During the COVID-19 pandemic, children fell behind on their vaccinations. While some students are catching up, they still have a ways to go, said Dr. Zack Moore, state epidemiologist and the epidemiology section chief in the state Division of Public Health. Photo by CDC on Unsplash

As students and parents brace for the start of the school year, many are entering North Carolina classrooms without the protections of required vaccines.

During the COVID-19 pandemic, children fell behind on their vaccination schedules, and while some students are catching up, they still have a ways to go, said Dr. Zack Moore, state epidemiologist and the epidemiology section chief in the Division of Public Health of the N.C. Department of Health and Human Services.

“We did see a dip in vaccination rates in young kids” during the pandemic, Moore said. “A lot of kids were not being seen for their well-child care (visits), including their vaccinations.”

School districts report to NCDHHS every year on vaccination rates for students in their districts.

Last school year, according to state reports, 2.7% of kindergarten students, 4.6% of seventh graders, and 6.8% of high school seniors did not have all of their required immunizations. This does not include those with religious or medical exemptions, which are less than 2% of children at each grade level.

“A lot of people were afraid to come to the health department because we were testing and vaccinating for COVID,” said Diane Creek, director of the Toe River Health District, which oversees health operations in the Mitchell, Avery and Yancey county health departments. 

These figures dropped after pandemic restrictions loosened on schools statewide, Moore said.

In the 2020-21 school year, 9.9% of high school seniors statewide were behind on vaccinations, compared with 6.8% in the 2021-22 school year.

“Fortunately, that looks like it’s turning around now,” Moore said. “We’re starting to see increases in vaccine ordering that are back to pre-COVID levels. That’s really encouraging because we do worry a lot about some of the things that could happen.”

However, Mitchell County’s public school seniors are bucking that trend. The school system reported 64% were behind on vaccinations in the 2020-21 school year. That figure soared to more than 73% in the 2021-22 school year, state data show.

What about polio in North Carolina?

Polio is of recent concern due to an outbreak in New York state. Last month, an unvaccinated adult man in New York presented to health officials with “leg paralysis,” the Rockland County Health Department in New York said in a news release.

Health officials there said polio viruses had been detected in the wastewater of the patient’s county of residence, and a neighboring county, up to 25 days before and for 41 days after the patient’s symptoms began, according to a report to the Centers for Disease Control and Prevention.

People can be infected with polio and never know it or only have a low-grade fever or sore throat. A fraction of people, usually children, can have serious complications from the virus. In the early 1950s, polio caused more than 15,000 cases of paralysis each year in the United States.

When Dr. Jonas Salk revealed his vaccine for polio was effective and safe, parents felt relieved. Historic accounts show they lined up for blocks to get their children inoculated against the virus. In 1959, North Carolina was the first state in the country to require all children be inoculated with Salk’s vaccine.

Aerial view of a crowd awaiting polio immunization in San Antonio, Texas, in 1962.
Aerial view of a crowd awaiting polio immunization in San Antonio, Texas, in 1962. Photo courtesy of the Centers for Disease Control and Prevention

Children who are vaccinated with all three of their shots against polio have nearly 100% protection against the virus, and that protection lasts through adulthood, Moore said.

The state is currently monitoring about two dozen wastewater systems statewide for COVID-19, which could be expanded to search for other viruses.

“We’re making decisions about whether and how wastewater testing for polio might be useful for North Carolina,” he said.

Schools responsible for vaccination enforcement

By kindergarten, children are supposed to have most of their childhood vaccines, according to NCDHHS, including four doses of the polio vaccine, two doses each of measles, mumps and chickenpox, one vaccine for rubella and five doses for diphtheria, tetanus and pertussis.

NCDHHS monitors vaccination rates at public and private schools statewide. Children who do not have their full course of vaccinations “shall be excluded from attending schools,” according to state law.

However, the enforcement falls to individual schools, school districts and local boards of education, said NCDHHS spokeswoman Kelly Haight Connor.

In Wake County, only 4.1% of high school seniors were reported as being behind on their vaccinations last November. 

“The Wake County Public School System School staff are well educated on the immunization schedules, as students are required to have specific vaccines upon registration and school entry,” said Nanette Bowler, Wake County health and human services director.

The school system also reminds parents about vaccinations via the school website, over social media, regular mail, text messages and calls from the principal.

Mitchell County Schools has the highest percentage of students who are behind on one or more of their vaccinations. Last November, 73.2% of its 142 high school seniors were reported as not having all of their required immunizations. For seventh graders, that figure was 42.5% of its 146 students.

“We don’t know why the numbers of seventh and 12th grade children who are behind in their required immunizations are so high,” Creek said.

The health district sends letters to parents twice per year if their child doesn’t have the mandated vaccines. Many, however, did not grant permission to vaccinate their child.

“It’s up to the parents. I’m not sure if there’s anything else we can do,” Creek said.

Several days after contacting the district to ask about the high number of children without all of their vaccinations, Assistant Superintendent Jennifer Gregory said several factors contributed to the high number, including the delay of well-child visits.

“We are currently reviewing the (DHHS) report and have designated immunizations as a priority as we begin the 2022-2023 school year,” Gregory said.

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Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.