Wednesday, June 8, 2011

Delayed/Selective Vaccination and Public School Attendance

Recently I got this comment on my Hep B post:
We avoided this one with our newborn, and I want to continue to avoid it. But if it's required for school entrance, at what point should we have it done so we won't have issues with the school nurse in five years? 
(image source)

Well, there are two answers to that question, and it depends on what your longer-term vaccination plans are. Are you a delayed vaccinator? Or are you a selective vaccinator?

If you are simply a delayed vaccinator, and plan to get all the shots but on a delayed schedule, then you simply spread the vaccines across 5 years rather than doing them all in 2 years (which is what the recommended schedule says). You have twice as long, so you can spread them out easily. Utilize a public health clinic to get the 'off-schedule' shots, or you can do what I do and take multiple children every time one of them has a doctor's appointment, and get shots for everybody even if it's not "their" appointment. (My doctor has been great about this.)
In this case, of course, by the time the child is school-aged, they have had all the 'required' shots for school, and there are no hassles.

Please note--keep your own records of your kids' vaccinations.  Many medical offices will give you a little card to track them, and that works fine, but if you don't have a card then make some kind of chart. You should have your own records and not just rely on what the doctor has in their office. For one thing, the 'recommended schedule' has more injections than what is actually required by the state or school (for example, for polio the CDC says that a child needs 3 injections, with the final one being after age 4. However the typical state schedule says to do 3 injections plus an additional one after age 4. I choose to spare my kids that extra shot!) You need to have your own records so that you can determine which shots to get for your child and when to get them. If you leave it up to your doctor, they will likely try to pressure you into getting "caught up" and/or getting more shots than you truly need.
So I'll repeat myself: keep your own records, make your own choices about what to get and when to get it. Take responsibility for your child(ren)'s health, don't leave it up to someone else. ☺

In the United States, if you are a selective vaccinator or a non-vaccinator, then you will have a different issue if you want your children to attend public school. It depends a little on how selective you are. The list of "recommended" vaccinations is far longer than the list of "required for school" vaccinations. If you get the required ones then you'll still be fine. But, if you opt out of some of those (such as the Hep B), then you will need to do a little extra paperwork in order to keep out of fights with the school nurse.
That extra paperwork comes in the form of claiming an exemption and putting it on file with the school.
The exemption filing process varies from state to state, however you can look it up online. You can also ask at your doctor's office or your local public health office, but they may not be very friendly about it...I recommend starting online (and the forums are a great place to start, I would go to "find your tribe" and find your region and then ask there for pointers about what to do for your area).
In some places you can just do it once, I believe in other places you may need to re-file for each school year. There should not be a fee associated with it, but I think I heard that in some places there is. I've never had to pay one so I'm not sure.
And how does an exemption work? Simple, you put it on file with your school, and your kids attend. IF (and only if) there is an outbreak of something your child hasn't been vaccinated for (measles, pertussis, etc), then you will be asked to keep your child home from school for the duration of the outbreak. That's all.

There are three types of exemptions: medical, religious, and personal/philosophical, but not all are available in all states. Every state has to allow medical exemptions for children who have certain allergies or who are immuno-compromised. A medical exemption has to be signed by your doctor, stating why the child is exempted. I believe that all states also have to allow the religious exemption, because otherwise it would be discrimination. This is just a matter of printing off the form and signing it and turning in a copy to the school. The personal or philosophical exemption is only available in some states, but essentially it says "we don't believe in or don't want vaccinations [for whatever reason, we don't have to tell anybody why]" and, like the religious exemption, you just fill out the form, sign it, and turn it in to the school. In some states you may need to have it notarized.
For those who are choosing selective vaccination (or non-vaccination) for personal reasons rather than medical, this can become sticky if you are in a state which only allows medical or religious exemptions. I, personally, still feel comfortable with claiming a religious exemption. My religion is not opposed to vaccination, but it does teach that we should "search, ponder, and pray" when making decisions. My research, thought, and prayer over my family's health has led me to the decision to vaccinate selectively. I suppose not everyone would feel comfortable with that reasoning, but I do.

So that's how we work it out with delayed/selective vaccination and public school attendance. Of course, a lot of folks who opt out of mainstream vaccination practices also opt out of mainstream educational practices, and homeschooling doesn't have any vaccination requirements either way. ☺


Tim said...

