Ashland School District Immunization Rates
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1 Ashland School District Immunization Rates Summary of Post-Intervention Data SOUTHERN OREGON UNIVERSITY RESEARCH CENTER July 19, Authored by: Patricia E. Styer, PhD Submitted to Jim Shames, MD, Medical Director, Jackson County, Oregon i Southern Oregon University Research Center
2 (Intentionally blank) ii Southern Oregon University Research Center
3 Table of Contents Executive Summary... iv Introduction... 1 Research Methodology... 1 Comparison of and Immunization Rates... 2 Comparison of Immunization Rates for New and Returning Students Appendix A Oregon Immunization Requirements Appendix B 2012 CDC Catch-up Immunization Schedule Appendix C Immunization Tallies by School, June 3, Data Extract iii Southern Oregon University Research Center
4 Executive Summary This report summarizes and compares immunization rates for Ashland School District students using data records from May 31, and June 3,. The initial data extract shows baseline immunization rates prior to a series of activities overseen by the Ashland Immunization Outreach Team (AIOT). The baseline data has been summarized in a preliminary report and was used to complete epidemiological models of a measles outbreak in the Ashland School District. The second data extract represents a post-intervention remeasurement of immunization rates. The comparison of baseline and remeasurement data shows: The percentage of students in the Ashland School District with all required immunizations did not increase. For most individual vaccine series, the percentage of students with complete immunizations did not increase. Overall immunization rates for H influenza b and hepatitis A did increase. The requirements for hepatitis A changed during the study period so increases were particularly large at the elementary school level. For some grade levels, immunization rates consistently increased, but overall gains were offset by decreases in other grade levels. Similarly, changes in immunization rates differed by school. Students entering Ashland School District during the two year study period had similar rates of partial and full religious exemptions compared to students who were enrolled during both measurement periods. Newer students had slightly lower rates of complete immunizations iv Southern Oregon University Research Center
5 Introduction This report summarizes immunization data extracted from the Ashland School District vaccination records on May 31, and June 3,. The data contains records for individuals enrolled in seven public schools. The number of student records from each school is shown in Table1. Table 1. Number of students from each school Ashland High School Ashland Middle School Elementary 1 (Bellview) Elementary 2 (Helman) Elementary 3 (Walker) John Muir (K-8) Willow Wind Total Each student record includes the status and dates of immunizations or disease history for these vaccines: diptheria/tetanus/pertussis (DTP), poliovirus, measles/mumps/rubella (either combined or as single antigen vaccines), varicella, hepatitis A, hepatitis B, and Haemophilus influenzae type b (H influenza type b). Parents provide dose dates or exemption information, and school personal may add information utilizing the Oregon ALERT system. Research Methodology School district personnel provided a data listing of individual records from the immunization database with all personal identifying information removed. Students were assigned a unique identification number to permit linking records from the two extraction dates. The database includes indicators of overall immunization status, called the form status, and indicators of immunization status by individual antigen. There were some inconsistencies in the database between the form status and the records by individual antigen, probably because each student record includes information from multiple sources and review periods. For this report, a new summary variable was developed to describe the immunization status by individual antigen capturing maximum information from parent reporting and use of the ALERT database. Recoding of Individual Antigen Status Each student record includes actual dose or disease dates in addition to an assigned status by 1 Southern Oregon University Research Center
