I have had firsthand experience and dozens of episodes reported to me of school officials attempting to convince parents that there something wrong with their signing the waiver. Parents have been coerced and threatened over and over again, particularly about the hepatitis B vaccination being absolutely required for entry to kindergarten, sixth or seventh grade. This is not true and represents a serious violation of the letter and the spirit of the laws of the state. This vaccine, along with any and all others, can be waived and refused. School entry may not be denied by either public nor private schools.

I recommend vaccines, gave most of them to my daughter and to the children of my friends, and still support the absolute right of parents to make decisions regarding vaccinations.

Hepatitis B is a terrible disease which causes liver damage and can lead to liver cancer. The vaccine is very effective but preliminary controversial research has suggested that the vaccine itself may increase the incidence of autoimmune diseases such as lupus, multiple sclerosis, diabetes and rheumatoid arthritis. To repeat, this research does not have the support of mainstream experts nor the backing of even a large minority of American doctors. The data were convincing enough, however, for the temporary suspension of administration of this vaccine in France. The disease is transmitted through high risk behavior: IV drug use or promiscuous unprotected sexual contact. Vaccination does not protect against any other sexually transmitted disease such as AIDS, hepatitis C or gonorrhea.

Additionally, the mercury used to preserve the vaccine has drawn the attention of the American Academy of Pediatrics who have recommended, as of August 1999, removal of the preservative and temporary discontinuation of the vaccine for babies under six months of age.

Do not be bullied into believing that your child must have these vaccines for school entry. Likewise, do not be stampeded away from the immunizations by research which is quite incomplete. This is a personal/medical choice without a wrong answer.

My only problem involves the schools, both public and private who are not displaying good judgment as they threaten parents with either non-admission or expulsion. They do, however have the right to exclude non-vaccinated children from school in the event of an outbreak of a contagious illness like whooping cough or measles. Outbreaks of these illnesses are few and far between but possible.

I will be happy to accept phone calls from your school nurse.

In my practice, there seems to be a great deal of confusion about vaccinations and the requirements for school entrance. I have been asked a number of questions and I'd like to show you the answers I've given.

Q. "I have been told that my child may not start kindergarten until he has had all the vaccines on a list given to me by the school system. Why is this?"

A. Many illnesses can be prevented by immunization and the best way to do this is to control school entry. Public health and school officials feel very strongly about "universal immunization." This means getting every single child vaccinated against every single preventable disease. These diseases are much more "communicable" (catching) in larger groups, like a school room for instance.

Q. "Why would anybody object to this?"

A. Good question. Some children have had bad reactions to vaccines involving very high fevers, seizures, "collapse syndrome" and other problems. Some of these reactions strictly prohibit giving another dose of that same vaccine. From a purely medical point of view, most of these reactions do not mean another dose should not be given, but the parents or doctor may be uncomfortable enough to stop that particular vaccination series. TV shows sensationalized the very rare severe reactions to the old DPT shot. They showed children who had been damaged or even fatally injured by the vaccine without giving any balance to the issue. The only benefit this may have had was to speed up the development and usage of the new, safer and more effective DPaT vaccine which does a much better job of preventing whooping cough without the side effects commonly seen with the old shot.

Q. "All right, but if a child has not had any bad reactions to vaccines--or has not even had any shots yet, why would someone object to beginning the vaccines to protect their children against these illnesses?"

A. Another excellent question. Some people think that the shots might cause harm to the immune system. Some have religious or philosophical objections to the vaccines. Others point to the studies which show that certain immune system problems may be caused by the vaccines and that the risk might even outweigh the benefits of the vaccines. Honest opponents of vaccines must admit two very important facts:

1) Vaccines work very well and have eliminated or nearly eliminated some illnesses which used to injure or kill many, many people. These diseases include small pox (gone!) polio (nearly gone) measles (100 cases in the USA last year down from a peak of nearly one million cases in the worst year) and Hemophilus Influenza B, which used to be the number one cause of bacterial meningitis under age two years and which is now virtually unheard of in the pediatric population in America. Pertussis (whooping cough) cases are way down and the new vaccine is the reason.

