Immunization requirements this year are turning out to be more a pain in the rear than a shot in the arm.
New requirements that Alaska children be immunized against hepatitis A and B added to the normal chaos of the first school day Wednesday and left students, parents and school staff -- especially nurses -- in a tizzy. Despite months of notice about the new requirements, schools are turning away dozens of students who have not been vaccinated.
Amanda Trux, a senior at Kenai Central High School, was called into the school office along with her brother Kyle, a sophomore, and others. They were told they could not go back to class and could not leave the building until a parent came to get them, she said.
"I would guess they sent maybe 100 kids home," she said.
Numbers for how many Kenai Peninsula students were affected the first day are not yet available. Traci Davis, the health service coordinator for the Kenai Peninsula Borough School District, said that each school has a separate count and has handled notification procedures on its own.
But she estimated that on average, roughly 10 percent of district students are not ready for school because of the new immunization requirement. That would be nearly 1,000 people.
"It is law, and you are not to be in school without the shots," she said. "We are sending kids home. ... Central office has been clear. We are going to abide by the law."
The new state of Alaska requirements affect children attending day care or school through high school. The main complication is that the hepatitis series requires at least three vaccination sessions spread over six months to complete. Students who have not begun the shots or have fallen behind in the series are not allowed in school.
"Not only is it a series, but the time frame is different for each one," Davis said. "It is difficult to explain to people. ... And the timing makes it much more difficult."
She contrasted the situation with the vaccination drive in 1998 to combat a measles outbreak. That effort taught schools and public health nurses how to work effectively together. But it was simpler, because students got one shot and they were done. The hepatitis immunizations are more confusing and time consuming, she said.
This time, many families that began the series in the spring are now out of compliance because the second or third shots are due. In addition, some families have yet to begin.
The Trux family was one of many caught off guard. Amanda's mother, Susan, was in the grocery store when she got the call on her cell phone to pick up her children. It was an unpleasant surprise.
"We were in here the 15th to get shots, and they said we didn't need them," Susan Trux said as she stood in line Wednesday afternoon at the crowded Kenai Health Center with her teen-agers.
The public health nurses had told her then that the shots were not due until September or October. The school nurse said they were due now. The school had not notified her beforehand that her children were on the noncompliant list, and she was in suspense waiting to find out what the other schools would say about her two younger children, she said.
Susan Trux criticized the process as confusing and inconsistent.
Others present blamed themselves for lack of preparedness.
Sephra Daniel, a junior from KCHS, said her family got a recorded message Tuesday reminding them that she was not immunized.
Her mother admitted that they had procrastinated and misplaced paper work.
Wednesday morning, Sephra slept in and headed for the health center rather than even trying to go to school.
"We just put it off to the last minute," she said.
Shot clinics have been packed for weeks with families trying to avoid such scenarios.
Public Health Nurse Mary Jane Hanley paused between shots just long enough to comment that in the last couple weeks the clinics had seen literally thousands of children and teens.
"And apparently we are not done," she said.
The word from the schools is that the hassle started the new year on a sour note for some.
"It's made quite a rough start to school. ... Parents are not happy, of course," said Karen Mahurin, the senior secretary at Sears Elementary School in Kenai.
She estimated that about 30 first- and second-graders at her school were affected. The school's kindergartners do not show up until next week.
Mahurin also heads the Kenai Peninsula Education Support Association, the union that represents non-teaching staff, including school nurses.
The nurses have been telling her that this year's task of sorting through who has what shots, notifying families of their status and catching up with the backlog of vaccination information is overwhelming, she said.
"It just can't get done," she said.
Davis added that the first day of school is always hectic for nurses. They have their hands full reviewing requirements of students who have serious medical conditions or need to have medications administered at school.
This year, the district allowed the school nurses 14 extra contract hours to tackle the extra work.
Davis said the extra hours made a world of difference.
But Mahurin said nurses have called them inadequate.
"They are stressed out -- max," she said.
The crunch has generated another problem as well. Frustrated parents have been asking for immunization exemption forms in record numbers and may be abusing the exemption process, Mahurin said.
To obtain a medical exemption, families need a note from a physician. But requirements for religious exemptions are vaguer.
Usually her school issues one or two religious exemptions a year, but this year has had dozens of requests, she said.
"I had a parent tell me they didn't have time to get shots, so they filed for a religious exemption," she said.
Two others told school staff they were philosophically opposed to immunizations. When told that was not a legally valid excuse, they requested religious exemption forms, she said.
Davis said such maneuvers violate the rules and could expose parents to legal action.
Religious exemptions apply when the tenets of a family's denomination or church oppose vaccination.
"A parent who signs such a statement based upon philosophical opposition to immunization is in violation of Alaska law. ... All religious exemptions must be documented," she read from the state immunization handbook.
Davis warned people, "We have had people from (the state section of) epidemiology down interviewing parents in the past, but it's been a while."
The hepatitis vaccinations have been recommended for years. Last year, the regulations were changed and, since July 1, the two sets of hepatitis shots are required.
Public health and school nurses began a drive last fall to get families to immunize their children, and most area schools held in-school clinics last spring offering the shots.
Hepatitis A is a viral infection of the liver that causes fever, yellow skin and eyes, loss of appetite and nausea. It is spread from person to person.
It can also be contracted by eating food (including shellfish from polluted water) or drinking water that has been contaminated with sewage.
Hepatitis A infection is a major health problem in Alaska, especially in rural areas and Native populations. The state continues to have major hepatitis A outbreaks every five to seven years. During the last outbreak in 1993, four people in Alaska died from hepatitis A infection, according to the Epidemiology Section of the state Department of Health and Human Services.
Hepatitis B is another serious liver infection. It can pass from an infected mother to her newborn during childbirth and from one person to another through blood, body fluids or by sexual contact. A lifelong infection with this virus can cause liver cancer and death. Nationwide, hepatitis B costs for medical care and work loss exceed $500 million annually, according to the state epidemiology Web site.
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