The Back-to-School Vaccination Checklist


Parents sending their kids back to school may purchase warm winter jackets, fuzzy mittens, ear muffs and slip-resistant shoes, but what’s really essential to their safety is having updated medical records. To prevent the spread of many common illnesses like chickenpox, mumps and whooping cough, school systems often require that each student receive mandatory immunizations and regular physicals.

According to many physicians, these requirements are beneficial. Still, many parents are shying away from vaccinating their children.

“Immunizations are not as appreciated as they used to be,”says Dr. Charles Shubin, the Director of Pediatrics for Mercy Medical Center in Baltimore. “There are a lot of children who are not as current [with immunizations] as they need to be.”

Dr. Andrew Lieber, founder and Chief Medical Officer of Rose Pediatrics in Denver, and Pediatric Nurse Practitioner Mary Beth Petraco, who is the Chair of Long Island's Legislative Affairs Committee of the Nurse Practitioners Association, also report a decrease in vaccination visits. All three physicians partially attribute the decline to a belief that many formally fatal diseases no longer subsist, a sentiment easily disproven by a 2008 outbreak of measles in San Diego. The outbreak occurred when an unvaccinated boy contracted measles while traveling in Europe. While the boy unknowingly exposed 839 people to the disease, 11 more unvaccinated children also fell ill. Among them were three babies too young to receive immunizations.

“By not getting vaccinated, you not only put the healthy child at risk,” Petraco says, “You put the poor, defenseless children who can’t receive the vaccination for medical or other reasons at risk as well.”

While many parents may still chose not to vaccinate since they don’t want any unknown or potentially harmful substances injected into their children’s bodies, those that are electing to immunize should talk the their pediatricians about the what vaccinations are required in their school district.

Requirements vary from state to state, but generally children undergo two rounds of mandatory immunizations while in grade school. Prior to starting kindergarten, children ages 4-6 must receive their last round of the following vaccinations:

  • DTaP: Prevents a child from getting bacterial infections such as diphtheria, tetanus and pertussis, or whooping cough.
  • MMR: Prevents measles, mumps and rubella.
  • IPV: The inactivated polio vaccine prevents poliomyelitis, a disease that leads to the loss of movement.
  • Chickenpox: Prevents children from contracting the varicella-zoster virus, or chickenpox. According to Petraco, children are required to receive two chickenpox vaccinations (the first is administered when the child is 12-15 months old) because the initial shot is only effective in 95% of all recipients.

When a child reaches 6th grade, typically he or she is required to get the Tdap vaccine by their school system. According to Lieber, this shot is the teenager and adult version of the DTaP shot given to younger patients. It protects the recipient from the same diseases, but is required primarily to prevent them from transmitting the ailments to more vulnerable infants.

For this and various other reasons, many health care professionals recommend getting immunizations that aren’t necessarily required by your child’s school (though, depending on your particular state, some may be). These include:

  • Meningococcal Conjugate Vaccine: Protects a child from contracting bacterial meningitis, an infection of the fluid surrounding the brain and spinal cord that can be fatal. Children typically receive this vaccination during the pre-adolescent immunization visit at 11 or 12 years old.
  • Hepatitis A: Protects against the viral liver infection Hepatitis A. Lieber recommends the vaccine for children whose families travel often, eat out regularly or live in areas that have a history of the disease. Hepatitis A can be transmitted through close personal contact or by eating food or water that contain the virus.
  • H1N1 and Seasonal Flu Shot: The Centers for Disease Control recommended that everyone six months or older receive flu vaccinations during the 2010-2011 flu season. This year, an all-in-one flu shot is being offered that protects against both strains of influenza. All physicians we spoke to recommended that all school children (and their parents) get this vaccination, which will be available as soon as August. “We plan on offering it to everyone who comes in,” Dr. Shubin says.

Of course, many families may avoid frequent doctor visits due to high expenses. Lieber notes out-of-pocket vaccinations come with hefty prices tags, but there are options out there for those who are uninsured. The Vaccines for Children Organization, for example, is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of their family’s inability to pay.

“There are ways to keep costs down,” Lieber says, adding that many state health departments offer other alternatives that families in need can find out about at their local doctor’s office.

Additionally, each physician we spoke to, in an agreement with the CDC, recommends girls receive the Human Papillomavirus or HPV shot when they come in for their adolescent immunization check-up. The shot essentially protects women from cervical cancer (which can be caused by the Human Papillomavirus) and genital warts, but as Shubin and Petraco point out, the HPV vaccine is available to boys as well. This also protects them from contracting genital warts and from being carriers of the virus.

According to the physicians, parents often consider the HPV shot taboo, saying it promotes sexual activity in adolescents. However, Shubin compares the HPV shot to giving a vaccine for Hepatitis B, a sexually transmitted disease, to infants.

“You need to get the vaccine before you get the virus,” he says. “As pediatricians, we live and breathe prevention. That’s the name of the game.”

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