With the start of a new school year, many parents are searching for vaccination records and hoping they're current, but what does "up-to-date" look like these days?
That depends on whether it's what the school requires or what pediatric experts recommend.
"Not all vaccines that we recommend on the schedule are required by schools," said Wendy Sue Swanson, a pediatrician at Seattle Children's Hospital. "But schools help us keep up-to-date and have an annual assessment" of vaccine status.
Swanson explained that during childhood, three key school transitions coincide with vaccine schedules. The first, she said, is when a child enters kindergarten. Then, "typically, at sixth grade, we refresh again. And there are updates that we provide kids at the end of high school as get they ready to go to college," she added.
Each of these turning points usually means exposure to a new population of students. For kindergartners, said Swanson, schools usually require being up-to-date on all doses of DTaP (diphtheria, tetanus, and pertussis, or whooping cough), and on the varicella (chicken pox), polio and measles/mumps/rubella (MMR) vaccine series.
The U.S. Centers for Disease Control and Prevention lists five recommended shots in the DTaP series by age 4 to 6, four for polio by age 4 to 6, two for MMR by age 4 to 6, and one for chicken pox.
Requirements for kindergarten entry can vary by state. California, for example, currently requires all of these vaccinations at kindergarten entry plus a three-vaccination series for hepatitis B. Oregon, on the other hand, has the same requirements as California but also adds two vaccinations against hepatitis A.
Swanson recommends hepatitis A even if it isn't required. She also recommends the influenza vaccine, which she considers "an essential vaccine for childhood because we know that young and school-aged kids are more likely to get the flu than the rest of us" because of the way they interact with each other in close quarters.
Middle school students might not behave like kindergartners, but their age is another critical turning point for vaccination. Students entering sixth grade, when they are usually 11 or 12, are typically required to have a Tdap, a booster intended to bump the waning immunity of earlier pertussis vaccines. Swanson also recommends the meningitis vaccine, even if schools don't require it, because it covers four types of bacteria that cause the sometimes-fatal brain inflammation.
Another vaccine that's not required at this age for school entry but that Swanson and other pediatricians recommend is the vaccine against HPV (human papillomavirus). This virus can cause cancers of the tissues it infects.
"It's an anti-cancer vaccine," Swanson said of the current three-shot series. "We can immunize kids in their teen years before they have any exposure to the virus so that they won't have the risk of oral and pharyngeal (throat) cancers and cervical cancer."
What might surprise some parents is that the approaching college years aren't only a turning point for their child's education, but also are another critical period for vaccination. Here, the vaccine against meningitis takes center stage in the form of a booster at age 16.
Swanson said that the reason for administering this dose after the middle-school dose is to enhance immunity just in time for the close-quarters of dorms, which can promote spread of the disease.
"We know you're at higher risk for getting bacterial meningitis when you live in a dorm or in groups of people, particularly for those first years of college," Swanson explained. In addition to the existing vaccines against meningitis, a new one has just become available that broadens protection even more, targeting a bacterial strain involved in 2014 outbreaks that ended with some deaths.
Colleges and universities vary on whether or not they require immunization against meningitis, in some cases depending on student age and residency on campus.
Some children can't receive vaccines for medical reasons, such as a history of allergic reaction. Every state offers medical exemptions for these students, but the availability of other types of exemptions varies by state. West Virginia and Mississippi, for example, don't allow exemptions for personal beliefs, and California will be joining them next year.
California state senator and pediatrician Richard Pan (D-Sacramento) said that he authored the law to guard against future outbreaks following a measles outbreak that began at two Disney parks in that state last December. Many other states do allow such exemptions.
"We've come through a funny time," said Swanson. The tightening of exemptions in some states serves as "sticks rather than carrots trying to mandate the true benefit of vaccines, which is protecting the individual but secondarily protecting the population," she explained. "That's what's different about vaccines. If you're thinking about declining a vaccine, you're not just affecting your child's life, you're affecting other students' lives."
Pan agreed. "All children have the right to attend school safe from the threat of contracting harmful and potentially deadly diseases that we can prevent with vaccines," he said.
On that note, Swanson has one more recommendation about vaccines as the school year begins: Check your school's percentage of vaccinated children. "You want to go to a school that's well-immunized," she said. "It's a great part of making sure your child is safe whenever you send them back to school because we want to drop our children off at a school that's really well protected."