Back to School Update 2018-2019 SY

Immunization Status Reporting All public and private schools, and licensed preschools must report the immunization status of students by Nov. 1 each year per state law. Schools/Preschools can find reporting information on DOH’s school reporting web page (http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolStatusReporting) Send all questions about immunization reporting and requirements to: oicpschools@doh.wa.gov. Report in one of three ways: Use the WA State Immunization Information System (IIS)- For private/public schools that don’t have a SIS. If you have never used the IIS, email waiishelpdesk@doh.wa.gov. They will email you a username and password. Email a data file from Skyward or another student information system (SIS) to oicpschools@doh.wa.gov. Use the IIS School Module – no report needed

School and Preschool Immunization Requirements Childcare/Preschool Requirements: https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-425- ChildcareImmReqforParents2018-2019.pdf. K-12: https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-295- SchoolImmReqforParents2018-2019.pdf. Individual Vaccine Requirements Summary: https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-284- IndividualVaccineReqs2018-19.pdf.

Individual Vaccine Requirements Summary Companion piece to the Vaccines Required charts for child care/preschool and school entry. The purpose of the summary is to assist school nurses and those working with student information systems to understand state immunization requirements and the immunization schedule. Both the requirements and schedule are based on the recommendations of the national Advisory Committee on Immunization Practices (ACIP). Requirements are listed in alphabetical order by vaccine. In each section, you will find detailed information about the immunization schedule and the exceptions to the schedule. Exceptions may apply when vaccine administration errors occur or when the ACIP recommendations are not followed.

Vaccine Recommendations for Staff Immunizations are not required for school staff, BUT knowing staff’s immunization status can prepare schools in advance of a disease outbreak. All susceptible staff not completely immunized or immune may be excluded from school. To prevent the spread of disease and protect all staff, schools should:  Keep track of staff vaccinations. This will tell you which staff are susceptible.  Promote vaccination for staff members in an effort to safeguard the school, preschool, and child care community.  Exclude susceptible staff members during an outbreak (refer to your school or agency policies about whether staff can take sick leave when excluded). The following immunizations are recommended for school staff: measles, mumps, and rubella (MMR); varicella (chickenpox); hepatitis B; diphtheria, tetanus, and pertussis (Tdap and Td); and influenza (flu).

Promotion of Immunizations Grant Community and Practice-Based Interventions to Increase Tdap, HPV, and Meningococcal Vaccination Coverage Among Adolescents in Chelan and Douglas Counties

Why the focus on Teens While our immunization rates remain high for vaccines mandated for school entry, recommended adolescent vaccines remain below the Healthy People 2020 recommended targets of 80% (US Department of Health and Human Services [USDHHS], 2010) Our current county data: Chelan County- UTD Mening=64% UTD HPV=56% Tdap=91% Douglas County- UTD Mening=60% UTD HPV=54% Tdap=87% Our focus will be on improving adolescent vaccination rates, specifically for Tdap ,meningococccal, and HPV vaccines because… Even though our Tdap coverage is meeting the 2020 goal of 80%, I am including it in this project because it is part of the adolescent platform.

Causes for low rates Not recommended by providers Participatory vs presumptive recommendation Vaccine hesitancy- safety/AE’s Child not sexually active (HPV) Lack of knowledge about the vaccines Not needed or necessary There are several reasons why our rates are low…for mening and HPV vaccines, providers don’t always give a strong recommendation, which is the number one indicator of vaccination. The conversation with parents would go something like…Tdap is required for school and there are 2 other vaccines that are recommended for your child but not required. It is really up to you. This is not the way to recommend these vaccines. This is the participatory approach. Also, parents and providers worry about vaccine side effects and they lack knowledge about vaccine recommendations. For HPV vaccine, parents think that if their child is not yet sexually active, there is no need for the vaccine and providers sometimes agree. This is the wrong message for parents, because all vaccines, including HPV are given prior to exposure… and we know from the data we have that the younger adolescents produce a better immune response, compared to older teens and young adults.

Intervention Goals Increase the number of adolescents 13-17 years who are UTD (for age) with Tdap, HPV, and meningococcal vaccines in our 2 counties- improve county coverage by 5%. Promote interprofessional collaboration (with dental providers, medical providers, retail pharmacies, school nurses) and media coverage of vaccines The overall goal of this project is to increase the percentage of teens 13-17 years of age who are UTD for their age in our counties by 5%. 5% is a goal that our local providers often set to achieve in a 6 month period, so I am hoping that it can be achievable within our grant period. I will be working a little with our medical providers, but most of the work will focus in the school setting and with dental providers, because they also have role to play in educating patients about the risks of HPV related oropharyngeal cancers and how they play an important role in educating parents. We cannot rely only on physicians. We have to promote interprofessional collaboration. And Historically the health district has done very little in terms of media outreach, so this grant will give us the opportunity to improve our media and social media presence.

