School nurse Jennifer Comer vividly remembers the number of students she had to exclude from Clark Middle School in Bonner Springs on a single day in 2013: 289.
Why? They weren’t up to date on their state-required immunizations.
In the past, the Bonner Springs-Edwardsville School District in Wyandotte County technically required vaccines. But if families flouted the rules, their kids could still go to school.
School nurses had been pushing district leaders to take the requirements more seriously. Twelve years ago, they finally got their wish.
So when the school’s deadline for vaccinations hit, staff members started calling families to come pick up their kids.
It wasn’t fun, and it didn’t get better right away.
“It was painful the first couple years,” said Kimberly Bolewski, the district’s nurse coordinator, stationed at McDanield Preschool. She noted that families weren’t used to the requirements being enforced. “Here we are saying, ‘No, really, you can’t start school.’”
But that pain has paid off.
Kansas’ 2023-24 data — the most recent available — show kindergarteners at Bonner Springs schools had the best measles, mumps and rubella (MMR) immunization rate in Johnson or Wyandotte counties, a rate of nearly 98%.
Earlier this month — 25 years after the United States declared measles eliminated — nationwide measles cases hit their highest annual number since 1992. But the district is “in a pretty good spot” to weather a local outbreak without widespread illness and quarantines, Bolewski said.
“If our vaccination rates weren’t really high, it would be a nightmare,” she said. “The higher the vaccination rate, the less likely of a lot of our students becoming ill.”
Not all districts in the state or county are equally secure. While Kansas’ Department of Health and Environment determines which vaccines are required for school and the state defines what kinds of exemptions are valid, districts control enforcement.
That’s partially why neighboring Kansas City, Kansas, Public Schools had a kindergarten MMR vaccination rate of about 67% percent in 2023-24, though less than 2% of students had medical or religious exemptions. KCKPS says its overall vaccination rate is now 80% and rising.
KCKPS stopped excluding unvaccinated students when they were learning remotely during the COVID-19 pandemic, Director of Health Services Lajasmia Bates said. The district plans to resume enforcing the policy for the 2025-26 school year.
“We do realize that when those compliance rates are low, that we’re at a higher risk,” Bates said. “We wanted to do something about that to make sure that we can get as close (as possible) to having a herd immunity to be able to stop the spread of those communicable diseases, including measles.”
Upcoming school vaccination events
Johnson County Health Department summer vaccination walk-in clinics focused on school-required and recommended childhood vaccines:
- Aug. 1, 1-4 p.m., Health Services Building, 11875 S. Sunset Drive, Olathe.
- Aug. 8, 9 a.m.-3 p.m., Northeast Office Building, 6000 Lamar Ave., Mission.
Wyandotte County Health Department vaccination events
- Turner Back to School Bash, July 30, 4 – 6:30 p.m., Turner High School, 2211 S. 55th St., Kansas City, KS (For Turner USD 202 families)
- Wyandotte County Back to School & Health Fair, Aug. 9, 8 a.m. – 1 p.m., HomeField KCK, 9250 State Ave., Kansas City, KS (For all Wyandotte County students)
State vaccine requirements
Kansas law empowers the Kansas Department of Health and Environment secretary to decide which specific vaccines or tests families must obtain before children can attend school.
The state currently requires multiple doses of seven vaccines, some of which immunize against multiple illnesses.
For example, the MMR vaccine protects against measles, mumps and rubella. Kansas says children should have two doses: one at age 12-15 months and another before entering kindergarten.
There’s a catch-up schedule if children fall behind, and exemptions if a physician certifies that vaccines “seriously endanger” the child or a parent says that the child’s religious denomination opposes vaccines.
Federal laws also ensure children can enroll without all of their required paperwork, including proof of vaccination, if they’re in the foster care system or unhoused.
Schools must notify parents of vaccine requirements before May 15 each year. And the law says the school board “may exclude from school attendance” any students who haven’t complied.
School officials told The Beacon that gives districts leeway to determine exactly when — or even whether — they exclude students who fall behind on required vaccines.
Measles vaccination in Kansas
That’s led to a situation where vaccination rates can range wildly.
In 2023-24, Riley County schools recorded the state’s lowest kindergarten MMR vaccination rate: 36.67%. The neighboring Manhattan-Ogden district had a rate of 97.27%. Meanwhile, about three dozen districts claim a 100% rate.
About one-third of the 238 districts with public vaccine data have an MMR kindergarten immunization rate at or above the 95% threshold needed for herd immunity for measles. Herd immunity means that enough people are vaccinated that the disease is unlikely to spread.
Overall, Kansas kindergarten MMR vaccination rates declined from above 94% in 2019-20 to about 90% in 2023-24. Medical exemption rates remain tiny — about 0.25%. Religious exemptions have more than tripled since 2010-11, approaching 3% in 2023-24.
MMR vaccine rates in Missouri have followed a similar pattern, falling from about 95% in 2019-20 to about 91% in 2023-24. Missouri does not report individual districts’ data.
In Johnson and Wyandotte counties, the Bonner Springs, Piper-Kansas City, Blue Valley and Shawnee Mission school districts had kindergarten measles vaccination rates high enough for herd immunity during the 2023-24 school year.
Olathe is barely below the herd immunity threshold. De Soto, Turner-Kansas City, Spring Hill and Gardner Edgerton range from approximately 1 to 4 percentage points below, and Kansas City, Kansas, is well below.
Comparing two districts’ policies
KCKPS policy already says that unvaccinated students may be excluded. But it hasn’t actually taken that step in recent years.
As it moves to enforce its policy again, the plan is to enroll students whether or not they’re vaccinated, Bates said, and give them 30 days to comply.
In Bonner Springs, vaccine records are required for enrollment. But the rules aren’t one-size-fits-all there, either.
