For a third year, Tennessee school districts are at risk for more disease outbreaks amid less child vaccinations

Sara Guylas wasn't aware that vaccination rates for kindergarten students in Middle Tennessee public school districts were dropping and had been for years until about a week ago.

For the Robertson County mom, who has a kindergartner enrolled at East Robertson Elementary and two middle schoolers at other nearby public schools, the news was concerning, especially since she said she knew that many doctors in the area would cancel appointments with child patients if their parents refused to allow vaccinations.

"I wonder if these parents are even taking their kids to the doctor,” Guylas said. She noted that she's grateful for vaccinations because some members of her family weren't lucky enough to have them.

"My grandma didn't get vaccinated as a child because they didn't have them readily available," she said. "My parents did, but I got more than they did, and now, it seems like kids get a lot of vaccines. But overall, I'm thankful for them. It's nice to know that my kids won't get certain illnesses that I did because there was no vaccine at the time.

Why are the rates dropping?

Public health officials cite vaccine mistrust after the COVID-19 pandemic and a sharp rise in religious exemptions as reasons why many parents are opting their kids out of vaccinations.

A recent report from the Tennessee Department of Health shows a statewide drop in kindergarten vaccinations over the past three school years. The department said it doesn't know all the factors contributing to the decline, just that there's a clear association with the pandemic and religious exemptions. It also can't predict how immunization coverage rates will change in the future.

But, for a community to remain at low risk for a highly infectious vaccine-preventable disease outbreak, such as measles, the fully immunized threshold of a school should be above 95%, the report said.

With fewer fully-immunized kindergartners statewide, many counties fail to meet that minimum threshold.

In fact, 43 of Tennessee’s 95 counties met the threshold during the 2021-2022 school year, down from 72 counties in the 2020-2021 school year, according to the report.

Only 26 counties met the same threshold for the 2022-2023 school year.

By the numbers: How protected are Middle TN county school districts?

Sixty-nine counties did not meet the minimum immunity threshold this school year. Davidson County, home to Nashville, had a vaccination rate of 92.5% last year. But what about the counties surrounding Davidson County?

What percentage of students are fully immunized in each of those? Let's take a look:

• Cheatham County: 95.5%

• Dickson County: 96.4%

• Montgomery County: 93.7%

• Robertson County: 94.2%

• Rutherford County: 94.2% in Rutherford County Schools and 93.7% in Murfreesboro City School District

• Sumner County: 92.6%

• Williamson County: 92.9% in Williamson County Schools and 90.8% in Franklin Special School District

• Wilson County: 93.9% in Wilson County Schools and 91.9% in Lebanon Special School District

Reasons given for lower percentages include students who may not be fully immunized due to religious or medical exemptions, temporary certificates or incomplete or missing records.

Religious exemptions from kindergarten vaccinations have seen a sharp incline in recent years and were up 0.7% in public schools statewide for the 2022-2023 school year, according to the report.

Let's break that down at the county level.

Religious exemptions rose 0.5% in Cheatham County, 0.7% in Montgomery County, 2% in Robertson County, 0.8% in Rutherford County, 0.9% in Sumner County, 0.3% in Williamson County and 1.8% in Wilson County. Dickson County was the only school district that saw a decrease of 0.1%.

Williamson County students claim religious exemption more than any of these eight counties, with about 5.5% of kindergarten students abstaining from vaccinations.

So which schools could be putting communities at risk?

High immunization rates are critical to avoiding vaccine-preventable disease outbreaks, the report said.

Elementary schools with immunization rates below 90% are at an increased risk for outbreaks. The following schools were noted in the report as falling below that rate:

Robertson County

• East Robertson Elementary: 88.6%

Sumner County

• Beech Elementary: 89.8%

• Clyde Riggs Elementary: 81.6%

• Lakeside Park Elementary: 88.1%

• North Sumner Elementary: 87.2%

• Oakmont Elementary: 88.9%

• Portland Gateview Elementary: 87.7%

• Vena Stuart Elementary: 89.8%

• Watt Hardison Elementary: 85.7%

Williamson County

• Johnson Elementary: 87.2%

• Liberty Elementary: 88.8%

• Chapman’s Retreat Elementary: 89.3%

• College Grove Elementary: 88.4%

• Hillsboro Elementary: 84.2%

• Oak View Elementary: 85.9%

• Thompson’s Station Elementary: 89.4%

• Winstead Elementary: 87.1%

Wilson County

• Jones Brummett Elementary: 85.1%

• W A Wright Elementary: 88.9%

Cheatham, Dickson, Montgomery and Rutherford Counties had no public schools with an immunization rate below 90% during the 2022-2023 school year.

What are health officials saying?

The United States has shown a decline in overall vaccination rates after the state of emergency caused by the COVID-19 pandemic, the report said.

Public health officials cite a mistrust of health care professionals and vaccinations bred from public misinformation and anti-vaccination propaganda during the pandemic as one of many reasons for the recent and sharp decline in immunization rates.

“Unfortunately, the lower vaccination trend for our children has worsened recently, during and after the COVID-19 pandemic,” said Infectious Disease Specialist Dr. Jayesh Patel, of TriStar Hendersonville Medical Center and TriStar Skyline Medical Center.

“The virus's origin, its treatments and immunization using the modern mRNA became hot items for political activists and the anti-vaccine groups got fresh energy. They became more active and more influential, and their messages made parents more hesitant in getting their children immunized.”

Declining vaccination rates worry physicians like Patel because he knows firsthand how quickly certain diseases can spread and how deadly they can be for vulnerable populations.

“I grew up in India and Africa, my basic medical schooling was in Africa and I’m a postgraduate in tropical diseases from London," Patel said, adding that many of the diseases he'd seen during his training had once been widespread in the U.S., but "due to vaccination, they have become so rare. They still are quite common in developing countries where I have been."

Patel said he's watched or cared for patients “suffering from polio, tetanus, rabies, as well as the old diseases like measles and everything else that used to maim and kill children.

"I’m very worried that if we don’t get our vaccination rates up … common diseases can come back and spread rapidly into the community if we don’t have enough herd immunity to reach immunization,” he said. “It’s a real possibility.”

Because such outbreaks aren’t as common in the U.S., Patel said there can be a false sense of security in certain communities, which further adds to the problem of declining vaccination rates.

“I do sincerely hope that our scientists, pediatricians, infectious disease experts, public health experts, schoolteachers as well as health organizations and societies can be more effective in getting the message across to parents to protect their children and future generations by getting their children immunized as per the current guidelines,” he said.

For some parents, the message is clear.

Like Robertson County's Guylas, Sumner County mom Amy Krause McKenna believes vaccinations are necessary to keep children healthy and prevent the reoccurrence of harmful diseases. Her third and fifth graders attend Lakeside Park Elementary School

“It’s hard to say if the declining vaccination rates will have an affect down the road, but there is always that potential,” McKenna said.

Tennessean Reporter Frank Gluck contributed to this report. Katie Nixon can be reached at knixon@gannett.com.

This article originally appeared on Nashville Tennessean: More Tennessee school districts at risk of disease outbreaks in 2023