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ND starting new school immunization requirements

Two-year-old Sierra Foss is distracted by blowing bubbles while being held by her mother Jessica Foss as nurse Julianna Emanuel gives her a hepatitis A vaccine shot Wednesday, Dec. 14, 2016, at the Sanford Children's Clinic in Fargo. Forum News Service file photo

FARGO—The state of North Dakota is implementing four new immunization requirements for children in schools and child care facilities. None involve administering vaccines not already required.

Three of the changes modify what grades will be impacted. The fourth change will require a booster for a vaccine that children are now required to receive only once.

The state Department of Health, which announced the changes Thursday, Dec. 28, is also changing the deadline by which school students must be compliant with all immunization requirements or be excluded from school.

The most significant change will require students entering grades 11 and 12 to receive a second dose of meningococcal conjugate vaccine (MCV4). Previously, one dose of MCV4 was required for entry into seventh grade.

The MCV4 vaccine protects against meningococcal disease, a bacterial infection that can cause meningitis and possibly lead to death or permanent disability.

"You really do need that booster," said Lexie Barber, epidemiologist for the state Department of Health. "Immunity does start to wane after a while."

Because the North Dakota University System already requires the booster, about 30 percent of 16- and 17-year-olds have already received the second dose, she said.

The new rules also require the first dose of MCV4 for students entering seventh through 10th grades, rather than just for students entering seventh grade. That change is meant to address the fact that students who entered schools after the eighth grade — if, for example, they relocated to North Dakota — were not required to have the vaccine.

"There were kids who slipped through the cracks," said Paul Carson, director of the Center for Immunization Research and Education at North Dakota State University. "It was just an oversight that they weren't checked or caught."

A similar change is being implemented for the whooping cough (Tdap) vaccine. In the past, it was only required for students entering seventh grade. Now it will be required for students in seventh through 12th grades.

The three changes to immunization requirements for school-age children will take effect with the 2018-19 school year.

The final change will impact children in child care facilities. Beginning Jan. 1, all children in child care will be required to have the hepatitis B vaccine. Previously, the vaccine was required of all school-age children, so the change only impacts the timing of when children are required to have the vaccine.

Most children receive three doses of the hepatitis B vaccine in their first year, but about 15 percent of children in child care in the state have not received the vaccine, according to Barber.

Students already enrolled in day care that do not have the hepatitis B vaccine have only a few days to get the vaccine, but the Department of Health will not be enforcing the Jan. 1 deadline with child care facilities.

How tightly the deadline is enforced is up to individual child care facilities. The Department of Health sent a memorandum to all child care facilities about the change on Dec. 22. The department did not send out the memo until then because the rule change was not approved until this month.

"It is a tight turnaround," Barber acknowledged.

The state Department of Public Health also changed the deadline by which students must be compliant with all immunization requirements, or be excluded from school. Students must now be compliant by Oct. 1, or else schools are required to exclude them from attending.

Previously, students were required to be compliant within 30 days of enrollment, but that meant the deadline differed from school to school, depending on when the school year started. There was also confusion over whether the 30-day deadline meant 30 school days or 30 calendar days.

The new deadline "makes it cleaner, simpler, clearer for schools," Carson said.

North Dakota allows children to be exempt from immunization requirements for three reasons: medical, religious or personal beliefs. The percentage of children exempted for religious reasons or personal beliefs has increased. It rose from 1.42 percent for kindergarteners in 2011-12 to 3.14 percent in 2016-17.