1. School Immunization Law Update April 14, 2011

2. Agenda Important info for school year 2011-2012 School year 2010-2011 update America’s favorite new game: Clinic vs. School

4. Hepatitis A: Not-So-New-Anymore Requirement Dose 1 required for children 18 months and older to in childcare, preschool, Head Start, kindergarten, 1 st, 2 nd, and 3 rd grade Dose 2 required by 12 months after the first dose Hepatitis A will be phased in: One grade level per year through 5 th grade in 2013-2014 All grades through 12 th in 2014-2015

5. Students now in grades 3-8 will be required to have Hepatitis A vaccine before they graduate!

6. One dose of Tdap is required for all 7 th - 10 th graders by Exclusion Day 2012 Tdap will be phased in: One grade level per year, finishing with 12th grade in 2013-2014 CDC Public Health Image Library ID#2121 Tdap: Not-So-New-Anymore Requirement

7. Primary Review Summary-Page 1

8. Changes to Primary Review Summary—Page 1 Kids with religious exemptions for some vaccines but incomplete for other vaccines go in the Incomplete category Complete and Up-to-date fields combined into one

9. Primary Review Summary—Page 2 No changes to this page

10. Primary Review Summary- Page 3

11. Changes to Primary Review Summary—Page 3 Count the number of kids with religious exemptions for each vaccine. Note—sites using eSIS will begin reporting this information for School Year 2011-2012!

12. School Year 2011-2012 School Year 2012-2013 Schools/facilities submit Primary Review Summary (PRS) pages 1-2 to the local health department (LHD) January 11, 2012January 16, 2013 Exclusion orders mailed by LHDFebruary 1, 2012February 6, 2013 Exclusion DayFebruary 15, 2012February 20, 2013 Schools/facilities submit updated PRS pages 2-3 to LHD February 27, 2012March 4, 2013 LHD submits County Immunization Status Report to the State March 9, 2012March 15, 2013 Exclusion Timeline

14. Exclusion Summary 2011 Children in Oregon covered by school and children’s facility immunization law: 659,526 Exclusion orders: 36,776 Children excluded: 4,932 NWHF Public Health Youth Photo Contest, 2010

18. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam 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% 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%

19. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam Morrow Umatilla Grant Union Baker Wallowa Malheur 0.0% 0.4% 3.5% 2.7% 3.8%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% Kindergarten and First Grade Religious Exemptions, 2001-2002 (Oregon 2.4%)

20. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam 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% Kindergarten and First Grade Religious Exemptions, 2002-2003 (Oregon 2.8%) 1.9%  <2%  2-4%  4-6%  6-8%  >8%

21. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam Morrow Umatilla Grant Union Baker Wallowa Malheur 0.0% 2.9% 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%

22. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam Morrow Umatilla Grant Union Baker Wallowa Malheur 0.0% 0.5% 6.0% 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% Kindergarten Religious Exemptions, 2004-2005 (Oregon 3.4%) 4.3%  <2%  2-4%  4-6%  6-8%  >8%

23. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam 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% 1.2% 4.9% 7.8% 3.1% 1.6% 18.2% 2.2% 1.2% 6.7% 1.6% Kindergarten Religious Exemptions, 2005-2006 (Oregon 3.5%) 4.4%  <2%  2-4%  4-6%  6-8%  >8%

24. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam Morrow Umatilla Grant Union Baker Wallowa Malheur 6.7% 0.0% 4.9% 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% Kindergarten Religious Exemptions, 2006-2007 (Oregon 3.6%) 5.9%  <2%  2-4%  4-6%  6-8%  >8%

25. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam 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% Kindergarten Religious Exemptions, 2007-2008 (Oregon 3.9%) 7.6%  <2%  2-4%  4-6%  6-8%  >8%

26. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam 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% Kindergarten Religious Exemptions, 2008-2009 (Oregon 4.9%) 5.7%  <2%  2-4%  4-6%  6-8%  >8%

27. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam Morrow Umatilla Grant Union Baker Wallowa Malheur 0.6% 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% Kindergarten Religious Exemptions, 2009-2010 (Oregon 5.2%)

28. 1 facility 2 schools 1 facility 3 schools 1 facility 2 schools 2 facilities 1 school 2 facilities 1 school 1 facility 2 schools 1 facility 4 facilities 1 school 1 facility resurvey 5 schools 1 school 1 facility 3 facilities 2 schools 1 facility resurvey 1 facility 1 school 1 facility 1 school 1 facility 1 school 2 facilities, 3 schools 5 facilities 1 school 3 schools 1 facility 1 school 1 facility 2 schools 1 school resurvey 2 schools 1 facility 1 school 2 facilities 1 facility resurvey 1 school 2 schools none Validation Surveys 2007 Validation Survey Totals Facilities—36 Schools—42 Facility Resurveys—3 School Resurveys—2 Total Surveys—83 1 school 1 school resurvey  Janis  Lorraine  Peggy  Stacy  None Clatsop Columbia Tillamook Washington Multnomah Clackamas Yamhill Polk Marion Lincoln Linn Benton Lane Douglas Coos Curry Josephine Jackson Klamath Lake Jefferson Wheeler Crook Deschutes Harney Hood River Wasco Sherman Gilliam Morrow Umatilla Grant Union Baker Wallowa Malheur 1.4% 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% Kindergarten Religious Exemptions, 2010-2011 (Oregon 5.6%)

30. Question 1 Clinical Answer:School Law Answer: A student has received 1 dose of varicella vaccine. Does he need a second dose?

31. Question 2 Clinic:School: Should a potentially subpotent dose be counted as an acceptable dose?

32. Question 3 Clinic:School: A kindergartner received her 4 th dose of polio at 2 years of age. Does she need a 5 th dose? CDC Public Health Image Library ID#7224

33. Question 4 Clinic:School: A college freshman is moving into a dorm. Does he need a dose of meningococcal vaccine? http://www.pcc.edu/about/locations/rock-creek/

34. Question 5 Clinic: School: A 7 th grader is in for her Tdap. Does she need anything else? http://www.preteenvaccines.org/

35. Intermission

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

37. Adolescent Immunization Recommendation Updates Tdap expanded age recommendations Meningococcal vaccine booster dose HPV for males Influenza for all ages Pharmacists can give vaccines down to age 11 years

38. Question 6 Clinic:School: A preschooler got two doses of Hepatitis A vaccine three months apart. Does he need to repeat the last dose? CDC Public Health Image Library ID#2739

39. Question 7 Clinic:School: A child got MMR before her first birthday. Does she need to repeat this dose? CDC Public Health Image Library ID#7498

40. Question 8 Clinic: School: A 4-year old missed the Hib booster dose because of the shortage. Does she need her last dose of Hib for preschool now? CDC Public Health Image Library ID#1616

41. Question 9 Clinic: School: A 7 th grader got a Td booster 4 years ago. Does he need Tdap now? CDC Public Health Image Library ID#7220

42. Question 10: The Bonus Question Will the new ALERT IIS have the printable Certificate of Immunization Status?

43. Oregon Immunization Law: Schools, Children’s Facilities & Colleges Oregon Revised Statutes 433.235 through 433.284 (Disease Control in Schools) Oregon Administrative Rules 333-050-0010 through 333-050-0140 (School Immunization Rules) public.health.oregon.gov/PreventionWellness/VaccinesImmunization/RulesLaws

44. Immunization School Law Contacts Janis Betten 971-673-0292 janis.s.betten@state.or.us ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Stacy de Assis Matthews 971-673-0528 stacy.d.matthews@state.or.us ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Peggy Lou Hillman 971-673-0292 peggy.hillman@state.or.us public.health.oregon.gov/PreventionWellness/ VaccinesImmunization/GettingImmunized/Pages/school.aspx