If they haven't already had chickenpox, school kids in Minnesota would be required to receive the chickenpox vaccine under a Minnesota Health Department proposal.

The proposal also would require infants and toddlers in day care facilities to get more shots in addition to the chickenpox (also known as varicella) vaccine: pneumococcal and hepatitis B vaccines.

Health officials say the changes would bring Minnesota in line with national recommendations and a majority of other states.

"We're actually getting to the point where we're one of the last states to do it, or to consider it," said Kristen Ehresmann, head of the immunization program at the Health Department.

A public hearing to air any concerns about the vaccine proposals is planned for Wednesday in St. Paul. The hearing is a first step in an approval process that could take two years, Ehresmann said.

No one has opposed the changes so far, but school nurses say they're concerned because they'll have to enforce the rules with no additional funding.

"We really know that it's a wonderful public health tool for protecting kids," said Ann Hoxie of the School Nurse Organization of Minnesota. But "it's just become a huge exercise for schools to maintain these records and to enforce the law."

A 1998 study found that Minnesota schools spent almost $5 million a year to enforce the rules. Sometimes, nurses must track down records or hound parents to get their children immunized and turn in documents.

Once the rules take effect, young children will be required to get the chickenpox vaccine before entering kindergarten; those already in grade school have until 7th grade to meet the requirement. Older kids will be exempt, as would those who have had chickenpox.

The vaccines are available at public and private clinics, and any child without insurance can get the required shots through a government-sponsored program, Ehresmann said.

However, parents would still have the option to exempt children from the shots for personal or medical reasons, she said. State law gives individuals the right to opt out of any required vaccine.

Cases of chickenpox, with its telltale itchy red spots, have dropped dramatically since the vaccine was introduced in 1995. But that means some people could be at higher risk if they're not vaccinated, Ehresmann said.

"You'll run the risk that you'll have people who are unprotected and then get to adulthood when the disease is more severe, and you'll have pockets of outbreaks," she said.

Although many think chickenpox is harmless, it can be life-threatening. About 100 Americans died and 4,000 to 9,000 were hospitalized from chickenpox each year before the vaccine was introduced, according to the U.S. Centers for Disease Control and Prevention.

The proposals were recommended by the Health Department's Immunization Practice Task Force, a coalition of medical groups. They also have been endorsed by the federal Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians.

The hearing is scheduled for 5:30 p.m. Wednesday at the Health Department office at 1645 Energy Park Dr. The proposals have been posted on the Web at http://

www.health.state.mn.us.

-- Maura Lerner is at mlerner@startribune.com.