The race to vaccinate

Several nurses sat in stations marked off by white cloth dividers, filling syringes in preparation for a large wave of tweens and teens who were starting to fill a small waiting room nearby. Kids expressed their apprehension about getting their Tdap vaccine at this recent clinic, offered by the Butte County Department of Public Health.

“They’re nervous, a lot of them,” said Kiyomi Bird, a health-education specialist who organizes the immunization clinics. “They know what’s going on since they’re older, and they don’t want to get a shot.”

For the last six months, the Chico Unified School District has been scrambling to communicate one message to parents of students entering the seventh to 12th grades: Get your child his or her Tdap vaccination.

The statewide requirement for the 2011-12 school year has sparked the largest single-focus communications campaign the CUSD has ever conducted, but as of early August, only about one-third of the 6,000 students in Chico entering the targeted grades had satisfied the requirement, putting the district and the health department in a bind, said David Scott, the district’s director of student-support services.

“I know that, come Sept. 10, we’ll have some challenges,” Scott said, referring to the deadline for kids to be vaccinated. “Are we going to throw a student out of school?” As Scott waits on advice from the state on how to handle noncompliance, he cannot answer that question.

The reason for all this stems from fall 2010, when then-Gov. Arnold Schwarzenegger signed Assembly Bill 354 after more than 7,800 confirmed and possible cases of pertussis—also known as whooping cough—were reported in California last year, the most cases since 1947.

Schwarzenegger’s law required students to be vaccinated by the first day of the 2011-12 school year, but by late July an estimated 1 million California tweens and teens had yet to be vaccinated, prompting Gov. Jerry Brown to sign a bill allowing a 30-day grace period. For the CUSD, the new deadline for students to provide proof of vaccination is Sept. 10.

As that deadline approaches, Scott is continuing his efforts to communicate with parents—including through automated phone messages, press releases, posters and word-of-mouth—and, as in other districts around California, is waiting for more information about how to best handle students who do not satisfy the requirement on time.

“We’ll do our best to work with each family,” Scott said. “But we also need to protect and respect those students who got the immunization.”

Tdap is a booster for DTaP, a series of five immunization shots given to kids between 2 months and 6 years of age that protects against diphtheria, tetanus and pertussis, all of which are caused by bacteria and can be deadly. It’s been discovered that the DTaP vaccination wears off around age 10 or 11, hence the need for a booster.

Anyone can come down with pertussis—a highly contagious bacterial disease marked by the “whooping” sound individuals make when gasping for air during a coughing fit—but the illness is especially dangerous to infants who are too young to get their shots. For this reason, the Advisory Committee on Immunization Practices recommends everyone ages 11 and older be vaccinated, but the new law targets older students in the interest of preventing spread of the disease around schools and at home.

“What we are doing is providing a cocoon of protection for infants,” explained Brandy Miller, a health-education specialist with the Butte County Department of Public Health.

Last year, 32 cases of pertussis were reported in Butte County, but none of them were deadly, Miller said. The number is a spike compared to years previous, when it was common for fewer than 10 cases to be reported. (Fourteen cases have been reported in Butte County this year so far.)

The state started communicating with the Butte County Department of Public Health through e-mails and reports in October 2010, when the disease was declared an epidemic and legislation was in the works.

“We worked really hard to get the word out early, but based on the number of calls we’ve been receiving, there is definitely still a demand [for the vaccination],” Miller said.

The public-health department has offered several clinics throughout the summer to administer the Tdap vaccine. Its efforts were apparent during a recent visit to a vaccination clinic at the department’s Oleander Avenue location in Chico. Furniture was pushed to the side in a conference room, where nurses sat in cloth-divided stations, preparing for their second round of appointments. In all, 170 vaccinations were scheduled for the daylong clinic.

Nurses scoot students through the vaccination process in about five minutes, and ask them to wait outside for 10 minutes afterward to ensure they’re feeling OK before they head home. As is the case with all immunizations, the biggest concern is a student having an allergic reaction (although it’s rare), or feeling sick in some way, Miller said.

The health department’s clinics take MediCal, but the resounding message to parents is that it’s best to take children to their private health-care provider, she said. Personal doctors know a child’s immunization and health history, and can also conduct a routine check-up during the same visit.

Scott supports the state’s Tdap mandate, he said, but if he had one gripe, it’d be that it came unfunded. A lack of money makes it extra hard to get the word out to parents through media such as television ads, as well as eliminates the possibility for the public-health department and district to offer no-cost vaccination clinics, which they’ve been able to do during flu outbreaks in the past.

“I fully support it, but gosh, give us some money to do something about it,” Scott said. With little to no money to spend on a communication campaign, Scott has taken advantage of the district’s automated phone-messaging system (a message was sent to 3,800 parents over a 40-minute period last week, for example), which has options in Hmong and Spanish.

Scott expects to see the official count of students vaccinated rise as district employees return to work and sift through forms dropped off over the summer. He also anticipates a surge on the first day of school, when some parents are likely to drop off their child’s form in person.