2) There is no conclusive research which has shown damage from vaccines. There is some good research, some incomplete research, some ongoing research but there are no "anti-vaccine" studies which have drawn the support of the majority of mainstream experts in the field.

Q. "What is your opinion?"

A. The medical community have never been completely honest with parents about the risks and benefits of vaccines. Parents should not only have much more information, but much more input into the decisions about vaccines. These decisions might include when and if certain shots are given.

Parents might decide that their child is not at any risk for contracting hepatitis B and decide that the benefits from that shot don't outweigh the possible risks. I think this is a parent's privilege.

All 50 states allow for a medical exemption from the shots, most allow a religious or philosophical exemption and at least a dozen allow a "personal choice" refusal. There are many web sites which will give you the information you need to make an informed choice and for a full explanation of the convention AMA/American Academy of Pediatrics point of view, discuss this issue at length with your pediatrician.

Q. "The vaccination against Hepatitis B seems to be the biggest 'sticking point' in getting my children into school. How do you get hepatitis B?"

A. The disease is transmitted through high risk behavior: IV drug use or promiscuous unprotected sexual contact. Vaccination does not protect against any other sexually transmitted disease such as AIDS, hepatitis C or gonorrhea. There may be a very small number of cases of Hep B transmitted through "unknown" means. I have never found this data convincing but many doctors believe it.

Q. "Why does the issue of school vaccinations concern you so much?"

A. I have had first hand experience and dozens of episodes reported to me, of school officials attempting to convince parents that there is something wrong with their signing the waiver. Parents have been coerced and threatened over and over again particularly about the hepatitis B vaccination being absolutely required for entry to kindergarten, sixth or seventh grade. This is not true and represents a serious violation of the letter and the spirit of the laws of most states. This vaccine, along with any and all others, can be waived and refused. School entry may not be denied by either public nor private schools.

I recommend vaccines, gave most of them to my daughter and to the children of my friends and still support the absolute right of parents to make decisions regarding vaccinations.

Do not be bullied into believing that your child must have these vaccines for school entry. Likewise, do not be stampeded away from the immunizations by research which is quite incomplete. This is a personal/medical choice without a wrong answer.

Q. "But, modern medicine has come along to the point where could treat Hepatitis B and cure it if we get it, right?"

A. Sadly, no. There is no known cure for Hepatitis B and treatments are only partially effective at slowing the progression of the disease.

Hepatitis B is a terrible disease which causes liver damage and can lead to liver cancer. The vaccine is very effective but preliminary controversial research has suggested that the vaccine itself may increase the incidence of autoimmune diseases such as lupus, multiple sclerosis, diabetes and rheumatoid arthritis. To repeat, this research does not have the support of mainstream experts nor the backing of even a large minority of American doctors. The data were convincing enough, however, for the temporary suspension of administration of this vaccine in France. Again, the disease is transmitted through high risk behavior: IV drug use or promiscuous unprotected sexual contact and the vaccine should give no one false confidence about these behaviors: Vaccination will not protect against any other sexually transmitted disease.

Additionally, the mercury used to preserve the vaccine has drawn the attention of the American Academy of Pediatrics who have recommended, as of August 1999, removal of the preservative and temporary discontinuation of the vaccine for babies under six months of age.

Q. "With all this conflicting information, how can I make an informed choice?"

A. You might want to err on the side of caution, as people like to say. The vast majority of doctors and experts recommend this vaccine very strongly; The vast majority of children entering school are receiving the vaccine. I do not feel that getting the shots poses a high risk to children and, by the same token, I don't feel that refusing them sets up a high risk situation for an otherwise healthy child.

This is another medical issue without an absolutely correct answer but there is no wrong answer either.