1. An Evaluation of Vaccine-specific Exemptions in Multnomah County, Oregon Kelly McCarthy Howard PHAP Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2014 PHAP Spring Training April 4, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. School Immunization  State School Immunization Law  Medical exemptions  Non-medical, philosophical, religious exemptions  Grounds to enforce immunization requirements  School Exclusion Maintain high immunization rates  Outbreak preparedness Documentation for exempt students http://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html

3. Immunization Surveillance  Annual CDC reports based on school vaccination surveys  MMWR: Vaccination Coverage Among Children in Kindergarten  Immunization surveillance goals:  Identify groups at risk of contracting vaccine-preventable diseases;  Stimulate efforts to increase coverage;  Evaluate how well the efforts work http://www.cdc.gov/vaccines/imz-managers/coverage/imz-coverage.html http://www.cdc.gov/vaccines/imz-managers/coverage/articles.html

4. National Childhood Vaccination Rates and State/Community Data Infographic http://www.cdc.gov/vaccines/parents/infographics/schoolvaxview-states.html

5. Multnomah County, OR  Nationally, Oregon had the highest rate of non-medical exemptions among Kindergarteners from 2012-2014  Trend of increasing non-medical exemptions, above State average Oregon Immunization Program

6.  Senate Bill 137  Required vaccine education to obtain a non-medical exemption Vaccine education videos Healthcare Provider counseling 2014-2015 School Year: Two Key Events  California Measles Outbreak  December 2014-February 2015  High-profile, media attention https://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/GettingImmunized/Documents/SchoolDataFAQ.pdf http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm

7. Methods  Review of vaccine-specific exemptions among: 1) Total Kindergarten population 2) Kindergarteners with one or more nonmedical exemption  Determine Yearly Percent Change  By vaccine

8. Oregon Immunization Program Results

9. Oregon Immunization Program Results (continued)

10. Results (cont.) Oregon Immunization Program Kindergarteners Exempt/ Total Number of Students Exempt for One or More Vaccine DTPertPolio Measles MumpsRubellaHep BHep AVarAll 2012 73.34%72.74%78.16%80.57%68.98%68.67%78.01%80.87%75.00%50.75% 2013 70.58%71.59%76.39%79.92%71.97%71.34%78.16%81.44%78.54%58.08% 2014 65.99%65.88%72.95%74.41%63.75%63.86%82.27%76.99%73.06%49.83% 2015 N/A64.02%70.86%59.92%58.41% 83.17%80.30%68.40%47.06%

11. Yearly Percent Change Oregon Immunization Program Results (cont.) PertPolioMeaslesMumpsRubellaHep BHep AVarAll 2012- 201312.52%11.74%13.41%19.29%18.76%14.54%15.13%19.72%30.84% 2013- 20141.01%4.82%2.19%-2.77%-1.74%15.54%3.77%2.12%-5.83% 2014- 2015 -16.71%-16.75%-30.99%-21.47%-21.61%-13.35%-10.61%-19.77%-19.06%

12. Conclusions  Although causation cannot be determined:  SB 137:  Overall decrease in non-medical exemptions  California Measles Outbreak:  Distinctive reversal in non-medical exemptions to measles vaccine http://www.cdc.gov/vaccines/imz-managers/coverage/imz-coverage.html

13. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you! Kelly McCarthy Howard KHoward1@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

14. Multnomah County Kindergarten Vaccine-Specific Coverage Rates Oregon Immunization Program

15. MeasureMedian Rate2014-2015 Oregon Rate MMR2 coverage94.0%94.1% DTAP5 coverage94.2%93.8% Total nonmedical exemptions1.5%5.8% Total any exemptions1.7%6.0% Percentage point difference in any exemption from 2013-14 to 2014-15 -0.1-1.1 State Total Nonmedical Exemptions Idaho6.2% Vermont5.9% Oregon5.8% Colorado5.4% Wisconsin4.9% Median1.2% Vaccination Coverage Among Children in Kindergarten- United States, 2014-15 School Year, MMWR August 28, 2015 / 64(33); 897-904 Top Five Exempting States