It is springtime which means it is time to start thinking about kindergarten roundup. If you see pediatric patients between 4 and 6 years of age, think immunizations.
Your kindergarten pediatric patients are ideal vectors for disease, especially in close group settings such as the classroom, cafeteria, and playground. It is important to assess their immunization record at every visit to see which vaccines they need. For the best protection, health care providers should vaccinate their pediatric patients from vaccine-preventable diseases according to the recommended child and adolescent immunization schedule from the Advisory Committee on Immunization Practices (ACIP).1
By vaccinating according to the recommended ACIP schedule, you can ensure your patients will receive the vaccines required for school entry. Even though some ACIP-recommended vaccines are not required for school entry, they are important for children to receive. At the 4-year-old well visit, DTaP, Polio, MMR, and Varicella are recommended. The well child visit is a great time to ensure children are up to date for all recommended vaccines. This includes Haemophilus influenzae type b (Hib) and pneumococcal conjugate (both up to 5 years of age, i.e., through 59 months), Hepatitis A and B, as well as other vaccines that may be needed due to a high-risk medical condition. It is also important for children to receive flu vaccine every year, possibly two flu vaccines in one season depending on their age and immunization history.
The administrative rules in Michigan require all kindergarteners and 4-6 year old transfer students to have appropriate documentation of vaccines protecting against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, hepatitis B, and varicella. Appropriate documentation of immunity is acceptable in lieu of vaccination for some of these diseases (e.g., varicella). For the 2019-20 school year, Michigan’s kindergarteners had adequate coverage levels of select vaccines (94.7% for 4 or 5 doses of DTaP, 94.8% for 2 doses of MMR, 94.4% for 2 doses of varicella). However, Michigan’s kindergarten vaccine exemption rate is at 4.4%.2
To help understand school and daycare vaccine requirements, the Michigan Department of Health and Human Services (MDHHS) has created easy-to-read handouts that target healthcare providers, schools and daycares, and parents. These documents are available on the MDHHS website.3 As a reminder, patients requesting a non-medical waiver for school should be referred to their Local Health Department (LHD). Health care providers should only provide parents with a medical immunization waiver (i.e., true medical contraindication to vaccine(s)) when needed.
Providers are encouraged to use the Michigan Care Improvement Registry (MCIR) for every patient at every visit, including sick visits, to determine which vaccines are needed. MCIR can conduct reminders and recalls ensuring patients are up to date on all their vaccines. Recall letters can be generated in MCIR and can assist with identifying cohorts of patients who are overdue for a specific vaccine. Reminders and Quality Improvement (Eligible Not Yet Overdue Immunizations) reports can also be generated in MCIR to identify those that may be coming due for vaccines. For more information on MCIR or how to run reminders or recalls, visit www.mcir.org or contact your MCIR regional staff. Contact your LHD (www.michigan.gov/LHDmap) for information on Quality Improvement reports.
The COVID-19 pandemic has brought numerous challenges to health care, including a decline in pediatric immunization rates due to the “Stay Home Stay Safe” executive order. However, we are seeing dose administration levels rebound. It is important to continue offering immunization services against these highly contagious diseases to keep your patients healthy, not just at school but everywhere. Through vaccination, it is crucial that we protect our pediatric patients from diseases, especially as we continue to fight the COVID-19 pandemic. By protecting your patients with all ACIP-recommended vaccines, you help young Michiganders stay healthy and ready to learn.
RESOURCES
1 Centers for Disease Control and Prevention (2020). Immunization Schedules. Retrieved from https://www.cdc.gov/vaccines/schedules/index.html on January 26, 2021.
2 Seither R, McGill MT, Kriss JL, et al. Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2019–20 School Year. MMWR Morb Mortal Wkly Rep 2021; 70:75–82. DOI: http://dx.doi.org/10.15585/mmwr.mm7003a2 on January 26, 2021.
3 Michigan Department of Health and Human Services (2019). Immunization Waiver Information. Retrieved from http://www.michigan.gov/mdhhs/0,5885,7-339-73971_4911_4914_68361-344843–,00.html on January 26, 2021.
4 Bramer CA, Kimmins LM, Swanson R, et al. Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020. MMWR Morb Mortal Wkly Rep 2020; 69:630–631. DOI: https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e1.htm on January 26, 2021.