Benefits of Interprofressional Collaboration Empowers team members Eliminates health care hierarchy Closes communication gaps-all team members create consistent messaging Reduces missed opportunities Promotes a team mentality Improves care coordination Patient outcomes (quality/cost of care) are optimized when disciplines work toward a shared goal

Role of school nurses Promote all adolescent vaccines School nurses are opinion leaders- provide a strong recommendation for vaccination Get school district support for vaccine education Provide access to educational materials for parents/students Incorporate other evidence-based strategies to increase HPV/Mening vaccine uptake, such as providing reminders to students and families about when to begin the vaccine series; the importance of completing the series according to the recommended schedule; and accessing state immunization information systems to identify students who need to be vaccinated

RCW 28A.210.080 (2)(a) Beginning with sixth grade entry, every public and private school in the state shall provide parents and guardians with information about meningococcal disease and its vaccine at the beginning of every school year. The information about meningococcal disease shall include: (i) Its causes and symptoms, how meningococcal disease is spread, and the places where parents and guardians may obtain additional information and vaccinations for their children; and (ii) Current recommendations from the United States centers for disease control and prevention regarding the receipt of vaccines for meningococcal disease and where the vaccination can be received. (b) This subsection shall not be construed to require the department of health or the school to provide meningococcal vaccination to students. (c) The department of health shall prepare the informational materials and shall consult with the office of superintendent of public instruction. (d) This subsection does not create a private right of action. (3)(a) Beginning with sixth grade entry, every public school in the state shall provide parents and guardians with information about human papillomavirus disease and its vaccine at the beginning of every school year. The information about human papillomavirus disease shall include: (i) Its causes and symptoms, how human papillomavirus disease is spread, and the places where parents and guardians may obtain additional information and vaccinations for their children; and (ii) Current recommendations from the United States centers for disease control and prevention regarding the receipt of vaccines for human papillomavirus disease and where the vaccination can be received. (b) This subsection shall not be construed to require the department of health or the school to provide human papillomavirus vaccination to students. (c) The department of health shall prepare the informational materials and shall consult with the office of the superintendent of public instruction. (4) Private schools are required by state law to notify parents that information on the human papillomavirus disease prepared by the department of health is available.

Barriers for School Nurses Lack of HPV and Meningococcal disease and vaccine knowledge Not seeing yourselves as opinion leaders Lack of confidence in providing parent education Perception of or lack of support for education Time

NASN position statement It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood.  Promotion of immunizations by the registered professional school nurse (hereinafter referred to as school nurse) is central to the public health focus of school nursing practice (American Nurses Association [ANA] & NASN, 2011).  NASN supports the Advisory Committee on Immunization Practices (ACIP) vaccine recommendations that are adopted by the Centers for Disease Control and Prevention (CDC) (CDC, 2014a, 2014b).  The school nurse is well-poised to create awareness and influence action to increase the uptake of mandated and recommended immunizations. The school nurse should use evidence-based immunization strategies, such as school-located vaccination clinics, reminders about vaccine schedules, state immunization information systems (IIS), strong vaccination recommendations, and vaccine education for students, staff, and families. Using these strategies will help reduce health-related barriers to learning (Guide to Community Preventive Services, 2008, 2009, 2010; Ylitalo, Lee, & Mehta, 2013; Bobo, Carlson, & Swaroop, 2013). This is a position statement from the National Association of School Nurses that immunizations are essential to disease prevention and that promotion of immunizations is central to school nursing. As school nurses, you have the ability to influence action to increase the uptake of mandated and recommended vaccines. And that is the key to this project…finding ways to promote vaccines that are not mandated but are recommended for their age.

Project Ideas within the school setting The adolescents are listening, so our message should be focused toward them as well Phone hold messages at schools School nurses can train staff to communicate messages When school nurses refer to PCP for catch-up vaccines, include HPV and Mening vaccines (use IIS forecast) Parent letters Posters/flyers Parent teacher forums & message boards Speaking at and/or sharing written informational material at PTO meetings Website messaging

Project Ideas Cont… Partner with as many schools that serve students 13-17 years Work with the staff to identify one or more immunization champions at the school and implement immunization-related activities Evaluate each component of the intervention and compare immunization rates at the beginning and end of our time working in the school Vaccine education programs- October 2018 with focus on Tdap & mening and January 2019 with focus on HPV   To me, it would be ideal to implement the same interventions in all of the schools but if we run into barriers implementing some of the interventions, I am willing to work with you on what would work best at your school. I will have to evaluate the effectiveness of the interventions and I welcome your ideas for doing so.

Next Steps Meet one on one with school nurses/staff to determine the interventions to implement at your school Share online resources/toolkits with you Provide education so you feel comfortable in your role as an opinion leader (attending vaccine dinner programs) The next phase of my project will be to meet with you one on one to determine interventions to implement. I have collected a plethora of resources and will share them with you and hopefully you can attend the dinner programs we will be offering. It may be best if Cathy I meet with you first to get your thoughts about the best approach on moving forward.

Cari Hammond,BSN cari.Hammond@cdhd.wa.gov 509.886.6411