Public health officials in five of Colorado’s most populous counties are trying to make a dent in the state’s low measles vaccination rate, targeting parents of kindergarteners as they warn rates are too low to prevent an outbreak.

In Denver County, the parents of about 800 children ages 4-6 got letters notifying them their kids need measles shots. Jefferson County health authorities have created a radio ad cautioning that kids who aren’t vaccinated could miss out on at least three weeks of school.

And Tri-County Health Department sent letters this fall to schools in Douglas, Adams and Arapahoe counties in an attempt to get schools to focus on vaccines.

The statewide average vaccination rate for MMR — the measles, mumps and rubella vaccine — among kindergarteners is 87.4%, among the lowest in the nation. In Denver and Douglas counties, it’s even lower at 85-86%.

The rate recommended by the Centers for Disease Control and Prevention is 95%, high enough to provide so-called “herd protection” for those who are unable to get vaccinated because of organ transplants or other health issues.

The three health departments joined forces this fall with a goal of long-term awareness. They blame Colorado’s low rate on a variety of issues, including misinformation about the safety of vaccines, access to regular health care and lax enforcement of the law requiring school children to have vaccines.

But at the top of their list is Colorado’s relatively easy process for parents to exempt children from vaccines.

Contentious legislation that failed in the statehouse this year would have made it more difficult for parents to obtain a religious or personal-belief exemption from immunizations required to enroll children in school.

Current law allows parents to sign a form at school — or even scribble their objection on a napkin — to avoid getting their kids vaccinated. The proposed law would have required them to sign a standardized form and get it certified by a state or local public health agency, then file it with their school. Medical exemptions would have required a signature from a medical professional.

The legislation died in the final days of the legislature in May.

In June, Gov. Jared Polis issued an executive order to improve rates and directed public health agencies to take immediate action. The goal is to increase the statewide rate to 90% by next June.

Metro-area public health officials began planning their campaign over the summer as they grew increasingly concerned that Colorado is vulnerable to an outbreak. New Jersey and New York were struck with measles outbreaks last year.

“All of those outbreaks were caused by one problem — that was unvaccinated people getting exposed,” said Dr. Bernadette Albanese, a medical epidemiologist with a specialty in pediatric infectious disease at Tri-County Health Department. “We don’t want to be in that situation.”

Massive measles outbreaks in other parts of the world have underscored her point. This spring, more than 1,200 people died of measles in Madagascar, where the immunization rate was 58%, and in Somoa, the death toll from a measles outbreak climbed to 42 last week. The vaccination rate among infants there is an estimated 31%, according to The Associated Press.

Tri-County counts 1,100 kindergarteners, or 6%, in three counties who are not up to date on measles vaccines.

The health department has expanded its clinic hours and partnered with fire departments to host vaccination clinics at fire stations. It also sent letters to 112 schools that either are not reporting their immunization rates to the state — as required by state law — or have low rates.

“There is room for improvement to keep your school’s children and families safe,” the letter said. It also points out that Colorado’s MMR vaccination rate dropped last school year compared to the year before, falling to 87.4% from 88.7%.

Of the 112 schools that received the letter, 22 were not reporting their rates to the state.

Measles is a highly contagious illness that travels through the air. A sick person can infect 90% of the people in the same room, and the virus can live in that room for about two hours.

“It is a miserable illness. People die,” Albanese said. It lasts for a week, with high fever, body aches, fatigue and a rash. It can also lead to brain infection and pneumonia.

The public awareness campaign is intended to last long-term, so that parents of kindergarteners five years from now are even more educated about vaccines, health officials said. In the future, health authorities would like to see an automated system that notifies parents statewide if their child is not up to date or not exempt from vaccines.

“This effort is not just one and done,” said Dr. Judith Shlay, associate director of Denver Public Health. “We’re going to have to build infrastructure and maintain this in a concerted effort to keep this community safe.”

The process could look similar to what Denver County did this fall with help from the Colorado Department of Public Health and Environment, but instead of a letter sent via mail to 800 families, it could include texts or emails.

The Colorado Immunization Registry System is a centralized dataset that keeps track of children’s vaccines — whether they got them at their pediatrician’s office, the local Walgreens or a public health clinic. As of now, though, the system does not have the capacity to send statewide reminders to families.

In August, Denver County sent schools letters jointly signed by Superintendent Susana Cordova and Denver Public Health Director Dr. Bill Burman, urging them to make a stronger effort to increase vaccination rates.

“We really need to make it so people don’t opt out of vaccines just for convenience,” Shlay said. “To do it just for convenience is an unwise situation.”

A big part of the awareness campaign is to bust myths that vaccines aren’t safe, health officials said.

“There are also education gaps. There is a lot of misinformation out there that plays into the vaccine hesitancy,” said Gwyn Rodman-Rice, public health nurse supervisor at Jefferson County Public Health.

The radio ads only recently hit the airwaves in Jefferson County, where the MMR rate among kindergarteners is about 90%. Public health officials have not yet noticed an uptick in immunization appointments.

“It’s think it’s a little too early to know,” Rodman-Rice said.

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