School Immunization Law Update

1. School Immunization Law Update April 14, 2011

2. Agenda • Important info for school year 2011-2012 • School year 2010-2011 update • America’s favorite new game: Clinic vs. School

3. Changes for School Year 2011-2012

4. Hepatitis A:Not-So-New-Anymore Requirement • Dose 1 required for children 18 months and older to in childcare, preschool, Head Start, kindergarten, 1st, 2nd, and 3rd grade • Dose 2 required by 12 months after the first dose • Hepatitis A will be phased in: • One grade level per year through 5th grade in 2013-2014 • All grades through 12th in 2014-2015

5. Students now in grades 3-8 will be required to have Hepatitis A vaccine before they graduate!

6. Tdap:Not-So-New-Anymore Requirement • One dose of Tdap is required for all 7th-10th graders by Exclusion Day 2012 • Tdap will be phased in: • One grade level per year, finishing with 12th grade in 2013-2014 CDC Public Health Image Library ID#2121

7. Primary Review Summary-Page 1

8. Changes to Primary Review Summary—Page 1 Complete and Up-to-date fields combined into one Kids with religious exemptions for some vaccines but incomplete for other vaccines go in the Incomplete category

9. Primary Review Summary—Page 2 No changes to this page

10. Primary Review Summary- Page 3

11. Changes toPrimary Review Summary—Page 3 Count the number of kids with religious exemptions for each vaccine. Note—sites using eSIS will begin reporting this information for School Year 2011-2012!

12. Exclusion Timeline

13. 2010-2011 Summary

14. Exclusion Summary 2011 Children in Oregon covered by school and children’s facility immunization law: • 659,526 Exclusion orders: • 36,776 Children excluded: • 4,932 NWHF Public Health Youth Photo Contest, 2010

18. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten and First Grade Religious Exemptions, 2000-2001 (Oregon 1.9%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 2.7% 1.3% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 2.0% 1.1% Umatilla Tillamook Hood 1.0% Wallowa Multnomah 8.5% Washington River 0.2% 2 schools 1.3% 1 facility 1 school none Morrow 0.0% Gilliam none 0.0% 1.5% Sherman 1 facility Union 2 schools none 2 schools 3.5% Clackamas 1.1% Yamhill 1 facility 2 schools 1.7% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 1.5% 3 schools 1.5% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 1.7% 0.0% Lincoln Jefferson 0.9% 1 school 1 school 1 facility 3 schools 2.8% 1.5% Grant Linn 3.6% 0.8% 1 school none Benton Crook 1 facility 2 schools 1.5% 4 facilities 1 school 1 facility resurvey Lane Deschutes 4.2% 1 facility 0.4% Malheur 2.1% Harney Douglas 1 facility 2 schools 1 facility 0.5% Coos 5 schools 1.1% 2 facilities 1 school 1.6% Lake 1.6% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 5.0% Jackson 1 facility 1 school 0.8% Josephine 3.6% 3 facilities 5.2% 1 facility 1 facility

19. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten and First Grade Religious Exemptions, 2001-2002 (Oregon 2.4%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 3.8% 1.6% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 2.2% 1.4% Umatilla Tillamook Hood 1.1% Wallowa Multnomah 7.9% Washington River 2.0% 2 schools 3.2% 1 facility 1 school none Morrow 0.0% Gilliam none 0.0% 2.0% Sherman 1 facility Union 2 schools none 2 schools 4.7% Clackamas 1.2% Yamhill 1 facility 2 schools 2.7% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 1.6% 3 schools 2.5% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 2.1% 3.5% Lincoln Jefferson 1.5% 1 school 1 school 1 facility 3 schools 3.5% 0.6% Grant Linn 4.2% 0.8% 1 school none Benton Crook 1 facility 2 schools 2.8% 4 facilities 1 school 1 facility resurvey Lane Deschutes 5.0% 1 facility 2.7% Malheur 0.4% Harney Douglas 1 facility 2 schools 1 facility 1.2% Coos 5 schools 1.3% 2 facilities 1 school 1.6% Lake 0.0% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 4.5% Jackson 1 facility 1 school 0.1% Josephine 3.4% 3 facilities 11.2% 1 facility 1 facility

20. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten and First Grade Religious Exemptions, 2002-2003 (Oregon 2.8%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 3.5% 2.6% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 2.8% 1.5% Umatilla Tillamook Hood 1.0% Wallowa Multnomah 4.7% Washington River 2.0% 2 schools 3.2% 1 facility 1 school none Morrow 0.8% Gilliam none 0.0% 2.3% Sherman 1 facility Union 2 schools none 2 schools 3.1% Clackamas 1.3% Yamhill 1 facility 2 schools 3.1% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 1.8% 3 schools 1.6% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 1.9% 12.5% Lincoln Jefferson 1.9% 1 school 1 school 1 facility 3 schools 4.4% 0.0% Grant Linn 10.2% 0.9% 1 school none Benton Crook 1 facility 2 schools 1.2% 4 facilities 1 school 1 facility resurvey Lane Deschutes 5.8% 1 facility 4.1% Malheur 0.4% Harney Douglas 1 facility 2 schools 1 facility 2.5% Coos 5 schools 1.3% 2 facilities 1 school 1.1% Lake 0.0% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 9.6% Jackson 1 facility 1 school 1.0% Josephine 4.3% 3 facilities 10.8% 1 facility 1 facility

21. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2003-2004 (Oregon 2.8%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 2.8% 1.5% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 3.0% 1.6% Umatilla Tillamook Hood 1.2% Wallowa Multnomah 1.6% Washington River 1.6% 2 schools 4.6% 1 facility 1 school none Morrow 1.8% Gilliam none 0.0% 2.4% Sherman 1 facility Union 2 schools none 2 schools 4.5% Clackamas 1.0% Yamhill 1 facility 2 schools 3.2% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 1.7% 3 schools 2.5% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 0.6% 6.3% Lincoln Jefferson 2.1% 1 school 1 school 1 facility 3 schools 3.2% 1.3% Grant Linn 3.0% 4.4% 1 school none Benton Crook 1 facility 2 schools 1.5% 4 facilities 1 school 1 facility resurvey Lane Deschutes 5.6% 1 facility 4.9% Malheur 2.9% Harney Douglas 1 facility 2 schools 1 facility 3.4% Coos 5 schools 0.8% 2 facilities 1 school 3.4% Lake 1.3% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 7.2% Jackson 1 facility 1 school 1.0% Josephine 4.5% 3 facilities 7.3% 1 facility 1 facility

22. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2004-2005 (Oregon 3.4%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 3.5% 1.0% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 4.2% 2.0% Umatilla Tillamook Hood 0.7% Wallowa Multnomah 10.5% Washington River 1.6% 2 schools 2.6% 1 facility 1 school none Morrow 1.8% Gilliam none 0.0% 2.2% Sherman 1 facility Union 2 schools none 2 schools 7.9% Clackamas 2.7% Yamhill 1 facility 2 schools 3.5% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 2.2% 3 schools 2.8% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 4.3% 100% Lincoln Jefferson 2.1% 1 school 1 school 1 facility 3 schools 6.0% 1.8% Grant Linn 6.5% 1.2% 1 school none Benton Crook 1 facility 2 schools 1.3% 4 facilities 1 school 1 facility resurvey Lane Deschutes 6.2% 1 facility 5.1% Malheur 0.5% Harney Douglas 1 facility 2 schools 1 facility 0.0% Coos 5 schools 2.1% 2 facilities 1 school 3.6% Lake 1.4% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 8.8% Jackson 1 facility 1 school 1.9% Josephine 4.9% 3 facilities 7.7% 1 facility 1 facility

23. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2005-2006 (Oregon 3.5%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 3.5% 2.3% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 4.0% 1.6% Umatilla Tillamook Hood 1.2% Wallowa Multnomah 7.8% Washington River 3.0% 2 schools 6.7% 1 facility 1 school none Morrow 1.6% Gilliam none 10.0% 2.2% Sherman 1 facility Union 2 schools none 2 schools 4.9% Clackamas 3.1% Yamhill 1 facility 2 schools 4.2% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 2.0% 3 schools 3.0% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 4.4% 18.2% Lincoln Jefferson 3.3% 1 school 1 school 1 facility 3 schools 5.5% 2.1% Grant Linn 8.6% 1.2% 1 school none Benton Crook 1 facility 2 schools 2.0% 4 facilities 1 school 1 facility resurvey Lane Deschutes 6.6% 1 facility 6.0% Malheur 0.4% Harney Douglas 1 facility 2 schools 1 facility 1.3% Coos 5 schools 2.2% 2 facilities 1 school 2.4% Lake 5.8% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 6.1% Jackson 1 facility 1 school 1.7% Josephine 5.8% 3 facilities 8.5% 1 facility 1 facility

24. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2006-2007 (Oregon 3.6%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 4.3% 1.6% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 4.7% 1.9% Umatilla Tillamook Hood 1.4% Wallowa Multnomah 4.8% Washington River 3.4% 2 schools 7.0% 1 facility 1 school none Morrow 0.5% Gilliam none 6.7% 2.8% Sherman 1 facility Union 2 schools none 2 schools 4.4% Clackamas 3.1% Yamhill 1 facility 2 schools 4.3% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 2.0% 3 schools 1.6% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 5.9% 25.0% Lincoln Jefferson 2.3% 1 school 1 school 1 facility 3 schools 4.9% 1.9% Grant Linn 3.8% 3.0% 1 school none Benton Crook 1 facility 2 schools 2.5% 4 facilities 1 school 1 facility resurvey Lane Deschutes 5.8% 1 facility 5.7% Malheur 0.0% Harney Douglas 1 facility 2 schools 1 facility 1.3% Coos 5 schools 3.1% 2 facilities 1 school 4.2% Lake 1.2% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 3.9% Jackson 1 facility 1 school 1.3% Josephine 6.1% 3 facilities 8.1% 1 facility 1 facility

25. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2007-2008 (Oregon 3.9%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 5.6% 1.0% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 5.2% 1.9% Umatilla Tillamook Hood 1.5% Wallowa Multnomah 9.0% Washington River 4.0% 2 schools 4.3% 1 facility 1 school none Morrow 0.5% Gilliam none 0.0% 2.2% Sherman 1 facility Union 2 schools none 2 schools 7.2% Clackamas 3.2% Yamhill 1 facility 2 schools 4.9% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 2.2% 3 schools 2.3% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 7.6% 6.7% Lincoln Jefferson 1.7% 1 school 1 school 1 facility 3 schools 5.8% 2.0% Grant Linn 8.5% 3.6% 1 school none Benton Crook 1 facility 2 schools 1.5% 4 facilities 1 school 1 facility resurvey Lane Deschutes 5.3% 1 facility 6.6% Malheur 1.2% Harney Douglas 1 facility 2 schools 1 facility 1.6% Coos 5 schools 2.6% 2 facilities 1 school 3.2% Lake 1.3% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 1.3% Jackson 1 facility 1 school 1.6% Josephine 6.4% 3 facilities 8.7% 1 facility 1 facility

26. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2008-2009 (Oregon 4.9%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 6.2% 1.8% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 6.3% 2.9% Umatilla Tillamook Hood 2.0% Wallowa Multnomah 14.3% Washington River 4.2% 2 schools 8.9% 1 facility 1 school none Morrow 1.0% Gilliam none 0.0% 3.1% Sherman 1 facility Union 2 schools none 2 schools 5.8% Clackamas 5.9% Yamhill 1 facility 2 schools 5.8% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 3.3% 3 schools 3.7% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 5.7% 0.0% Lincoln Jefferson 3.4% 1 school 1 school 1 facility 3 schools 6.1% 0.4% Grant Linn 2.2% 5.1% 1 school none Benton Crook 1 facility 2 schools 3.2% 4 facilities 1 school 1 facility resurvey Lane Deschutes 7.6% 1 facility 7.4% Malheur 0.8% Harney Douglas 1 facility 2 schools 1 facility 3.8% Coos 5 schools 3.8% 2 facilities 1 school 4.8% Lake 1.4% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 4.4% Jackson 1 facility 1 school 1.6% Josephine 5.1% 3 facilities 10.9% 1 facility 1 facility

27. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2009-2010 (Oregon 5.2%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 6.1% 3.4% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 6.8% 3.4% Umatilla Tillamook Hood 1.4% Wallowa Multnomah 10.3% Washington River 5.0% 2 schools 5.7% 1 facility 1 school ←1.9%→ none Morrow 1.0% Gilliam none 3.3% Sherman 1 facility Union 2 schools none 2 schools 6.2% Clackamas Yamhill 1 facility 2 schools 5.6% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 3.6% 3 schools 3.5% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 4.0% 0.0% Lincoln Jefferson 2.0% 1 school 1 school 1 facility 3 schools 7.3% 1.4% Grant Linn 1.8% 4.1% 1 school none Benton Crook 1 facility 2 schools 3.6% 4 facilities 1 school 1 facility resurvey Lane Deschutes 7.8% 1 facility 9.5% Malheur 0.6% Harney Douglas 1 facility 2 schools 1 facility 3.0% Coos 5 schools 3.8% 2 facilities 1 school 6.6% Lake 4.5% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 5.9% Jackson 1 facility 1 school 3.1% Josephine 6.0% 3 facilities 9.3% 1 facility 1 facility

