Tag: school

Vaccine Requirements for College Entry

Most of our kids are up-to-date on their vaccines by the time they are ready to start college.

That’s likely why few of us give college vaccine requirements much thought.

Will this chicken pox outbreak in Ohio spread?
Will this chicken pox outbreak in Ohio spread?

But maybe it is something we should start thinking about more, as it seems that many colleges do not have actually require their students to be vaccinated and protected!

Vaccine Requirements for College Entry

The one vaccine that is the most often associated with going to college is the one that protects our kids against meningococcal disease.

That’s actually two vaccines though:

  • MCV4 – Menactra or Menveo
  • MenB – Bexsera or Trumenba

Which other vaccines should kids get before going to college?

They should get whatever vaccines they might have missed when they were younger, including MMR, chicken pox, hepatitis A, hepatitis B, Tdap, HPV, and polio vaccines.

Plus they should get a flu vaccine every year.

Vaccine Recommendations for College Entry

Unfortunately, in many cases, instead of requirements to attend college, we really just have recommendations that students can choose to ignore.

What’s the likelihood that your fellow students are vaccinated and protected?

How many are unvaccinated?

Which school do you plan on attending?

“Immunizations are recommended to protect your health and the health of others, but they are not required by the university.”

Welcome to the University of Michigan!

Fortunately, most schools do require at least some vaccines.

In addition to either Menactra or Menveo, many require two doses of MMR.

Some also require three doses of hepatitis B vaccine.

A few, like the University of Michigan and the University of Wisconsin don’t require any vaccines though.

These are the ten of the biggest colleges in America, at least in terms of enrollment, and their immunization rules:

TdapMMRVarHepA/BMCV4MenBHPVIPV
OSU12
2X/31XX4
FlaR2RR/31RRR
Minn12XXXXXX
ASUR2XXRXRX
UTRRRR/R1XRX
UCFR2RR/RRRRR
A&MXXXX1XXX
MichRRRR/RRXRR
PSU
R2RR/RRRRX
WiscRRRR/RRX
RR

On the bright side, Ohio State University, with one of the largest combined graduate and undergraduate enrollment, has the strongest immunization requirements.

On the other hand, it is quite sad that many of the others either have weak requirements, only recommend (R), but don’t actually require many common immunizations for enrollment, or don’t even mention them (X).

Why don’t more colleges have stricter immunization requirements for enrollment?

It is likely that they haven’t caught up with the problem of parents skipping or delaying their kids’ immunizations.

“While many infectious diseases such as meningitis are rare, it is not uncommon for hundreds of students at a large university to contract the flu each season.”

Contagious on campus

Which brings us to a problem – how can colleges hope to control outbreaks well if they don’t even know which students are vaccinated or not, and so can’t easily quarantine unvaccinated students? They seem to manage mumps and meningococcal outbreaks, but neither are as contagious as measles or chicken pox. 

Do we really need to wait for more outbreaks on college campuses before we start requiring that kids be vaccinated and protected before going to college?

At the very least, can we at least start tracking vaccine-preventable disease rates in college kids, make flu deaths in college students reportable, and report vaccination exemption rates by college campus?

More on Vaccine Requirements for College Entry

Do Vaccine Mandates Force Parents to Vaccinate Their Kids?

Listening to some parents talk about new vaccine laws, you would think that pediatricians are going to start kidnapping babies or simply hold them down to force them to get vaccinated and follow the latest immunization schedule.

Is there any truth to that?

Of course not.

The History of Vaccine Mandates

There have been vaccine mandates in the United States since 1827, when Boston became the first city to require all children attending public schools to be vaccinated against smallpox.

Surprisingly though, it took a long time to get vaccine mandates protecting more children. It wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children required vaccinations before starting school.

This followed continued measles outbreaks in the mid-1970s and studies showing that states with vaccine mandates had much lower rates of measles than states that didn’t. And it likely explains why there were 10 measles deaths in the United States as late as 1980, even though the first measles vaccine was introduced in 1963.

