Legislation seeks boost in vaccines for youth

A proposed change in immunization rules for Arkansas children requires shots to prevent hepatitis A and meningitis.

At a public hearing on the proposal last week, Arkansas Department of Health staff members said the changes will go before two legislative committees early next year before coming back to the department for final approval, tentatively in April.

Parents would have to abide by the additional immunizations before the start of the 2014-15 school year.

No one commented at the public hearing held at the Health Department headquarters on Markham Street.

Epidemiologists at the department said Friday that the changes would bring Arkansas more in line with the federal Centers for Disease Control and Prevention guidelines for immunizations. Dirk Haselow, the department’s state epidemiologist and medical director of communicable disease and immunizations, said Arkansas has work to do.

“Arkansas ranks in the bottom two states nationally with coverage of hepatitis A, meningococcal, chicken pox and Tdap [tetanus, diphtheria and pertussis] vaccines,” he said. “It is clear that recommendations alone are not sufficient to protect our children from these diseases.”

Haselow said 41 percent of Arkansas children were vaccinated against hepatitis A in 2012, the second-lowest vaccination rate among the 50 states. Hepatitis A is a virus that causes a swelling of the liver that is not fatal in most cases but causes fatigue, nausea and jaundice among other symptoms.

“We haven’t seen any major outbreaks in the last year or two, but other Southern states have,” Haselow said. “And with our low coverage, we are clearly at risk.”

Other changes to the immunization rules would increase the requirement from three to four doses of polio vaccine for patients who fall behind on immunizations. The changes eliminate an allowance in the immunization schedule that allows patients who fall behind to receive only three doses. The normal schedule calls for four doses.

The changes also would alter the time frame in which children receive a Tdap vaccine to 10 years old instead of the seventh grade. Haselow said Arkansas and the rest of the country has recorded more outbreaks of tetanus, diphtheria and pertussis among 10- and 11-yearolds.

The new rules would require a medical professional to attest to a history of chicken pox to waive the requirement for a varicella vaccine, meaning notes from mom or other relatives assuring children have had chicken pox will no longer be accepted.

In addition, parents would have to start vaccinating children for meningitis, with one dose required for children older than 16 and two doses required for children who received the vaccine when they were younger than 16. Haselow said the reasons are similar to those requiring hepatitis A shots for the first time — increased incidents in other states — but the consequences of meningitis are greater.

“We’re in the bottom two states for vaccinations against meningitis, and most states are beginning to mandate it,” he said. “While it’s rare, meningitis is very, very serious. It can be fatal, but it’s preventable. That’s why we’re adding that requirement.”

The Arkansas Legislature approved parents’ ability to opt out of immunizations based on philosophical objections in 2004. Nationwide, 19 states allow those exemptions.

Since that exemption became legal in Arkansas, requests for philosophical exemptions and exemptions overall have increased steadily every school year until this school year, according to Health Department records.

Roughly 4,200 exemptions were granted for the 2013-14 school year, a drop from a little more than 4,300 in the 2012-13 year. Before the 2004 legislation went into effect, there were about 600 exemptions granted for medical and religious reasons. Those exemptions have grown to about 1,100 annually, according to department records.

The proposed changes would be subject to exemption requests.

The Public Health, Welfare and Labor Committee is scheduled to hear the proposed changes at its Jan. 24-25 meetings. The changes then would be heard by the Arkansas Legislative Council’s Administrative Rules and Regulations Committee in February before coming back to the Health Department’s Board of Health.

Department staff members said at the hearing last week that they hope the process moves quickly enough to get the word out to parents before this school year ends. In some cases, staff said the department’s 110 local health units would offer those vaccines and may hold clinics before school is out.

The Health Department “does not bear the full burden of immunizing all children, and schools are particularly interested in getting any changes as early as possible in order to educate parents … to include any new information in student handbooks and to arrange for school immunization clinics during the spring,” Haselow said.