Exclusion of Students During an Outbreak of a Vaccine Preventable Disease Identified in the Immunization of School Pupils Act, 1990

Policy

Category: Control of Infectious Diseases
Subject: Exclusion of Students During an Outbreak of a Vaccine Preventable Disease Identified in the Immunization of School Pupils Act, 1990
Division: Health Protection
Policy Number: CA.82.01.133
Effective Date: March 26, 2015

POLICY STATEMENT

In the event of a laboratory confirmed vaccine preventable disease outbreak in a school it is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) to enforce the Immunization of School Pupils Act (ISPA) through exclusion of non-immunized or under immunized students without proof of immunity. Enforcement of exclusion will pertain to vaccine preventable diseases identified in the ISPA, including (as of July 1, 2014): meningococcal disease, pertussis (whooping cough), varicella (chickenpox), rubeola (measles), mumps, rubella, diphtheria, tetanus and polio. Meningococcal disease, pertussis and varicella were added as a new requirement for the 2014/2015 year; varicella is a requirement only in those children born in or after 2010.

SCOPE

This policy applies to all Control of Infectious Diseases (CID) Public Health Nurses (PHNs) and Public Health Inspectors (PHIs) that investigate the reportable diseases covered under the ISPA

DEFINITIONS

Immunization of School Pupils Act R.R.O. 1990, Regulations 645, Consolidation Period: from July 1, 2014 to the e-Laws currency date.

Outbreak – The declaration of an outbreak in the school will be made by the Medical Officer of Health based on disease, evidence of transmission (epi-link) and laboratory confirmation of disease. 

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.133 Exclusion of Students During an Outbreak of a Vaccine Preventable Disease Identified in the Immunization of School Pupils Act, 1990

Immunization of School Pupils ActR.R.O. 1990, Regulations 645, Consolidation Period: From July 1, 2014 to the e-Laws currency date.  Available at: http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900645_e.htm

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis

APPROVED BY

Robert Thompson  


Procedure

Category: Control of Infectious Diseases
Subject: Exclusion of Students During an Outbreak of a Vaccine Preventable Disease Identified in the Immunization of School Pupils Act, 1990
Division: Health Protection
Procedure Number: CA.82.02.133
Effective Date: March 26, 2015

PROCEDURE

 In the event of an outbreak of a vaccine preventable disease identified in the Immunization of School Pupils Act (ISPA), Wellington-Dufferin-Guelph Public Health (WDGPH) will proceed with the exclusion of all under and unimmunized students without documented evidence of immunity. At the discretion of the Medical Officer of Health (MOH), an outbreak may be declared when there is laboratory confirmation of disease with evidence of transmission within the school/community setting.

Process for Exclusion of Students under the ISPA
  1. When a report of an infectious disease that falls under the ISPA (diphtheria, tetanus, polio, measles, mumps, rubella, meningococcal disease, pertussis, and varicella) is received by the Control of Infectious Diseases (CID) team, the Manager and/or Supervisor will determine if the School Health Team (SHT) needs to be notified. This decision is based on reviewing the case details, laboratory results (if any), disease type, level of suspicion and knowledge of transmission or previous cases.
  2. CID may prepare an advisory to be sent to the school when there is a suspect or confirmed case of an infectious disease that falls under the ISPA.
  3. When the decision is made to notify the SHT and request an “at risk list of students”, the CID Manager or Supervisor will notify the SHT Manager and Directors via email. SHT will request an at-risk list be run and CID will be one of the recipients of the list.

If the MOH directs that parents/students be notified and/or offered immunization prior to moving to exclusion of students the SHT is responsible for contacting students/families of the children at risk. SHT and Clinical Services (CS) will organize, staff, and run/manage any required immunization clinics.

  1. Once there is evidence of transmission and a decision to exclude under and unimmunized students without proof of immunity has been made, the CID team will take the lead. The CID team is the contact for any student with exemptions on file as well as any student who has been excluded based on his/her immunization status.
  2. The Health Analytics Panorama clerks will prepare exclusion orders using the mail merge feature (Exclusion Order template and the At Risk List). Three copies of the exclusion orders are required to serve to the principal of the school, the parent of the child, or if 16 years or older, the student, and the MOH. Orders are considered delivered/served when delivered personally or sent by ordinary mail addressed to the person to whom it is being served or delivered at his or her last known address. An order sent by mail is considered served on the seventh day after mailing.
  3. An area/designated PHN/PHI from the CID team and an area/designated PHN from the SHT will jointly attend the school on the day(s) of exclusion. The CID PHN/PHI will be responsible for serving the exclusion orders to the principal of the school, the parent of the child, and if 16 years or older, the student.  The PHN from the SHT will be responsible for reviewing immunization records that may be received from students or parents. The Manager/Supervisor of CID or the SHT may be in attendance as well.
  4. After the decision has been made to serve the exclusion orders, all immunization records being submitted for student re-entry must be reviewed and validated by the CID team. The SHT will provide interpretation of immunization records for difficult cases and those that may be off-schedule.
  5. The CID team will communicate with the principal in an ongoing manner throughout the exclusion period regarding exclusion orders and rescind orders.
  6. The CID team will serve the rescind orders on those who provide the documented immunization requirements necessary to attend school or proof of immunity.
  7. The CID team will direct those families/students requiring immunization appointments to the CS team.
  8. For all excluded students who remain under or unimmunized with no proof of immunity, orders will be rescinded when the circumstances for making the order no longer exist and will remain in force until rescinded in writing from the MOH.

RESPONSIBILITIES

Management will:
  • Require that the CID team read and understand the policy CA.82.01.133 and procedure CA.82.02.133 Exclusion of Students During an Outbreak of a Vaccine Preventable Disease Identified in the Immunization of School Pupils Act, 1990 in order to ensure that employees understand the process in the event of an outbreak or declaration by the MOH to exclude children based on the ISPA.
Employees will:
  • Follow the procedure CA.82.02.133 Exclusion of Students During an Outbreak of a Vaccine Preventable Disease Identified in the Immunization off School Pupils Act for the exclusion of pupils in the event of an outbreak of a disease covered by the ISPA, and with the MOH’s direction to move to exclusion of susceptible children. Employees should discuss questions or concerns regarding the exclusion process with the Manager/Supervisor if they are unsure of the requirements/process.

DEFINITIONS

Immunization of School Pupils Act – R.R.O. 1990, Regulations 645, Consolidation Period: from July 1, 2014 to the e-Laws currency date.

Outbreak – The declaration of an outbreak in the school will be made by the MOH based on the disease, evidence of transmission (epi-links) and laboratory confirmation of disease.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.133 Exclusion of Students During an Outbreak of a Vaccine Preventable Disease Identified in the Immunization off School Pupils Act

Immunization of School Pupils Act – R.R.O. 1990, Regulations 645, Consolidation Period: From July 1, 2014 to the e-Laws currency date.  Available at: http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900645_e.htm

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis

APPROVED BY

Robert Thompson