By Stefanie Cole, BSN, RN, MPH, Pediatric Immunization Nurse Educator, Michigan Department of Health and Human Services, Division of Immunization
It’s finally springtime! And springtime means it’s time for kindergarten roundup. Children are perfect vectors for disease, especially in close group settings such as the classroom, cafeteria, and playground. If you see pediatric patients between 4 and 6 years of age, make sure you assess their immunization record at every visit to see which vaccines they need. To best protect children from vaccine-preventable diseases, healthcare providers should vaccinate their patients according to the Advisory Committee on Immunization Practices’ (ACIP) recommended immunization schedules.1
Michigan administrative rules require all kindergarteners and 4-6-year-old transfer students to have appropriate documentation of vaccines protecting against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, hepatitis B, and varicella. For some of these diseases, appropriate documentation of immunity from the disease is acceptable in lieu of vaccination. For the 2017-18 school year, Michigan’s kindergarteners had decent coverage levels of select vaccines (95.3% for 4 or 5 doses of DTaP, 95.0% for 2 doses of MMR, 94.7% for 2 doses of varicella). What’s concerning, though, is that Michigan’s kindergarten vaccine exemption rate was 10th highest in the country at 4.2%, an increase of 0.5% from the previous year.2 By vaccinating children according to the ACIP schedule, your patients will receive all the vaccines required for school and daycare entry. These vaccines protect against diseases that we still see in Michigan today.
While there have been several national measles outbreaks over the past decade, Michigan does not usually see many cases.3 However, in 2018, Michigan had 19 confirmed cases of measles, the most cases we’ve seen since 1994 when 26 cases were reported. Most measles cases in Michigan are associated with unvaccinated international travelers returning to Michigan and spreading the disease to other unvaccinated individuals. These diseases are truly only a plane ride away. It is vital to make sure your pediatric patients are protected against these highly contagious and dangerous diseases to keep them healthy, not just at school but everywhere they go.
Even though some ACIP-recommended vaccines are not required for school and daycare entry, they are just as important for children to receive. At a child’s 4-year-old well visit, they should receive DTaP, Polio, MMR, and Varicella. These vaccines are recommended between 4 and 6 years of age but by vaccinating at 4 years, children get that protection earlier. Children should also receive flu vaccine every year, possibly even two flu vaccines in one season depending on their immunization history. Well visits are also a great time to make sure children are up-to-date for all other vaccine series routinely recommended by ACIP, including Haemophilus influenzae type b (Hib) and pneumococcal conjugate (both up to 5 years of age, i.e., through 59 months), Hepatitis A and B, as well as any other vaccines that may be needed if a child has high-risk medical conditions.
In 2017, MDHHS created easy-to-read handouts detailing the school and daycare vaccine requirements and targeting healthcare providers, schools and daycares, and parents. These documents are on the MDHHS website in color and in print-friendly black and white versions.4 As a reminder, healthcare providers should only provide parents with medical immunization waivers (i.e., true medical contraindications to vaccines) when needed. Refer patients to their local health department for all non-medical waivers for school and daycare.
Check the Michigan Care Improvement Registry (MCIR) for every patient at every visit, even sick visits, to determine which vaccines are needed to best protect them. All vaccines administered to persons less than 20 years of age, including flu vaccine, are required to be entered into MCIR within 72 hours of vaccine administration. For more information on MCIR, visit www.mcir.org. By protecting your patients with all ACIP-recommended vaccines, you help young Michiganders stay healthy and ready to learn.
1 Centers for Disease Control and Prevention (2019). Immunization Schedules. Retrieved from https://www.cdc.gov/vaccines/schedules/index.html on January 23, 2019.
2 Mellerson JL, Maxwell CB, Knighton CL, Kriss JL, Seither R, Black CL. Vaccination Coverage for Selected Vaccines and Exemption Rates Among Children in Kindergarten – United States, 2017-18 School Year. Morbidity and Mortality Weekly Report 2018;67:1115-1122. DOI: http://dx.doi.org/10.15585/mmwr.mm6740a3
3 Centers for Disease Control and Prevention (2019). Measles Cases and Outbreaks. Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html on January 23, 2019.
4 Michigan Department of Health and Human Services (2019). Immunization Waiver Information. Retrieved from http://www.michigan.gov/mdhhs/0,5885,7-339-73971_4911_4914_68361-344843--,00.html on January 23, 2019.