1. Mark V. Francesconi Vaccine Manager, Immunization Program Rhode Island Department of Health

2. VBYG: Goal Goal: Ensure that every high school senior has an opportunity to receive all ACIP recommended immunizations before entering college or the workforce. Vaccinate Before You Graduate (VBYG) is a free immunization program, offered to compliment the medical home, for all seniors at high schools and alternative schools.

3. VBYG: Stakeholders VBYG is an initiative of the RI Department of Health’s Immunization Program in partnership with the RI Childhood Immunization Action Coalition Key participants: - Health Department- Department of Education - School administrators- School Nurse Teachers & Faculty - Parents / Guardian- Students - Contractor/Vendor (The Wellness Company)

4. VBYG: In the beginning… THE CONCEPTION AND BIRTH OF VACCINATE BEFORE YOU GRADUATE STATE OF RHODE ISLAND, 2000 – 2002 Hepatitis B vaccine for adolescents School regulations requiring hepatitis B Regulations requiring second dose of MMR New college and university regulations Rhode Island law requiring meningococcal vaccine purchase Increasing concern about risk factors for meningitis for students entering college and lack of access to the vaccine “Welfare to work” provisions Increasing numbers of young children vaccinated against Varicella Too many adolescents with too few providers and too few immunizations What were the elements that came together at just the right time resulting in VBYG’s conception?

5. VBYG: In the beginning… THE CONCEPTION AND BIRTH OF VACCINATE BEFORE YOU GRADUATE STATE OF RHODE ISLAND, 2000 – 2002 2000 Data on RI’s adolescents: –44.4% missing at least one dose of Hepatitis B. –29.4% missing Td booster. –29.5% missing Varicella 74% of the senior had not received a Td booster in the last 10 years.

6. VBYG: In the beginning… Problems: RI workforce under-immunized and can’t afford vaccines Teenagers do not go for regular check ups. Where to find adolescents? THE CONCEPTION AND BIRTH OF VACCINATE BEFORE YOU GRADUATE STATE OF RHODE ISLAND, 2000 – 2002 Solutions: School environments offer Captive audience Opportunities to educate and vaccinate

7. VBYG: In the beginning… THE CONCEPTION AND BIRTH OF VACCINATE BEFORE YOU GRADUATE STATE OF RHODE ISLAND, 2000 – 2002 Problems: How to develop such a program? Who is Eligible? How to Fund? Eliminate financial obligation VFC G-317 SSV (State Supplied Vaccine)

8. VBYG: In the beginning… THE CONCEPTION AND BIRTH OF VACCINATE BEFORE YOU GRADUATE STATE OF RHODE ISLAND, 2000 – 2002 Funding: CDC Federal Grant RI is a Universal Vaccine State Series may be completed after they leave school

9. VBYG: Program Components Educational component teaching students about Vaccine-preventable diseases (VPD) and the importance of immunizations. School Assemblies School Health Fairs After school events

10. VBYG: Program Components Outreach component targeting parents to secure consent for student immunizations. Mailings: Screening Questionnaire, Consent Form & current VIS VBYG Brochure (PTO) Parent Teacher Organization Meetings Vaccine records supplied by vendor for all immunizations received through VBYG

11. VBYG: Program Components Immunization clinics held once consent is obtained from parents and coordinated with school calendars. Multiple Events, 4-5 per school Vendor offers in office, scheduled appointments Summer Clinics, 2-3 events held in public locations (Mall, DOH building) Incentives Pens, Stress balls, Lanyards, Lip balm, etc… Vaccines Provided by VBYG:  Meningococcal  Polio  Influenza (2005)  HPV (2007)  Hep B  MMR  Td / TDaP  Varicella

12. Vendor Involvement Schedule clinic sessions w/ schools Staff clinics Administer vaccines –Bill insurance for admin fees (when applicable) Generate vaccine administration records to individual students and school personnel. Storage and delivery of vaccines according to CDC standards. –Track lot # Manage all medical waste from event –Gloves, gauze, needles, vials, etc… Maintain medical director –for standing orders and medical assurance Maintain database of students served Submit data to State Immunization Registry VBYG: Program Components

13. VBYG: Lessons learned Get schools involved early in the process. Share responsibilities. Get parents and students involved. Subcontract program administration to an outside organization with strong youth skills and a community active medical director. Collect insurance information for vendor administration reimbursement. Regular communication between vendor and DOH Annual program evaluations –Schools

14. VBYG: Lessons learned Keep the medical community aware of program events –KIDSNET (registry data) –Annual Reports Community awareness –Local media- School assemblies –Town meetings- Health fairs Utilize websites (DOH, Vendor, School, Town, etc…) –Calendar of events Distribute current VIS –With consent form – Available at each event.

15. VBYG: 2001 Annual Results Summary of the 2001 RI VBYG program participation.  31 schools with senior classes participated in the 2001-2002 VBYG program.  1,024 students enrolled in the program.  1,024 students received any immunizations.  764 students completed all the immunizations for which they enrolled.  2,406 “shots” were administered:  453 students received 1,044 doses of Hepatitis B vaccine.  196 students received MMR (Measles, Mumps, Rubella).  291 students received Td vaccine (Tetanus, Diphtheria).  616 students received Meningitis vaccine.  126 students received 236 doses of Varicella vaccine (chicken pox).  23 students received Polio vaccine.

