This post has been updated to correct an error. The Kenai Public Health Center works off a sliding scale for services when it comes to the immunization clinics.

With yet another school year starting Wednesday, the decision of whether or not to vaccinate their children will soon present itself to area parents.

To help community members be prepared, the Kenai Public Health Center began offering weekend immunization clinics in June to help families who don’t have the means or time during the week to go to other providers. So far, the monthly clinics have drawn 28 patients who received multiple vaccines each, said Nurse Manager Leslie Felts.

Felts said the public’s reception to the clinics has been positive, and she hopes to continue offering the clinics in the future. For now, the last scheduled clinic is set for Nov. 14.

Some parents are more reluctant to vaccinate their children, however. A previous report by the Peninsula Clarion found that 1,060 exemptions from immunizations, both for medical and religious reasons, were filed in the Kenai Peninsula School District as of February in the 2014-15 school year. The district has around 9,000 students.

Health Services Coordinator Carmen Magee said this school year’s number of immunization exemptions won’t be tallied for some time, as exemption forms are still rolling in. In order to exempt a child from being vaccinated, parents or guardians must submit either a medical or religious exemption form, which must be notarized, to the district.

“Before, you did not have to have (the form) notarized,” Magee said. “It was just a simple statement the parent made.”

Magee said requiring immunizations for school is a way to ensure the safety of the whole student population and to keep students from missing school unnecessarily.

“The reasons that we like vaccines are, it keeps our student population healthy, and it keeps the students from passing around those diseases that can be prevented,” Magee said. “It keeps them in class, too. It keeps them in their seat to learn, which is what our goal is.”

There are numerous reasons parents cite for choosing not to vaccinate their children, Felts said. Some are concerned the vaccine schedule could overwhelm a child’s immune system, while others are wary of the chemicals used in the production of vaccines.

Increased parental concern about the contents and effects of immunizations is actually a good thing, Felts said.

“At this juncture, I have to say I’m glad that people are looking into the very minute quantities of substances that are in vaccines, just as I know parents are looking at the very minute quantities of all the foods that their children eat and all of the other medications that they have to give their children,” Felts said. “It’s good that people are looking at that kind of thing.”

Some substances that give parents pause, including aluminum and formaldehyde, are used to make vaccines and as a way of making them more effective, Felts said. Formaldehyde is used in the production of vaccines before being washed out. Some trace amounts remain in the vaccines, but not enough to cause harm to children, Felts said.

“The amount of formaldehyde in a baby’s circulation is five times more than the amount that’s found in the vaccines,” she said. “Formaldehyde is essential in human metabolism, so we have formaldehyde anyway in our bodies. All humans have detectable quantities of natural formaldehyde in their circulation.”

Aluminum is used as an adjuvant in vaccines, or a substance that enhances the vaccine and allows small parts of the given virus to be effective and recognized in the body, Felts said. If a baby follows a regular vaccine schedule, it will be exposed to 4-6 milligrams of aluminum over a 6-month period.

Felts said breast feeding a baby for the same amount of time will expose it to 10 milligrams of aluminum. Feeding a baby formula would expose it to 40 milligrams, and soy formula would expose it to 120 milligrams of aluminum.

“Basically, aluminum is a common metal,” Felts said. “It’s present in our water, our soil, air, fruit, vegetables, all of our foods.”

As for the concern that too many vaccines in a certain amount of time could overwhelm the immune system, Felts said immunization schedules have been studied so thoroughly that there is little chance of that happening. There are no studies or clinical trials that suggest extending the normal vaccine schedule is helpful for a child’s immunity, she said.

While it is possible some providers will work with concerned parents to elongate their child’s vaccine schedule, Felts said that means many more doctor visits for the child. That child would also be at risk for not qualifying for certain schools or day care centers if they were behind other children in terms of immunization, she said.

“Infants aren’t going to remember,” Felts said. “But if it’s drawn out, there might be a real fear developed about a medical procedure that, although it certainly causes our baby to cry, compared to cancer treatments, or invasive hospitalizations, I think it’s a pretty small inconvenience.”

Child vaccinations have recently been taken up once again at the federal level as well. Rep. Frederica Wilson (D-Florida) introduced a house bill called the Vaccinate All Children Act that would allow the federal government to withhold “preventative health services grants” from states that could not prove “to the Secretary’s satisfaction” that all of its children in elementary and secondary schools were being vaccinated. The bill, introduced in May and referred to the House’s Subcommittee on Health, allows for medical exemptions from vaccines, but not religious ones.

Magee said the school district would have to comply with any federal law related to school immunizations.

“We always are mandated to follow the laws by the state of Alaska and they in turn also incorporate federal law,” she said. “So, if there is something passed federally or (by the) state, then we will adhere to that.”

Medical providers must sign off on medical exemptions requested by parents, but the school district does not look into the reasons behind religious exemptions, Magee said. If a large enough portion of the district’s student population was exempt from being vaccinated, Magee said there would be the potential for the spread of disease, though she said she is not sure how many students would need to be exempted for that to happen.

“I don’t know what the tipping point would be,” Felts said. “It would depend on the school, the student body, and how many in that school were exempt. But, at some point, there would be enough students that … if they were truly not immunized, they would then be more susceptible to those diseases.”

Felts said the Kenai Public Health Center makes a point to listen to the concerns parents have about immunization and to give them all the facts before they decide whether they want that for their children. Essentially, the effects of a parent’s choice of whether or not to vaccinate go beyond the family unit, Felts said.

“Parents have lots of choices. To put on a seat belt, to feed their child nutritious food, to use a helmet — lots of different choices that parents have to make that affect them and their family and their children,” Felts said. “When we’re talking about vaccines, we’re talking about the larger population, and I think that parents need to make that conscious decision if they’re choosing not to vaccinate, to think about the big picture too.”

Another aspect of vaccines that sometimes gets overlooked is the importance of certain vaccines for adults and the elderly. Shelley McManamy, an outreach specialist for the Kenai Peninsula Family Caregiver Support Program, has been traveling to senior centers around the peninsula to speak with older adults and their caregivers about vaccines every Tuesday of this month.

“The elderly are more susceptible to things, and they have … other health conditions,” McManamy said. “We’re finding out that the vaccines that we were given as children may need to have boosters as we’re getting older.”

The most common diseases among the elderly include shingles, pneumonia, diphtheria and pertussis, McManamy said. Felts said providing adults with the pertussis vaccine is especially important to keep them from passing it on to children or grandchildren.

As with other vaccines, education and access are the keys to making sure older adults continue getting the immunizations they need, Felts said.

Reach Megan Pacer at megan.pacer@peninsulaclarion.com.