6 antigen. Immunization status by individual antigen has been reassigned using a combination of information from the individual antigen status, the form status, the CDC recommended immunization and catch-up immunization schedules, and the recorded dose and disease dates. As noted, this coding scheme is intended to capture maximum information from multiple sources. Additionally, incorporation of the CDC catch-up schedule reflects the likely scenario that many Ashland students have been immunized using a delayed vaccination schedule. The status for each individual disease antigen may have up to three-levels (if multiple doses are required): None Zero doses; no disease history. Partial At least one dose has been received, but fewer than the minimum indicated in the CDC catch-up schedule; school personnel has not indicated that the series is complete. Complete Number of doses complies with the CDC catch-up schedule OR school personnel has indicated that the series is complete and the overall form status is complete or up-to-date Notes on Individual Vaccines Currently only one varicella shot is required in Oregon so the varicella series is complete if there is a record of at least one dose. Mumps and rubella are reported separately from measles since Oregon requires only one mumps and rubella dose. Because of the age-based variation in the Tdap requirements, this vaccine is not reported separately from DTaP. All diphtheria/tetanus/pertussis doses have been combined into a single count. H influenza type b is not required for grades K-12 in Oregon but is tracked in the ASD immunization database. See Appendix A for a list of Oregon requirements from the remeasurment period. Appendix B shows the concurrent CDC catch-up immunization schedule. Comparison of and Immunization Rates Table 2 shows the overall immunization status from both measurement periods. Note that the rate of complete immunizations decreased during the study period from 72.6% to 69%. The rate of up-to-date forms increased from about one percent to over three percent. This classification indicates that the student is in the process of completing all series following an appropriate catch-up schedule. 2 Southern Oregon University Research Center
7 Table 2. Overall classification from the ASD database Ashland School District Immunization Rates Frequency Percent Frequency Percent Complete Incomplete Medical All Medical Part No Record Religious All Religious Part Up-to-date Total Table 3 shows the completion rates for each vaccine series using the recoded data for the and extracts. Appendix A shows the same three-level completion rates by individual school for the data extract. Note that completion rates by vaccine are virtually unchanged except for hepatitis A and H influenza type b. 3 Southern Oregon University Research Center
8 Table 3. Completion Rates by Vaccine for all Students Vaccine Status Frequency Percent Frequency Percent Measles None Partial Complete DTP (all forms) None Partial Complete Rubella None Complete Mumps None Complete Poliovirus None Partial Complete Varicella None Complete Hepatitis A None Partial Complete Hepatitis B None Partial Complete H influenza type b None Partial Complete Figure 1 shows the percentage of students with completed vaccinations by individual antigen and school for both the and measurement periods. Note that Willow Wind, Walker Elementary, and Bellview Elementary have increased completion rates for several vaccines. Rates of immunization at John Muir have decreased for most vaccines. 4 Southern Oregon University Research Center
9 Figure 1: Rates of Complete Vaccine Series by School, and Measles Willow Wind 41% 37% John Muir (K-8) 54% 58% Elementary 3 (Walker) Elementary 2 (Helman) Elementary 1 (Bellview) Ashland Middle School Ashland High School 80% 75% 78% 84% 85% 82% 83% 85% 81% 82% 0% 20% 40% 60% 80% 100% DTP (Combined) Willow Wind John Muir (K-8) Elementary 3 (Walker) Elementary 2 (Helman) Elementary 1 (Bellview) Ashland Middle School Ashland High School 53% 49% 60% 64% 82% 78% 83% 88% 88% 84% 84% 86% 84% 84% 0% 20% 40% 60% 80% 100% 5 Southern Oregon University Research Center