16. VBYG: 2002 Annual Results Summary of the 2002 RI VBYG program participation.  49 schools with senior classes participated in the 2002-2003 VBYG program.  1,640 students enrolled in the program.  1,541 students received any immunizations.  1,380 students completed all the immunizations for which they enrolled.  3,082 “shots” were administered:  446 students received 1,035 doses of Hepatitis B vaccine.  60 students received MMR (Measles, Mumps, Rubella).  430 students received Td vaccine (Tetanus, Diphtheria).  1,280 students received Meningitis vaccine.  143 students received 252 doses of Varicella vaccine (chicken pox).  25 students received Polio vaccine.

17. VBYG: 2003 Annual Results Summary of the 2003 RI VBYG program participation.  53 schools with senior classes participated in the 2003-2004 VBYG program.  1,534 students enrolled in the program.  1,463 students received any immunizations.  1,298 students completed all the immunizations for which they enrolled.  2,379 “shots” were administered:  335 students received 632 doses of Hepatitis B vaccine.  44 students received MMR (Measles, Mumps, Rubella).  325 students received Td vaccine (Tetanus, Diphtheria).  1,248 students received Meningitis vaccine.  82 students received 123 doses of Varicella vaccine (chicken pox).  7 students received Polio vaccine.

18. VBYG: 2004 Annual Results Summary of the 2004 RI VBYG program participation.  50 schools with senior classes participated in the 2004-2005 VBYG program.  1,707 students enrolled in the program.  1,621 students received any immunizations.  1,566 students completed all the immunizations for which they enrolled.  2,353 “shots” were administered:  269 students received 465 doses of Hepatitis B vaccine.  24 students received MMR (Measles, Mumps, Rubella).  210 students received Td vaccine (Tetanus, Diphtheria).  1,477 students received Meningitis vaccine.  87 students received 153 doses of Varicella vaccine (chicken pox).  24 students received Polio vaccine.

19. VBYG: 2005 Annual Results Summary of the 2005 RI VBYG program participation.  60 schools with senior classes participated in the 2005-2006 VBYG program.  2,118 students enrolled in the program.  2,003 students received any immunizations.  1,909 students completed all the immunizations for which they enrolled.  3,046 “shots” were administered:  132 students received 209 doses of Hepatitis B vaccine.  33 students received MMR (Measles, Mumps, Rubella).  323 students received Td/TDaP vaccine (Tetanus, Diphtheria).  1,519 students received Meningitis vaccine.  61 students received 92 doses of Varicella vaccine (chicken pox).  25 students received Polio vaccine.  845 students received Influenza vaccine (Flu shot) New

20. VBYG: 2006 Annual Results Summary of the 2006 RI VBYG program participation.  64 schools with senior classes participated in the 2006-2007 VBYG program.  2 summer “catch-up” clinics were held.  1,700 students enrolled in the program.  1,677 students received any immunizations.  1,631 students completed all the immunizations for which they enrolled.  2,954 “shots” were administered:  75 students received 100 doses of Hepatitis B vaccine.  16 students received MMR (Measles, Mumps, Rubella).  524 students received Td/TDaP vaccine (Tetanus, Diphtheria).  1,322 students received Meningitis vaccine.  107 students received 117 doses of Varicella vaccine (chicken pox).  26 students received Polio vaccine.  849 students received Influenza vaccine (Flu shot) Restricted New

21. VBYG: 2007 Annual Results Summary of the 2007 RI VBYG program participation. (As of February 1, 2008)  73 schools with senior classes participating in the 2007-2008 VBYG program.  2 summer “catch-up” clinics scheduled.  1,237 students enrolled in the program.  1,480 students received any immunizations.  1,039 students completed all the immunizations for which they enrolled.  1,823 “shots” were administered:  40 students received 59 doses of Hepatitis B vaccine.  5 students received MMR (Measles, Mumps, Rubella).  134 students received Td/TDaP vaccine (Tetanus, Diphtheria).  67 students received Meningitis vaccine.  42 students received 54 doses of Varicella vaccine (chicken pox).  6 students received Polio vaccine.  774 students received Influenza vaccine (Flu shot)  412 students received 722 doses of HPV vaccine. New

22. VBYG: Annual Results

23. VBYG: Program Results Summary of the 2001-2007 RI VBYG program participation.  9,723 students enrolled in the program.  9,329 students received any immunizations. (96%)  8,548 students completed all the immunizations for which they enrolled. (88%)  16,220 “shots” were administered:  1,710 students received 3,485 doses of Hepatitis B vaccine.  373 students received MMR.  2,103 students received Td/TDaP vaccine.  7,462 students received Meningitis vaccine.  606 students received 973 doses of Varicella vaccine  130 students received Polio vaccine.  1,694 students received Influenza vaccine*  412 students received HPV vaccine** *VBYG started offering Influenza vaccines in 2005-2006 school year **VBYG started offering HPV vaccines in 2007-2008 school year

24. Contact Information: Mark V. Francesconi Vaccine Manager 401.222.5988 Mark.Francesconi@health.ri.gov Kathy Marceau VBYG Coordinator 401.222.4624 Kathy.Marceau@health.ri.gov Patricia Raymond RN, MPH Immunization Program Manager 401.222.5921 Patricia.Raymond@health.ri.gov Randall Linn The Wellness Company 401.461.0622 rlinn@thewellcomp.com