By Sara Tiradossi
Michael Krug has never received the flu vaccination because he is skeptical about the efficacy of the drug itself.
For Johnna Miller, vaccinating against the flu is one of her priorities when flu season begins.
Krug and Miller, graduate students at Winona State University, have contrasting ideas about vaccinations. No matter if they decided to vaccinate against the flu this year, they both had to show proof of certain vaccinations in order to be enrolled at the university.
According to the College of Physicians of Philadelphia, vaccination requirements changed over time and continued to be updated as new vaccines were developed for more diseases. Since the 1940s, some vaccines have been added while others have been removed or replaced.
Polio immunization was recommended in the 1950s, and tetanus, diphtheria, pertussis, polio, measles, mumps and rubella appeared in the 1970s. A vaccine for hepatitis B was added in the mid-1990s.
The College of Physicians of Philadelphia also stated by the 1990s, all 50 states required students to receive certain immunizations in order to attend classes.
Mitzi Girtler, a licensed school nurse and the coordinator of health services at Winona Public Schools, said vaccination recommendations are not the same in every country.
In the U.S., she said, school immunizations laws are not imposed by the federal government, but by the individual states. For instance, the state of Minnesota has different requirements than the state of Wisconsin.
According to the Minnesota Department of Health, the law requires all children seven years of age and older to show proof of vaccinations against diphtheria, tetanus, pertussis, polio, mmr (measles, mumps and rubella), hepatitis B, varicella and meningococcal.
According to the Wisconsin Department of Health Services, children entering kindergarten through fifth grade, and sixth through 12 must have received a specific amount of doses of polio, hepatitis B, mmr (measles, mumps and rubella) and varicella vaccines depending on the age group.
Students who enroll in college have to show proof they have been vaccinated against measles, mumps, rubella, tetanus and diphteria, according to the Minnesota Department of Health. Any student who fails to show proof of vaccinations within the first 45 days after first enrollment cannot remain enrolled.
Despite the requirements, not every individual is in favor of vaccinations.
Girtler said some people and communities object to school immunizations because they disagree with the mandates and have religious or personal beliefs that are in disagreement with vaccinations.
Other factors imply a lack of confidence, uncertainty toward the effectiveness of the vaccine and increased perceived risk of side effects of the vaccine, Girtler said.
Individuals who do not want to immunize their children, she said, can request an exemption to address their concerns.
In Minnesota, the Department of Health may allow exemptions from immunizations if a statement signed by a physician is submitted to the administrator, or in case of conscientiously held beliefs of the parents.
Depending on each state, some communities of people, she said, will not follow the state requirements. For instance, she said home school families typically are against vaccinations.
Vaccine hesitancy refers to those parents who show concerns about the decision to vaccinate one’s self or one’s children, according to Daniel Salmon, author of an article in the American Journal of Preventive Medicine.
The article specifies the number of parents who claim non-medical exemptions to school immunization requirements has been increasing over the past decade. Other causes of vaccine hesitancy may include the fear of allergic reactions, the inability of parents to control the risks of adverse reactions, and the possibility the child’s immune system might be weakened.
The influenza vaccination is one of the immunizations parents are skeptical about, Girtler said.
In terms of influenza vaccination, the Center for Disease Control and Prevention recently reported on the national early-season flu vaccination coverage with findings showing approximately 40 percent of all persons and 37 percent of children were vaccinated by early November 2016.
The late flu season vaccination report from 2013 to 2016 showed 45 percent of all persons and almost 60 percent of children were vaccinated against the flu.
The CDC noted efforts are needed to increase the percentage of the population vaccinated during the next few months in order to reduce the burden of flu.
The CDC showed the percentage of vaccinations in Minnesota is higher compared to other states, with a coverage in 2010-11 through 2015-2016 of 49.7 percent of all persons that is compared to a 42.7 percentage in Wisconsin.
Winona Senior High School, Girtler said, is an example of schools in Minnesota where vaccination trends are high.
Girtler said the school claims a high percentage of the required vaccinations needed to be registered, with over 96 percent of the students being fully vaccinated.
The school does not provide the vaccine but encourages students and families to go to their health care provider.
Because immunizations are a state law requirement, Girtler said the high school acts as a gatekeeper, and keeps track of them through school attendance.
The district’s immunization plan includes three groups of students: incoming kindergarteners, seventh graders, and new students coming in from another state or district.
With kindergarteners and seventh-graders, the district makes sure to contact the families months before the beginning of school, letting them know about the state requirements. Parents of the incoming students will individually meet with school officials.
The school officials send alerts to parents of sixth graders, similar to a phone system of advertising, she said. Girtler said the school encourages vaccinations in an effort to protect students who cannot be vaccinated due to health reasons or allergies.
Students who do not have the proper vaccinations at the beginning of the school year will usually get the shot right after they have been notified. The district, she said, occasionally has to turn away a student or two due to a lack of immunization.
“We provide them resources and try to find funding or transportation if needed,” she said.
In the Gale-Ettrick-Trempealeau school district in Wisconsin, Registered Nurse Barbara Hogden said almost every student in the school is vaccinated. Only 37 out of 1,392 students have personal waivers, exempting them to immunize, she said.
