County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Hepatitis B and MMR Vaccine Coverage Levels Among Children Entering 7 th Grade in Los Angeles County Wang, Rose, MPH; Gambill, David, MS; Pulido, Marifi, MPH; Todoroff, Cheri, MPH; Fujimoto, Glen; Hartoonian, Lidoosh; Roby, Karen Los Angeles County Department of Health Services Immunization Program

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Background  On July 1, 1999 California implemented a new school entry immunization requirement  Prior to entering 7 th grade students must receive: –3 doses of hepatitis B vaccine (HBV) –2 doses of measles containing vaccine (MCV)  New and unfamiliar concept to many parents, schools, and providers

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Background  California Department of Health Services conducted “Fall 1999 Seventh Grade Immunization Assessment” to evaluate immunization rates during the 1 st year of this new law  “Complete” defined as: –3 doses of HBV –2 doses of measles containing vaccine (MCV)  Conditional entrants not reported

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Sample Assessment Form CDS Code:_________________________  Public School School Name:__HAPPY MIDDLE SCHOOL__ District: ______________________ Address:__123 SMILEY LANE________  Private School City, Zip: Los Angeles, 90001___ IMMUNIZATION ASSESSMENT OF SEVENTH GRADE STUDENTS 7 TH GRADE ENROLLMENT: Enter Number of: 1. Students with all required immunizations: 371 (3 hepatitis B and 2 measles-containing immunizations) 4. Students needing hepatitis B follow-up: Permanent Medical Exemptions (PME): 0 5. Students needing MMR follow-up: 1 3. Personal Beliefs Exemptions (PBE): 1 Person completing form: ___________________Date: __________Phone:__________ 481

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM 7th Grade Immunization Assessment Results, Fall 1999 CaliforniaLos Angeles Number of Students464,476119,947 Percent with all required Immunizations 65.1%66.9% Percent with 3 doses of HBV68.6%70.1% Percent with 2 doses of MCV93.2%91.7% Percent with PME*0.2%0.16% Percent with PBE*1.4%0.65% Number of Schools4, *”PME” is Permanent Medical Exemption and “PBE” is Personal Beliefs Exemption

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Objective  To determine completion rates by ethnicity for both HBV and MCV of 7 th grade students at three points in time: –Age at 7 th grade entry –Age 11 –Age 10

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Methods  40 of 851 reporting schools were randomly selected for retrospective review  Review was conducted May-June 2000  Schools with less than 20 enrolled 7 th grade students were not included in the sample selection  Both public and private schools were included in the sample

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Methods  33 of 40 schools had self-reported completion rates < 60%  7 of 40 schools had self-reported completion rates  60%  CASA software used as data collection and sampling tool –If < th grade students, then all active records were reviewed –If  200 students, then a maximum of 200 randomly selected records were reviewed

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Methods  Total number of 7 th grade records reviewed (n = 5,103)  For each record selected we collected: –Date of birth –Race/ethnicity –Dates when each dose of HBV and MCV was administered  Analyzed completion rates by race/ethnicity at 7 th grade entry, age 11, and age 10

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Results Race/Ethnicity of Students n = 5,103 (n = 2,506) (n = 300)(n = 1,385) (n = 410) (n = 502)

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Results Completion Rates at Specific Age Intervals 3 HBV + 2 MCV 3 HBV2 MCV Age 1020%28%68% Age 1128%36%73% 7 th Grade Entry78%80%97%

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Coverage Levels for 3 Doses of Hepatitis B Vaccine (HBV) by Race and Age

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Coverage Levels for 1 Dose of Measles Containing Vaccine (MCV) by Race and Age

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Coverage Levels for 2 Doses of Measles Containing Vaccine (MCV) by Race and Age

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Discussion  Immunizations for pre-adolescents was an unfamiliar concept prior to implementation of the law  Completion rates were generally higher for MCV than for HBV  Our retrospective review estimated higher completion rates at 7 th grade entry than those reported by schools

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Discussion  Schools’ self-reported completion rates may underestimate true completion rates among 7 th grade students due to: –Lack of familiarity with reviewing immunization records –Miscalculations when completing the form –Incomplete student immunization records at time of assessment

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Discussion  Data limitations: –Selection bias of schools –Selection bias of records –Timeliness of review  Changes in student population –Immunization awareness programs/activities conducted by other agencies, clinics or schools

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Conclusion  Implementation of school mandates can effectively increase immunization coverage levels among pre-adolescents  School mandates can reduce disparities in completion rates between different races/ethnicities

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Recommendations  Continue to educate providers, parents, and schools about the law  Conduct similar review of immunization records of 7 th grade students enrolled in Los Angeles County schools

County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Immunization Program 3530 Wilshire Bl. Suite 700 Los Angeles, CA Phone: (213) Fax: (213)