South Carolina

Religious exemptions from vaccinations climbing among Midlands students

Measles could make a comeback in SC. Here’s why

The amount of immunization exemptions for religious reasons have skyrocketed in South Carolina in the past five years.
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The amount of immunization exemptions for religious reasons have skyrocketed in South Carolina in the past five years.

More Midlands parents are claiming religious exemptions to avoid vaccinating their children, part of a statewide trend that health experts say is worrisome.

State figures show that the number of religious exemptions in Richland County increased from 448 to 764 from the 2013-2014 school year to last school year. In Lexington County, the number of religious exemptions increased from 375 to 630 during the same years.

The number of religious exemptions in Kershaw County grew from 18 to 51, according to numbers provided by the S.C. Department of Health and Environmental Control.

“It’s concerning,” said Dawn MacAdams, lead nurse for Richland School District 2. “We worry about students that are unvaccinated — (we worry) for their health and the health of other students for spreading vaccine-preventable diseases.”

Elsewhere in the state, religious exemptions during that time frame increased in Charleston County from 267 to 722; in Beaufort County from 171 to 278; in York County from 375 to 837; and in Greenville County from 979 to 1,946.

Statewide last school year, more than 9,400 children were not vaccinated for religious reasons, DHEC numbers show. That was up from 4,761 in the 2013-2014 school year.

What is a religious exemption?

A certificate of religious exemption, which can only be obtained at a county health department, may be granted to any student whose parent or guardian signs a document “stating that one or more immunizations conflicts with their religious beliefs,” according to DHEC regulations.

People seeking a religious exemption for their children are not asked about their religious beliefs and only need to fill out a form and get it notarized, a DHEC spokeswoman said.

State law allows a medical exemption, which requires certification from a licensed physician, under DHEC regulations.

Why are there more of them?

Experts cannot pinpoint an exact cause for the increase in religious exemptions, but there are plenty of theories, according to Dr. Anna-Kathryn Burch, a pediatric infectious diseases physician for Palmetto Health Children’s Hospital and Palmetto Health USC.

One of them is that parents are using the religious exemption to get around the vaccination requirement for their child’s school, Burch said.

“I think that’s the big elephant in the room,” she said. “There’s a lot of false information out there on the web when it comes to science. It’s very easy for parents to Google that and find websites or things that might support that claim that MMR (measles, mumps and rubella) and other vaccines can cause autism.”

Despite scientific evidence that has discredited, and debunked stories that suggest links between vaccines and autism, misinformation about vaccines still is being circulated, according to Heather Brandt, an associate professor at the University of South Carolina’s Arnold School of Public Health. A 1998 study in particular claimed that the measles-mumps-rubella vaccine caused autism in 12 children, and was eventually retracted.

“It was completely misrepresented, misinterpreted and continues to be a rallying cry for celebrities who continue to seize onto that notion that there’s a link between vaccines and autism,” Brandt said. “The scientific evidence we have shows clearly that’s not the case. That’s where we’ve lost the forest from the trees.”

But, there’s no philosophical exemption to vaccines in South Carolina, MacAdams noted.

“You can’t just say, ‘I don’t want to have my child vaccinated because I just don’t want to do it,’” she said. “You have to have either a medical exemption or a religious exemption from the health department.”

Another contributing factor, Burch said, is that parents today are so far-removed from diseases of the past that were all but eliminated.

“Parents in this day and age don’t necessarily think that measles exists anymore, (that) polio exists anymore,” she said. “It’s not that frequent. If it’s not that frequent, there’s no risk to my child. But in reality, the reason it’s not that frequent anymore is because of a vaccine.”

Fewer people getting vaccinated can diminish the benefits of what health experts call the “herd immunity.” That happens when a high percentage of a population is vaccinated, which strengthens a community’s overall resistance to a disease.

“Herd immunity matters because we protect those who can’t be vaccinated,” Brandt said. “It becomes concerning when we see exemptions increase, resulting in a reduction of herd immunity. Therefore, those who can’t be vaccinated for medical reasons or because of their age, become at risk.”

The good news

While the number of religious exemptions is up, the proportion of children receiving the exemptions remains small.

In the 2013-2014 school year, 0.62 percent of S.C. students received exemptions compared to 1.18 percent in 2017-2018, according to DHEC.

“Though we don’t know the exact reasons for the continued small increase in religious exemptions requested in South Carolina, we do know that most kindergarten children are receiving the required vaccines,” said Dr. Tracy Foo, a medical consultant for DHEC’s divisions of immunization and acute disease epidemiology. “It is important for parents to make informed decisions regarding immunizations for their children.”

That’s a point emphasized by Brandt, who cited a report last fall by the Centers for Disease Control and Prevention that showed South Carolina with a 1.9 percentage of kindergartners with religious exemptions from vaccines.

“We’re just slightly above the U.S. median (1.8 percent) in terms of the percent increase in exemptions,” she said. “Kindergarten exemptions are almost nil. If a parent is opposed to vaccinating, they’re going to be opposed particularly from the beginning.”

‘We present them with options’

Last month, DHEC confirmed South Carolina’s first case of measles since 1997. The patient is a Georgetown County resident.

“Though measles was declared eliminated in the U.S. in 2000, it is still common in other parts of the world,” the agency said in a release at the time.

There are no current multi-state measles outbreaks in the U.S., according to the CDC, which says the 124 reported cases in the U.S. so far this year is similar to recent years.

Still, health experts say vaccination is the best way to maintain the “herd immunity” and ensure diseases like measles don’t make a comeback.

“For years we didn’t hear anything about measles, and then in the last few years we started to have pockets of measles cases again,” said Cindy Richards, lead nurse for Lexington-Richland School District 5 in the Irmo-Chapin-Dutch Fork area. “The theory is because we’ve increased the number of unvaccinated children.”

School health professionals cannot encourage parents one way or the other on vaccinating their child or seeking an exemption, Richards said.

“We only educate parents to that being an option,” she said. “We present them with options and support them in whatever plan they choose.”

If a case of a vaccine-preventable disease is confirmed at a school, districts have guidelines dictating how long all students who were not vaccinated for that disease must be kept out of school.

“That’s no reason to hit the panic button,” Brandt said of the increasing number of exemptions, “but to keep the message that vaccines are safe, they last and they should be used as recommended.”

Experts say the best source of accurate information regarding vaccines is your child’s health care provider, along with DHEC, the CDC and the American Academy of Pediatrics websites.