Keeping up with Vaccinations in School The Immunizations K-12 & College Students Need & How to Get Them

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Patricia Haddeland Read bio

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Shannon Lee Read bio

The importance of vaccines in saving lives cannot be understated. Vaccines are especially important for those more vulnerable among us, such as the elderly, those with certain medical conditions, and children and youth. By requiring certain vaccines for school-aged children and those entering college, society has seen health dramatically improve across all populations. The misunderstandings about vaccines have led to many not being properly vaccinated, and therefore vulnerable to a host of diseases that can injure or even kill the person who contracts them. This guide will help students and their parents understand more about vaccines, how they work, and when the proper time is to get them.

Kindergarten through 12th Grade Vaccinations

Despite the proven advantages of vaccines, there is currently no national standard for student immunization requirements. Each state has its own requirements, including its own set of allowable exemptions to the vaccination requirement. Each student or parent must confirm their state’s specific requirements to be sure the student is compliant with vaccination requirements.

In most cases, the general vaccination requirements that most states follow closely align with the recommendations issued by the American Academy of Pediatrics. The order in which the vaccines are given might be different from one state to another, but many of the following are often given quite early, often before the age of three. For students entering preschool or kindergarten, many schools require the following:

  • Polio (IPV or OPV)

  • Hepatitis B (HepB)

  • Rotavirus (RV)

  • Pneumonia (PCV13)

  • Haemophilus influenza type b (Hib)

  • Measles, Mumps and Rubella (MMR or MMR-V)

  • Diphtheria, Tetanus and Pertussis (DTaP)

  • Chicken pox (VAR, MMR-V or VZV)

Though the initial vaccines are very effective, some of them do lose efficacy over time. That’s why when a student is entering middle school or high school, they are advised to get booster shots that help ensure their protection. The following are the most common booster shots required for students in middle or secondary school:

  • Polio

  • MMR

  • DTaP

  • Chicken pox

In addition to these requirements, the American Academy of Pediatrics, along with the Centers for Disease Control and Prevention (CDC) and other medical groups, strongly recommends the following vaccines for students:

  • Influenza (Flu) – as soon as possible and every year after that

  • Human papillomavirus (HPV) – by the start of middle school

  • Meningococcal conjugate – by late elementary school

  • Hepatitis A (HepA) – as soon as possible

What if your child hasn’t had all their shots?

At the beginning of the academic year, schools do a review of the vaccination status of their students. If a student hasn’t had all vaccines necessary, the student and parent will be notified immediately and given an opportunity to get the shots. Getting the shots will be required to continue at the institution, unless a student or parent produces a proper waiver that allows them to be exempt from the vaccination requirements.

A waiver can be granted for several reasons; however, with the recent uptick in parents making the decision to not vaccinate their children and the resulting outbreaks of highly contagious and preventable infections (such as whooping cough, mumps or measles), some states have eliminated certain types of waivers or made them much more difficult to get.

Some states have made it more difficult for parents to refuse vaccines for their children based on personal or philosophical beliefs.

  • For example, the state of Michigan does allow for waivers on vaccination requirements, but not until parents have undergone vaccine education administered and certified by their local health department.

  • In California, students are no longer allowed to opt out of vaccines based on personal beliefs. Medical waivers are allowed in all states, but many require regular renewal of the medical waiver, often on a yearly basis.

States have good reason to make waivers more difficult to obtain – and that reason is known as herd immunity. the more people in a population that get vaccinated, the more protection from the infection they receive. If the vast majority of students are vaccinated, then those who can’t get the vaccine – such as those with serious medical conditions – are still protected somewhat, because the odds of anyone around them contracting the disease are extremely low.

The CDC defines herd immunity, also known as community immunity, as such:

“A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community.”

A few examples of those who can’t get the vaccines include:

  • Patients with an allergy to a key ingredient in the vaccines

  • Patients who have just received an organ transplant

  • Patients with a weakened immune system due to chemotherapy or other medical treatments

When too many people decide to forego vaccination, it not only puts that person at risk, but puts those who are unable to get the vaccine at greater risk of serious illness or even death.

