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States Require Vaccines for Middle Schoolers

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A trip to the doctor's office for a series of vaccines used to be a ritual that only babies and toddlers endured before entering school for the first time.

But thousands of middle school students will soon be feeling the sting, too. Several states have recently adopted policies requiring older students to get immunized before heading back to class.

Florida became the latest state to act when health officials adopted a regulation last month that requires all 7th graders to get a series of inoculations--a second dose of the measles vaccine, a series of three hepatitis B shots, and a tetanus-diphtheria booster--by the time they enter school in September.

Oklahoma has approved a rule requiring the state's 48,000 7th graders to have a series of hepatitis B shots before they enter school next year. Colorado, Hawaii, Maryland, and North Carolina have also adopted policies in the past few years mandating that middle school students get inoculated against a range of illnesses, including chicken pox and mumps.

In part, the states are responding to federal calls to do more to curb contagious diseases. Spurred by public health concerns over recent measles outbreaks and the continued prevalence of hepatitis B infection among young people, a federal immunization advisory panel issued recommendations last year that state health departments adopt more rigorous vaccination guidelines.

Health officials also hope that the rules will get adolescents accustomed to seeking medical care.

Immunizing older children is a way to get adolescents to the doctor when they're increasingly vulnerable to contagious diseases, said Dr. Francisco Averhoff, a medical epidemiologist at the federal Centers for Disease Control and Prevention's national immunization program in Atlanta and a member of the advisory panel.

While toddlers and elementary-school-age children tend to visit the doctor fairly regularly, teenagers make up the group that is least likely to see a medical professional for preventive care, Dr. Averhoff said. And adolescence is a period when young people often start engaging in behavior--such as unprotected sexual intercourse--that puts them at risk for a range of illnesses, like hepatitis B, a highly contagious virus that damages the liver and is passed through blood or bodily secretions.

Florida's campaign to inoculate all 7th graders against three diseases is one of the most ambitious of the new programs, especially because the infection rates for the diseases are relatively low in the state, health officials said.

"It wasn't, 'Oh my God, we've got a terrible outbreak, and we've got to do something,'" said David Adams, a spokesman for the immunization bureau at the Florida health department. "It's just a good preventative step to take," he said.

Tricky Implementation

In anticipation of the September 1997 deadline, most Florida school districts are mounting aggressive campaigns to educate parents about the vaccination requirement, which affects the estimated 180,000 students who will enter 7th grade next year.

Shelby Morrison, the health director of the Orange County, Fla., public schools, said the district is sending home fliers and permission slips to 10,000 parents. In addition, a coalition of health-care agencies, fire departments, and hospitals around Orlando plans to launch a blitz of television and radio broadcasts next month.

Florida health officials recommend that students go to their private doctors for the vaccines, which are commonly covered under health-insurance plans. County health departments will also offer the immunizations to students free of charge. As in other states with mandatory vaccine programs, children in Florida who are eligible for Medicaid can get their shots through private physicians and get reimbursed through the federally funded vaccines-for-children program. Some doctors may charge a $10 administrative fee.

Even though the program will be widely publicized and inexpensive, Ms. Morrison is worried that many students will come to school next fall without proof that they have had their shots. Florida health officials say that students who do not have a Florida certificate of immunization that shows they have at least started their series of shots will not be allowed to enter school in the fall.

Whether officials will be able to enforce the rule, though, is uncertain. "We simply don't have the clerical staff to call the doctors and follow up on all of this," Ms. Morrison said. "And you don't want to over-immunize," she said.

Off Target, Too Risky

Parents' groups in other states have criticized mandatory immunization programs targeting students of any age. They charge that the vaccines are inappropriately administered or medically risky.

Last spring, a group of parents in Memphis, Tenn., claimed that the county's mandatory vaccination program to quell an outbreak of hepatitis A unfairly targeted black students. A $500 million lawsuit against the school district and the county health department likened the shots to a "badge of slavery." District officials countered that because the student population was 85 percent black, the program could not be deemed to single out blacks. ("Memphis Parents Seek To Halt Vaccine Program," May 15, 1996.)

More than 2,000 cases of hepatitis A, which is spread chiefly by fecal contamination, have been reported in Memphis since 1994.

Some parents, meanwhile, argue that any mandatory vaccine program can be dangerous to children's health. Parents are often rushed into signing permission slips without knowing the medical consequences, said Trina Jones-Hylton, a parent from Oklahoma City. When she took her 10-week-old son to the doctor for the required diphtheria-pertussis-tetanus shot three years ago, the infant had a bout of severe seizures that has significantly delayed his development, she said.

As a member of a group called Dissatisfied Parents Together, Ms. Jones-Hylton has lobbied against Oklahoma's new mandatory vaccination program that requires 7th graders to get three doses of hepatitis B vaccine and a series of DPT shots by September.

"It has gotten to where it's too easy to give these shots, and there isn't enough regard given to the possible side effects," she said.

Edd Rhoades, the child-health director at the Oklahoma health department, said last week that parents have a right to exempt their children from the requirement for medical, personal, or religious reasons. And, he added, parents are well informed of the risk.

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