Aug 11, 2014

Dr. Gellner: It's school registration time again, and that means your child needs to come in for a check-up of they haven't had one in the past 12 months, and if you're child is entering kindergarten or is age 11, or going into 7th grade it's time to discuss vaccines. I'm Dr. Cindy Gellner, and we're going to talk about school entry requirements with vaccines today on The Scope.

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Dr. Gellner: So in order to register your child for kindergarten or junior high, or high school, you're going to have to show them that your child's vaccine record. What vaccines do your children really need? Well most of the vaccines are actually done prior to them even turning two. And the vaccines that are needed for kindergarten are the tetanus and whooping cough booster, the polio booster, measles-mumps and rubella booster, and chickenpox booster. And for most of these we actually have combination vaccines. Now there are other vaccines your child still will have to show proof that they have had hepatitis B vaccines if they have been born after 1993, and if they were born after 1996, after July 1, 1996. You're going to have to show that they've had two hepatitis A's, and three hepatitis B's in addition to those other vaccines that I just mentioned.

How do you know if your child is really up-to-date on their vaccines? When your child is born they're given a vaccine card, please remember to bring that to all of your child's well-child visits, because that gives us an opportunity to review the vaccines that they've gotten, the vaccines that they're due for, and to make sure that the card itself is up-to-date. I have a lot of patients coming in who the school is saying your children aren't up-to-date because they were not given updated vaccine records by the parents. So make sure that your child's vaccine records match what we have in the doctors office, and we can always give a copy to you of what we have in our system to you, so that you can take that paper copy to the school as well and let them keep that, so you have your vaccine card as well.

The school will ask for written proof, and again this is your vaccine card, and the record has to include your child's name, date of birth, the type of vaccine it was, and the dates given, and the date must include the month-day and year; all of those are needed, because there's actually a schedule for when your child gets vaccines, whether they're on the traditional schedule or if they were behind on vaccines there's a catch-up schedule posted by the Centers for Disease Control. And there is a specific minimal interval between each vaccine, and if your child gets a vaccine too early they're going to have to have that one repeated again. So make sure your child gets the vaccines on time and not too early.

So what if you don't have a written record of the vaccines? That's when your doctor can come in handy trying to get the records from previous doctors if we have to request the records, we can give you copies of what we have on file, and if your child was given vaccines in the state of Utah we have WebKIDS or USIIS. And what that does is any office that participates in the state of Utah, we can actually print out the vaccines that they've gotten in the state of Utah, because vaccines should be entered into the state-wide database so that if you go from one clinic to another we can see what your vaccine record was even if you don't have your copy with you. Unfortunately, if you cannot produce written proof of when your child got their vaccines, and we have no way to get those records, your child will need to get the vaccines again, so that's a very important piece of paper that you're holding onto with their vaccine record, keep it somewhere safe.

What about vaccines given outside of the United States? I see a lot of patients who come from outside of the United States, and the good news it that the vaccines given in other countries are acceptable if the schedule is similar to the United States schedule. Mexico and Canada, and most of Central and South America have the exact same requirements that we do, but most countries in the world are able to show you documentation of at least some vaccines that they were given. And if your child has gotten the vaccines elsewhere, those count, as long as we have full information on the dates they were given.

So what if your child isn't completely immunized? Is there a grace period to get your child immunized by, so that they can get admitted into school? No, there's not. To protect the health of all children, the school cannot admit a child without written proof of immunizations, but they can be admitted on what's called "Conditional Enrollment". So conditional enrollment is when they enroll in a school, and this also applies to childcare programs, most accredited daycare in the state of Utah follow these same guidelines. So if a child has received at least one dose of each of the vaccines required for his or her age, and is currently on a schedule to complete the remaining doses, and your doctor can actually write that schedule out for you, again that goes back to the catch-up schedule from the Centers of Disease Control, then your child can be admitted to school. If the child does not get the vaccine within one calendar month after the scheduled due date for the next dose of the vaccines, the conditional enrollment period ends, and the child will not be able to return to school until that vaccine is received.

We hear a lot about students being exempted from vaccines lately, so can a child be exempted from the Utah immunization rule for students? Yes and there are three types of exemptions allowed in Utah, and a copy of the exemption form must be given to the school, and put in the students permanent file. Now the exemption form is usually available from the school, or from the Health Department, we don't usually have the exemption form. But what we do have is from the American Academy of Pediatrics we have a Parental Refusal form, and the Parental Refusal form says that we have sat down and spoken with you about the vaccines that your child needs, and we've discussed the risks and the benefits of them, and why we recommend them, and if you still chose to not have your child vaccinated we will have you sign that, and we will sign that as well at the same time to show we have that conversation. And that will also go into your child's medical record, and you can take that American Academy of Pediatrics form to the school and say that "Look my doctor and I have had this conversation, I still choose on a personal philosophical or religious reason to not have my child vaccinated from these specific vaccines," and it actually lists every single vaccine that your child should be getting, and then you can turn that into the school.

Now please note, it is our jobs as pediatricians to continue to have the vaccine conversation with you. I've had several cases where a child's health maybe you know, changed, a child may develop diabetes, or asthma or another condition where it's really, really important to get the child that vaccine that they're missing. And we will continue to have the conversations with you about vaccines on those dates, and we might need you to sign the form again that said you know, "Look, it's been a couple of years since we've discussed vaccines, and we discussed them again, and the parents still have decided against the vaccines," and we'll have you sign it again. But that's our job pediatricians, and advocates for your children. So don't take it personally, but we do need to continue to have that conversation. Religious exemption forms, there are some religions not many, even the Amish have started vaccinating after the recent measles scare, and those children who have religious exemptions, the Health Department has those forms.

What about medical exemptions? What if your child had that vaccine, and they had a really bad reaction to it? That is something we can actually take care of, because that's not an exemption because you don't want your child vaccinated, your child had a life-threatening reaction to that, and honestly we don't see this very much. Most children tolerate the vaccines without any complications whatsoever. It's been very rare that I've actually seen a true medical exemption from a vaccine, and in that case we have a legitimate reason for doing it. There are other medical exemptions; children who are going through chemotherapy, I have had to fill out forms for children going through chemotherapy.

So what happens if your child has one of these exemptions and there's an outbreak? If your child is in a school where there is an outbreak of any vaccine preventable disease, your child will be kept out of school or childcare as long as the outbreak lasts. This happened with measles, this happened with whooping cough just in the past two years here in the Salt Lake Valley. And this rule actually helps protect un-vaccinated children from getting these diseases. The incubation period for some of these diseases can be several weeks long, so your child may be out of school for a couple of weeks if they are not vaccinated against the disease that is having an outbreak at the school.

So again you will be asked to produce vaccine documentation when you register your child for school, if you don't have that information, come and speak to your doctor, we'll be able to let you know if your child is up-to-date, if they need any vaccines, and we'll be able to address any of those exemption concerns you might have. But the bottom line is shots are there to protect you, and your child will need them before going to school.

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