Those who don't get vaccinated for things like measles should know that their choice can be both dangerous and terribly expensive. Measles outbreaks in the U.S. are increasing as more and more people choose to not vaccinate. This is not only dangerous to those who choose not to vaccinate and the innocents who are too young or for health reasons can't be vaccinated, but it also causes serious issues in the school systems.

If your state only allows for exemptions for religious or health reasons, and your religion does not prohibit vaccinations, you are probably breaking the law by claiming a religious reason. That doesn't mean you'll be prosecuted, but it does mean what you're doing is illegal. (More likely to get prosecuted is claiming religious reasons for avoiding the draft when your religion doesn't prohibit becoming a soldier. Just keep in mind that both situations are illegal).

SisuGirl said...

From one pot-stirrer (is that a real word?) to another...Where does your 3 injections for Polio come from? This CDC page says 4 for kids, 3 for adults both on the site and on the VIS. ( As someone who works for IHS, if there was a way to save money (not giving an unnecessary immunization, for example!), that would be the practice.

Jenni said...

(from my polio post)
The IPV is recommended at 2m, 4m, 6-18m, and 4-6y. Doses must be given at least 4 weeks apart, and while 4 doses are on the recommended schedule, 3 doses is considered sufficient vaccination so long as the final dose is given after age 4.

Since I don't even start vaccinations until 6m, and do the DTaP first anyway (6m, 9m, 12m), then they get two polio vaxes, and then I go on and do other things...and come back to get the final polio shot after they are 4.

The DTaP (or whichever combo) is the same kind of deal. 5 are on the schedule, but only 4 are required so long as the last one is after age 4. So we only do 4 of them.

Jenni said...


If you research measles, you'll find that the information is not one-sided. For example, most outbreaks of measles (and of pertussis) are in predominantly if not exclusively vaccinated populations. It is also documented that the measles virus is mutating into new strains which are NOT vaccine-prevented. The research in my opinion is actually staggeringly in favor of just catching actual measles rather than getting the vax, however it is very difficult to come by wild measles at this point, so my children do get this vax.

As for the religious exemption. I do agree with you that it's not really the intended application of the religious exemption. Thankfully a lot of states have the personal/philosophical exemption. But for those that don't, I am faced with a choice between something I consider detrimental to my child's health and taking a 'looser interpretation' of the exemption policy. I contemplated it at some length, and felt like the latter was preferable.

Jenni said...

SisuGirl--here is the link to "the pink book" from the CDC--the tome of all things vaccination (this is the polio chapter)
Page 254 indicates the efficacy is 99% with 3 doses of IPV. It's 90+% at 2 doses in fact.
So, would best practice argue for doing the least interventionist thing that does the job? Yes, I think so. But you're not making money off it like big my not so humble opinion they have lobbied HARD to get more vaccines and more doses on the CDC 'required' and 'recommended' list than need to be there based on research. Is that extra dose hurting anybody, probably not. Is it padding somebody's pockets? I think so.

Tim said...

Given the following, I have a very hard time seeing how you can take a religious stand against the measles vaccination if you're LDS:

There is also some very interesting LDS history about members who refused to get vaccinated. I'll do some research on it and write a post about it in the near future.

Jenni said...

I, personally, am not taking a stand against the measles vaccine Tim. I AM taking a stand for doing your research and making individual choices for your family.

And for what it's worth, I think there is an enormous difference between vaccination in a third world country and vaccination in a wealthy first world country. There is a reason that polio is hanging on in rural Africa even though it was eradicated from the USA years ago...

Tim said...

Yes. It's called vaccinating...

Jenni said...

If you look at the full picture of facts, Tim, the evidence is not so cut and dried. We are typically shown graphs that show a drastic decline in infection rates at about the time the vaccine was introduced, but if you look at graphs that cover a longer timespan, the decline actually began *before* the vaccine. The decline began with things like improved hygiene (handwashing in hospitals!) and better availability of running water in homes.
Yes, I believe vaccines contributed to the more rapid eradication of polio. But they are not the only savior here; they are just the only marketable one. :)

KarleeKale said...

Hello! I was wondering if it is possible to contact you through email? Our daughter starts K in the fall and we selectively vaccinate. I was hoping to ask you a couple of questions, but not in the blog comments section. Please let me know if I can do this.

Jenni said...

KarleeKale, if you click on my name there it will go to my profile, and there is an email link there.

Linked Within

Related Posts Plugin for WordPress, Blogger...