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

Source: Centers for Disease Control and Prevention

2015-2016:

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.

2222----17 months 17 months 17 months 17 months entering Child entering Child entering Child entering Child Care or Early Care or Early Care or Early Care or Early

Education Education Education Education

18 months or 18 months or 18 months or 18 months or older entering older entering older entering older entering

Preschool.Preschool.Preschool.Preschool. Child Child Child Child Care, or Head Care, or Head Care, or Head Care, or Head

Start Start Start Start Kindergarten or Kindergarten or Kindergarten or Kindergarten or

Grades 1Grades 1Grades 1Grades 1----6666 GradesGradesGradesGrades 7777----9999 Grades 10Grades 10Grades 10Grades 10----12 12 12 12

Check with healthcare provider or school/facility 4 DTAP 5 DTAP 5 DTAP/1 Tdap 5 DTAP/1Tdap

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: DiptheriaDiptheriaDiptheriaDiptheria////TetnusTetnusTetnusTetnus/Pertussis/Pertussis/Pertussis/PertussisMMR: MMR: MMR: MMR: MeaselsMeaselsMeaselsMeasels, Mumps and Rubella, Mumps and Rubella, Mumps and Rubella, Mumps and Rubella

Within 30 days

of the start of

school share

immunization

rates

January 17,

2018: Primary

Review

Summary

(PRS) forms 1

& 2 are due to

the County

February 7,

2018:

Exclusion

orders are

mailed to

parents and

schools by

County

February 21,

2018:

Exclusion Day

March 5,

2018: Primary

Review

Summary

(PRS) forms

updated page

2, 3 and 4 due

to the County

March 23,

2018: Share

immunization

rates

“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 333secondary review and follow up. OAR 333secondary review and follow up. OAR 333secondary review and follow up. OAR 333----050050050050----0010001000100010

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)

Total Issued 2017-2018

Totaled Issued 2016-2017

Students Excluded 2017-

2018

2858

3825

433

289 351

44

Washington County Exclusion Orders Issued

and Students Excluded

Incomplete/Insufficient No Record

Source: Immunization Record Information System (IRIS)

Decrease in Orders Issued Between

2016/2017 and 2017/2018

Incomplete/Insufficient: 25% decrease

No record: 17% decrease

AdjustedAdjustedAdjustedAdjustedEnrollEnrollEnrollEnroll NMENMENMENME % % % % D/T/PD/T/PD/T/PD/T/P %%%% MeaslesMeaslesMeaslesMeasles %%%% HepHepHepHep AAAA %%%% AllAllAllAll %%%%

Kindergarten 7,021 385 5.5% 225 3.2% 285 4.1% 255 3.6% 144 2.1%

7th 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?

Using a health equity lens, are there specific

disenfranchised groups WCPH should work closely with

or organizations we should partner with that are closely

associated with these groups?

Questions?

Nike Neuvenheim

(503)846-4855

Nike_Neuvenheim@co.washington.or.us