It took even longer for the vaccine mandates to cover kids in all grades and not just those entering school, to cover kids in daycare, and to cover kids in college. And tragically, it didn’t take long for politicians to chip away at those vaccine mandates. Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions.

Still, even before the addition of personal belief vaccine exemptions and without the abuse of religious exemptions and medical exemptions, vaccine mandates have never equaled forced vaccination.

Even the Vaccination Act of 1853 in the UK, which required everyone to get a small pox vaccine, didn’t actually force them to get vaccinated. It originally levied fines on people until they got the vaccine, but they soon allowed a conscientious exemption to vaccination, which many people took advantage of. Over the years, so many people were claiming conscientious vaccine exemptions in the UK, that in 1946, they repealed their vaccine requirements altogether.

What Is a Vaccine Mandate?

Since a mandate is typically defined as an official order to do something, a vaccine mandate would be an order to get a vaccine. But it is hardly an order to hold down and force a vaccine on someone.

Likewise, state laws that mandate vaccines aren’t forcing kids to get vaccinated. They are typically mandates to get vaccinated before attending daycare, public and private schools, and/or college.

Is your child going to camp this year? They might mandate certain vaccines if kids want to attend.

Do Vaccine Mandates Force Parents to Vaccinate Their Kids?

Do vaccine mandates take away a person’s choice about getting vaccinated?

Anti-vaccine folks go to great lengths to scare you into thinking that someone is going to force you to vaccinate your kids. They aren't...
Anti-vaccine folks go to great lengths to scare you into thinking that someone is going to force you to vaccinate your kids. They aren’t…

Of course not.

Again. We are not talking about forced vaccination.

For example, if you work in a hospital that requires a yearly flu vaccine, you can decide to work somewhere else. Sure, you no longer simply have the choice between getting vaccinated or leaving yourself unprotected and continuing to work at the same job, but you can still decide to skip the vaccine and look for another job.

These are mandates with a choice.

The same is true with vaccine mandates for kids to attend school or daycare. If you choose to skip one or more vaccines for a non-medical reason, then even if you are in a state that doesn’t allow religious or philosophical vaccine exemptions, you won’t be forced to get vaccinated. While it may not be an option you are happy with, homeschooling is an option for those who don’t want to vaccinate their kids.

That is your vaccine choice.

Public education is a benefit of those who comply with mandates or compulsory vaccination laws.

These state immunization laws and vaccine mandates have nothing to do with forced vaccination. They also don’t take away your informed consent, are not against the Nuremberg Code, and are not unconstitutional.

Have kids ever been forced to get vaccinations?

Not routinely, but there have been cases of health officials getting court orders to get kids vaccinated and protected, usually during outbreaks of a vaccine-preventable disease.

In 1991, for example, a judge ruled that parents of unvaccinated children who were members of the Faith Tabernacle Congregation in Pennsylvania had to get a measles vaccine. As a measles outbreak spread through Faith Tabernacle, an associated church, and the rest of the city, there were at least 486 cases of measles in the church, mostly among children, and 6 deaths.

“Parents are free to become martyrs themselves. But it does not follow that they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”

Prince v. Massachusetts

In addition to being unvaccinated, these children didn’t get any medical care, as their families instead relied on prayer. Finally, after the order was appealed all the way to the state Supreme Court, only nine children got vaccinated.

When parents disagree about vaccines, a judge might also step in decide that a child be vaccinated over one parent’s objections. A child might also get vaccinated against their parents wishes if they have lost custody for reasons that have nothing to do with the child’s medical issues and so a legal guardian, which might be the state, is making those decisions now.

Still, these are not the usual circumstances we are talking about with state vaccine laws. They are simply laws to get kids vaccinated and protected before they are allowed to attend daycare or school.

What to Know About Vaccine Mandates and Forced Vaccinations

Vaccine mandates do not force parents to vaccinate their kids.

More on Vaccine Mandates and Forced Vaccinations

 

Immunization Requirements to Start School and Daycare

If you are following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, or college.

There aren’t usually any extra vaccines that they will need to start school.

Of course, if you have skipped or delayed any vaccines, then they might have to catch up on some immunizations before starting school.

