Assessment of Immunization Records Under the Immunization of School Pupils Act

Report to: Board of Health

Meeting Date: March 2, 2016

Report Number: BOH Report – BH.01.MAR0216.R03

Prepared by: Neena Riarh, Manager, School Health

Approved by: Rita Sethi, Director, Community Health and Wellness

Submitted by: Dr. Nicola Mercer, Medical Officer of Health & CEO

Recommendation(s)

(a) That the Board of Health receives this report for information.

EXECUTIVE SUMMARY

In 1982, Ontario became the first province to pass laws requiring children to be vaccinated against certain diseases in order to attend school.1 This law, The Immunization of School Pupils Act (ISPA) outlines that all children attending school between ages 4 to 17 are required to be immunized according to the Publically Funded Immunization Schedule for Ontario. 2  The purpose of this act is to improve the health of children by protecting them from diseases that spread easily in schools.

ISPA provides public health agencies in Ontario with the responsibility and authority to collect immunization records, assess records for completeness and enforce immunization of all students.  Parents of children/students who do not wish to be vaccinated must file an exemption (medical or conscientious) with Public Health.2

Wellington-Dufferin-Guelph Public Health (WDGPH) has a comprehensive plan to ensure that all students who are overdue for ISPA immunizations are informed and provided an opportunity to provide updated records to WDGPH. This year, WDGPH will be focusing on the 7 and 17 year old immunization records as public health is accountable to the Ministry of Health and Long-term Care for these indicators. Students in this group who remain overdue for immunizations, despite numerous opportunities to update their records, will be suspended from school. In June parents of students aged 3 to 16 who are overdue for ISPA immunizations according to public health records will be sent a letter and provided methods to update their records with public health.

A broad ISPA Communication plan was launched in November 2015 informing the public of the need to update their immunization records and report these to Public Health. The campaign included newspaper advertisements; a media release; physician update; postcards, posters and pamphlets for schools and physician offices, and a Guide to Assessments and Suspension for school principals. An online reporting tool (www.immunizewdg.ca) was also launched for parents to report immunizations to public health and a call centre established to respond to calls related to immunizations from the public.

BACKGROUND

In 1982, Ontario became the first province to pass laws requiring children to be vaccinated against certain diseases in order to attend school.1 This law, The Immunization of School Pupils Act (ISPA) outlines that all children attending school between ages 4 to 17 are required to be immunized according to the Publically Funded Immunization Schedule for Ontario.  In 2014, ISPA was amended to include protection against 3 new diseases (meningococcal disease, pertussis, and varicella) in addition to the six previously required diseases.

  • Diphtheria
  • Tetanus
  • Polio
  • Measles
  • Mumps
  • Rubella
  • Meningococcal Disease-NEW requirement
  • Pertussis- NEW requirement
  • Varicella-NEW requirement (for children born on or after January 1, 2010)

ISPA provides public health agencies in Ontario with the responsibility and authority to collect immunization records, assess records for completeness and enforce immunization of all students.  Parents of children/students who do not wish to be vaccinated must file an exemption (medical or conscientious) with Public Health.2

In late 2015 the Ministry of Health and Long Term Care released a document “Immunize 2020; Modernizing Ontario’s Publicly Funded Immunization Program”.1 This document reflects the findings and recommendations from other recent key reports including:

  • Immunization System Review (2012)- The Ministry of Health and Long-term Cares review of the efficiency and effectiveness of Ontario’s Immunization System
  • Auditor General of Ontario’s 2014 Annual Report – The Auditor General of Ontario conducted an audit of Ontario’s Immunization system and eleven key recommendations.1

The Immunize 2020 report urges a comprehensive system-wide approach to the immunization program. It focuses on new vaccines and technologies, and on ways of strengthening the current system. The plan also emphasizes the need to develop system-level performance measurement systems to monitor our progress toward meeting accountability indicators and appropriate vaccine coverage.1

Additionally, new for 2016, the Ministry of Health and Long Term Care included an Accountability Indicator that measures the assessment and suspension of 7 and 17 year olds in our jurisdiction. This indicator is a monitoring indicator for this year (to serve as baseline values), however, once bench marks are set it will be an assessment indicator. 

ANALYSIS/RATIONALE

WDGPH has a comprehensive plan to meet the requirements of the ISPA; Accountability Indicators and address the components of the “Immunize 2020; Modernizing Ontario’s Publicly Funded Immunization Program document. 1

2016 School Year Assessment Plan

From January 2016 to June 2016, all 7 and 17 year olds will be assessed for overdue immunizations. Students and parents of children under 17 years old, will be notified of  immunizations reported as overdue in Public Health’s database, Panorama. Parents and students will be given ample opportunity to provide updated records to Public Health prior to suspension dates. A brief timeline of the 17 year old and 7 year old assessment and suspension process follows

Assessment Plan
Date Action/requirement
17 year old Assessments
January 2016 17 year old immunization records assessed
February 5, 2016 17 year olds letters sent indicating overdue immunizations according to Public Health records
February 16-March 2 Immunization clinics will be offered in all WDG high schools to provide missing immunizations and collect records.  
March 7, 2016 Last day for students to return immunization records to WDGPH
March, 2016 Suspension of 17 year old students who are overdue for ISPA immunizations
7 year old assessments
April 2016 7 year old immunization records assessed
April 20,25, 2016  7 year old letters sent indicating missing immunizations
May 2016  Immunization clinics will be offered in all WDG offices to provide missing immunizations and collect records.  
May 13, 2016 Last day for parents to return immunization records to WDGPH
May, 2016  Suspension of 7 year old students who are overdue for ISPA immunizations.
Students aged 4- 16 years old
May 2016 Assessment of all students 4-16 years old (except 7 year olds) 
June 2016 4-16 years old (except 7 year olds) letters sent indicating missing immunizations and the potential for suspension in upcoming school year if not up to date. 