Hogden said 103 students decided to get the influenza vaccination at the school, and the other children had the choice to get it through their health care provider.
This year, Hogden said there were only three cases of influenza at the school because most of the students are vaccinated. The few who decide not to vaccinate usually do not believe in the vaccines, or they do not have enough information about them, she said.
For those parents who are in contradiction with the vaccines, Hogden said she encourages them to gather information from reliable online sources and to talk to their health care provider.
“Parents should always weigh both sides and do their research,” Hogden said. “There is a lot of information out there; they just need to look for it.”
While parents determine children’s necessity of receiving a flu vaccination, college students like Krug and Miller, can decide whether to vaccinate on their own.
Krug said he is skeptical about flu shots because he read online the vaccine protects against three types of the virus only, though there are more; and the virus constantly changes.
“I have always trusted that with good hygiene and proper nourishment, I can stay healthy for the most part,” Krug said.
On the other side of the spectrum, Miller takes advantage of the flu shot every year.
Miller said she is glad the flu vaccine is so easily accessible for students, especially in a college environment where germs are passed easily. The flu, she said, can spread quickly, and have a large impact on a population.
Vaccination requirements, Miller said, should be recommended but not mandatory because people need to have a say in what they receive in their bodies. She said she thought it is important to get vaccinated not only for a person’s health, but for the health of a whole community.
“When different things are forced or required, they can have negative connotations associated with them,” Miller said.
Winona State University Registered Nurse Joyce Peckover said the Health and Wellness Services on campus administered about 350 flu shot vaccinations this academic year.
The Health and Wellness Services is able to administer immunizations for several diseases, and the flu shots are available at the clinic for $25 billed to a student’s insurance. Peckover said the shot is covered by most students’ health insurance under preventable care.
According to Peckover, the amount of flu shots the university administers depends on whether there has been a bad outbreak of influenza across the U.S. In that case, she said, the following year people are more willing to vaccinate against the flu because they are afraid they might get sick again. This year, influenza started later than usual, with a peak in January, she said.
When students walk into the Health and Wellness Services for an appointment, Peckover said the registered nurses try to encourage the flu shots. Sometimes, students decide not to be vaccinated because they do not believe in the vaccine, or they have never taken it before.
Peckover is in charge of the Ask-A-Nurse line, and said she often receives calls from parents who want to keep track of their son’s or daughter’s health and ask if they have received the shot. Other times, the students purposely will not get vaccinated because of their parents’ decision.
Until the flu shots expire in June, Peckover said she will keep administering flu shots. Health and Wellness Services collaborate with the health promotion center to encourage flu shots via online and across the university through informative posters.
“We are always looking for new ways to encourage it,” Peckover said. “As much as we market the flu shot, it’s never enough.”
Peckover said the registered nurses work together with nursing students every fall, and set up a flu shot clinic to make it more convenient for students to stop by the booth during their lunch break.
Peckover said it is important to educate on flu shots because they can prevent serious illnesses and doctors’ visits. At the academic level, she said students who get influenza might be absent from classes for a few days, and lower their performance.
According to the CDC, an annual seasonal flu vaccine can keep people from getting sick with influenza, reduce the risk of flu-associated hospitalization, and protect people with chronic health conditions who are more vulnerable to flu illnesses.
No matter if individuals have had a flu shot or not, in order to prevent influenza and the spread of germs, Peckover said getting good nutrition and resting helps to keep the immune system built up.
The CDC recommends avoiding contact with sick people, covering the nose and mouth with a tissue when coughing or sneezing, cleaning and disinfecting surfaces and objects that may be contaminated with germs like the flu and others.
“Everything comes down to prevention,” Peckover said. “Our goal is to provide education and prevent diseases to stay healthy.”
Despite the high percentages of student vaccinations in the Winona area public schools, in some cases, Girtler said students could be sent home from school because they do not have the proper vaccinations, or proof of exemptions from them. Kindergarten is the time they can first be blocked from schools, she said.
Rochester public schools recently did not allow 80 students to attend classes in the school building because they did not submit the paperwork before the deadline on March 1.
The district notified the families whose children did not have all the required vaccinations from Jan. 27 through Feb. 20, but they were not successful in providing the documents.
Both Girtler and Hogden said diseases, which used to be common in the U.S., including polio, measles, diphtheria and rubella, can now be prevented with vaccination.
Those parents who are against vaccinations were not alive when polio spread all over the country and are not aware of the number of people who died from it, Hogden said.
Agata Blaszczak-Boxe, author of an article on vaccine refusals, said parents think vaccine-preventable diseases are rare these days, and their memory of these diseases may be fading.
Some of the recent measles outbreaks prove those beliefs wrong. Girtler said California experienced a large, multi-state measles outbreak at Disneyland in 2015 from a traveler who became infected overseas with measles. Other measles cases occured quickly afterwards.
Girtler said in order to encourage more vaccinations in the future, interventions are needed on the individual level. She said health care providers are the best source of information for individuals who are hesitant to immunize their children.
One-on-one conversations usually work best because parents are able to listen closely to an expert’s opinion on the matter, she said.
“We are encouraging vaccinations to protect not only children, but the whole community,” Girtler said. “This is a public concern.”