It's perhaps the most dreaded of back-to-school needs -- shots.
On Sept. 28, the state requires all school districts to send home any students who haven't had the immunizations required at each grade level -- an annual cause for concern even in relatively well-immunized Howard County.
"There's no way to measure how many children still need immunizations," said Barry Trostel, assistant chief for the state's Center for Immunization. But "invariably there's always a push in the latter part of the deadline -- the procrastination effect."
Howard County, which usually reaches 99 percent compliance by the end of September each year, has been on guard in recent years since a 1991 measles outbreak was traced to a wrestler at the east Columbia Oakland Mills High School. About 110 measles cases were reported throughout the state as a result of that outbreak, including 20 in Howard County.
County health officials hope to prevent such outbreaks with aggressive immunization efforts through free clinics they started this year at local high schools and with a new state computerized immunization registry, which will maintain records of children immunized in Maryland.
One of the biggest problems in Howard County, health officials say, is tracking paper immunization records of children who move from elsewhere. In the past 12 years, more than 44,000 people have moved to Howard, 63 percent from elsewhere in Maryland.
"The ones that pull us down are the transients," said Margaret Kim, supervisor for child health at the county health department. She said immunization records usually are transferred with a child's education records, but sometimes papers get mixed up in the shuffle.
Sometimes the problem is a child who hasn't been enrolled in public school at all. That was the case last week of a 12-year-old from east Columbia's Long Reach village, who was told he would have to have two shots so he could start at Mayfield Woods Middle School today.
The seventh-grader had been studying at home, but his parents decided to register him last week for public school. A nurse said the boy -- whose parents did not want him identified by name -- was behind schedule for his Diphtheria, Tetanus, Pertussis (DTP) and measles, mumps and rubella immunizations.
So one day last week, the boy visited the health department clinic in west Columbia's Town Center, off Little Patuxent Parkway. "I hope it's not a big needle," he said awaiting the shots.
He squinted as clinical nurse Marion Friedman placed a plastic immunization gun -- the latest tool for vaccine injections -- on his right arm and fired the DTP shot into his muscles. Then she injected him with a needle in his left arm for his combined doses of measles, mumps and rubella vaccinations.
Since April, more than 500 children have visited other free county health clinics held monthly at public schools. About half the vaccinations given at the clinics have been a second shot for measles, mumps and rubella.
The second measles, mumps and rubella shot is a state requirement that started in 1992. This year, children in kindergarten through third grade and sixth through ninth grade are required to have the second dose. The state started requiring it after measles outbreaks in 1989, 1990 and 1991.
Health officials say the diseases that can result when children are not vaccinated can be life-threatening.
Diphtheria causes an infection of the throat that can lead to breathing problems, heart failure, paralysis and death. Tetanus causes painful muscle spasms. Pertussis, also known as whooping cough, is a bacterial respiratory infection that can lead to pneumonia, seizures and death. And measles, mumps and rubella cause problems such as fever, rash or swollen glands.
The Howard school system and county health department have not kept track of how many schoolchildren have failed to be immunized by the start of classes today. But as school staff members continue to comb through their records, they'll be looking to identify all students not yet in compliance.
For children who still need immunizations, the health department will hold free clinics every Wednesday next month at a different county high school each week. The health department also offers free immunizations by appointment at its Ellicott City, Columbia and North Laurel clinics.
For more information about vaccinations and free county clinics, call 313-7500 in Columbia, 313-2333 in Ellicott City and 880-5888 in southeast Howard County.
Children entering kindergarten should have had these vaccinations, according to state regulations:
VACCINE ....... ....... DOSES
Pertussis ........ ....... 4
Polio ............ ....... 3
Measles .......... ....... 2
Rubella .......... ....... 1
Mumps ............ ....... 1
SOURCE: Maryland Department of Health and Mental Hygiene
BACK TO SCHOOL
For Howard County back-to-school information, call Sundial at (410) 783-1800 and enter the four-digit code 6177.