization program.

"If more than 10 percent of your kids aren't vaccinated, there's a chance of an outbreak," he said.

Vaccination rates for Michigan public and private schools

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This online database shows the 2017 vaccination waiver rates for Michigan public and private schools. You can search by county, by school district or type in the name of a school. If you call up a county or district without specifying a building, you can see schools ranked by their 2017 vaccine waiver rate.

(If the database is not visible in this post, click here.)

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To have so many Michigan schools and day cares with relatively high waiver rates is "really scary," said Dr. Maureen Ford, a Mattawan school board member who is an emergency room physician and the mother of three school-age children.

"It's something we need to be paying attention to," Ford said. "When you get below 95 percent (vaccination rate), you're losing your herd immunity," which protects the population against contagious disease.

Herd immunity occurs when enough people are vaccinated that contagious disease is stopped in its tracks because of lack of people who can spread the virus.

Public health officials stress the importance of herd immunity to protect babies too young to be vaccinated and elderly people where immunizations have waned as well as those who can't get vaccinated for medical reasons and individuals where the vaccine is ineffective.

"If you don't have that herd immunity, you're at risk" of the kind of outbreak occurring in Oregon and Washington state, said Linda Vail, the Ingham County health director.

Vaccination rates for Michigan child-care programs

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This online database shows the 2017 vaccination waiver rates for licensed child-care programs. You can search by county or type in the name of a program. If you call up a county without specifying a building, you can see facilities ranked by their 2017 vaccine waiver rate.

(If the database is not visible in this post, click here.)

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Vail notes measles is so contagious that a person can catch it from entering a room where a measles patient coughed an hour before.

Ford said that she's never seen a case of measles, but she's treated patients with pertussis, better known as whooping cough -- another vaccine-preventable disease.

"People who are against vaccines say these diseases aren't that bad," Ford said. But as a doctor, she knows "even the typical version of these illnesses aren't fun and what's really a problem are the 1 percent of cases where there are complications."

Before the measles vaccine "there were people who died or had permanent disabilities from measles," she said. "We don't appreciate how sick kids can get" from vaccine-preventable illnesses.

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In 2017, about 50 people in Michigan were hospitalized because of pertussis or chicken pox, according to state records. And last year, Michigan had 19 cases of measles -- the state's highest number in 24 years, Swanson said.

While many people think these diseases have been eradicated, "they are not gone," Swanson said. "You need high vaccination rates so they don't get out of control."

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Interactive map of 2017 vaccine-waiver rates

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This interactive map shows 2017 vaccine waiver rates at a county level. You can click on a county to see the underlying data. This map combines the numbers for K-12 school and child-care programs.

(If the map is not visible in this post, click here.)

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Vaccine waivers

Herd immunity is particularly important in day cares and schools because contagious disease tends to spread more quickly among children, mainly because of their haphazard hygiene habits.

Michigan mandates that schoolchildren be immunized against 14 contagious diseases. But it's also one of 19 states that allow parents to waive vaccines for "philosophical" reasons in addition to medical waivers and waivers based on religious beliefs.

In 2012 and 2013, 6 percent of Michigan children entering kindergarten had a vaccination waiver. Then during the 2014-15 school year, multiple school systems struggled with outbreaks of pertussis.

Starting in fall 2015, the state made those waivers harder to obtain: Instead of filling out a form at the school or writing a note, parents obtaining waiver now have to obtain a form in person from their county health department and sit through a presentation on the importance of vaccinations.

Michigan requires immunizations records for children when they first enroll in a licensed day-care program, at the start of kindergarten and seventh grade, and when/if children transfer into a new school system.

About 400,000 children in K-12 schools and about 170,000 children in child care were asked to provide immunization records or a waiver in 2017. Statewide, 3.5 percent of the K-12 students and 2.5 percent of day-care children had a waiver.

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Source: Michigan Department of Health and Human Services, Division of Immunization

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"We saw a significant drop in waivers" as a result of the tougher standards implemented in 2015, Swanson said. "But we're still concerned about some of those pockets" with high waiver rates.

Vail said that Michigan as a whole is "doing fairly well" on childhood vaccination rates. "We're never getting to zero" in terms of unvaccinated individuals because some people can't get vaccines for medical reasons, she said. So the challenge is to immunize as many people as possible.

But even with a statewide vaccine waiver rate of 3.5 percent, "we're right on the edge" of drifting into a danger zone, Vail said.

"It's time to quit hitting the snooze button" on the importance of vaccinations, she said.

Michigan vaccination rates for kindergarten

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Source: Michigan Department of Health and Human Services, Division of Immunization

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'Vaccine hesitant' parents

The higher vaccine waiver rate, the higher the risk of a disease outbreak at a school.

