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Missed shots spur kids' suspension

Students lacking required vaccinations may be kept out of school

The Toronto Star, Kristin Rushowy, EDUCATION REPORTER, January 2, 2009

They haven't done anything violent, illegal or even behaved badly.

But thousands of students across the province are suspended - or threatened with suspension - for not keeping up to date with vaccinations.

It's a necessary step to keep diseases from spreading, and to do that, high compliance rates are needed, says Dr. Vinita Dubey, Toronto's associate medical officer of health. Toronto Public Health oversees vaccination compliance for the city's school boards and private schools.

Under Ontario's Immunization of School Pupils Act, students can be suspended for a period of 20 school days if they don't have the required vaccinations for diphtheria, tetanus, polio, measles, mumps and rubella (German measles). Shots for illnesses like whooping cough or the flu are simply recommended.

The Peel District School Board and that region's health unit launched a massive review of students in the last school year, a plan that was fast-tracked after a potential outbreak of measles, said the board's director of education Jim Grieve.

"It became very clear that we had to have this done fully, immediately," Grieve said.

The board worked closely with Peel health and divided this year's cases, roughly 34,000 students, into three groups. The first group of about 13,536 received letters in October, and have until the end of January to comply. Another 14,969 letters went home on Nov. 11, and the remainder at the end of the month.

About 500 Peel students received a notice of suspension in the last school year, and within three days, the number of students either suspended or waiting to be suspended dropped to 10. Three days later, all were cleared.

"The experience last year was excellent," said Grieve. "The schools bent over backwards - no one wants to see a child suspended."

Toronto public health assesses 850 schools a year, a task that takes the entire school year, for a total of more than 350,000 students. It studies school and board records, and then determines who's not up to date.

Then "we send them a note that says their child is not up to date for the following vaccinations," Dubey said. Each year, 70,000 letters are sent out; if no information is received within three weeks, then a final notice goes out, usually to about 40,000 students. Three weeks after that, if nothing has been done, a suspension order is issued.

"In general, about 25,000 students get a suspension order," said Dubey. "It says that as of this date, your child is eligible for suspension ... because they're not up to date. As for actual suspensions, it's about 6,000 students every year."

It's mostly students aged 7 or 15, given the age guidelines for shots.

"What we find is by and large, 85 per cent of individuals have up-to-date records, they just have to let us know about them," Dubey said.

Sometimes families can't find a doctor; others assume their physician is forwarding the information. If families are new to Canada, they may not have health coverage, or lack records from their homeland.

In Peel, letters were translated into 25 languages and sent home. Often, schools also called home.

"We are well aware of the population we're dealing with here," said Grieve. "They may be brand new to the country. ... They're trying to learn a new language, get settled, get a job, find a place to live, and the last thing they think of is getting immunized. They're not told anything about this."

Grieve said sending letters home in parents' native language made the most profound change.

"We've also taken the step of meeting with faith leaders, and get this information out among other things as well," he added.

"It's a gargantuan task," he said. "It's quite a personal approach."

In Ontario, families who wish to opt out for religious, philosophical or medical reasons are required to submit notarized letters to Toronto Public Health for the exemption to be valid, Dubey said. Despite reports of an anti-vaccine movement, that number has remained at about 2 per cent for several years.

"It's the concept of herd immunity," said Dubey. "If most of the kids are vaccinated, it will act to prevent the disease from coming into the school."

Suspension may seem drastic to some, but earlier this year in Belgium, two sets of parents were fined $8,000 and given five-month prison terms for not vaccinating their children for polio, the only one required by law. It's not known if the parents did serve any jail time.

For Toronto students who require shots, public health runs evening clinics. For kids who've immigrated to Canada and have no records, "we assume they were never vaccinated and start from scratch," Dubey said.