More than 180 public school students in Rochester will be removed from school March 1 if they are not vaccinated or officially exempted from the state law that requires them to be immunized.

School officials said this week that they have worked “diligently” since January to inform families that students must be vaccinated to attend school or provide documentation for an exemption.

“We sent multiple letters, worked with our bilinguals if necessary, and each school made additional efforts to connect with the families impacted to assist them with submitting the proper documentation,” school officials said in an e-mailed response to questions.

As a “last resort,” school board officials unanimously voted Tuesday to remove the affected students from school March 1 if they don’t submit the necessary vaccination documents. They will be allowed to return to school once they do.

School officials said the law doesn’t provide clear guidance on how districts should enforce the law mandating vaccinations. A state attorney general’s opinion says students “must be afforded some level of due process” before being excluded from school for not complying with vaccination requirements.

“The procedure utilized by the district in this situation was an attempt to strike a balance between enforcing the requirements of the statute and being mindful of the fact that the right to an education is a fundamental right in Minnesota,” school officials said in an e-mail in response to questions. “Preventing a student from enrolling in school is a serious issue. The district wanted to make sure it gave families ample opportunity to bring themselves into compliance before it prevented any students from attending school.”

When school board members met this week, they had a tally of 204 students who had fallen short of the requirements. By Thursday, the number of students at risk of being turned out of school March 1 had dropped to 183 when the others showed proof of vaccination.

Superintendent Michael Muñoz said it was the first time in his six-year tenure that he has had to ask the board to take such action.

A district spokeswoman said officials can’t speculate why these students, who are spread throughout the district and age groups, have failed to meet the requirements six months into the school year.

Nationwide, there has been anti-vaccine sentiment in some families who believe the vaccines aren’t safe. But it’s unclear whether such beliefs, which scientists widely refute, are a factor in Rochester.

Ben Christianson, an epidemiologist with the Minnesota Department of Health, said it would be difficult to determine why the Rochester students haven’t yet met the vaccination requirements this year.

It could be they just haven’t gotten into a provider’s office to get the vaccine, Christianson said. And in some cases, students might be immunized but the paperwork hasn’t been submitted, he added.

How the law works

Rochester, the seventh-largest school district in Minnesota, has more than 17,600 students. School officials said they are working with Olmsted Public Health, the Mayo Clinic and the Olmsted Medical Clinic to provide easier access to immunizations before school starts in fall 2017.

In general, students entering kindergarten must be vaccinated against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, hepatitis B and chickenpox. In seventh grade, students receive the meningococcal vaccine and a booster for the diphtheria, tetanus and pertussis vaccine.

Students can be exempted if there is a medical reason or if the parent or guardian provides a notarized statement saying it’s a violation of their “conscientiously held beliefs.” Minnesota is one of 18 states that allow exemptions for philosophical or personal beliefs.

California allowed such exemptions until a measles outbreak in 2014 infected 145 people across the United States and dozens in Canada and Mexico. It then enacted one of the nation’s toughest vaccination laws, eliminating exemptions for religious and personal beliefs, according to national reports.

In Minnesota, the overwhelming majority of students are vaccinated, state officials say. During the 2015-16 school year, vaccination rates were 90 percent or higher for each of the five vaccines required for kindergarten students. For 2020, state health officials have set a goal of vaccinating 95 percent of students enrolled in kindergarten. High vaccination levels are crucial to protect the broader population from vaccine-preventable diseases, state officials said.

Medical exemptions are rare, Christianson said. And of the 70,000 kindergartners in the state last year, the number of exemptions for conscientious reasons ranged from 2 to 3 percent for each of the five required vaccines, he said.

“We’ve seen a slight increase in the nonmedical exemptions — the conscientious exemptions — over the last five years,” Christianson said. “But it’s only a couple tenths of a percent. So not a huge increase.”

Diane Peterson, associate director for the national Immunization Action Coalition, said parents normally have 30 days to get immunization documentation at the start of the school year. “So the fact that it’s now February … it’s surprising,” Peterson said.

Exemption ‘pockets’

Although Minnesota isn’t experiencing a large increase in vaccine exemptions, there are always pockets with larger numbers of them, she said.

“In Minneapolis, there are those in the Somali population who aren’t getting their measles shots because they feel there’s some connection with autism. That’s been disproved, but there are still people who are out there believing that and trying to convince them it’s the truth,” Peterson said.

According to statistics, the counties with the highest rates of kindergartners with nonmedical exemptions are all in rural areas. In Wadena and Hubbard counties, more than 8 percent of kindergartners have a nonmedical exemption for all vaccines.