In 2017, Michigan had 25 schools where 40 percent or more of students submitted vaccination waivers in lieu of immunization records in 2017. Twenty-one of those buildings are private schools and two are public school programs for home-schoolers.

Statewide, about 7.6 percent of kindergartners at Michigan's private schools submitted a vaccine waiver in 2017 compared to 3.3 percent of public-school kindergartners.

Almost three-quarters of Michigan's vaccinations waivers are for "philosophical" reasons versus medical issues or religious beliefs.

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A 2017 Emory University study looked at closely at the rationale of what they termed "vaccine-hesitant parents." The researchers said the parents are worried about putting something they perceived as unnatural in their children's bodies, worrying that vaccines contain "toxins" or "contaminants." Some parents also don't like the government or the medical community telling them what to do, and they don't trust assurances that vaccines are safe.

Among those parents is Catherine Sears, the mother of four grown daughters. She had her daughters vaccinated before they started school, but Sears became skeptical about vaccines in the 1990s after a boy in her community died from a reaction to a DTP vaccine. In retrospect, Sears said, it's likely the death of her 4-month-old sister in 1956 was related to a DTP immunization.

Sears said she firmly believes that vaccines are ineffective and they can severely damage people's immune systems. She points to her granddaughter, a toddler in day care, who has never been vaccinated and never gets sick. "It's the vaccinated kids who are out sick all the time," Sears said.

"I refuse to believe our Creator designed an immune system that needs to be pumped full of chemicals," Sears said. "If you treat your body right, it will do great things for you."

Her stance, she said, is that parents should do their research and be allowed to make a choice. "If they want to vaccinate their child and their child dies, it's on them," she said. "But to have a law that makes it mandatory, I think that's horrific."

Sears added the medical and scientific community has been bought off by the pharmaceutical industry, saying she doesn't trust the government when it comes to vaccine safety. "I think it's all about money," she said.

Connie Johnson is the media director for Michigan Vaccine Choice, an organization that advocates for "informed choice" and giving parents the ability to opt out of vaccines.

"It's a very basic civil rights issue," she said.

Johnson said she thinks it's "unconscionable" that health officials are using the measles outbreak in Oregon and Washington state to "terrify parents" in a push for vaccinations.

"It's a coercive tactic," she said, adding that "measles in a healthy child is a fairly benign" illness.

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In the scientific community, the consensus is overwhelming in favor of vaccinations.

No mainstream medical organization in the United States or anywhere else in the world opposes immunizations and the World Health Organization recently listed the anti-vaxx movement as one of the top 10 global health threats in 2019.

Experts say the theory vaccines are linked to autism has been thoroughly discredited, and say anti-vaccination literature is rife with distortions and falsehoods. And while adverse reactions to vaccines occur in rare cases, experts say the benefits of vaccines vastly outweigh the downsides.

The numbers bear that out. In 2018, 1,238 claims were filed with the National Vaccine Injury Compensation program, which equates to about four of every 1 million vaccines administered.

Weigh that against the toll of the diseases that vaccines prevent.

Before the measles vaccine in 1963, measles caused about 400 deaths a year in the United States, according to the federal Centers for Disease Control. Before the chicken pox vaccine in the 1990s, chicken pox was causing about 100 deaths and 9,000 hospitalizations a year. There were 13,850 cases of paralytic polio in 1955, the year the polio vaccine was introduced. During the 1964-65 rubella epidemic, 11,000 babies exposed to the virus in utero were born deaf, 3,500 were born blind and 1,800 were developmentally disabled.

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This chart, which covers 1954 to 2008, shows how measles cases dropped significantly after the introduction of a vaccine in 1963.

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'A form of privilege'

Jessica Wesel teaches a Western Michigan University class on world ecological problems, which includes a look at the impact of immunizations on global health.

Wesel said it's often well-educated, affluent parents who are skeptical of vaccinations, buying into what she calls "a conspiracy theory."

"People in my age group don't remember and haven't seen what it was like to live before vaccinations," said Wesel, a 40-year-old mother of four. "So they can afford to say, 'I'm not going to vaccinate my child' " because they live in a time and place where most people are vaccinated and vaccine-preventable diseases are now rare.

"It's a form of privilege," she said.

Michigan vaccination rates for 7th graders

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Source: Michigan Department of Health and Human Services, Division of Immunization

Ford, the Mattawan doctor, said it's not too late for parents to rethink the decision not to vaccinate.

"Just because they made a decision they thought was in the best interest of their kids at the time, in light of new tangible threats like measles, they might want to reconsider," she said. "Especially when they see the low rates of immunizations" in some schools and day cares.

"I'm sure my colleagues in primary care are willing to work with them on getting kids caught up," she said.

Said Wesel: "Everybody who can be vaccinated should be. I feel pretty strongly about that."

Michigan vaccination rates for transfer students

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Source: Michigan Department of Health and Human Services, Division of Immunization

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