Deschutes coalition meeting 05 22 12.1

Paddling Against the Current:

Oregon School Immunization Law and Exemptions

Deschutes County Immunization Coalition

May 22, 2012

Background

Where are immunizations required?

•Public

•Private

Schools

•Preschool

•Child Care

•Head Start

Children’s Facilities

•2 doses of measles vaccine

Colleges

What exemptions are allowed?

Medical

Immunity

Religious

What do providers do?

≥1 Tdap ≥1 MCV4 ≥1 HPV (female)

0

10

20

30

40

50

60

70

80

90

100

NIS-Teen Adolescent Vaccine Uptake, Ages 13-17 Years

US, 2008Oregon, 2008US, 2009Oregon, 2009US, 2010Oregon, 2010

Percent

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

Data

2001-

2002

2002-

2003

2003-

2004

2004-

2005

2005-

2006

2006-

2007

2007-

2008

2008-

2009

2009-

2010

2010-

2011

2011-

2012

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Enrollment, Exclusion Letters and Exclusions, 2001-2012

Number of exclusionsNumber of exclusion orders issuedNumber of children enrolled in schools and children's facilities

DTaP Tdap

Polio MMR 2nd Measles

Hep B Varicella Hep A Hib0

10

20

30

40

50

60

70

80

90

100

Percent of Children with School/Children's Facility Required Vaccines, 2012

Children's Facility Kindergarten 7th Grade

Pe

rce

nt

Medical Exemptions Religious Exemptions No Record0

1

2

3

4

5

6

7

Percent of Children with Exemptions to School/Children's Facility Immunization Requirements or

No Record, 2012

Children's Facility Kindergarten 7th Grade

Pe

rce

nt

2000

-200

1*20

01-2

002*

2002

-200

3*20

03-2

004*

2004

-200

5*20

05-2

006*

2006

-200

7

2007

-200

8

2008

-200

9

2009

-201

0

2010

-201

1

2011

-201

2

0

1

2

3

4

5

6

7

Religious Exemption Rates, 2000-2012

Children's Facility Kindergarten and 1st Grade* 7th Grade

% R

elig

iou

s E

xe

mp

t

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools

2 facilities1 school

2 facilities


1 facility2 schools

1 facility

4 facilities1 school1 facility resurvey

5 schools

1 school

1 facility

3 facilities

2 schools1 facility resurvey

1 facility

1 facility1 school

1 facility1 school

1 facility

1 school

2 facilities, 3 schools


3 schools

1 facility1 school

1 facility2 schools1 school resurvey

2 schools

2 schools

1 facility1 school

2 facilities1 facility resurvey

1 school

2 schools

none

none

none

none

Validation Surveys2007

Validation Survey TotalsFacilities—36Schools—42

Facility Resurveys—3School Resurveys—2

Total Surveys—83

1 school1 school resurvey

Janis Lorraine Peggy StacyNone

Clatsop Columbia

TillamookWashington Multnomah

ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

0.0%

2.1%

2.8%

1.7%

2.7% 1.3%

1.6%

1.5%

5.0%

0.4%

1.1%

3.6%

0.5%

3.6%

1.5%

5.2%0.8%

1.6%

4.2%

0.9%

1.5%

2.0%

1.5%

0.2%1.0%

3.5%

8.5%

1.1%

1.1%

0.0%

1.5%

0.8%

1.3%0.0%

Kindergarten and First Grade Religious Exemptions,2000-2001 (Oregon 1.9%)

