Requirements for Back-to-School Immunizations

Part of this annual back-to-school ritual is to be sure children are up to date on their vaccinations. Most immunizations are administered before a child is two years old; however, between ages four and six, prior to entering kindergarten, children are due for several booster shots. Children between 12 and 15 years of age might be due for booster shots, too.

While no one looks forward to vaccine injections, the benefits of preventing serious vaccine-preventable diseases far outweigh the mild discomfort of the shot (or shots) and low risk of side effects. Not only do vaccines keep our children healthy, the State of Wisconsin requires children to be fully vaccinated (or in the process of being fully vaccinated) prior to entering school. Parents or guardians may receive a waiver to not vaccinate their children for medical, religious or personal conviction reasons.

The Wisconsin Immunization Law is intended to protect all of our children from vaccine-preventable diseases. The state law requires children in licensed day care centers and students in kindergarten through grade 12 to be immunized according to their age/grade level by the beginning of the school year. Immunizations are required against measles, mumps and rubella (MMR), diphtheria, tetanus and pertussis/whooping cough (DTP), polio, Hepatitis B, and chickenpox (varicella). The same vaccines plus Haemophilus influenza b (Hib) are required for children in day care.

These diseases can have damaging complications that can result in blindness, hearing loss or deafness, mental retardation and even death. Students must present written evidence of completed immunizations (or a waiver) to their school, including the day, month and year, of each vaccination. State law allows schools to exclude students without completed vaccinations or a waiver. In addition, if an outbreak of a vaccine-preventable disease occurs, unvaccinated children can be excluded from school until the outbreak is controlled.

Vaccination requirements have changed over the years. Beginning with the 1997-98 school year, Wisconsin state law began to phase in the Hepatitis B vaccination requirement. Hepatitis B is passed through infected blood or sexual contact. There are about 5,000 Hepatitis B deaths each year in the US. Individuals infected with Hepatitis B generally die due to overwhelming infection, liver cancer or cirrhoses (scar tissue in the liver). For most people, the Hepatitis B vaccine's series of three shots provides protection for a lifetime.

It was in 1990 that Wisconsin state law was changed to phase in the requirement for two MMR shots. This was completely implemented for all Wisconsin schoolchildren as of 1997.

If a child has not had the chickenpox illness, Varicella vaccine is administered soon after the child's first birthday, often at the same time as the MMR shot. Only one dose of Varicella vaccine is needed up to age 12. If a child is after age 12 at the time of Varicella vaccination, two doses of the vaccine are recommended. Likewise, Hib -- which among other things protects against one type of meningitis -- is not required to attend public schools, but is generally given to infants by most doctors.

Flu shots are usually given to all adults starting at age 65. Children and younger adults at high risk of having complications of influenza -- including those with diabetes or asthma, or who are around high-risk individuals -- should receive a flu vaccination each fall, usually in October. Anyone over age six months can get the flu shot (after consulting a doctor); however the flu shot is not required for school.

Vaccines and vaccination schedules continue to change. The oral polio vaccine was replaced by an injection for the year 2000. A very tiny proportion of children have gotten the polio infection from the live-attenuated (partially killed) oral polio vaccine. Polio infection is not possible from the injectable polio vaccine since it is a killed vaccine.

While doctors' offices and health departments keep vaccination records, it is helpful for parents to keep their own records of their children's vaccinations. Not only is the information needed for school, but a complete immunization record can then be passed along to their children as they become adults. This may be important for such immunizations as tetanus booster shots, which should be repeated every 10 years. Measles, mumps, rubella and chickenpox vaccination status is also important for adults. Good records will make it less likely that adults will be unimmunized.

For more information about immunization, contact your family doctor, pediatrician or local public health department. The Immunization Action Coalition or the Centers for Disease Control are good Web sites for further information on vaccinations. Public health departments provide vaccinations free of charge. In addition, some school-based clinics may provide immunizations

Following are the minimum required immunizations for each age/grade level. It is not a recommended immunization schedule for infants and preschoolers. For that schedule, contact your doctor or local health department. DTP is Diphtheria-Tetanus-Pertussis, also called combination baby shots or 3-in-1 shots, and used for children under seven years of age. DTaP is Diphtheria-Tetanus-acellular Pertussis. DT is pediatric Diphtheria-Tetanus without pertussis for those few children under age seven who, for medical reasons, should not receive Pertussis vaccine. Td is the Tetanus-Diphtheria shot for ages seven and above. MMR is the Mumps, Measles and Rubella vaccine and Var is Varicella, or Chickenpox.

AGE/GRADE	NUMBER OF DOSES
Pre-K (2 through 4 years)	4 DTP,DTaP, or DT; 3 Polio; 1 MMR; 3 Hep B; 1 Var
Grades K2 through 8	4 DTP, DTaP, or DT3; 4 Polio4; 2 MMR1; 3 Hep B; 1 Var
Grades 9 through 12	4 DTP, DTaP, or Td3; 4 Polio4; 2 MMR1; 3 Hep B

¹MMR vaccine for all students: The first dose of MMR vaccine must have been received on or after the first birthday.

²DTP/DTaP/DT vaccine for children entering kindergarten: Your child must have received one dose after the 4th birthday (either the third, fourth or fifth dose) to be compliant.

³ DTP/DTaP/DT/Td vaccine for students entering grades 1 through 12: If your child received the third dose after the fourth birthday, further doses are not required.

⁴Polio vaccine for students entering grades kindergarten through 12: If your child received the third dose after the fourth birthday, further doses are not required.

⁵Chickenpox disease history is also acceptable.

⁶Students 13 years of age or older without a prior history of chickenpox disease or a prior history of chickenpox vaccine require 2 doses of varicella vaccine.

Douglas J. Bower, MD
Associate Professor of Family & Community Medicine
Medical College of Wisconsin
Plank Road Clinic

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.