Another situation where you might need to do some catching up is if you move, and instead of following the CDC schedule, you were just getting the minimum number of vaccines that were required to attend school where you used to live. For example, your kids could have been all set to start kindergarten in Arkansas, but if you suddenly moved to Texas, they might need a second MMR, a booster dose of Varivax, and two doses of hepatitis A vaccine, as none of those are required in Arkansas.

Immunization Requirements to Start Daycare and Preschool

Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.
Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.

Since many new parents have to go back to work when their baby is only about two to six weeks old, they won’t have time to get their first set of vaccines at two months.

That won’t keep them out of daycare, but delaying too much longer, usually more than a month, probably will.

To start daycare or preschool, infants and toddlers need to get most of the vaccines on the CDC immunization schedule. This includes DTaP, hepatitis B, Hib, Prevnar, and IPV (polio), and then once they are 12 months old, booster doses of the primary series of vaccines and the MMR, Varivax (chickenpox), and hepatitis A vaccines.

The only vaccine that is missing from many state mandates is the rotavirus vaccine. And that simply has to do with the strict timing requirements of when you need to start (before 15 weeks of age) and finish this vaccine (by 8 months).

Some states do require rotavirus though, and simply state that kids must follow “age appropriate dosing.” That way, if they are too old, they just don’t need to get it.

Immunization Requirements to Start Kindergarten

In addition to most of the vaccines they needed to start daycare or preschool, to start kindergarten, kids need their 4 to 6 year old boosters:

  • the fifth dose of DTaP to protect them against diphtheria, tetanus, and pertussis
  • the fourth dose of IPV to protect them against polio
  • the second dose of MMR to protect them against measles, mumps, and rubella
  • the second dose of Varivax to protect them against chicken pox

If using combination vaccines, these four immunizations can be combined into just two shots – Proquad (MMR + Varivax) and either Kinrix or Quadracel (DTaP + IPV), which your preschooler will appreciate to help reduce the pain from getting these shots.

If your kids were missing any vaccines, they will also need to get caught up on those before starting school.

Immunization Requirements to Start Middle School

Preteens and teens get a few vaccines when they start middle school when they are around 11 to 12 years old, including:

  • a dose of Tdap to protect them against diphtheria, tetanus, and pertussis
  • a dose of Menactra or Menveo to protect them against meningoccocal disease

Although not required by most schools, the HPV vaccine is also usually given around this time.

Immunization Requirements to Start College

And then, before going off to college, at around age 16 years, kids will usually need:

They can also get the MenB vaccine, although it isn’t yet required for all students. This vaccine (Bexsero or Trumenba) has a “permissive” recommendation, in that parents are told they can get it if they want their kids to avoid meningococcal B disease, but it is not required yet.

What about a third dose of MMR?

While an extra dose of the MMR vaccine is now being given in some situations, it is mainly if your child is at high risk because of a current mumps outbreak. A mumps booster shot is not currently recommended just because your child is going off to college.

What to Know About Immunization Requirements for Incoming Students

If you have been following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, and college without needing any extra vaccines.

More on Immunization Requirements for Incoming Students

 

Ask Amy About Intentionally Unvaccinated Kids at a Holiday Party

How do you avoid fighting with friends and family when you get together at the holidays?

Some say to talk about whatever you want, but just have empathy for others when you talk about controversial topics.

Other experts say to simply avoid talking about things like politics, religion, and sex.

Going that route, it is easy to imagine that the list of things that you can’t talk about can get pretty long in some families.

Topics Too Dangerous To Avoid

Are some topics too dangerous to avoid talking about?

I’m not talking about in the long-term, what’s going to happen to our world kind of dangerous, but short term dangers to your kids and the rest of your family.

For example, what if you instinctively think that you should avoid talking about guns when visiting your uncle’s house, because you remember seeing all of his Facebook posts about the NRA. But you want to make sure there aren’t any unsecured guns lying around the house that your toddler could find. Do you ASK about guns in the house?

Ask Amy About Intentionally Unvaccinated Kids

What about vaccines?

