AMBER MANOS VILLELLA AND HER DAUGHTER, WILLOW

Amber Manos Villella worries her daughter won’t always be protected because she cannot get all her vaccinations.

Her child was among more than 2,000 school-age children in the state medically exempt from vaccines last year. Willow, 8, has juvenile idiopathic arthritis, a chronic inflammatory disease that causes pain in the joints and limits mobility. Her treatment includes taking immunosuppressant drugs, which limits her accessibility to vaccines.

Willow “is not allowed to have an updated MMR [measles-mumps-rubella] or the chickenpox vaccine because those are live viruses,” said Manos Villella, of Reserve. “She relies on others being vaccinated for these.”

Vaccination rates among children in several southwestern Pennsylvania counties are below herd immunity — the minimum percentage of people vaccinated to protect against an outbreak, according to doctors. Counties with lower than 95% of school-aged children kindergarten to 12th grade vaccinated include Allegheny (94.1%), Beaver (91.5%), Butler (94.3%), Fayette (92.5%), Greene (92.3%), Indiana (93%) and Westmoreland (92.1%), according to 2024 data from the commonwealth’s Department of Health.

Vaccine exemptions overall are also on the rise. Almost 1,800 students in Allegheny County submitted medical, religious or philosophical vaccination exemptions in 2024, compared with about 1,300 in 2020. In Westmoreland County, 926 students filed for exemptions in these categories and time frame, compared with just under 400 in 2020.

According to state law, all school aged children, including those who are homeschooled or attend cyber schools, must have certain vaccines.

• Kindergarteners must have four doses of DTaP, four doses of polio, two doses of measles, mumps, rubella (MMR), three doses of hepatitis B, and two doses of varicella (chickenpox) or evidence of immunity.
• For seventh grade, students must have the ones above, one dose of Tdap, and one dose of MCV4.
• Students in 12th grade must have all the ones above and a second dose of MCV4.

Exemptions are allowed, but a child, like Willow, may be excluded from school during an outbreak of a vaccine-preventable disease.

Exemptions are allowed, but a child, like Willow, may be excluded from school during an outbreak of a vaccine-preventable disease.

“My biggest concern is an outbreak of measles; we’ve already seen them,” Manos Villella said. “If that happens, I’ll have to pull her from school and go into seclusion, which would be very upsetting.”

Fellow Reserve parent Danielle Sowers vaccinates her children, but they are exposed to a relative who is not.

“We’re going to continue to vaccinate the rest of our children no matter what, so we limit the risks for our younger children,” Sowers said.

Sowers’ twin daughters, 6, were both born with heart defects and tend to be more affected by colds than others. That means they have to take extra precautions, she said.

“All this misinformation makes it much harder for us and for our kids to be around others,” Sowers said.

Beaver County saw the overall lowest vaccination rate of children in the region last year at 91.5%, with 7.5% submitting non-medical exemptions; only 0.3% were medical. In 2020, overall vaccination was at 93.8%.

COLLEEN KELLY SITS WITH HER CHILDREN ON HER PORCH IN BADEN. WITH A GENERAL DECLINE IN VACCINATIONS AMONG CHILDREN, KELLY HOPES THAT HERD IMMUNITY WILL CONTINUE TO PROTECT HER DAUGHTER, ARLOE, WHO HAD AN ALLERGIC REACTION TO THE MMR VACCINE AND REMAINS UNDER-VACCINATED. | PHOTO BY ERIN YUDT

Colleen Kelly’s daughter Arloe, 10, received her first dose of the MMR vaccine around her first birthday and experienced an allergic reaction.

“Within minutes of her getting vaccinated, her whole thigh was covered with hives,” said Kelly, of Baden. “Thankfully we were still in the office, and they gave her Benadryl to calm things down.”

Dr. Joseph Aracri, system chair of Pediatrics with Allegheny Health Network Pediatric Institute, said these allergic reactions are rare and can be confused with side effects such as pain and swelling at the injection site, irritability, or a low-grade fever.

