Back to school: What parents should know about children’s immunizations

Gessel Cisneros, 5, is comforted by family after receiving a flu vaccination shot from medical assistant Jameela Yousos, left, at the Sea Mar Clinic in west Olympia in January 2013.
Gessel Cisneros, 5, is comforted by family after receiving a flu vaccination shot from medical assistant Jameela Yousos, left, at the Sea Mar Clinic in west Olympia in January 2013. Staff file, 2013

As families start moving into back-to-school mode in the coming weeks, physicians hope parents will take a few moments from shopping and schedule planning to make sure their child’s immunizations are up to date.

Understanding the importance of vaccinations, keeping track of which shots a child has had since infancy, and knowing which ones are needed for entry into school, can be a challenge.

We turned to the state Department of Health and Dr. Scott Lindquist, state epidemiologist for communicable diseases, for help.

Q: There’s been a lot of talk about vaccines in recent years, including from parents who oppose them. Why are they necessary? What are the consequences of allowing children to remain unvaccinated?

A: “Immunizing our children protects the entire community,” Lindquist said. “People with weakened immune systems are more prone to die of diseases like chickenpox or measles.”

Vaccine-preventable diseases are easily spread. Even one infected person can cause an outbreak, and infants and young children are in the greatest danger.

Last year in Clallam County, a young woman died due to measles. There also have been outbreaks of whooping cough in the Puget Sound region and elsewhere.

“It’s very confusing for parents right now,” Lindquist said. “You can go on the internet and see someone saying how harmful they (vaccines) can be.”

But he and other experts point out that the side effects of vaccines are rare, while dangers from the diseases they are designed to prevent are real and can be deadly.

Lindquist said old assertions that certain vaccines triggered autism are “starting to fade a bit.” He said several follow-up studies found no links. The physician who first raised the alarm in the 1990s in the British medical journal, The Lancet, has been discredited and the publication retracted his work.

Lindquist also practices one day a week at the Port Gamble S’Klallam Tribe Medical Clinic.

“As an infectious disease doctor, I’m the doctor kids come to when they have these (vaccine-preventable) diseases,” he said. “I have seen 11 children die from these diseases. I have never seen a child harmed or die from a vaccine.”

Q: What vaccines are required for kids to attend school in Washington?

A: Full requirements, including those for children entering day care and preschool, are spelled out on the state Department of Health website.

The childhood vaccination schedule begins in infancy, with doses being administered periodically.

A child who is on schedule should have received the following required vaccines by the start of kindergarten:

▪ Three doses of Hepatitis B vaccine.

▪ Five doses of the combination diphtheria/tetanus/pertussis vaccine.

▪ Four doses of polio vaccine.

▪ Two doses of the combination measles/mumps/rubella vaccine.

▪ Two doses of the varicella (chickenpox) vaccine, unless a health care provider can verify that the child had the disease.

The vaccines are required for children from kindergarten through grade five.

Children entering sixth grade, along with older students, need an additional booster shot of the diphtheria/tetanus/pertussis vaccine.

Also this fall, all high school students must have two doses of varicella (chickenpox) vaccine. All students in kindergarten-eighth grade already should have received two doses.

Q: I thought kids got only one dose of the chickenpox vaccine?

A: “Initially, it was a single dose,” Lindquist said. “But now every child has to have two doses of chickenpox vaccine to be in school in Washington state. That is new.”

Q: Isn’t chickenpox a minor disease? Why require vaccination?

A: “It is fairly benign in most children,” Lindquist said. But it can prove deadly. One of the 11 child deaths he’s encountered involving vaccine-preventable illness involved a case of chickenpox.

Q: What if my child is behind schedule?

A: It’s possible to catch up where your child left off, without starting over. Ask a health care provider how to get your child back on track.

Q: How can I keep track of what shots my child has had, and when?

A: The Washington State Immunization Information System is a statewide, secure, web-based registry that stores immunization records. When children receive vaccines, the information is entered into the system. (Parents can request that their child’s information not be entered.)

Doctors can access the system to find out whether your child is up to date on immunizations and can print out a record for you. You can also request a copy through the state Department of Health.

Or, you can access your child’s records online by registering and following the steps listed on the department website.

Q: Are vaccines expensive? What if I can’t afford them?

A: In Washington state, all vaccines for children from birth through age 18 are provided at no cost.

Health care providers might charge an office visit fee and/or a fee to give the vaccine. This administration charge can be waived for people unable to pay the fee.

The Tacoma-Pierce County Health Department sponsors frequent immunization clinics. Parents must bring their child’s vaccine records to participate.

For more information and a schedule of upcoming clinics, go to the department website or call 253-798-6410.

Q: Where should I go to get more information about immunizations for my child?

A: “The internet is part of the picture,” Lindquist said. He urges parents to consult reliable online sources such as the American Academy of Pediatrics.

He also urges them to speak with their child’s doctor.

Q: What if I just don’t believe in vaccination? Does this mean my child can’t attend school?

A: Parents in Washington state can claim an exemption from the vaccine requirements for their students for one of three reasons: a child’s medical condition (such as a severe disease or a compromised immune system), the family’s religious beliefs or a philosophical objection.

The state has tightened the requirements for the last one.

“You can’t just walk into a school and say, ‘I have a philosophical objection,’ ” Lindquist said. “You must have a signed note from a physician (or other provider) saying that they explained the risks and benefits.”

Lindquist said the provision is aimed at reducing the percentage of unvaccinated students in Washington schools.

Debbie Cafazzo: 253-597-8635, @DebbieCafazzo

Vaccination rates

These are fall 2015 immunization statistics for kindergarteners in Pierce, Thurston and King counties. (Numbers don’t add to 100 percent because the remaining children are on a catch-up plan called conditional status.)




Out of compliance













Source: Washington State Department of Health