Tuesday, August 13, 2002

By SHERRY KUYT

Sixth-graders returning to school this fall will need to bring something else besides pencils, paper, and notebooks.

Local school officials are warning parents that they must submit an up-to-date record of immunizations for their child by the first day of sixth grade.

If they don't, according to a new state law, the student will not be allowed to attend.

For years, parents in Michigan only had to submit proof of immunizations before their kids started kindergarten, or in some cases, when an older child entered a new school.

Now, an amendment to the Michigan Public Health Code (HB 5292), effective this year, requires a parent or legal guardian to present to the school an immunization status when enrolling any child in sixth grade.

Meanwhile, residents of Kent County are catching a break as a result of a glitch in the fee scheduling for immunizations. The Health Department, which was directed to stop providing free injections to children who have insurance for immunizations, will continue offering the free shots until Oct. 1 because the county has not yet taken action on the change.

In submitting immunization status to schools, date of administration will be needed for the following immunizations: hepatitis B; tetanus; diphtheria; mumps, measles and rubella (MMR); and varicella, or chicken pox.

Students entering sixth grade this year were, as kindergartners, required to be vaccinated for tetanus, diphtheria, MMR, and polio, unless parents opted out of the procedure for certain accepted reasons.

In the meantime, however, requirements for varicella and hepatitis B injections have been added to the list for those entering kindergarten. According to health officials, the new law will ensure that sixth-graders "catch up" before reaching adolescence, when these diseases can hit hardest.

Children may forgo varicella shots if parents can document the child having chicken pox, including approximate dates, or can provide laboratory proof of immunity.

Hepatitis B injections consist of three shots. The first two are one month apart, and the third is six months after the second.

A child entering sixth grade may also need a tetanus booster if it has been more than 10 years since the last shot, or more than 5 years after a serious injury or cut.

While the law requires parents to submit a record of actual immunizations, there appears to be some leeway as to how soon a student must be completely up-to-date.

Rockford Public Schools nurse Linda Rothenthaler said staff members there would be placing immunization records onto a computer program during the first few weeks of school, adding new information to that previously submitted.

After that, she said, parents would be notified if their child needs more immunizations. But she said students would not necessarily be excluded from school if they haven't had all their shots.

"If they have a dose of DPT and a dose of MMR, you really can't keep them out of school," she said.

In Grandville, parents of sixth-graders were told by school nurse Sally Weener they need to submit a complete, updated record of all immunizations before school starts.

"If you have not yet submitted a new immunization record for your student, he/she will not be able to start school on the first day," she stated in the district newsletter.

While some insurance companies, especially HMOs, pay for immunizations, others pay only a percentage. Those with insufficient coverage could face a hefty before-school bill the cost for the three-part hepatitis B series ranges from $105 to $165, while a single varicella injection is upwards of $70. A tetanus booster is about $20.

According to Nancy Vanden Berg, who is the practice manager for Brookville Pediatric and Adolescent Care in Grand Rapids, some insurance companies pay only about $18 per injection, leaving parents to pay the difference.

She said her office has been working hard to educate parents of older children about the need for additional vaccines, so the new requirements wouldn't catch them by surprise.

"We've known this was coming," she said.

Ironically, while more immunizations are being required, local county health departments have been told by state health authorities to stop providing free injections to children who have any level of insurance for immunizations.

The change already affects those in Ottawa County, according to Sue Schreiber, immunization coordinator. She said it resulted from budget shortfalls at the state and national level and a diminished supply of government-funded vaccines.

"Now that there is less money available and less vaccine, you can't be using (state-funded) vaccines for the kids who have coverage," she said.

In Kent County, however, the glitch has prevented the Health Department from following the new fee guidelines, at least for now.

According to Kristi Cooper, immunization program coordinator for Kent County, the department was directed by the state to cut off free shots for non-eligible clients after June 1.

But since the change in the fee schedule has not yet been authorized by the Kent County Board of Commissioners, Cooper said, the department will be providing one free immunization session through Oct. 1.

"We're not supposed to," she said. "We're supposed to charge them. Because of a lack of established fees, we can't."

The temporary "grace period" in Kent County is likely to be appreciated by parents who were unaware of the new immunization requirements.

"Those are the kids who get kicked out of school (for inadequate immunizations), so they quick come to the Health Department, because they don't need an appointment," Cooper said.