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Colorado school officials are worried about an outbreak because of the state's low vaccination rates. To prepare, some have started following state law. (Heather Hazzan via SELF American Academy of Pediatrics Vaccine Photo Project)

Concern that Colorado is vulnerable to a major outbreak of measles, mumps or whooping cough has prompted a few school districts to try something new: follow state law.

Colorado requires that school districts exclude students from school if they do not have up-to-date immunizations or exemptions on file. But most districts do not follow that law, and the state health department has no mechanism to enforce it.

That means thousands of Colorado students are attending school despite not having the required vaccines and without medical, religious or personal exemption forms on file.

This year, though, at least two school districts “updated policy” to follow the law as written, each setting a cut-off date for when students could no longer attend school without the required paperwork.

Littleton Public Schools picked Friday as the day students still not in compliance — despite numerous phone calls, emails and letters going back to May — were excluded from school. On Thursday, school officials called the nearly 100 students left on the list. And on Friday, those still without vaccinations or exemptions were sent to the office, where parents were required to pick them up. 

Boulder Valley School District, which has the highest vaccine-exemption rate in the state, set Dec. 2 as its deadline. The district started the school year with 4,900 students not in compliance and has whittled that down to about 1,100 after months of communication, including letters listing the exact vaccinations each noncompliant student was lacking. 

The two districts are following the lead of the Brighton school district, called 27J Schools, which revamped its policy three years ago. The first year was an “epic disaster,” recalled Haley Houtchens, a Children’s Hospital Colorado nurse who works in four Brighton schools through a partnership between the hospital and the district. 

Nearly 300 kids were sitting in the halls, waiting on their parents. And when parents were called at work to pick up their children, “obscenities were flying,” she said. 

Now in year three, the policy is working much more smoothly. Still, there were dozens of students kept out of class on Oct. 16, Brighton’s deadline.

“It’s always one of those days that makes the hairs on my arms stand up because it’s a little contentious,” Houtchens said. “It’s always a little dicey.”

But here is why Houtchens and six other nurses rewrote the Brighton policy and why they care so much that the district is making sure as many kids as possible are immunized. “Watch the news: Last year we had a measles outbreak in this country,” she said, referring to the 372 people sickened by measles in 2018 across several states, mainly in New York and New Jersey. “This stuff is real.” 

Closer to home, Houtchens helped monitor a mumps outbreak last year at one of Brighton’s middle schools. Two students who had not been vaccinated against the disease were kept out of school for three weeks. 

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Schools rely on herd immunity to protect those who cannot receive immunizations for medical reasons, she said. Last year, Houtchens was tasked with helping protect two students who could not have the mumps vaccine — one who had a kidney transplant and another who had a heart transplant. 

The issue is especially concerning to school and public health officials in Colorado, which has some of the lowest vaccination rates in the nation, according to the Centers for Disease Control and Prevention. 

School districts need records on every student so that in case of an outbreak, they can quickly determine who is at risk, Houtchens said. 

In all three districts — Brighton, Littleton and Boulder — more parents took their children to get the required vaccines than filled out the exemption form after they were notified their children were out of compliance, school officials said. In many cases, students hadn’t received vaccinations not because their parents were opposed, but because they were unaware or weren’t keeping up with annual health checkups.

“That was a really pleasant surprise,” Houtchens said. “I thought we would have a lot of parents who were going to say, ‘Give me the stupid form.’” In Colorado, getting an exemption is as easy as writing a note on a napkin, although parents are required to ask for the exemption every year. 

Boulder Valley began tightening its immunization policy three years ago, said Stephanie Faren, director of health services. The district not only had the highest number of exemptions in the state, but also one of the highest percentages of students without required documentation. 

The district employed letters, emails and phone calls, but “that only went so far,” said Faren, noting that Boulder “has been a well-known pocket of vaccination controversy.”

This year, the district got serious, setting its Dec. 2 exclusion date — no paperwork, no school. 

Already this fall, Boulder Valley has increased its vaccination rate by about 3%, or about 1,000 students. It also increased its exemption rate, going to 5% of the 31,000-student population from 3%.

While public health officials aren’t necessarily happy about that increase in exemptions, Faren says it’s better to have the records. “My argument is that if we have a situation going on, an outbreak, at least we know … instead of having thousands of kids where we just had no clear information.”

The policy was revamped after last year’s uptick in measles cases across the country. Colorado has had a single measles case so far in 2019, a Denver adult who had traveled out of the country. The state also had two cases in 2016, according to the CDC. Measles had been declared eliminated by the CDC in 2000.

MORE: Polis doubles down on education, outreach in vaccination fight as Colorado rates continue to worsen

“It really provided enough of an impetus to move forward and say, ‘We honor your right, if you don’t want to vaccinate your child, that’s fine … and we also want you to know what that means in case of an outbreak.’”

Local public health departments have jurisdiction to enforce quarantines during an outbreak. Standard practice is to exclude any unvaccinated student or staff member from school for 21 days following the last reported measles case. 

The district is now requiring all teachers and staff to provide their immunization records. “You can’t have a school open if there are no teachers,” Faren said. 

Officials at the Colorado Department of Public Health and Environment said they were pleased that some districts are choosing to follow the law as written. 

“We applaud districts that are stepping up to follow the law by ensuring kids have the right vaccination or exemption paperwork on file,” said Dr. Daniel Shodell, acting chief medical officer. 

The state and local health departments have increased efforts in recent years to communicate with schools, making sure they understand the law and the importance of vaccines. 

Gov. Jared Polis’ budget request, which was released Friday, calls for $2.5 million for the state health department to increase vaccination rates in Colorado. The request notes that Colorado’s measles, mumps and rubella vaccination rate of 87.4% last school year does not meet the 92-94% herd immunity threshold recommended by health authorities to protect against a measles outbreak.

Gov. Jared Polis speaks at a news conference in the Colorado Capitol. (Jesse Paul, The Colorado Sun)

Under state law, schools receive regular health and safety inspections during which health authorities can ask school officials to produce immunization records. But there is no penalty for not being able to produce the required documents. 

Many school districts set a date when immunization records are due, but they do not exclude students from school if they don’t comply. Denver Public Schools and Douglas County, for example, have no exclusion date. 

State law also requires school districts to report their immunization rates to the state health department by Jan. 15 each year, but not every district complies. 

Littleton started the year with about 1,000 of its 15,000 students out of compliance, said Melissa Cooper, director of student support services.

The communication those families have received since May has been relentless. Cooper herself dialed between 50 and 75 phone numbers of families in one day last week. 

Many of the nearly 100 noncompliant students showed up with vaccination records Friday or didn’t come to school. A few were sent home. The district still had 27 students who weren’t allowed to attend Monday unless they arrived with the proper paperwork. 

The goal was not to exclude anyone from class, and for the most part, parents have understood. “After you get seven emails, it can get a little annoying, but they understand they just need to provide the information that we need,” Cooper said. 

“What’s really happening is that the policy hasn’t changed. The state law hasn’t changed. But our implementation of it has.” 

Jennifer Brown writes about mental health, the child welfare system, the disability community and homelessness for The Colorado Sun. As a former Montana 4-H kid, she also loves writing about agriculture and ranching. Brown previously...