As the class of 2010 is preparing for school for the first time, parents are reminded to add more than school clothes and supplies to their to-do list.

Missouri children must be immunized against certain infectious diseases before entering public and most private schools. With only weeks left before the first day of classes, immunization records need to be double checked.

"They cannot enter the classroom. That's the bottom line," said Pam Stovall, head nurse for the Cape Girardeau School District.

"Their immunization records must be up-to-date and in place when school starts."

Immunization noncompliance can result in dismissal. There are always some exceptions to the rule such as religious restrictions. In that case, a form must be signed stating the noncompliance reasons.

"It is not our goal to have students miss school," said Stovall. "We want to help parents as much as we can. The school nurses and the public health nurses will make every attempt to provide the needed immunizations."

The district has tried to give every parent the opportunity to be aware of what immunizations are needed for their child.

"We have made phone calls and sent out letters to inform them. We have notified those who need initial immunizations and those who need boosters," said Stovall.

An immunization or shot record must show proof of the vaccinations, or a parent or guardian must show an immunization appointment time has been made.

The purpose of the vaccinations is to prevent potentially serious communicable diseases in children and adults.

Measles, mumps and rubella vaccines are the most commonly known.

The measles virus can cause deafness, blindness, brain damage and can even lead to death.

Mumps, also viral, is manifested by swollen testicles or ovaries and pancreas. Hearing loss may occur.

Rubella is an acute contagious disease that is a form of German measles.

Those entering kindergarten should have received the MMR vaccine by the age of 15 months and again by the age of 6 years.

The hepatitis B series was added to the required immunizations a few years ago.

The series helps prevent a sometimes fatal hepatitis caused by a double-stranded DNA virus that persists in the blood serum of those infected. It is transmitted by contact with infected blood.

"The hep B series is required for those entering public school pre-school programs and kindergarten," said Stovall.

"Once the series of hep B immunizations begins it must be continued."

Tetanus, commonly known as "lockjaw," is a disease that enters the body through deep wounds. Symptoms can be headaches, sweating and muscle spasms in the jaw or abdomen.

The tetanus vaccine is first given at the age of two months in combination with vaccines for pertussis and diphtheria.

Pertussis, better known as whooping cough, can develop into pneumonia. Diphtheria, which is caused by bacteria, can block the windpipe with a "membrane."

Boosters for tetanus are needed every 10 years.

Stovall said a immunization against Haemophilus influenza type b is required for all children entering pre-school programs.

Immunization against chicken pox currently is optional but is included on most immunization schedules.

Most public schools no longer provide immunizations on site.

"Giving shots in school is no longer practical," said Stovall. She said immunization clinics sometimes will be offered on school campuses after hours.

Immunizations can be obtained free from local county health clinics or through private physicians for a fee.

The Cape Girardeau County Public Health Center provides immunizations free of charge.

Jane Wernsman, the center's assistant director, said appointments are encouraged even though the shots are free.

"Appointments keep control of the traffic and the waiting period time," she said.

The center asks that those needing immunizations bring their record books with them.

Immunization clinics will be offered from 9 a.m. to 3:30 p.m. for all ages on the following dates:

Wednesday and Aug. 27 -- at the center.

Aug. 18 and 25 -- in the basement of the First Presbyterian Church in Jackson.

Aug. 13 will be school booster day at the center for children kindergarten age through 15 years old.

Private physicians offices also give immunizations per request. Most do charge a fee.

Monia Tally of the Cross Trails Family Practice Clinic said they also encourage appointments but will take walk-ins.

Tally said the center uses a sliding fee for pateients who need financial assistance.