“The typical side effects are all because the vaccine is doing its job,” Aracri said. “What we’re doing is we’re injecting part of a virus, and we’re trying to stimulate some of that immune response that way you make your antibodies.”

Kelly said Arloe’s pediatrician recommended she not get the second dose of the MMR vaccine, which is typically given around ages 4 to 6, and the varicella vaccine.

“We moved around a lot, so the new schools needed fresh statements from doctors on why she doesn’t have these vaccines,” Kelly said. “It’s just like constantly having to prove you’re right.”

As Arloe gets older, Kelly said she is open to completing her vaccine schedule.

“I do think it’s important if it can be done,” Kelly said. “Because I have a daughter that is slightly less vaccinated, I would hope that if you can vaccinate your child, that you [vaccinate] to protects all kids.”

Kelly said she also thinks it is a privilege for parents to choose to vaccinate their children.

“People wouldn’t be making choices not to have health care if it was not available to them,” Kelly said. “If you are able to choose not to vaccinate your kids for some non-medical reason, then it’s probably because you’re in a sort of a setting where you don’t feel at risk.”

Accessibility and affordability of vaccines is at the center of a bill proposed to the state House by Rep. Arvind Venkat (D-Allegheny). Introduced earlier in September, the bill would require insurance companies to cover vaccines based on federal and state recommendations.

“The state Board of Pharmacy has done a lot of work on accessibility to make sure that pharmacies can continue to administer vaccines specifically flu and COVID vaccines through pharmacies where most adults receive those vaccines,” Venkat said. “But on the affordability piece, unless we take legislative action, we are essentially at the mercy of insurance companies.”

Venkat, a former emergency medicine doctor, said Pennsylvania joining the Northeast Public Health Collaborative is also crucial as the Centers for Disease Control and Prevention continues conversations around changing vaccine recommendations.

“Infectious diseases do not respect political boundaries. It’s not a matter of what happens in Pennsylvania, stays in Pennsylvania,” Venkat said. “The challenge is that it’s not something that states have been set up to do since after World War II; we’ve relied a great deal on the federal government for these issues.”

Earlier this month, the CDC’s Advisory Committee on Immunization Practices panel voted to change a recommendation on the combined measles, mumps, rubella and varicella (MMRV) vaccine, separating MMR and varicella (chickenpox) shots for those under the age of 4.

Aracri said the combined shot does carry a risk of “febrile” seizures caused by the body’s temperature spiking quickly and most commonly found in those 14-18 months old.

“Febrile seizures are not harmful for children. The majority of children have no problem with it, but they’re terrifying for parents to watch,” Aracri said.

The panel also voted to change its recommendation of the COVID-19 vaccine for most adults to individual-based decision-making.

“Whenever you’re first introducing the vaccine to a patient, we always have a conversation,” Aracri said. “I guess it’s one of those things that [the CDC] wanted to make sure that, if you’re getting the COVID-19 vaccine, you know the risks, the benefit for it.”

Dr. Barbara Nightingale, deputy director for Clinical Services at the Allegheny County Health Department, said the county has seen a slow but consistent decline in vaccinations among children for the past decade.

“We saw a huge bump because of the pandemic and people getting COVID-19 vaccines, but we’re going down in students who have completed all of their vaccinations, as well as vaccination rates for each individual required vaccine,” Nightingale said.

In a survey conducted by the county health department, Nightingale said many responses for those who were missing some vaccinations was that they were being exposed to misinformation.

“We’ve always recognized the importance of vaccines. That’s why we have a dedicated clinic. And we understand that we are now more than ever facing questions about it,” Nightingale said. “We’re going to continue to provide vaccines to be able to make sure that people have access to information, to answer whatever questions they have. And to provide the message that is consistent for many, many years, which are generally vaccines are very, very safe.”

Erin Yudt is a reporter with Next Generation Newsroom, part of the Center for Media Innovation at Point Park University.