As the country contends with a burst of measles cases, almost all Cambridge schoolchildren are fully vaccinated against measles and other childhood diseases, figures from the state health department show. But vaccination coverage can be uneven, with immunization rates in some Cambridge schools lower than the level that public health experts say is necessary to protect the community from infection.
Measles, for example, is so contagious that up to 90 percent of people who are not vaccinated will get it if they get close to an infected person. The virus can live for two hours in the air after a person with measles leaves the area, the Centers for Disease Control and Prevention says. At least 95 percent of the population must be fully vaccinated to keep a community safe from measles, according to the CDC.
Kindergarten students at the Tobin School and the Benjamin Banneker Public Charter School didn’t reach that level last fall although they came close: Tobin reported a 93 percent measles vaccination rate and Benjamin Banneker 94 percent.
“Ninety-four and 93 percent are probably close to okay; it’s hard to pinpoint,” said Dr. Elizabeth Barnett, professor of medicine at Boston University and a pediatrician specializing in infectious disease at Boston Medical Center.. “We want to aim for 95 percent or higher.”
Statewide, 96.3 percent of kindergarteners are fully immunized against measles, according to state health department figures for the current school year. The proportion of kindergarten children vaccinated against measles has exceeded 96 percent for all but two of the past 10 years – the rate was 95.9 percent in 2020-2021, the first full school year of the pandemic, and 94.7 percent in 2014-2015.
In the first four months of this year, there have been 128 cases of measles nationwide, almost all in unvaccinated children and adults. None were reported in Massachusetts. There were 58 cases in all of 2023. Fewer children and adults vaccinated have led to measles cases in 49 countries, with outbreaks in Europe, Great Britain, India and Yemen, public health authorities say. Canada is also seeing increased cases. U.S. officials have recommended that people traveling abroad get vaccinated if they have not already received shots or had the disease.
Barnett said the pandemic “disrupted the general systems that were in place to provide immunization to children. Many health care systems chose to prioritize newborns and often this left slightly older children not coming in either because [their parents] were afraid to come or hunkering down or simply weren’t able.”
Then “the experience with Covid vaccine exacerbated … vaccine hesitancy,” she said. Some states expanded the availability of vaccine exemptions, Barnett said. Massachusetts, which allows exemptions for medical or religious reasons, wasn’t one of them. Still, the number of children with exemptions in Massachusetts and nationally has increased, according to CDC and state figures.
Statistics on required vaccinations for students in Massachusetts can be found here.
Caveats on statistics
Most Cambridge schools reported no kindergarten children with exemptions this school year; exceptions were the Cambridgeport School, where 5 percent of children had exemptions; Maynard-Fletcher Academy, with 4 percent; and 1 percent at the Tobin and the Amigos schools. Statewide, 1.4 percent of kindergarten students have exemptions this year, most of them for religious reasons.
Not having an exemption doesn’t mean a child was vaccinated, though. In Cambridge, 13 percent of kindergarten students at the Kennedy-Longfellow School failed to get a required vaccination for which they did not have an exemption; only 88 percent of kindergarteners at the school got the required two shots against chicken pox.
Barnett said the 88 percent chickenpox vaccination rate is worrisome because it is markedly lower than the rate at other Cambridge schools. “It suggests it’s lower than the community and there may be clustering [of unvaccinated children],” she said.
“People who are underimmunized often cluster together. Those are kind of hot spots. A virus will find these people,” Barnett said.
All the vaccination numbers, though, have a flaw: They represent the figures at a specific time last fall and can change during the year as more children get vaccinated, or students come or leave the school system. “It’s a snapshot,” Barnett said, echoed by Dawn Baxter, spokesperson for the Cambridge Public Health Department, which oversees school nurses. “The school health team reviews vaccine records for all students on an ongoing basis and works with families to ensure vaccine access,” Baxter said.
Shelter vaccination
For example, nurses held a special vaccination clinic at the central site where children from the East Cambridge emergency overflow migrant shelter were being registered for school in Cambridge, said Ellen Semonoff, assistant city manager for human services. She spoke at a meeting of the Cambridge Health Alliance population health committee April 4. Though families at the shelter were told they could get their children vaccinated at CHA primary care clinics, “most of the vaccinations happened by setting up that one vaccination site,” Semonoff said.
One measles outbreak this year happened at an emergency migrant shelter in Chicago where many children weren’t vaccinated. Barnett said newcomers aren’t necessarily the major cause of infections.”When an unimmunized or underimmunized person travels outside the U.S. and if they are on a short trip, they can bring [measles] back,” she said. U.S. health officials recently recommended that travelers who didn’t get vaccinated or have measles as children get vaccinated before going abroad.
Lisa Dobberteen, medical director of the Cambridge Public Health Department, told a meeting of the CHA public health committee April 25 that “lots” of newly arrived children were already, vaccinated, but “most have no records.” The city and its health department are working intensely to get kids integrated into school, connected to health care and vaccinated if needed, Dobberteen said.
“It’s a problem that has so many moving pieces,” she said. “We have to focus on what we can do.”
Barnett said that “there’s a great effort among every health care professional I know to provide vaccination … I want people to know there really is a huge effort among all of my colleagues and all of the people in health care.”
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My heartfelt thanks to everyone at the Cambridge Health Alliance for attending to the health of all of our children.
They did a great job during the pandemic and they continue to work hard!