Time for school vaccines as state sees exemption rates rise, immunization rates fall

Missouri Department of Health and Senior Services

The weeks before the start of school are some of the busiest for the Cape Girardeau County Health Department.

Health professionals are busy giving an estimated 1,900 vaccines to schoolchildren. These vaccines are required for school attendance. But the rate of vaccinated students is slipping as more parents opt out, citing religious exemptions.

Missouri statutes give the Missouri Department of Health and Senior Services authority to set rules and regulations for vaccines against polio, rubella, rubeola, mumps, tetanus, pertussis, diphtheria and hepatitis B. The health department, though independent from the state, works closely with the DHSS in many areas of public health, including immunizations.

The law states it’s unlawful for children to attend schools without immunizations unless “the child is properly exempted".

Historical context

The vaccine schedule is rooted in historical heartbreak. Among the most notable stories of the 20th Century was the polio (formally called poliomyelitis) outbreak that gripped the country, including Cape Girardeau. Polio is an infectious, crippling disease that targets children, sometimes paralyzing them and rendering them unable to breathe. Saint Francis Hospital, according to Southeast Missourian archives, was among the hospitals that opened a polio wing in 1949 as the disease spread across the country. By the time the month had ended, 100 cases had been reported in the area. By the end of the year, 180 had been hospitalized, with six local children dying, according to newspaper reports. The World Health Organization reports that during the height of the polio epidemic, the disease killed or paralyzed over 500,00 children every year. A mass vaccination effort stopped polio in its tracks.

Because of the vaccine, the last polio case that originated in the U.S. came in 1979. Today, polio only occurs naturally in Pakistan and Afghanistan, according to the CDC.

In addition to polio, the vaccine schedule protects children and the broader public from several diseases that vary in severity. Among them are rubella and rubeola, which are both rash diseases. Rebeola (measles) can, according for the Centers for Disease Control and Prevention, cause serious health complications, especially in children younger than 5 years old. The MMR vaccine addresses rubeola, rubella and mumps. Mumps affects the salivary glands. It can cause painful swelling of the jaw and even inflammation of the brain, among other symptoms, according to the CDC.

Pertussis, also known as whooping cough, begins as a cold but can last for weeks, and those affected can be contagious for weeks. The Pertussis vaccine is given several times throughout a person’s life as a preventive measure.

One important aspect of vaccines that is not universally understood, according to many sources, is that not all vaccines are 100% effective.

“One common misconception that I hear all the time and heard a lot during COVID was, ‘Billy got vaccinated and still got it, so the vaccine doesn’t work,’” said Autumn Grim, director of the health department. “That is an incorrect statement. Vaccines essentially prime the immune system to have a response so that if you are exposed to a pathogen your body will prevent infection and further spread throughout the body of that particular disease. Vaccines lessen severity of illness but don’t necessarily prevent infection. Some vaccines such as MMR are really good at both prevention and lessening severity, but the primary purpose of vaccine is to lessen severity and prevent death.”

Exemptions increasing

While the vaccine schedule has proven to be effective in preventing the spread of disease, the number of parents filing for exemptions for the shots is on the rise.

Children can be exempted from getting vaccines on either a religious or medical waiver.

According to numbers from the DHSS, the rate of Missouri kindergarten children who were given religious exemptions climbed from 1.9% in 2016-2017 to 4.3% in 2023-2024. For eighth graders, the rate has climbed from 1.3% to 2.4% over the same time period.

The data shows the exemptions affecting the overall rates of immunization, including the following rate decreases among Missouri kindergarteners from 2016 to 2024:

a 5% drop in the DTAP (diphteria, tetanus and pertussis) vaccinea 4.5% drop in the polioa 5% drop in MMRa 3.1% drop in Hep Ba 5% drop in the Varicella (chicken pox) vaccine

Meanwhile, medical exemptions, which are certified by a licensed medical doctor, have remained relatively flat over both periods.

County-by-county numbers were not available for comparison.

It’s possible that some parents may be using religious exceptions out of fear that immunizations can have adverse side effects.

“Vaccine safety and efficacy are determined by conducting clinical trials and evaluating that data,” Grim said. “Clinical trials are extensive studies done typically in phases that progress as each phase proves safe and efficacious. As the phases progress more and more individuals are receiving the vaccine lending to the safety profile. After the vaccine is approved and authorized for use, data is continually collected on any adverse effects and is constantly monitored to ensure that no anomalies are seen after widespread use. There are lots of checks and balances put into place to ensure their safety.”

Three clinics coming up

The Cape Girardeau County Health Department will conduct three drive-thru vaccine clinics at its facility at 1121 Lindent St. in Cape Girardeau at the following times:

9 a.m. to 4 p.m. Aug. 129 a.m. to 6 p.m. Aug. 199 a.m. to 4 p.m. Aug. 26

The shots are available to all ages, but are primarily targeting schoolchildren going into kindergarten, eighth grade and 12th grade. According to Grim, no child who needs a vaccine will be turned away. The health department can handle those who are insured and those who are not.

The public health department will also travel to school districts within the county. The drive-thrus are an opportunity for parents to get their children vaccinated if they missed the opportunity at school.

Children and adults can also get their vaccines through their primary care physician.