Nurses are flexible when it’s clear a family is doing their best to get vaccination figured out, said Kristi Flack, the school nurse at Delaware Ridge Elementary.
Students can start school if they show proof of an upcoming vaccine appointment, she said, or if it’s obvious they had a mix-up about which vaccines they were supposed to get.
In those cases, she said, “The parents clearly took the time to do it. I’m not going to say, ‘OK, sorry, you didn’t get it. You can’t come back.’ I work with them.”
Nurses also work with families who have special circumstances such as getting medical records from overseas. If proof doesn’t arrive, they can help plan a catch-up schedule.
Vaccine skepticism
Bolewski said she’s starting to see more vaccine hesitancy at the preschool age.
“I think that’s from misinformation,” she said. Nurses have to ask: “‘How can I help you understand? Who can I connect you with?’ It doesn’t work to just simply say, ‘Well, you just have to do it.’”
Comer has run into issues as well.
“I’ve had threats. I’ve had very, very angry parents,” she said. Some will abruptly claim religious exemptions. “But most parents want what’s best for their kids, and they just get busy and time gets away from them.”
Comer said she’s followed news of outbreaks around the U.S. and tracked state and national-level conversations that could complicate efforts to vaccinate kids. She’s worried Kansas could broaden vaccine exemptions and said misinformation, including from the federal level, is “very scary.”
Doctors and major medical organizations overwhelmingly recommend childhood vaccinations, which have been used for decades to prevent diseases like measles, diphtheria and whooping cough.
But now that Robert F. Kennedy Jr., a known vaccine skeptic, leads the U.S. Department of Health and Human Services, public health officials worry that vaccine skepticism is growing.
In June, Kennedy dismissed members of an advisory committee that is charged with recommending vaccines and, ultimately, influences which will be covered by insurance. Kennedy’s appointments to fill those vacancies have included vaccine skeptics, fueling fear that long-standing vaccine protocols could be uprooted.
Kennedy has also publicly questioned whether vaccines are linked to autism, a debunked claim. And in May he released a report that included calls for increased scrutiny of childhood vaccines. The report was found to include inaccurate citations and reportedly relied on artificial intelligence.
Dr. Christelle Ilboudo, a pediatric infectious disease doctor at Children’s Mercy Hospital, said she often gets referrals to consult with parents who are questioning whether to move forward with recommended childhood vaccinations.
“Oftentimes we spend up to an hour in our clinic … going over the different vaccines,” she said. “Ultimately, the decision is up to the parents. But our duty is to make sure that they are truly making an informed decision based on the facts that we’ve discussed and presented to them.”
Overcoming other barriers
In addition to skepticism or health concerns that make some parents hesitant about having their children vaccinated, some families also run into logistical barriers related to language, transportation, cost and scheduling, the school nurses said.
Flack said her district tries to help parents by sending reminders, scheduling appointments and finding interpreters if needed.
Comer suggests families with insurance try pharmacies like Walgreens, CVS and Walmart that may have longer hours if appointments during the workday are tough. For walk-in appointments, she recommends the Johnson County Health Department, which she said accepts residents of other counties as well.
In addition to its normal walk-in schedule, the department is offering summer vaccination clinics. Public information officer Ashley Follett said in an email that those clinics are meant to offer a “more convenient and efficient option” for school vaccines specifically.
The Wyandotte County Health Department also offers low-cost vaccinations to certain qualifying families and plans to offer vaccines at back-to-school events.
In KCKPS, Bates said the district has been communicating with families and warning them about the upcoming enforcement, which helped increase the K-12 vaccination rate to about 80%.
KCKPS has worked to translate information into languages families understand, direct them to where vaccines are available and give context for requirements, she said.
“The nurses aren’t just sending out a letter telling them what immunization their student needs,” Bates said. “We’re telling them, OK, if the student doesn’t get the immunization, what could happen? What are the benefits of getting the immunization?”
Preparing for a measles outbreak
Both districts said they’d heavily rely on the Wyandotte County Health Department for guidance in the case of a measles outbreak.
Flack got a preview when a student came down with whooping cough, another disease that can be largely prevented with a vaccine. She said the department told her exactly what to do, spoke to the family and gave her information for other families in the class.
“They handled it really well, and made me feel confident that I could do what I needed to do,” she said.
If a suspected or confirmed measles case were to appear, Flack said the district would have to contact the county and state health departments within hours.
“We would mask them, wear gloves and then keep them separate from the general population until they’re able to be picked up from school,” Bates said.
The Bonner Springs nurses said a measles outbreak in a district with a low vaccination rate would be very serious. Not only is the disease highly contagious and capable of causing major health complications, but quarantine times are long for unvaccinated students who get exposed.
An outbreak would mean contact tracing and kids missing lots of school.
Even if an unvaccinated student were lucky enough not to catch the disease from an exposure, they would have to be out of school for three weeks, Flack said.
If that child still doesn’t get vaccinated and is exposed again, she said, “then they have to start their exclusion all over again.”
In a district with fewer unvaccinated students such as Bonner Springs, the disruption could be much less severe. Most students could stay in school even if exposed.
And parents shouldn’t forget, Ilboudo of Children’s Mercy said, that vaccines prevent dangerous and sometimes life-threatening diseases.
“Our biggest challenge is that vaccines have worked too well,” Ilboudo said. “When you talk to people who have seen their classmates or their neighbors go through polio, they remember. They remember their neighbor who died from measles. They remember their neighbor who was paralyzed because of polio.
“Nowadays parents truly don’t know the risks that these infections will present because we haven’t seen them. We haven’t seen them for years and years and years.”
Suzanne King contributed. This story was originally published by The Beacon, a fellow member of the KC Media Collective.
