NEEDLE POINT THERE IS A GOOD REASON TO VACCINATE AGAINST DISEASES NOBODY GETS ANY MORE.

Byline: Evan Henerson Staff Writer

Who experiences more pain, the uncomprehending 5-year-old who is being jabbed with a needle during a preschool doctor visit or the parent who has to watch it happening?

A better question: Who risks getting hurt if the child doesn't get those vaccinations? Immunizing children is one of the most vital decisions parents can make, say many public health officials and pediatricians.

``We've got some very deadly diseases,'' said Scott Calig, chief of pediatrics at West Hills Hospital and an assistant clinical professor of medicine at USC. ``To my mind, there is one reason and one only why we don't have children dying - because we've got a good, safe, effective series of vaccines.''

Vaccination works by exposing a person to a minimal amount of a weakened or dead strain of a disease. The vaccine is administered orally or by injection, either method causing the immune system to begin manufacturing an antibody to the disease. If a vaccinated person is infected with the disease later, he or she then has the antibodies to fight it.

Are they necessary?

Whether or not you believe in the safety and effectiveness of vaccinations - and there are people who stand strongly in each camp - those dreaded needles that kids hate so much are also all but mandatory. In order to start school, every child must go through a standard battery of immunizations.

For admission to public schools, children must be vaccinated against the big 10: polio, tuberculosis, measles, mumps, diphtheria, tetanus, pertussis (whooping cough), rubella, hepatitis B, and - new as of July - chicken pox. You can refuse and sign a waiver based on medical, religious or moral objections.

Some believe immunizations do more harm than good. Why subject my child to shots, they argue, when the diseases they're being protected against are practically nonexistent anyway? News stories about children contracting the very disease they are supposed to be getting protected against or enduring horrible side effects from the immunization can be more than enough to scare nervous parents away from vaccinations.

Within the Los Angeles Unified School District, very few choose not to have their children vaccinated, say school health officials. In October 2000, the parents of approximately 90 of 50,000 kindergarten students within LAUSD signed personal belief vaccination waivers, said Suzanne Rue, communicable disease control resource nurse for the district. She pointed out that a signed waiver could mean that a parent might object to a single vaccination, not necessarily the whole slate.

If any vaccine-preventable disease breaks out in a classroom, any child who has not been immunized is sent home until the incubation period is over.

Rue believes the number of unimmunized children entering school should be even smaller. Like zero.

``Vaccinations only work if every single child is immunized,'' said Rue. ``The larger the population that is not immunized, the more people that are put at risk. These diseases will come back if people don't keep their children immunized.''

The undeniable proof

Vaccinations have contained or halted the spread of about 20 serious diseases, according to the National Immunization Program and the Centers for Disease Control and Prevention. Medical science has wiped out smallpox and all but eradicated polio. There is a generation of parents who have never seen measles or mumps, and health officials say we're due for a generation of parents who have never experienced varicella (chicken pox), a disease many parents used to deliberately expose their children to so they could get it over with. Officials now believe contracting chicken pox can make kids more susceptible to diseases such as encephalitis.

For now, parents need to remember that these diseases are rare, not gone, says pediatrician Glenn Irani, who has a private practice in Tarzana. At Encino Tarzana Medical Center, where Irani is vice chief of staff in the division of pediatrics, a child was recently treated and released for symptoms of whooping cough. It was later determined the patient had been exposed to another child with similar symptoms at Valley Presbyterian Hospital.

``That's two children with whooping cough; it's still in the San Fernando Valley,'' said Irani. ``We are a city of both immigrant and incompletely immunized kids. The germs cannot be eradicated.''

Health officials recommend the immunization schedule start shortly after birth. Researchers are continuously looking for ways to combine vaccinations into a single injection. The vaccination against diphtheria, tetanus and pertussis, for example, is now a single shot, called DTaP. A combined vaccination for both hepatitis A and B may also be possible in the future.

But - sorry kids! - you can't get full immunization in a single shot, so parents need to do some planning to get their children up to date. The better you plan, doctors say, the greater your options as far as spacing shots out, and the lower your chances of side effects.

This year, in addition to the new varicella requirement, a national shortage of the tetanus-diphtheria vaccine has prompted a federal recommendation that physicians delay the fourth shot of the five-dose regimen until children are 4 years old. The Centers for Disease Control and Prevention has also recommended that schools allow 14-year-old students to put off tetanus-diphtheria boosters until Aug. 1, 2002.

The requirements of the California School Immunization Law are what most districts - including LAUSD - follow. These guidelines only carry up to seventh grade, unlike the Recommended Childhood Immunization Schedule for the United States - which is approved each year by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians. Nor are you off the hook once you get out of junior high and high school.

The ACIP, a division of the Centers for Disease Control and Prevention, recommends that college students consider getting a vaccination against meningitis. Incoming freshmen who will be living on campus are at slightly higher risk than other students, according to the guidelines. Adults should keep up with tetanus boosters, and the FDA has recently approved a vaccination for Lyme disease for people age 15 to 70.

Urban vaccination legends

But health officials say it's news of the side effects and horror stories that seem to sway parents more than decreasing disease statistics. The CDC and National Institutes of Health recently formed an Immunization Safety Review Committee to investigate a possible link between the measles, mumps and rubella vaccine and autism. In April, the committee concluded that ``the vast majority of cases of autism can not be caused by MMR vaccines'' and recommended that the vaccine remain part of the existing national recommendation schedule.

