1. Chris Finley and Karen Halverson Ensuring Herd Immunity Immunization Rules for Schools and Child Care

2. Today’s objectives  Rationale for immunization regulations  Reporting requirements  Statewide variations in rates  Addressing challenges

3. State Immunization Rules  Prevent disease transmission  Reduce risk in group settings  Support herd immunity

4. Herd Immunity

5. Measles at Vermont’s borders Massachusetts, New York and New Hampshire 50 cases 1/1/11-10/8/11 Only religious and medical exemptions allowed No philosophic exemptions

6. Measles at Vermont’s borders Quebec 745 cases 4/3/11 -10/5/11 11% of cases hospitalized No vaccination requirements for school

7. Development of Immunization Rules  Specific state statutes  Rules provide details for implementation  Defined process for passage of rules  Opportunity for public input  Reviewed by two committees

8. Vermont’s Immunization Rules  Immunizations required for enrollment  Application in child care and school settings  Annual reporting period

9. Vermont Recommended Child and Teen Vaccination Schedule

10. Child Care Requirements  Who do the rules apply to?  How are these different than school rules?  Who completes child care reports?

11. Information for Child Care Providers  Put in pictures of 2 brochures and manual

13. School Requirements  Align with Advisory Committee on Immunization Practices (ACIP) recommendations  Allow for exemptions  Provisional admittance limit of one year

16. Kindergarten data 2010-11

17. Measles outbreak risk in Vermont Herd immunity threshold for measles: 95% 2010-11 kindergarteners with 2 doses MMR: 90.9% Schools with coverage below 95%: 136

18. School Site Visits  January - May 2011 Pilot visits to selected schools by Immunization Program staff  Sept 2011 - May 2012 Site visits to all schools conducted by District Office school liaisons  Sept 2011 - May2012 Quality improvement project visits for 15 schools conducted by VCHIP/VDH

19. Increasing Compliance with Vermont Vaccine Requirements  Utilize electronic data sources VT Immunization Registry school health software programs

20. Increasing Compliance with Vermont Vaccine Requirements  Outreach at enrollment before vacation and holiday breaks newsletters, websites, PTO

21. Immunization Program Support  Vermont Immunization Program 1-800-640-4374 immunizationprogram@state.vt.us  District Office staff School liaison Immunization Designee