College Vaccinations

Most incoming college students must meet vaccination requirements of their respective school, just as K-12 students do. College requirements typically follow the guidelines of the state in which the college is located; some colleges choose to follow comparable or more stringent recommendations, such as those set forth by the Centers for Disease Control and Prevention. These requirements typically require students to have the following up-to-date vaccines upon enrollment:

  • Hepatitis B

  • Measles, mumps and rubella

  • Chicken pox (or sufficient proof that the student has already had chicken pox)

  • Tetanus, diphtheria and pertussis

Even if not required, it is advisable for college students to also be vaccinated against the following (and many states or schools require one or more from this list):

  • Human papillomavirus

  • Bacterial meningitis

  • Hepatitis A

  • Influenza

  • Pneumonia

All these vaccines are recommended due to the severity of the infection, as well as the ease in which infections can spread on campus, especially in dorms and other similar college living arrangements. Not only are individuals living in close quarters, they might also be using shared utensils, plates and cups, and even swapping clothing and other personal items.

In addition, many college students are sexually active; this close contact with others adds another method of potential infection. College students might also suffer from suppressed immune systems, thanks to a lack of sleep, poor diets and sometimes quite significant stress levels. All these risk factors lower a person’s ability to fight off infection.

Very rarely, an individual will have an adverse reaction to a vaccine. According to the CDC, for most vaccines, a severe adverse reaction occurs in only about one in every million doses. The Department of Health and Human Services tracks every potential reaction at the Vaccine Adverse Event Reporting System. Those who suspect they are suffering an allergic reaction or bothersome side effect from a vaccine can report the situation to help researchers develop vaccines that are even easier on the human body than the current ones available.

Spotlight on Meningococcal Disease in College

Meningitis is the name for a serious and life-threatening health condition where the protective membranes that surround the spinal cord and brain (the meninges) become inflamed. Meningitis is usually caused by a microorganism, such as a virus or bacteria. Meningococcal disease refers to any illness caused by the Neisseria meningitidis bacteria, although in many situations, these bacteria cause meningitis.

According to the CDC, about 10 to 15 percent of those infected with bacterial meningitis will die from it. And of those who survive, 11 to 19 percent will suffer a permanent disability. This form of bacterial meningitis is one of the most common and serious forms of meningitis, especially in college. It is easily spread through saliva, so kissing, sneezing, coughing and sharing anything that comes into contact with the mouth (such as towels, utensils, cups and cosmetics) can quickly spread the bacteria to others. The infection spreads very quickly; severe cases can lead to death within a matter of days.

The most common serogroups of the Neisseria meningitidis bacteria includes A, B, C, W and Y. The best way to be protected from meningococcal disease is to get vaccinated. There are currently two vaccines that protect against all five of these serogroups: the MenACWY vaccine (also called the meningococcal quadrivalent conjugate vaccine) and the MenB vaccine (also called the serogroup B meningococcal vaccine). The MenACWY immunizes individuals against all common serogroups, except B, while the MenB vaccine immunizes against the B serogroup. Most people can receive both vaccines at the same time, although students will probably want to receive each injection in a different part of their body, such as one shot in each arm.

Not all states or schools require students to get vaccinated against bacterial meningitis, but given the ease in which it can spread, along with how deadly and debilitating it can be, any college student who intends to live on campus is strongly advised to get vaccinated.

To learn more about requirements, visit the Immunization Action Coalition.

Proof of Immunization

Keeping good medical records is vitally important, including vaccination records. Most pediatricians will have a record of a patient’s entire immunization history and should be able to assist in completing the necessary immunization certification form. This typically consists of completing the state-provided immunization verification form with a list of vaccines and dates of administration, followed by a signature from the pertinent doctor or other medical professional confirming the child’s immunization history.

Some students might have received their vaccines through their local health department; they can get a copy of the record by following a few simple steps as required by their state. Another option is to check with the state registry. Most states have a database that records the immunization history of children. A list of the state registries can be found on the CDC’s website.

