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Back to school could be a shot in the arm
new vlc immunization pertussis-graph-2012-lg
After a year of larger than normal pertussis outbreaks throughout the United States, health officials are weary with the start of another school year what the coming year will bring. The vaccine is required in all school aged children, unless parents sign either a medical or a religious waver. If an outbreak occurs, these kids will be subject to being taken out of school until the threat of infection has gone. The CDC is recommending that all adults make sure their immunization to the disease is current, as it is easily spread, and infants under the age of 2 mos. cannot be vaccinated yet, but are the most susceptible to the disease. - photo by courtesy of CDC

School nurses in Great Bend started a two-week countdown this week as students returned to classes for the 2012-2013 school year.  That’s how much time parents have to get their children’s immunizations up to date. Notices of what students within the district needed went out to parents by May 15, Cindy Prescot said.  That gave parents 90 days, which the state requires.  Now, as new students enroll, nurses are busy determining what these new students may need to be up to date, and will begin sending notices home and giving parents two weeks to comply.  After that, unless parents sign a waiver for either a medical or religious exemption, they may be asked to leave school until they’ve all required shots have been administered.  But trying to piece together a childs history to determine if certain shots were already recieved can be a hassle for parents moving into a school district.  Often records get lost or misplaced.  

Tool makes task easier

Kansas Web IZ, an immunization registry for all people under the age of 18, is helping to make that task easier every year.  The program was piloted five years ago, and in the last two years the number of county health departments, school nurses and private doctors offices trained to use the database has increased.  

“The more providers we get on, the more complete records we get,” said USD 428 school nurse Cindy Prescott.  She and her fellow school nurses especially love the program, she said, because they used to have to call the health department while trying to determine if students were at risk or had the green light to attend classes.  Now, they can get online and check for themselves.  

“The three of us think it’s the best thing and we use it all the time,” she said. When a parent doesn’t have or has lost their children’s records, they can print off a copy for them too. “It’s one of the best things our taxpayer dollars have paid for.”  Not only can nurses access the information in the database, they can add new information to it so incoming students are added to the system as information is received.

Families who come from out of state should bring their own immunization records.  If they can’t, but they know where to start looking, a search can be initiated.. “It’s kind of like detective work,” said Barton County Health Department Supervising Nurse Karen Winkelman, RN.  “We’ll do everything we can to locate them, but if we can’t, we’ll just start over because the risk of infection outweighs the risk of duplicating an immunization.”

The last two or three weeks before school starts is really busy at the health department with students coming in for required shots.

Winkelman has been working with Kansas Web IZ since it began, and likes it because there is not as much duplicaton, and it allows access to records after hours when many doctor’s offices are closed.  The BCHD offers immunizations every day on a walk-in basis, with extended hours on Thursday evenings.  They won’t turn anyone away, even if they are from out of the county, she said.  For many, the health department is the only resource for immunizations, as many private practices do not offer immunizations.  Access to the registry means they don’t miss opportunities now, and if an immunization is recommended, but not required, they can offer it.  

This is especially important today because of the increased number of immunizations that are both available and required.  Winkelman has seen the list grow over the years.

Numerous vaccines

“It used to be so basic what we gave 16 years ago when I began, and I thought the schedule was difficult then,” she said. “We have more protection from disease now, but some diseases have become broader in scope and more strains need to be covered.”  

For people who graduated from high school prior to 1989, most immunizations were recommended before the age of two.  They included four doses of DTP (diptheria, tetanus and pertussis), thee doses OPV (oral polio vaccine), and one dose MMR (measles, mumps and rubella).  After that, a booster of DTP and OPV before or at the entry of school, and finally an adult tetanus shot at the entrance of high school.  

Today, the list of vaccine preventable diseases has grown. Between the ages of birth to six years old, a child could recieve 10 kinds of vaccinations that prevent 14 diseases.  The schedules require several early doses of six of these vaccines, and the fist dose of three others.  

One recommended for everyone aged 6 mos and up is the Influenza vaccine which changes every year.  Then, between the ages of 11-12, three new vaccines are required, Tdap, the adult version of the Tetanus, Diptheria and Pertussis vaccine, HPV, for the human papillomavirus, which prevents cervical cancer and genital warts, and can be administered up to the age of 26.  Finally, a dose of MCV4, which prevents meningitis.  Booster is required at age 16.  

Two others are recommended — one for Pneumonia and one for Hepatitis A.  

“Alot of adults have not received the Hepatitis A and B immunizations because they were not required when they were in school,” Winkelman said. “We’re always excited when a doctor sends them in because they reviewed their shot records when they are an adult.”

She recommends making sure Tdap is up to date, as well as getting the annual flu shot, the pneumonia shot once before 65 and once after, and the shingles shot (Zostavax) after the age of 50.  Tetanus shots, everyone’s favorite, need boosters every five-10 years.  A case of tetanus was reported in the Great Bend area recently when a gardener became infected from a deep splinter.

“If you have a dirty wound and its been five or more years since your last tetanus, you need to update it.  Otherwise, you can go up to 10 years,” she said. Of course, there are alos foreign travel vaccines recommended.  

Flu shots once were recommended only for special populations but today are recommended for everyone.  Winkelman said doing so helps protect the entire population.
“There can be so many complications, and we’re so mobile now,it is impossible to know who you are around who might be immuno-compromised people you are around,” she said. “It’s not just protecting yourself, its protecting the people around you too now.”

This spring, an outbreak of Pertussis across the country illustrates this.  Authorities said there are cases of the disease every year, but many states have seen dramatic increases.  The Centers for Disease Control recommend anyone who may have contact with infants or immunocompromised people make certain their immunization against the disease is up to date.  That’s because infants under the age of 2 mos. are not old enough for the vaccine yet, but they are subject to the highest risk of severe illness or even death.  

While some states like Kan. actually have shown a decrease overall, several other states have shown two-fold, three-fold or even more increases in reports of the disease.  These cases were reported between the end of June 2011 and the end of June 2012.  An outbreak was reported in the Kansas City area, close to the Missouri border.  That state has experienced between two and three times as many reported cases of the disease than normal during that time, according to information from the CDC.

Affordable protection

The health department isn’t the only place to get immunizations.  Doctor offices give immunizatons too, Winkelman said.  There is the private supply, that comes directly from the manufacturer, and the state supply, which is exactly the same vaccine, but is purchased and distributed by the state.  Most private practices that immunize their patients pull from the private supply because the paperwork to pull from the state supply is extensive.  

The private supply is costly, but if insurance covers immunizations, that is what must be used, Winkelman said.  Those who are uninsured or underinsured, or children covered by Healthwave receive vaccine from the state supply.  This is what the majority of patients at the health department receive. Because it is purchases by the state, only an administrative fee can be charged for them, so they cost less, she said.