Presented by Nike Neuvenheim, MPA Sr. Program Coordinator, Disease - PowerPoint PPT Presentation

Presented by Nike Neuvenheim, MPA Sr. Program Coordinator, Disease Control and Prevention Program April 10, 2018: Presentation to Washington County Public Health Advisory Council

Vaccines are among the most cost-effective clinical preventive services and are a core component of any preventive services package. Childhood immunization programs provide a very high return on investment. For example, for each birth cohort vaccinated with the routine immunization schedule (this includes DTap, Td, Hib, Polio, MMR, Hep B, and varicella vaccines), society: • Saves 33,000 lives • Prevents 14 million cases of disease • Reduces direct health care costs by $9.9 billion • Saves $33.4 billion in indirect costs

Despite progress, approximately 42,000 adults and 300 children in the United States die each year from vaccine-preventable diseases.* Communities with pockets of unvaccinated and under vaccinated populations are at increased risk for outbreaks of vaccine- preventable diseases. In 2008, imported measles resulted in 140 reported cases—nearly a 3-fold increase over the previous year. The emergence of new or replacement strains of vaccine-preventable disease can result in a significant increase in serious illnesses and death. *This includes influenza, but does not include deaths due to 2009 H1N1. Source: Office of Disease Promotion and Health Prevention, Healthy People 2020

MMR: 2016-2017 MMR: 2015-2016 Source: Centers for Disease Control and Prevention

2015-2016: Source: Centers for Disease Control and Prevention

Various surveys founds high exemption clusters associated with some of the following: • Both high and lower socioeconomic status clusters – survey results were contradictory. • Lifestyle categorized as “alternative living” , which includes veganism or vegetarianism, organic gardening, and use of natural healing remedies. • Sociodemographic composition of the school and surrounding community also predicted exemption rates. Higher exemption rates were associated with higher proportion of Whites, higher percentage of college graduates, higher median household income, and lower percentage of families in poverty at the census tract, zip code, or school district level.

• More exemptions in rural than in urban school districts , and exemption rates were higher, and increased faster, among private than public schools. • Perceptions of information provision and sufficiency were correlated with exemption preferences. Parents who did not believe that they had enough immunization information were more likely to believe that states should grant exemptions on the basis of religious and personal beliefs and that parents should be allowed to obtain exemptions for their child even if it raised the risk of disease for everyone else. However, evidence was inconsistent regarding access to information. Source: American Public Health Association: Nonmedical Exemptions from School Immunization Requirements: A Systematic Review. November 2014

OAR 333-050-0020, Purpose and Intent (1) The purpose of these rules is to implement Oregon Revised Statutes (ORS) 433.235 through 433.284, which require evidence of immunization, a medical or nonmedical exemption, or immunity documentation for each child as a condition of attendance in any school or facility, and which require exclusion from school or facility attendance until such requirements are met.

18 months or 18 months or 18 months or 18 months or 2 2 2- 2 -17 months - - 17 months 17 months 17 months older entering older entering older entering older entering entering Child entering Child entering Child entering Child Preschool. Preschool. Preschool. Preschool. Child Child Child Child Care or Early Care or Early Care or Early Care or Early Care, or Head Care, or Head Care, or Head Care, or Head Kindergarten or Kindergarten or Kindergarten or Kindergarten or Education Education Education Education Start Start Start Start Grades 1- Grades 1 Grades 1 Grades 1 - -6 - 6 6 6 Grades Grades Grades 7 Grades 7 7 7- - - -9 9 9 9 Grades 10 Grades 10 Grades 10- Grades 10 - - -12 12 12 12 Check with healthcare provider 4 DTAP 5 DTAP 5 DTAP/1 Tdap 5 DTAP/1Tdap or school/facility 3 Polio 4 Polio 4 Polio 4 Polio 1 Varicella 1 Varicella 1 Varicella 1 Varicella 1 MMR 2 MMR 2 MMR 2 MMR 3 Hepatitis B 3 Hepatitis B 3 Hepatitis B 3 Hepatitis B 2 Hepatitis A 2 Hepatitis A 2 Hepatitis A -- 3 or 4 Hib -- -- -- DTAP: DTAP: DTAP: DTAP: Diptheria Diptheria Diptheria Diptheria/ /Tetnus / / Tetnus Tetnus Tetnus/Pertussis /Pertussis /Pertussis /Pertussis MMR: Measels MMR: MMR: MMR: Measels Measels Measels, Mumps and Rubella , Mumps and Rubella , Mumps and Rubella , Mumps and Rubella

