Schools May Ban Kids Without Shots

Hilina Kibrom, 12, awaits her vaccination as a syringe is filled with vaccine by a community health nurse during a shot clinic at Col. E. Brooke Lee Middle School in Silver Spring.
Hilina Kibrom, 12, awaits her vaccination as a syringe is filled with vaccine by a community health nurse during a shot clinic at Col. E. Brooke Lee Middle School in Silver Spring. (Photos By Michael Williams -- The Washington Post)
By Susan Levine
Washington Post Staff Writer
Saturday, December 16, 2006

Thousands of Maryland students could be barred from classes after the holiday break because they have not been vaccinated against chickenpox and hepatitis B, as required by the state's latest immunization schedule.

Local health departments and school systems have sent repeated notices on these sixth- through ninth-graders, made follow-up calls in numerous jurisdictions, run ads on radio and in community newspapers and offered free clinics. But response continues to lag as the Jan. 2 "exclusion date" nears.

Students who return to school next month without a record of being immunized -- or, in the case of chickenpox, without the month-and-year documentation of when they had the disease -- by law should be kept from attending school. The only exception would be those who arrive with proof of a pending medical appointment to get the shots. Their grace period ends Jan. 22.

School systems now are down to "the hard core," as one health officer put it this week. As many as 5,000 children might remain out of compliance in Montgomery County, nearly 3,000 in Anne Arundel County, 700 in Charles County and about 10,000 in the city of Baltimore.

Prince George's County is still gauging how many children are affected. In Howard County, officials have mailed certified letters and have visited homes since spring, yet more than 1,600 students have not supplied the necessary verification. In addition, an undetermined number of private and parochial school students also have not met the requirement.

"The principals are very worried," said Joshua Sharfstein, Baltimore's health commissioner. "There's a lot of testing that goes on [in January], and there's worry that kids could be excluded."

Despite those concerns and the efforts being made to avert problems, Sharfstein and public health administrators across Maryland support the broader coverage. In a time of expanding vaccine protection aimed particularly at older children, "it jump-starts the whole area of adolescent immunizations," explained Anne Bailowitz, who heads Baltimore's child health and immunization bureau.

The requirement will keep growing, too. By September 2009, students through 12th grade will need to be immunized against hepatitis B and chickenpox (the common name of varicella) to start school every fall. That's four years ahead of the state's original timetable.

"We want to make sure more students are protected sooner rather than later," said Greg Reed, program manager at the Maryland Health Department's Center for Immunization.

The two infectious diseases were targeted because of their potential risks -- the same reason some national medical groups are advocating vaccine coverage for all ages.

Parents have tended to view the itchy blisters of chickenpox as more of a pain than a peril, but the virus that causes them can lead to severe complications, especially in older teenagers and adults. Every year the country records about 100 deaths from varicella.

Hepatitis B, which attacks the liver, is even more dangerous, in part because a third of people infected have no symptoms and do not realize they could be transmitting the disease to others. Thanks to immunization, the incidence of the disease among children and adolescents has plummeted by more than 90 percent since 1990.

Reed said he hopes schools will have to send home few students Jan. 2. But he knows that, given human nature, "it may take an exclusion date to get [some parents] to take their children to the doctor."

People working to minimize those numbers have faced a decided challenge. Not only are multiple upper grades the ones targeted, rather than the kindergarteners whose parents are most attuned to providing documentation, but the deadline is out of sync with the usual back-to-school immunization push.

"It's not when parents usually expect," noted Judy Covich, director of school health services for the Montgomery County Health Department. "Those are the two issues -- the calendar and the grades."

Through Wednesday, every Montgomery middle and high school has a vaccination clinic scheduled for students with signed consent forms. In Charles County, the health department is contacting pediatricians and family practitioners to emphasize the urgency of the situation. Anne Arundel principals plan to meet a second time with students whose records are incomplete.

"We are so desperate to get these kids into compliance," said Donna Heller, the Howard County school system's coordinator for health services. She said they're considering every strategy, "every idea that comes along."

It all may come down to a countdown. In Prince George's, Ernestine Nicholson, immunization nursing supervisor for the health department, offered a timely analogy: "It's just like the holiday rush. People wait to the last hour."

© 2006 The Washington Post Company