28. <2% • 2-4% • 4-6% • 6-8% • >8% Kindergarten Religious Exemptions, 2010-2011 (Oregon 5.6%) Validation Surveys 2007 2 facilities 1 facility resurvey Clatsop Columbia 2 facilities 1 school 6.0% 3.8% 1 facility 2 schools 1 school resurvey 2 facilities 5 facilities 1 school 7.1% 3.3% Umatilla Tillamook Hood 1.2% Wallowa Multnomah 9.4% Washington River 6.1% 2 schools 6.9% 1 facility 1 school ←4.6%→ none Morrow 1.1% Gilliam none 4.4% Sherman 1 facility Union 2 schools none 2 schools 6.2% Clackamas Yamhill 1 facility 2 schools 6.4% Wasco 1 facility 1 school Marion Polk 2 facilities, 3 schools 3.4% 3 schools 3.7% 2 schools 1 facility resurvey Baker Wheeler 1 school 1 school resurvey 6.0% 0.0% Lincoln Jefferson 3.7% 1 school 1 school 1 facility 3 schools 6.2% 2.5% Grant Linn 8.3% 6.8% 1 school none Benton Crook 1 facility 2 schools 3.7% 4 facilities 1 school 1 facility resurvey Lane Deschutes 8.4% 1 facility 9.0% Malheur 1.4% Harney Douglas 1 facility 2 schools 1 facility 0.0% Coos 5 schools 4.8% 2 facilities 1 school 5.5% Lake 3.2% 1 facility 1 school • Janis • Lorraine • Peggy • Stacy • None Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 Curry Klamath 7.2% Jackson 1 facility 1 school 2.4% Josephine 7.7% 3 facilities 12.7% 1 facility 1 facility

29. Clinic vs. School

30. Question 1 Clinical Answer: School Law Answer: A student has received 1 dose of varicella vaccine. Does he need a second dose?

31. Question 2 Clinic: School: Should a potentially subpotent dose be counted as an acceptable dose?

32. Question 3 Clinic: School: A kindergartner received her 4th dose of polio at 2 years of age. Does she need a 5th dose? CDC Public Health Image Library ID#7224

33. Question 4 Clinic: School: A college freshman is moving into a dorm. Does he need a dose of meningococcal vaccine? http://www.pcc.edu/about/locations/rock-creek/

34. Question 5 Clinic: School: A 7th grader is in for her Tdap. Does she need anything else? http://www.preteenvaccines.org/

35. Intermission

36. http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis

37. Adolescent Immunization Recommendation Updates • Tdap expanded age recommendations • Meningococcal vaccine booster dose • HPV for males • Influenza for all ages • Pharmacists can give vaccines down to age 11 years

38. Question 6 Clinic: School: A preschooler got two doses of Hepatitis A vaccine three months apart. Does he need to repeat the last dose? CDC Public Health Image Library ID#2739

39. Question 7 Clinic: School: A child got MMR before her first birthday. Does she need to repeat this dose? CDC Public Health Image Library ID#7498

40. Question 8 Clinic: School: A 4-year old missed the Hib booster dose because of the shortage. Does she need her last dose of Hib for preschool now? CDC Public Health Image Library ID#1616

41. Question 9 Clinic: School: A 7th grader got a Td booster 4 years ago. Does he need Tdap now? CDC Public Health Image Library ID#7220

42. Question 10:The Bonus Question Will the new ALERT IIS have the printable Certificate of Immunization Status?

43. Oregon Immunization Law: Schools, Children’s Facilities & Colleges Oregon Revised Statutes 433.235 through 433.284 (Disease Control in Schools) Oregon Administrative Rules 333-050-0010 through 333-050-0140 (School Immunization Rules) public.health.oregon.gov/PreventionWellness/VaccinesImmunization/RulesLaws

44. Immunization School Law Contacts Janis Betten 971-673-0292 janis.s.betten@state.or.us ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Stacy de Assis Matthews 971-673-0528 stacy.d.matthews@state.or.us ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Peggy Lou Hillman 971-673-0292 peggy.hillman@state.or.us public.health.oregon.gov/PreventionWellness/ VaccinesImmunization/GettingImmunized/Pages/school.aspx