Middle School Vaccines

As children begin middle school, parents should ensure their child meets vaccination requirements. New York state law requires all students to show proof of having DTaP (diphtheria, tetanus and pertussis), MMR (measles, mumps and rubella), varicella and hepatitis B vaccines.

State laws differ on whether or not exemptions from vaccine requirements are allowed. Teachers can help families understand these laws.

Immunization Recommendations

All teens should get the Tdap vaccine to protect against tetanus, diphtheria and pertussis (whooping cough). Preteens should also get the MMR vaccine, which protects against measles, mumps and rubella. They should also get the hepatitis A vaccine, which prevents hepatitis A and hepatitis B, and the HPV vaccine to protect against human papillomavirus, which causes genital warts and cervical, vulvar, vaginal and anal cancers.

Vaccine delivery in school settings can increase uptake of recommended vaccines, especially among adolescents. School-based health centers located in many schools can provide vaccines at no cost to children and their parents.

New entrants into seventh grade should receive one dose of tetanus, diphtheria, and pertussis (Tdap) vaccine. Those entering into ninth grade should receive the meningococcal (meningitis) vaccine, which is required by law in Georgia for all ninth-graders. Children should also receive a yearly influenza vaccine and hepatitis A vaccine. Hepatitis A is especially important for those with underlying illness like asplenia or terminal complement deficiency.

Immunization Requirements

All students entering 7th grade must have one dose of the quadrivalent meningococcal conjugate vaccine MCV4. This is a vaccine that protects against meningitis and some cancers. Teens who don’t get the MCV4 vaccine will be required to be provisionally enrolled until they do.

In addition to MCV4, a single dose of the booster Tdap is needed before entering school. This vaccine protects against tetanus, diphtheria and pertussis (whooping cough).

In the case of Hepatitis A vaccination, the law requires that two doses are given to prevent disease. However, most vaccines are administered in a series of shots to avoid vaccine injury caused by too many shots at once. If the second dose in the hepatitis A series is due and the child will not receive it within the 20-day window, they may be required to be provisionally enrolled. A statement signed by a health care provider that explains why the second dose is not being received should be provided to the school.

Immunization Surveys

School nurses have good rapport with families and are able to effectively educate about the importance of vaccinations. Moreover, many children and teens have multiple siblings going through the same schools, so their parents know the school nurse as well.

To track vaccine coverage, the CDC conducts a series of surveys called National Immunization Surveys (NIS). These are telephone interviews with parent and guardians asking about the vaccination status of their kids or teens.

The NIS includes a questionnaire on child and teen vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP) as well as a short questionnaire on the flu vaccine for children and teens. The NIS also includes the National Immunization Survey-Child COVID Module and will include an adult COVID module in 2021.

The NIS results are published annually and are used to monitor the national trend. The accuracy of the data depends on whether the responses are accurate and complete, and how well the interviewers ask about the vaccine schedule and questions about why a kid or teen has not been vaccinated.

Immunization Exemptions

A child must be vaccinated against measles, mumps, rubella, polio (four doses), hepatitis B, pneumococcal and varicella to attend school in Rhode Island. Parents may claim a religious exemption, but the parent or guardian must detail their objections for each vaccination, meet with a physician to discuss vaccine risks and benefits, and provide a signed certificate that is reviewed by local school authorities.

Vaccine mandates with exemption allowances are working to improve vaccine coverage, but continued evaluation is necessary. This includes assessing state-level changes to exemption policies and laws, including their impact on vaccination rates.

Discussions of vaccine requirements must also consider the different beliefs held by parents of children attending alternative education systems, such as Montessori and Waldorf schools. These students are more likely to choose non-medical personal belief exemptions from vaccinations, and their presence in schools and day care centers contributes to the spread of vaccine-preventable diseases [45]. [46]

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