10 Figure 1, cont. Rates of Complete Vaccine Series by School, and Polio Willow Wind John Muir (K-8) 49% 50% 57% 61% Elementary 3 (Walker) Elementary 2 (Helman) Elementary 1 (Bellview) Ashland Middle School Ashland High School 83% 79% 83% 88% 89% 85% 85% 86% 84% 85% 0% 20% 40% 60% 80% 100% Varicella Willow Wind John Muir (K-8) Elementary 3 (Walker) Elementary 2 (Helman) Elementary 1 (Bellview) Ashland Middle School Ashland High School 47% 46% 61% 65% 81% 77% 81% 87% 86% 83% 88% 87% 85% 85% 0% 20% 40% 60% 80% 100% 6 Southern Oregon University Research Center
11 Figure 1, cont. Rates of Complete Vaccine Series by School, and Hepatitis A Willow Wind John Muir (K-8) 17% 31% 37% 28% Elementary 3 (Walker) 42% 66% Elementary 2 (Helman) Elementary 1 (Bellview) 42% 49% 70% 71% Ashland Middle School 30% 42% Ashland High School 16% 34% 0% 20% 40% 60% 80% Hepatitis B Willow Wind John Muir (K-8) 46% 46% 54% 57% Elementary 3 (Walker) Elementary 2 (Helman) Elementary 1 (Bellview) Ashland Middle School Ashland High School 81% 79% 83% 88% 88% 85% 85% 86% 82% 81% 0% 20% 40% 60% 80% 100% 7 Southern Oregon University Research Center
12 Figure 1, cont. Rates of Complete Vaccine Series by School, and H influenza type b Willow Wind John Muir (K-8) 43% 40% 51% 43% Elementary 3 (Walker) Elementary 2 (Helman) Elementary 1 (Bellview) Ashland Middle School Ashland High School 69% 66% 78% 81% 76% 65% 73% 69% 70% 61% 0% 20% 40% 60% 80% 100% Figure 2 shows the percentage of students with completed vaccinations by individual antigen and grade level. Immunization rates for H influenza type b increased for all grade levels. For all other vaccines, there is a slight increase in completion rates for fourth and fifth grade students in the remeasurement period. Figure 2: Rates of Complete Vaccine Series by Grade Level, and 100% 90% Measles 80% 70% 60% 50% K Southern Oregon University Research Center
13 Figure 2, cont. Rates of Complete Vaccine Series by Grade Level, and 100% 90% DTP (Combined) 80% 70% 60% 50% K % Polio 90% 80% 70% 60% 50% K % Varicella 90% 80% 70% 60% 50% K Southern Oregon University Research Center
14 Figure 2, cont. Rates of Complete Vaccine Series by Grade Level, and 100% 90% Hepatitis A 80% 70% 60% 50% K % Hepatitis B 90% 80% 70% 60% 50% K % H influenza type b 90% 80% 70% 60% 50% K Southern Oregon University Research Center
15 Comparison of Immunization Rates for New and Returning Students Table 4 compares the overall immunization status in for students enrolled during both measurement periods with students enrolled only in. The summary excludes newly enrolled students in kindergarten and first grade to match the grade levels of continuously enrolled students. Here, the rate of complete immunization is slightly lower for newly enrolled students, but the up-to-date rate is higher. This suggests that these students are in the process of completing their immunizations and documentation. Rates of religious exemptions are similar for the two groups. Table 4. Form Status by Continuous versus New Enrollment Excluding Kindergarteners and First Graders Enrolled Both Years Frequency Enrolled Both Years Percent Enrolled Only Frequency Enrolled Only Percent Complete % % Incomplete 1 0% 6 1% Medical All 0 0% 0 0% Medical Part 6 0% 0 0% No Record 2 0% 0 0% Religious All % 85 16% Religious Part % 60 11% Up-to-date 44 2% 24 4% Total Southern Oregon University Research Center
16 Appendix A Oregon Immunization Requirements 12 Southern Oregon University Research Center
17 Appendix B 2012 CDC Catch-up Immunization Schedule 13 Southern Oregon University Research Center
18 Appendix C Immunization Tallies by School, June 3, Data Extract These counts are included to permit further modeling of disease outbreaks or other data summaries. Vaccine Number of Doses Ashland High School Ashland Middle School Bellview Elementary Helman Elementary Walker Elementary John Muir (K-8) Willow Wind Measles Measles Measles Rubella Rubella Rubella Mumps Mumps Mumps DTP Combined DTP Combined DTP Combined DTP Combined DTP Combined Chickenpox Chickenpox Chickenpox Polio Polio Polio Polio Hepatitis A Hepatitis A Hepatitis A Hepatitis B Hepatitis B Hepatitis B Hib Hib Hib Hib Southern Oregon University Research Center
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