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Parents who choose not to have their child immunized need to show proof they have chosen to decline the new immunizations.

The department published a notice of hearing to adopt the rules in December. The department will hold a hearing before an administrative law judge in February. Following the hearing, the judge will set a period for taking written comments, ranging from two weeks to a month. The judge will then recommend whether the department should adopt the rules.

If approved, the changes would take effect in the 2004-05 school year.

Before beginning this formal process, MDH held two public meetings in July and September and a statewide videoconference in August to discuss the proposed changes with Minnesota residents. Based on these meetings, comments received, and a review of scientific research, MDH developed the new immunization requirements.

Besides making some adjustments to the current immunization schedule, the proposed changes also include a couple of new vaccinations. Under the proposed rules, proof of chicken pox vaccinations would be required for children in child care, kindergarten, and seventh grade. Children under two years old in child care also would need to show proof that they are immunized against pneumococcal disease.

Both of these new immunization requirements are supported and recommended by major national medical groups, including the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatricians (AAP), and the American Academy of Family Physicians (AFP); 38 states already have laws requiring the chicken pox vaccine.

The proposed changes do not change the medical exemption or the option for parents to decline any or all vaccines for conscientious reasons. In fact, the proposed rules include a provision that requires all child care facilities and elementary/secondary schools to use the official MDH record form or a similar document approved by MDH. This is in response to concerns from parents and others that the information schools and child care facilities send out does not always follow the law and does not always include information about the legal exemptions.

Schools and child care facilities already check for vaccination coverage. These two new vaccines would be added to the existing list.

"Parents, MDH and local public health agencies, health care providers, and schools are all critical partners in helping children stay up to date with their immunizations," said Kristen Ehresmann, who heads the Immunization, Tuberculosis, International Health Section at MDH. "We all need to work together to make these new requirements effective."

In the five years before use of the varicella vaccine began, approximately four million cases of chicken pox occurred every year in the United States, resulting in an average of 11,000 hospitalizations annually and 100 deaths. More than 80 percent of the cases and 40 percent of the deaths were in children.

One of the most important effects of varicella vaccination is that it helps to prevent severe varicella disease and its complications, such as pneumonia, encephalitis, and a form of severe streptococcal infection. "While these complications are not very common, we do see them every year, and a small number of people with these complications become significantly ill and even die. We should not be seeing such complications in this country," Ehresmann said.

The pneumococcal vaccine protects against a type of bacteria that can cause blood infections and a form of meningitis, as well as pneumonia. Recently, the increase in antibiotic resistant strains of streptococcus pneumonia has made treating the disease more difficult, thus increasing severe illness. The vaccine has also helped reduce rates of antibiotic-resistant infections.

"Many serious diseases can be prevented, or their severity greatly reduced, by immunization," said Ehresmann. "This only works if most of the people in a community are vaccinated. Immunization requirements result in high levels of immunization coverage, reduction in disease, and healthy schools and communities for all Minnesotans."

In addition, effective immunization programs produce substantial savings for the state by reducing the number of children who need state medical assistance and special education programs for blindness, deafness, mental retardation, and congenital heart defects, according to the MDH.

Thanks to the success of vaccination programs, once-common childhood diseases, such as measles and mumps, are no longer prevalent in the United States. Other preventable diseases, such as diphtheria, have been virtually eliminated through vaccination, according to the MDH.

More information about the proposed immunization rule changes can be directed to the MDH at 1-877-676-5414 or by e-mail at ImmunizeRule@health.state.mn.us.