1.7%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

0.0%

0.4%

3.5%

2.7%

3.8% 1.6%

1.6%

2.8%

4.5%

2.7%

1.3%

4.2%

1.2%

3.4%

0.6%

11.2%0.1%

0.0%

5.0%

1.5%

1.6%

2.2%

2.5%

2.0%1.1%

4.7%

7.9%

1.2%

1.4%

3.5%

2.0%

0.8%

3.2%0.0%

2.1%

<2% 2-4% 4-6% 6-8% >8%


1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

0.0%

0.4%

4.4%

3.1%

3.5% 2.6%

1.1%

1.2%

9.6%

4.1%

1.3%

10.2%

2.5%

4.3%

0.0%

10.8%1.0%

0.0%

5.8%

1.9%

1.8%

2.8%

1.6%

2.0%1.0%

3.1%

4.7%

1.3%

1.5%

12.5%

2.3%

0.9%

3.2%0.8%


1.9%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

0.0%

2.9%

3.2%

3.2%

2.8% 1.5%

3.4%

1.5%

7.2%

4.9%

0.8%

3.0%

3.4%

4.5%

1.3%

7.3%1.0%

1.3%

5.6%

2.1%

1.7%

3.0%

2.5%

1.6%1.2%

4.5%

1.6%

1.0%

1.6%

6.3%

2.4%

4.4%

4.6%1.8%

Kindergarten Religious Exemptions,2003-2004 (Oregon 2.8%)

0.6%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

0.0%

0.5%

6.0%

3.5%

3.5% 1.0%

3.6%

1.3%

8.8%

5.1%

2.1%

6.5%

0.0%

4.9%

1.8%

7.7%1.9%

1.4%

6.2%

2.1%

2.2%

4.2%

2.8%

1.6%0.7%

7.9%

10.5%

2.7%

2.0%

100%

2.2%

1.2%

2.6%1.8%


4.3%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

10.0%

0.4%

5.5%

4.2%

3.5% 2.3%

2.4%

2.0%

6.1%

6.0%

2.2%

8.6%

1.3%

5.8%

2.1%

8.5%1.7%

5.8%

6.6%

3.3%

2.0%

4.0%

3.0%

3.0%1.2%

4.9%

7.8%

3.1%

1.6%

18.2%

2.2%

1.2%

6.7%1.6%


4.4%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

6.7%

0.0%

4.9%

4.3%

4.3% 1.6%

4.2%

2.5%

3.9%

5.7%

3.1%

3.8%

1.3%

6.1%

1.9%

8.1%1.3%

1.2%

5.8%

2.3%

2.0%

4.7%

1.6%

3.4%1.4%

4.4%

4.8%

3.1%

1.9%

25.0%

2.8%

3.0%

7.0%0.5%


5.9%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

0.0%

1.2%

5.8%

4.9%

5.6% 1.0%

3.2%

1.5%

1.3%

6.6%

2.6%

8.5%

1.6%

6.4%

2.0%

8.7%1.6%

1.3%

5.3%

1.7%

2.2%

5.2%

2.3%

4.0%1.5%

7.2%

9.0%

3.2%

1.9%

6.7%

2.2%

3.6%

4.3%0.5%


7.6%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none




Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur

0.0%

0.8%

6.1%

5.8%

6.2% 1.8%

4.8%

3.2%

4.4%

7.4%

3.8%

2.2%

3.8%

5.1%

0.4%

10.9%1.6%

1.4%

7.6%

3.4%

3.3%

6.3%

3.7%

4.2%2.0%

5.8%

14.3%

5.9%

2.9%

0.0%

3.1%

5.1%

8.9%1.0%


5.7%

<2% 2-4% 4-6% 6-8% >8%

1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none


Validation Survey TotalsFacilities—36Schools—42Facility Resurveys—3School Resurveys—2Total Surveys—83



Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur0.6%

7.3%

5.6%

6.1% 3.4%

6.6%

3.6%

5.9%

9.5%

3.8%

1.8%

3.0%

6.0%

1.4%

9.3%3.1%

4.5%

7.8%

2.0%

3.6%

6.8%

3.5%

5.0%1.4%

6.2%

10.3%←1.9%→

3.4%

0.0%

3.3%

4.1%

5.7%1.0%

4.0%

<2% 2-4% 4-6% 6-8% >8%


1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none





Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur1.4%

6.2%

6.4%

6.0% 3.8%

5.5%

3.7%

7.2%

9.0%

4.8%

8.3%

0.0%

7.7%

2.5%

12.7%2.4%

3.2%

8.4%

3.7%

3.4%

7.1%

3.7%

6.1%1.2%

6.2%

9.4%←4.6%→

3.3%

0.0%

4.4%

6.8%

6.9%1.1%

6.0%

<2% 2-4% 4-6% 6-8% >8%


1 facility

1 facility2 schools

1 facility3 schools

1 facility2 schools


2 facilities


1 facility2 schools

1 facility


5 schools

1 school

1 facility

3 facilities


1 facility

1 facility1 school

1 facility1 school

1 facility

1 school



3 schools

1 facility1 school


2 schools

2 schools

1 facility1 school


1 school

2 schools

none

none

none

none





Clatsop Columbia


ClackamasYamhill

Polk Marion

Lincoln

LinnBenton

Lane

DouglasCoos

Curry

JosephineJackson

Klamath

Lake

JeffersonWheeler

Crook

Deschutes

Harney

HoodRiver

Wasco

ShermanGilliam

Morrow

Umatilla

Grant

Union

Baker

Wallowa

Malheur0.9%

6.7%

6.6%

4.3% 4.3%

8.0%

5.0%

12.0%

7.7%

4.7%

5.9%

4.1%

6.3%

1.0%

10.7%2.2%

7.3%

8.5%

4.7%

4.0%

7.6%

5.1%

3.7%2.0%

4.6%

6.1%←4.6%→

3.8%

7.1%

4.7%

4.8%

5.7%1.1%

6.9%

<2% 2-4% 4-6% 6-8% >8%


Religious Exemptions by Vaccine

Full data for children in kindergarten and children’s facilities was collected in 2012.

Exemption rates for different vaccines were variable across counties.

Religious Exemptions by Vaccine

Preliminary findings:One-third of kindergarteners and one-half of

children in children’s facilities with a religious exemption were selective about vaccines.

Exemption rates for different vaccines were variable across counties.

Statewide Highest:

Statewide Lowest:

Deschutes Highest:

Deschutes Lowest:

Tracking exemption rates by vaccine

Statewide Highest:Measles (K)Hep A (Children’s)

Statewide Lowest:Pertussis (K and

Children’s)

Deschutes Highest:Measles & Hep A (K)Hep A & Varicella

(Children’s)

Deschutes Lowest:Hep B (K)Pertussis (Children’s)

D/T Pertussis Polio Measles Mumps Rubella Hep B Hep A Varicella0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percent exempt by vaccine, of kindergartners with selective religious exemptions

Oregon Deschutes

D/T Per-tussis

Polio Measles Mumps Rubella Hib Hep B Hep A Varicella

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percent exempt by vaccine, of children in chil-dren's facilities with selective religious exemptions

Oregon Deschutes

Vaccine Safety Resources

healthoregon.org/imm

Click on “Vaccine Safety”

Engaging the Media

Bend Bulletin Oregonian Portland Tribune Eugene Register

Guard The Lund Report Umpqua Post Corvallis Gazette

Times

Central Oregonian Ashland Tidings Medford Mail Tribune Portland Monthly Salem Statesman

Journal KBND KEX KGW

Local Public Health Communication Plans

AssessmentExisting resourcesBarriers

IdeasSite visitPlan

Case Response Plan

Other Activities

Child care provider trainer trainingsVaccine safety resource packetsFacebook and Twitter: OregonImmunize

Looking Downstream

Looking Downstream

Measles model to show what an outbreak in a school or community might look like.

Prenatal plan. An online webinar/learning module on vaccine

safety for parents (on the website). Recruit and train parent advocates. Develop discussion guide for information

sessions. Work with local health departments to target

high exemption rate schools.

Oregon Immunization ProgramSchool Law Team

Stacy de Assis Matthews971-673-0528

[email protected]

Janis Betten971-673-0292

[email protected]

Peggy Lou Hillman971-673-0292

[email protected]

1.oregon.gov/OregonSchoolLaw

Health & Medicine

Deschutes coalition meeting 05 22 12.1