The above sources should help most students and their parents get a complete immunization record, but that’s not always the case. Some children will go through several doctors, so it’s difficult to get a complete record of vaccines from one place. Those who have been in foster care or have been adopted might not have complete records. And if doctors fail to update a patient’s registry record, the resulting state immunization registry for a student could be incomplete.

For those who don’t have proof, they will have no choice but to get revaccinated. While an inconvenience and potentially uncomfortable, it is completely safe for an individual to get a vaccine, even if they have already been vaccinated for it at some point in the past.

Where can you get caught up on your immunizations?

Students who need vaccinations or booster shots can go to several different places to get the vaccines.

  • The most convenient source will be a pediatrician or primary care physician. Their offices should be able to provide any vaccine the student might need for school or to be extra careful due to increased risk, such as traveling to an underdeveloped part of the world.

  • Another possibility is an urgent care or walk-in clinic. Most of these clinics can provide all the required vaccines as part of the routine medical care they provide, and some of the recommended vaccines as well.

  • A third place to try is a state or local health department. Some of these organizations will provide a variety of vaccines for free or at little cost to the patient; many of them work on a sliding payment scale.

  • Pharmacies also provide a limited number of vaccines, such as the flu or chicken pox vaccine.

  • Finally, students can get caught up through their school’s student health center. But in most cases, student health centers stock only the booster shots or vaccines that are optional for students to attend class on campus. In some cases, the school itself will organize a large-scale vaccine program for specific infectious diseases, such as meningococcal disease.

Paying for Immunizations

Most health insurance policies will cover routine vaccinations, at no or low cost.

For those without insurance, there are a few options available. Some local public health clinics will provide vaccinations to patients with pricing based on the patient’s family income. This means those in financial need can get their vaccines for only the cost of a small administrative fee.

Many states have special programs where children can receive routine and school-required vaccinations at no cost to the parents; Florida’s program is a good example of this. Some of these programs provide vaccines and related supplies directly to participating healthcare providers. This means children who have a participating pediatrician not only can get their vaccinations for free, but they can avoid seeing another doctor or health care worker to receive their required vaccinations. One such program is Vaccines for Children, which is administered by the CDC.

College students who aren’t sure how they will pay for vaccines can speak to their student health center; at the very least, the staff there can direct students to a variety of services that might help them get insurance, find low-cost vaccines, or otherwise meet the requirements to stay healthy.

Exemptions

Though vaccines are recommended for everyone who doesn’t have a medical reason not to get them, there are still some individuals who object to vaccine based on religious, philosophical or personal beliefs. All states allow for medical exemptions. However, some states are getting tougher on allowing religious and personal or philosophical waivers. Here are some reasons why individuals might choose not to vaccinate:

  1. 1. Medical

    The medical exemption is the most widely accepted immunization exemption in the United States. This applies to students who have a medical reason as to why they will forego a specific vaccination. Examples include an allergic reaction to an ingredient in the vaccine or a weakened immune system. Many states require a health professional to certify that this exemption applies. And in many instances, this exemption is only temporary. Therefore, students may need to get recertified every year or so to confirm the medical exemption still applies.

  2. 2. Religious

    This exemption allows parents to refuse immunizations based on religious objection. Parents seeking this exemption must typically certify (with a notarized form or affidavit) that their decision is based on a religious belief they hold dear. However, many states don’t require the parent to provide details as to what religious beliefs specifically led them to object to the vaccination. The majority of states allow for the religious exemption.

  3. 3. Personal or Philosophical

    This is the most controversial vaccine exemption and the least common among states. It allows parents to skip their child’s vaccines based on a personal belief that their child should not receive the vaccine. Given the recent rash of outbreaks of infectious diseases among school-age children, a few states that had this exemption are removing this option altogether. Some states that still have it will only allow parents to opt out of vaccinating their children who attend school if they first receive pertinent medical information about the benefits of immunization and the risks that children face when not vaccinated.

