State health board alters student vaccine regimen

Correction: Starting Sept. 1, students will have to receive their Tdap vaccination — which guards against tetanus, diphtheria and pertussis — at age 11. The revised Arkansas Board of Health rules also newly require one hepatitis-A vaccine dose for kindergartners and first graders. This article gave an incorrect age for the Tdap vaccine and incorrectly explained the hepatitis-A requirement.

The Arkansas Board of Health approved changes to the vaccination schedule for students Thursday to make it more closely mirror federal Centers for Disease Control and Prevention recommendations.

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Starting Sept. 1, students will have to receive their Tdap vaccination -- which guards against tetanus, diphtheria and pertussis -- at age 10 and the meningococcal vaccine, called MCV4, before entering seventh grade and again at the age of 16.

The revised rules also reduce the number of hepatitis-A vaccine doses required for kindergartners and first-graders from two to one and requires that a physician -- not a parent -- submit a history of chickenpox to exempt a child from receiving the chickenpox vaccine.

In addition, students will need only three doses of the polio vaccine instead of four, and one of them must be given on or after the child turns 4.

The changes -- based on recommendations from the CDC's Advisory Committee on Immunization Practices -- take effect Sept. 1, but there will be a grace period until Oct. 1 for students to get into compliance with the new regulations.

Dr. Jennifer Dillaha, medical director for immunizations for the Arkansas Department of Health, said many physicians already follow the committee's recommendations, so not all children will need to get extra shots.

The state previously required the Tdap vaccination for students entering seventh grade. Dillaha said it needs to be administered earlier, because there have been an increased number of children getting pertussis, also known as whooping cough, at ages 9, 10 and 11.

Dillaha said children receive five doses of a vaccine called DTaP between the ages of 2 months and 6 years that has the same components as Tdap in different amounts. But by the time they reach age 9, those vaccines start wearing off.

About 120 10-year-olds contracted pertussis in Arkansas between 2009 and 2013, according to the state Department of Health.

The only age group that contracted more cases of pertussis during that period were babies younger than 1 year.

Dillaha said the new regulation targets 11-year-olds and is based on recommendations from the Advisory Committee on Immunization Practices.

Rick Hogan, general counsel for the state Department of Health, said the federal committee is studying whether to lower the age for the Tdap vaccine to 10.

"If ACIP changes, we'll change to be consistent with that," he said.

But that doesn't mean families can't choose to get the vaccine earlier now.

"That's outside the ACIP recommendations, but providers could do that if they chose to," Dillaha said. "It should be a decision between the provider and family."

These regulations mark the first time the MCV4 vaccine has been required by the state Department of Health, Dillaha said.

The health board lowered the number of required polio vaccinations to accommodate students who fall behind on their vaccination schedules.

"If a child starts late, after a certain age, all that is recommended is three," Dillaha said.

The reduction in hepatitis-A doses, from two to one, will also help students who get started late.

After a child gets the first dose, he must wait six to 18 months to get the second one, Dillaha said.

A note from a medical professional will now be required to exempt a child from the varicella vaccine, which prevents chickenpox. In the past, only a parental statement was required.

"When studies were conducted around the country where you compare the parents' history with what the blood samples show in terms of immunity, they didn't match up very well," Dillaha said.

Another amendment to the regulations for kindergarten through 12th-grade students will require all medical exemptions from vaccinations to be approved by the state medical director of immunizations. Previously, the exemptions could be approved by other medical professionals.

Kerry Krell, spokesman for the state Department of Health, said the agency has been working with physicians, immunization clinics and schools to prepare for the new regulations.

"There's been local health units across the state that have been having after-hours immunization clinics," she said.

But she said many families won't have to worry about meeting the Oct. 1 deadline at all.

"If you vaccinate your children based on ACIP recommendations you will have no problems," she said.

Metro on 07/25/2014

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