Flu Preparations Underscore Schools' Key Role in Vaccinations

At the beginning of each school year, the school-nurse coordinator for the 3,000-student Ashland, Ore., district plans a “parents night” around the topic of vaccinations for the safety and health of children.

But that’s only the beginning of Belinda Brown’s contact with parents who are skeptical about the necessity of immunizations, a routine part of preventative care for most families.

While the vaccination-exemption rate for kindergarten students in Oregon is around 4 percent, in Ashland, about 28 percent of kindergarten students have exemptions on file, meaning they are missing one or more of the 10 vaccines required by the state for their grade. And so Ms. Brown starts every school year gently urging parents to consider all the risks to their child before forgoing inoculations. But most of all, she listens as they share their concerns.

“The key, I’ve found, is for people to feel heard, allowing them the time, providing the information. We’ve had success with that,” Ms. Brown said. “But it’s very, very time-consuming.”

As the United States prepares for a fall resurgence of H1N1, or swine-flu virus, the role of schools in the public-health effort to prevent illnesses is drawing more attention. A recent National School Boards Association survey of 485 districts found that about three-quarters said they would allow vaccinations to take place in school buildings.

“Parents trust their schools, and for good reason,” said Anne L. Bryant, the executive director of the Alexandria, Va.-based organization. Schools can serve both as locations for vaccination clinics and as a conduit for important information, she said.

Decisions for how and when to inoculate children against the swine flu will be made on a state-by-state basis.

Higher Contraction Rate

But research examining the role of the public education system in promoting public health goes far beyond merely being a convenient site for such clinics.

Public-health researchers say mandatory vaccination policies for school attendance have led to the eradication or control of diseases such as polio, diptheria, and measles. Nearly eliminating many formerly dreaded diseases from the population is considered a public-health triumph.

Even though vaccines are mandatory for public school attendance, all states permit medical exemptions, with 48 allowing them for religious reasons and 21 for personal beliefs. Each state decides how easy or difficult it will be for a parent to obtain an exemption to a vaccine.

But there can be consequences to those exemptions. A June study in Pediatrics, the publication of the American Academy of Pediatrics in Elk Grove, Ill., showed that parental refusal of the pertussis, or whooping cough, vaccine was associated with a greater risk of pertussis infections.

The study, which examined cases of pertussis in children enrolled in the Kaiser Permanente of Colorado health plan between 1996 and 2007, noted that vaccine refusers were 23 times as likely to contract the disease as unvaccinated children.