That’s another topic that’s too important to avoid talking about.

Ask Amy took on the issue of the risk of an intentionally unvaccinated child to the rest of the family.
Ask Amy takes on the risk of an intentionally unvaccinated child at a holiday party.

What’s the problem? Some family members don’t want to come to a family gathering if their sibling is going to bring their intentionally unvaccinated child.

And why is that a problem if they are all fully vaccinated (a common argument posed by anti-vaccine folks)?

It should be clear that they are not all fully vaccinated. At least one of the grandchildren is just 6-months-old, so is too young to be fully vaccinated. She will not get her first dose of MMR and chicken pox vaccine, for example, until she is at least 12 months old.

But she isn’t the only one at risk. The other children and adults could be at risk because no vaccine is 100% effective. Vaccines work and they work very well. They just aren’t perfect.

What Ask Amy Gets Right and Wrong

Ask Amy was smart to turn to a pediatrician for help on this question.

And Dr. Thoele is right, this intentionally unvaccinated child is getting away with hiding in herd (at least so far) and won’t get anyone else sick unless he is exposed first and gets sick himself.

“If you choose to delay some vaccines or reject some vaccines entirely, there can be risks. Please follow these steps to protect your child, your family, and others.”

CDC on If You Choose Not to Vaccinate Your Child, Understand the Risk and Responsibilities

Many of us would take exception to the part that it is “highly unlikely” that this child could get a vaccine-preventable disease though. There are usually one or more outbreaks of chicken pox, mumps, pertussis, and measles, etc., going on in different parts of the United States throughout the year. And because parents who don’t vaccinate their children often cluster together in groups, it increases the chances that their kids will catch something.

Have they traveled out of the country? Have they been exposed to someone who has? That increases their risk too.

And what about the flu?

“(Dr) Thoele and I both hope that everyone attends the family get-together and that all family members should try their best to be nice to one another. There is, fortunately, no vaccine preventing that.”

There is also nothing preventing those parents from vaccinating their child.

Unvaccinated Kids at a Holiday Party

So should this intentionally unvaccinated toddler come to the holiday party?

Should other kids come if the unvaccinated child will be there?

While no one wants a family to be split over such a matter or for grandparents to be put in the middle, it is a much more complicated issue than wishing that everyone play nice.

Not Vaccinated? No Kisses!
A billboard advocating that teens and adults get a Tdap booster.

Not surprisingly, pediatricians get asked about these kinds of situation all of the time:

  • Should new parents allow family members to visit if they won’t get a flu shot?
  • When can they allow a family member to see their new baby if they won’t get a Tdap booster?
  • What do they do about the family members who don’t get vaccinated and don’t even take their kids to the doctor for regular checkups?

And what’s the answer?

Understand that kids aren’t at least partially protected against:

  • pertussis until after the third dose of DTaP at six months
  • the flu until after getting a first flu shot at six months, keeping in mind that they are actually going to need a second flu shot for full protection, since it is the first time that they are being vaccinated against influenza
  • measles, mumps, and chicken pox until they get their first dose of MMR and the chicken pox vaccine when they are 12 months old

And that’s why many parents would not, if they had a choice, expose their children to an intentionally unvaccinated child until after they had at least had their 12 to 15 month vaccines. By this time, they have also gotten 3-4 doses of Hib and Prevnar, and have completed their rotavirus vaccines.

Of course, if the child, or any of the adults, had an immune system problem, were getting treated for cancer, or had any other condition that would put them at higher risk for getting a vaccine-preventable disease, then they would likely never voluntarily expose themselves to someone who was intentionally unvaccinated.

I say voluntarily, because we often don’t have a choice.

In most states, folks are allowed to send their intentionally unvaccinated kids to school and daycare. And those kids put us all at risk.

And yes, there are vaccines to prevent that.

What to Know About Unvaccinated Kids at a Holiday Party

Many parents would avoid voluntarily exposing their kids to an intentionally unvaccinated child until they have at least completed their primary series of vaccines, when they are 12 to 15 months old.

More on Unvaccinated Kids at a Holiday Party