Back to school means check vaccine status

Jul. 28—Julie Hall, head nurse at Clarksville Community Schools, knows intimately the risk children face when they're unvaccinated.

Before the chickenpox vaccine was introduced in 1995, students would have to miss up to two weeks of school to recover, she said. She remembers when polio paralyzed her father's cousin in a time before the vaccine was readily available.

Both the chickenpox and the polio vaccine — along with several others — are now required for school-aged children in Indiana, meaning far fewer cases and less concern about the diseases over the last two decades.

"The vaccines have made it so that we can have a healthier life and be able to function normally, so that you can go and learn," Hall said. "That's really our goal: that children learn and have their best life."

Health officials are encouraging Southern Indiana families to get their students caught up on routine school vaccinations that officials say will keep them, and others, safe as they head back to school for the 2023-24 academic year. After a drop in vaccination rates among Indiana children in the three years since the start of the COVID-19 pandemic, numbers are going up and state health organizations are working to increase vaccine accessibility.

Rates up, vaccine hesitancy down

The kinds of vaccines that are required for students vary by state. In Indiana, required school immunizations are set by the Indiana Department of Health. Public schools in Indiana must follow state guidelines when it comes to vaccination requirements, and cannot typically change them one way or another.

For pre-K through 5th grade, essential vaccinations required for the 2023-24 school year include jabs to prevent hepatitis A and B, diphtheria, tetanus, whooping cough and polio, along with chickenpox, measles, mumps and rubella. These requirements stand for children in 6th grade and above, who are also required to receive the meningitis vaccine.

Recommended — but not required — for students in Indiana are the flu, HPV and COVID-19 vaccines.

Indiana saw a drop in vaccination rates after the start of the pandemic. According to previous reporting from newsgathering partner Indiana Capital Chronicle, essential vaccination rates dropped 10% among children 19-35 months between the start of the pandemic and the 2021-22 school year. In 2022, most Indiana counties reported just 50% to 71% of kids were fully caught up on necessary vaccines that year.

Clark County Health Officer Dr. Eric Yazel attributed the drop to immunization hesitancy following negative attitudes and misinformation surrounding the COVID-19 vaccine, which made some people leery of all vaccines, he said. For others, accessibility issues like closed doctor's offices or insurance issues also meant falling behind on vaccinations.

Floyd County Health Officer Dr. Tom Harris said vaccinations can be "a sensitive issue" in public health; some parents fear vaccines will cause autism — though studies have shown they have no impact on autism likelihood, he said. Parents also fear a preservative called thimerosal, he said, which has not been used in pediatric vaccines for almost a decade.

Despite some fear and hesitancy surrounding vaccinations in the wake of COVID-19, most families are meeting requirements today, Harris said.

While Indiana is still among the lowest in the nation when it comes to childhood vaccination rates, percentages are improving. As of the 2022-23 school year, a majority of students in Clark and Floyd counties completed the school-required course of vaccines, according to individual county data from the Centers for Disease Control and Prevention. In Clark County, 74.4% of students were covered, while 81.6% were in Floyd County.

Hall, the head nurse at Clarksville Community Schools, said that for the most part students in her corporation are up to date on their vaccinations and generally have been since she started her role in 2020.

"I think you still have that there's a few people who — it may be due to situations where they are more fearful about vaccines, but really we have a low number of that at our schools," Hall said. "People are pretty good about getting their vaccines."

Yazel echoed Hall, stating he hasn't seen vaccine hesitancy in the past year or so as much as he did when the pandemic began.

"I think the vaccine, kind of like the masks, almost became a political statement for a while," he said. "That side of things, I think, has settled down a little bit more."

What about the flu and COVID-19?

When it comes to the flu and COVID-19, Harris said, there is not yet good intel about the prevalence of the diseases, especially COVID-19, this fall.

