Shots help protect Idaho kids

After years of lagging behind other states, immunization rates get a boost

By Colleen LaMay

Are your teen-agers and college students up-to-date on their shots? With the development of new vaccines that are safe and effective for older kids, public health officials are placing a new emphasis on shots for tweens, teens and college students.

"We’re seeing a real trend even with state universities that they recommend an overall immunization update for that age group," said Cindy Howarth, immunization program manager for the Central District Health Department in Boise.

In Ada County during 2006, almost 1,000 doses of a vaccine against meningitis were given, up from 385 during 2005. Meningitis is a potentially fatal bacterial infection that poses a higher danger to high-schoolers and college freshmen.
Children ages 11 or older and young adults may need vaccinations for hepatitis A, hepatitis B, chicken pox and whooping cough, among others. A new shot against human papillomavirus, which can cause cervical cancer, is recommended for girls.

Shots may not just be for little kids anymore, but the emphasis of public immunization programs remains on the younger set. Many parents with kids who started school or day care this fall remember scouring the house for immunization records or wiping away tears after shots at the doctor’s office.

Treasure Valley public-health officials say it was for a good cause. Idaho’s immunization rate for young children, once among the lowest in the nation, is up to the national average of 78.9 percent. Parents who object to immunizations for personal or religious reasons can just say no, but the state makes it clear that parents can’t say no just because they can’t dig up kids’ records when school starts.

"We’ve made big progress," Howarth said. But, she added, "There’s still a ways to go."

Karleen Davis of Boise and her preteen daughter Sally Turley are doing their part. The pair visited the health department so Sally could get a booster shot for tetanus. "It really doesn’t hurt that much," Sally said afterward.

An epidemic warning shot

A 1997 epidemic of pertussis, also known as whooping cough, prompted a statewide effort to track kids’ immunizations, remind parents when shots were due and toughen the state’s school and day-care immunization laws.

The epidemic has not reoccurred, but pertussis, which can be life-threatening to infants, continues to be a problem here: Idaho cases consistently exceed the national average. The state also continues to report sporadic cases of mumps, rubella, hepatitis A and other vaccine-preventable diseases.

Davis said she keeps Sally up-to-date on her shots partly to protect people at higher risk of getting sick. "If we have a herd immunity, it won’t get spread," Davis said.

Idaho parents are required to show proof their kids starting school have had five shots against diphtheria, tetanus and pertussis, usually combined in one immunization; three doses of hepatitis B; two doses of MMR, the combined measles, mumps and rubella shot; and three polio shots.

The list of required vaccinations is shorter than in many other states, but a few booster shots, including one against pertussis, have been added here. A pertussis booster, part of a combination vaccine, now is recommended for ages 11-12. It is expected to keep immunity to the disease from wearing off as those kids grow up.

And in 2005, the state started requiring 4- to 6-year-olds to get two booster shots, one for measles, mumps and rubella and another for diphtheria, tetanus and pertussis. "We were the last state in the nation to pass the second MMR (measles, mumps and rubella)," Howarth said. "Idaho code is far behind the medical recommendations, and that is slow to change," she said.

Six other CDC-recommended vaccinations, including the new vaccine to fight human papillomavirus, or HPV, don’t make the Idaho list. The Central District Health Department has the HPV vaccine, approved just this summer to ward off genital warts and cervical cancer caused by the human papillomavirus.

Despite recommendations from health-care providers, the vaccination, given in three doses to girls and young women, hasn’t caught on in Boise because it is expensive: about $145 a dose, Howarth said. "It is hugely popular with (health-care) providers, who feel the potential for prevention of really serious disease is great," Howarth said. "The issue is making it cost-effective for people to be able to get it."

Blue Cross of Idaho and Regence BlueShield of Idaho, the state’s largest insurers, pay for the vaccination. An estimated 80 percent of women nationwide will be infected with the sexually transmitted disease by the time they are 50 years old.

Vaccines to expect

Parents in the Treasure Valley can generally expect the following vaccines, recommended by the federal Centers for Disease Control and Prevention, to be offered at the ages indicated below.
Shots required for day-care or school entry or both are marked with an dash:

Birth
-Hepatitis B (first vaccination)

2 months old
-DTaP (first vaccination for diphtheria, tetanus, pertussis)
-Polio (first vaccination)
-Hib (Haemophilus influenza type b , first vaccination)
-Hepatitis B (second vaccination)
Pneumococcus (first vaccination)
Rotavirus (first vaccination, taken orally)
Just to make things more complicated, take note that Idaho’s vaccine program supplies Pediarix, which is a single shot combination vaccine for DTaP/polio/hepatitis B and can be given at 2, 4, 6 and 12-18 month visits.

4 months old
-DTaP (second vaccination for diphtheria, tetanus and pertussis)
-Polio (second vaccination)
-Hib (Haemophilus influenza type b, second vaccination)
Pneumococcus (second vaccination)
Rotavirus (second vaccination, taken orally, no shot)

6 months old
-DTaP (third vaccination for diphtheria, tetanus and pertussis)
Pneumococcus (third vaccination)

12 months old
-Hib (Haemophilus influenza type b, third vaccination)
-< ahref="http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75727">MMR (first vaccination for measles, mumps and rubella)
Hepatitis A (first vaccination, recommended but not required in Idaho)
Rotavirus (third vaccination taken orally)
Varicella (first vaccination for chicken pox, recommended but not required in Idaho)

15 to 18 months old
-DTaP (diphtheria, tetanus and pertussis, fourth vaccination)
-Hepatitis B (third vaccination)
-Polio (third vaccination)
Hepatitis A (second vaccination for hepatitis A, recommended but not required in Idaho)
Hib (Haemophilus influenza type b, fourth vaccination not required by Idaho law for day-care entry)
Pneumococcus (fourth vaccination)

4 to 6 years old
-DTaP (fifth vaccination for diphtheria, tetanus , pertussis)
-MMR (second vaccination for measles, mumps , rubella)
Polio (fourth vaccination for polio recommended in Idaho, but not required by law)
Varicella (second vaccination for chicken pox, recommended but not required in Idaho)

11 to 12 years old
Human papillomavirus (girls) 3 doses.
Meningococcus (This shot to prevent bacterial meningitis is recommended at ages 11 or 12 or during adolescence. Infants get more cases of the illness, but adolescents are at higher risk of dying from it.)
Tdap (This is a booster dose for pertussis to be given once within five to10 years of your kid’s last DTaP booster or tetanus booster. Follow-up booster shot for tetanus and diphtheria should be given every 10 years, according to federal recommendations.)

One more
If your kids never have had annual flu shots, they’ll need two doses a month apart. After that, it’s one dose every flu season, just like you.