1. www.lapublichealth.org/ip/ 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

2. www.lapublichealth.org/ip/ 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

3. www.lapublichealth.org/ip/ 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

4. www.lapublichealth.org/ip/ 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: 109 2. Permanent Medical Exemptions (PME): 0 5. Students needing MMR follow-up: 1 3. Personal Beliefs Exemptions (PBE): 1 Person completing form: ___________________Date: __________Phone:__________ 481

5. www.lapublichealth.org/ip/ 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 Schools4,048851 *”PME” is Permanent Medical Exemption and “PBE” is Personal Beliefs Exemption

6. www.lapublichealth.org/ip/ 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

7. www.lapublichealth.org/ip/ 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

8. www.lapublichealth.org/ip/ 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 < 200 7 th grade students, then all active records were reviewed –If  200 students, then a maximum of 200 randomly selected records were reviewed

9. www.lapublichealth.org/ip/ 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

10. www.lapublichealth.org/ip/ 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)

11. www.lapublichealth.org/ip/ 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%

12. www.lapublichealth.org/ip/ County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Coverage Levels for 3 Doses of Hepatitis B Vaccine (HBV) by Race and Age

13. www.lapublichealth.org/ip/ County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Coverage Levels for 1 Dose of Measles Containing Vaccine (MCV) by Race and Age

14. www.lapublichealth.org/ip/ County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Coverage Levels for 2 Doses of Measles Containing Vaccine (MCV) by Race and Age

15. www.lapublichealth.org/ip/ 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

16. www.lapublichealth.org/ip/ 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

17. www.lapublichealth.org/ip/ 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

18. www.lapublichealth.org/ip/ 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

19. www.lapublichealth.org/ip/ 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

20. www.lapublichealth.org/ip/ County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Immunization Program 3530 Wilshire Bl. Suite 700 Los Angeles, CA 90010 Phone: (213) 351-7800 Fax: (213) 351-2780 www.lapublichealth.org/ip/