COVID-19 is no longer at peak pandemic levels in Southern Indiana, he said. On July 24, 2023, for instance, Indiana's COVID-19 dashboard showed just 130 confirmed and reported cases of COVID-19, compared to 903 cases the same day in 2020.

Flu vaccination levels typically stay the same, Harris said: those who get it, get it annually, and those who don't, don't. There isn't a lot of vaccination against COVID-19, specifically, happening within Southern Indiana recently, he said.

"We saw that, basically, kids with chronic medical problems got vaccinated fairly quickly, which was the desired outcome," he said. "When the disease mutated towards the end into a 'severe' form of COVID, then the interest from the adult perspective and from the child perspective kind of waned. We haven't done much COVID vaccinating of kids here for a while."

Although vaccination against the flu and COVID-19 is not required for Hoosier students, Harris said he encourages students to get vaccinated. He predicts COVID-19 will continue to be present in low levels for the foreseeable future.

Schools and organizations work to help families complyYazel, Hall and Harris said it's rare for families to outright refuse student vaccination without a valid reason — usually when a student isn't up to date it's due to religious or medical exemptions, or simply access issues like time or money, they said.

"There's other people that are going through something," Hall said. "Maybe the child's been sick a lot and has to wait. It also may just be that they've moved. It may be something in another situation."

Indiana state law allows schools to give noncompliant students a 20-day waiver at the start of the school year to allow them more time to receive required vaccines. If a child is behind on vaccinations, Hall said, they can usually start school as long as arrangements are being made to get them caught up. Hall said she couldn't yet say how many letters would be sent out to families in her school district because Clarksville Community Schools typically sends them in September or October.

"We do trust that they're going to do that," she said. "It's really extreme things where, if they don't get them, they may have to be exempt from school. But it's very rare that that occurs."

If a student has a religious or medical exemption, their parent or guardian must submit paperwork with their school.

Medical exemptions must be documented by a provider and must state in writing that a particular immunization may be detrimental to a child's health, according to the Indiana Immunization Coalition. A religious exemption must state in writing the objection is based on religious grounds, but there is no requirement of proof.

Hall said her school corporation in Clarksville works to give families as much information as possible about what the requirements are and how to fulfill them. CCS is planning to hold a vaccine clinic in October for students and staff who cannot make it to the health department to get vaccines.

Harris, the Floyd County health officer, said the Floyd County Health Department held a clinic July 24 that was one of the busiest of the summer. Harris said the health department tries to operate through a lens of health equity rather than equality, which means targeting vaccination opportunities to different demographic groups — for example, the health department is holding walk-in clinics on weekday evenings and Saturdays to help families who work during the day, as well as offering flexible appointment times.

Harris said common reasons parents fall behind on vaccines include struggling to find time to get their child caught up or simply being unaware they aren't meeting the requirements.

"They tend to sneak up on people," Harris said. "We really recommend you sort of take a look at your child's health record, especially if they're starting kindergarten or if they're starting middle school."

He recommended people use the Children and Hoosier Immunization Registry Program to stay up to date, which permanently stores a person's immunization records electronically.

Yazel, who works in Clark County, said recent grants have introduced new staff members — Cooperative Agreement School Liaisons — in Southern Indiana, who work with school nurses to hold vaccine clinics and improve school communication.

"Basically to make it as low-barrier as possible, to make it very, very easy on the parents to get their vaccinations," he said.

The Clark County Health Department offers free immunizations to people under 18 who are underinsured or uninsured. Floyd County offers the same, extending the window to cover people up to 19 years of age free, regardless of insurance status. The Indiana Immunization Coalition travels around the state offering mobile clinic services, and a schedule of dates and locations can be found on the coalition's website.

Overall when looking at the importance of vaccinations, Yazel said, all of the same points health officials have made since the beginning of the pandemic and before still stand.

"When your kids go back to school, if they don't feel well and they're sick and have a fever, keep them home," he said. "It's a challenge sometimes logistically for families, but that's the best way to prevent the spread of illness, whether it be COVID or anything else."