At least 8,500 students were barred from Baltimore schools yesterday because they didn't have the necessary immunizations, and 13,000 others have been notified that they face the same consequences if their shots are not up to date by Sept. 26.
"It is a crisis," said Dr. Penny Borenstein, director of the city Health Department's bureau of immunization. "We've been taking a risk of having children in our schools who are not immunized properly and spreading disease."
City school administrators are largely to blame for the fact that 18 percent of the city's 113,000 students are not fully immunized as required by state health law, said Dr. Borenstein.
At least 8,500 students were told by teachers on Wednesday, the first day of school in the city, not to return -- a policy enforced in a written notice from school Superintendent Walter G. Amprey.
An additional 13,000 students and their parents were notified last week that they must receive vaccinations by Sept. 26 and bring proof to the schools or face exclusion. The 8,500 students were listed last year as not being fully immunized; the others are newly identified.
Many school systems in the area have enforced the law more strictly than Baltimore, said Dr. Ebenezer Israel, the state health department's director of epidemiology and disease control.
In recent years, some have reported individual schools with more than 95 percent of students up to date on all shots.
However, he added, "What we have noticed is that having the children adequately immunized is a problem in all jurisdictions."
Several school systems, including Carroll, Anne Arundel, Frederick and Baltimore counties, did not have or would not release immunization counts yesterday.
By state law, districts have 20 days from the start of school to enforce the immunization law.
"Our goal is not to send any child home," said Michele Prumo, coordinator of health services for Baltimore County schools.
Howard County school officials said 99 percent of students had their shots when school began Aug. 28. Harford County health officials said their schools' compliance rate last year was about 98 percent, and they expect about the same this year.
Dr. Borenstein said the problem in Baltimore grew from "years of nonenforcement" of a state law that requires students to be fully immunized before they are admitted.
She blamed administrators and principals for the poor enforcement, saying some principals did not want to exclude children for lack of immunization "because it's counter to their educational philosophies."
Mary Nicholsonne, associate superintendent for instruction for the city school system, said in a statement yesterday that the administration had left "the responsibility for documenting and following up on immunizations to the individual schools," a policy that apparently caused problems at times.
"Most principals were diligent in following up on noncompliant students and prodding parents to get their children immunized," the statement said. "However, recognizing that schools provide our youngsters with much more than they acquire in the classroom -- for instance a meal and safety from the streets -- some principals granted extensions to parents of noncompliant students."
Poor recordkeeping by schools and clinics in Baltimore also is an issue. "That's always been recognized as a bigger problem in the city than in other jurisdictions," said Diane Dwyer, state epidemiologist.
City Health Commissioner Peter Beilenson said yesterday that at least 300 children were being immunized each day during the current push.
"This tactic is working," said Dr. Beilenson, who made note of an outbreak in the winter of 1990-1991 in which several hundred children got measles and mumps. "There are real public health reasons for enforcing this law. It's not a bureaucratic issue. . . . We don't want kids getting sick from these diseases, some of which can be fatal."
Dr. Borenstein said the emergency largely stems from a 1992 change in immunization requirements that call for an additional measles booster shot when children are entering kindergarten or middle school.
At a clinic yesterday at school headquarters on North Avenue, hundreds of students from kindergarten to middle school -- most barred from attending school -- came with parents and relatives.
Inside, 20 nurses from the city Health Department administered the free vaccines beginning at 8:30 a.m. while a videotape of a fairy tale played in a makeshift waiting room.
"I know that she needed the shots, but I have eight grandchildren to take care of and I just got behind," said Ruby Herbert, grandmother of Shannon Bethea, 9, a fourth-grader at Park Heights Elementary School who was told by her teacher not to return to school.
Sheena Garrett, said her daughter Teaira Brooks, 8, was told she could not return to fourth grade at Cecil Elementary School until she received a vaccination.
"She went to school yesterday and her teacher told her she couldn't come back without her shots," Ms. Garrett said.
In February, about 40,000 children were identified by health officials as not having proper immunizations. That prompted Dr. Beilenson to meet with Mayor Kurt L. Schmoke and plan a push.
By the end of the school year, 18,000 children still needed shots. The administration withheld report cards from those students, hoping to prod parents or relatives to act, Dr. Borenstein said.
Along with incentives, such as a coupon for a 20 percent discount at Mondawmin Mall, parents were notified by telephone and in letters over the summer to have their children immunized, Dr. Borenstein said.
When those tactics failed, Dr. Amprey and Dr. Beilenson sent a stern letter to 8,500 parents in early August and a warning letter to 13,000 parents last week.
Another letter on Wednesday to those being barred -- and a one-on-one lecture from a teacher to young students as they were turned away -- seems to have worked, Dr. Borenstein said.
"I would say once it got the proper attention, we and the school system have done quite well," she said.
Dr. Israel, the state epidemiology director, said that despite low compliance rate in the city, credit should given for the emphasis put on immunizations this year.
"We've had no big outbreaks of measles in the schools, including in Baltimore, in the last three years," he said. "Our mumps rate has gone way down because of the school law. If we compared Baltimore City with other large urban areas, Baltimore does very well."