Marilyn W. Edmunds, PhD, CRNP
The Immunization Status of Home-Schooled Children in America
Choi BK, Manning ML
J Pediatr Health Care. 2010;24:42-47
The immunization of children against a vast number of life-threatening infectious agents is one of the greatest public health interventions of the 20th century. In America, the morbidity and mortality associated with many common childhood infectious diseases have all but vanished over the last 4 decades. Although not perfect, requirements by states for school entry vaccination play a significant role in achieving the high immunization rates among children and adolescents and are responsible for the decline in infectious diseases.
Schools have efficient procedures to review records and follow up the immunization status of students. This ensures that immunization rates are high except among children in states that allow exemptions to immunizations because of religious or philosophical beliefs of parents. Many of these parents are too young to remember children dying or being permanently harmed by common childhood diseases. Thus, these parents often focus on their fear of the adverse effects of immunization and refuse to allow their children to be immunized -- placing them at greater risk than if they received the immunizations. The lack of immunization in some children not only increases the risk for disease in these children but also in all other children in the community.
In view of the success of the school-entry immunization requirements, it is difficult to explain why no similar regulation is in place to monitor the immunization status of the ever-growing home-schooled population.
To document the lack of standardization in what information is collected about home-schooled children and whether they are properly immunized, the authors explored the varying state regulations on childhood immunization. Specifics are provided about what some states do and do not require. What emerges is that no one really knows whether the nearly 2 million home-schooled children are adequately immunized.
Every year more families participate in home schooling. Pediatric and family nurse practitioners in the primary care setting will need to play an aggressive role in trying to educate parents and protect the health of these children, as well as the public's health.
It boggles the mind to read that for so many home-schooled children, immunization may not be required or there is no follow-up to determine whether required immunization is completed. A brief survey of Internet resources suggests that more and more groups are concerned about this issue, but to date, I could find no national policy to address this problem that will protect general public health. The most recent Healthy People report indicates that increasing childhood immunizations is a priority, so the loophole that allows 2 million home-schooled children to escape immunization seems unacceptable.
This failure to have adequate national policy to protect children through immunization does not sound like the type of regulation that would be difficult to pass. Immunizing children should not be a partisan issue. This is a problem that has a clear-cut solution -- and one that we know would make a difference. This is a problem that many provider groups, especially nurse practitioners, should support and push on to the national policy agenda.