School nurses throughout the county have been poring through health records for weeks to determine which returning students are not in compliance with the more stringent immunization requirements unveiled in January.
Though many students have come into compliance over the summer, county and school health officials say they are expecting thousands of students to show up for the new school year lacking proper immunization status.
"We've seen an increase over the summer of about 50 percent for students receiving immunizations," said Andrew Bernstein, a health officer for the county Health Department. "And as school starts, people will realize they haven't gotten their kids' shots yet, and we're going to be very busy."
Students will have 20 calendar days from the start of school to meet the requirements or face being barred from attending, school officials say.
State health officials handed down the revised requirements this year to take effect at the start of the 2006-2007 school year. The changes, which are based on recommendations by the federal Centers for Disease Control, are intended to adapt to changes in illness patterns.
In the spring, school nurses published the new requirements in school newsletters and mailed letters to parents.
The Health Department will add hours of operation at its immunization clinic. Usually open from 1 p.m. to 4 p.m. Tuesdays, the clinic also will be open from 9 a.m. to 11 a.m. on Tuesday this week and next week.
"We may add more clinics, depending on what we see over the next two weeks," Bernstein said. Last year, 509 children received 762 vaccinations through the Health Department.
Some of the recommendations the CDC has made are being implemented this year, such as Prevnar for preschoolers, said Greg Reed, the program manager for Maryland's Center for Immunization.
"The vaccine is highly effective in preventing things like chronic ear infections," he said. "The state already requires it for children in day care and now has decided that preschoolers could also benefit from the vaccine."
Although the varicella and hepatitis B vaccines have been required for some ages, Maryland decided to accelerate the timetable for requiring the shots for other ages.
Originally, the vaccines were scheduled for administration between 2006 and 2013, said Reed. That has been moved up to 2009, so ninth-graders will be receiving the vaccinations this year, 10th-graders next year, 11th-graders in 2008 and 12th-graders in 2009.
The timetable for the hepatitis B shot has been advanced because of the increase in diagnosed cases of hepatitis B among teenagers and the high-risk activities some adolescents engage in, Reed said.
"There were about 80,000 cases of diagnosed hepatitis B last year, and 8 percent of them were adolescents," Reed said. "Adolescents are engaging in riskier behaviors such as sex with multiple partners and intravenous drug use. So they are getting hepatitis B more often."
Parents most commonly say the cost of the immunizations is an impediment to being in compliance. In response, the county Health Department became involved in Vaccines for Children, a national program that provides vaccinations for youth up to age 18.
Through the initiative, more than 750 providers throughout Maryland administer vaccinations. To participate, families must receive Maryland Medicaid, be uninsured, be underinsured or be American Indian or native Alaskan. Clinics and physicians in the program receive vaccines free of charge. The patient is not charged for the vaccine but can be assessed a fee of $15.49 per dose.
Another common reason for noncompliance is vaccine shortage. Clinics order vaccinations in advance, with no way to predict how many children will come in for shots, said Susan Reiman, coordinator of nursing services for the county .
"They don't order enough and the kids have to wait to get a shot," Reiman said.
In other cases, children lack a record of having received the required shots or of having had an illness - such as the chicken pox - that makes a vaccination unnecessary.
For example, school nurses reported to Reiman that parents said they called their doctors when their children had symptoms they thought were chickenpox and that the doctors told them not to bring the children into the office with an infectious illness.
According to the school nurses, the parents said the doctors didn't keep records of the phone calls, she said. "There would be no formal record."
The new guidelines state that the parent must provide the doctor's record or a note from a doctor stating the month and year when the child had the illness.
"If they can't get that, they need to have a blood titer test done or have the child vaccinated again," Reiman said. "Either way, the key is not to wait but to get the immunizations now."
The new immunization requirements include:
One Pneumococcal (Prevnar PCV7) vaccine to protect against meningitis, blood diseases and chronic ear infections, for all students who are younger than 5;
One dose of Varicella (chicken pox) vaccine, on or after the student's first birthday, a blood test to prove immunity for students entering grades preschool through nine, or a physician's note stating the month and year the child had the disease;
Three doses of Hepatitis B for students entering preschool through ninth grade, a blood test for immunity, or vaccination dates.
Source: Harford County Public Schools