If in the remoter parts of Pakistan military escort had to be provided to doctors administering polio shots, in the Prince George's County in the Washington region parents had to be threatened with jail in order to get their children vaccinated against flu.
Scores of grumbling parents facing a threat of jail lined up at a courthouse Saturday to either prove that their school-age kids already had their required vaccinations or see that the youngsters submitted to the needle.
The county school system has struggled to get all county fifth grade to ninth grade students immunized for hepatitis B and chicken pox since the Maryland state law barring students without vaccinations from coming to school went into effect in January.
It is shots for hepatitis B and chicken pox are the shots children lack the most. Those immunizations were added to the state's required list last year.
Some children already have been out of the classroom for a month and the fight is affecting students as young as kindergarteners. But it's mostly affected middle and high school pupils.
District officials said they had tried everything from sending notices to parents to offering free-shot clinics in order to get the children immunized, and finally they sought the help of the judiciary.
Circuit Court Judge C. Philip Nichols ordered parents in a letter to appear at the courthouse Saturday and either get their children vaccinated on the spot or risk up to 10 days in jail. They could also provide proof of vaccination or an explanation why their kids didn't have them.
By about 8:30 a.m. Saturday, the line of parents stretched outside the courthouse in the county on the east side of Washington.
But the parents who eventually queued up complained that their children already were properly immunized but the school system had misplaced the records. They said efforts to get the paperwork straightened out had been futile.
"It was very intimidating," Territa Wooden of Largo said of the letter. She said she presented the paperwork at the courthouse Saturday and resolved the matter.
"I could be home asleep. My son had his shots," said Veinell Dickens of Upper Marlboro, who also blamed errant paperwork.
Aloma Martin of Fort Washington brought her children, Delontay and Taron, in 10th and 6th grade, for their hepatitis shots. She said she had been trying to get the vaccinations for more than a month, since the school system sent a warning letter. She had an appointment for Monday, but came to the courthouse to be safe.
"It was very heavy handed," she said of the county's action. "From that letter, it sounded like they were going to start putting us in jail."
School officials deemed the court action a success. School system spokesman John White said the number of children lacking vaccinations dropped from 2,300 at the time the judge sent the letter to about 1,100 Friday.
After Saturday's session, 172 more students were brought into compliance, including 101 students who received vaccinations at the courthouse and 71 whose records were updated.
That still left more than 900 students out of compliance with vaccination requirements, White said.
"Obviously, we still have some more work to do," he said.
Any children who still lack immunizations could be expelled. Their parents could then be brought up on truancy charges, which can result in a 10-day jail sentence for a first offense and 30 days for a second.
Prince George's State's Attorney Glenn Ivey couldn't say Saturday whether he would prosecute parents who fail to comply.
"We have to sit down with school and health services," he said. "We haven't ruled anything out. We need to figure out where we stand."
White said the school system, with about 132,000 students, had been trying for two years to get parents to comply with state law. That law allows children to skip vaccines if they have a medical or religious exemption. It was unclear how many medical or religious exemptions were involved.
Maryland, like all states, requires children to be immunized against several childhood illnesses including polio, mumps and measles. In recent years, it also has required that students up to high school age be vaccinated against hepatitis B and chicken pox.
Nichols said nobody actually came before him Saturday, but he was there if any parent asked to see him.
The judge noted the unhappy looks of some of the kids in line waiting for vaccinations.
"It's cute. It looks like their parents are dragging them to church," Nichols said.
Several organizations opposed to mass vaccinations demonstrated outside the courthouse. While the medical consensus is that vaccines are safe and effective, some people blame immunizations for a rise in autism and other medical problems.
"People should have a choice" in getting their children immunized, said Charles Frohman, representing a physicians' group opposed to vaccines.
Mean time the office of Attorney Glenn Ivey has confirmed a recent case of staph infection.
The student, rumored to be an athlete, was sent home on Nov. 9. White did not confirm or deny if the student was an athlete with any of the school's teams but said, "it makes sense," noting the increased risk for infection in locker rooms. Team members using communal showers and handling the same equipment can easily spread the infection.
Five more schools also had individual cases of staph infection. White said none of the infections have been linked to the antibiotic resistant strain methicillin-resistant staphylococcus aureus or MRSA.
Staphylococcus aureus or staph is a bacteria commonly carried on the skin or in the nose of healthy people. These bacteria are also among the most common sources of infection in the country.
Staph infections can be as minor as pimples and boils or as major as bloodstream infections and pneumonia. While staph infections are common, MRSA infection is not. It typically occurs among hospital patients in a health care setting.
White said the school system was working to help sanitize school locker rooms. "We're using medical-grade disinfectant in our middle and high schools," he said.