Hepatitis-Shot Law Pressures Parents, Schools

State health officials estimate that up to 145,000 incoming seventh-graders may lack required hepatitis B vaccinations, prompting concerns that scores of students could be barred from entering middle school next month if they don’t roll up their sleeves for shots soon.

A new state law that took effect last month mandates that students cannot enter, advance to or repeat the seventh grade if they have not started the three-dose hepatitis B series, administered over four to six months.

“I had the [school] nurses do statistics for me at the end of last school year and we think half are immunized correctly,” said Sandy Landry, the health and wellness administrator for the Orange County Department of Education. “That means we’ll have to check the other half and make sure they’re up to date.”

Landry hopes that many more parents will provide proof of immunization on the first day of school. Otherwise, untold numbers of Orange County’s 35,000 or so entering seventh-graders could be sent home the first day of school. “Schools could have to turn away thousands of kids,” she said. “It’s not just that they could, or should, but that’s a state law we have to comply with.”

The situation appears a little less bleak in the Los Angeles Unified School District. A vast immunization program aimed at fifth- and sixth-graders over the last two years should ensure that only about 5,000 of the district’s 50,000 to 55,000 seventh-graders will begin school in September without the necessary shots, said Suzanne Rue, the communicable disease resource nurse for L.A. Unified.

Officially, if students either haven’t begun the three-shot immunization series or are late in receiving the next shot in the series, they aren’t supposed to set foot in a classroom. Indeed, some year-round schools have already denied entry to unvaccinated youngsters and referred them to clinics, said Dr. Natalie Smith, immunization chief for the California Department of Health Services.

In practice, however, many school districts have neither the personnel to monitor students that closely at the beginning of the year, nor the desire to eject willing pupils, said officials with several districts. In the weeks after school begins, many staff members will pore over student records to make sure children have been properly immunized and give parents a chance to comply.

In Los Angeles Unified, laggard pupils at the district’s more than 80 middle schools will be sequestered in homeroom or auditoriums on the first day and given consent forms to take home to their parents, Rue said. Within the first month of school, some 40 nurses and nurse practitioners will fan out across the sprawling district to immunize any stragglers.

To alert parents to the needed shots--and the requirement for seventh-graders to receive a second dose of the measles vaccine--schools launched a public information campaign last school year. Officials have placed ads in local newspapers, on local cable television shows, and in school newsletters. They’ve pasted fliers to the walls of schools, held dozens of free or low-cost clinics and, in recent weeks, some districts have resorted to calling parents of nonimmunized children directly.

Some parents expressed disbelief that the law requiring the vaccine only took effect in July, though students could have received their shots before that.

“Do they expect miracles?” asked Rick Palombo, a Costa Mesa radiologist and the parent of an incoming sixth-grader. “That’s ridiculous.”

It hasn’t been easy on either side of the syringe, said Kathy Strobel, Anaheim Union High School District’s health services coordinator and nurse practitioner. Parents have been standing in line with their children for two hours to get the shots, and at one session on Wednesday, nurses delivered 88 vaccines in an hour--one every 41 seconds.

“I’m taking my shoes off to cool my feet,” Strobel said Thursday after another lengthy immunization session, this one at Lexington Junior High School. “I’m sure that our principals and assistant principals are losing sleep at night, fearful of what was going to happen to their students. This is going to be a big headache all the way around.”

Hepatitis B is an infection of the liver caused by a virus present in the blood and other bodily fluids. An estimated 140,000 to 320,000 U.S. residents a year contract the disease, according to the Centers for Disease Control and Prevention in Atlanta. About 5,000 to 6,000 people die annually from hepatitis-related liver ailments.

The hepatitis B vaccine had been available since 1982, and, for two years now, California kindergartners have been required to show proof of hepatitis vaccination before starting classes.

The new law is intended to catch older children who missed earlier inoculations and are approaching the years when the disease is often contracted. As with other school immunization laws, families may opt to have their youngsters skip the shots for medical reasons and personal beliefs. However, those children may be excluded from school during disease outbreaks.

Capistrano Unified nurse Mary Ann Kelly is among those fretting about the new law. Only 1,800 to 2,000 of the district’s 3,200 entering seventh-graders have notified the district that their shots are current--and school starts Sept. 9.

“Every day it gets a little better,” Kelly said. “Parents really need to be reminded to get it done.”

She suspects that the parents who haven’t notified school officials are perhaps out of town, procrastinating or waiting until their children have all three shots before alerting the schools.

