THE VACCINE ROUTINE: BOOSTER SHOTS AND CHECKUPS ARE AN ESSENTIAL PART OF THE BACK-TO-SCHOOL RITUAL

Dozens of parents check school lists to make sure they have the correct notebooks, pencils, rulers, glue and crayons for their child's return to school.

But do they check vaccination records or make appointments for a wellness checkup too?

Immunizations and checkups are an important part of the back-to-school routine, area school nurses say. During August, the Department of Health and Human Services Department is encouraging parents to make sure their child is vaccinated, particularly before they return to school.

When Jeanne Phillips went to enroll her now 7-year-old son in Cape Girardeau schools, she had to show his immunization records. She produced a blue card that had been stamped or initialed by the pediatrician after each shot. Her 4-year-old daughter is current on immunizations and won't need more shots until she begins kindergarten.

Shortage of tetanus vaccine

A nationwide vaccine shortage for tetanus means that some students who require a booster shot might have to wait until next year to get it. Most children get a tetanus shot around age 5 and require a booster shot at 15.

However, the nationwide shortage means going without but only for a little while, said Charlotte Craig, director of the Cape Girardeau County Public Health Center.

The Center for Disease Control and the Missouri Department of Health are urging doctors offices, hospitals and health clinics to reserve their supply of the tetanus vaccine for serious wound cases until greater supplies are manufactured.

Letters have been sent to schools all across the region informing them about the vaccination delays, Craig said. She expects to hold on-site clinics at schools once the vaccine shipments arrive.

"Otherwise it would be a nightmare for the school nurse," she said.

But school nurses say students must have an in-progress note from the health clinic or a doctor saying they are aware of the shortage and will get the shot once it arrives.

After the easy part

Making sure children are immunized is the easiest part of their health care at school, some nurses say. What isn't easy is making sure every child has seen a doctor and dentist for a checkup or that families have insurance.

"There are more and more children with serious health problems in the classroom setting," said Mary Ann Hoffman, a nurse at Franklin Elementary School.

The Jackson school district is working on a plan to identify students' health needs early, particularly for students with chronic illnesses or who require special care. The plan involves a meeting with parents and sometimes the student, a school nurse and occasionally a doctor, said Pam Harper, a district nurse.

"Kids at school come sicker now than they used to," said Pam Moyers, who is a nurse in the neighboring Oak Ridge school district.

And sometimes they don't inform school nurses about all the medications they are taking. Parents are better about keeping nurses informed when the child is in elementary school, but the communication lags at the older ages, nurses said.

Parents "just assume the students will tell the nurse or that you know what's been happening to them during elementary school," said Sue Marchbanks, a nurse at Cape Girardeau Junior High School.

Being prepared

School nurses have to be ready for to handle just about every possible health crisis that could arise.

About 75 nurses, principals and school counselors attended the fifth annual seminar on health issues for school-age children Friday, sponsored by the Generations Resource Center at Southeast Missouri Hospital.

The seminar topics are selected by a committee of school nurses and school officials so that the information is useful and relevant to their work, said Laurie Hill, who helped organize the seminar.

Often school nurses don't have the back-up personnel available that larger institutions do. "It's a lot different than working in a hospital where you have all the resources at your fingertips," she said. "Some of these nurses are the only person there and some have more than one school they cover."

Discussion topics included allergic reactions and how to treat them, storing medications, diagnosing behavior disorders and childhood obesity and nutrition. Past meetings have offered educational resources on rashes, infections, how to handle conflict, teen-age pregnancy, first aid on the playground and seizures.

How vaccines work 1. A vaccine is given by a shot or liquid by mouth. Most vaccines contain a weak or dead disease germ.

2. The body begins to make antibodies to fight the weakened or dead germs in the vaccine.

3. The antibodies practice on the weak germ so that when a real disease germ invades the body, the antibodies will know how to destroy it and the person doesn't become ill.

4. Protective antibodies stay on guard in the body to safeguard it from disease.

Vaccination facts:

* Newborn babies are immune to many diseases because they have antibodies from their mothers. This immunity only lasts about a year.

* Between 37 percent and 56 percent of American children are not fully immunized by age 2, according to records from the Centers for Disease Control.

* There are 11 diseases to vaccinate against, with as many as 16 doses in five visits before a child's second birthday.

Required vaccines:

* Hib: This vaccine is usually given in three or four doses to protect against an influenza strain.

* DTP: This vaccination protects against diptheria, tetanus and petussis. It is given at 2, 4, 6 and 15 to 18 months, with a booster at 4 or 6. Another booster shot for tetanus is required every 10 years.

* Hepatitis B: This vaccinations protects against a viral disease that is transmitted through blood and bodily fluids. Children are not at great risk for this disease. The CDC recommends vaccinations before a child is 15 months old in three doses.

* Polio: There are two polio vaccines. One is an inactivated vaccine with a dead virus. The second is taken from live, weakened viruses and is administered orally.

* MMR: This protects against measles, mumps and rubella (German measles). It is given in two doses at ages 12 to 15 months and again at 4 to 6 years old. Sometimes it is given before junior high school.

* Chickenpox: This vaccine was first licensed in 1995. A single injection is recommended for children ages 1 to 12. It can be administered at the same time as the MMR shot.

Now children in Missouri must get the vaccine or show proof of having chickenpox before they can attend licensed day-care centers. The new rule took effect in July.

Source: Centers for Disease Control; Food and Drug Administration