Evaluating Middle School Immunization Laws and School-based Immunization Programs

1. Evaluating Middle School Immunization Laws and School-based Immunization Programs • Thad Wilson, RN, Phd • University of Missouri-Kansas City • Mid America Immunization Coalition National Hepatitis Coordinators’ Conference 2003

2. Evaluation Foci • Impact on Health Department workload • Effectiveness of School-based programs • Effectiveness of law

3. Impact on Health Department Workload • 1999 all 7th grade students required to have HBV • Retrospective, statewide analysis • MOHSAIC • Health Dept survey’s

4. Results of Study • Statewide - +375% in HBV immunizations given to 10-14-year-olds • Non-rural settings, total number of vaccines administered did NOT rise significantly

5. Results of Study • Health departments that used “out of office” alternative strategies (school-based, mall, etc) in both 1998 and 1999 had the least change.

6. Overview of Kansas City Metropolitan Program 1997 - 2000 • 16 – 23 School Districts • 1 – 30 private schools • 106 – 195 school buildings • Two states • 4 – 6 Health Departments • 7 – 13 volunteer organizations or agencies

7. Overview 1997 - 2000 • 46, 749 students have been offered school-based immunizations • 79.26% returned consent forms • 23.7% chose not to participate • Most because already immunized • 94.7% received at least one dose • 80.9% completed series

8. Research Studies Conducted • Qualitative • Evaluation Research • Impact Assessment • Descriptive Correlational • Cost-effective Analysis

9. Qualitative Study Findings • Organization • Time • Obtaining consent • Educational opportunity • School support • Student tracking

10. Impact Assessment • Immunization rates rose from 8% to 80% • 9.9 immunizations per hour of school personnel • 8.9 immunizations per hour of health department personnel • Hepatitis B incidence in KC – unchanged

11. Descriptive Correlational • Income – high and low don’t participate • Race – non-white have lower participation rates • Location of school – urban schools had significantly lower participation rate (.58) than suburban schools (.90)

12. Cost-effectiveness Analysis • Yearly program costs $81,972 - $142,485 • Vaccine costs $247,051 – $304,276 • Total administration cost/dose $3.28 - $5.06 • Typical private office costs $15.00/dose • Typical health department costs $5.62 • $53 million of future costs avoided

13. Effectiveness of Law – Pilot Study • Retrospective, school-base, random, student immunization record review • School nurse survey • Two urban high schools, 3 suburban & 4 rural middle schools • Each group in single district

14. Preliminary Results • Urban High School – • 1300+ students • School-based HBV programs as 6th graders • NO 7th grade entry requirement • Sample 50 juniors and 50 seniors • 10% UTD Td (shortage) • 82% UTD MMR • 8% UTD HBV

15. Preliminary Results • Suburban Middle Schools – all had school-based programs in previous year • 1.3% exemption • 100% tetanus and MMR • 61% - 91% HBV, mean 73.5% • 0% varicella

16. Preliminary Results • Rural Middle Schools – no school-based programs • 1.7% exemption • 100% tetanus and MMR • 50% - 90% HBV, mean 61% (2.7% exemption) • 0% varicella • 0% - 40% HepA (recent outbreak in one area)

17. Interesting Tib-Bits • Suburban middle school • School nurse vocally against HBV • Almost 5% exemption for HBV • Suburban school districts with strong leadership and a nurse in each school • <1% exemption • 98% HBV

18. Conclusions • School entry laws • Effective – exemptions, school compliance in urban settings problematic • School-based programs • Effective, cost effective • Urban settings still problematic