Lack of Shots May Exclude Many From Classes

State health officials estimate that up to 145,000 incoming seventh-graders may lack the required hepatitis B vaccination, prompting concerns that many 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.

In Los Angeles County, a vast immunization program aimed at fifth- and sixth-graders over the last two years could lessen the impact on school districts.

Only about 5,000 of Los Angeles Unified’s 50,000 to 55,000 seventh-graders will begin school in September without the necessary shots, said Suzanne Rue, the district’s communicable disease resource nurse.

But Kristin Brusuelas, the county immunization program’s chief of staff, said that up to half the county’s seventh-graders could lack the proper immunizations.

The situation also appears dire in Orange County. “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 many more parents will provide proof of immunization on the first day of school. Otherwise, untold numbers of Orange County’s almost 35,000 entering seventh-graders could be sent home.

“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.”

Officially, if students either haven’t begun the immunization series or are late in receiving the next shot in the series, they aren’t supposed to set foot in a classroom.

Although some year-round schools have already denied entry to unvaccinated children and referred them to clinics, most such schools already in session have been able to catch up on shots with a minimum of chaos, said Dr. Natalie Smith, immunization chief for the California Department of Health Services.

The law is aimed not at keeping children from classes, but at shielding them from a serious ailment.

“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.”

In practice, however, many school districts don’t have the personnel to closely monitor students at the beginning of the year or the desire to eject pupils, said officials with several districts. In the weeks after school begins, staff members will pore over student records to make sure that children have been properly immunized and give parents a chance to comply.

In L.A. 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.

In Irvine Unified, officials said, a nonimmunized student won’t be turned away; rather, a letter will be sent home giving parents 10 days to comply. A student would be plucked from a classroom only after that time expires, 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.”

To alert parents about 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.

Some Wait in Lines for Hours

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

“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 Wednesday, nurses delivered 88 shots in an hour--one every 41 seconds.

Hepatitis B is an infection of the liver caused by a virus present in the blood and other body fluids. The disease infects an estimated 140,000 to 320,000 U.S. residents a year, according to the federal Centers for Disease Control and Prevention in Atlanta. About 5,000 to 6,000 people die annually as a result of hepatitis-related liver diseases.

The hepatitis B vaccine has 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 children skip the shots for medical reasons or personal beliefs. However, those children may be excluded from school during disease outbreaks.

Staff writer Nona Yates contributed to this story.

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Immunizing Against Hepatitis B

Under a state law that went into effect July 1, students cannot enter, advance to or repeat the seventh grade if they have not received the hepatitis B vaccine, which is given in three doses over a four-to six-month period.

Vaccination Schedule

Approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians.

Birth - 2 months: Dose 1

2 months - 6 months: Dose 2

6 months - 15 months: Dose 3

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Catching up

Recommended ages for beginning vaccination series for those not previously immunized: 18 mos., 4-6 yrs., 11-12 yrs., 14-16 yrs.

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Infected Area

Hepatitis B is a disease that causes inflammation of the liver. This can cause liver cell damage, which can lead to cirrhosis and an increased risk of liver cancer. Blood test can determine if there has been an infection.

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Free Immunizations

The Los Angeles County Immunization Project has a toll-free number to call for locations for free hepatitis B vaccinations. Ask or the immunizations clinic at (800) 427-8700.