1. Evaluating Middle School Immunization Laws and School-based Immunization Programs
National Hepatitis Coordinators’ Conference 2003
Thanks for having me!
Thad Wilson, RN, Phd
University of Missouri-Kansas City
Mid America Immunization Coalition

2. Impact on Health Department workload
Evaluation Foci
Impact on Health Department workload
Effectiveness of School-based programs
Effectiveness of law

3. Impact on Health Department Workload
1999 all 7th grade students required to have HBV
Retrospective, statewide analysis
MOHSAIC
Health Dept survey’s

4. Results of Study
Statewide % in HBV immunizations given to year-olds
Non-rural settings, total number of vaccines administered did NOT rise significantly

5. Results of Study
Health departments that used “out of office” alternative strategies (school-based, mall, etc) in both 1998 and 1999 had the least change.

6. Overview of Kansas City Metropolitan Program 1997 - 2000
16 – 23 School Districts
1 – 30 private schools
106 – 195 school buildings
Two states
4 – 6 Health Departments
7 – 13 volunteer organizations or agencies

7. Overview
46, 749 students have been offered school-based immunizations
79.26% returned consent forms
23.7% chose not to participate
Most because already immunized
94.7% received at least one dose
80.9% completed series

8. Research Studies Conducted
Qualitative
Evaluation Research
Impact Assessment
Descriptive Correlational
Cost-effective Analysis

9. Qualitative Study Findings
Organization
Time
Obtaining consent
Educational opportunity
School support
Student tracking

10. Impact Assessment Immunization rates rose from 8% to 80%
9.9 immunizations per hour of school personnel
8.9 immunizations per hour of health department personnel
Hepatitis B incidence in KC – unchanged

11. Descriptive Correlational
Income – high and low don’t participate
Race – non-white have lower participation rates
Location of school – urban schools had significantly lower participation rate (.58) than suburban schools (.90)

12. Cost-effectiveness Analysis
Yearly program costs $81,972 - $142,485
Vaccine costs $247,051 – $304,276
Total administration cost/dose $ $5.06
Typical private office costs $15.00/dose
Typical health department costs $5.62
$53 million of future costs avoided

13. Effectiveness of Law – Pilot Study
Retrospective, school-base, random, student immunization record review
School nurse survey
Two urban high schools, 3 suburban & 4 rural middle schools
Each group in single district

14. Preliminary Results Urban High School – 10% UTD Td (shortage)
1300+ students
School-based HBV programs as 6th graders
NO 7th grade entry requirement
Sample 50 juniors and 50 seniors
10% UTD Td (shortage)
82% UTD MMR
8% UTD HBV

15. Preliminary Results
Suburban Middle Schools – all had school-based programs in previous year
1.3% exemption
100% tetanus and MMR
61% - 91% HBV, mean 73.5%
0% varicella

16. Preliminary Results Rural Middle Schools – no school-based programs
1.7% exemption
100% tetanus and MMR
50% - 90% HBV, mean 61% (2.7% exemption)
0% varicella
0% - 40% HepA (recent outbreak in one area)

17. Interesting Tib-Bits Suburban middle school
School nurse vocally against HBV
Almost 5% exemption for HBV
Suburban school districts with strong leadership and a nurse in each school
<1% exemption
98% HBV

18. Conclusions School entry laws School-based programs
Effective – exemptions, school compliance in urban settings problematic
School-based programs
Effective, cost effective
Urban settings still
problematic