Despite the concern, state immunization chief Smith said most year-round schools already in session have been able to catch up on shots with a minimum of chaos. The law isn’t aimed to keep kids from classes, but to keep them healthy.

“Hepatitis B causes a significant toll in California,” Smith said. “Most infections [occur] in adolescence and among young adults. We really want these kids to be protected.”

Edna Hammond, a health technician at the Tustin Unified School District, said administrators have done all they can to prepare students to comply with the new law. The onus, she said, is now on parents.

“Some people just don’t pay attention,” she said. “All we can do is let the parents know. It’s up to the parents to follow through. And for one reason or another, they just don’t do it.”

In many cases, bureaucracy and practicality seemed to collide. In Tustin, for example, officials included a notice about the new law in their newsletter, which is mailed directly to parents. But when the schools composed additional warning letters, they decided not to mail them to students’ parents. Instead, they trusted that students themselves would act as couriers.--

“We can’t afford to mail it,” Hammond said. “We give it to the students to take home to the parents. Many times, [parents] don’t get it.”

While the new law says unimmunized seventh-graders can’t join their classmates on the first day of school, nurses are reluctant to keep students from their lessons.

In Irvine Unified School District, officials said, unimmunized students won’t be turned away; rather, a letter will be sent home giving parents 10 days to comply. Those students will be removed from the classroom only if they don’t get their immunizations within the 10-day period, said Sally Snyder, Irvine’s health services coordinator.

“The reason we are all here, and the reason we work in education, is to have kids in school to learn,” she said. “While we strive for that 100% compliance, we are not going to patrol kids as they come in the door and put a sticker on them or anything.”

Just a year ago, nearly 100% of Irvine Unified’s 23,500 students had received their required vaccinations--no small feat in an area where students routinely float from one school to another. When schools open there on Sept. 9, Snyder said, “that’s going to go down considerably” because of the new law.

Still, few districts are willing to estimate exactly how many children might be affected. Snyder, for example, would only estimate that dozens of the district’s 1,700 seventh-graders might be remiss in getting their shots.

“I don’t think anyone can give you that answer now,” said Tustin Unified’s Hammond. “During the summer a lot of them have gone to get their first or second or third dose. It’s impossible for us to know until the first day of school.”

With extra vaccine ordered, the Orange County Health Care Agency is ready to prick a lot of upper arms in September, said Mary Wright, the agency’s immunization coordinator. And she’s urging parents to avoid the hassle in future years.

“You don’t have to wait for seventh grade--that’s just a checkpoint,” Wright said. “Parents who have third-, fourth- or fifth-graders who don’t have it yet can save themselves a lot of grief if they have [the hepatitis shots] taken care of at regular doctor’s appointments over the next year or so.”

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Free Immunizations

The Orange County Health Care Agency sponsors free immunization clinics at these locations. For information, call the health referral line at (800) 564-8448.

Location Days Hours

ANAHEIM

Health Care Agency

2137 E. Ball Road Mon. & Fri. 8-11:30 a.m.

1-4:30 p.m.

BUENA PARK

Health Care Agency

7342 Orangethorpe Ave. Tue. 8 a.m.-4:30 p.m.

Thu. 8 a.m.-7:30 p.m.

COSTA MESA

Health Care Agency

2845 E. Mesa Verde Drive

Wed. 11 a.m.-7:30 p.m.

HUNTINGTON BEACH

Oak View Elementary

17241 Oak Lane

2nd & 4th Fri. 1-3:30 p.m.

ORANGE

La Purisma Catholic Church

18801 Spring St.

1st & 3rd Mon. 8-11:30 a.m.

SAN JUAN CAPISTRANO

Health Care Agency

27512 Calle Arroyo

Thu. 11 a.m.-7:30 p.m.

SANTA ANA

Health Care Agency

1725 W. 17th St. Mon./Wed./Fri. 8 a.m.-4:30 p.m.

Tue. 8 a.m.-7:30 p.m.

*

Corbin Community Center

2215 W. McFadden Ave.

Thu. 8 a.m.-11:30 a.m.

*

El Salvador Community Center

1825 W. Civic Center Drive

2nd & 4th Mon. 8 a.m.-11:30 a.m.

*

St. Joseph School Auditorium

608 E. Civic Center Drive

4th Tue. 8-11:30 a.m.

*

Wilshire Presbyterian Church

940 W. Wilshire

Wed. 8-11:30 a.m.

STANTON

Stanton Community Center

11822 Santa Paula

1st & 3rd Wed. 8:30-11:30 a.m.

Source: Orange County Health Care Agency