One unintended outcome to emerge from Horace Mann’s foresight in the creation of Massachusetts universal public education system in 1837 has been a high rate of childhood immunization. State based school entry and most privately base school entry requires evidence of vaccination against vaccine preventable disease (VPD). A recent trend in childhood education has seen a dramatic rise in home-based education, which in many states effectively thwarts the usual oversight for immunization that public school entry provides.
Johnson et al. (doi:10.1542/peds.2013-1636) of the CDC as well as colleagues at the Oklahoma Department of Health write in the December issue of Pediatrics Case Report section about two home-schooled children who developed tetanus after incurring wounds caused by dirty objects. These children had not had completion of their primary immunization sequence. Johnson et al. also reference other outbreaks of VPD that have occurred in the home-school population who were not immunized. The authors make a plea for new more effective ways to oversee immunization status in the growing number of home-schooled children.