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?
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 Mothering.com 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. ☺