``The stories can be darned convincing, and they can be difficult to sort out,'' said West Hills pediatrician Christopher Tolcher, a spokesman for the American Academy of Pediatrics. ``A child develops symptoms around the time of receiving the vaccine, but it doesn't mean that the vaccine caused the illness.''

After they've dried the tears, parents are advised keep a close eye on their children for a few days after the immunization shot and watch for certain symptoms, such as pain at the injection site or a slight fever.

Some symptoms are expected, ``because it means that the body is reacting to the agent,'' said Alvin Nelson, medical director of L.A. County's Immunization Program. ``More serious reactions are rare, but if parents have any concerns, they should contact their physician.''

Staff writer Linda Hutchinson and the Associated Press contributed to this story.

Get your shots in

So have you procrastinated until now in dealing with the vaccinations for school? There is still hope.

We suggest you consult with your child's pediatrician, local health clinic and local school to start or continue a schedule of immunizations.

According to the American Medical News, the current cost of a complete immunization series in a doctor's office is about $400, but it's important to remember these costs can be spread over five or six years, if immunization starts when a child is 6 months old.

If you take your child to a public health clinic, there may be a small cost associated with administering the shot, but the vaccine itself is free. To find a public health clinic near you, go to www.lapublichealth.org or call [phone] or [phone].

The Kids Care Fair will be making several stops in the area to offer families free screenings and immunizations.

Sunday, 9 a.m. to 1 p.m.:

NEVHC-LAC Valencia Health Center, 23763 Valencia Blvd., Valencia.

YWCA of GLA-North Valley Place, 1200 N. Maclay, San Fernando.

South Oxnard Community Center, 200 E. Bard Road, Oxnard.

Aug. 27, noon to 4 p.m.:

Boys & Girls Club, 2950 Lemon Drive, Simi Valley

And this week is Community Clinic Week. The Northeast Valley Health Corp. will be setting up express immunization clinics at various locations in the San Fernando and Santa Clarita valleys today through Friday. For information, call [phone].

El Proyecto Del Barrio Family Health Care Clinics are also offering vaccinations. For locations, call [phone]. The Tarzana Treatment Center Family Medical Clinic (18646 Oxnard St.) is offering free school immunizations from 8 a.m. to noon Saturday. For more information, call [phone].

- Daily News

IMMUNIZATION REQUIREMENTS

To enter or transfer into public and private elementary and secondary schools (grades Kindergarten through 12) in California, children under age 18 years must have immunizations as outlined below. Exemptions are allowed if the vaccines go against parents' personal beliefs or if a physician advises against immunization.

VACCINE: Polio (OPV and/or IPV)

REQUIRED DOSES: 4 doses at any age, but 3 doses meet requirements for ages 4-6 if at least one was given on or after the 4th birthday; 3 doses meet requirement for ages 7-17 years if at least one was given on or after the 2nd birthday.

SIDE EFFECTS: Vaccine-induced polio, from oral vaccine only.

VACCINE: Diphtheria, Tetanus, and Pertussis (Whooping cough)

Age 6 years and under (Pertussis is required)

DTP or DTaP or any combination of DTP or DtaP with DT (tetanus and diphtheria)

REQUIRED DOSES: 5 doses, but 4 doses meet requirements for ages 4-6 if at least one was on or after the 4th birthday.

Age 7 years and older (Pertussis is not required)

Td or DT, or DTP or DTaP or any combination of these

REQUIRED DOSES: 4 doses, but 3 doses meet requirement for ages 7-17 years if at least one was on or after the 2nd birthday. If last dose was given before the 2nd birthday, one more (Td) dose is required. Seventh grade: Td booster; 1 dose. Not required but recommended if more than 5 years have passed since last DTP, DTaP, DT or Td dose.

SIDE EFFECTS: Prolonged crying, fatigue, fever, loss of appetite, nausea. Serious reactions, such as severe allergic reactions, seizure, coma, lowered consciousness, are rare.

VACCINE: Measles, Mumps, Rubella (MMR)

REQUIRED DOSES: Kindergarten: 2 doses, both on or after 1st birthday. Seventh grade: 2 doses, both on or after 1st birthday.

For kindergarten and 7th grade: Two doses of measles-containing vaccine required. One dose of mumps and rubella-containing vaccine required; mumps vaccine is not required for children 7 years of age and older.

Grades 1-6 and 8-12: 1 dose, must be on or after 1st birthday.

SIDE EFFECTS: Fever, rash, swollen glands, seizures, joint pain. Rare serious effects are serious allergic reaction, deafness, long-term seizure, coma or lowered consciousness.

VACCINE: Hepatitis B

REQUIRED DOSES: Kindergarten: 3 doses. Seventh grade: 3 doses.

SIDE EFFECTS: Fever, tenderness at injection site.

VACCINE: Varicella (Chickenpox)

REQUIRED DOSES: Kindergarten: 1 dose.

SIDE EFFECTS: Stiffness, soreness, fever, nausea, swelling.

CAPTION(S):

drawing, 2 boxes

Illustration: (cover -- color) IMMUNIZATION: THE SHEILD AGAINST DISEASE

Know updated vaccination requirements as children prepare for return to school

John Gerung/Staff Artist

Box: (1) Get your shots in (see text)

(2) IMMUNIZATION REQUIREMENTS

SOURCE: California Administrative Code, National Immunization Program and Chenters for Disease Control and Prevention.