Student Immunization Question

[Patti_RN]

Sorry if this has been covered before, but I have a question for the school nurses out about vaccines.

As we all know, the effectiveness of vaccines relies on having all or most of the population immunized. Like any med, there are risks, no matter how remote. The parents who choose not to immunize their children bank on others taking that risk thereby almost eliminating diseases like polio, pertussis, measles, etc. So the kid not immunized enjoys the benefits of the group's immunity, but does not accept the risks of the vaccine.

Back in the dark-ages when I was a child, the school nurse checked each and every child for proof of vaccines. If a kid's vaccines weren't perfectly up-to-date, that kid didn't return to school until they were.

So, what is the policy at your school? Or, your state or county? Are kids allowed in the classroom who aren't immunized?

[Flare, ASN, BSN]

in my state (meaning state law)students are required to adhere to the minimum vaccination standards - no shots, no school. Of course religious and medical exemption are permitted, but require documentation.

[Jolie, BSN]

The answer to this question depends upon your state law and school district policy.

State law can be found on your State Dept. of Health website. District policy can be found at your administration office.

Just for comparison, in NE, students must be up to date on immunizations on the first day of school, or have a written "catch-up" plan in place approved by their healthcare provider, the school nurse and the building principal. If that plan is not followed to the letter, the student can be ordered out of class until s/he is in compliance. This requires that records be submitted well in advance of the first day of school and that school nurses be given working time prior to the first day. In our district, it's not a problem, but some places it is.

NE law allows for medical exemptions only when signed by an MD, DO PA-C or APN. We have had students try to submit exemptions from Chiroractors, Dentists, and all kinds of other health care providers, but only accept those written by physicians, PAs and APNs.

Religious exemptions are accepted only when put in writing and notarized. Students with valid medical and/or religious exemptions may be excluded from school if there is an outbreak of an illness for which they are not immunized.

There is no allowance for "personal" objections.

[Patti_RN]

So, who can claim a medical or religious exemption? My question stems from a case that I know of where the parents are convinced their older daughter's autism was caused by vaccines so have not vaccinated their younger children. I guess all it takes is a sympathetic doctor who is willing to write the letter.

As far as religious convictions, that seems like a constitutional dilemma that weighs the rights of the parents and child or self determination/ religious freedoms against the risks of the community.

[Patti_RN]

Jolie, I'm aware of my own state's laws and my own district's policy. I'm asking about what OTHER states do and what OTHER school district policies are. In other words how other decision makers balance two conflicting issues.

The issue is a constitutional gray area where the rights of the individual have to be weighed against the protections of the masses. Unlike TSA regulations where airport passengers have the option of not flying if they don't choose to be security screened, this issue conflicts two governmental demands: one that all children be educated and the other that all children are to be immunized.

[Jolie, BSN]

It's not so much who can claim an exemption, but who can obtain support for such a claim with proper documentation from a qualified medical professional.

The medical exemptions I've had range from autism spectrum disorder, to leukemia, to allergies to components of various vaccines, to auto-immune disorders, and I'm sure there area others that I'm not thinking of ight now.

I agree that some are unquestionably valid and others not, but if it is signed by an appropriate health care professional, there is nothing I can do other than accept it and try to educate the parents to the extent that they are open. One important point...we do not accept "blanket" waivers. Every vaccine that the child is missing must be accounted for separately by the HCP. For example, if the child had a previous reaction to DTP, that does not excuse him/her from receiving polio, MMR, Hepatitis B, Varicella, etc.

I have found that many parents put off by the fear of autism soften their stance over time and allow some vaccines, especially Hepatitis B as their kids approach adolescence, and measles and whooping cough when outbreaks are documented.

[schooldistrictnurse]

In Wisconsin, proof of immunization is required by the 30th school day. Exemptions may be claimed for medical (requires physician signature), personal conviction or religious. ( only need parent signature). Students not immunized may be excluded in case of an outbreak, as determined by the Health Dept.

[Autymn]

Hmm. I've never heard anyone from any state relay to me that there is a 'personal' objection. There is a considerable difference between "Well it was just their 'personal' decision to not complete the recommended vaccination schedule for little Sarah." or "Research and reflection led one family to decide to delay vaccinations until the age of 4, and then to specifically choose single vaccinations in order to protect their child." (*Which is btw, a parental obligation and expectation.)

I believe it is in most cases entitled, "philosophical (or personal conviction), medical, or religious" descriptions for exemption.

What is very odd to me is how few families actually even know about the ability to get an exemption, and the myriad of complete myths and repulsive insults and comments surrounding the children and families who do make that choice.

The greater good is not black and white. There are substantial justifiable reasons to consider an exemption for some families and/or their children some of which Jolie outlined very clearly in her post.

And, of those two governmental directives -- the one about educating the child, can be attained in an other-than-public-school setting, with quality results. If they choose to have their children be part of the public school districts, then they must adhere to the law. One certainly hopes that the school nurse, and family doctor are examples of those a family would seek advice from.

But, having done that - as long as there are thoughtful ways provided to gain exemption...(*ways I might add which historically involve the 'public' community, legal authority and moral considerations all used in order to sculpt the laws regarding vaccinations), it should be accepted and respected.

I'm highly impressed when I see families who inform themselves, and make deliberate choices individually about and for each of the children in their family. They are not really the families we should be worried about.

[Purple_Scrubs, BSN, RN]

Here is the policy on exemptions in Texas:

"The law allows (a) physicians to write a statement stating that the vaccine(s) required would be medically harmful or injurious to the health and well-being of the child, and (b) parents/guardians to choose an exemption from immunization requirements for reasons of conscience, including a religious belief. The law does not allow parents/guardians to elect an exemption simply because of inconvenience (for example, a record is lost or incomplete and it is too much trouble to go to a physician or clinic to correct the problem). Schools and child-care facilities should maintain an up-to-date list of students with exemptions, so they may be excluded in times of emergency or epidemic declared by the commissioner of public health."

I have only ever had one "reasons of conscious" exemption. It is a big run around to get the affidavit, so unless the parent is really morally opposed to vaccines it is generally easier just to get the shots!!! I've had one student with a medical exemption due to a condition that required high dose steroids, so any live vaccine was contraindicated. To avoid errors they just delayed all immunizations. Other than those rare cases, all the kids at my school are immunized.

[NutmeggeRN, BSN]

My state requires students to be vaccinated per the guidlines.....the exceptions are:

1) Medical reason-ie immune system issues/allergy to certain vaccines etc

2) Religious exemption-paperwork must be on file at the Superintendants office and a copy in my file

3) According to the McKenny-Vento Act re homeless students (Federal Law)

They may enroll regardless of Iz status but have 30 days to produce documentation or beging the series over.

The caveat of all this is the district reserves the right to exclude a student in the event of an outbreak (pertussis etc)

Philisophical/Personal Exemption is not recognized in my state.

Students are not allowed to start classes without written proof. If they are under immunized they can begin but have 30 days to obtain what they need.

At the HS level is is usally the Tdap and a second Varicella is what is needed to get them up to speed.