Communication Campaign

In November 2015, WDGPH launched a campaign to inform the public of the need to report immunizations to Public Health. This was in anticipation of a suspension period in March. The following is a summary of key communications that have occurred from August 2015 to February 2016:

Month

Communication
August 2015
  • Meetings with Schools Boards to provide overview of ISPA and need to assess student immunization records and possibly suspend students. Timelines drafted.
November 2015
  • ISPA Campaign launched with newspaper ads in Guelph Mercury, Wellington Advertiser and Orangeville Banner informing public to update immunizations and report them to Public Health
  • Posters, pamphlets, postcards and covering letter sent to secondary school principals informing them of assessment and suspension plan
  • Postcards asking parents to vaccinate children and report records to Public Health sent to family physicians in Vaccine orders to display in their offices
  • Video developed with MOH Dr Mercer as spokesperson
  • On-line tool for reporting immunizations developed and launched (www.immunizewdg.ca)
December 2015
  • Updated website with up-to-date information on immunization requirements for school attendance and link to video
  • Call centre established with nurses responding to public questions related to immunizations 
January 2015
  • Media release distributed to local papers in regards to 17 year old students needing to report
  • Physicians’ Update regarding ISPA requirements and 17 year old assessments sent to all local physicians
  • Liaised with communication officers at School Boards to provide messaging for school websites and Twitter in regards to 17 year old assessments
  • School Boards emailed Guide to Assessment and Suspension Process to forward to all secondary school principals
February 2015
  • Principals emailed sample website, twitter, email/phone broadcasts for messaging for parents and students
  • Letters sent to all 17 year old students outstanding for ISPA immunizations. High school clinic to update immunizations advertised on letters. 

Plans to catch-up overdue students

WDGPH will provide many opportunities for students to obtain overdue immunizations. Public Health will be holding catch-up immunization clinics in each of the 15 secondary schools in WDG from February 16 to March 2, 2016. In addition clinics will be held in each of the Guelph, Orangeville and Fergus offices daily over March Break. Additionally a clinic will be held in Public Health’s Mt. Forest and Shelburne offices on March 17.

Nurses will be calling outstanding students after the high school catch-up clinics if they remain overdue for immunizations. Students will then be encouraged to attend March Break Clinics.

For the 7 year old assessments, Public Health will increase the number of evening clinics offered in Public Health offices during the month of May to provide opportunity for parents to bring in their children for vaccination. Students that are overdue for immunizations may also see their family physician to obtain their vaccinations.

Ontario Public Health Standards

Vaccine-preventable Diseases

Goal:

  • To reduce or eliminate the burden of vaccine-preventable diseases.

Board of Health Outcomes:

  • The Board of Health achieves timely and effective detection and identification of priority populations facing barriers to immunizations, their associated risk factors and emerging trends.
  • The public is aware of the importance of immunization across the lifespan.
  • Target coverage rates for provincially funded immunizations are achieved.
  • Children have up-to-date immunizations according to the current Publicly Funded Immunization Schedules for Ontario and in accordance with the Immunization of School Pupils Act and the Day Nurseries Act.

Disease Prevention Requirements

7. The Board of Health shall promote and provide provincially funded immunization programs to any eligible person in the health unit, including:

  • Board of Health-based clinics
  • School-based clinics (including, but not limited to, hepatitis B and meningococcal immunization)
  • Community-based clinics
  • Outreach clinics to priority populations

WDGPH Strategic Commitment

Strategic Directions
DIRECTION APPLIES? (YES/NO)
Health Equity: We will provide programs and services that integrate health equity principles to reduce or eliminate health differences between population groups.       NO
Organizational Capacity: We will improve our capacity to effectively deliver public health programs and services.        NO
Service Centred Approach: We are committed to providing excellent service to anyone interacting with Public Health.      YES

Building Healthy Communities: We will work with communities to support the health and well-being of everyone.

  • This direction is met through our partnerships with local schools boards and schools to deliver immunization clinics in schools through WDG.
  • The Immunization team also partners with parents to ensure that their children are vaccinated according to the Publicly Funded Immunization Schedule.
     YES

Health Equity

An individual’s access to appropriate, timely and effective healthcare at no cost, has a direct impact on their overall health. Vaccinations falling under the Immunizations of School Pupils Act are provided to all students free of charge in schools, public health offices and physician offices. 

Appendices

N/A

References

1. Immunize 2020: Modernizing Ontario’s Publically Funded Immunization Program. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/immunization_2020/ 

2. Immunization of School Pupils Act. [Internet]1990, R.S.O. 1990, c. I.1 [cited 2015 Oct 19] Available from: http://www.ontario.ca/laws/statute/90i01