AIKEN -- No shots. No school. It's state law.
Districts throughout the Palmetto State are warning parents this year that without the required shots, little Johnny can't come to class. Big Johnny can't, either, without some immunizations that have been added to the list.
The law's been around for years, but it's stricter now than before.
So as schools beckon, children are flocking to physicians in record numbers.
On Friday, at least 75 schoolchildren squirmed in the waiting room of the Aiken County Health Department for that moment when a registered nurse would call their name, lead them down a narrow hallway and plop them in a cold, uncomfortable plastic chair.
Nurse Jennifer Smoak calls it the torture chamber. And Tony Blake was one of her many "victims." He was updating his immunization shots for his sophomore year at South Aiken High School.
"They're so nervous when they come in," said Mrs. Smoak. "They've heard all kinds of dreadful things, so I spend the first few minutes talking with them about the shots."
Some patients beg her not to pierce their bone with the syringe, while others think they are dart boards and Nurse Smoak will just aim wherever she chooses.
But when the needle goes in, many have felt nothing more than a sting.
"That's it?" Tony marveled, as he examined his right arm for the spot where the tetanus shot punctured his skin.
Making the shots mandatory for students and children in group care is South Carolina's way of forcing people to do what many would not on their own.
Proof of immunization is required to enroll in day-care centers and schools unless the children have been granted an exemption by the state.
No school in South Carolina can accept any other state's immunization certificate. Students transferring from out of state should secure a South Carolina Immunization Certificate as soon as possible to avoid loss of school days. Certificates may be picked up from the health department or doctors' offices.
The requirement may be waived in two ways. Some medical reasons preclude children from getting vaccinated, including immune-system problems and certain allergies. Parents also can seek exemption if their religion prohibits immunizations.
Mississippi and West Virginia are the only two states where children are absolutely required to get vaccinations before school.
In South Carolina, which has become a leader in immunizing children, most babies born each day will get at least 17 vaccinations before they start first grade. In some states that number reaches as high as 21. And never have questions about vaccines been so pointed.
On Wednesday, the issue got an airing in Congress, when Rep. Dan Burton, R-Ind., chaired a hearing on vaccine policy.
At the hearing, Mr. Burton, chairman of the House committee on government reform, said more than 11,000 cases were reported last year of children getting sick after inoculations. Many of their ailments were minor, but some required hospitalization.
"We are going to be beating on this issue as long as I am chairman of this committee," Mr. Burton said -- in part because his granddaughter had to be hospitalized within hours of a hepatitis-B vaccine. And his grandson became autistic after getting a shot he was required to have.
For the vast majority of parents, getting the "baby shots" their doctors recommend is automatic. Vaccines protect against diseases that once killed or disabled thousands of children, from polio to rubella to tetanus.
Now, many doctors fear rumblings over safety will chip away at a national vaccine initiative that has been highly successful, resulting in nationwide vaccination rates of 90 percent of higher.
Parents bringing their children to the Aiken County Health Department have been inquisitive too, after seeing documentaries that only tell the tragedies of the shots.
"The chances of something horrible happening are slim," Mrs. Smoak said.
During the congressional hearing, U.S. Surgeon General David Satcher defended using mandatory childhood shots, noting that America's public health service has the toughest vaccine controls in the world.
"Vaccines are very safe and effective," Dr. Satcher said. "But they are not perfect."