COEUR d'ALENE - Last year, Idaho had more kindergarten students attending school without required vaccinations than every other state, a statistic that has raised alarms with local officials.

Last year, 11.6 percent of kindergarten students enrolled in Kootenai County Schools had an immunization exemption on file, higher than the statewide exemption rate of 6.5 percent, according to a recently released national report by the Centers for Disease Control and Prevention. Kootenai County school officials are taking the trend seriously, and are working with state officials to increase their educational outreach.

"As nurses in the school district it concerns us when parents sign waivers as opposed to getting their children immunized," said Dr. Cindy Perry, coordinator of Coeur d'Alene School District Health Services. "Whenever possible we do try to discuss this issue with the parents."

Idaho allows immunization exemptions for philosophical, medical, or religious reasons and, according to the CDC study, most of the exemptions on file were for philosophical reasons. The same study found that the median percentage of exemptions in the 49 states it received data from was 1.6.

Information provided by the Idaho Department of Health and Welfare states that the majority of children with exemptions have received some vaccines, but are not in line with current school recommendations.

"Some parents actually have such a strong belief that immunizations are 'bad' for their children and they actually refuse to sign the waivers," Perry said. "They believe that it is their duty as parents to protect their children from the bad effects of immunizations."

The short term goal for Perry and others then becomes getting parents to either sign the waiver or to immunize their children, which is required for compliance with statewide reporting. A long term concern arises as well, Perry said, because, in the event of an outbreak of one of the vaccine preventable diseases in the community, it is important to know which students are at risk.

"Having a high percentage of students who are not fully protected from preventable diseases is concerning, especially for other children who cannot receive vaccine protection because of medical conditions,"said Dr. Christine Hahn M.D., Idaho Public Health Medical Director, in a press release.

Hahn added that many parents sign exemptions for convenience, preferring "the path of least resistance" when registering a child for school who is behind on their vaccine schedule.

"However, that path can lead to serious illness to their children or classmates," she said. "We believe Idaho can do better."

In the Post Falls School District, Superintendent Jerry Keane told The Press that approximately 6 percent of parents have exempted their children from vaccination requirements. Keane, who has been superintendent for 14 years, said he has noticed an increase in awareness about vaccination in the wake of a measles outbreak at Disneyland last winter.

"We always encourage vaccination and offer free vaccination in conjunction with the Panhandle Health District," Keane added.

Brad Murray, superintendent of the Lakeland Joint School District, said the nurses in his schools are on the front lines of this issue, and he often hears their concerns. The entire district shares the nurses' concerns, he added, about children not being fully protected from preventable diseases.

"Our district has a partnership with Heritage Health which has resulted in a mobile clinic serving all of our residents, not just students, and travels to a number of our schools in the different communities," Murray said.

Nurses and officials in Coeur d'Alene hand out printed information on vaccination whenever the opportunity presents itself, Perry said. The district is also closely following efforts at the state level to improve the exemption trends with education and support.

"(But) It is a tough issue because when a parent signs a waiver it is because they really do believe that is what is best for their child," Perry added.