February 7, March 5, January 17, 2018: 2018: Primary Within 30 days 2018: Primary Exclusion Review March 23, of the start of Review February 21, orders are Summary 2018: Share school share Summary 2018: mailed to (PRS) forms immunization immunization (PRS) forms 1 Exclusion Day parents and updated page rates rates & 2 are due to schools by 2, 3 and 4 due the County County to the County “Primary Review Summary” : a form provided or approved by Primary Review Summary” : a form provided or approved by Primary Review Summary” : a form provided or approved by Primary Review Summary” : a form provided or approved by the Public Health Division to school and facilities for enclosure the Public Health Division to school and facilities for enclosure the Public Health Division to school and facilities for enclosure the Public Health Division to school and facilities for enclosure with records forwarded to the local health department for with records forwarded to the local health department for with records forwarded to the local health department for with records forwarded to the local health department for secondary review and follow up. OAR 333- secondary review and follow up. OAR 333 -050 050- -0010 0010 secondary review and follow up. OAR 333 secondary review and follow up. OAR 333 - - 050 050 - - 0010 0010

508 Washington County Sites (children’s facilities and schools) Total Enrollment: 113,967 Children Not Counted: 3,501 (spend a majority of their time at another site) Adjusted Enrollment: 110,466 (total enrollment minus children not counted) Medical Exemptions: 207 Nonmedical Exemptions: 3,485 Source: Immunization Record Information System (IRIS)

Washington County Exclusion Orders Issued and Students Excluded Incomplete/Insufficient No Record 3825 2858 Decrease in Orders Issued Between 2016/2017 and 2017/2018 Incomplete/Insufficient: 25% decrease No record: 17% decrease 289 351 433 44 Total Issued 2017-2018 Totaled Issued 2016-2017 Students Excluded 2017- 2018 Source: Immunization Record Information System (IRIS)

Adjusted Adjusted Adjusted Adjusted Enroll Enroll NME NME % % D/T/P D/T/P % % Measles Measles % % Hep A Hep A % % All All % % Enroll Enroll NME NME % % D/T/P D/T/P % % Measles Measles % % Hep Hep A A % % All All % % Kindergarten 7,021 385 5.5% 225 3.2% 285 4.1% 255 3.6% 144 2.1% 7 th Grade 7,325 205 2.8% 170 2.3% 122 1.7% 134 1.8% 71 1.0 Children’s Facilities 12,546 641 5.1% 331 2.6% 424 3.4% 460 3.7% 240 1.9% Full School (K-12) 94,338 3,104 3.3% 2,052 2.2% 2,149 2.3% 1,840 2.5% 1,213 1.3% Source: Immunization Record Information System (IRIS)

Why Share? Senate Bill 895, passed in 2015, requires schools and child care facilities to have their immunization and exemption rates available at their main offices, on their websites, and for parents on paper or electronic format. When to Share? 30 days after the start of school AND 30 days after Exclusion Day The online sharing of local-level data with the public contributes to transparency in public health by placing information about the risk for vaccine preventable diseases in the hands of parents and communities.

� In collaboration with the Oregon Health Authority - Oregon Immunization Program, promote AFIX (Assessment, Feedback, Incentives and eXchange) a quality improvement program supporting Vaccine for Children providers. � Use local-level vaccination data to identify clusters of low vaccination coverage, and develop and implement an effective outreach program. � Increase public health messaging focused on adherence to recommended immunization schedule targeted towards prenatal period and throughout infancy.

� Strengthen collaborative partnerships with Washington County School Districts, School-Based Health Care Centers, and safety net clinics. � Reduce school exclusion orders and nonmedical exemptions through an increased presence at back to school events and through a targeted media campaign.

As Washington County Public Health (WCPH) continues to address nonmedical exemptions prevalence and trends in Washington County what combination of targeted approaches would have the greatest impact?

As WCPH strengthens and develops partnerships at the state and local-level among policy makers, educational institutions and childcare facilities, non-profit organizations and the public – what partnerships do you believe would enable us to have the greatest impact on vaccine hesitancy and adherence to the recommended immunization schedules?