Comparing School Immunization Exemptions to Registry Records Joni Reynolds, RN/CNS, MSN Lane Wake, MS Immunization Program Colorado Department of Public Health and Environment Mary Beth Rensberger Health Services Coordinator Aurora Public Schools

School Survey History Self report Rates hovered around 90% Immunization Record Audits

Percent of Colorado Kindergartners Meeting Colorado School Immunization Regulations at School Entry by Series*, Antigen and Year, Colorado School Survey * Up to Date is 5 DTaP, 2 MMR, 4 Polio, 3 Hepatitis B, 1 Varicella or a History of Disease

Percent of Kindergartners Claiming an Exemption by School Year, Colorado School Survey

Type of Exemption Claimed by Kindergartners, Colorado School Survey, 2005/2006-2007/2008

Children Attending Aurora Public Schools who took an Exemption in the 2008/2009 School Year Total enrollment for APS is 35,523 students. Data query using Infinite Campus software to select any child in APS district with an exemption for DTaP (Tdap), MMR, Polio or Hepatitis B 1,734 shots exempted from for 673 children for the 2008/2009 school year 2% of children exempted from required school immunizations

Of Children Claiming an Exemption Percent by School Grade (n=673), Aurora Public Schools 2008/2009

Of Children Claiming an Exemption (n=673) Percent by Type of Vaccine, Aurora Public Schools 2008/2009

Percent of Children by Number of Vaccines Exempted from (n=673), Aurora Public Schools 2008/2009

Number of Vaccines Exempted from (n=1,734) by Vaccine Type, Aurora Public Schools 2008/2009

Exemption Type (n=673) Aurora Public Schools 2008/2009

Exemption Type by Vaccine Exempted From, n=1734, APS District 2008/2009

Of Children Claiming an Exemption Percent by School Grade and Vaccine (n=673), APS District 2008/2009

Linking APS Exemption data to Colorado Immunization Information System (CIIS) 62% (n=422) of children who exempted in the APS database had a record in the Colorado Immunization Information System (CIIS)

Shots in APS data Compared to Percent with Record in CIIS by Number of Shots Administered Vaccine # in APS data # in CIIS # of Shots Percent DTaP 538 324 (60.2%) > 4 50.9% MMR 432 257 (59.5%) > 2 38.9% Polio 380 220 (57.9%) > 3 26.8% Hep B 384 225 (58.6%) 43.0%

Number of Shots Greater than Required Recorded in CIIS by Vaccine Exempted From Percent DTaP > 5 11.7% MMR > 2 2.7% Polio > 4 4.5% Hep B > 3 5.7%

Overimmunized Child, Aurora Public Schools, 2008/2009

Adjusting APS Exemption Rates by Number of Children Up to Date in CIIS # of kids exempt School Exemption Rate (n=35,523) Number of kids UTD in CIIS Adjusted School Exemption Rate (n=35,523) Percent Difference DTaP 538 1.51 172 1.00 33.8% MMR 432 1.22 226 0.58 52.5% Polio 380 1.07 220 0.45 57.9% Hep B 384 1.08 245 0.39 63.9% Overall 673 1.89 116 1.57 16.9%

Caveats Immunization data are entered into Infinite Campus from the child’s record Exemptions seem to be entered randomly in Infinite Campus – no relation to actual dose Did not download the child’s full immunization history just the shots with an exemption.

Conclusions Exemption data obtained from school records in Colorado is unreliable Electronic data collection by schools may be unreliable in tracking accurate exemption information Access to CIIS can assist schools in accurately determining a child’s immunization status

Questions? Lane Wake lane.wake@state.co.us 303-692-2631 Joni Reynolds joni.reynolds@state.co.us 303-692-2363