From the Expert

Patricia Haddeland received a Bachelor of Nursing Science from Oregon Health and Sciences University and a Master of Nursing from University of Washington. She is a board-certified nurse practitioner in McMinnville, Oregon and the Director of Linfield College’s Student Health, Wellness and Counseling Center.

Meningitis has been in the news quite a bit in recent years. In addition to getting vaccinated, what can students do to protect themselves?

Meningitis is spread through respiratory secretions and saliva, so avoiding contact with these secretions reduces the risk of exposure to infection. Good handwashing is essential for the prevention of the spread of infection! Students should wash their hands often. Avoid sharing eating utensils or drinking vessels. Behaviors which protect others such as covering one's mouth with an elbow or shoulder when coughing and staying home when ill help control the spread of disease. Meningitis can progress quickly and cause serious illness and harm, including the possibility of disability or death. People experiencing fevers, muscle aches, especially neck pain, and headaches should seek immediate medical care.

Whenever vaccines are discussed, inevitably someone will ask about safety. Just how safe are they?

Vaccines are medications and all medications, whether pharmaceuticals or natural remedies carry the risk of side effects. Vaccines are well studied before they are introduced to the population. Common side effects of immunizations include pain and redness at the injection site, and some may develop a mild fever. Some individuals might experience fainting with a needle stick. An allergic reaction to the vaccine is a very rare condition but may occur within a few minutes to a few hours after the injection. Severe side effects are rare and should be reported to a health care provider if a more serious side effect occurs. The Centers for Disease Control and Prevention maintains a Vaccine Adverse Event Reporting web site, where individuals may report their own adverse events from vaccine. Certain individuals may not be candidates for specific immunizations and should talk to their health care provider about their health concerns prior to receiving vaccines.

Is there anything else you would like to add about vaccinations for students?

Vaccines save lives and protect against debilitating diseases. Because of the effectiveness of previous generation’s vaccine efforts, most people today have never experienced polio or measles, but even today people die of influenza each year and many others are maimed by the effects of meningococcal disease. Students can not only protect themselves but also protect others in their college community by getting fully immunized before leaving for college.

Resources

  • American Academy of Pediatrics (AAP) – Immunizations

    The APP is the primary professional organization for pediatricians. Its website contains a special section on immunization recommendations.

  • CDC – Vaccines & Immunizations

    The Centers for Disease Control and Prevention offers information concerning vaccines, including recommendations for special groups of individuals, including travelers, children, adults and those with specific health conditions.

  • Children’s Hospital of Philadelphia (CHOP) – Vaccine Education Center

    CHOP is a premier children’s hospital with a generous amount of information on common vaccine issues and topics, as well as details on all types of vaccines available, including those not commonly provided to children.

  • US Food and Drug Administration (FDA) – Vaccines

    The FDA is most well-known for the approval of pharmaceutical drugs, but it has a detailed section of its website focusing on explaining the safety and approval of vaccine use in the United States.

  • Healthychildren.org

    This website is run by the American Academy of Pediatrics with the goal of maintaining and improving the health of children. It has a special section devoted to discussions about vaccines, including a number of informative articles.

  • PKIDs Online

    Parents of Kids with Infectious Diseases is an online resource for parents who have children who have, or could contract, an infectious disease. PKIDs offers a wide array of methods for protecting children from infection, including getting vaccinated.

  • Immunization Action Coalition (IAC)

    The IAC promotes immunizations by disseminating educational information about the benefits of vaccines to both parents and healthcare workers.

  • Vaccinate Your Baby

    Vaccinate Your Baby explain the reasons for getting a child vaccinated and offers details regarding safety and potential side effects.

  • Vaccineinformation.org

    Run through a partnership between the CDC and IAC, this site explains the diseases that have vaccines currently available for not just children, but teens and adults.

  • Why Immunize Kids?

    This website aims to teach parents the importance of vaccines and why they’re important. Part of the website’s mission is to dispel the myths of immunizations.