By Pete Kendall/reporter@trcle.com

Major changes have been instituted in required immunizations for school children by the Texas Department of State Health Services.

The changes, beginning with the 2009-10 school year, impact immunization for diphtheria, tetanus and pertussis, usually referred to as DTP; measles, mumps and rubella, usually called MMR; varicella, or chicken pox; and hepatitis A.

Kindergarten students are required to have five doses of DTP or four doses if the fourth dose was administered on or after the fourth birthday.

Students will be required to have two doses each of MMR, varicella and hepatitis A .

Seventh-graders will be required to have three doses of DTP, with a booster dose required if five years have elapsed since the last dose of tetanus-containing vaccine, and two doses each of MMR and varicella.

Eighth- through 12th-graders will be required to have three doses of DTP three doses, with a booster dose required if 10 years have elapsed since their last dose of tetanus-containing vaccine, and two doses each of MMR and varicella.

Immunization requirements for polio, hepatitis B and meningococcal have not changed.

All immunizations should be completed before students register for the new school year, said Cleburne ISD nursing coordinator Diane Banton. Kindergarten registration will begin this spring.

“We got several e-mails previous to the [news] release stating that [the changes] were forthcoming, so we’ve been on alert,” Banton said. “There have been changes in the past, but these are pretty significant.

“Hepatitis A is a big change. All students entering kindergarten will be required to have two doses, two shots six months apart. They’ll also be required to have two doses of MMR. Before, it was one dose of all three (mumps, measles, rubella), and it could be any measles-containing vaccine. Now they’re requiring it to be MMR. Varicella is also a big change. All students entering kindergarten will be required to have doses. It was one in the past. You can also have a written statement from the doctor or nurse stating that the child has already had the disease.

“DTP for seventh graders is a little complicated. They will be required to have a booster dose if it has been five years since their last dose. Most kids have a tetanus booster around the age of four. So most kids in seventh grade will be required to have the booster because it will have been five years. All students entering seventh grade will be required to have the one dose of meningococcal vaccine, which is for meningitis.”

The changes are because of “health concerns in general,” Banton said, “but the state of Texas did this because it wants to adhere more closely to the recommendations of [Centers for Disease Control] and American Academy of Pediatrics and Immunization Practices. There is probably an increase in numbers in several of these diseases. Though not specifically in Johnson County or the area, there have been increases in measles. The one dose for chicken pox was not effective. We knew that was coming. And it’s never a bad thing to have protection from hepatitis A.”

Children can be given the vaccinations all at once or over a period of visits to a health care provider, Banton said.

“Most students get multiple vaccinations at one time. Sometimes, a child will leave the health department having had four or five at a time. Sometimes, parents will opt to do part of it and come back later. The problem is, you have to meet the requirements to get into school. If you are in the process, and it’s in a timely manner, then you can be in school. As soon as you go past the deadline, it’s up to the [school] nurses to start sending request letters.”

Immunizations are supposed to be completed by Aug. 1.

“We’re sending home notices about these requirements in the report cards the next two six weeks,” Banton said.

Parents occasionally object.

She said she tells them, “This isn’t a Cleburne ISD law or my law. This is a state law. At the spring registration, we try to provide an option onsite. The Texas Department of Health usually comes for registration.”

For families unable to afford vaccinations, the department of health is an option. It’s minimal fee or no fee.

“They work closely with the hospital and Shots for Tots,” Banton said.

For more information, call the department of health at 817-517-2306.

On the Web:

www.dshs.state.tx.us/immunize/docs/school/6-14.pdf